Navigating Bureaucracy: Accompanying Indigenous Maya Patients with Complex Health Care Needs in Guatemala

Indigenous populations worldwide endure disparities in access to biomedical health care. This article suggests that institutional bureaucracy is an important and underexamined barrier to health care for indigenous Maya people in Guatemala. Based on interviews, participant observation, and seven years of experience with a non-governmental organization's patient advocacy program, we examine how biomedical institutions' administrative systems impede indigenous patients' abilities to obtain specialty medical treatments. Particularly, we examine the roles that street-level bureaucrats such as security guards and nurses play in restricting access to health care as well as how bureaucratic adherence to procedure can override clinical concerns in ways that actively harm patient health. We also highlight how indigenous Maya patients with limited Spanish language abilities and low literacy tend not to have the cultural capital to successfully navigate hospital environments. As such, bureaucracy in biomedical institutions replicates colonial and postcolonial social inequalities in ways that restrict access to care. Patient navigation is a valuable and urgently-needed service for Maya patients and a gap that could be filled by the numerous health service organizations operating in Guatemala.