Renate Mommsen is a 23 year old nurse and a member of the Woodcrest Community in Rifton, NY. She is working at a small hospital in the village of Yalve Sanga, located in the central part of the Paraguayan Chaco, a vast plain of scrubland and palm trees where temperatures soar as high as 122 degrees in the summer, and for much of the winter months a hot, searing north wind blows, driving sand and dust before it. As a result of these conditions life is very harsh and difficult for the indigenous people, who are also marginalized and impoverished. The hospital, staffed by one Mennonite doctor and several nurses (Paraguayan, Indigenous and Mennonite), serves twelve thousand indigenous people from nine different tribes.

The early reports are at the bottom of the page.

December 15

As I approached the hospital this morning, I was still enjoying the fresh and cool morning air. Outside the front door I stopped, hearing the sound of wailing coming from Victor's room. Only half an hour earlier, he had finished the final struggle between life and death.  Inside the hospital it was silent,  except for the sound of crying. Soon the doctor walked past me with a tear-stained face; he had sat by Victor´s side and accompanied him until he passed away. Many of the other nurses were also weeping quietly. Most of the night, and up until the last moment, Victor had suffered a lot of pain, which remained severe even with morphine and other analgesics.

We met at 3:00 this afternoon for the funeral in the Nivacle church in the center of Yalve Sanga. The small building was packed; I counted over 200 people, and many more sitting on the ground outside. Almost every single worker from the hospital was there, most of us still in our uniforms. Victor's family sat in front. He had two grown daughters and their husbands, his wife Elsa, and several granddaughters. His mother is also still living. Most of the service was in Nivaclé, interspersed with songs. All of us from the hospital sang several songs together as well. Victor had worked in the laboratory for 33 years.

After the final prayer, said standing, the open wooden coffin was placed outside on benches under the trees, so that everyone could go by and say a final goodbye. That was a moment I will never forget. The raw grief cut right to one's heart. Elsa was one of the first to say goodbye, although escorted on either side she almost couldn't walk because of her sorrow. The air was filled with loud wails and sobs as everyone filed past. There was a line of men quietly standing in front of the coffin because many of the women tried to hold on as they went past. Although it may seem foreign or disturbing to us from a western culture ( it was painful to hear and see), I believe that in this way the indigenous recognize the ugliness and reality of death and separation. It is not that they do not have hope in life after death, but neither do they turn away from experiencing the pain of losing a loved one. While the grave was being filled in we stood close together in the hot sun; it felt as if we were part of a big family.

Evelyn Arnold, a young sister visiting Paraguay for three months from our community in Rifton, NY has been working with me for the last several weeks, also helping with the care of Victor. She experienced this passing with me and writes:

"The desperate cries and weeping of Victor's mother, daughters and grand daughters will never leave me.  Never have I experienced such a painful, gripping, and so genuine a grief.  Victor's mother, a small woman whose weathered face reads that this is far from the first difficult time in her life, is escorted by two other women.  As she passes the rough wooden coffin she attempts to hold on tight, screaming in anguish.  She is not the only one who cannot pass silently by.  Peace I know will come later, but I can only respect, and be moved by, this stark expression of grief, and the defiance of death."

Back in the hospital, in the room next door to where Victor died, another struggle was taking place, this one for new life. How amazing to be able to participate in both the beginning and end of a life in the same day, to hold up the screaming, pink, newborn girl so that her mother could see her,  and smile and laugh together for the joy of a baby's safe birth.

December 13

Summer has arrived in full force! Riding on a motorbike to Belén last Saturday, we felt as if we had entered a drive-in convection oven. Scorching heat radiated from the sand on the road, and apart from decreasing the visibility a good deal, the hot wind covered us with a fine layer of grit, so much so that our skin felt like sand-paper. And sure enough, the thermometer read 45 C, or about 115 F, in the shade!! But for all that, because it´s dry heat, it´s not hard to tolerate, provided that one keeps drinking. The following day,  around 2 pm we felt a change in the direction of the wind, it was coming from the South. Within six hours it had dropped about 40 degrees, to 68 F by 8:00 in the evening. The Chaco lives up to its reputation for being a place of extremes!

December 10

Victor Martinez has worked in the Yalve Sanga hospital for more years than I have lived. He is a slightly stooped Nivaclé man in his mid-fifties and the first signs of gray have just started appearing in his longish, pitch black hair. Victor has mostly worked in the small hospital laboratory (the many hours hunched over a microscope are probably why he stoops), as well as manning our ancient, though good quality, X-ray machine.

During the time I have known Victor, he has always been amiable, but generally reserved. And woe to us nurses if we didn´t fill out an x-ray request form properly, or if we asked him to do a white blood cell count ten minutes before the work day ended. Then Victor´s reservation would melt away, and we would hear clearly what he thought of our thoughtlessness! But through good and bad days, every single member of the hospital has grown to love Victor and regard him as a grandfather-type figure.

About two months ago Victor stopped the doctor in the hall one afternoon, and quietly asked him if he could see him once in his consultory. He mentioned that he had not been feeling himself the last months, always being tired, no appetite, and lack of concentration and patience. The doctor was shocked at the sky-high results of the analysis of Victor´s kidney function - no one would have suspected, but Victor was in acute (and probably terminal) renal failure. The rest of us were stunned as well, but bit by bit people started remembering that they had seen things that had caught their attention. "Remember how he seemed to have less and less patience? It must have been because he was feeling rotten." or "Last week I went into the lab, and he had fallen asleep over his microscope." One nurse, Marlene, asked the anguished question, "But how could we, who are his compañeros , who are his family and fellow believers, how could we have not noticed that he was so sick?" It was a difficult, but important question.

The doctor arranged for specialists in Asuncion to see Victor as soon as possible. Their opinions were sobering, the only hope of prolonging his life would be ongoing dialysis, and possibly a kidney transplant later. And Victor's answer? A firm "no" to all of it, no to months and months spent in some distant hospital undergoing studies, and no to the stress of bumpy and nauseating rides several times a week to Filadelfia to receive dialysis. The doctor explained to him that, short of a miracle, the probable consequences of his decision would be that he did not have long to live.

Now I jump forward to the last weeks, to scenes that have stayed with me. Victor, gradually feeling worse, but asking to be taken outside the hospital to sit under the stars. He is in a wooden armchair, and his family, wife Elsi, children and grandchildren, sit around him in a circle. They sing, talk, laugh, and cry together, passing tereré around, sometimes until 10:30 or 11:00 pm. He would go home for the weekends, enjoying and using every minute that he has left to be with those around him, and to enjoy the beautiful Chaco at dawn. Every time I enter the room he gives a warm and happy smile of recognition, and shakes my hand.

Last week Victor suddenly experienced an overwhelming fear of death, and asked to be readmitted to the hospital. He was breathing rapidly and agitatedly fought the nurse, Eveyln, who tried to take his vital signs. At the end of that morning he called the doctor and Evelyn into his room, and under tears asked Evelyn for her forgiveness for how he had treated her, which she readily gave.

Since that moment it has been a privilege to try to stand by Victor and his family. His room is packed every night with relatives, friends, and many children. They read together from the Bible in Nivaclé and sing, accompanied by guitars. Yet Victor has to fight hourly with fears of dying and death. Some days he asks those of us on duty to sit by him and not leave. At other times he fights sleep, although he is exhausted, saying he is afraid that if he falls asleep he will never wake up.

Last night, on my night shift, Victor woke up at 2:00 am because his lungs are slowly filling up with fluid and he was having difficulty breathing. We administered morphine and then Leonardo, the Nivaclé nurse on duty with me, read the 23rd Psalm. There could have been no better words to describe what Victor was experiencing, "Yea even though I walk through the valley of the shadow of death I will fear no evil..." We said a prayer together, and Victor slept the rest of the night, his wife Elsi close to his side. For the last two nights of my shift, I pray that I may be able to stand by Victor´s and Elsi's side, and to show them love in whatever way I can.

November 13

We moved Elsi to a private room today. She doesn´t talk or open her eyes anymore, or sit up. Now  it has been four days since she arrived. To be honest, when I came to work this afternoon I almost felt a certain sort of repugnance, and found it really hard to go into Elsi´s room. I know for the other nurses it's the same. It´s simply hard to see and hear someone who could be your own mother or grandmother dying alone, and though I wish I could be more by her side, we have other patients that also need care. Some people have a long and hard road to travel.

Nevertheless, when there is a lull in our work, I pull up a chair by her bed, and take her small, calloused hand in mind. Each time she takes a breath, there is an ugly, rattling sound in her throat, and her mouth and lips are so dry. As I watch her brown and creased face, now swollen and disfigured, fighting her last great fight, the words of the Salvadoran archbishop Oscar Romero came into my mind:

Advent should admonish us to discover
in each brother or sister that we greet,
in each friend whose hand we shake,
in each beggar who asks for bread,
in each worker who wants to use the right to join a union,
in each peasant who looks for work in the coffee groves,
the face of Christ.
Then it would not be possible to rob them, to cheat them, to deny them their rights.
They are Christ,
and whatever is done to them
Christ will take as done to himself.
This is what Advent is:
Christ living among us.
-Oscar Romero, December 3, 1978

Suddenly I am once again overwhelmed by what a privilege it is to live and work here in the Paraguayan Chaco, among people like Elsi, and so many like her. Though despised and rejected by society, they point us towards God, and cause us to remember His immense love for each one "made in His image", and perhaps His especial love for  the poor and humble.

November 11

Two days later and Elsi keeps fighting for life, and it is definitely a fight. Since she has come to the hospital in Yalve Sanga she has been alone, without family members for support or help. Speaking no Spanish, she communicates with the Enlhet nurses translating, and sometimes with the few word of Enlhet that I know. She never complains, though I don´t see how she is not in pain with all the effort it takes for her to breathe. It will always be an image in my mind, her small form hunched over, cross-legged in the hospital bed, her silvery black hair falling around her face. She changes position often in a struggle for more air, sometimes half kneeling, half crouching.

Today when I walked into her room though, Elsi was feeling better, not gasping as much, her face less swollen, and she even gave me a beautiful smile. Did she have pain? No, a strong shake of her head as if to say, stop asking me the same question so much. For supper she ate a few spoonfuls of yogurt. Elena, her Enlhet roommate, told me how Elsi kept her cross-legged vigil all night long, singing sometimes or whistling. She talked about her house, how pretty it is.

But Elsi is dying, and it´s an agonizing, drawn out death. I sometimes wonder if she knows that she is not going to get better. After supper she grew more agitated and removed her oxygen mask, saying that it gave her a headache. Her suffering is painful to see. Before we went home today, Regina and I, together with Elena, said a prayer around Elsi's bed. Her eyes were shut, and her labored breathing audible throughout the hospital.

November 9

It´s Tuesday evening in Yalve Sanga hospital. The work load has thankfully lessened over the weekend, also with the end of the elections and political campaigns. Regina, my Nivaclé coworker and I are relaxing, drinking tereré and laughing about some of the funny happenings of the day. However we´re soon interrupted by the cell phone, which we use to communicate with the clinics in the different communities. It´s Revelino, the health promoter from Pozo Amarillo. He is calling from the house of a patient, 74 year old Elsi, and is hoping for advice and suggestions for what to do. Elsi has been sick for a few days with a cold, and now is having more difficulty breathing, and her face and extremities look swollen to him. I scribble down what he tells me on the back of an envelope, then suggest that he take Elsi to the Pozo Amarillo clinic for closer observation, and to let us know if she gets worse. As Revelino hangs up I can tell he´s not very happy. But it is sometimes very hard to differentiate over the phone which patients need more intensive care, or whether it´s a matter of more time, or perhaps that the health promoter doesn't feel like spending a night on call in the clinic. However, I feel uncomfortable about this patient, so after checking with the doctor, we send the ambulance out to fetch her.

When the ambulance returns an hour and a half later I'm thankful that we didn´t delay in sending it. Pulling open the door, we find a diminutive little woman curled up in fetal position on the stretcher. She is gasping for breath. Regina carries Elsi from the stretcher to the wheelchair like a child,  as Elsi´s body is so small and light. Once inside the hospital, it is evident she hasn´t bathed, or possibly eaten or had a drink for days. The skin under her fingernails and around her mouth is blue, and her eyelids and face are so swollen that she can´t shut her eyes. Soon the doctor arrives on his motorbike to help and direct us. By the time I leave she has clearly stabilized, but I wonder if I will see her alive the next day.

Friday, November 5

It´s regional election time in Paraguay, and we´ve gotten a glimpse of the slightly absurd and almost laughable electoral process here, as the big day approaches. It´s well known that the indigenous vote strongly affects the outcome, so the politicians have been extremely busy and active the last weeks with philanthropic works in the indigenous communities. At all hours of the days and nights vehicles from the different political parties have rolled into the hospital, almost in competition to see who can bring more indigenous patients. "The patient doesn´t have insurance?" No problem, crisp bills are doled out by the smiling politicians to cover whatever expenses may accumulate.

Biking through the indigenous communities, we saw how in every cluster of houses the politicians had left big sacks of pasta, rice, oil, meat, and other ingredients so that the neighbors could have a "fiesta"  in honor of the candidates, whose names were plastered on signs and stickers everywhere around the villages. Some of our friends motioned for us to come and join them. "We know that on Monday after the election the politicians are going to forget about us again, but at least we get a free meal out of the deal," they told us wryly. In many voting sites the parties also sponsor free meals and in some cases alcohol for those who have voted. Other friends told us of how people openly buy up national photo ID cards on the side of the street, then take the cards to register and vote with. Through it all, most Paraguayans we know seem to accept the openly corrupt electoral process with some humor, knowing that afterwards things will probably stay much the same.

 

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