Re-entry, both ways

Greetings from the igloos of Central America!  It’s a breezy 70 degrees outdoors and we are bundling up as if there were snow on the ground.

Our semiannual trip to the US produces a cultural shift which causes me to teeter between reorientation and disorientation.  Marietta and my first step in preparation for leaving (as we did in July) is to let patients know our plans.  This guarantees pandemonium.  Panicked patients hear the dates, confuse them, and spread the confusion as truth.  Regular patients get squeezed between new clients who hear of our departure and decide to have their ten-year-old symptoms evaluated before the clinic closes.  Eighty-year-old women come in for their first-ever PAP smears in our last week in the country.

I, as well as patients, feel the need to wrap up things before we leave.  My check list usually includes proofing the clinic against pest and storm, saying good-bye to neighbors, and making sure patients aren’t left dangling.  So it was that the Sunday evening before furlough Marietta and I crawled under barbed wire fences to visit Griselda (patient names have been changed).  Griselda, 25 years old, mother of five, homestead 30 minutes from the road, was in her final week of pregnancy.  Her husband was in the middle of a drinking binge. I thought a home birth far too risky under these circumstances and wanted to discuss a hospital delivery with her.   We found her and her tribe at the creek below her house, washing the family’s laundry in anticipation of the birth.  Cows had trampled the favorite washing hole so she and 8-year-old Susana were washing downstream from where the rest of the children were playing.  It was dusk when Marietta and I helped carry the wash baskets uphill to her house, panting. We worried again that Griselda was carrying the family’s water up that same hill every day.  She smiled wearily and shrugged her shoulders. What were her options?

When we got to the top of the hill, a 15-minute trek, husband Manuel was sitting on a rock outside their adobe home.  He acknowledged us through bleary eyes but couldn’t communicate well so we left Griselda with the task of proposing a scheduled induction of labor.

On the way home we were sorry that we tried to out-guess the Salvadoran rainy season. The skies clouded over and shoes became non-floating boats. Drenched clothes were a great excuse for making hot drinks at home, though.

Leaving town several days later felt impossible.  We had bedded down the clinic for its 2-month hibernation and the staff had been dismissed until September.  Our packed suitcases were on the front porch.  I stepped out only to be mobbed by patients.  “But I just found out this morning that you are going to be gone!!  You can’t leave without giving me my diabetic medication!”  “Please (please, please, please, please) can’t you just give me several asthma inhalers?  You know how bad I get without them!”  Chickens in a small coop squawk less noisily than panicked patients.

The plane ride and layovers weren’t quite long enough to purge my brain of the crises of the previous weeks. Thank God for family as comfortable as old bedroom slippers!  On the ride to my parents’ house we plied each other with questions while my eyes adjusted to plains instead of hills,  to immense wheat fields containing combines as big as adobe houses; just the previous day I had watched thin men carry 3-gallon pumps on their backs to fertilize corn planted in ditches.  The seat-belted safety again seemed normal; was it only the week before I had ridden to Santa Ana in the back of an open pickup?

Exactly one week after the visit to Griselda I was in the church of my childhood,  welcomed by bearded  and bonneted friends.  Aging aunts invited my family for lunch where their garden sweet corn, green beans, new potatoes stirred up memories of childhood summers; tamales and pupusas suddenly seemed foreign.  We chatted and chuckled in Pennsylvania Dutch.

My sister Melody and I tore ourselves from this family meal to head to a reunion of my Wichita church home.  The 3 major church homes of my life are all dear to me but suddenly I found their juxtaposition a bit disconcerting. Just the previous Sunday I with my Latin family, listening to earnest Spanish and fretting about local crises.  This morning I had been in my childhood environment of rural Pennsylvania Dutch families with century-long roots in the community.  Now, several hours later I was scrambling for names of dear friends with whom I had worshipped a decade before in the urban and more professional setting of my Wichita church.  It was too much:  when I drove into Wichita I had to be reminded where to find the 13th Street exit!

But, time with family and friends retrieved the old routines and I soon began enjoying sleeping beyond 4:30 a.m. on work days, reading past midnight, and driving a vehicle on uncrowded roads.

Summer highlights included joining my entire family on my parents’ farm to demolish some old outbuildings and construct a new garage.  I also got to chat with some of you, package medications you donated, travel to New York and Ohio to spend time with siblings, eat massive amounts of comfortable foods, and rest for ten quiet and blessed days in friends’ Ozark retreat.  Then it was time to transfer my heart to El Salvador again.

The reverse whiplash was no less intense.  Within two hours of landing in San Salvador I was bussing to El Resbaladero.  The streets seemed smaller and dirtier than before I left and people crowded and shoved more than I had remembered.  Our house was small, dark, and dirty (it always happens:  in several days it miraculously became airy, ample, and amiable again).

The wedding on our third day back reminded us that we were no longer living in the land of tight schedules regulated by worried glances at one’s watch.  We agreed as a clinic staff to meet early for the 9 a.m. event.   Marietta and I guessed that “early”  meant 8: 57 a.m.  We wandered up and down the road for 15 minutes, waiting for our friends.  The church house was empty except for a few ill-advised North Americans who still believed that 9 a.m. was when the clock’s hour-hand pointed due west and the minute-hand straight north.  We finally set out to find our friends and discovered one calmly chatting by the roadside.  Another decided

to play a soccer game rather than go to the wedding.  Several others must have been held up by high waters in the creeks.  By 9: 25 we had found our seats in the mostly-empty church.  At 9:35 a pickup deposited guests from a distant community and headed the opposite direction to carry the bride from her mountain home, a 20 minute trip. At 10 a.m. a quartet hesitantly arose to sing and the bride and groom and families marched into the church.  Most of the guests were now seated and briefly lifted their heads to watch the bride and groom walk in before continuing their conversations.  Children munched chips from nearby tiendas and flung the plastic bags on the ground.  The emcee chose not to use the microphone so the half of the audience which sat on backless benches outside the church couldn’t hear the order of the service–the better for continued chatting.  The main speakers did use the mike but by that time we were hot and weary so didn’t listen too well anyway.

The entire group walked or crowded into friends’ vehicles for a ride to the bride’s home for lunch.  The family has diligently prepared for the occasion but the previous night’s downpour had left the overhead tarps dangling while the rented metal tables sank into the loose dirt outside the home.  The chicken and rice were superb, however, and the horchata, that sweetened drink made of roasted seeds, tasted great after a sunny walk.

The 2-month absence brought both bustle and change at the clinic.  Several staff members talked of leaving for the US.  Patients, out of their meds, flocked in as soon as they heard that we had been spotted alive.  Staff members updated me on the clinic news:  did they only remember the tragedies?  On the first day back I found out that one of our patients, a friend, was found dead in his field, dressed in women’s clothing and throat slashed. He had no meanness or money; motives for the murder are hard to assign.

Another patient-turned-friend shocked us with the news of the death of Mirinda, a 28-year-old with congenital heart disease, inoperable in our country’s medical system.  Two years ago she and her mother had been provided intense care for 3 aging family members.  Their deaths, while deeply painful, had been anticipated.  Mirinda died while shopping at the market; her 73-year-old mother is left alone and disconsolate in their house.

All in El Salvador is not intense and sad, however.  One morning I heard Olga urgently summoning Dany, the only male on our staff.  When the hubbub persisted I decided to follow the noise to its source.  In Exam Room 3 people were giggling nervously at the long tail and claws dangling through a ceiling vent.  The iguana which had managed to slip into a plastic ventilation pipe had been unable to scoot backward, so had attempted forward motion. Our patient preferred having her PAP smear  without a reptile’s supervision so we moved next door while another patient, experienced in iguana combat,  helped Dany remove the vent and grab the creature.

A new season at the clinic allows for implementation of new programs.  Before our furlough a student nurse at the clinic prepared a self-study program for diabetics.  Illiteracy is high among our people so Marietta started using the material in small groups.  The rest of us hear roars of laughter from the conference room  as waists are measured (in front of the rest of the group, and no one minds!), weight trends are noted, and discussions are held how to make  traditional foods both palatable and healthy.  I have been so grateful to see improved blood sugar control in two-thirds of those who have participated in the small groups. The patients aren’t so sure about a low-lard diet, however.  One patient confided that her family is afraid she will induct them into her diet and claim her low-fat pupusas taste exactly like a Salvadoran sombrero.

You will be starting the annual holiday season when you receive this letter.  Let me use this chance to again thank you for your friendship and support and love over the years.  Warm season’s wishes to each of you!

Yours sincerely,
Jana Nisly

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