Just Like Someone Without Mental Illness Only More So (21 page)

On the way to breakfast I saw very well nourished vultures in the trees and nicely dressed laughing kids atop two-hundred-dollar dirt bikes.

Breakfast was fruit and eggs and bacon with waffles from overflowing platters on a giant buffet table or omelets cooked to order. The Reverend Calvin Peters, an Argentinean who made a living shepherding medical missions like ours, got us each to give him a few hundred dollars, which he would exchange for us for Honduran lempiras so we could have some spending money. He said that he could get us the best deal, since he would be exchanging a large amount. He also posted sign-up sheets for shopping trips he would arrange so we could buy local arts and crafts.

Peters was a smooth, soft man with thin arms and legs, silky silver brushed hair, and a small round belly that made him look a little bit pregnant or like a python who had swallowed a baby pig. His wife, who joined our trip with him in Houston, was about twenty-five years old and Barbie-doll bouncy.

We spent most of Sunday setting up the clinic so we could see patients the next morning. The clinic was going to be in a school. A peeling faded wooden sign announced
ESCUELA J F KENNEDY
. I got a lump in my throat.

Next to the school were weeds that looked like twelve-foot-high asparagus stalks, bearing individual red and yellow fruits the size of candlepin bowling balls. Subfreezing temperatures and the changing seasons give New England foliage a certain
seriousness and discipline. I’ve never looked at an oak or maple tree and thought that there might have been a different way to do things. Here, next to the bright colors of the plants, the school’s gray concrete and gray wood trim made it nearly invisible.

Mark Twain said, “Coconut palms look like feather dusters that have been hit by lightning.” I wished I’d said it first.

The school had no plumbing or electricity. There were no windows, just chain-link mesh where windows should have been. For blackboards each room had a square section in the middle of the front wall where the concrete was more smoothed out than the rest of the wall. There was a one-story building and a two-story building, neither very big.

The dentists took the one-story building because it had a porch; they set up three dental chairs and could work in the open with plenty of air and sunlight. There were five dentists and five dental assistants who manned the three chairs in rotation, twisting, pulling, rocking, chiseling, and leveraging rotten teeth. People waiting to see the optometrists and doctors watched people get their teeth pulled while they stood in line.

Kids in the courtyard made impressive human pyramids and played soccer with a crumpled paper-and-tape ball. By the end of day one, they would all have tennis balls.

The optometrists took the upper floor of the two-story building, which normally was the school principal’s office. That left the bottom of the bigger building for the medical team. The adult doctors wanted to see some kids. I didn’t want to see adults.

There was a chiropractor with an adjustment table who liked kids and others looking on while he cracked necks and spines.

——

I had an Ambu breathing bag with a full set of pediatric masks. I shoved two desks together to make an exam table. I had solutions to clean wounds, antibiotic ointments, sterile gauze and triangular bandages for slings, IV catheters and solutions, a stash of IV antibiotics, and five hundred 3x75-inch index cards. I was going to make out a card for every patient I saw. If I had managed to keep up with the index-card idea, five hundred wouldn’t have been enough.

An internist who had been on an earlier trip said that virtually all the children would be malnourished and infested with parasites and that we should worm them all, but the kids playing in the school yard looked healthy and well nourished.

It was late Sunday afternoon by the time we had things set up and ready to go. Patients would start lining up at seven the next morning, and we would start seeing them at about eight. We boarded our sweltering hot chartered bus and waited to be driven back to the resort.

Tela and the surrounding towns were plastered with posters announcing the clinic. A charter bus company was planning to run buses from La Ceiba, sixty miles east. What we didn’t know, because none of us had seen the posters, was that every patient was expected to make a contribution of one lempira, about forty cents, for each doctor they saw.

That night we had a meeting in the same room where three weeks earlier the presidents of several Central American countries had worked out a peace plan that was unacceptable to the United States. You had to go up ten steps to reach the podium, reminding me of the Whaleman’s Chapel in New Bedford from
Moby-Dick
.

The first speaker was Lorenzo James, a midsized dentist from Texas dressed in battle fatigues with surgical tubing, Kelly and straight clamps, and several sizes of needle holders hanging from his double-punched black leather and steel eyelet belt.

“How does that surgical equipment stay sterile out in the field?” I asked Max.

“Without him this trip wouldn’t be possible,” said Max. “He’s the president and founder of the Foundation for Medical and Dental Care for Central America.” President George H. W. Bush had declared Lorenzo James a Point of Light.

Along with the clinic at Escuela John F. Kennedy there would be a mobile unit that went out into the bush, as they called it, with two Land Rovers. They would set up in remote village squares and take care of whoever needed taking care of, sleeping in the homes of villagers and moving on when they ran out of patients.

Among the positive attributes of the Honduran people cited by Lorenzo James was their deep gratitude for the help we were bringing, their hospitality, and the fact that they bled less and required less pain medication than patients in the United States. The germs in Honduras were less likely to be antibiotic-resistant, so small doses of penicillin usually did the trick. The children were very brave and rarely cried. James told a joke about malpractice insurance.

The next speaker was Dr. Sandor Martinez, the chief of service and only surgeon at the local hospital and commissioner of public health for Tela and the surrounding area. It was under his auspices that we would be practicing. He would arrange follow-up care for anything we thought needed follow-up. He mentioned that the local doctors and dentists weren’t thrilled
with our presence. It had never occurred to me that there were local doctors.

“The Hondurans are a very conservative and dignified people. Please don’t wear shorts except in the resort compound. Please don’t pull any more than four teeth from any one patient. You don’t know what happens when you leave. Some of these patients bleed and bleed and we can’t transfuse them.”

Three teachers from the school, one of whom was pretty, said through translators how grateful they and the whole community were that we were there. They knew they were closing the school for a week for a greater good.

The last speaker was the school principal. He was a maybe five-foot-tall Mayan who smiled only briefly and spoke perfect English. After the bare minimum of pleasantry he said that what the school needed more than anything else was a new fence and that they would be setting up a gate to charge patients one lempira per consultation. The teachers would man the gate.

All hell broke loose.

“We’re like a bake sale,” I said to Max.

Could we make a cash contribution or come back later and put up a fence ourselves? It was important that the care we gave be free, that people not have to pay.

The principal shook his head. If we were here to do what was good for them, we could start by listening to what it was that they wanted done, and what they wanted was to charge one lempira per consultation and use the money to buy a fence.

It became clear from the discussion that Calvin Peters had known all along about the fee and that he himself had been paid a fee by the school to recruit our mission. When we got the money he had gathered from us at breakfast it was three days
later and at an exchange rate considerably less favorable than that offered by waiters, cabdrivers, and assorted street urchins. Exchanging dollars for lempiras made no sense anyway, as there was not a merchant in Honduras who wouldn’t gladly deal in dollars. The rev was doing nicely for himself.

Lorenzo James was outraged and urged a boycott of the clinic we had spent all day setting up. We should just run shuttles with the Land Rover and go out into remote villages like he and his crew were planning to do and as the previous two missions had done.

“They’re a very proud, grateful people. They have no money but bring food and carvings. No one in the bush has ever seen a doctor. Forget the clinic.”

The pharmacy, the optometry equipment, and lots of the other equipment we had set up wasn’t very portable, and who was to say the school principal and teachers and community would want to let us come and go as we pleased if we weren’t taking care of patients?

“Could we wear shorts in the bush?” I asked Max.

We offered the school two thousand dollars cash to let us take care of people for free. No go.

Max said that if we had to charge, maybe we should make it more like five dollars a head and see if we could come away with some real money. No one laughed.

So if we didn’t open and run the clinic as advertised, what would we do? Visit Mayan ruins and fish for the twenty-pound largemouth bass I had heard existed in a remote lake? Maybe just chill at the beach resort? I would have been more than a little disappointed to have come all that way, set up my little area, and then not be able to see how it worked. We should have
offered them ten thousand dollars and found ways to take most of it back like third-party insurers do.

A little after midnight, Gavin Archibald, our fearless leader, got up and said that we couldn’t and wouldn’t shortchange the Honduran people. We would have one of our translators at the desk monitoring the teachers collecting the money, making sure no one was turned away. We were professionals and certainly weren’t going to refuse to treat thousands of people over a lousy forty cents per patient seen.

At breakfast it was announced that anyone who wanted to could be taught how to pull teeth and that the four-teeth-per-patient limit was silly. There is a fancy word for twisting and rocking back and forth while you pull that sounds like the fancy word for burping.

A hospital in Rhode Island had donated two thousand sets of blue disposable paper scrubs, enough for each of us to have a fresh set every day. A battalion of white people in dazzlingly bright blue scrubs descended from the blue-and-white bus and took their places in the school clinic, watched by Hondurans who had paid their fee and were waiting patiently. There were adolescents on bikes with assault rifles strapped on their backs in lieu of police.

On the first day of our clinic the nurse practitioners and I saw 187 patients. Nearly 100 more were given vouchers assuring them of a good place in line for the next day. There was as little or less wrong with most of the patients I was seeing than was usual back home. Most of them were well-nourished, bright, healthy children who didn’t eat what their mothers thought they should or who coughed, usually without fever or waking up or any other symptom. Two children in the first hour
were for second opinions on hernias. In both cases Sandor Martinez was right: the umbilical hernia would get better by itself; the inguinal hernia would not.

Once people pay, even if it’s only forty cents, the expectations and entitlement follow as night follows day. The people controlling the gate had no incentive to not ram as many people as they could through the one-week-only-see-the-Yankee-doctors moneymaker.

I had three twelve-year-old girls from the local Catholic school translating. They sometimes did it by committee and would argue among themselves about what it was that the patient or I was trying to say. “Bones ache,” “Baby no eat,” and “Cough” were the most common chief complaints.

The first “Baby no eat” I saw was a beefy thirty-pound two-year-old with wrist rolls, chipmunk cheeks, and a Buddha belly. “Baby eats,” I said. “Maybe the neighbors are feeding the baby or the baby gets up and raids the refrigerator when the mother is sleeping.” The translators looked back and forth nervously.

Of the babies and children complaining of cough, almost none of them coughed. I never figured out what “Bones ache” meant, but I weighed and measured everyone and asked about whether or not they ate or coughed and if the bones ached more during the day or at night and showed them where their child was on the growth chart, and everyone seemed happy.

One of my first patients was brought up to the front of the line by our triage nurses right after he had a grand mal seizure. He was back to himself by the time I saw him. He was a strong, handsome, nonverbal boy who had had six to eight seizures a day for many years. His mother was a small, shy, pretty woman who looked like a teenager herself. It wasn’t the seizures she
was worried about but the fact that for months he had been holding his penis and screaming while smashing the wall with his other hand whenever he had to pee. She couldn’t look at me for more than a millisecond. It was just as well that I didn’t speak Spanish so we didn’t have to say
penis
back and forth.

There was no discharge; the penis looked fine. It could have been a bladder infection. I had brought a couple hundred urine dipsticks from my office that could tell me in minutes if there was blood or protein or sugar or white cells in the urine.

“Just a small amount of urine in the cup,” I explained to my translators, who passed it on.

He seemed to understand what he was supposed to do and put a small amount of urine in the cup and a much larger amount in a giant arc on my cardboard partition while he screamed and punched the wall.

His urinary stream was excellent. The urine in the cup was normal. I had brought the full weight of medical science to bear on his simple problem and had come up empty. I didn’t have the faintest idea why he held his penis and screamed when he peed.

I tried to explain that he could have a lot fewer seizures a day with medication and wrote out a note to Sandor Martinez. The boy’s mother was politely trying to seem interested. I gave one of our tennis balls to her son, who nodded appreciatively and rubbed his cheek with it.