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.

August 29

This morning at 6:10, after a hard night, Evelina gave birth to her second child, a boy weighing 4.8 kilos. He had been long anticipated, her first son is already eight years old. Evelina's mother is called Elena and is well known and loved as a health worker in the local Enlhet communities. Although she doesn´t have a formal training, she accomplishes more for her community than many, without being paid. She is always on hand to translate for patients who don't speak Spanish, spend the night with someone without family members, or wash out dirty linen. She often braves the heat of the day, or the empty roads at night, to bike the three or so miles to the hospital to request an ambulance for a sick neighbor.

All the more I was happy to be able to assist in the birth of her grandchild, and then horrified as suddenly things took a turn for the worse and the birth became extremely difficult; we could no longer hear the baby's heart beat. After delivery the baby lay without breathing, his body a whitish color. I could only watch and pray as the doctor and another nurse, sweat pouring down their faces, worked to resuscitate the little life. Once again the lack of access to more advanced medical care became cold reality it was just our best efforts and prayer to save the baby's life. After ten minutes there was still no improvement and I thought the baby had died. But the doctor kept working, he could still hear a heart beat. Finally, twenty minutes after the baby was born, he took his first spontaneous breath. I think everyone in the room wept for joy, though we still weren't out of the woods. We gave thanks to God for answered prayers.

August 18

Last night on night shift there was a power outage for 2 hours, from 11:30 pm to 1:30 am. Luckily none of the patients in the hospital were seriously ill, so in between making our rounds with flashlights, we sat in the dark trying not to fall asleep. Unsuccessfully. I had just dozed off when the phone rang. It was a woman promoter from Paz del Chaco, calling for help. She had a patient who was hemorrhaging, and she asked if we could send the ambulance and assistance. Paz del Chaco is the most distant indigenous community in our hospital's program, at 80 kilometers away. I called the ambulance driver, a young Mennonite, and quickly packed everything I thought we´d need: saline, equipment for IV placement, medications etc, and last but not least, a flashlight in case the power outage kept going.

Soon we were bumping along the dirt roads into the night, I was guessing it would take about an hour to get there. Meanwhile they were trying to arrange to take the patient to a place where we could find her. The only available vehicle was a tractor.

Suddenly we heard a grating sound, the back wheel had been punctured. We were in the middle of nowhere, about halfway between the hospital and our patient. Fortunately there was cell phone signal so we could call the doctor to arrange for another nurse who lives close by to travel out and offer first aid to the patient. Meanwhile the ambulance driver and I spent a frustrating hour trying to change the tire. As luck would have it he was new and didn't know where any of the tools were, or how to access the spare tire.

The end of the story is that we met up with the patient and the other nurse at a half way point, and the woman was safely brought to Yalve Sanga, but it reminded me of how far away, and sometimes inaccessible, help is for many of the indigenous people.

August 4

This morning I wanted to go to a friend's house to drink mate with her, but she wasn't home. I decided to continue biking until the end of the road; it is a section of Yalve Sanga where many Nivaclé families live. Finally, on the porch of the last house, I spied some signs of life -  a group of four sharing tereré in a circle. Although I didn't really know them, they invited me to join them - Marcos, his wife, and two other Nivacle women.

They told me they had just been discussing how they could reach out and help the needy and poorest in the surrounding Nivaclé villages, especially in the cold weather. Marcos said, "In our church we´ve been thinking how the Gospel tells us to help our neighbors. This Thursday we want to send out a truck to pick up all the orphans, widows, widowers and old folks and bring them to our church. Then we want to cook up a meal and share it together."

I asked how they were planning to fund it. Sandra, Marcos´wife, told me that the food basics - oil, rice and galletas, were part of a donation they had recieved, but they still weren't sure how thy were going to cover the rest. They needed to hire the truck and they wanted to buy vegetables and a bit of meat to compliment the meal. Every Thursday afternoon a goup of women get together in the church to sew bags and knapsacks on an old treadle sewing machine, which they then sell. The proceeds are then used for projects like this.

Their enthusiasm and motivation for how they could show more love to their neighbors was inspiring to see and hear, especially since none of them are well off themselves. Unfortunately I couldn´t participate because of my work schedule, but the next afternoon, after the event, one of the women came past our house especially to tell us what a great time everyone had had, over 100 people had come.

July 19

Today I attended an indigenous funeral for the first time. After days of cold the sun came out this afternoon, making it pleasant to walk out to the Enlhet community of Belén with two other nurses from the public health department of the hospital. After entering the cool darkness of the church, we sat on wooden benches facing the front where the closed wood coffin rested, next to it a burlap sack which contained Sara's clothing and other possessions, to be buried with her. Slowly more people trickled into the church, but not many, and most of the benches remained empty.

Though she herself did not know the year of her birth, we assumed Sara to be in her mid 80s. She was a small, slight woman with deeply creased and darkened skin from a lifetime of Chaco sun and wind. I first met her about a year ago, though, the circumstances were unpleasant. She was on a stretcher, her hair and clothes matted with mud, crying out in pain at every jolt. Her left  leg was angled unnaturally from her body - she had fractured her hip in a fall. Sara was a tough woman. At her advanced age she not only survived a hip replacement, but also recovered to a degree her ability to bear weight and use a walker. Speaking almost no Spanish, we communicated in a mixture of German dialect and Enlhet, punctuated by laughter at the frequent misunderstandings. She loved going out to enjoy the hospital gardens, often collecting the seeds "to plant at home." We would comb her gray hair, "Sara, you are an Oma Hermosa." She would chuckle toothlessly, "No, I'm not at all hermosa." (Hermosa means beautiful) After about a month, the surgical wound had healed beautifully and she was released from the hospital.

For me, the tragedy of the last years of Sara's life was that, although she had seven adult children, none of them wanted to take her into their house. Some months after her surgery, the public health nurses found her lying on the floor in her own excrement, starved and emaciated. The hospital became her temporary home while they tried to find different families for her to live with. Because of this we grew to know her well and love her. Finally this April, Enrique and Ines, an elderly Enlhet couple, agreed to care for her, but they themselves were not in good health and did not manage long. In the last month she was living with one of her sons and his family. Their house has a roof, but not proper walls, so when the cold and rain hit last weekend, Sara, like many others, did not have protection from the elements. She died on Sunday night.

Isabel, a friend who's sitting next to me, kindly whispers translations from Enlhet into Spanish. The service is short and simple, emphasizing that Sara's very real sufferings on earth - hunger, cold, pain, rejection, and loneliness, are now over. Afterwards, we file out into the bright sun to the cemetery, behind the six men carrying the coffin. As Sara is lowered into  the ground, many of the women around me break into sobs, and comfort each other. Although I agree with and was encouraged by the pastor's words, still, I can't help feeling a sense of sadness when I think of the last years of Sara's life. Did she die alone, lying on the mud floor? Did she suffer much? Did she feel rejected and outcast, knowing that almost no one in her village, including the children she had raised, wanted her to live with them?

It's a challenge for me to not miss the many daily opportunities to show love and encourage those I come into contact with. And I am very thankful for the times spent with Sara.

July 18

During most of the year it's hard, if not impossible, to imagine the Chaco cooling down below 90 degrees, let alone be cold. But as I write, with three jackets on, a scarf, freezing feet, and numb hands, I can testify to the reality of winter in the Chaco, however short it may be. The cold drizzling rain started yesterday morning, and it's been going continually, turning the dirt roads into a spongy, slimy, impassable bed of mud, ruts, and water. Just walking is a daring adventure, the mud is more slippery than one would imagine, and a slight lack of concentration can make an innocent pedestrian one with the ground in short seconds. Try riding a bike or motorbike, it takes a delicate mix of the right velocity, balance, luck, and skilled driving to remain upright; most bikers creep along, their legs stretched out on both sides ready to steady frequent swerves or falls.

Nevertheless people are generally happy for the extra moisture being added to the ground and trickling into the water cisterns of their houses. The part that is difficult to deal with is the damp cold and wind ( in the night it can get down into the 30's, plus wind chill), especially for the majority of the indigenous who don't have proper housing. Often a house will consist of a wall-less structure with tin roofing, though not all have tin, and plastic strung up as a wind shield around the perimeter. Heat is provided by small, smoky fires, around which the whole family huddles, trying to absorb the warmth.

Not many folks venture out to the hospital because of the roads, but those who are really sick come. Last night a father with two children, ages seven and five, came cycling up at around 3:30 am. How they managed to all fit on one bike and come from their village about two miles away, I don't know. Maybe the father pushed the kids part of the way. The children, noses running and with barking coughs, were hardly dressed for the weather. The smaller one, a little girl, was barefoot, and the seven year old boy sported muddy socks and flip flops. They each had several baggy, adult sized sweaters and sweatshirts on, coming down below their knees. Their faces, like their clothes, were smudged gray with smoke and soot; because of the cold they had not been bathed for at least several days.

I tried to imagine them in their house, crouched outside around the fire, and then braving the cold wind and rain to get to the hospital. After consulting and receiving the medicine for the children, we invited them to sit by the hospital fireplace with us and enjoy the roaring fire. The children quietly looked at me with big eyes, now and then daring a smile, especially when lollypops were produced.

Although winter here won't last more than a month, it is a time when many people, and especially children, suffer from cold and sickness. They've probably never had the experience of having a warm house and bed to sleep in during the winter. This morning when I arrived home, tired and cold, yet to a weatherproof home, I kept thinking, "what is one's responsibility to our neighbors when one knows of the inequality of resources within walking distance of our houses?"

July 15

An update on both of our babies, Rubian and the little premature baby: they've both taken an amazing turn for the better! With his bulging, chubby cheeks, Rubian is practically fat and is an exceptionally happy baby. To think that less than two months ago he was fragile and skeletal, battling for his life against fevers and bloody diarrhea, and having strength only to whimper, and now he bursts into laughter and giggles when spoken to. He will probably be able to go home with his grandmother next week and, although the future isn't totally certain, it looks promising that his grandma will continue to care for him and raise him, as his parents continue to not want him.

The mom of the preemie has, (after we have been on her case for weeks to name her baby), promised to tell us the name on Monday. We only know it will start with a "J". The baby has now stabilized, and is slowly and steadily growing, with no more frightful respiratory arrests thankfully.

With both babies whose lives were in such balance only weeks ago, one cannot but see the healing hand of God, who despite all the primitiveness and deficits in the medical care we have available here, must have a plan for each of their little lives, and has brought them safely to this point.

July 8

This week the little premature baby has been a lot on my thoughts. In one sense he is doing as well as can be expected, maintaining his body temperature, not vomiting up his feeds etc. He has even yanked out his feeding tube twice. On the other hand he sometimes seems to hover between life and death, as when his mother came and told me and another nurse today that he had stopped breathing. He had turned a grayish color, his little hands and feet were cool to the touch, and his body rigid. We worked for an eternity of two minutes with artificial respiration until he started breathing spontaneously again. The young mother sat quietly on the bed opposite and watched, and only when her baby was breathing normally again did she release her emotions, her shoulders shaking. It is the fourth time he has had a respiratory arrest this week, and it's so hard not knowing from one minute what God's plan is for him. Sometimes as he lies there, bundled up with hot water bottles and blankets, he reminds me of a little angel, as smiles flit across his face while he sleeps.

July 6

The man with the deep puncture injury had an almost miraculous recovery and went home, no major intestinal surgery needed!

Rubian's grandmother is getting burnt out, and Rubian continues to make little progress, although he can sustain his neck a little more, and has started to really interact, smiling and babbling. The doctor tried to get his mother to come to the hospital and trade places with the grandmother so that she could go home, but the mother refused to come. So I guess the grandma will have to stay and keep going.

July 3

Although Rubian still weighs in under four kilos, he gave me his first smile the other afternoon! I was so happy to see it, it made my whole day. He is learning to eat pureed fruit and vegetables, which we spoon into his open mouth as he cries and screams in disgust. He much prefers milk, but that doesn't have all the minerals, vitamins, and calories needed by his starved little body. His grandmother has asked repeatedly when they can go home. She is exhausted and tired of being in the hospital, but the fear is that he will go back to square one if he goes home now. Because of a few bouts of vomiting and diarrhea, Rubian's weight hasn't increased that much since he came, and he is still not out of the woods. So the grandmother will have to hang in there because she is the only one offering herself to care for him.

July 1

Eighteen year old Sabina's first child, a baby girl, was born prematurely only a year ago, and so I'm sure with her second pregnancy she had many fears, doubts, and worries. And not without reason, because only a few weeks ago her second child, a little boy, was born in the clinic in the Nivaclé community of Campo Alegre, weighing only three pounds. What is amazing is that instead of panicking and rushing to the hospital, she took her tiny boy home and tried to care for him there, spoon feeding him, until it became evident that he needed more care than she could provide. Now they are in our hospital. Every two hours the baby is fed through a nasogastric tube, and kept bundled up in blankets because of the cool weather.

His foot is about as big as my thumb, and his body and face are covered with soft down. He has a delicate, finely featured little face, and an elflike mouth which sometimes flashes smiles while he sleeps. Every now and then he lazily blinks open his dark brown eyes, and than goes back to sleep again. Words definitely don't describe how sweet he is!

 

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Responses

Your comment: "what is one's responsibility to our neighbors when one knows of the inequality of resources within walking distance of our houses?"  is indeed thought provoking and stirs me to prayer.  This is our situation here in South Africa.  Do we really do enough?  Do we actually even touch the surface. 

Thank you again for what you are doing faithfully.

Lindy
South Africa