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(Alan) Curt, Julie and Gregory Wands-Bourdoiseau in Colombia
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A Choice for Life
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A choice for life
Rarely does life reflect contradictions as flagrantly as at this moment. If this were a scene in a movie, some would think it too contrived. A similar reading from Gabriel Garcia Marquez, the famed Colombian writer, would invoke claims of “magical realism” of a Latin American style, certainly not of reality. Gladys[1], the midwife in this remote riverside community, is trying to concentrate on telling me the story of a difficult birth she recently attended. While she recounts the story her eyes nervously keep an eye on the dozens of guerrillas crossing the narrow river. What makes this moment most disconcerting is the army helicopter circling high above the civilian village where Gladys and I continue to dialogue. “So, once the newborn’s head was out I saw the cord wrapped around the neck” Gladys continues. “I got the cord around his head, just like we learned in our last class” she continues while the helicopter, from far above, opens fire on an unknown target several miles away. Several guerrillas half-hide under the thin palm trees in the community, offering no real protection to them or to the civilian community they are putting at risk. The guerrillas are herding the cattle they have recently stolen across the river, resulting in several of the small community boats being trampled. Most community members have discretely gone to their huts, keeping the family close by, preparing to flee if there is direct combat. The memory of the massacre in Bojayá[2] three years ago keeps people from congregating in a central location. One of the priests tries to argue that our boat is not to be used to transport armed actors of any party, to no avail. Eventually over 150 guerrillas make their way through the village, cattle in tow, and head into the jungle on the other end of town. Over the course of the rest of the afternoon I work with the Health Promoter on several patients; an asthmatic who ran out of her medication, removal of stitches placed with a sewing needle and thread, adjusting blood pressure medications (and who wouldn’t have higher blood pressure after this afternoon?), treating skin lesions, and the run of the mill infections that abound in these communities. We do no community organizing work today due to the concerns of the heightened military presence. Several days later the 17th Brigade of the army did arrive, ripping down the signs and banners that declare this to be a civilian community. The army then stole the few cattle that the community did own. After leaving I received news that the police force in this region turned Orlando Valencia from a nearby community (I had just treated family members of his) over to the infamously brutal Paramilitary. I just learned today that his body was found in a nearby river. He had been traveling from the zone, accompanied by several international and national representatives, so as to attend a conference in Chicago, IL in the U.S. . From this far away, flooded, rainforest I get rare glimpses of news of other U.S. wars in Iraq and Afghanistan. I also get occasional glimpses of hope by shortwave radio or on the Internet (when we are in a place with both phone and electricity and a computer) in those who chose to bring life into the world instead of take lives out. Only two weeks before, Heberto, one of the advanced Health Promoters and I accompanied a delegation to the village of Pueblo Antioquia. This village had recently had visits from both the guerrillas and the Paramilitary. Both sides threatened members of the community for allegedly giving support to the other side. The Paramilitary tortured several members of the village, causing two thirds of the community to flee. We were invited up to take testimonies and work with the village for a few days. Arriving at this village is a feat; with a 6 hour boat trip followed by a 9 hour hike up several thousand feet of muddy clay paths. There is another hour boat ride or hike at the end of this hike. We arrived exhausted, but glad to arrive. Upon arrival Heberto and I were asked to do an urgent visit for a young boy who had difficulty breathing and a high fever. Quickly, Heberto took a medical history in the patient’s Emberá language, performed an appropriate physical exam, and diagnosed the boy with pneumonia. I concurred with Heberto´s diagnosis and suggested course of treatment, which included injected penicillin, an inhaled bronchodilator and counsel on what we would do over the next days to follow-up the delicate state of health of this boy. It was encouraging to see his improvement over the next days. We were informed that we were the first medical personnel in this village in 15 years! For this young boy our trip had probably meant the difference between life and death. The trip back is even more precarious, with a 5 ½ hour trip by hand built rafts that are literally torn apart in some parts of the river. At certain points, everyone disembarks from the rafts, which are then sent solo downstream. At a safer point, several people jump into the current and rescue what is left of the rafts that are then hauled ashore, repaired and the trip resumed. On each of our trips we attempt to do preventive health work, curative exams, and community organization. Now being 1 ½ years into this project we can count on several of the advanced Health Promoters to actively participate in these trips. Frey, one of the advanced promoters, as well as Brian Good a pediatrician visiting us from the U.S. accompanied this trip to the village of Quiparadó. The primary goal of this trip was to teach about cleaner drinking water and install a 1,000 liter tank for each home. However, on arrival in the village, the Health Promoter, a Waunann Indigenous woman, advised us of a very ill 2 year old girl. She had recently had bouts of diarrhea with high fevers and chills. More disconcerting was her severely malnourished state. She barely eeked out a whimpered cry, her eyes were only half open and she had not eaten for 2 days. The exam took a long time, as is frequently the case with new Health Promoters. Frey took his time in reviewing the technique of how to take a temperature, and we watched while her fever rose over 1 ½ degrees centigrade over the next 45 minutes. With an enlarged liver we recognized the signs and symptoms of malaria, highly endemic to this zone. She was treated with appropriate anti-malarials, oral rehydration solution, and given an analgesic for her fever. By the next day she was sitting and eating again. Quite the relief! It is worth mentioning that a medical doctor from a for-profit health agency (EPS) had been in the community this very day and performed over 100 “medical exams”, complete with diagnosis and treatment… in just over 3 hours. That averaged out to less than 2 minutes per exam. He missed the malaria diagnosis. The major purpose of these once a year-or-two medical “brigades” is to sign up clients for the health services which the agency is paid the equivalent of $100 U.S. dollars per month for each person signed up. An article in El Tiempo newspaper earlier this year claimed that 65% of these EPS health agencies are associated with the Paramilitary. We have a LONG way to go in terms of improving health conditions and institutions in this region. The water project was a complete success. By written accord each family in the community had built a platform to hold their water tank prior to our arrival. On the day we arrived, a meeting was held with the community to agree to a mutual work plan. Early the next morning the entire community began by building one model water tank for an elderly couple that needed the help in constructing their tank and the rain gutter for collecting the water. All participated families participated, as well as our own team including the Dr. Good who delved into the manual labor with as much vigor as he does his medical work! By evening every home in the village had a water tank, and with that nights rain all were filled from ½ to ¾ by the next morning. Another community meeting was held the next day to discuss the methods of purifying the water gathered in the tanks. We discussed the use of alum and chlorine, boiling, and solar purification. With the Health Promoters we performed a skit to demonstrate dehydration utilizing a handmade doll that leaks water as if it had diarrhea and vomits (water) over those watching the performance. The promoters make a home made mixture of water, salt and sugar for oral rehydration “saving” the doll from drying up and dying of dehydration. The courses are progressing slowly but steadily. By early next year we should have over 20 villages with Health Promoters capable of 1st level Primary Health Care. Still, the need for more volunteer medical advisors is one of our major obstacles. The classes are too big and we are now too many in the program. The low level of literacy and comprehension, due to the lack of educational opportunities, slows the advance of the Promoters to a dramatic degree. There is not a single Ministry of Education middle school or high school in the 32 communities we work in. Nonetheless, when I recall that not one Health Promoter could take a reliable temperature only a year ago I recognize that we have made great strides. The provision of medicines for the communities continues at a pace consistent with the capabilities of those Health Promoters who manage these health kits. The medications are provided on the basis that they be utilized as a revolving fund. Previously medications from other programs were donated, but when the programs were ended, so did the provision of medications, leaving the communities without even the most basic medicines like aspirin or acetaminophen available. Even without the war; and the subsequent harassment from the army, police, guerrillas and Paramilitary, getting medicines into these areas is difficult. They are carried in on horseback, backpack, and in boats shoved through swamplands. But the difference in people’s lives is palpable. The 14 year old epileptic in the upper part of our territory now has a consistent source of his medication and he doesn’t seize three to four times a day. The diabetic in Montaño gets his insulin before he runs out every month, just as the schizophrenic who tried to kill his mother now gets his haloperidol (allowing everyone to sleep better.) Children and infants get antibiotics before their infections get to the crisis point and Health Promoters have suture to sew up wounds instead of a needle and thread used for clothes. The midwives in the region received training in prenatal care and safer delivery techniques through Julia Martínez a Guatemalan midwife who came from Guatemala to support our project. Many of the midwives are illiterate or monolingual in an Indigenous language, yet are the ones responsible for the birth of all children in the community. Two of the midwives had delivered more than 100 children, yet had never received a course in midwifery. We covered the basics of high risk signs and symptoms during pregnancy, prenatal care, normal and abnormal childbirth presentations, and aftercare of the baby and the mother. Health kits were provided to give basic instruments for their work. Prior to the course none of the midwives had scissors adequate for cutting the umbilical cord. The advanced Health Promoters had a course teaching them the same skills, taking into account their abilities to take blood pressures, do basic urinalysis and perform a more complex exam. In each community we worked to have a new relationship between midwife and Health Promoter. Part of our personal hopes for Julia’s visit had been for her to do the delivery of our baby, but
he decided to wait until several days later to be born in our simple, plank board home, with dad doing the delivery. We had a truly blessed experience of a quick and safe delivery. Our Gregory Mateo Wands-Bourdoiseau was born on July 25 in Ríosucio, Chocó, Colombia. His tri-national status (Colombian, French, U.S.) he is known locally as the Chocoanito (the little Chocó
boy) which local people announce with mirth (he is the WHITEST boy ever born there), and pride that we would chose to share
our lives with this community on such a deep, yet natural level. He is a tremendously
joyful addition to our lives here since that first Monday morning he was born. His
laugh and coos are great distraction to the serious parts of our lives. We
look forward to his meeting our families in December and January!
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