Rotación at Sub-Centro de Salud Luchadores del Norte

What does a mental health professional “do” when she encounters significant poverty, medical need or trauma? The words that we rely on for our talking therapies are quite inadequate, maybe even inappropriate when faced with such suffering. What does a supervisor “offer” to those who are encountering these overwhelming situations and their accompanying emotions?

This week our Lucero second-year students are working in (and outside of) a neighborhood medical clinic. These “neighborhoods” exist in several sections of Guayaquil in response to an invitation of the government to rural and mountain people to move into the city. As president Gonzalez explained, the land is essentially free at first to those who settle there and create some kind of shelter. We saw several neighborhoods of bamboo shacks that are the first generation of such settlements with subsequent iterations becoming cinderblock dwellings of several small rooms on dirt streets without sewage. The neighborhood of Dr. Montero’s Sub-Centro de Salud Luchadores del Norte clinic is such a place. The people are poor with many families separated due to parents seeking work in other countries and children being raised by extended family or even friends.

Our students are now working this week with these families. Since Dr. Montero and his colleagues will serve these families for many years, a psychosocial history will be a very valuable asset to their work.

In addition to seeing families in clinics our students are visiting them in their cinderblock homes with the medical team. On such a visit they met a mother of not one but two young children with crippling illnesses that require her to lift and transport them. She, herself, is physically injured and the family is very poor. They spoke of their ‘needs’ and what would “help”. For this family the needs are basic: food, clothing, shelter, and some assistance with the burden of care of these children. Although there is impressive love, care and commitment, there is real suffering here.

Maslow writes that more cognitive and emotional exchanges can only follow individuals’ basic needs being met. It is not only challenging for the mental health professional to help, when words are our medium of exchange, it is challenging for a supervisor to be helpful to the student who is encountering such need. What “words” can make a difference?

In such circumstances the mental health professional has little to offer from the panoply of psychological interventions. These moments are not about doing, they are about being. The only real offering, it is hard to call it an intervention, is the connection and compassion that one human being can offer to another in distress.

Hopefully, the “turning towards” rather then “turning away”, the being with rather than leaving alone can be comforting to this woman and those of this community whom our students will meet. It is what there is for a mental health professional to offer.
Certainly such an experience of mutual helplessness will impact the professional and personal development of our MSPP students. This experience will take some significant time to metabolize, but the emotions, more than any cognition, will be with them, likely, forever.

Nick Covino
President