One Foot in the Operating Theatre, One in Her Native Village

Roxana Tabakman

January 10, 2020

CURITIBA, Brazil — In the village Rio das Cobras, they call her Krexu, which means waxing moon.

In the operating theatre of Instituto de Neurologia e Cardiologia (INC), to talk to her, you just need to ask for Dr Myrian. Born from an indigenous father and a white mother, or jurua, Dr Myrian Krexu Veloso Wisniewski has a foot in both worlds.

   

Dr Myrian Krexu Veloso Wisniewski

She is in the fourth year of specialisation in cardiovascular surgery at INC, a Brazilian centre for highly complex neurosurgical, neurological, and cardiac care, in the Paraná state capital, Curitiba. INC is considered a high-tech centre in Latin America for its pioneering use of technologies such as gamma knife surgery, or intraoperative magnetic resonance imaging (MRI). There, Dr Myrian is held in high regard.

"Since the beginning of her specialisation in cardiac surgery, Dr Myrian has always shown commendable performance, both in her ability to work and in her continued interest in learning", Professor Francisco Diniz Affonso da Costa, head of the Cardiac Surgery Department at INC, told Medscape's Portuguese Edition.

"She will certainly have a bright future as a cardiac surgeon."

Bridging Cultures

Although living and working in town, during her holidays Dr Myrian always returns to the indigenous village where she comes from. With just over 3000 inhabitants, on the left bank of the Guarani River, in a region crossed by two tributaries of the Iguaçu River — Rio União and Rio das Cobras rivers. She belongs to the Guarani people, specifically the Mbyá Guaraní, a group of about 27,000 people living in various villages across Brazil, Paraguay, Argentina, and Uruguay. In the Rio das Cobras indigenous village, the Mbyá Guaraní live with another indigenous group, the Kaingang. Dr Myrian speaks both languages, in addition to Brazilian Portuguese: Guarani and Kaingang.

In the indigenous village where she grew up, the bridges that connect different cultures go beyond tribes. "There is a medical outpatient clinic and a pajé (shaman), spiritual leader who has deeper knowledge on teas and herbs. When the pajé realises that conditions cannot be cured by natural medicine, he tells people to go to the doctor, to seek cure through allopathic [modern, science-based] medicine. The indigenous village health team has to be able to respect and integrate both bodies of knowledge. One thing does not exclude the other", said Dr Myrian.

She provides medical care to the village whenever she is there. "For my people, it is essential to be cared for by someone like them, there is greater trust in the doctor-patient relationship, especially among the elderly and the women", she told Medscape.

According to the physician, patients don’t feel very comfortable when interacting with someone who does not understand their culture. For this reason, the patient's family often asks Dr Myrian to be their physician, as many do not want to be seen by white doctors.

"I go to people's homes, and it's very effective because being in their own environment, indigenous people feel more comfortable to talk about their problems", she said.

Dr Myrian trusts the work of the pajés from the village but does not use indigenous practices on her patients. "This knowledge belongs to the elders and the sages. I'm 31 years old, so I'm still too young to acquire this knowledge about traditional indigenous medicine."
 

National Entrance Exam

Dr Myrian joined the university through an affirmative action policy called the Indigenous Peoples Entrance Exam, created in Paraná in 2006. In 2019, 750 Indian students from different ethnicities applied for 52 places at different universities. She said that when she applied, there were only five vacancies, and the eventual course was chosen after the exam.

The period following her entrance exam approval was "quite difficult", according to Dr Myrian. As a rule, Brazilian indigenous households are extremely poor, and her situation was similar.

"I was awarded a monthly scholarship grant of 600 Brazilian reals, which was actually not enough, and not always paid in a timely manner."

The financial difficulty was added to the prejudice she experienced, sometimes in the way other people looked at her or talked to her.

"People talk to the indigenous as if they don’t understand what they are saying", she said, adding that this was not always the case at Unioeste.

"Some professors helped me, giving me a lot of support. They cared a lot about me."

Dr Myrian majored in Medical School in 2013, and for the first 3 years, she served as a doctor in indigenous health, a period of her formation she highly values.

"I learned not to overuse drugs and to work with scarce resources. Not always having access to complementary examinations makes you develop more clinical skills. My differential today is knowing how to come up with solutions to problems most professionals don’t know how to solve without financial resources or lab and image studies."

Brazil's Ethnic Populations

In Brazil, there are 307 indigenous ethnic groups. In the last census (2010), the self-declared indigenous population consisted of 896,917 people, of which more than half lived on reservations. Among these, 32.5% are illiterate. But the number of self-declared indigenous entering college is increasing. 

In 2017, 56,700 Brazilian indigenous people enrolled in higher education (0.68% of the total students who reached this stage), mostly thanks to the Lei das Cotas or 'The Quota Act', that reserved places for indigenous people according to the percentage of these populations in the different regions.

But the dropout rate is still high. "In college, I met other indigenous students who, over the years, dropped out of school. It is difficult to go to a place in a different culture, without having enough resources to live outside the indigenous tribe, leave the family, and, on top of this, not having a strong formal education."

On the other hand, only 37.4% of Brazilian indigenous speak, like Dr Myrian, any of the 274 indigenous languages, which would be essential to preserve their cultural background.

Positive Influence

Dr Myrian said she was never disrespected, nor did she feel that her professional ability was being challenged by patients because of her ethnicity.

"Overall, it is not a question raised during medical visits, some are even happy to hear that I come from an indigenous background, but some patients are still afraid of being treated by women."

She says she does not want to be seen as an example - at most, a positive influence. Her achievements, she believes, could show others like her that it is possible to leave the tribe, study, and make a difference in the lives of their communities.

"I draw attention to where I come from, but all medical doctors come from somewhere; each one of them brings their own history, and everyone has their own worldview. I was born to be a medical doctor for indigenous, whites, blacks, all kinds of people."

Translated and adapted from Medscape's Portuguese Edition.

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