Pacientes. un bebé chulo. quirófano. disparejo.
I’m not accustomed to eating breakfast this way.
Steaming coffee perched on the makeshift table to my right, an omelette made with quesillo and tomates from the small tienda down the street, and Moi and Kevin giving an impromptu concert in the welcome area of the CES office. Breakfast has always been my favorite meal of the day, but on a typical weekday morning at Harvard, I know that I would most likely be eating it alone and–I confess–while perusing the news on my computer. The very idea of doing that here seems blasphemous. In Mexico, the rhythm of life is different, slower, and–at this particular moment–happened to be playing along to the beat of a soft guitar and drums.
But the rhythm I seek to describe here is of a different kind altogether. Let’s call it disparejo (bumpy). We started out early yesterday morning. The pickup truck was packed and ready to go (‘dispensas’ or food baskets for the community health workers had been packed in the back) and there were five available seats in the truck itself. I was eager to return to Honduras, the community where I will be spending the rest of the semester and where I will be focusing my research. It is a quaint community, where the pastelería and the lavandería and the peluquería are all located within a stone’s throw from one another. It’s the kind of place I’ll get to know by foot.
But first: getting there.
Hanna and I knew that there wouldn’t be enough seats for the seven of us…and so, two would have to ride in the bed of the truck. I was reminded of the many forms of transportation I experienced in Tanzania (from boda-bodas to dala-dalas) and I figured that this would be something I could handle.
To the back we went.
With hair tied back, sunscreen on, and the best of attitudes, Hanna and I squeezed in between the dispensas to settle in for the ~3.5 hour car ride. I know my mom would have expressed her reservations (or rather shared her cries of disapproval) but no matter how much dust or sun or stares came our way, I am convinced that we truly did have the best seats in the house.
This, after all, was the Sierra Madre.
The laughs kept coming as Hanna and I bounced our way along in the bed of the truck, getting a feel for the beautiful landscape of Chiapas as it flew past. At moments the sheer ridiculousness of our situation left us in stitches; at others we were quiet as we soaked in the scenes around us. And of course, there was plenty of Spanish in between. The truck would come to a halt in one small pueblo or another whenever we needed directions but before long we were off again, no doubt leaving many passerby confused as to what these two foreign-looking chicas were doing gazing starry-eyed at the world around them. It was one of the best rides I’ve ever been on and I couldn’t be more grateful that Hanna was my companion through it all. We’ve literally climbed mountains together.
Sights along the way
Upon arriving at the Honduras clinic, Héctor’s was one of the first voices I heard. “¡Hola Hola! ¿Cómo te va?” he said with a broad grin. I had seen him greet his patients with the same amount of joy and sincerity practically swelling up from within him. I hope I’ll greet my patients like that one day.
The nurse’s station at the clinic in Honduras
The pharmacy located across the street from the clinic
He was busy though–today was ultrasound day in the community. One of the three rotating ultrasound machines was currently stationed in Honduras and I could hear the speakers blaring outside to alert the community. “¡Señoras, señoras!” It called for all of the pregnant women to come to the clinic for what would be their only chance to see their children before the rest of the world did too. The flow of patients was continuous and Héctor, the visiting medical residents, and Argenis (the pasante assigned to Honduras) were all running around in order to keep up.
We decided we would come back a bit later. After we had eaten, I decided to accompany Iván while he conducted interviews for his mental health project. Iván is a current medical student from Mexico who has been working with CES since January to develop a mental health course that he will be delivering to patients of depression in Honduras in a few months. Mental health issues are infamously ill-addressed in resource-constrained settings, and so I was happy to see that CES was putting so much emphasis on it. And while I have conducted interviews for articles and other research projects before, I had never done so completely in Spanish (and certainly not when discussing such tentative topics). I was eager to learn.
Iván and a patient after conducting the first interview
Later in the day, Héctor was kind enough to introduce Hanna and I to a local partera (midwife) who told us that she has been delivering babies for over 40 years. She was more than happy to share some of her most memorable stories, waving her hands for emphasis as she explained some of the local birthing practices in the community. As I watched her share the experiences of a lifetime with the two strangers who had just walked into her living room, I couldn’t help but think that her energy seemed positively boundless. How wonderful it was that so many children had been brought into the world under her care.
As we left the home of the partera, Héctor, Hanna and I didn’t make it far before we saw a father approach us with his daughter in tow. Looking at Héctor, he began to explain that his daughter had a small protrusion on her ear and that it had been bothering her for some time now. He was looking for a doctor. Soon, another child was standing before us, seeking answers that he and his parents usually didn’t have an opportunity to seek out. Héctor gave each of them his time, no questions asked. No matter that he had other work to attend to nor that he wasn’t being paid for his time nor that he could have easily asked the patients to come to the clinic tomorrow–he was a doctor who could provide answers today.
I watched him with admiration. I knew that a similar query from a passerby to a doctor would probably have ended very differently in my hometown. Myself and most of the people I know are accustomed to having access to regular medical care, making appointments, and viewing time as a resource too precious to waste–especially when it comes to the healthcare system. But in the communities of the Sierra Madre, the freedom to escape from the pressures of a ticking clock is one of the things that I have appreciated most. I knew that Héctor would see every patient that approached him.
By the time we left Honduras the sun had fallen, and so I knew that our drive wouldn’t have us back in Jaltenango till near midnight. I stared out into the darkness as we retraced our way back through the mountains, this time carrying a patient from the community who needed to go to town for a referral. I could still see the mountains towering above us in the distance. Dark though it was, somehow they seemed familiar to me now. And they also gave me space to think.
My mind flashed through the scenes of the day–from the emphatic gestures of the partera to the baby chick I had held in my hand to the faces of the women Iván and I had spoken with. CES was providing healthcare here, where no doctor had come before. Miguel (a medical resident and our gracious driver for the night) explained that there are at least fifty more communities on the waiting list to receive a doctor. Town leaders have driven 4-5 hours to visit the CES office and to offer food, housing, and anything else that they are able to in the hopes that they too could have access to medical care. It was heartbreaking to hear.
And yet, even in the six communities that CES currently operates in, there are still misunderstandings and conflicts between the doctors who come from afar to deliver medical care in a community that they can only come to know with time. As much as they are providing a much needed service, the risk of their committing cultural gaffes is not uncommon. I may have studied the importance of cultural competency from my books and in reading the ethnographies of others, but I had never seen the concept unfolding before my eyes in real time. And CES, too, is not immune.
I knew that I would observe many more of these issues and various means of resolving them in the coming weeks and months. But in those moments, I was tired. Slowly blinking my eyes open, I realized too that we had long ago left the mountains behind.
In a few moments, we were walking sleepily from the truck to our rooms. I could still see the beautiful views of the Sierra Madre flying past as my head hit the pillow.