Short-term medical missions (STMMs) are groups of volunteer medical providers who travel to provide health care, including basic services and surgeries, to global low-income populations. STMM organizations present their work as contrary to both public and private systems within Guatemala that do not adequately serve the patient population, though they operate within the same framework as other providers and mirror the same neoliberal ideology in their planning, organization and strategy, and execution. STMMs strive to offer free, high-quality access to surgeries and basic health care services via volunteer medical providers willing to dedicate their time and skill to low-income patients. The patient population of STMMs in Guatemala, who are often rural, indigenous, and low-income, already experience diminishing access to health care due to neoliberal health policies and discrimination within the existing health care landscape, going to great lengths to access quality health care services. This research investigates the planning, organization and strategy, and execution of STMMs through the lens of the enduring influence of neoliberal health ideologies on volunteer medical providers and existing health resources in Guatemala. Organizational strategies that prioritize the ease of travel for volunteer medical providers mirror the geographical lack of health care access, neglect of indigenous language services in the health care context, and urban focus already existing in the country’s public health care system. The patient population experiences heightened vulnerability exacerbated by STMMs when seeking care because of their low adherence to Guatemalan law surrounding registration requirements for foreign medical providers and poor institutional accountability, burdening patients, who lack legal literacy and financial resources, with denouncing malpractice or post-operative problems. Finally, STMM providers expect patients to both demonstrate passivity, humility, and material deficiency and show that they can be ‘good’ patients—able to understand and abide by the authority of the medical providers, know what information to provide, and communicate effectively—essentially, to be good health consumers. Ultimately, this research demonstrates how neoliberal health ideologies remain deeply engrained in the psyche of STMM organizations, despite their targeted approach to deliver health care to patients struggling to access services in Guatemala’s chaotic health care landscape.

In this dissertation, I examine how social perceptions of physical disability shape interactions in healthcare. Drawing upon the lived experience and insights of Diné (Navajo) individuals with physical disabilities, family members, and Diné
on-indigenous healthcare workers and service providers, I explore the interrelationship of social perceptions of physical disability with understandings of identity and performance of personhood. Embedded within discourses and critiques of ableism/disablism, narratives highlight the interconnection of constructs of personhood and productivity.

Findings show that social perceptions of physical disability are closely linked to broader cultural norms surrounding concepts of health/illness. I offer a critical analysis of contemporary impacts of colonization and historical trauma on the physical, emotional, sociocultural and economic wellbeing of Diné people and those who fill service provision roles for this diverse population. Situated within broader contexts of defining constructs of ‘Whiteness’ and ‘Indigeneity’, the role of culture and discourses regarding stereotypes are particularly prominent factors in shaping relationships.

This interdisciplinary ethnography brings together contributions from Anthropology, Disability Studies, and Indigenous paradigms. Placing a particular emphasis on the social dynamics in two urban centers in the state of Arizona, this ethnography centers on analyzing areas of medical practice that work well, as well as gaps in the provision of healthcare services, with a particular focus on systemic and infrastructural barriers. These concerns are shared not only by Diné individuals with

physical disabilities and family members, but also by non-indigenous service providers and healthcare professionals.