(Some names have been changed to protect patients’ privacy.)
A barefoot woman in traditional Otavaleña dress wandered up to the schoolyard in Larcacunga, grey hair trailing from under her head wrap. “What are you doing?” she asked.
“We’re offering free medical consultations,” I replied. “Would you like to see a doctor?”
“Well, okay. I’m healthy, but I have pain here,” she said, placing her hand on her back. “Where are you from?”
“Very far away,” I answered in Kichwa.
“All the way from Otavalo?” she asked, eyes wide at the thought of us traveling ten kilometers from the market city.
“Even farther than Otavalo.”
“Even farther?” she asked, incredulous now. “How is it that you came all this way to my community?”
How is it, indeed? It’s a winding story that began ten years ago when I first came to Ecuador as a volunteer for a neighboring village. But even given the incremental, mostly-explicable growth in that story, the question’s underlying surprise merits remembering. It is a bizarre thing we are doing, though we often forget that in the enthusiasm and instrumental focus to our energies. We collect volunteers, including doctors, nurses, and willing assistants with no medical experience, from the United States, bring them to the Andean highlands, and each day take them and our boxes of supplies to a different village’s school or community center to provide basic health care. A bizarre thing, but a beautiful one.
Beginning my usual set of questions for arriving patients, I learned that her name was Maria Juana Perugachi Torres and that she could correctly state her age at 90. Many elderly patients weren’t sure of their age, or guessed something different than the birth date on their identity card suggested, but Maria Juana was right on. I couldn’t help grinning at her, and she responded with the most beautiful smile I could imagine.
“Open your mouth,” Katie instructed my new friend, holding out a thermometer and demonstrating with her own mouth, “under your tongue.” She gently nudged the thermometer into Maria Juana’s mouth. Maria Juana sat there, mouth gaping wide, waiting for Katie to finish whatever odd thing this was she was doing. Katie motioned for her to close her mouth, using hand gestures, forcefully closing her own mouth, saying in her brand-new Spanish, “close your mouth.” But Maria Juana didn’t understand. Finally, a middle-aged woman who had already been through this process and was waiting her turn to see a doctor came over and taught Maria Juana how it worked.
As Katie helped her roll up a sleeve to make room for a blood pressure cuff, Maria Juana repeated, “I’m healthy!”
Guessing she might fear her sleeve was being raised for an injection, I reassured her that it was only to take her blood pressure, as if that meant anything in her world. Next, she was asked to climb up onto a scale. She stepped squarely up from the side, her left foot entirely covering the plastic window where her weight would be read. Katie and the middle-aged patient managed to convince her to turn 90 degrees and then inch backwards so that her weight could be recorded, then instructed her to dismount. What an odd set of tests, Maria Juana must have thought; she would have a story to tell when she got home. Speaking of home, her breakfast was there, waiting to be cooked and eaten.
“What time is it?” she asked, as if she were late for an important meeting. Receiving her answer, she waited patiently for a few minutes and then asked again. “I haven’t eaten yet,” she offered, as if to appease our quizzical looks. Unsure of how to respond, we gave her more blank stares, and then I remembered the boiled eggs in my pocket. I pulled them out, offered one to her, and began to peel the other one for myself.
Why was she so pleasing to me, this 90-year-old I had just met? Was it the sly, toothless smile, the high voice blending Kichwa and Spanish, or her self-confident air, asserting quite indisputably that she was healthy? Perhaps it was her approach toward difference. Walking through the center of her community, she discovered strangers from a distant land there, doing inexplicable things in the name of “medical consultations.” She wasn’t afraid or angry and neither was she clamoring for a panacea or a handout. She was curious enough to try it out, and trusting enough to have her vitals taken, but not so enthralled that she forgot about her breakfast. In a sense, that attitude shouldn’t be surprising; you don’t get to be 90 in her circumstances without developing a certain self-assurance in addition to an impeccable cardiovascular system. But she had none of the complaints of loneliness or aches and pains, laments about lost joys that are the staple of some of her contemporaries. If only all of us could approach new experiences and others with that sort of calm curiosity and confident equanimity.
I was hungry too, so I gobbled up my egg and a protein bar, taking advantage of a lull in arrivals. José Manuel, the current president of Larcacunga, approached me with his bag of pills. “When do I take these?” he asked.
Reading the simple instruction sheet in the bag with the medication, I replied, “one with breakfast and one with dinner.” Many patients liked to double and triple check their instructions, so I was not surprised. I noticed his pills were for stomach problems.
“With which water?” he asked.
“Oregano,” I suggested, knowing that oregano tea was considered the best remedy for an upset stomach, “if you have it, or if not then with toronjil or cedrón or anise, any water is okay.”
“Anita!” called Joaquin, an interpreter we had hired to work with one of our doctors. “Jim has a patient with women’s problems.” Joaquin, indigenous himself and fluent in Kichwa as well as Spanish, cared about the patients and was sensitive to women’s modesty and reluctance to discuss female issues with him in the room. I bounded up the steep bank to the principal’s office, which Jim was using as an examining room. I translated for Jim as he asked a few questions, and then Molly brought in the patient’s pregnancy test results: positive, not at all what she was hoping for. Elena was nineteen and already had one child. Apparently, things weren’t going well with her husband and she was not excited to bear a second child. She hadn’t even mentioned the possibility of being pregnant, until Jim asked to make sure a prescription he had in mind would be okay.
After Elena left, eyes downcast and red, I reemerged on the sunny soccer field to the sight of the kids, out to recess, running madly up and down, kicking a tiny ball. Maria Juana was heading home with a bag of ibuprofen (she was healthy! Just had some pain in her back). She stopped to shake my hand, saying “yusul pagui.” God pay you. As we rode down in the van that afternoon, Jim related the story of one of his patients. The diagnosis was situational depression; what she needed was someone to talk to. She had talked to Joaquin for half an hour about her pain; her teenage adopted son had disappeared, perhaps to Colombia, and she wanted to make sure her younger daughter, also adopted, was healthy. Joaquin had related only the basics of the story to Jim, but both had watched her attentively as she spoke. Jim had examined the daughter, found her perfectly healthy, and told the mother she was doing a great job of caring for her. The mother spoke to Joaquin some more, reiterating her worries, and he noted her name and her son’s to see if he could help her by contacting immigration authorities about her son. She thanked Jim and Joaquin profusely, saying she hadn’t been able to tell anyone about her troubles before, and departed, her burdens at least a little bit lighter.
Sinking back in my seat, I felt a warmth in my eyes. This was the kind of medicine that touched me. I had sometimes wondered how it came to be that I, who had always been rather suspicious of medicine, was coordinating groups of volunteers and taking them out to Ecuadorian villages to practice it. My motives, I must confess, were more about intercultural interaction and education for the volunteers than medicine, when I began the program. I realized, though, that what bothered me was less about medicine itself and more about the power relations that are typically set up in the clinic and the bureaucratic structures that reinforce them. Here we were, listening to patients, sharing laughs with them, trying to respond to their needs, and asking only a 50-cents-per-family contribution for the medications we provided. Our volunteers were doing their best to learn the villagers’ languages, welcome them, play with the young ones, smile with the old ones. And many of the patients walked away with the means to improve their health.
That night, exhausted from the responsibilities of organizing the group’s work and activities, I closed my eyes. Maria Juana walking away from the school, trailing her wisp of grey hair, was the first vision that appeared.