Lemonade from lemons

It is again, indeed, Thanksgiving time.  Forgive me for rubbing it in, but—well, I like our frost-free existence here.

Not that weather doesn’t give us fits, for it does.  Two weeks ago, our ‘dry season’ converted to ‘drizzle season’ and parts of El Salvador received 14” of rain in a weekend.  Deforested hills deal poorly with this kind of deluge and land slides covered major highways and filled houses and destroyed lives.

You know how, in kindergarten, we were told that, “When life hands you lemons, make lemonade? They didn’t include part b:  when life hands you inconveniences…  Some months ago after a brief trip to Kansas, we had boarded the plane and were sitting in the runway in Wichita.  Now you and I both know that the air traffic in Wichita is such that a significant delay in take-off means more than runway congestion.  And, alas, they soon announced what I was fearing:  mechanical problems.  But, they would get us on the very next flight to Houston.  Not too consoling:  a group was awaiting my return to hold an important meeting before missionaries returned to the US the following day [, my thoughts were already taking in the day’s schedule.  Short layover in Houston; important meeting in San Salvador as soon as I landed.  ]

So I sighed quietly when they told us that this plane would not be leaving but to relax, because they would get us on the very next flight to Houston.  “Be calm”, I instructed myself, “you never know what good might come out of this”.

The next flight to Houston brought me in at about the time that my plane was taking off for San Salvador.  The important meeting on my mind, I asked the ticket agent at the doorway about the status of that flight.  “It’s still here.  If you hurry, you might make it.”  One shouldn’t say that to a flustered Nisly—you can give them coronary arrests.  But I dashed across the airport and got to the gate; and, good news, and my plane was still there.  Bad news:    when they rebooked the flight in Wichita, my  seat was given to someone else and this flight is already overbooked and …. No amount of pleading looks changed the facts.  So, I called internationally to explain that I really couldn’t make the meeting that evening, no matter how much I wished to.

Once on my flight, I fleetingly wished for a bit of leg room and lots of quiet in order to transition from some intense days in the US back to the upcoming schedule in El Salvador.  And I got put in a row with a generously-proportioned(!) woman in the middle seat and a friendly chatterer in the aisle seat.  I quietly dismissed all hopes of leg room, elbow room, and soul-renewal and reminded myself of the day’s refrain:  you never know what good might be planned behind all this. The three of us enjoyed our quickly -formed friendship when we discovered that one of the women was married to a physician who had practiced in Wichita during my student days there.  He was flying to El Salvador to preside over a meeting of the Salvadoran-American Medical Society (SAMS) which would start the following day.

Suddenly, I was no longer irritated over mechanical difficulties or full plane rows.  What a marvelous opportunity for networking!  Within 10 minutes the president of SAMS had pulled the program’s registration form from his briefcase and had promised to personally pay the registration fees for as many of our clinic staff as were interested.  It was the beginning of a happy friendship.  Indeed, we were able to attend the conference by cancelling a day at the clinic and met Salvadoran physicians I would not have had any other opportunity to meet.

Indeed, during one of the luncheons we happened to sit by a young man who introduced himself as being a cardiologist who had done part of his training in the US.  Since I had been introduced to the conference attendees as someone working within the country to help medically underserved Salvadorans, his first words were, “I’d like to help you.”   It was a moment when those of us from our clinic looked at each other and said, “So THAT was what the mechanical problem in Wichita was all about.”

And thus it was that, for the first time in 16 years of work in El Salvador, I could get echocardiograms for some of my sickest and poorest cardiac patients.

And the rest took care of itself, as well.  We left San Salvador for the clinic at 6:20 on the morning after we landed and stopped to have the important meeting with the missionaries who were leaving the country that very day on the way out to the clinic.

You would tire of reading this letter before I could describe the precious motley bunch I sent that cardiologist the first time.  Manuel, who softly asks at each clinic visit if we have any milk for him—‘because I just can’t afford it, you know’.

Today I was humbled, as I often am, by a patient.  An abjectly poor woman, her clothing were all sown by hand in a rough stitch visible to any casual glance.  Her teeth had never seen a dentist, nor had the ones she was missing.  But when I walked into the room, I felt as if I must be a visiting dignitary.   She bowed, grinned broadly, hugged, kissed my arm, hugged, and stroked my arm.  And my embarrassed mind thought, “If I get this much affection and do so little to deserve it, how little care does she receive in the rest of her life?”   I know part of the answer, though I have not visited her home.  She knows so little gentleness.  Her days start by getting a wood fire started for the tortillas which she grinds by hand.  Hauling water up from the stream or a neighbor’s spigot is the next job of the day.  And then scrubbing the families frazzled clothing.  As far as I know, she is no longer chasing her naked, psychotic daughter around the hills since we were able to get the daughter started on medications.

Why are our poorest people on my mind so much?  Several weeks ago I had one of those foolish moments of distrusting a patient when they told us they couldn’t pay for their meds.  I noted that their address was of a neighboring city and I couldn’t fit them into one of my ‘poor country folk’ categories.  When I went in to the exam room to see the 19 year old seizure patient, I was troubled by both his gait and his speech, much worse than I had ever seen him.  His mother told me that he was having multiple seizures in a day since her ran out of meds.  I decided it was time for a home visit to get a straight story on this family’s economic status and try to get a feel for the level of compliance.

We would have never found the patient if we hadn’t been in El Salvador.  From the time we left the main road, we asked for directions from passersby.  Without fail, they interrupted their journeys, paused and pondered where we would find Fidelina and her son, and directed us in the most likely direction of their house and suggested who might be able to give us more directions.  Even the soccer players in the soccer field interrupted their game to discuss how to best direct us.   Just then a sweating, panting woman came down the path and said that she had been sent away from the area where food donations were being given to this poor community in order to tell us where to go.  And, although it was a suburb of a large city, you could have fooled me.  As usual, it was across a stream with only a log for a bridge (and Salvadorans always hold their breaths when they watch me start across; we usually agree it’s just best for me to take of my shoes and get my feet wet).

Word kept spreading about our arrival and people stopped their work to tell us how to get to Fidelina and Santiago’s house, and upon our arrival we had enough tour guides to pull us all up the steep steps dug into the hill which led to their house.

Did I say “house”?  Well, I came to find out their socio-economic status, and one glance told me they were right and I was wrong.  The entire living quarters for the patient, his mother, and brother was a tin-sided shed with one opening for a doorway, no windows, just enough space to squeeze 3 cots at various angles, and a heap of clothes on cardboard at the foot end of one cot.  I didn’t see any kitchen or cooking facilities, and they must have gotten any drinking water from neighbors.  The cots were so close together that those of us using them for seating (those 3 cots were the only furnishings in the house; I didn’t see a single chair; besides, there was no room for it anyway) crawled over each other’s laps to find more sitting space.  Both Santiago and Fidelina were jovial and pleasant.  Fidelina assured me that Santiago’s dad would help pay for his medications if only Fidelina could amass enough money to pay for bus fares to his house.  She could only manage that twice a year, although Santiago’s father’s house is less than 20 miles away.