Most people I know volunteer for something, whether they call it that or not. The volunteer experiences that have taught me the most are the ones where I am the farthest away from my daily life and its corresponding To Do lists. My listening skills are greater, and the dialogue lends as much to the success of the project as the work accomplished.
During our three month trip through Mexico and Central America, we decided that spending time in a volunteer capacity was important to each of us, and contributed our efforts to a rural medical clinic in Guatemala. To arrive at the clinic we were told to catch a bus at four corners, an intersection of four roads, and head towards San Marcos. Due to other recommendations, we actually ended up at Los Encuentros, another intersection, with some time on our hands to scrutinize each passing flame and scripture adorned school bus to see if any of them pertained to the school districts of our childhoods. I can’t help but thinking that travel to school would have been more exciting if we had been allowed to bring chickens along.
Once boarded, the bus ride proceeded in the usual noise and confusion as we continued to pick up passengers in the already past capacity bus. As usual, the driver and passengers all notified us of our imminent arrival to our stop and usher us out of our recently acquired seats to stand teetering with our backpacks near the door for about half an hour before the rolling stop that dispatches us into the streets of a small, dusty town.
Following directions we go to the center of the town of San Juan Ostuncalco, and with our backs facing the church head up the street to the right, pass the town’s one bank, and find the clinic located just before the cemetery. The town has a mainly indigenous population, with the no more than four feet in stature people colorfully arrayed in hand woven clothing out on the streets in great numbers on this Sunday Market day.
Rosario Diaz Vicente,a mid-wife and the Director of the clinic, is a Mam women of indistinguishable age. Mam is one of the many Mayan indigenous populations of Guatemala, and forms its own language group. Her traditional clothing is topped off with a Tar Heels baseball cap, and she insists on carrying one of our unwieldy backpacks as she leads us from the clinic to the house where we will be renting rooms for the week.
Rosario grew up in a mountain community not too far away from San Juan Ostuncalco which functions to this day as a collective land holding. Her obligations to her family and their distance from the education system prevented her from receiving a primary or secondary education. At her best estimate she was 21 or 22 years of age whens he moved down the mountain and began to learn the Spanish language. Her skills as a mid-wife were learned through apprenticeship and practice, and her demeanor is of confidence and assurance. Her knowledge is passed on to young women who work at the clinic as cooks, cleaners, dispensers of pharmaceuticals and in other jobs because she also draws them into the birthing room. A full time female doctor who lives in a near by city is also employed by the clinic, but Dr. Miriam Poti rarely assists in the births. That is Rosario’s area of expertise.
Our volunteer work began on Monday morning at 7am with giant bowls of mush and plenty of Nescafe. The negotiations for what needed to be done in the clinic and what we could realistically accomplish in a week began immediately. The roof of the clinic leaks so the poor condition of the clinic building was compounded by mold that could make most mold blanch. Susannah, being a nurse, helped us decide on priorities by identifying objects and problems that would have otherwise been unfamiliar to us. What was not unfamiliar to us is that clinics should be clean, bordering on sterile. The moldy walls and floors of this clinic were splattered in bodily fluids. An old household bookcase and several small tables loosely held the medical supplies which were wrapped in dirty cloth or newspaper. Syringes, new, used and full were found in all places imaginable, including on the floors.
The volunteer week progressed with huge amounts of cleaning solution, paint scrapers and then loads of dark and light blue paint. We were fueled by three meals a day including pancakes, corn flakes with hot milk (pasteurization is welcome in whatever form), black beans whole and refried, tamales and the women even invited us to help them make tortillas one day for lunch. After ours turned out awkwardly lopsided and thick, the mainly just called for us when it was time to eat thereafter.
The view from the windows of the clinic punctuated our work days with interesting stories. On Mondays, the indigenous population comes into town from all over the area to lay flowers on their family graves. A steady stream of flower vendors and flower purchasers pushed by the clinic all day long. During the week there were several funeral processions, an occasion for all the people in the clinic including the doctor and her patients to pause in their work and go outside to find our who it was that passed away. For funerals, every person that the deceased knew well is involved in the procession, including neighbors, employers, friends and family. Because of this, the processions included Ladinos, or people of mixed decent, as well as indigenous people. The women carry the casket and the music is both as mournful and as loud as possible. The same group passes by again on the third day after the funeral to visit the grave.
Susannah worked as a nurse at the clinic to the extent possible with the patient’s native language being Mam, hers being English, and the best case communication medium being Spanish or pantomimes. On our last day at the clinic a pregnant woman came into the clinic very early in the morning with her Mother and her Aunt. She is 17 and a half years of age, and she lost her last baby to fever and also had another child at home. She paced the clinic all morning, dilated but not ready, while we frantically made ready the newly painted birthing room. Rosario decided that we should go ahead with the good-bye lunch they had planned for us, as the mother to be continued to pace. At the end of the meal, Rosario called Susannah to go with her into the birthing room where the babies head had emerged before Susannah even had a chance to wash her hands.
Rosario did not talk to the mother during the birth, nor introduce her top the baby when he had safely arrived. Susannah administered her usual friendly nursing practices, including the usual showing off of the baby, and also thoroughly checked the baby in the way she would have in the United States. Rosario held the baby upside down, whapped his butt, and then weighed the baby in a market type scale (baby on one side of the scale, add weight to the other side while holding it up in the air until balance is achieved). Both agreed he was a health child.
Although the clinic was prepared for the birth since the morning hours, the equipment was sterilized in a pressure cooker at the back of the room as was needed. The gauze and other materials were not sterile, nor was the dirty newspaper that was put over the birthing bed that we had wiped thoroughly that morning with our travel pack of antibacterial baby wipes. The mother, who never uttered a word or shed more than a silent tear, had experienced tearing during the birth, and although Susannah or the Doctor could have given her stitches, Rosario did not bring up that it was necessary, so the woman was sent home to heal. The baby, who did not yet have a name, was diapered in an old wife-beater tank top and three hours after the birth, ushered out to the 19 year old father who had brought the family pick up into town to take them home up a bumpy mountain road.
The thought that we all took away with us is that even in a clinic that is severely under-resourced, it seems that the resources it does have at its disposal are not being well allocated. A week of cleaning, organizing, making lists, and making requests to people we know who may be able to donate some supplies led us to see that the real work that needs to be done at the clinic is in education. The education that is needed will require some longer term commitment from a volunteer, or perhaps a change in their societal perceptions. That a cleaner environment will lead to less infections or overall better health care is a far off concept, as is the acceptance of AIDS and other transmittable diseases in their community. As with most volunteer experiences, we left San Juan Ostuncalco feeling like we wanted to do so much more.
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