We are conducting an ethnography on the rural health service that is a one-year period that graduates in medicine develop in rural or urban-marginal settings. The rural health service is almost like an ethnographic fieldwork for some medical students, recently graduates, who mostly come from urban environments. These young doctors do not usually visit the rural or marginal areas of the country before this year of health service. Ecuador is a multicultural country where 14 different ethnical groups and nationalities live, however, university students do not receive training in anthropology to work with communities. In the specific case of medicine, they are trained to work in well-equipped hospitals that are not in rural areas of difficult access (there are only few of these hospitals in the most important cities).
In addition to this training in the hospital environment, students of health sciences are being prepared to fight against the disease but only in a very small extent to promote health. This pathogenic approach contrasts with the traditional medicine knowledge used by indigenous populations and the inhabitants of the rural and marginal urban areas. Thus, although the health professional has a cultural shock when they arrives at their rural health destination, the inhabitants who are going to be cared by the new doctor do not always want to go to the health center, and almost never go to the hospital because it is seen as “a place to die” (interview).
At UDLA medical school and elsewhere, we know the importance of training students in the arts as a health promotion strategy (Badin, Martinez and Gabela, 2016, Arts on a health context; Pink, Martinez and Diaz, 2017- forthcoming, Salud creativa). Now we are preparing different projects that involve architects and environment designers that facilitate the work of health promotion with the communities in those places where young doctors work and where the hospital is geographically and culturally far away.
Ana Martínez Pérez, anthropologist, UDLA, Quito, Ecuador