Health-And-Quality-Of-Life-Of-Mexican-Woman.Pdf
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1 2 Health and Quality of Life of Mexican women; a case study Copyright @ B H Massam, R Espinoza S and C Ko ISBN 978-0-9917743-8-8 Swn Y Mor Press 402-18 Wanless Avenue Toronto Ontario M4N 3R9 Canada Printed and bound in Mexico: 2017 ISBN 978-0-9917743-8-8 I Title DO NOT DISTRIBUTE 3 4 Table of Contents 1 Preface …………………………………………………………………... 6 2 Introduction …………………………………………………………...... 9 3 Selection of communities and women to be interviewed ………….. 24 4 Overview of responses about each community ………………........... 30 5 Overview of each community for each age group …………………... 48 6 Overview for each community: opinions of medical personnel …… 57 7 Policy recommendations and concluding remarks ………………….. 65 Appendix I Draft protocol and questions ………………………............ 69 References ………………………………………………………………… 72 Biographies of authors ……………………………………………………. 75 Acknowledgements ………………………………………………………. 78 5 1 Preface The focus of this project is on the health of women in 7 communities in Mexico. The communities are El Tuito, Higuera Blanca, Ixtapa, Las Palmas, Morelos, Sayulita and Tomatlán. We will seek clarification of the determinants of health for these women. We will focus on 4 groups of women in each community: old (50+), single (31-50), teenager (13-20), young mother (21-30). Rather than describing specific clinical details of the health or sickness for each woman we will focus on attitudes and perceptions of their health from their perspectives. Members of the medical professions in charge of the Public Clinics in each community will complement the data collected from the subjects, by offering comments and assessment of the health of women in the 7 communities. For comparative purposes, we will collect responses from 40 men in each community regarding health and the influence of tourism on health as they perceive it. The photograph on the cover is of four Mexican women: Rodrigo’s Mother, his wife and two daughters-each has a story about health and quality of life (QOL) as seen from their own experiences and situations. Using schematic diagrams (Figs 1, 2, 3, 4, 5 and 6) shown at the end of section 2 we summarise possible connections for each woman regarding attitudes toward health, sickness and wellbeing. We must recognize that health, illness and disease are complex matters of science, perceptions and attitudes toward life. Disease may be considered as a pathological entity whereas illness is the effect of the disease on a person’s entire way of life. It may be tempting to suggest that health can be measured objectively and policies developed to alleviate pain, discomfort and suffering, and so enable individuals to live a full engaged life in their family, neighbourhood and community, and thus contribute to the overall welfare, success and stability of the state. Reality is much more complex. Health is defined by individual women in many ways: it defies a simple one- dimensional definition. Health as perceived and experienced by women may be connected in direct and in subtle indirect ways to happiness and quality of life as well as their inherited genetic characteristics and the social, 6 economic, environment and cultural milieu in which they live. Perspectives on health vary over time as information about medical matters and approaches to health care management are disseminated. Also over time a woman’s values and attitudes regarding health evolve and expectations are modified. One view of the ways that medical science impinges on health offered by Harari (2016) is that medicine helps to reduce premature death and ease pain. Whether such interventions reduce suffering as expressed by thoughts in the mind is debatable: the mind cannot exist without the body and much pain is felt somatically. The search for relief from pain and suffering often involves resorting to medical interventions, especially in modern western societies. However, the easing of suffering especially in societies that lack medical services often relies on support and the meaningful presence of family and friends, and a sense of belonging to a community and accepting the inevitabilities of life with a measure of equanimity rather than despair. The communities we will study are selected from ones we have previously used as part of a long-term project on the impacts of tourism on QOL in Mexico. This new project complements earlier work (Massam et al. 2003, Massam et al. 2013, Massam and Sanchez 2012, Massam,Hracs and Sanchez 2012, Massam and Espinoza 2011, Massam et al. 2016, Massam, Hracs and Espinoza 2015, Everitt et al. 2008, Espinoza et al. 2014). Data derived from surveys using formal questionnaires, and interviews with members of the health care professions will be used to describe the perceived and actual health of women. Samples of women in four age categories in each community will be used. We offer interpretations of the status of health and connections with QOL as well as the impacts of tourism. Also, we will suggest approaches that may offer improvements for public policies, as well as behaviour by individuals, that may serve to improve the health of women in the communities. This case study can provide a framework for further work in other communities and so help in the overall object of our work; namely to understand and improve the human condition of all citizens in Mexico. 7 An overview of health in Mexico and the subject of the global burden of disease are provided on two web sites. http://www.healthdata.org/sites/default/files/files/country_profiles/Subnati onal/Mexico/CountryProfile_Subnational_Mexico_Mexico_2015.pdf http://www.economist.com/blogs/graphicdetail/2016/10/daily-chart-7 As individuals are living longer given improved medical interventions there are increasing numbers who suffer the consequences of severe chronic conditions. This raises complex ethical and economic issues that must be confronted by individuals and states in the coming years. 8 2 Introduction It can be argued that most people live their lives locally and for the most part in the present time. How a person feels, acts, reacts, thinks and behaves is so often related to current circumstances and specific conditions around them. Of course, each person has memories of earlier times and may indeed envisage their future and how life may turn out for them and for others in the future. More reflective enquiry may engage a person to consider the long view of themselves as a unique sentient human being on the path of evolution of our species. The determinants of our current perceptions of health are embedded in our history as a species. Currently most of us are concerned about caring for the sick and dealing with matters of heath as a reflection of personal concerns regarding happiness, wellbeing, relationships with others, fears, hopes and dreams of a meaningful satisfying life worth living and the legacy that is left when we die. The ego and notions of the self as expressed by I, me and mine guide and control to a considerable degree, perhaps even dominate a person’s language and behaviour, the perceptions about ‘who I am’ and ‘what I want in life or do not want’, and also how a person relates to his or her body and mind, as well as their impressions and values about many aspects of the world. Matters concerning health, sickness and wellbeing are strongly influenced by perceptions and attitudes, and consequently thoughts, emotions and feelings of an individual, to say nothing about expectations and explanations which are embedded in the cultural context. We may assert and believe ‘I am sick because I have not placated the Gods, eaten the wrong food in the wrong way, and perhaps at the wrong time, not taken the right medications, caught a bug, bacteria or virus, not taken care of myself appropriately etc.’ The notion that we own our body and have control over it is pervasive in many western cultures, even as we observe the body changing following the immutable laws of physics, chemistry and biology. The somewhat misguided view of personal control leads us to suffer, and we often envisage 9 that if we can find the right diagnosis of the causes of our suffering we may be able to find a cure and treatment. This partial truth leaves many people anxious, distressed, and depressed as well as angry, annoyed and frustrated by what is perceived of as inadequacies of a health care system. We cry out for a better system and more expenditure or investments in health care to prolong our lives, and improve the quality of our lives and relieve us of pain and suffering. Implicit in this approach to health individuals tend to adopt the attitude that their happiness and wellbeing is closely connected to QOL and health. In a review of Harari’s (2014) fascinating book about human history Strawson notes ‘Harari draws on well-known research that shows that a person’s happiness from day to day has remarkably little to do with their material circumstances. Certainly, money can make a difference-but only if it lifts a person out of poverty. After that, money changes little or nothing … if we had an infallible ‘happyometer’, and toured Orange County and the streets of Kolkata, it’s not clear that we would get consistently higher readings in the first place than in the second.’ https://www.theguardian.com/books/2014/sep/11/sapiens-brief-history- humankind-yuval-noah-harari-review The renowned British author Penelope Lively (1997) observes in a story (In Olden Times) in her collection Beyond the Blue Mountain that the protagonist ‘Just occasionally, she was able to identify happiness. She saw it made manifest, and perceived what it was …it was Katie [her daughter] laughing in the bath … It could be quite other things, too, quite different things-a blue and green May morning, starlight, the sun on your face.