Her colorful corte (skirt) exuded joy contrasting against her tired face. She burst into tears when I asked her if she was “triste”, or depressed. She proceeded to tell me that her mother had recently passed away and she was struggling with how to deal with the loss. Her story haunted me because I had just lost my father right before the mission.
Grief is a tough thing where there is support, but how do you deal with the sadness when there is no support, no access to mental health care, and no way out?
Many patients presented with somatic symptoms like headaches, generalized pain, and such. When you asked them if they were “triste”, it was unnerving how many were quick to cry and would unravel the yarn of their lives as though you were the only one who ever bothered to ask. Maybe we were the only ones to ask. Perhaps no one cared enough to ask. Undoubtedly, everyone was struggling to survive and probably didn’t have time to indulge each other with their sorrows.
With tears in my eyes, I listened to her story, I listened to her sister’s story, and I listened to every man, woman, and child who came in and had a story to tell.
And yet, I hear outsiders say, “They smile all of the time. They’re such a happy people.”
The mission took place many hours and barely passable roads west of Guatemala City. The needy hospital was on the side of a plateau that looked up to one of the country’s volcanoes and reminded me of a cloud forest with it’s frequent rains and vibrant plant life. A quiet community, it was built on a Preclassic Mayan site whose culture peaked 2000 years ago and is much more famous for the region’s cacao, coffee, and unlikely post-WWII German settlement.
Lush tropical foliage belies the oppressive heat, insects, and generally poor living conditions of the people. Malnourishment was prevalent so much so that my average height left me towering over many of the men. Skin conditions were frequent and pruritic. Mosquito-borne illnesses were common with post-Chikungunya pain syndromes, Zika, and malaria. The people commonly attributed all illness to their gall bladder and kidneys. As a Guatemalan doctor said, it’s as though they forget that they carry extraordinarily heavy loads for long distances and have muscle and bone that can cause pain.
There was one man who knew that his musculoskeletal system caused pain. This unfortunate man had fallen 22 feet from a mango tree only to land between 2 rocks leaving him a paraplegic. He was wheelchair bound in an area where the roads were difficult to walk, much less navigate in a wheelchair. I could smell the bacteria from what was surely an infection when he pulled a baggie from his pocket with a piece of bone that he said had come out of the abscess over his spine. We quickly cleaned the wound, dressed it, and gave him antibiotics hoping for the best, but knowing full well what the worst might be.
Then there was Pascuala. She came into the clinic in stage 3-4 kidney failure and high potassium. Those who know medicine know that this is ominous and imminent. Thanks to the help of the translator and another doctor, we were able to get her enough drugs to prolong her life. Hopefully she will survive until the next clinic in November. With the medications that she was given, she can breathe and sleep without drowning in her own fluid for now. The medication is not a cure but as someone who just went through terminal cancer with my Dad can say, those months mean everything.
We devised a color-coded system for her medication because she is illiterate. Illiteracy is endemic in an area where at best women typically get a 2nd grade education leaving the region’s women the most vulnerable of the vulnerable.
As we asked her to do, she came back on our last day with a big smile on her face and loose sandals that were previously filled with taut, swollen feet. As she left, she hugged me, cried, and said I pray to God for your safe journey home and that he brings you back to me.
These people desperately need help. How do you survive any illness when you live on less than $2 a day, you are unable to read, and you have no medical provider? The tipping point between life and death is a fine one.
On this mission like many missions before it I have frequently heard, “but they’re such a happy people.” Statements like this undermine the intelligence and overstate the simplicity of an oppressed people who have access to the outside world and know that their life is very difficult compared to some. Maybe people assumed that their smiles represent happiness. While there are many moments of joy and laughter, this belies the reality of their deeply impoverished life.
Next time someone comments on the happiness of a people I would say, as I did to someone else on the mission, did you ask the people if they are happy? I would challenge you to go a little deeper and find out how they really feel and what their life experience is. You may be the only one that has the time to listen and truly hear.
In our busy day-to-day in the developed world, it can be tough to remember our great fortune in life. Journeys like this remind me that the greatest gift that I can offer is my health care skills that help people. I intend to use this ability whenever I have the opportunity. So I would thank the people of Guatemala for having enough trust to allow us to treat them and for allowing me to do what I love. This trust is a precious gift to me. I do not take this trust for granted because the vulnerable are the ones who can least afford incompetence. And, in spite of these difficult stories, I would return a thousand times to the remote corners of earth.