Time Discipline and Health/Communicative Labor in Pediatric Primary Care

ABSTRACT

In rural Southern Chile, native Mapuche families receive care mostly from non-indigenous clinicians. Parents and doctors alike orient to the importance of timely medical care, but clinical and communication norms also result in misunderstandings and tension. Parents find it hard to communicate about structural obstacles, and valued practices of care in families may conflict with normative expectations for timely presentation. Parents’ disclosures about the duration of their children’s illnesses can expose them to clinical censure, which in turn reinforces pernicious negative stereotypes about this racialized and marginalized community.

RESUMEN

En los sectores rurales del sur de Chile, donde las familias Mapuche reciben cuidado médico principalmente de médicos no indígenas, tantos apoderados como médicos reconocen la importancia de recibir atención médica de forma oportuna. Las normas locales acerca de la atención pediátrica oportuna, tantas clínicas como las de comunicación, también producen malentendidos y tensiónes. A los apoderados les resulta difícil comunicarse con los médicos sobre los obstáculos estructurales para acceder a la atención médica de forma oportuna. Las formas de cuidado que son valoradas en las familias Mapuche a veces pueden estar en conflicto con las expectativas normativas para el cuidado oportuno. Las explicaciones de los apoderados acerca de la duración de las enfermedades de sus hijos pueden exponerles a la censura de los médicos, la cual a su vez refuerza los estereotipos perniciosos y negativos sobre esta comunidad racializada y marginalizada.

KEYWORDS:

• Chile
• care
• clinical interaction
• health/communicative labor
• Mapuche
• time-discipline

Acknowledgments

I am grateful to the staff and patient families at the rural primary care clinic for their time and willingness to participate in this research. I also thank colleagues Anna Corwin and Steve Black for organizing the AAA panel from which the idea for this special issue emerged, Lynnette Arnold and Steve Black for bringing the issue together, Charles Briggs for his suggestions and pioneering work at the intersection of linguistic and medical anthropology, Medical Anthropology Editor Lenore Manderson for her guidance, and three anonymous reviewers for their insightful recommendations. Any remaining inaccuracies or omissions are, of course, my own.

Additional information

Funding

This research was possible thanks to the support of a Fulbright IIE Award; Institute of American Cultures, University of California, Los Angeles; International Institute, University of California, Los Angeles; Latin American Institute, University of California, Los Angeles.

Notes on contributors

Jennifer R. Guzmán

Jennifer R. Guzmán is Assistant Professor of Anthropology at State University of New York at Geneseo. Her research on medical interaction in Chile and the United States has appeared in the Journal of Linguistic Anthropology and the Journal of Family Medicine and Disease Prevention. Address correspondence to: Jennifer R. Guzmán, PhD, at Department of Anthropology, SUNY Geneseo, One College Circle, Geneseo, NY 14454, USA. Email: [email protected]