House Call in Cabanacondi
It was day one of Quechua Benefit’s IV medical Mission to the Colca Valley in Peru. Quechua Benefit (QB), www.quechuabenefit.org, is a nonprofit organization founded by alpaca owners and breeders in the USA, Canada and Australia. The QB focus is to provide medical, educational and sociological care to the region from where alpacas were exported, the native land of the llamas, guanacos, vicunas and alpacas. Casa Chapi, a QB project, is under construction in the valley. It is located just a few kilometers from the town ofChivay and near the village of Yanque. Casa Chapi will provide 100 youth from the Colca Valley with a place to live while going to school learning a trade that will provide themselves and their families a livelihood when they complete their education. QB activities are a sort of “payback” to the Peruvian people who helped make it possible for us north of the equator and in other areas of the world to enjoy the benefits of owning and caring for herds of the lovable alpacas.
I consider it a privilege to have been asked to participate as a Spanish/English interpreter on this medical mission. I was assigned to Medical Team 1. After a6 ambreakfast at Hotel Nativo in Chivay, our 18 passenger bus picked us up for the 2-hour ride westerly down the valley and along the south rim of theColcaCanyon. Views of the canyon, the snow-capped mountains and condors rising on the thermals from their nesting places on the canyon walls to make their daily flight toward the coast in search of prey kept my attention and made the bumpy ride over the one-lane road bearable and yes, even enjoyable.
It seemed almost unreal that on his Friday morning it had been little more than 48 hours since leaving Portland at 6 am Wednesday, arriving at Midnight in Lima, a short rest at the Hotel Vista del Sol, a morning one-hour flight to Arequipa, a 4-hour ride to Chivay over the central range of the Andes mountains where at one point the road was 4,910 meters (16,108 feet) above sea level, settling into Room 209 at Hotel Nativo, dinner with the entire QB entourage at a Chivay community center built a few years ago by benefactors fromSpainand then helping sort medications we had brought from the US.
I usually travel with only a carry-on bag, but in this case had checked two large suitcases weighing exactly the limit of 50 pounds each, filled with medicines. Others had done likewise, so there were ample medications to dispense at the “pharmacies” set up daily at each team’s clinic. The medications are purchased from a supplier working with pharmaceutical firms that help provide medicine at low cost for groups such as QB who provide care in area of poverty.
We arrived about 9 am at the Cabanacondi Puesto de Salud, a government clinic staffed by a nurse and technician. We set up quickly, with Dr. Bailey in one room and our pharmacy group in another. Our own nurses and assistants set up in a room to do triage and take blood pressure, temperatures and pulse rate. We put a small desk in the lobby for Ruth, our Peruvian assistant, to register each patient on a triage form. Dr. Bailey’s wife Deborah would be in the examination room with her husband, and for each patient he would dictate to her his diagnosis and prescribed medications. She would write this information on the triage form and the patient would then be accompanied to the pharmacy group to receive medicines prescribed.
Our visit to Cabanacondi, a village of people with mixed Spanish and Quechua descent, had been publicized for several weeks, and it was apparent that we would not lack for patients. A line of folk began to form and we were underway by9:30. I was assigned to interpret for Dr. Bailey.
Before the trip I had suffered a degree of angst about the responsibility of interpreting in a medical setting. I had done it inHonduras, but that was over thirty years ago, and I knew that in recent years my Spanish language skills were declining because of limited usage. My good friend inPortland, Dr. Steve Boyer, had reassured me that the Spanish inPeruwas easy to understand and that I would not find it difficult to interpret. He was right!
The best way I can thing of describing the spoken Spanish inLima,Arequipaand out in the villages is that it is “pure and crisp”. It is similar to the textbook Spanish I had found to be the case inColombiaquite a few years ago when I worked inCali. It was a somewhat effortless transition from thinking in English to thinking and communicating in Spanish and passing on the interpretation in English to Dr. Bailey. Chatting with the Peruvian locals was an experience that once again connected me with the struggles of wonderful people who eke out a living from their chacras (the fields they till and plant). Most of their plantings are habas (broad beans) and potatoes.
When Pizarro and his Spanish conquerors took Peru in the 1500s they introduced Europe to potatoes, found then only in Peruand other South American countries. Then from Europe a few varieties were introduced by the colonists to North America and with the help of Luther Burbank in the early 1900s we now have the popular Russet potato, grown extensively inIdahoand easternOregon. The Ore-Ida Corporation would not exist had it not been for the Peruvian farmers!
Excuse me for getting off on a tangent. But it is facts like these that helped to create casual conversations with the villagers, to connect with their day-to-day life in the mountains and endear me to the wonderful rural fold of the communities where we worked along the valley overlooking the Colca River Canyon.
In the early afternoon that dist day at Cabanacondi, Dr. Bailey asked me to announce at about 3:30 to the people waiting in line that we would not see patients after 4 pm, but to assure them we would return the next day and if they were already registered would be first in line to see the doctor. He told that the reason for quitting early was that he had agreed to make a house call before leaving town that afternoon. He asked me to be sure to go with him to interpret. So at about 4pm we buttoned up the clinic and five or six of our team walked just a few blocks to a most humble home.
The fist thing I saw inside was an elderly gentleman on a makeshift bed, groaning loudly with each breath. There was only a dirt floor and besides that I don’t know what. My focus was on the suffering eighty-year old patient, the relative gathered around him, and Dr. Bailey. According to the family, the man had suffered from a stroke more than ten years previous and since that time had been unable to talk. The groans were the only way he could express the pain he was enduring. After a brief examination Dr. Bailey asked me to have the family and the others in the group to stay by the bedside, and for me to step outside with him for a minute or two. Once outside, he told me, “Richard, the man has extensive pneumonia and is very weak. He will probably die. Please talk to the family and explain to them that we will give strong pain medicine and begin antibiotics, but that even in the finest of hospitals, it would be a miracle to survive his present condition.”
The middle-aged son who had arranged the house call was the obvious one for me to talk with. After searching in my mind and soul for what to say, I asked the son to step outside with us. As I related to him Dr. Bailey’s message, he nodded his understanding of what I was saying. Then he told me that the family had suspected their father and grandfather was near the end, that they were prepared for the event and would be relieved to see the end of the suffering. Then he went with one of our pharmacy group to bring back the pain medicine and antibiotics. When the son returned a few minutes later Dr. Bailey helped give the first doses of medicine. We reviewed dosages with the family to make sure they understood how much of each medicine to give in the morning. We left with somewhat heavy hearts, but knowing there was nothing more we could do.
As planned, we returned to Cabanacondi the next morning and fell back into the “routine” of receiving patients. About midmorning someone told me that a man had come to see me and was waiting outside. It was the son of the house call patient. He told me that for the first time in many days his father had slept the night without groaning in pain and wanted to thank the doctor for giving his dad a good night’s rest. But he said that when his dad awoke, he was still in pain and resumed the groaning. The family had given him more pain medication and the antibiotics as prescribed. He said the family would stay at the bedside regardless of what might happen. He hugged me goodbye before leaving and repeated his request to thank the doctor and the others in the group.
That afternoon the man passed away. We were ourselves comforted by the thought that one of our medical team. “At least he was given one last good night of sleep before he died. And his family was thankful for that.”
Thanksgiving Day weekend, 2011