What is at stake in doctor-patient interactions? Offering a corrective to studies of health communication that privilege the biomedical interview, T.S. Harvey sets out to understand the interactional complexities of transcultural healthcare in highland Guatemala, which feature participants beyond just doctor and patient. Physicians at the Centro de Salud are Ladino Spanish-speakers who expect to proceed with the patient according to a normative biomedical view of the interview. But Maya ‘wellness-seekers’ often arrive at the Centro de Salud with several companions, who together compose an account of the wellness-seeker's struggles. To represent this multiplicity of voices, Harvey introduces an ‘ethnography of polyphony’ to attend to the nuanced ways in which Maya K'iche’-speaking wellness-seekers and Ladino Spanish-speaking practitioners relate to one another.
Chapter 1 opens with a K'iche’-speaking wellness seeker bringing her sick child to the Centro de Salud. There she finds herself overwhelmed by the biomedical bureaucracy, dismissed by physicians when she says her child has already been vaccinated, and confused by practitioners' instructions about how much medicine to give the child. The remaining chapters contextualize the dynamics of this troublesome care-seeking visit. Chapter 2 reviews literature on medical interactions, making the case for attention to multiple actors and their varied contributions to an interaction. Harvey introduces a method of transcription he calls ‘the polyphonic score’ which positions speakers in relation to one another horizontally to recognize the interplay of both speech and silence along the lines of an orchestral score. Chapter 3 illustrates the polyphony inherent in K'iche’ illness narratives, wherein a wellness-seeker and her companions together relay the story of the sickness to the doctor. The K'iche’ co-authoring is discordant against the doctor's serial questioning. Chapter 4 attends to the role of silence in these medical interactions, offering a heuristic for considering the ‘discourse roles of silence’ (p. 61). Chapter 5 takes the reader into the interactional milieu of Maya healing as it describes traditional K'iche’ practices of eliciting and narrating information about illness and wellness. Chapter 6 illustrates this with an example from a K'iche’ healing interaction, highlighting the healer's sociolinguistic role: she is supposed to facilitate divine intervention to remedy the illness, but this can be hindered if she ‘gets in the way’ by talking too much! Here, Harvey asks how such sociolinguistically dissimilar interactional models of biomedical consultation might affect the outcome of cross-cultural care. Chapter 7 speaks more broadly of ‘curative conflicts’ between biomedical health practitioners and Maya ideas of illness, wellness and care, focusing especially on the politics of vaccination.
Having been drawn into these subtle communicative struggles, the reader wishes for associated sound or video, especially to help appreciate the moments of silence that Harvey finds so important. And having been convinced of the profundity of these communicative clashes, the reader also wonders whether they are reflected in data on health disparities, and at what scale. But Harvey may be intentionally resisting this sort of declaration, as he calls for social science to embrace the indeterminacy of meaning.
