Prescription for Shoes

By Anthony Saxton, MSc-GH ‘16

We walk into the exam room—Jeremy, a fourth year medical student on the cusp of finishing a clinical rotation at the Mayan Medical Aid health post, and me, a global health graduate student eager to learn about healthcare in indigenous communities in Guatemala.

Stooped on a modest wooden stool we find Juana*, an elderly Mayan woman whose legs sway in the air since they are too short to reach the ground. Flanked on her left is Antonia, the clinic’s translator who effortlessly goes back and forth speaking Kaqchikel with the patient and Spanish with us.

Jeremy asks the patient what brings her into the clinic, and Antonia relays that the patient feels stiffness in her back and weakness in her legs. He asks follow-up questions, like when the pain started and if she has any other sort of discomfort, and we learn that Juana often works long hours in the fields carrying large bundles of wood strapped to her head and back.

Jeremy, recognizing a pattern consistent with other patients he has seen, turns to me and says that the patient appears to have osteoarthritis. “Nearly everyone in this community has arthritis,” he explains to me, “because they all have to work too hard just to survive.”

He does a physical examination of the patient, and finally we determine where exactly it hurts and what sets off the pain. As the patient goes to put on her shoes, we also see that her feet are covered in callouses and the edges bear the glossy hallmark of chafing. It looks like her shoes are two sizes too small for her feet, and she tells us that she has worn the same pair for years now.

After finishing up, Jeremy asks the patient to excuse us, and we go to another room, where Dr. S, the founder of the clinic, is waiting for us to give a report on the examination. Jeremy goes through a step-by-step recap of our process and ultimately recommends a mix of medicines that could help Juana control her osteoarthritis and the pain. Dr. S agrees on the course of action and heads over to a shelf to fill the prescriptions, but the furrowed brow on Jeremy’s face reveals that something else is bothering him.

“She also needs a prescription for shoes,” he says, “and to take it easier around the house. Her work is taking such a toll on her body.” Dr. S. sympathizes, telling us that Juana, like so many others in this indigenous community, lives in extreme poverty on less than $2 a day. That does not even afford her the ability to provide enough food for her family, let alone buy a brand new pair of shoes for herself.

When we return back to the exam room with her medication, Juana is extremely grateful for what we have to offer.  As Antonia translates Jeremy’s recommendations for proper lifting techniques and the importance of properly fitting shoes, Juana nods encouragingly and promises to take it easy at home.

But as I sat there in the clinic, I could not shake the thought that in all likelihood Juana would probably be back in the fields tomorrow with the same undersized footwear, her slumped back and calloused feet symbols of her unwavering dedication to her family, and for me a reminder of the complexity in addressing health issues. All too often, health problems are manifestations of disparate socioeconomic status, political imparity, or in the case of Juana’s community, the disenfranchisement of indigenous groups. I think to myself that if we could tackle the root causes of poverty, if we could empower the people who struggle to survive, then maybe Juana could finally fill her prescription for shoes.

* Name changed for privacy