Thursday August 26 2010

The funeral is scheduled  to begin at nine o´clock, so we have little time to finish the necessary preparations.  A simple wooden casket is brought, painted a light sea green.  A Mennonite nurse and her husband arrived from nearby Neuland colony. She used to work in Campo Alegre and they brought flowers and then helped us to arrange everything.  The casket was loaded onto the back of their pickup truck.  I climbed up behind Sara on the motorbike and the truck followed us to the church.

As we parked outside the building I could hear the mourning.  Inside the church many women were sitting on the floor, wailing and sobbing, rocking back and forth some with towels or T-shirts flung over their faces.  As the casket was carried in the sound crescendos and Sara clung to my arm, propelling me to a bench five rows back.  Her eyes were red and I am crying too.  Grief, almost to the point of despair seemed to surround us. 

The service began, but since it was given in Nivaclé I mostly heard the weeping around me.  More and more people streamed in to the church, some of the women almost fainting.  I felt exhausted by all this grief - won't somebody read some words of comfort? 

Sara noticed a mother entering with a small baby  and went to take the baby from her arms.  Moments later, she passed him to me and whispers that she needs to go and find her daughter.  I nod and gratefully take the little boy into my arms.  He stretches and wrinkles his forehead in his sleep, but doesn´t wake up. 

As the service continued I began to hear more than just the crying around me.  Virginia´s father spoke, and even though I could not understand all he said, I could feel somehow that he was at peace. 

The baby lying in my lap began to kick and then woke up.  Immediately I noticed why, and since he was not wearing diapers I had to use packs of tissues.  I was glad that I had four.  He gazed up at me happily and I was comforted.

A number of the nurses along with the doctor from Yalve Sanga travelled down to attend the funeral.  The doctor was asked to say something, and spoke of consolation and faith in God´s greater plan for each person.  Virginia studied nursing and worked for a dozen years in the hospital at Yalve Sanga as well as here in Campo Alegre before she quit due to her poor health.  She was obviously well known and loved by many people.  

This afternoon Bricelda, Sara, José and I were sitting together behind the clinic during break, drinking tereré and relaxing after the stress of the last days.  A man appeared, a dirty rag wrapped around one finger as a crude bandage, and as he approached, he calmly produced a bloody plastic bag from his pocket, explaining in  Nivaclé that it contained his fingertip.  José quickly ushered him inside.  Apparently the chair he was using collapsed, claiming the tip of his finger, which he had carefully retrieved and brought along with him.  Needless to say, the severed member could not be salvaged, but the way in which the patient had come, with no apparent pain and presenting his finger as if it were a broken part in need of a repair, was very surprising and in a way humorous.

Patients always come during tereré break, and you never know what to expect!

Wednesday August 25 2010

This morning José and I were doing consultations.  The others had gone out to one of the villages, so it was just the two of us.  The previous night he had been called to Colony Three, so he had been quite busy going back and forth between the house of the patient and the clinic.  A middle aged woman had apparently fainted, but then recovered and declared herself fine after receiving an injection. 

Most of the patients today had complaints of coughs and flu-like symptoms.  Suddenly a motorbike roared into the drive and José went to see who was in such a rush.  It was Virginia´s father, who had come because she was not doing well, so José left with him.  Just as I was wondering what to do next, since none of the patients waiting could speak or understand enough Spanish for me to communicate on any more than a basic level, José returned. 

     “She´s gone,” he said as he walked in.

     “What?” I exclaimed.

     “Virginia´s gone.” I stared at him.  How was it possible?  So fast?  He too was shaking his head in disbelief.  By the time he had arrived it was already too late.  He pulled out her chart.  It was a thick wad, one of the largest medical histories I have seen here, and she was only thirty eight years old. 

For the rest of the morning nobody came for consultations.  We stayed in the clinic, since all of the others were relatives of Virginia and had gone home.  That afternoon her body was brought to the clinic and I realized that even after death, the healthcare personnel here were expected to care for physical needs.  The funeral would take place the following morning. 

Monday August 23 2010

I´m back in Campo Alegre for the last week of work before the fourth semester begins.  Marilina is also back and has been interned once again in the clinic.  I spent a good part of the morning checking in on her and the baby who has not been named yet, a common practice here.  Luisa has stationed herself with the baby on a blanket on the floor next to Marilina's bed.  They are all clearly still recovering and sometimes when I enter the room Marilina is lying on her bed crying. She understands very little Spanish, but what would I say to her anyhow?  So I just sit by her and wipe the tears from her eyes and the sweat from her forehead with a damp cloth.  I feel so helpless.  Nobody should have to become a mother at the age of fourteen. 

Later during the night Bricelda and I are woken by loud sobs and cries.  We rush over to her room.  Whenever she lies down to sleep she seems to experience pain and begins to panic.  I wonder if more than anything it is fear that what she went through on Wednesday could happen again. 

Eventually she regains her composure and by dawn when I administer her medications she is smiling and peacefully sitting on the edge of her bed.  We decide to send her home later that morning.  She will stay at her grandfather's house nearby and we will visit her during the next days.

Saturday August 21 2010

I keep thinking about Marilina, praying that she and her baby are ok.  This weekend I am staying in Yalve Sanga and someone tells me that she is in the hospital here, recovering from surgery.  Both mother and baby are doing quite well.  I can´t think of more wonderful news! 

This afternoon I went to visit them and as I walked into the room, Marilina gave me a shy smile of recognition.  Her mother Luisa was there too and beamed as I shook her hand.  There on the bed sleeping peacefully was a robust baby girl.  Stroking her soft, black hair I could only think, what a miracle!

Wednesday August 18, 2010

I wasn't sleeping well, getting up every once in a while to check on Aurelia, or being woken by her coughing.  At the sound of a large vehicle pulling up to the clinic I jerked awake.  My alarm clock read 4:50 am and somebody was already pounding insistently on the front door.  Bricelda was already on her feet and hurried to open it.  A few seconds later I stepped out of our room.  Two men were carrying a young pregnant woman in from the trailer of a flatbed truck.  She appeared to be unconscious.  I raced to help them, and we half lifted, half dragged her onto the hospital bed.  I was filled with dread as I recognized the girl. 

Marilina looks older than her fourteen years.  I had seen her twice before, once when Sara and I visited her at her house and the second time just over a week ago when she came in for a prenatal control. 

I grabbed a stethoscope and blood pressure cuff, and the results confirmed what I had feared.  Her blood pressure was incredibly high.  As Bricelda phoned for help I searched for a fetal heartbeat without success.  At the foot of the bed an older woman stood quietly watching me.  Marilina's mother.  Marilina's breath was already coming in grunts and I fought down my panic - no time for that.  I leaned over her and called her name, not sure if she would even respond any more, but she turned her head towards me.  Help is coming I told her, but her eyes were already rolled back.  Inside I was crying and I prayed that the nurse would arrive soon. 

It must have taken only minutes for Sara (the nurse) to arrive, but those minutes dragged by.  Apparently Marilina´s symptoms had begun around four o´clock.  I groaned inwardly,  for so long she had been like this?  But immediately I could imagine the scene.   Marilina lives out in Colony 1, five to seven kilometers away.  By the time someone from her house would have gone to wake up one of the truck drivers, load her on to the high truck bed and bring her here to the clinic an hour easily would have passed. 

Finally Sara arrived.  As we worked to install an IV line, Marilina began to go into convulsions despite the medications we had already administered.  All we could do was make sure she could breathe and didn´t hurt herself or fall off the bed--and pray.  As her body gradually stopped shaking we quickly continued.
An ambulance was already on the way, sent by the hospital in Yalve Sanga, but that would take at least half an hour to arrive since there were 50 to 60 kilometers of dirt roads between us. 

What a relief when it came!  Marilina had finally stopped convulsing, but was unconscious and in great danger.  As the ambulance drove off Sara looked at me, smiled and asked me if I was OK.  It was just past six, so at her suggestion we took some chairs outside to drink tereré as the day dawned.

Tuesday August 17, 2010

Today we interned a patient in the clinic for the first time since I've been working here.  Aurelia is a young woman in her late thirties, mother of four and lives just across the road from the entrance to the clinic.  She has a reputation for taking advantage of this position and arriving for consultations at any time except during the hours posted on the clinic door.  However, this time she really does need attention, as it is the third day in a row that she's come and the treatment she started on doesn´t seem to be improving her condition at all.  Hugging her abdomen and moaning, she shuffles in and sits down. 
Half an hour later after drinking almost one liter of water and starting stronger medications she has calmed down.  We will keep her here in the clinic for a few days for observation and to make sure she is taking her meds correctly.

Saturday July 24, 2010

For the past two weeks I have been living and working in the indigenous Nivaclé community of Campo Alegre, far from the clutches of computers, e-mail and the likes!  Even cell phone coverage is patchy and the clinic has its own antenna to ensure that calls can be made for work and emergency situations.

Before our fourth semester begins each of us students is required to work for seven weeks in the clinic and health program of their own community. So at the moment I'm teaming up with Bricelda who is of the Nivaclé ethnic group.  We have been given an extra room in the clinic, where we sleep on mattresses on the floor.  The clinic is probably the most modern in the area, built less than two years ago and complete with running water, inside facilities and a few AC units.

The staff includes a total of five people plus ourselves. Santa is a middle aged Nivaclé woman who has been working in the field of healthcare for upwards of twenty years.  José is younger, probably in his thirties, and also has a lot of experience working as a nurse and community healthcare worker here.  Cintia has had no formal training as a nurse but helps with clinics, home visits to patients, cleaning and so on.  The secretarial work is the responsibility of Zebedeo who also helps us out with the various clinics, documenting the patients we see and running errands. Finally Pedro, a nurse from the nearby Mennonite colony of Neuland, comes in a few times a week.

Campo Alegre is a sizeable community, the biggest in the program, with a population of 1,870 in ten different villages or "colonias", the farthest at a distance of 10 to 15 km from the center.  In addition there is the community of Laguna Verde a good 18 km away, which is an offshoot of Campo Alegre. A good deal of our time is spent traveling back and forth between the central clinic and the other villages, visiting patients, providing consultations, administering vaccinations and holding infant clinics in each village once a month, as well as other activities such as education in public health.  Our means of transport is by motorbike and so all supplies are hauled along in backpacks.  Bumping over kilometers of dirt roads soon leaves one covered in fine dust, and I have gained a new respect for all the women here whom I often see washing out their family's clothing by hand in five gallon buckets or big washtubs. With the scarcity of water and the dusty environment, all clothing quickly becomes grimy and, as I have found out for myself, it is no small task to get it clean again!

The weather has been very cold over the past weeks with a biting south wind, overcast and  often drizzling skies.  With temperatures dipping into the low forties (fahrenheit) it feels awfully cold-when you are used to 90 F heat.  For most of the day I feel cold, but as we drive by so many houses each day made of boards, plastic, and mud brick walls, the windows stuffed with old T-shirts and bits of wood or plastic, I have to think of where I get to sleep each night and I feel ashamed of my complaints.

One of the activities which I enjoy the most is home visits to patients and the visits we do to interview different families as part of an assignment.  Mostly the people are delighted to have a visit and pull up their best chairs for us: a well worn wooden stool, a stump, some bricks, or an old lawn chair held together more often than not with bits of wire or twine.  There is always a small fire or glowing coals to warm ourselves, and a number of the family are present as well as the dogs, and occasionally a cat, all huddled as close as possible to the warmth. Of course they always want to know where I am from, and seem to be happy to know that I will be here for a number of weeks.

Thursday July 22

Today was the date set for the annual "spiritual retreat" for all the healthcare personnel from the Yalve Sanga hospital and from the outlying clinics in the program. It is an all day event and the theme this year is "The love of Christ." Travel logistics always loom large for an occasion such as this where distances are great, dirt roads are often impassable due to the weather and many people do not have personal vehicles. In the end, a 25 foot flat bed truck was hired for ten of us from three different clinics - Casuarina, Campo Alegre, and Campo Largo.

We arrived late, due to delays because of a patient in serious condition in Campo Largo. When we finally pulled in at 9:30 am, chilled from the long ride, everyone was already waiting, most sipping mate and munching cake.

After singing together, prayers, and a sermon, the pastor gave time for anyone who wished to share their personal experience, testimony, or a Bible passage. After a silence, Rudi, the health promoter from the village Nicha Toyish rose, a strikingly tall Nivaclé man who is the sole healthcare worker in his relatively large community. The rest of us soon were attentive as he began to speak. He began by saying that at similar events he had hidden his true feelings, but he can't be silent longer. He told of how for years he has been involved in the healthcare of his community, but how his heart was hardened to the need of the patients who came to him. He spoke of sending a woman in labor away who had come to give birth in the clinic because she didn't have health insurance. (Required by the regulations of the program here in order for any patient to receive care). In this instance, he said, it was as if he couldn't have feelings of empathy or pity when the woman broke down in tears, pleading for him to help her. Another time a father brought in his young son whose arm had been burnt badly and the child was screaming from pain. Rudi said he had refused to treat the boy until the father brought him the correct paperwork. Once again, he said, it was as if he couldn't hear the child crying.

Rudi spoke all this, and more, with such honesty, not trying to maintain his image, or soften what he had done. I was amazed, as were many of my coworkers. Rudi, of all people, had reason to complain. Just last year he had been blamed by many in his community for the death of a four year old child who had been brought to the clinic when it was too late, severely dehydrated from diarrhea. The child had died in the ambulance while being brought to the Yalve Sanga. Hospital. Upon hearing this, the relatives gathered an angry mob to try to destroy the clinic, beating Rudi up in the process. And in the hospital I had heard more than once how the people from Nicha Toyich are known for being hard-headed and difficult to work with.

Rudi went on to say that for years his beliefs and work have been like a T-shirt with a nice design: they looked good from the outside, but it wasn't what was inside of him. Then, through talking with an older man, he began to realize this and have a change of heart, recognizing how he had been living. He began to find new purpose in his work and life, beginning each day trying to reflect God's love to the patients who came for help. He read to us from Mark 4:21-23 where it speaks of lighting a lamp and placing it on a stand so that the surroundings are illuminated. Each day that is his fight, to find the love of Christ for the people he meets.

I was touched and challenged. The outward situation for Rudi has not changed much. Besides having to make many difficult decisions alone, he still has to deal with patients who refuse to or cannot pay, abuse the clinic's services, or are not appreciative. But surely, the change of heart that Rudi has experienced will continue to touch other hearts. He ended with expressing the hope that by sharing his story, it would be an encouragement to all of us, his compañeros, many of whom also must feel very alone and isolated sometimes.

While I listened, I couldn't help but be reminded of a similar experience last year. It had been Antonio's turn (also a Nivaclé nurse) to bring the weekly devotional to the hospital staff, administrator, secretaries, cleaning ladies, nurses, doctor etc. A quiet man who loves playing accordion and guitar, Antonio has almost 30 years of experience in the hospital. The Christmas season was nearing and he had picked out the text from the Gospel of the angel's annunciation to the shepherds. He had led us in singing some Christmas songs, playing his guitar as usual. Before picking up his Bible, he spoke "I believe we can only receive the message of the angels and of Christmas if our hearts are open and ready. I want to ask forgiveness of all my compañeros and compañeras where I have been short with you, where I've thought I've known better, or where I haven't loved enough." Again, such heart felt honesty and vulnerability, without anyone asking or prompting him to speak.

As I think of these two experiences, I can only say that one felt God's spirit close as these men dared to confess their failures to all of us, witnessing to God working in their hearts and lives.

Wednesday May 19, 2010

During the month of May I have been working in the public health department of the hospital. Within the past two weeks we have visited twice a young man at his house in one of the nearbye Nivacle villages. He is the father of five beautiful children, as we approach the house they run out behind him, almost all of them are barefoot. A handful of pitifully thin emaciated puppies tumble at their feet. I try not to stare at the shack they have for a home. It is unbelievably tiny, and I find it hard to imagine how seven people can find space to live inside, let alone sleep.
Manuel is 34 years old, and for a while the nurses have been trying to pursuade him to accept help. His health is so poor that the neighbors who hear him coughing have asked the nurses a number of times to intervene. Attempts have been made in the past, but Manuel has apparently rejected them, so we are relieved when he finally accepts that we test him for tuberculosis. As one of the Nivacle students explains to him the procedure, a gaunt, sad-looking woman, Manuel's wife, comes out of the house. She must be in her 30s as well, but  hard life has worn her down and she is prematurely aged. I hope that we can help her husband recover. (See more on Manuel from Renate)

Friday April 23, 2010

This afternoon Dolly and I were scheduled to go out to La Esperanza to continue with home visits for community health education in tuberculosis. Rain was in the forecast so we left early in a large four wheel drive pickup truck driven by the director of our course. She wanted to see us in action, so she was taking Vedelina, another student from Pozo Amarillo, as well as us and we would make rounds in both communities.

We had scheduled visits in two different houses. At the first location there were a lot of people, I suppose three or four families with many children. We had their interest until a fruit vender drove up, bullhorn blaring ¨Llegando, llegando, manzana, naranja, banana, pomelo...¨ (Arriving, arriving, apples, oranges, banana, grapefruit...) Oh well. After that the attention was somewhat divided! The second place was a low building, a hut really, situated at the end of an old road overgrown with weeds and high grass. As we pulled up two skinny dogs ran out to meet us, but not a soul was in sight. Dolly and I got out and called, but nobody answered. Our truck dwarfed the shack in front of us, made mostly of old boards and plastic with a corrugated iron roof. We decided to try our luck at the other houses we had passed on the way in, with the idea of spontaneously offering our presentation. Backtracking to the first one we were directed further on by the sole inhabitant at home that afternoon.

It was a small house made mostly of boards and bits of plastic, even worseoff than the other. But the man of the house was drunk, lying in a hammock loudly talking to no one in particular. All around him children played, kicking a soccer ball back and forth. They seemed to ignore him, or were they just used to it?

We continued past a sesame field partially cut already, the drying stalks tied up in teepee formation. We could see two people out there and on a sudden inspiration we stopped and got out to go see. The incredulous expressions on their faces as we advanced towards them caused us to break into laughter. Yes, we must have been quite a sight with our folders, the director in nice shoes walking through the field. After a good laugh together they reluctantly rejected our offer of a presentation in the sesame field. After all they had work to do.

After trying another house with no luck we returned home. So, health promotion is not always what it seems!

Wednesday April 14, 2010

Each morning first thing all the nursing staff go on rounds with the doctor to see the patients one by one. Yesterday another baby was born and both mother and daughter are doing well. As we walk into the room, it is the grandmother that is holding the baby and she is bubbling over with pride. After the doctor checks over both patients, they are given permission to return home that afternoon if all continues well. As the other nurses file out of the room I hang back to enjoy the baby, thick black hair and screaming with indignation at the disturbance of her slumber, but she calms down once she's in her grandmother's arms again. Her grandmother glances up at me and declares with an enormous smile ¨Lindo!¨—Beautiful.

Monday April 12, 2010

For the month of April I have been assigned to the hospital ward as my area of work experience along with one of my classmates. There are lots of “firsts” this year as we apply the theory of all the procedures we learned in the classroom. First injections, first installation of an IV line and so on.

This week we've had a lot of children interned for various respiratory infections. Autumn is definitely here and as the weather continues to grow colder, I'm sure we will see many more. One of my patients is a two and a half year old boy from a nearby Enlhet village. Bernardo is tiny for his age and weighs less than twenty pounds. He was brought in for malnutrition, pneumonia and problems with his vision, but seems to be gaining ground, eating everything that comes his way and growing more mischievous. Whenever we examine him he stares and stares at us in fascination. His mother has to constantly watch that he doesn't yank out his IV line as he clambers about on the big hospital bed. The latest attempt to draw attention to himself includes throwing the toys he's been given as occupation onto the floor. This makes an impressive clatter which makes everybody look!

Thursday April 8, 2010

Today we had an interesting class with a biochemist Dr. Sawatsky who works in the hospital laboratory of one of the nearby Mennonite colonies. He came to teach our class how to take a smear of a sputum sample of a person with suspected tuberculosis. As a diagnostic tool, microscopic examination of three sputum samples is by far the cheapest and most reliable method. However, in most, if not all, of the communities where we will be working, hospital labs are far away, so health workers in the field need to know how to prepare the microscope slides themselves, which can then be sent to the nearest lab for studies. Dr. Sawatsky has taught in many different courses over the years and clearly knows the realities of so many Chaqueñan communities. He showed us low cost, simple ways of creating the basic equipment necessary in place of buying expensive lab instruments.

Thursday March 25, 2010

It is just one month since I am back in the Chaco—back to begin the second year of a three-year health promotion and nursing training at Centro de Salud Yalve Sanga, a small hospital that was founded especially to serve the indigenous people of this area of Paraguay. It is located some ten kilometers from the Trans-Chaco Highway, which cuts through this isolated western region of the country. The hospital of Yalve Sanga serves approximately 12,000 people living in dozen indigenous communities that lie within fifty to seventy kilometers of the hospital. These people are from two main ethnic groups, the Enlhet and Nivaclé, as well as others from the southern Enlhet tribe, Sanapaná, the Toba and various other Guaraní tribes.

We are thirteen students of five different ethnicities. Classes are given in Spanish, the common language of all. But during our work experience each student often uses her mother tongue to communicate with the patients. Often I find myself asking the other students for help, since I have not learned more than a few words or phrases of Enlhet and Nivaclé.

Each month students are assigned to a different area of the hospital where we work three mornings a week. This month I have been assigned to the pharmacy/dispensary. Another student works at the front desk, assisting the secretary as receptionist, and a third helps to admit people one by one, finding their chart, taking vital signs and referring them for consultation. That may sound tame but here, where the population of any given village is fairly mobile, it is often a real puzzle to figure out where a patient is from originally in order to locate his or her chart.

A fourth student learns the ropes of basic consultation with the indigenous nurses as they interview the patients, whenever possible in their own language. Two others work the morning shift on the ward and another works in emergency, seeing anything from the results of a kick from a cow to spider bites. But most frequently they deal with things like daily dressing changes. The remaining six students work in the public health department carrying out various campaigns, vaccinating children in the villages, home visits to patients, and preparation and presentation of educational materials on health.

One of my classes this year is on tuberculosis control—an important subject and a big problem in Paraguay, particularly in the Chaco. A big part of learning about the disease is the emphasis put on teaching the people themselves the basics of what signs to look for, how the disease spreads, prevention, and the fact that tuberculosis can be cured. To put this into practice each student travels back to their home community weekly to visit and teach their own people.

Dolly is one of my classmates who originally comes from a distant Guaraní community along the Pilcomayo River bordering Argentina. She and I have been assigned a community about forty-five kilometers from Yalve Sanga. The indigenous community of La Esperanza is relatively small and home to around 440 people of the Sanapaná. Most of them speak some Guaraní, so I guess that's the next thing I should study. Needless to say, Dolly does most of the talking!

On Friday, March 20 we arrived in La Esperanza around 5:30 p.m. after more than an hour's drive and after dropping off one of the other students in the nearby settlement of Pozo Amarillo. The driver surveyed the clouds that were building in the sky and told us cheerfully that if it rained we could count on staying here for a week. In the Chaco most roads are unpaved so during the rainy season, which is now, entire communities can be left completely inaccessible for days, even weeks after a downpour. However, it also seems that until it actually begins to rain, a buildup of clouds means nothing and frequently the storms are localized.

We were met by the nurse, a cheerful Paraguayan who has lived and worked at this clinic for over three years now with her husband and small daughter. Gloria is responsible for the healthcare of La Esperanza and its neighboring community La Anaconda. The populations of both are of the Sanapaná. As of now there are no other health workers from these communities that work with her, although she receives support from the hospital at Yalve Sanga. Conditions at the clinic are primitive. Dolly and I are given a room at the back where Gloria and her husband Ramón also have their simple living quarters. Once the building must have had running water, judging from the faucets, shower, and sinks, but now all water has to be hauled up from the underground cistern which is storage for all the collected rain water. We bathe by dipping water out of a basin, and use an outhouse. That is common here since most people cannot afford the high water usage of modern toilets.

After organizing ourselves for the following morning, Gloria serves us a delicious meal of rice salad and Paraguayan tortillas. Then it's bedtime. With the sunset and the darkening sky, the thousands of insects of the Chaco night are attracted by the lights in the house. The screens are old and not as bug-proof as they once must have been, so we turn off the lights in order not to have too much unwanted company.

The following day Dolly and I leave the clinic at eight am. The morning is cool and it is beautiful to walk along the sandy roads. The fields of sesame, the local cash crop, are in full bloom; the small white trumpet blossoms attract many yellow and white butterflies as well as bees. I hope that this year there will be enough rain to produce a good crop, as last year was too dry. We visit two different family groups to give the first part of a series of talks on tuberculosis. The second group we visit is especially striking. We walk through a field to an island of trees. At the center is the family dwelling. The bench seat of some long-gone vehicle is propped up outside the front of the house under an old tarpaulin strung up on ropes. This is the living room sofa. The sandy ground has been swept clean; in fact the whole patio under the trees has received the same care. We are warmly welcomed by Don Pedro, his wife Margarita, and their daughter Rosa. Although nobody else comes to our lecture, we spend two hours together, mostly just enjoying each other's company. They tell me that I should learn Guaraní, and laugh when they notice the few things that I do understand. Finally, it is noon and we head back to the clinic. It has not rained, and I'm looking forward to my next visit.

 

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Responses

Reading this account of clinic life in Paraguay makes me realize how much we take for granted as public health providers and as patients here in the States.  Sometimes comparisons are made between private health offices and our public health dept. and we think we're not operating on the cutting-edge, but the reality is that we have so much to be grateful for.  I would like to have the opportunity to work in a clinic such as this --I imagine the patients are very thankful for the health care that is provided there.  This is not always the case in our culture, unfortunately.

kate jocelyn
hendersonville NC