title: Who's judging the quality of care? Indigenous Maya and the problem of "not being attended".
abstract: In developing countries, lack of trust in the quality of care provided is often cited as a major factor promoting reluctance to seek biomedical help for obstetric emergencies. This article draws on fieldwork among Mayan informants in Sololá, Guatemala, to explore poor perceptions of the quality of care received when seeking obstetric care in the hospital. Using data collected over two years, I set out to understand why interviewees repeatedly complain that hospital staff "do not attend to you." I maintain that the powerlessness of patients to influence the treatment they receive further reduces their trust in the quality of care delivered, ultimately negatively impacting the decision to seek obstetric care. Finally, I argue for the importance of recognizing the influence of the wider historical and social context in creating the dynamics of this interaction. The implications of this research in defining the quality of care and skilled attendance within the quest to make pregnancy safer are discussed.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. nicole_berry@sfu.ca
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Berry
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D006166:Guatemala; D006801:Humans; D007197:Indians, Central American / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008880:Midwifery / Q000592:standards; D009774:Obstetrics / Q000592:standards*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010817:Physician-Patient Relations; D011247:Pregnancy; D011787:Quality of Health Care; D035502:Trust