We were all out of bed and downstairs in the "dining room" by 6:30 AM. Morning prayer and some songs from the MMI hymnbook began the day and we were on the bus by 8. Our first session was set up in a tidy little Mennonite clinic, not far from the church we had attended on Sunday. The supplies had been sent on a separate bus and we all pitched in to carry everything inside. This time there were no dentists, so we were spared from having to load and unload the heavy chairs and other equipment they'd need.
Already a long line up of patients was there to welcome us at the entrance. It was a clear day. A brief rainfall in the evening had made the grass moist and green. Kids tumbled about in the small courtyard as volunteers put up tent shelters and rows of chairs. For some patients, a check up and a referral would be an all day process. Many of the ladies there wore traditional garments; multi layered skirts, several sweaters and blouses and knee high woolen socks. Tall white hats and long braids, often tied together at the bottom or finished with long tassels of black wool, made them stand out from the crowd. These were Quechua and spoke little Spanish. It was important to find translators who could speak to them and translate for us, so that we could then translate the Spanish into English for the doctors. We soon found several young women, nurses and volunteers who still spoke this ancient language and were eager to help.
Inside the neat little clinic, I was paired up with Dr. Pam Bradford from Maryland. She and her husband, Norman, were given a small room, divided into two by a set of hospital screens. We would have about 4'x5' of space each. Plastic bags were being applied to an adjoining window to create some privacy and to darken a room that the optometrist would work in. The staff had given us an examining table and Pam was pleased to see that we had a sink with running water. In the hall outside our room, two other cubicles had been created with pipes and curtains. Examining tables had been set up there, too. It was a clean and very well organized space, even if it was tiny! Down the hall was a room for pharmacy, to the left of the pharmacy was a long bench for waiting patients and around the corner to the left again, was triage where patients would be lead first to have their weight and blood pressure taken and their charts prepared.
It took some time to set ourselves up. The first day is always a fluster of where to put things, how to arrange the flow of patients and which volunteer is best suited to what job. By 10:00 am, we had a system and by noon, we were a team! Liuba had been assigned to Erin Hannigan, a young (and very pretty) pediatrician. Their space was in one of the administration buildings across the courtyard from us. Many complexes and private homes are arranged like this, around a central square or rectangular garden which serves as a living or gathering space. The building is hidden by a high wall. The outer doors then open to reveal a courtyard around which the residence is formed. The rooms all open to face the garden in the center; a tiny replica of the public square downtown. We saw this in Pompeii, so this ancient, Latin- style of architecture remains popular today.
Liuba's and Erin's space was next to Nora Porter, also from Maryland. Nora, a family physician, spoke fluent Spanish so she was on her own for most of the time, calling on Liuba only when someone's speech was too difficult to decipher! Liu was in her element with the children, but her memories of growing up in Russia with little to eat and hand-me-down clothing would come back to haunt her time and again. It was hard for her at first to separate herself from the families who were in dire need, but her experience made her all the more compassionate, kind and understanding. I soon heard her laughing and teasing the little ones while she did the translation.
We all established an easy pace, wanting to be as thorough with examinations as possible and still see as many people as we could. Pam and I were a compatible pair. I loved her gentle, understanding style and so respected her abilities. Patients in these areas tend to suffer from the same things. Hard work and carrying heavy loads on poorly supported feet cause backaches, calluses and sore legs. Dry air - filled with sand the consistency of talcum powder - irritates eyes and throats. Vendors in the streets get up at 5 and work until sundown. Construction workers and farmers work without the proper equipment or adequate food. Women abandoned with children complain of headaches they can't stand and this is often from stress. Just telling another woman about her difficult life was what they needed more than anything.
At first, when Pam asked if a patient wished to pray, I felt uneasy. I knew my medical terminology, but religious phrases were embarrassingly foreign to me. Pam would hold the patients' hands, bow her head and ask God to take the pain away. "Heal your daughter's aching muscles, calm the pain in her head, give her rest from all her duties and make her husband realize that he must support his children. Let her know that she is loved and cared for and that you are listening..." Words like this don't come from the Bible. They come from the heart.
What Pam would say could not be given as advice or in conversation. We were, after all, strangers; foreigners. But, her comforting acknowledgement and sage advice, if given in a prayer, was gratefully accepted and would last far beyond the small bottles of meds we could give her. I soon became part of an intimate trio; Pam holding the patients' hands, my hands on Pam's and the patients' shoulders. I wanted to be a translator, but this was a private exchange beyond words, beyond borders, beyond looks and lives, possessions and beliefs. It was an experience I can't even begin to explain, which is rare for a talker like me!!
Outside our little cube, patients were waiting patiently for their names to be called. "Runners" would put their charts into the docket on the wall, then lead patients to the next station after their appointment. Treatment continued with a "charla". This is an opportunity for nurses, therapists and ministers to help people understand how parasites and other diseases are transmitted and how to avoid them. Plastic models showed how the back works and how lifting in certain positions can put too much stress on the spine. Exercises to improve back and leg strength were demonstrated. People could learn about nutrition and infant health, and there were two psychiatrists as well who would talk to people about their lives, their fears and their faith.
Fear is a serious problem- for everyone. In a country where services which house and protect the elderly are either too expensive or non-existent, the fear of having a terrible disease or a chronic ailment is constant. In a modern city in 2010, it's hard to believe that such services are so underfunded. Even hardy young people fear a health problem, as work cannot stop because of an aching back. Somebody has to feed the family and pay the bills.
On the first day, Pam and I saw more women than men. This meant that we dealt with a lot of intimate problems and one in particular made us laugh for the rest of the week. Our patient was a woman of about 50, well into menopause and trying to cope with the crazy ups and downs of hormone change. One of her concerns was that she peed when she laughed. Pam smiled and said there was an exercise she could do to strengthen the muscle that controls the opening of the bladder. "The next time you urinate" she said, "stop before you're finished and hold on for the count of ten. This exercise can be done anywhere, once you know how to do it, and you should do it at least 10 times a day.". Even though Pam made it clear that you didn't have to run to a washroom, the lady was confused.
"Look" I said. "you practice on the toilet, but you can do the exercise anywhere! Nobody has to know what you're doing- you just do it. For example," I went on, "you can do it on the bus!" I held an invisible stanchion and lifted my eyebrows as if counting to ten. "You can do it in the kitchen!" I whisked invisible eggs and grimaced up to ten. "You can do it while you're buying groceries!" I pretended I had a bag of grocs and was paying the cashier as I flexed my privates secretly. Both Pam and the patient laughed until they cried. This is the kind of audience a comic adores....and is far too encouraging.
We saw the dear Quechua ladies who complained of varicose veins. Their stockings, held up with strong elastics formed ligatures behind their knees and we asked the local nurses to find a solution if they could. They complained of aching backs, arthritis and dizziness. Pam listened and administered without letting on that she had seen and heard the same story from almost every patient. One of the things everyone seemed to overlook was their need for water. In a climate as dry as this, Pam recommended at least 8 tall glasses a day; something we hear often enough as well. It's amazing what happens to your body if you don't get enough water.
There weren't enough otoscopes to go around, so the few we had were in great demand. Blood pressure instruments break with the change in altitude, so we needed those as well and the one little knee-knocking hammer made the rounds, too making us a lot more aware of what was going on in the other operatories around us. It was clear to everyone that bringing all your tools with you was a good thing to do!
Around 4 in the afternoon, the line was halted and we were able to able to clean up and head for the hotel. Little was said on the bus. We were all more tired than we realized, having worked non stop all day with just a short lunch break in which to catch your breath. Liuba decided to try and use the miserable hotel computer and I crashed on the bed in our room. I was starting to catch a cold and hoped it wouldn't tie me down at all. Dinner began with grace and after we had all been fed, we dissected the day's events. Everyone had a story to tell about an unforgettable patient or a system we could try. Good suggestions and good laughs always followed dinner and after dinner, bed felt wonderful - cold mattress and all.