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.