Christmas was busier than I thought it would be...but I say that every year. Here are the final two installments in the Peru Diary. Happy New Year... and I hope my memory serves me well!!
On the last day of our Mission, we set up in a community center in a very run down neighborhood. This long cinderblock building was attached to a private home- a small, adobe flat with two large, vacant chicken coops at one end. The owner was inside the house watching television. He appeared briefly in his pajamas to use the latrine outside then got dressed and left for the day, giving us access to the property, the latrine and the chicken coops.
Inside the center, volunteers had created cubicles for the doctors with wire, string, blue plastic sheets and black garbage bags put together with clothes pins and masking tape. Triage was in the first cubicle, Pam and I were given the second, Liuba and Erin the third. Pam's husband was across from us, optical was in the back of the hall, pharmacy at the front. Outside, a tent was erected for integrated health and the psychiatrists found privacy in the chicken coops into which were placed a table and two small chairs. Seeing psychiatry being taken seriously within the shade of a chicken coop was the highlight of the day and we took turns going out to take photographs!
Pam and I saw the usual assortment of complaints and then a young man came to us with an older gentleman who had trouble walking. The young man was attractive, well dressed and well educated. His companion was about 55, dressed in the traditional garb of the agricultural worker; loose pants, white blouse and at his waist a colourful woven sash. The young man explained that this was his father's best friend. He had survived an attempted murder and was suffering from numbness down his arms, dizziness and depression. The story was right out of "The Sopranos". He had been a successful farmer - well respected and well liked. His wife, however, had a lover. She and her lover attempted to kill him, but failed. It was an amazing story. After his release from hospital this man continued to suffer but doctors blamed his numbness and dizziness on his pent up rage. Pam examined his neck and back and concluded that he had a pinched nerve - that his symptoms were not psychosomatic, but caused by the beating he endured. This news was such a relief that he nearly cried. After all that had happened to him, to be told that he was making up his symptoms was unendurable. We saw this so many times. When people actually know what their problem is, they feel better. To not know is as painful as the injury itself.
Next door, Liuba and Erin were working with moms and babies. Occasionally a stray youngster would crawl under the plastic divider into our space. Older kids would peer in through the masking tape, but we were all too busy to worry about it. Privacy wasn't as important as seeing as many patients as possible. Our next patient of note was a man in his eighties who was worried he had prostate cancer. He had no teeth, mixed Quechua with Spanish and I had a really hard time understanding him. Liuba was busy shooing toddlers from under the dividers, so for a moment I could ask her to help with translation. Pam had to do a prostate exam, so with me holding the sheeting together for privacy and both Liu and I looking the other way, our patient braced his hands against the wall and the exam took place. Pam told him he had an enlarged prostate but it was very unlikely to be cancerous. He sighed with relief. He had been worried for so long, he was almost in shock. "Now what do I do?" he asked. "Are you married?" Liuba replied "Yes" he said. " You're over eighty years old, you're a healthy man - go home and enjoy!" said Liu. The patient started to laugh and so did we. Once again, to be told you were going to be OK was the best medicine... and a good laugh comes second.
After awhile, it was necessary for me to go outside and use the latrine. It was a single toilet in a small, dirty space between the house and the community center. With all the people using it for urine samples, some local authority had put a padlock on it. This was our only nearby facility. Dr. Paul, having finished in the psychiatry unit for awhile was walking with one of the local volunteers down to the bus stop. I threaded myself past the waiting line of patients, through the chain link fence and ran after them. Desperate for a washroom, I asked the woman volunteer where I could go. She led me to a small, steamy restaurant and said for a small fee I could use use the washroom there. To digress slightly. I once met a man who was a health inspector - his specialty was restaurants. His advice was: "If you go to a new place to eat and you're not sure about the cleanliness, check out the bathroom. If the bathroom is spotless, then so is the kitchen. It never fails!" As I squatted to avoid touching any surface in the filthiest place I have ever been, I thought about his advice and thanked my lucky stars that I wasn't there for lunch.
Back at the community center, the sun had passed its peak. The patients outside were much more comfortable. They conversed with friends, sat passively and hoped to be seen before we had to close up shop. Dr. Norm, who had seen one too many back complaints and could speak Spanish quite well, decided to give a demonstration on how to avoid some back problems and set up a table outside. How do you explain core strengthening exercises and proper lifting techniques to a lot of people at once - especially if you're not sure they even understand you?!
Our last few patients were elderly ladies. The one Liu and I will always remember was a tiny, sweet natured woman who had a bad heart and breathing problems. In order to listen to her chest, we once again, had to peel away many layers of clothing before we could find her inside. It was a surprise to see that she was wearing a brassiere over the top of one of her sweaters. No matter - it was not our business to ask. She had trouble walking. Arthritis had reduced her hips to bone on bone. She was hungry, emaciated and alone. Pam gave her as much of a check up as possible with our limited resources. She called Tanya, the MMI representative over to our space and arranged to have a walker delivered to the woman's home - along with some food. It was good to know that walkers wheelchairs and crutches are kept in a warehouse in Cuzco and given to those most in need. We wanted to give her more. Since she was our last patient, Liuba, Pam and I wanted to give her a little money. We rolled together a few bills- maybe $30.00 Canadian in total, and she immediately reached inside her blouse and tucked it into her brassiere! It was not being worn as underwear, it was her purse.
Not wanting to see her lose her money, Liuba took off her waist pouch and put it on our patient. She then retied her apron to cover the pouch. Our little lady was delighted with the pouch, the money and the news that she was soon going to have the aid of a walker.
Around us, people were beginning to take down the plastic dividers. The folks in the pharmacy were packing up and Tanya was telling anyone who had not been seen when the next mission would take place. Our sweet patient sat on a bench near the door and watched. She didn't want to leave us. I gave her a banana and a granola bar that I had in my backpack. She smiled and put them away in the pocket of her apron. The bus had come to take us back to the hotel and still she wouldn't go. One of the volunteers took her by the hand and led her outside, telling her it was time for us all to leave and that she should return home. She sat down and watched as we loaded the bus and drove away.
Seems to me that every time you see a public service announcement asking for donations to support a child, there should be another announcement as well, asking us to help the countless, ailing and vulnerable seniors who have nobody to care for them, too. Poverty. It never ends.
Back at the hotel, there was a jubilant atmosphere. We were finished the mission and looking forward to a farewell dinner at a nice restaurant and a couple of days to explore. Liuba and I had a shower (mouths closed) and dressed for the Inca Wall. This lovely, upscale Cuzco eatery has incorporated a small piece of an original Inca stone wall into the decor behind their long and splendid buffet table. The table was laden with every local delicacy including "cuy"- or guinea pig. There were meats and salads and soups and pastries and as we gorged ourselves, an ample stage offered a variety of performances: singers, dancers - both modern and traditional. It was an absolute feast.
As we ate and enjoyed, I couldn't help thinking about our last patient and all of the others out there who were hungry. Just a few more days until the gift-giving and gluttony of Christmas and here I was seeing the "other side of life". Perhaps this is the gift I gave to myself; something to put my life into perspective and to make me thankful, once again for all that I have.