Offering Medical Care in the Amazon: My Interpretation

Offering Medical Care in the Amazon: My Interpretation
December 10, 2012 Callie Daniels-Howell

by Abi Rome

(Visit http://abitravelblog.wordpress.com/ to see Abi’s original blog post and many others.)

Deep in the jungle where there’s no running water, where mysterious bugs leave big red welts on your elbows even after you covered yourself with insect repellent, and where you’re lucky if there’s a flush toilet within walking distance, doctors are doing surgery. Their patients lie on elementary school desks or makeshift tables in an un-walled room covered by palm thatch, and the rain beats down a couple of feet away. One man has two cysts extracted. A woman has an ingrown toenail removed. And a third patient opens his mouth wide so the internist can reach in with forceps to yank out a loose molar. No one screams, no one questions what the doctor says or does. Instead, the patients accept their diagnoses, offer nods of thanks, and quietly take the small bags of pills handed to them at the makeshift pharmacy consisting of grey plastic tubs and battered suitcases.

I ask a sad, young Indian woman where her pains are, and whether the burning in her stomach is worse before she eats (yes, she answers) or after she eats (again, she says yes). I lean in close, trying to hear her soft voice, the one that admits that it hurts her when she urinates, that she’s got headaches and dizziness, that she’s worried about her protruding belly button. Her belly is round, holding her ninth, yet unborn baby.

I watch a wizened old man grimace as the doctor squeezes the his shoulder and upper back, tender after 60+ years of laboring in his cleared patch of forest, swinging a machete, planting stalks of yucca, lugging heavy sacks of plantains from his farm to his home, over an hour’s walk away. He indicates that he has pain all over his body, from his neck down the length of his legs. It keeps him awake at night.

I am talking to these people, and listening to their tales of pain and woe, because I am their interpreter. I am the bridge between them and the (mostly) American doctors who I’ve joined up with in the Ecuadorian Amazon on a medical brigade organized by Timmy Global Health, a non-profit dedicated to expanding access to healthcare around the globe. We are providing basic medical care and medicines to indigenous Quichua communities in the rainforest, hours away (by car) from the nearest health clinic or hospital. Because I speak Spanish, I help villagers communicate with our doctors, who wait in their blue scrubs as I establish what their ailments are. When a Quichua interpreter is required (especially for the older women), the doc and I sit together, listening to a string of guttural sounds interspersed with occasional Spanish words. Soon, sense will emerge.

We help them with their illnesses and their pain for we can appreciate what they feel. But, I note that not everything they tell us makes sense. We are from different cultures, and while bodily symptoms are common to us all, customs, traditions and beliefs are not. Two examples illustrate this.

Many of our patients complain of headaches and dizziness. Some have dry, itchy skin. Others have cramps and/or problems urinating. These are symptoms of dehydration. I ask them if they drink much water, and they inevitably say no. How much do they drink? Two glasses of liquid per day, they respond. And one of those is often guayusa tea, a stimulant made from rainforest holly leaves. A cup of guayusa in the morning contains more caffeine, which is a diuretic, than brewed coffee. Not only that, but men and women alike spend most of their day doing manual labor – hiking to and from their garden plots, swinging a machete, planting yucca and harvesting crops – in the hot sun.

Do they take breaks and rehydrate? No, they say. At first I wonder why not, but then it becomes clear. All of their lives, they’ve been told not to drink the water, that it’s bad for them. That’s because their water comes from the local river or spring. It is not filtered or processed in any way, and is full of unhealthy parasites. They do not know, or do not want to spend cooking fuel or firewood, to boil their water to make it healthy to drink. So they avoid imbibing the very liquid that’s essential for healthy bodies and minds. Sure, it makes sense from this perspective, but not if you want to live a long and more comfortable life. What seems so obvious to us has not been part of their belief system. We counsel them to drink at least 8 glasses of water per day, and hope that they will consent.

In the village of Lushianta, most of our patients are women, pregnant women carrying their youngest babies in slings across their belly. They enter the doctor’s examination area (a sectioned-off area separated from others by hanging bed sheets) with their toddlers, adjust their load, and sit down on one of the wooden chairs set up in a tight circle. I ask them how many children they have. They answer 8, 9, 6…. I venture to question one young woman further. Her ninth baby in is utero, and I ask how many children she thinks she’ll have. I expect the usual answer, the one I’ve come to expect of experienced mothers in the U.S., Ecuador and most other countries: “This is my last. I promise – my last.” But, no. This young woman says, “Me faltan cuatro.” I need four more. She’s telling me that she won’t be satisfied until she has twelve children. It turns out that she’s not the only one. Later I meet another woman who already has her twelve.

I fear for these babies. What will their futures be? They are being born into a culture in which there is no realization of the economic costs of children. It is a society where you build your house out of wood that you harvest yourself; where your diet is composed of rice, yucca and plantain (and sometimes eggs, chicken or fish) – i.e., crops you can produce yourself on infertile, tropical forest soils; where there’s virtually no place to spend money; and where basics of clothing, dishware, school supplies are donated to you by outside agencies. But, it is a society that is changing, where surviving off the land is not enough. The natural abundance of the forest is diminishing; climate change is beginning to affect productivity; oil production is encroaching on tribal lands; and electricity and Internet have just made it to these remote Amazonian villages. The Quichua we visited will need money to live on, and with more children, they will need more dollars (Ecuador uses U.S. currency). And as we help them improve health care, fewer children will die young – negating a traditional reason for women to have many babies. These indigenous people are living at a moment in time when the past and the future are colliding. Thus, the present makes little sense.

Regardless of what’s rational, the opportunity to use my Spanish as a volunteer on a Timmy brigade offers me many emotional rewards. They emerge at various moments of the weeklong trip: during the personal, and sometimes intimate, conversations I had with our Quichua patients; when watching members of our brigade kick around a soccer ball with children on a grassless field; by participating in a baptism where two members of our brigade became the godmothers of two local boys; in knowing that the care and medicines we distributed will improve lives; and by feeling the quiet appreciation from those with little access to healthcare or other comforts that most Americans take for granted. And, I – someone who has never been much of a caregiver – feel like I have actually nurtured people in need. All because I happen to be good at languages…

 

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