Monday, May 16, 2005

Into the Mountains

Feeling better steadily, still a little uncomfortable now and again. Am looking forward to even better days ahead.

Taking advantage of improved health, I pushed ahead and organized the trip up into the mountains for yesterday. Got up at the crack of dawn, snagged the 4 wheel drive pick up truck owned by the plantel and a couple of able bodies to help me load a few boxes of blankets into the back along with some stagnant clothes and old shoes. Given the delivery of new clothes from the Mormons last week (Wal-Mart a la cart) Jenny and I had gone through the children's clothes and collected some of the rattier things which I tossed on the truck as well. Felt a little bad giving out "triple hand me downs" but even if they used them for rags or stuffing for a bed mattress it would be more than they had before.

Now, Jenny has been feeling a little down since I became ill. She has realized that when I'm gone she will be here alone. As you can imagine it's extremely difficult to get things done solo around here. She's also concerned about her daughters education....quite frankly, there isn't any! Well, actually that's an over statement of a sad fact. They do have a school here but it is sporadic at best. Sometimes the kids go to school for only 1 or 2 hours and they send them home and the teachers have a bare minimum education themselves. For instance, Monday, Nana (Jenny's daughter) came home furious, she's 15. Apparently the teacher told her she spelled surgery wrong and the teacher made her write it 10 times in her note book the correct way. Sounds logical right? Well that's all well and fine but the teacher said it's spelled S..U..R..J..E..R..Y not s..u..r..G..e..r..y as Nana had spelled it. Given that her mom's a doctor she's probably got that one down pat wouldn't you think? but the teacher insisted she was wrong. When Nana pulled out her dictionary to disprove the teacher's allegations, the teacher stated "well that's a different kind of surgery" and moved on. All this said Jenny decided not to go to the mountains with me so she could straighten out some things at home.

I was uncomfortable going alone with only a driver but, so be it, figured it would work out in the end. Miraculously at the last minute the daughter of the plantation owner (who speaks English and had nurse training) radioed that she would like to come. Perfect! So, off we went with our blankets, clothes, wormer, vitamins and few medical supplies I through in my camo bag, just in case.

It took about an hour to climb up the winding dirt road that had huge gullies in it from the torrential rains we've been having. It was a beautiful day. I was grateful because the truck was an open bed and 40 wet wool blankets wouldn't do anyone much good ( not to mention that I had to ride in the back). As we went up in elevation the terrain changed only slightly but there were several coffee plantations and the vegetation was more stunted.

We drove through several villages each a little poorer than the one before. You might say a hut is a hut, but I have learned in fact, that is not the case. Some huts have the boards super tight and the roof is raised slightly up off of the top of the wooden walls allowing the smoke to escape from the oven ( I use the term oven generously, it is anything from an open pit fire to a slick little contraption of stone and metal sheeting that is elevated on concrete blocks and holds a wood fire). Other huts have the roof smack tight on the walls and there is no oven just a fire pit outside. A really nice hut might have separate rooms or an attached over hang that allows them to eat outside protected from the rain. Some have a shotty little outhouse. The less fortunate resort to the woods or the rivers and streams as a latrine. I also learned about bathing along the way. There are three, well four options. The fist of course is indoor plumbing. The second is interesting, as you climb the mountain there are veins of water streaming down that they can stick a pipe into and get fresh mountain water to bubble out, then using a burlap sack they make a two sided shower curtain for added privacy. The third way is just to use the toilet water ie. streams and rivers or the fourth way which is not bath at all.

Although in writing this I sound a bit flip, actually, I was really impressed with the resourcefulness they showed. They have minimum to no education and no resources. They essentially spend their entire life camping. Also worth a comment is the difference between residents of Pina Blanca and the mountain folks.....overall cleanliness was much better in the mountains. They were more poor but more proud. What they had was neat and orderly. There was less trash and above all else....they were happy. In Pina Blanca the conditions are crowded and dirty. There is no ownership and they have just enough education to make them miserable.

Our destination was a small three building school which encompassed all ages. The orphanage tries to reach this destination 2 times a year to administer wormer and vitamin A. We were eagerly greeted by about 15 kids all less than six years old, and 2 school teachers. We quickly realized there was no water for the kid's to take the meds and we had no containers to put them in to take home....oops! Luckily I had duct tape! We had the kids line up along the truck each with a little piece of paper from their school note book into which we folded the medicine they would need to take over the next three days and we duct taped it shut (now,... we all know of 102 ways! to use duct tape).

As we were giving out the medicine I began noticing all of the rashes, boils and odors of illness the children had. I began to worry because I brought a few extra meds but not a ton. My mission was blankets and wormer not mobile clinic. I just couldn't ignore all these things, or could I? Soon many of the residents of the area got wind we were here and flocked to the truck. One of the teachers was instrumental in quickly making a list of the neediest families. We gave them the blankets first. At the same time I started using what little supplies I had brought to treat the kids first and then the adults. My camo back pack contained alcohol, bandages, a few scalpels some ointments, pain meds and antibiotics. One by one I treated them until the last little girl, with diarrhea so bad it was caked on her legs had approached the truck. She needed medicine for amoebic dysentery which I didn't have. So we through her on the back of the truck and headed for her house. It was a well kept little hut just off the road. Her mother was apprehensive as we explained her child's needs and our lack of supplies. We wanted to take her with us but she wanted no part of that. We tried everything and offered to pay for their way back home which was her main concern, but still no. Not knowing what else to do we gave her some instructions on hydration and left promising that if she would come with the workers to Pina Blanca in the morning we would find a way to get her home. It was unsettling. Death is always an option for these little ones.

After that ordeal we started through "town" the kids all running behind the truck. We trudged up long trails to little huts here and there that were off the beaten path to deliver jackets and the remaining few blankets.

One particular hut we were urged into. As you walked in the door it reeked of rotten flesh. In the corner lay a man all of about 4 feet tall and wasted. He was feverish but cognizant. His mother was anxious and rapidly telling his story. They spoke of boil that started about a year ago the size of grape. They were seen in San Pedro at the free hospital. He was given a script for medicine and a follow-up appointment. Neither of which they could afford and so he went untreated. The woman explained that they scrape for food (which was obvious by her stature)and although she felt horrible they had had no other choice. Her husband had been ill (we soon discovered he'd had a stroke)and wasn't able to work in the field so they were basically starving. Honestly, I dreaded pulling back the sheets to see what lay beneath, but there was no one else, so I did. The boy had a growth (a tumor of some sort), not a boil, that was about the size of my hand and inch thick extending from his groin. It was pus covered and rotten. The sickening feeling of helpless overwhelmed me. Unfortunately it would not be the last before nightfall. Obviously we didn't have what this guy needed but we did have cash. So we gave them some cash and arranged to get both he and his sister to San Pedro to the hospital for palliative treatment. When I left I was fearful they may use the money for food instead but at least they now had options which they had been lacking most.

On to a few more homes and then we were brought to a building in the center of town. In this building was an old woman with weathered skin and urgency in her voice. She wanted us to see her husband. We gladly agreed and she rushed out back to get him. As came through the door my heart sunk yet again. He too had weathered skin and moved slowly under the weight of arthritis. His belly distended as if were 8 months pregnant and his eyes a dull burning yellow. He smiled as if I were a long lost granddaughter and reached for my hand, trembling. I had been down this road Bolivia my colleague and I were presented with the same situation...a man with end stage liver failure of one form or another. I remember my colleague being sort of cold when he told this man's family he was dying. It bothered me and I questioned why at that time but now realize that there is switch inside of you that trips when the load is too heavy to bear and you become disconnected. My switch was tripping....I tried desperately not to let it happen. Anita, the plantation owner's daughter saw that it was a difficult moment for me and she distracted us briefly by ushering out some of the children who had gathered. In the States end of life issue happen all the time, I've been trained in handling them and am about as comfortable with it as one can be. But in the states you can easily say "we've run all the tests, tried all the best medications and this is where things stand", but here I've tried nothing and not performed a single test. What if I'm wrong? He'd been to San Pedro already months back and they sent him out with water pills and no explanation. Compounding my anxiety, I had to have the conversation through a translator. As the conversation started, he seemed to already know from the tone of my voice and the way he was feeling what I was about to say. As I told him there was no medicine that could help him he interrupted with a smile and said "yes there is, it comes in the form of small squares of ground, that will cure everything" then he chuckled and we prayed aloud together in Spanish with his wife looking on....

PS: The little girl with diarrhea made it to the orphanage this morning:)


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