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.

 

October 29

The last few weeks the temperature has swung between over 110 degrees F, with a 100 km per hour hot wind, to a drastic change with a cool south wind dropping the temperature about 40 degrees in 8 hours. It's a fascinating phenomenon: just when it seems like it can´t get any hotter or more oppressive, you hear a rush of wind in the treetops and within minutes the air has suddenly cooled down. Consequently we've been seeing a lot of respiratory infections, mostly in small children. In fact, I have rarely experienced the hospital so full: all the beds are occupied and we have been filling the TB ward with overflow patients. About 80% are children under three years of age, and most have very bad pneumonias and some have pleural effusions (liquid in the lung cavities). 

Also difficult is the fact that  we haven´t had our doctor all week (he has been in Asuncion caring for his mother who is very sick), so the nurses have had to make many decisions to the best of our abilities. We have had to transfer four children to other hospitals where they can receive more intensive care.

On Friday morning the ambulance left yet again for the third time this week with two children, taking them to a larger hospital in the capital city of Asunción, approximately 434 kilometers from Yalve Sanga. Katia, a petite four year old with big, almond brown eyes, was admitted over three weeks ago. Her chest x-ray showed that she only had the top part of her lungs to breathe with, the rest was filled with pus and fluid. We wondered how she could have lived so many weeks with such a bad infection, but because she is a very uncomplaining little girl she must have become accustomed to always being short of breath. Katia was very concerned that she would be home by October 22, the day when her kindergarten celebrated the end of the school year with a little ceremony.

She was determined to participate in the songs and poem recitals that she had practiced. She was in the hospital with her mom and her little one year old brother Nilson, who had come with a cold. Sadly, he must have gotten Katia's infection and on Monday was also diagnosed with serious pneumonia.  I´ll never forget the sight of both children lying in the same bed attached to IVs, their exhausted mother lying between them and caring for both of them. And yet she always quietly maintained a positive outlook, and didn´t get stressed out. So now we await the good news that Katia and Nilson are getting better, after so many weeks, and that the rest of our little patients also turn a corner soon.

October 11

Last night ended another week of nights in Yalve Sanga Hospital, reminding me once again of the unique experience it is to work there. Some things that happen are so strange they are comical. Take Saturday night for example, at 11:00 pm. The stillness of the hot night was broken by the sound of a large vehicle crunching to a stop on the deserted road outside the hospital. I stepped outside to see what was up. It was a huge, antique red bus that had to have been built at least in the 1960s. The door was flung open, and a large procession of people began to exit and walk towards the hospital. "What is this, a late night tour group of Yalve Sanga?"  I wondered aloud to the other nurse, Alfredo. Soon the crowd had arrived, and they trailed silently past us into the hospital, smiling knowingly at our surprised faces as they filled the hall, lining both walls. I gathered that they were Nivaclé from Jope, an indigenous village some kilometers away. They had brought two patients to consult, who were ceremoniously seated on a bench in the middle. No one said anything except the two representatives of the group, who translated into Spanish. The rest, men, women, and children, watched us closely and silently as we attended and examined our patients, doling out acetaminophen, cough syrup, and advice. Once we were done the multitude  rose and filed out of the hospital, as mysteriously and wordlessly as they had come in, and headed back to the ancient red bus, which then rattled away into the night back to their village. Where they had acquired it I have no idea since if people own a motorbike around here they are doing well. As the last sounds of our late night visitors died away, Alfredo and I looked at each other and could restrain our mirth no longer!

Other things are less funny. Last night we were so busy I thought my legs would fall off. One motorbike after another parked outside the door bringing sick mothers, grandmothers, and children, all night long. Here is a fairly typical picture of how difficult life is for the indigenous people here:

At one in the morning, Samuel, a tall, strongly built Nivaclé in his 50s arrived on his motorbike, asking if we could send the ambulance to the village of Samaria, about six miles away to bring his three grandchildren to consult, all with vomiting and fevers. Why had he chosen the middle of the night to bring them? The situation was that the three, all under five years old, have been at home with their moms, sick all week since last Saturday. But as is common here, both the father and grandfather have work in far away ranches or farms and only come home on weekends with the family transport, the motorbike, as well as the only source of income. So even if they wanted to, the mothers of these children couldn't bring them, for lack of money to pay the consultation. And they had to wait for the weekend when their grandfather Samuel was home. He had to leave again for work early in the morning, so that's why the only way for them to get here was in the middle of the night.

The three children sat on their mother's lap, watching with big eyes. One of them was terrified that he would receive an injection, and shouted lustily. They all had high fevers, runny noses, coughs, and lungs full of rales. I think part of the reason why they are vomiting at home is the dirty water, right now everyone is running out of potable water and what most families drink looks more like chocolate milk than water.

Anyway, it's a challenge to try to provide good care in these instances, taking into account the patient's living conditions and lack of transport to come the next day for blood tests or chest x-rays, which would be the ideal. We gave them medicine and encouraged the moms, more than anything, to always boil the water that the children drink.

September 25

When I work in Room 4 in the hospital, my thoughts sometimes wander to all the patients I can remember that have passed through, some having recovered and others not. One little girl I still think about is Joana.  She was brought for a consultation at the beginning of this month, which incidentally Amaris helped with. At first glance nothing seemed to be too serious, weighing 6 kilos she looked like a normal six month old baby, though  perhaps slightly pale. Until the parents told Amaris that she was actually one and a half years old, and that in the last days she had completely stopped eating.

Upon unwrapping her more the apparent chubbiness of her face proved to be edema from her starved and protein-deprived body.  She was clearly a malnourished child, unable even to hold up her head, let alone sit, crawl, or walk.

Worst yet, her tongue was a completely white color from severe and even life-threatening anemia. The parents, in their early 20's, told how they had gone from hospital to hospital looking for help ( they are not from this region) and the only thing they had been told by one hospital was that Joana had tuberculosis. Desperate, they traveled the three or four hours to our hospital as a last ditch effort.

After receiving several blood transfusions, Joana improved somewhat, but it was clear her chief obstacle would be learning how to eat solid food because up until then she had only nursed (one of the factors in her becoming so malnourished). Most of the time she cried or whimpered nervously, never really settling down. After a few days with a nasogastric tube we tried to teach the mom how to feed her purees. It was a test of patience because Joana would struggle and scream, spitting the food out, retching, or refusing to swallow. However, after a few days, we rejoiced that progress, however slight, was being made.

On the fourth morning of Joana's hospitalization her mother must have been unable to cope with more. Arranging with a relative from one of the villages, she and her daughter left the hospital on the back of a motorbike without the knowledge of any of the hospital staff. Where they are now, or how Joana is doing, I don´t know. Will she relapse into the state she was when she came, or worse? But she will continue to be in the thoughts and prayers of those of us who met her and cared for her.

September 15

I am happy to report that Susana's symptoms have almost completely cleared up and she will probably be going home shortly. Because we didn't know what else to do to help, the doctor started Susana on anti-tuberculosis treatment, even though the sputum samples had come back negative. Within 24 hours her pain level went down and her night fevers stopped. This afternoon I met Roberto and Susana sitting outside the hospital. The exhaustion of the last days shows on their faces, but they are also happy and relieved to have a clear diagnosis. It is remarkable how fast the right treatment can help, and if Susana follows the six month regimen she should be completely cured of tuberculosis.

September 11

"What illness does my wife have? When is she going to get better?" It's the second or third time Roberto has asked me this question, and it's frustrating not to know the answer, and not to be able to give him some hope and encouragement. Although as I wrote, Susana seems to be gaining strength in the day, every night this week she has spiked a fever and groaned in pain, breathing fast and hard, and trying to find a comfortable position. Thursday night she was shivering so violently from a fever the bed was almost shaking, and last night her fever almost reached 104 F. The situation was made more difficult because I had a hard time finding an accessible vein to start an IV to administer antibiotics and medications for fever and pain.  Three times during the night Roberto came to us to ask if we could pray together, because Susana was also struggling with, as he said, "bad thoughts." I think she is battling the fear of dying. It is their custom for each person to pray out loud, so, while standing around the bed, simultaneous prayers were quietly spoken in English, Nivaclé, and Spanish, a heart wrenching moment, asking for God´s closeness and healing.

The rest of the night Roberto stood vigil by his wife's side, not sleeping, but he was up again at 6:00 am to help shower her and feed her breakfast.

September 4

Susana has been in the hospital around two weeks now, a Nivacle woman of about 38, she was brought in by ambulance from the community of Casuarina with diarrhea and vomiting. Susana has the added burden of suffering from rheumatoid arthritis, an extremely crippling and painful condition. Most people recover from gastroenteritis in three or four days, but Susana didn't seem to be recovering, and she always had sharp pain in her chest. Finally she was diagnosed with a small pleural effusion, and was started on the corresponding treatment, and although during the daytime she seems to be doing better, sitting outside under a tree etc., the nights have been rough and long. 

Accompanying Susana is her husband, Roberto. Rarely have I seen such love and devotion as Roberto has shown to his wife day and night for the last 14 days. Literally at Susana's side almost 24 hours each day, he helps to bathe her, comb her hair, massage her feet, and prepare compresses and hot water bottles. He sleeps on a mattress at the side of her bed, but often when I enter the room in the night he is sitting on a chair by her side holding Susana's  hand or watching over her. Yesterday he told me he is the responsible pastor in his community, and his wife helps organize activities with the women in the church. He said he was feeling extremely depressed and discouraged that his wife didn't seem to be getting better, and felt he didn't have strength to continue. But just that afternoon about twenty women from Casuarina arrived in the back of a truck to visit Susana. Filling the hospital room, they talked, sang, wept, and prayed together. This visit encouraged him and Susana to keep fighting.

 

---

Your Turn. Tell us what you thought about this article:

Responses

We'll keep Susana and her caring husband in our prayers.  I pray that the Lord will guide you to a diagnosis and that He will give you the answers to the questions been asked, and most importantly impart His peace on this couple.  I also pray that the correct medication will be available for this lady to recover. 

Lindy
Grahamstown, South Africa

---

Thank you, from the heart, for Renate to let us know about your Chaco patients.

This way we can pray for them, and for you as well. We hope you will have a great week!

Peter Hoover
Detention River, Australia