PALENQUE
Years ago, when getting warmed up in training sessions with fellow administrators, we might get asked a question, like, “Tell us something we don’t know about you.” In my early career, I was a sneaky social smoker and could terrorize my peers with this unknown fact. Another choice was, “If you weren’t a doctor, what career might you have chosen?” My answer? Archeologist.
This interest never has left me since fourth grade, and it has led to travel to Europe, Asia, South America, and, of course, North America. Chichen Itza, Uxmal, Kabah, and Palenque are in North America. I had done the easy rounds of some of these sites before becoming a doctor, but Palenque is not easy to get to. There is no beach or resort nearby; the cost in dollars and time is not insignificant. When I was offered a trip to do a medical mission in Palenque by someone who knew nothing of the ruins, I was hooked. My trip to Palenque took place in the later months of 1992.
Pakal was a king in Palenque during the, “late classical period.” I had read books on how the glyphs of the Mayans had come to be translated and some of the stories they told. I saw an opportunity to visit Pakal before laser light shows and 5 star hotels obscured him. I had only photos to go by, but the notion of being in a remote corner of Mexico (Chiapas) with his story under my belt and a chance to see the ruins while fulfilling a spiritual need was compelling. To do it, I would miss Halloween with the kids (aged 8 and 13 years) and would have to mail my ballot in before leaving as it was a presidential election year: Bush vs Clinton.
Marybeth was my ticket to this opportunity. I worked in Olympia and became known to her as a hard working doctor and one who spoke some Spanish. Marybeth was a pharmacist who would call occasionally to clarify a prescription order or shoot the breeze with me over lunch. She was a Baptist and her church sponsored a yearly mission to a rural clinic in Palenque Mexico. They really could use a practitioner who spoke Spanish. Would I be willing to spend a week’s vacation coming on a mission there?
You bet…….
Would not being a Christian be a problem though? No one asked that question specifically and I did not exactly phrase it that way, but my concerns were addressed at some of the preparatory meetings at the church. I saw energetic youthful people trying to do a good thing. I met doctors who would go with me and mostly, I saw my personal motivation in line with that of the people who would share this venture with me.
I pulled money from savings; I packed my, “kit;*” I got my vaccines updated. One option was for rabies which is typically not recommended unless one is going to be around wildlife in a rural or inner city environment. I thought it would be great to be immunized for this lethal disease until I found that given that it was for an optional trip: I would be charged $600 for the vaccination. What are the odds I would need that, right? I declined.
The trip to Palenque was not uneventful. I had been to Mexico innumerable times but never DF ie Mexico City. We were approaching for landing and I tried to make out all the historical sites I knew from history books. We descended and I saw a plane taking off——right under us. I was listening to the air traffic controller as this occurred; words and tone expressed concern. The plane accelerated and we circled around to try again—-with success. The airport of Mexico City was magical. It was modern, capacious, and full of kids in Halloween costumes. It was October 31 and who knew that they celebrated Halloween as we do in Mexico? More to my medical calling were public health posters advertising the need to take action (preventatively) against AIDS (in Spanish, SIDA) which in 1992, was a thing.
There was a short hop to Villahermosa and then a long drive South in a pickup. My diary reports that I hung my head out the window in the heat and the humidity to gaze up at the stars and the echoing flashes of lightening strikes to the East as we drove. We arrived in forested hilly country, hot and humid. In a clearing off the road stood the Hospital del Pastor. The crew that had gone a-missioning before us was not there. We were not expected and I spent my first night alone in a wood barracks built by the West Olympia Baptist Church. Bunk bed bins were built along the walls and there were hooks to keep one’s shoes off the floor—“to keep the scorpions out……” In the morning, I found some of my teammates for the next week. The previous week’s workers were doing a day of tourism before going home and were near the Guatemalan border. I met a few of my Olympia volunteers and David, a pastor from the Midwest. I was distressed to note that the group had brought Tupperware containers of food to be used for the week. I was dumbfounded. They had egg salad in Tupperware in a tropical climate. They had loafs of Wonderbread. They had canned Ham. They were terrified of eating local food.
What had I done to deserve this?
There was an old VW bus in a parking area next to the “Hospital.” The hospital was in fact an out-patient clinical compound with storage facilities, some housing, and space for perhaps three hospital beds and four to five clinical examination rooms. We met a few of the nurses and I met Naftolin, the doctor on site. As patients were not expected, we had a free day. I asked about the VW and bless him, Naftolin provided the keys and granted my request to take some of the volunteers into town for shopping. What did we need to shop for? Fresh food. The girls (for the volunteers that first day were all young women) looked at me askance. “You would buy food in town?”
My fellow travelers, despite my assurances, did not trust me. I had long hair, a beard, and did not look like a real doctor; I was suggesting it was safe to eat local food. Given the dismal surroundings with nothing to do, they were willing to come into town. I drove through beautiful hills on a two lane road into a working town, Palenque. I was able to find a Panaderia and fresh fruits in a market. Bananas, Pineapple, Mangoes were ours for a pittance. Orejas and baked bread. The verbal interchange was wonderful for me, rudimentary as it was. My American friends thought I was completely fluent as the exchanges were straighforward, no fuss, no bother. I could not convince them in a week to eat the fruit but they did like orejas. I was not longer dependent on the Tupperware fare.
Naftolin confided that we would be working hard the next day—he suggested if the ruins were of interest, this was the day to look them over. No one wanted to come with me. I headed out, alone. Palenque was everything I hoped it would be. The Castile, the tower, the whole thing. My diary tells me I did find the sarcophagus of Pakal though my memory fails me on this point. As with many ruins, the actual findings are often a disappointment compared to the expectations……….There were not a lot of tourists in the “tourist zone” but I noted that most were Mexican or Europeans. I took great pains to get a photo of an intriguing European woman soaking her feet in a pond, with the ruins in the background but was too self-conscious to make it so. I retreated into my work and the company of the next week.
The routine was easily established, I would take a quick shower (outdoors) in the morning when it was cool and people were not yet up. I would take a walk along the rural road, marveling at baseball sized tarantulas sunning themselves. Breakfast and then on to the clinic. Naftolin had outlined the record keeping (on 3x5 cards), access to simple meds, prescribing, and supplies. There was a small building for medical supplies and I was in awe: my world in 1994 was one of mass produced disposable medical supplies from needles to bedpans and beyond. This building had supplies a doctor from 1950 would have found comforting: stainless steel bedpans (try to find one now!), reusable glass syringes, reusable needles. We would have little need for most of this as the advertising rurally for the coming of the Gringo Doctors noted that the specialty of note for our week was, “ophthalmology.” Patients were triaged by nursing into obviously and unclear categories as it related to this care. I would further the triage from the “unclear” group.
My role in this setting (I am a Family Physician) was called to question that first day before we got rolling. Sandwiched in this “get acquainted” day was a young man brought in by his parents—-a five day walk—-and I agreed to see him unsupported by clinic staff. The husband gave the history as his wife spoke no Spanish—a common event in this part of Mexico and one that left me unsure just what value my medical Spanish provided in many of these visits—-but the boy spoke not at all. I saw a small statured teen aged boy staring into space and not moving spontaneously. He had months of deterioration with headaches, weakness of the right side, blindness, and then generalized seizures. A brief exam found him paralyzed on the right, pupils fixed and dilated with bilateral papilledema——this history and exam suggested a brain mass and increased intracranial pressure. The family was penniless. I learned that Villahermosa had a general hospital for the general public where he could perhaps be examined. I reviewed as best I could the likely outcome of his evaluation there and my sense that his prognosis was likely terminal. The family consulted and decided to take him home. I prescribed anti seizure medicine with some guilt—it was standard practice but really, where were they going to get more when they needed it, living where they did? And paying for it? Naftolin, catching up with me later agreed that this was the advice he would have given as well. He wasn’t sure they would even scan him given his condition…….
Dr. Allison, the ophthalmologist appreciated my role just fine—without me he would have been trying to evaluate and advise on such a patient and was happy to have not had to do that. Most patients had much less dramatic presentations. My two weeks in ophthalmology in medical school found me comfortable diagnosis pterigia—small opaque growths on the cornea of the eye. They usually don’t cause visual problems. Four out of Five people I saw that week in clinic came because their eyes were itchy, burning, aching, and had pterigia—with fear that these would turn into cataracts or otherwise obscure the pupil and lead to blindness.
Taking a, “careful history,” often with a nurse who took the history in Mayan, translating to Spanish for me and then back, I quickly developed a reassuring approach and “treatment,” that left some time to be sure there was not something else I could help with. Dr. Allison noted these as being common and an outcome from being in bright sun without sunglasses and possible worsened by wood smoke (In rural Chiapas, cooking in huts with wood is common). Sun glasses and eye lubricants are the usual interventions.
We brought glasses, but not too many sunglasses. Many of the patients were middle aged and the look on their faces when given inexpensive reading glasses for close up work was worth the price of the trip in and of itself. There was a role for me, though in honesty, plenty of the volunteers could and did this intervention without me.
My take- home at the end of the week was that medically, rural Mexico always challenges you with the exotic: I saw rashes whose cause was beyond me; I am sure I saw active TB and sent them on to the hospital for testing and treatment. I saw one little girl — a middle class family member who came to see the experienced doctor from the United States who had had high fevers for a few days now passed. She looked fine; I suggested a wait and see approach. The family was grateful. At dinner, Naftolin gracefully reported that when he chatted them up after seeing them, he learned that their other daughter had recently been diagnosed with Malaria and he took the liberty of prescribing for that in this little girl.
Ouch.
Additionally, and I have observed this elsewhere, many people in this “primary care” clinic in the jungle had exactly what I see in the United States: colds and minor illnesses with fear driving the visit to be sure it isn’t something more. There were “worried well” who in some cases, just wanted someone to hear them. Given double translations each way, this was not easy to treat effectively, but I tried.
The Mayan word for “pain” is “meesh.”
If you know Mexico, you know about Bimbo bread (basically it is Wonderbread). I learned that it was a joke that since Bimbo bread if washed down a drain often clogs up the plumbing, people used it as a remedy for diarrhea……
Dr. Allison in the meantime, was doing eye surgery—cataract removals and God knows what else. I was astounded when I saw an old man show up near the end of our week with an eye that almost looked ready to pop out. “Damn, I told him to stay in bed a few days after surgery and the nurse tells me he has been out in the field for ten hours a day since surgery….”
As nurses everywhere, the nurses at El Pastor were healers and mother-like figures calming, herding, and fixing things hour after hour. I had certain assumptions about third world nurses that I was disabused of promptly. A short nurse we worked with, Victoria, fixed her gaze on me late one afternoon and grimly held out an empty coffee can with a lid. She turned and pointed down the hall where a tarantula was slowly heading our way. I thought for a minute and scooped it into the can and put the lid over it. I gently shook that can back and forth with a resulting, “thud thud” sound as the creature hit each end of the can. I released him out in the jungle and Victoria just shook her head. I think she wanted me to kill it.
My interactions with rural citizens of Chiapas reinforced another stereotype. These people were tough, physically and mentally, enduring inconvenience, pain and suffering on a day to day basis. They were short statured, quiet, and dignified. I remain in awe of them. Naftolin, after dinner would wonder aloud how we might get a group some year and go to the villages with a traveling set up. He was meaning we would hike rural Chiapas to provide medical care. Hearing this, my awe of Naftolin, if he was serious was shared as with the patients I admired.
The spiritual needs of these people were, of course, part of the bargain—both the volunteers from Church and the indigenous people we were serving were to reap the benefits. We were a Baptist Mission and staffed with very sincere and forthright Christians. We gathered in the mornings to give sermons and pray with the day’s group of patient-pilgrims. I was curious how this would go and out of politeness, was a daily attendee for this prayer. David, was a minister from the Midwest. David was driven and I admired that in him—-he was married with two children and had by his history, “given up his material things,” and was away from his family for extended periods supporting missions like ours. He had formally studied Spanish with more focus than I—-my only C’s in high school were in third year Spanish. But while he had his tenses, pronouns and prepositions sorted correctly, he could not be understood because he was from the Midwest and spoke with a distinct Nebraskan (?) accent (is there such a thing?). He asked that I read from a Spanish bible, laying out the paragraphs needed. Reading from a text and correctly sounding out the words was easy and the “sermon” flowed beautifully.
This became a daily ritual and I welcomed it until the other volunteers, each assigned to give a sermon, came asking me to translate their home-grown sermons into Spanish. This was tough for me; I had a paperback English/Spanish Dictionary but what they were asking for was in fact an art form and not just a hacked translation. I demurred noting third year Spanish from High School, now nearly a quarter of a century later, was not up to this nor did my vocabulary quizzing patients in Spanish about headaches, chest pain, sore knees, rashes, and colds provide me with the vocabulary needed: Get on your knees; Love the Lord, Beg forgiveness, Peacemaker, Troublemaker, Laziness, Bow your head, Fealty, and, Pray.
David intervened after my attempt to translate a sermon live found me confusing the word, horación (prayer) with horario (calendar).
My conversations in Spanish in the evenings were more relaxed, spontaneous, and effective. I met Blanca and Brenda, children of hospital staff who lived on site. They went to a parochial school in blue and white uniforms. They were roughly the same age as my daughters and I marveled as I went over their homework assignments with them and they were in parallel with the basics of my own daughters. The math problems and writing were at the same level. Note to self: third world education in elementary school can be the same lesson plan your first world school is using. They loved hearing about my girls and they named me, “Caballo” because I wore my long hair tied up in the back. Oso was their dog, a mostly Labrador breed. Oso was a happy go lucky dog who bonded with me quickly (cheese sticks helped).
Blanca and Brenda came to me one night with Oso and pointed out that he had an engorded tick on his head, above his eyebrows. There are many legends not to mention parlor tricks about the best way to get a tick out, “without leaving some behind.” I had tried many of them and was convinced that the simplest way, if you have the right tools, is to simply pluck it out with a narrow hemostat. I happened to have several and so, I sat on a stool, with Oso’s head resting between my legs, looking up at me expecting a treat. Blanca held the flashlight and Brenda gave hims a squeeze about the shoulders as I snuggled the hemostats into the cleft with the tic and plucked it out. I got all of it. Oso was a star but as I released him from the grip of my thighs, I had a moment: “What could have gone wrong here?”
“Has Oso been vaccinated for rabies?” I had no idea how to ask that…….
All’s well that ends well.
The day we wrapped up, I had some time in the town of Palenque. I ambled about and bought a few keepsakes, including a machete from a hardware store for $5. The shopkeeper was not happy to accept American dollars which puzzled me. I came to the realization that this was a working town and not used to tourists. Apparently, exchanging foreign currency, for locals, was not so simple. Nor was helping a couple I had seen that morning. I had prescribed an antibiotic and the pharmacist could not read my handwriting. The couple saw me and asked for help. I was quickly able to get the medication and paid for it and handed it to the husband. He handed it off to his wife, three paces behind him. As I smiled and turned to go, he tapped my back. As I turned, his solemn face made eye contact with me and he handed the pesos needed to pay for the medication. He insisted I take it. I thanked him, smiled, and observed his very non-smiling countenance as he walked towards the edge of town, his wife carrying all their possessions —-three paces behind him.
I was tired; a smile crept on my face from a reflection the night before: I had wanted a cigarette. I have always associated Mexico with smoking, though it has never been a regular habit of mine. Generally, when in Mexico, I was with Kernie and the setting, romantic. I associated the heat and humidity with romance and smoking and drinking. Funny thing was, while I had desired a cigarette (alone and out of the way of my fellow missionaries) I did not indulge. Another funny thing: the realization that I had not thought about sex once in ten days. I reflected……….likely an effect of concentrated focus, hard work, the heat/humidity, and possibly, working with evangelicals (?). That might require some testing of theory.
Villahermosa was a tougher town than Palenque. It is a hot concrete city filled with working people. I managed to get a few things to bring home as gifts and we had a celebratory dinner. I was flattered by the group of volunteers, now much more comfortable in a hotel restaurant and we had a very nice meal. Mr. Paget (a banker from Olympia) toasted me noting I was nothing like he had expected and would go on another mission with me anytime. I returned the toast with feeling. I know that I had been circumspect with many conversations this trip and was excited that we would have president Clinton and not president Bush in January. Conservative Christians, even in 1992 were voting for conservative politicians; they wore it on their sleeves and yet, I still have satisfaction that none of that mattered for the work we had done.
Comentários