Defacement: Indigenous Patients' Experiences in Baja Verapaz, Guatemala

Abstract

Communication between health care providers and patients is wrought with challenges and involves issues of face and facework. This ethnographic qualitative study explores the patient experiences of the Rabinal Achi people with government healthcare through participant observation, informal interviews, and thematic analysis. The existing face literature is inadequate to explicate the abundant occurrences of dehumanizing communication by government providers emergent in the narratives of the Achi patients. As a result, a new construct is proposed, defacement. Defacement extends beyond the failure to mitigate other-face threats to the destruction of other-face. Defacement devalues the humanity and dignity of a person. Four types of defacement with subthemes, each increasing in intensity and defacing content, emerged from the data: (a) disregarding, (b) degrading, (c) regaño-ing, and (d) abusing. The findings reveal that access to healthcare is more complex than simple issues of clinic location and numbers of providers. Improving health care for the Achi patients requires addressing not only issues of availability and physical accessibility but also issues of face including prejudice, abuse of power, and cultural respect.

KEYTERMS:

• defacement
• face
• indigenous health communication
• intercultural communication
• intercultural health communication
• provider–patient communication

Acknowledgments

I would like to thank my mentor and advisor, Dr. Janice Schuetz, for her support, wisdom, and guidance. Your contributions to my scholarship and life are immeasurable. I would also like to thank my thesis committee: Dr. Pamela Lutgen-Sandvik, Dr. Richard Schaefer, and Dr. Rao Nagesh, whose support, suggestions, and guidance were invaluable. I am grateful to my in-field hosts and informants who made many accommodations and sacrifices for me, my in-field translator who sacrificed much time to assist me, and Iris Herrera who assisted with refined translations. I appreciate the anonymous reviewers’ comments that improved this work. Finally, I would like to anonymously acknowledge and thank the Achi people who entrusted their stories with me. May their voices be heard.

Versions of this article were presented at the Annual Meeting of the National Communication Association, San Francisco, CA, November 2010, and the CDC National Conference on Health Communication, Marketing, and Media, Atlanta, GA, August, 2010.