WOW

This is one of those times when I have so much I’m just bursting to tell and I don’t even know how to start. It’s like when I first got to country and every day was so much of an adventure and I didn’t know how to begin to write it all. I tended then to go chronologically, so perhaps that’s what I should do now.

Sunday evening I got a call. Could I please shuffle my schedule around to attend a med mission, to help interpret, just outside Santiago? These med missions are very popular, so getting invited to attend is difficult. I had petitioned the med mission committee (one of the many Peace Corps volunteer committees) to attend 2 other missions previously and been turned down both times. So I was thrilled that I was asked to come (apparently there had been a miscommunication and the committee hadn’t scheduled anyone for the mission), so not only was it not competitive to get to go, but it also wouldn’t count in the 2 med missions I’m allowed to partake in during my service because I wouldn’t be able to be there for the entire time.

I got to the mission on Tuesday. It was a bit of an adventure to find the place, but once I did I found it was beautiful. I found my way to the clinic and floundered, entering the clean areas without a face mask, hair net or booties over my shoes. Then I met some nurses who helped me get straightened out and put me to work registering patients for their surgeries. I took their personal information and then they were seen by the doctor to decide if they needed to be scheduled for this mission or for another in November. All of the patients were there because they suffered from hernias or similar problems (such as hydroceles, needing circumcisions, and cysts), and most patients were males. (Hernias are more common in males because the canal through which the testicles fall at the beginning of life sometimes doesn’t heal fully as the body develops. So the intestine is able to press through that muscle from that weakness (the definition of a hernia). They can also development when someone exerts themselves too much, such as doing too much heaving lifting.) I helped the doctor communicate with the patients a few times for some of the patient’s initial consults. If they were scheduled for the current mission they would move on to the waiting room (all patients needed to arrive at 7:00AM without having eaten anything for the previous 7 hours and wait for their turn) either that day or another day during the week. They tended to move small children up to the front of the list and completed 5 or 6 surgeries in a day in 2 rooms, so between 11 and 12 a day total.

So besides the clinic, my other role was the escort them from the pre-op to the OR. I would talk them off to sleep, and if the doctors decided to use local anesthetics I would stay by the patient to talk them through the surgery. I would periodically remind them they were doing a good job, that we were taking good care of them, that they were being strong and brave, and sometimes tell them if the doctors asked me to that a shot might sting and that it was important to hold still. If the doctors decided to give a general anesthetic then I simply had to be there to talk the patient off to sleep and be there when they started to come back. In the meantime I could circulate, watching surgeries or helping the kids in the waiting area to see their way to the coloring books that the doctors and staff had brought with them.

So Tuesday was a busy day. In the morning I worked mostly in the clinic, and then helped in a few surgeries, just with interpreting and sometimes running errands. I couldn’t get to sleep on Tuesday night because I couldn’t stop thinking about all that I had seen that day for the first time: human flesh being cut, human flesh being burned, human flesh being pinched, human flesh being tugged, human flesh being drained of its liquids, human flesh being removed, and human flesh being sewn back up. I’d never seen a surgery (or really much more than getting my own blood drawn) so close before, and even when I was so tired from being on my feet (the first time I’ve had to stand for so long probably since college) I couldn’t sit because I couldn’t peel my eyes away from what they were doing on those operating tables.

Wednesday was when the real fun began. After spending the morning in the clinic, I spent the afternoon in surgeries and found myself getting the opportunity to scrub in on a surgery, a hydrocele on an elderly gentleman. Before I even knew I’d be scrubbing in on his surgery I got to know him a little bit. He was very stoic, and then I talked him off to sleep as he muttered things I couldn’t make out.

Dr. Steve helped me to scrub in and was very cool about it. He then led the way into the OR and I followed, arms above my waste and touching nothing. In the OR I got a sterile gown on and a pair of gloves. It was really tricky to get the gloves on without letting my fingers slip out of the gown, but I had to do it to keep everything sterile. Once I was covered, I moved to the operating table and Dr. Steve told me to put my hands on the table. I left them there (terrified a bit to move them even ever-so-slightly because I don’t trust myself or my movements too much) until after the procedure had ended, he and Dr. Lora asked me to take a pair of tweezers. I held them pretty steadily. Then Dr. Lora asked me if I’d ever done any sutures before. (Earlier she’d let another non-medically trained person do a suture and I flipped! Why was he doing that, I wondered, and later felt slightly better when he told me he was pre-med. So at least he had that experience.) But where would I ever have done anything even remotely close to suturing? “No,” I told her, and I figured that was the end of that.

“Well why don’t you come around the table to my side over here.” I did as I was instructed and went to Dr. Lora’s side. She handed me another set of tweezers with a fish-hook-looking needle in them and instructed me to suture the patient. I’d seen them doing sutures for about 12 hours at that point, and to be honest, it did look pretty easy. So I decided not to defy my superior and go with the faith she’d shown in me. I picked up the instrument and looked down at the patient’s skin, which was almost completely sutured at that point. My hand didn’t shake at all, something I just realized, so I guess I actually felt confident. I pressed into the skin slightly, which was the easy part, and then the needle got stuck. Dr. Steve and Dr. Lora told me “it’s all in the wrist, just turn your wrist like you would a doorknob.” I didn’t get the instruction at first and sort of tried to jiggle the needle in (like you might on tough fabric.) Finally their instruction semi-clicked and I got the needle through. The cord they were using to suture the man was incredibly thick and sticky, as they’d said, it wasn’t what they were used to using in the US. (A lot of their working materials had been donated.) When I pulled the cord through it stuck, so I yanked a bit, but I got it. Then they handed it to me again and instructed me to suture the final one. So I took the instrument again and realized, “all I have to do is turn my right wrist,” and I did, and it went through perfectly. It felt so incredible to hear what they’d said and really get how that would work, and then get to see it work perfectly!

Then it was just such a rush to realize I’d just sewn a human beings’ skin. Wow. Me, someone with zero medical experience. Wow.

The day stayed good from there: I found out the grant I solicited to pay for the funds to my library project had gone through and I’d received the $4,999.97 that I’d asked for! The check is waiting for me in the capital right now. Then later I learned that the community service group I was a member of in college would like to donate the money they raise from the event I sort of started there to my stove project! Wow. Watching surgery, participating in surgery and then some great news about my work back in my community!

Thursday was another awesome day. I’d gotten used to the surgery aspect a little bit more as well as the flow of the center. So, I really took the opportunity to interact with patients. It didn’t hurt that the first 4 patients were all children. I felt nothing more strongly than the desire to be at their sides, reaffirming what everyone else was saying, that they’d be fine, but also wanting desperately to share with them that which I’d just come to appreciate so much: that what was about the happen to them was actually pretty interesting. The first patient was a 3 year old boy with a hernia. The doctors gave him a mask to play with and his mother stayed with him until we had to take him back. He got very scared and had a hard time once we were back there. He kept moving his head around, trying to avoid having the gas mask anywhere near his face. We all felt so bad trying to hold him still while the anesthesiology RN held the mask to the boy’s face. I tried to stroke his arm or his legs, which I found myself holding as still as I could while he kicked them. His surgery went well (as they all did) and his recovery was pretty smooth.

Next was a 14 year old. I could tell he was nervous when I first met him, so I tried to help him get his mind off of it. He was pretty hesitant to say much. The anesthesiology RN came back to start his IV. He got very scared and began to cry.

Imagine growing up in a small rural village, never going to the doctor until your abdomen hurt so badly you couldn’t take it. So the doctor says you need surgery and some American is going to do it. Perhaps you’ve never seen a white person up close before. You go to some Catholic retreat center, wait a few hours to be seen, they tell you to take off all of your clothes and then they say come back tomorrow. You don’t get to eat anything, come back the following day and wait a few more hours. People with terrible Spanish accents in ridiculous-looking outfits keep telling you that nothing is going to hurt and that you’re going to be okay. Someone comes at you with a giant needle, as she keeps insisting nothing is going to hurt. You know by now that everyone around you is lying to you and trying to get you to shut up. All you want to do is cry.

So at that point I about lost it, all internally of course, as I have learned is the most effective way to deal with Dominican ridiculousness. The Dominican woman (with a beard) who was assisting in the pre-op room told the 14 year old to stop crying because he was a man and men don’t cry. I was waiting for it, and I knew I’d hear it, and even though I was anticipating it, it still made me want to smack her in the face to hear it. It’s like when I see a mother here get frustrated with her crying baby and she hits him to get him to stop crying. And then she wonders why it doesn’t work.

Don’t tell a 14 year old boy nothing about what is about to happen to him and then tell him not to cry when he gets freaked out. Be honest with him; if he is almost a man as you say, then rationalize with him as adults. Sadly, it wasn’t just the Dominicans that held the patient to such a high standard.

I took the boy back to the OR. He walked, slowly because they’d given him a sedative, and as he was drifting in and out of consciousness, his body reacted and he tried to pull his arms up. His mother had told the doctors he couldn’t get a general anesthetic because her sister had had one a few years ago and had never woken back up. It’s a pretty typical story here. The doctors in the OR decided the boy wasn’t going to handle the local anesthetics and gave him a general one. Then one of the doctors made a comment in a frustrated tone that I couldn’t wrap my head around, “The kid’s 14 and this is such a simple surgery.”

But does the kid know this? Had anyone explained to him what was going to happen to him? Had he had a chance to have his questions answered, if he’d even learned the lesson that we in the US still haven’t even learned yet: what are you supposed to ask a doctor anyways?

I could have given the doctor some more slack if he hadn’t spent 2 years in another Latin American country, working and learning the language. Surely in those 2 years he’d been able to see what the poor experience in relations to Americans, white people in general, or other people of authority: total submission even if no one has told you what you’re submitting to.

So, if it’s not clear yet, I absolutely understood why the boy was freaked out and I wasn’t too keen on the idea to go over the mother’s head on the general anesthetic issue. But I’m not a doctor. I’m going to have to write that one down so I (and others) remember it.

He woke up slowly and was very groggy. He seemed to remember little of the moments before we went into surgery.

The next patient was a little 6 year old that I hung out with for a while before it was his turn to go back. I taught him how to give a high five, and I showed him some interesting things in the office so that he might look at the experience as an interesting one and not a frightening one. I showed him the coloring books and we talked a bit too. The doctor came back to examine the boy and realized the boy had had open heart surgery a few years ago. So he was going to be an old pro at this everyone thought. Luckily, they were all right. The doctor, the same one who’d made the comment I didn’t like about the 14 year old, won back some points with me. He asked the 6 year old if he liked planes and pilots. The boy did. “Would you like to fly a plane like one?” So he gave the boy a mask and told him later someone else would hold it so he and the boy could fly the plane. He was incredibly stoic as we walked him back the OR. And they started to fly the plane. It took a while and his body reacted to the gas, flinching a bit, but we held him and within minutes they started the procedure. I stayed and rubbed his hand and any other part of him I could get to safely. His surgery went well and his recovering was slow. I tried to stay by his side as much as possible. As he came to, he shook from the shock of the medicine and change in body temperature. After a while he began to wake up and started to cry, which is apparently quite common. He cried for a long time, and sure enough, it only took a little while for his parents, who had joined us in post-op, to start to tell him to stop crying. My tipping point was hearing the father tell him, “you’re a man, and you’re my son. Men don’t cry.”

I’m not a violent person, but if someone had set that man’s face in my left hand, and pulled my right one back, it would have been hard not to smack him in the face. Not only is it obviously very acceptable for a 6 year old boy to cry about anything, I think it is very acceptable for him to cry when it’s a reaction to the medication someone’s given him! Also, he was probably scared and cold, and being made embarrassed to be crying certainly doesn’t help a person to stop crying.

Nice thinking dad.

I attended the beginning of a woman’s hernia surgery and then had to leave to get back to my town to do some other pretty awesome things. On the drive over to my town I sat next to a small girl with crossed eyes. I’ve always thought of Dominican children as very cute, but when I looked at this girl I felt this incredible feeling to comfort her, and she wasn’t even in any pain. It was as if my medical experience made me look at the human body as something else, something that could be cut and prodded and pulled, almost like a fleshy machine, but the time working with the patients made me realize how profound we are, and how vulnerable. It’s a strange feeling, and I know I’m not expressing it well. Perhaps other people who have had a similar experience can relate.

The first thing I had back in my town was a session in the school about hand washing. (30 seconds of rubbing with soap, and use warm, running water! Count the ABCs (or Happy Birthday twice) to know when you’ve gotten to 30 seconds. Then rinse and dry with a clean, dry towel.) Saturday is International Youth Day, so in celebration of that I also decided to give out some toys to the small girls and boys! I had been supplied the bulk of the toys from my sister just about a year ago and had neglected to give them out because I couldn’t think of a fair way. At first I wanted to raffle them off to women in my women’s group classes (nutrition and first aid.) But when I had so many attendance problems, it seemed like a better idea to not reward the un-dedication with such awesome toys. Then I thought we could sell raffle tickets to the entire community on behalf of the Escojo group, but for our first run we sold less than 1/3 of what we had said we could sell (again from a lack of dedication on the part of the kids and community members) and so I decided to celebrate International Youth Day with a great hand washing session and toy prize.

I got to the school a lot later than I was hoping to because I had a really hard time pulling myself away from the mission, and ended up waiting for a bus to leave Santiago for almost an hour. I got to the school a little past 4 and ended up keeping the kids until past 6! They were supposed to get out of school at 5! The reason it went so long is because I did small group demonstrations of hand washing outside. There were 36 kids so we did 6 groups of 6. I’m not sure if they really even ended up getting the point that we have to wash with soap all over our hands for 30 seconds. Hopefully. At the end my goal was to ask them questions about the lesson and see what they remembered. Ideally the correct answers would earn the kids a prize. But, I wanted to give the cooler toys (such as the dolls and etch-a-sketches) to the younger kids so I separated the groups again. The kids who could answer a question got a toy first and then I just handed the rest of the kids their toys.

I think what prompted my sister to spend all of her Christmas money on the toys in the first place was because when I first got to my town I felt so sad to look at all of the kids here who had crappy, white, imitation Barbie dolls to play with. It made me really angry that no one was giving them (or perhaps no one was making) dolls that looked like they do. And the quality also made me angry. I think I could safely say that every single toy I ever had growing up was the utmost in quality (perhaps besides the toys inside goody bags from birthday parties) and the dolls I had always looked just like me. The boys’ situation here wasn’t much better: broken trucks, white action figures. You get the drill.

The enthusiasm definitely decreased as the age of the kids receiving the toys increased. By the end I was exhausted, trying to hand girls’ toys to the girls and boys’ toys to the boys and take pictures of the whole thing. The kids at the end (once the good toys my sister and mom had bought had already been handed out) got little games and things I’d collected over the year and were much less thrilled. That’s when I stopped taking pictures. Towards the end we also had some parents show up with their smaller children who weren’t yet school-age and I tried to scramble some stuff together.

I saved one doll for the little girl who shows up in a lot of my photos. I knew she was the main reason my sister had decided to buy the dolls, so I thought it was only fair that she get something. I gave her a stuffed doll and when she got it she was so thrilled. Her smile was so genuine and it made me so happy because I knew how happy it would make my sister.
I took a quick shower and then went to start our Escojo meeting. We’re going to try to form (another, hopefully more successful) new group, this time with kids from the community within walking distance and the kids who live here in my community who were too young last year. I had my doubts that people would actually show up, and can’t tell you how thrilled I was to see not only a huge group of kids from the original members, but also a ton of new faces. The new people were all super enthusiastic and very patient. We had no power so I lit 3 candles in the center of the room (also thanks to Julie- my sister savior) and we powered on. The 4 kids in charge of our Escojo group gave the first lesson: “What is Escojo?” At the end I talked just a little bit more. I get the feeling that this group is going to be a lot easier to start than the one last fall. The new kids all participated in the activities and helped us to quiet down the older members. It was great-there were moments when I could actually hear the person who was talking up front. What a nice change.

After a few days like these who could complain? Certainly not me.