A 4,000-mile house call: Bringing Midwestern medicine to the Mayans
By: Carey (Checca) Sullivan
(Winner of the 1996-97 Department of Journalism’s Brody Creative Feature Article Writing Award, also published in the C-U Octopus)
Professor Harrington showed his students not only the art of literary journalism, but how to sort through details to find those that would pull readers further into the story.
For this story, I spent a week in a rural Mayan village volunteering and reporting. I shot photos of the clinics, volunteers and locals. I took copious notes. Many of the details, scenes and interactions were edited out because they were, ultimately, unnecessary. With Prof. Harrington’s help, I learned good writing comes from choosing the right details and words, and then rewriting until it works.
This piece was recognized with the Marian Boruck-Brody Award.
– Carey Sullivan
FOG HANGS LOW in the branches of the orange trees in Othon P. Blanco, a Mayan village far into the rainforest of the Yucatán Peninsula. The morning’s cool breeze carries the conflicting scents of ripe oranges and rotting vegetables across the village’s dirt streets and into its plaza. A 5-foot-long brown sow waddles slowly down the road, sniffing garbage strewn across it. I walk in the opposite direction on my way to breakfast. A skinny brown dog sleeping in the middle of the street looks up as I pass then goes back to sleep.
“Buenos dias,” a few of the men gathered outside the corner store say.
The dark, mustachioed men, wearing rumpled polyester pants and shirts unbuttoned to the tops of their stomachs, sit on a bench fashioned from a board resting on concrete blocks. From their perch, shaded by the store’s palm-frond roof, the Mayan men watch as 67 gringos, living in the village for the next 10 days, wander in to a cinder-block kitchen. Inside the bright blue doors of the kitchen, I grab a plate and fill it with watermelon slices, papaya and scrambled eggs. Underneath the palm-roofed dining hut, I sit with the other gringos at tables covered with bleach-sanitized red-and-white-checked oilcloths.
“Our family strung crepe paper up in our room,” says Monica Heseman, a nurse from Decatur, Ill., and one of my roommates in the home of an Othon family. “And our señor hired one of those tricycles with the basket in the front to carry our bags to his house. There were about 10 bags on there, and the tires almost looked flat.”
“Hey, my family’s got a shower,” says Ted Dodd, a nursing student from Cleveland.
“A shower? Wow!” Monica says.
As it nears 7 a.m., the crowd in the dining hut begins to clear. Dishes are scraped and dumped into wash tubs. Dogs are shooed out one last time, and small bands of Americans make their way to dental and medical clinics set up in the village’s schools or to where they are pouring concrete for the floor of a new clinic.
I HAVE COME TO MEXICO by way of Intercambio Cultural Maya, a group of American volunteers who operate free clinics and undertake construction projects in a poor Mayan village one week each winter. The gringos are mainly Midwesterners — nurses, doctors, dentists, students and other comfortably affluent Americans. I’m one of the Midwesterners — a student at the University of Illinois at Urbana-Champaign who grew up outside of Joliet. In exchange for my fledgling journalism skills and the promise to produce two newsletters for the group, Intercambio has paid my way. I’ve looked forward to this trip for eight months, and I’m excited to live with and help these poor people. My parents questioned me: “Do you really want to do this? It’s going to be hard work.” Sure, I told them, but it’s not going to be too hard. It’ll be like camping out for a week with a bunch of friends. I’ve never really roughed it — lived without flush toilets and running water — but it can’t be too hard.
By 9 a.m., more than 100 people from Othon and the surrounding villages have lined up outside of the medical clinic’s wrought-iron gate to see the seven “American specialists” that the white banner spanning the main street advertises.
“I don’t want to see the little doctor,” one villager says in Spanish, referring to a Mexican doctor whose clinic is 60 kilometers away. The Mexican government provides free health care, but the villagers must pay for medication, which often is too expensive for them to buy. In the six days in which Intercambio’s clinic is open, its medical team will see more than 750 villagers and give away $7,000 worth of vitamins and medicine.
Entire families wait in the shade of orange trees across a narrow street from the clinic. A short, round Mayan woman wears a huipiel — a white dress with gardenias embroidered in bright blue around its collar and hem. Sisters wearing mud-splattered cotton dresses edged in lace and tied with pale satin sashes push their younger brother up and down the street in a stroller that has a board for a seat. A young woman’s white skirt is stained yellow with urine from her undiapered baby, who rests on her hip.
Inside the clinic gate, physician Ted Barnet, who works with lung transplant patients at the University of Illinois at Chicago Hospital, hangs out in a courtyard in well-worn khakis, white Reeboks and a gray T-shirt. He chain-smokes Marlboros before returning to the examination room. His translator for the day, Mimi VanEe, a young college student from Iowa, brings in 40-year-old Paulino Cataneda.
“What’s your problem?” Mimi asks Paulino, who sits on a child-sized bench and holds a brown baseball hat between his knees. He speaks and looks at Mimi, then at Ted. Mimi translates: “Sometimes when he reads his eyes water.”
“When he reads for how long?” Ted asks.
“After an hour it gets really bad. He also gets bad headaches — so bad that he doesn’t feel like working. He says he lies down in his hammock.”
Ted prescribes aspirin for Paulino’s headaches and medicine to combat his worms and tells the man to find among the eyeglasses that Intercambio brought a pair that clears his vision.
“I knew walking in the door what he needed,” Ted says after Paulino has left. “I added worm medicine, which we give to everybody. But it gives him a chance to tell his story. Everyone wants to show their scars.” Ted again steps out of the examination room and into the cement courtyard and lights up another Marlboro. He has traveled 4,000 miles to listen to people’s stories. “It shows, that I — that someone — gives a shit.”
He takes another drag and exhales.
“I do a lot of high-tech medicine,” he says of his work in Chicago, “and I use a lot of technology to get where I’m going, which is a good thing. But it leaves me out of touch with the stethoscope, the history and a good physical. You can’t do that in the States because it’s not acceptable care. Here, this is a step higher than what is already available, and I can help people who can’t otherwise get care.”
OUTSIDE THE MEDICAL CLINIC, red dust blows wildly with the breeze, and I turn to shield my eyes. I imagine that I can feel dust sticking to my sweaty arms and legs, on my neck and clogging the pores of my face. Young turkeys drink from a puddle of dirty dishwater outside a home made of thin tree trunks wired together. Ahead of me, I see what look to be Chinese lanterns hanging from a house’s palm roof. They glitter as they bounce in the wind, catching sunlight and tossing a sparkle onto one side of the house. I look closer and find that they are soft drink cans that have been cut vertically and squashed until the middle is pushed outward. Just then, Charlie Sweitzer barrels down the street in Intercambio’s old blue Suburban and honks at me.
“You want to go to Candelaria with me and pick up some supplies?”
I throw my backpack into the Suburban’s rear seat and climb in the front. Intercambio uses the Suburban to carry supplies to each village visited. When Intercambio isn’t using the Suburban, Intercambio’s contact in Mexico, Ramone Celis and his staff in Cancún, use it.
After rolling down the window, I pull my reddish-brown hair into a ponytail and wipe the sweat and humidity off my face with the sleeve of my already sweat-soaked shirt.
CHARLIE IS ONE OF THE ORGANIZERS of Intercambio and is one hell of a guy. Sixty-one years old, 6-feet tall, with a full white beard and a ring of wiry hair around his head, Charlie is a pastor at McKinley Presbyterian Church in Champaign, Ill. The church serves a congregation consisting mostly of faculty members, their relatives and a few students. Sixteen years ago, he met Celis, a Presbyterian minister from the Yucatán, and they began working together to bring groups of Americans to the Yucatán for work projects. “We didn’t know what to expect,” Charlie recalls. “It’s a wonder nobody died.”
Intercambio Cultural Maya — Mayan culture exchange — makes two trips to the Yucatán each year. There’s a construction trip in the summer and a combined medical and construction trip in the winter. Intercambio is invited to a village by the village’s elders.
“Crap!” Charlie says suddenly. “We’re almost out of gas.”
“Where’s the gas station?”
“The next town — José Maria Morelos.”
The gas station, however, is out of gas, and the attendant doesn’t expect more to arrive before 7 p.m. A 7-year-old boy on a rusty bmx bicycle tells us he knows where we can get gas. Charlie gives him 10 pesos (about $1.25) to show us the way. The boy rides his bike as fast as he can down a dirt road and turns right. A few blocks later, he stops in front of a plain-looking house. Inside the one-room house, three 55-gallon drums of leaded gasoline are lined up against a wall, 5 feet from two hammocks in which the family members sleep. A mother and her 10-year-old daughter pull out plastic hoses and buckets and begin siphoning gas with their mouths.
“Bitches, hurry up!” yells the father. He’s as tall as I am, 5 foot 3. His hard eyes meet mine with an angry look. He frightens me.
“What do the gas fumes do to their bodies?” I ask Charlie.
“I don’t know,” he says. “Kill them, I guess.”
Charlie retreats across the street to avoid the fumes and sits in the window of a cinder-block house that is under construction. I follow. “But Charlie, we’re helping to kill them,” I say. “Aren’t we here to help people?”
“I don’t know how to answer your question,” he says. “If they don’t sell it to us, they’ll sell it to someone else. They’ll die whether or not we buy gas from them.”
Barefoot and wearing a dusty pink dress, the little girl helping to fill our gas tank runs a full bucket to her father. She picks up an empty bucket sitting at his feet and starts running back to the gasoline drum. Halfway to the house she slows and flashes a toothy grin at me. She runs to the drum and again starts sucking on the hose to fill the empty bucket.
“Ven aqui con un alguno mas!,” her father yells angrily. “Come here with another one!”
By the time we leave, four more cars are in line for gas.
OTHON B. BLANCO is an ejido — a village created by the Mexican government to farm specific crops for export to the United States. Othon seems prosperous. Every home, whether it is built of cinder block or the narrow trunks and branches of rain forest saplings wired together, has electricity and a television set. The television sets seem to be on all day — and tuned to Speedy Gonzalez, Mexican soaps or “Married with Children,” dubbed in Spanish. Ninety percent of the village homes have dirt floors. Few have gas stoves. Most families cook over an open wood fire. Many of the houses have one room for cooking, another room for sleeping and another small, private bathing niche attached to the house. In the sleeping room, brightly colored cotton hammocks hang parallel to each other. To cross the room you have to duck under each hammock.
This afternoon, my 72-year-old señora sits regally at the kitchen table. Her gray hair is softly swept back into a bun near the nape of her neck and it shines in the light from a naked bulb that hangs from the center of the room. She looks at me and smiles when I step into the room. “Buenas tardes,” she says. Then she offers me one of the 50 or so freshly picked oranges that sit beneath the kitchen table. I ask her where I can get water for my bath. She slowly rises from her chair and fills a blue plastic bucket with warm water that has been heating over a wood fire in the kitchen.
“Monica, how do I do this?” I ask from the bathing niche.
“There’s a chair in there,” my roommate hollers. “First of all, you just sponge. And then when you wash your hair, you can pour it over your head.”
“Carey, is there enough warm water for me to share with you?” asks another of my roommates, Erin Lacey, a dental student from the University of Iowa.
“Sure. Wear your sandals, though. It’s pretty muddy in here.”
I scrub my armpits two and three times, trying to get the acrid smell of wood smoke, rotting garbage and sweat off my skin. I don’t think it washes off.
“Erin, will you smell me? I don’t think I smell clean.”
She leans over and sniffs my arm.
“You smell like soap to me.”
I lean forward and smell my towel. It stinks. Every day, I hang it out to dry on a clothesline, which happens to be on the other side of a fence that pens in my family’s five pigs.
AT THE DENTAL CLINIC, a Mayan woman sits in a wooden chair. Her bright pink dress is splattered with blood. Blood runs out the left side of her gauze-filled mouth. She rests her head on a makeshift headrest fashioned from a roll of paper towels taped to the chair.
“I’m trying to pull three of the woman’s teeth, but I can’t get her mouth very numb,” Erin says. “She has an infection in her gums, and I can’t give her any more Novocain. I feel so bad.”
Erin puts on a pair of sterile surgical gloves and covers her nose and mouth with a blue mask. Her clothes are protected from the blood by a purple lab coat. She inserts a pair of stainless steel dental pliers into the woman’s mouth and firmly twists the pliers back and forth. Twist, pull, wipe the blood. Twist, pull, wipe the blood. The woman’s eyes are wide with pain. Her back is arched and tense. But she stays quiet. Twist, pull — POP, and the tooth is finally out. Erin rushes to press gauze into the gaping socket, then takes a moment to examine the tooth. It has rotted down to the root. It’s not even good enough to put in her jar of alcohol and take home to Iowa to practice drilling and filling.
“We’re sacrificing teeth that in the States could be saved easily,” says Joyce Garton-Natte, a dentist from Fort Dodge, Iowa, and head of Intercambio’s dental clinic. “You have to realize that the main value here is to be free of pain. It’s a value system that I haven’t justified in my mind, except to know that we’re so shorthanded. It’s the only value system we can work under. It’s a risk coming down here, not knowing what you’re going to encounter. But I think you’ll discover that there are really some more important things than money. I’ve had my washer and dryer for 26 years and I thought, ‘Well, I deserve a new washer and dryer.’ But then I ran into a man who had no washer or dryer and I thought, ‘I don’t need a new washer and dryer until this one completely conks out.’ We certainly live richly compared to people here. And since I’ve been coming down, I’ve been doing a lot more free dental work at home because the need exists there just as well.”
Across the room from three dentists pulling and filling teeth, Shirley Beaver, a hygienist from Southern Illinois University, cleans teeth. In English, she slowly explains to her patients how to use a toothbrush and dental floss. The villagers, who speak Spanish or Maya, pay close attention to her words and mimic the way she shows them to brush. They seem to understand. The children among them, happy to have new toothbrushes, can’t wait to use them. They brush their teeth — and the walls, the dirt floor and the flea-ridden dogs.
“There’s a big garbage problem,” says Janet Short, a nursing student from Case-Western Reserve University in Cleveland. “And one of the big things is not only are there dogs, but there are pigs also. And they are a big proponent of disease because they eat the garbage. And then their excrement — that’s how worms are spread. A lot of kids don’t wear shoes and they’re playing in the street with all of this trash and all of this feces from the animals. That really puts them at risk.” Janet is working to teach the village women to pen up their families’ pigs and to wear shoes.
THE FAMILY I LIVE WITH seems pretty cleanly — which is, to be honest, a relief. Unlike many people in the village, they keep their pigs out of the kitchen. They drink bottled water and have a refrigerator. But they don’t have a flush toilet. Instead, they have an oval-shaped zone in the backyard that is littered with crumpled pages from a catalogue and screened from the view of the house and street by dried palms strung horizontally across vertical sticks. Erin and I refuse to walk in there. It’s raw sewage. No way is either one of us going to squat in that. Instead, we squat behind the narrow trunks of orange trees beyond the backyard.
“Erin, I can see your white butt!”
We both giggle like Girl Scouts camping out for the first time.
“Oh, be careful of your feet,” Erin says.
“I am. Doesn’t it smell?”
“Oh, look! I peed on my shoe!” I yell, and we both laugh.
“Oh, I did too!” Erin shouts. “Do you have any Kleenex?”
From my precarious position, I can see three village dogs watching us. We stand and zip up our Levi’s. Erin heads quickly back into the house, but I take my time. I listen to my family’s green parrot sing from its cage. I look for a ripe orange to pick from a tree. I stop, turn and look back. The dogs are eating our leavings. I turn my face away. I can’t help it. I vomit.
IN INTERCAMBIO’S KITCHEN, our cook, Geraldo Garia-Acosta, has four Intercambio people chopping onions, green chiles and tomatoes and mashing avocados. Geraldo wipes sweat off his forehead with his handkerchief, then walks across the room to rinse his hands in bleach water. He crosses the room to a stove, adds milk to refried beans and stirs. He pushes up his sleeves and mixes the chopped vegetables with the avocados.
“I need two limes,” he says. “Jeff, will you please pick some sour oranges form the tree outside? Thank you. OK. Squeeze the limes and oranges in here. Please hand me the milk.”
He adds milk and stirs. The guacamole is ready. I snatch a few chips full of guacamole before the rest of the gringos come to dinner. Beef kabobs, refried beans, grilled tomatoes, chips and guacamole are our Yucatecan dinner tonight. And Geraldo has prepared a special treat — chocolate truffles made with rich Parisian chocolate.
Before dinner starts, we throw scraps of vegetables into a garbage pile that sits under a row of thick-leaved trees. From the kitchen, I watch a crowd of pigs rummage through our newest scraps. Dogs and children, both with hungry eyes, stand in the kitchen doorway, watch us fill our plates and wait for handouts. During dinner, as we again eat at our tables covered with bleach-sanitized oilcloths, Charlie, Geraldo and I can see children digging through our garbage pile with the pigs. I clean my plate and leave to follow the children from the pile to their house across the street. It’s one room made from narrow tree trunks and branches. Two young brothers sleep together in one of four dirty, tattered hammocks. Smoke from an open fire rises to the palm-frond roof and leaves it black with soot and the air thick and dirty. Children wearing only underpants peer in the door to see the gringa talking with their mom.
“Hola. How are you?” I ask the señora in my broken Spanish.
“Fine. Please, sit down,” she says, motioning to one of the hammocks. After checking the hammock for crawling things, I sit.
“How many kids do you have?”
“Nine. Annie here is the oldest. She’s 15.”
“Wow! Nine kids,” is all I can think to say. I rack my brain for some-thing intelligent to say in Spanish, but I come up empty-headed. “What are the names of your other children?”
The señora tells me the names and ages of her other children, then starts talking about something else in rapid Spanish. I can’t understand a word. I smile and nod. In a pail blackened by the open fire, small orange squash — the type I’ve seen my family cook for their pigs — toss and turn in boiling water. “Do you have pigs?” I ask the woman.
“No,” she says.
Back in the kitchen, I tell Geraldo and Charlie what I’ve seen. Geraldo hands me 10 pesos and sends me to buy four pounds of tortillas from the nearby store. He fills a pot with leftovers and helps me carry the load of food to the woman’s house. One child in green underpants runs into the house and cries, “Mama! That gringa is here!”
Three of the younger children stand mesmerized as I spoon meat into their pots. The older brothers and sisters peek warily inside the door. I smile as the señora thanks me, but I cry as soon as I step outside. I’ve never seen poverty like this. The kids don’t have clothes or shoes or toys. Giving them our leftovers will help them tonight, but what happens when they’re hungry tomorrow and after we leave Othon? I can’t handle it anymore. I can’t watch people eat our garbage while I eat Parisian chocolate. I go to my hammock and fall asleep.
I WAKE WITH TURISTA — Montezuma’s revenge. I can’t make it to the backyard. I’ve lost all pride. I squat next to the front wooden gate that faces the street and hope no one walks by. Though it’s already 65 degrees and humid, I wrap myself in my sleeping bag and settle into my hammock. I’d really like a flush toilet. I haven’t felt clean for three days. No matter how many times I scrub my body, I still think I smell. I get the dry heaves every time the dogs follow me into the backyard. I’ve discovered that my neighbors have a flush toilet in a small building outside their house. I’ve started sneaking into their bathroom at night. My clothes are caked with red dust. I’d give almost anything for clean, soft clothes. The filth is everywhere — in my shoes, my socks, even my sleeping bag.
Three more nights here. I can’t wait to leave.
“Vivian, I’m sick of the dirt and the dust and the dogs. Aren’t you?”
“After seven years, it seems less of a chore,” says Vivian Dau, a school nurse from Iowa. As we sit in the shade on wooden chairs in the courtyard of the medical clinic, I ask her why she keeps coming back. “It’s two weeks, not even two weeks. The time in the village is the most uncomfortable as far as living conditions. And the dust is just there. I think, when you look back at this, it won’t be as much of a discomfort as it is now. It’s just a matter of getting through it, Carey. This has made me realize — well, have an awareness of — diversity of culture. Now my husband and I are much more tolerant of other people and much more intolerant of intolerance. We’re both in our 50s, and I think we assumed at this age we’d be slowing down, not experiencing new things. For us, it has been the opposite. It’s such a joy that we found we can grow and learn more about ourselves.”
Vivian leaves to test a urine sample. I think she’s a bit too sappy about Intercambio, but this is her seventh trip. She certainly understands better than I.
“Carey, are you feeling better today?” asks Patricia Higgins, a nursing professor from Case-Western University.
“Yeah,” I say. “Hey, thanks for the 7-Up and crackers yesterday.” Then I ask Patricia why she participates in Intercambio. Her answer is surprisingly direct.
“As a community health nurse, I consider my community to be the world.”
We’re finally leaving the village. I’m just four hours away from a shower, a flush toilet and a hotel room in Merida, Mexico. When I was gathering up my luggage this morning, I was so relieved to hear our two charter buses roar into the village. Our señora gives me a hug and kisses my cheeks. She shakes my hand and says something in Spanish that, once again, I don’t understand. I load my luggage into the old blue Suburban and run to use the pit latrine behind the dining hut. An old man who has been watching us from the village plaza all week is standing outside the latrine’s chest-high walls. He’s urinating. I turn around as fast as I can, walk into the dining hut and wait for him to leave.
BACK HOME in Urbana, back to my normal life: a hot shower, clean clothes, no stench of rotting vegetables or excrement. I’m shocked at how relieved I am to be clean again, but in the next few weeks, a small part of me begins to wish I were back in Mexico. My hammock was comfortable. I met interesting people every day. I ate oranges I picked from the village trees. From the comfort of my apartment, it’s easy to forget about the children who dug through the garbage, to forget the care I took to avoid the piles of dung in the road, to forget how repulsed I was by the filth. But now, America is newly repulsive in its own way. My apartment is twice as large as the house of the nine children who were digging through our garbage. I have more clothes than I can even wear. I have leather shoes that cost $100. If a villager had shoes at all, they usually were a pair of $1.50 plastic sandals.
But for all the compassion I felt for the people of Othon P. Blanco, for all my new sensitivities about American lavishness, I am still thinking about replacing my worn out Nikes with a new pair of $85 running shoes. I feel guilty and greedy because I know I could get a good pair of running shoes for $50 — maybe less if I cruised the clearance racks. But the $85 ones are comfortable and supportive, and blue is my color. I’ve got only one pair of feet. Shouldn’t I take care of them? Wouldn’t the Othon villagers buy shoes like this if they could afford them? I must look like an idiot standing in the Lady Footlocker with my mouth hanging open. Should I buy them and have well-supported feet? Should I buy less expensive shoes and give the money to Intercambio or save it to go on another Intercambio trip?
I LEAVE THE MALL and go to see Charlie at his church at Fifth and Daniel streets. “How can I justify spending $85 on a pair of running shoes,” I ask, “when I know that money could help someone who really needs it?” Charlie rubs his balding head.
“I don’t have an answer,” he says. “There are two ways rich people seem to respond to poverty. The first one says, ‘To hell with everyone else but me. I worked for the money. I’m going to do what I want with it. If only the people down there worked.’ That lets us off the hook too easily as to why I have so much and someone else has nothing. The other one is to give everything away, join the poor. That’s what most Christians mouth but don’t practice. Ultimately, I guess, if you give everything away, it just evaporates. Somebody else has to take care of you then.”
“But what’s the point of Intercambio if I don’t know what to do now?”
“Well, there are two purposes. One is to educate North Americans, and particularly university students, about how 90 percent of the Third World lives. And the methodology is experiential education. You went and saw; you lived there. I don’t know what you’ve learned, but I’m not responsible for what you’ve learned. You’re responsible for that. I’m only responsible for getting you there safely, getting you home safely and putting you in a context where all you can do is learn. You take people down there to do good for others, but you pirate the education. They don’t even know they’re being educated.”
I persist. “But what am I supposed to have learned?”
“Hell, I don’t know what you should learn.”
“Well then, what have you learned?”
“Oh, I’ve learned you can do something. It may not be much. It may not last very long. You know that woman you carried food to across the street? If you had gone over there empty-handed at meal time, she would have found something to feed you even though that meant less for her kids. Where do you see that happening around here? Carey, life is a series of compromises. You will always have to choose one thing over another.”
For the next few days, I think about what Charlie said and what I saw in Othon. Then I buy the $85 shoes.