cultura (culture)

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 I was interested before leaving for Ecuador to see how this expression of Latin culture would differ from my previous experiences in Honduras and Costa Rica.  Would South America hold different cultural traditions?  On the edge of the Amazon in the Oriente, would I encounter more indigenous people with their own cultural traditions.  Other than herbal remedies I've never heard of (e.g. cinnamon water to induce labor) and an occasional reference to believing in "both sides" (i.e. medicine and herbal remedies or sometimes spiritual causes of illness bordering on animism) or performing a limpieza (cleaning - done by a shaman for illness), however, much of what I've encountered has had much in common with my previous experiences. 

I have always enjoyed the affectionate nature of Latin culture.  In my month rotation in medical school, I remember struggling in India with the inability to touch people in public in a way that wasn't necessary for the physical exam.  I realized while I was there that I normally touch people informally ALL THE TIME.  My family is demonstrative, and I am also personally very much that way.

http://news.bbc.co.uk/2/hi/7040259.stm?lsm

So, here, I love the air kisses, cheek-to-cheek (as above), that I get from everyone on the resident/intern team and some of the nurses, too, when we encounter each other for the first time in the morning as we make our way around on rounds.  I love the easy hugs with the female residents/interns and the way I don't have to be afraid to pat children on the head or touch a patient's shoulder or knee.  I love the fact that I can grab a laboring patient's hand in a contraction and know she will mostly likely welcome the touch.  Yes, fellow LGH residents, you can make fun of me for wanting to comfort laboring patients with touch (cf. last year's Roast Night), but touch is a huge part of who I am; you know you enjoy my hugs, too, and it comes as a package! 

I also am reminded often of the importance of hellos and goodbyes in Latin culture.  The air kiss greeting is part of it, but even if you don't greet that way, you do always greet people.  You say hello to people in passing and buenos dias to the nurses in the hall on the way to a patient's room.  When walking into a meeting, even if late (although then it's whispered), you greet people with the greeting appropriate for time of day (buenos dias, buenas tardes, buenas noches). 

Goodbyes are also important.  The residents that have left have made a point of saying goodbye, usually in person, and expressing their appreciation/respect/affection as the situation makes appropriate.  They have also routinely given short speeches in morning report on their last day or so.  This might happen after an extended stay at another location in the States but much less commonly in a professional setting where it is expected that you rotate in and out routinely.  I have yet to give such a speech on a rotation to another specialty (e.g. gynecology, ENT, ophthalmology, surgery, etc.) even when I did feel much appreciation for the rotation, evidence of the ways our cultural expectations of despedidas (goodbyes) are different.

Time is dealt with differently here, as in much of the rest of the developing world (and even in parts of the developed world).  Something that someone tells me will happen ahora (now) or ahorita (right now) may not happen for another half hour or hour.  Both seem to be translated more to "in a little while."  It makes it hard to communicate to patients that yes, I do really want them to get that blood test right now if possible (ahora mismo has become my attempt at communicating this) rather than tomorrow or next week.  Even ya (already) seems to take on more of a "soon" translation in some contexts.  On the other hand, patients are extremely patient waiting for their turn to be seen (no advance appointments) and then waiting for their test results that help to determine their diagnosis and treatments, for which I am grateful.

Although for the most part I have enjoyed Latin culture, there are also cultural things that are not as much fun, the primary one being gender expectations.  I have been pleased to find that I have experienced almost no treatment that seems to differ because of my own gender, unlike some of my previous experiences.  Even the piropos (catcalls) so common to a gringa walking anywhere in Costa Rica are rare here.  Nurses listen to me (including the one male one I have met), and our male intern treats me with respect.  Patients also seem to listen to me, regardless of whether they are male or female.

However, I have now encountered two fourteen-year-olds pregnant by a much older man.  This is illegal here, and I think legal procedures were followed in both cases, but it does still point out the ways in which women can be treated differently.  I see teen moms routinely in my practice in the States - less commonly young teens, but their boyfriends are usually also in their teens, not their 20s, 30s, or 40s. 

Another evidence of differing expectations of men and women is the way in which some of my female patients will bring a husband, brother, or uncle along to their appointment who speaks for them.  It can make for interesting history-taking when I'm not sure which questions I can ask in front of the relative and not sure whether their answers are actually the true history or just what they think is happening.  It is further complicated by the fact that these are often indigenous women whose Spanish level of understanding is uncertain, so it's not clear to me what the reasons for the spokesperson are - linguistic or cultural or both. 

Overall, however, my experience of Ecuadorian culture has been very positive.  I've enjoyed trying new foods (although I have yet to try cuy, Ecuadorian specialty of guinea pig), greeting with air kisses, saying goodbye well, and generally feeling welcomed to an emotionally warm environment.  I will have to see how much I've learned of the culture when I have my own chance at despedidas next week.  I can't believe I have only a week left!  I will miss the interesting cases and regular use of Spanish, but I am also looking forward to seeing family and friends again regularly.  And it won't take me an hour to walk to the grocery store for fruit like it did tonight (since I got lost in the dark on the way back), although then again the avocado that is now soaking in disinfectant solution in my sink wouldn't cost me $0.35 and five apples $1 and five bananas $0.50 in the States, either.  :)