another bike ride...

It is really dark…kind of spooky…probably 11:30ish…I have my head-lamp on with its suddenly dwindling batteries…aside from the 2 small rocks I have ready for angry dogs, my hands are free to wrench the handlebars as my feet stomp the pedals. The rainy season has brought huge, cavernous puddles to the dirt roads. A few families have filled these puddles in front of their homes with dirt and stones, forming lakes of sticky mud with big rocks sticking out like tiny islands. My backpack is lob-sided and stuffed full of medical supplies. I have only a slight idea what I am going to need, have absolutely no idea where I am going, and I am going to wipe out…big.

A half hour ago I got a call from the daughter of the cook I described a few letters ago. Her mom, our friend, was pretty sick. She didn’t have a car to bring her mom to us at the house, so I am on my way to her. After getting the call, I woke up M, the promoter living in our home. She couldn’t describe where I needed to go, but thought maybe she could find it, if she saw it. As I had examined our cook in clinic just after lunch, I knew she was sick. I had recommended that she go to the hospital immediately. With money, transport, and uncertainty in the medical care in the hospitals, especially during the late afternoon, she opted to sleep in her home and go to the hospital early in the morning. Apparently she had gotten worse, and she really looked lousy 9 hours ago. M pulled her hair back with a band, and without changing from her pajamas, was ready to go. I put on some clothes, threw things into a bag, grabbed the car keys, and my license. We ran out the screen kitchen door. Empty driveway. Definitely a “crickets chirping” moment…we looked at each other…I ran around our classroom building because sometimes the promoters leave the trucks there. Empty. ”Bikes! Get your headlamp…” I said to my promoter friend as we ran back into the house. The promoter that lives here is a wonderful woman and a great medical provider, but I completely forgot she is just learning to ride a bike. I remembered this the moment I sped down the driveway, flew into the street and waited for her to call out a direction. More crickets. She persevered bravely, but fell pretty badly and soon after leaving the driveway as the roads were in atrocious condition. She tried to keep going, but her frustration broke through her universally pleasant demeanor. “Forget this…I am waking people up…I am going to find the cars…” Then she groaned as she remembered she used up her most recent pre-paid phone card and couldn’t make a call…I gave her my phone to call our colleagues. As I was really nervous about the time that had already passed since the initial phone call, I asked her where to go. She quickly said “al tope!”. (which means to the very, very end (of the road).) hmm…I jumped on my bike and sped off to "the end of the road". And I kept going. The road got smaller and more overgrown, the houses got further apart. When the road ended in a mass of trees and brush, I figured I had probably gone far enough. No one was waiting, no lights were on. It was dark. I raced up and down streets. Got chased by dogs. Nearly hit some goats(??) laying in the road. I think they were goats. They didn’t bark. It sort of felt like I was treading water in shark-infested waters…biding time until I found the house or received an inevitable mugging or dog-bite.

Meanwhile la pobre promotora…using my phone, she was unable to reach anyone. No one answered her calls. Stuck and getting more desperate, she started pedaling to the center of town. She cautiously approached some people working for a traveling fair that is currently on the town park-center. She got afraid and thought better of asking for their help and pedaled away at the last instant. With a fleeting thought of waking up the padre in the local Catholic Church, she opted for people she knew should be awake and had transportation. “La policia!” (I need to say the civil war here really changed how the public view government agencies like the police and the army. This relationship is vastly different and does not contain the innate trust people in the US have for people in these official groups. This was a big step.) On her way into the police building she had to walk through a group of armed soldiers. “There is a sick woman and we are trying to get to her house. It is an emergency. Can you help me?” They began to ask her some questions to clarify the situation in their minds. “Who is sick? What is the problem? Where does she live? What is her last name…”As we never use last names here, my friend had no idea about our patient’s last name. She was winded and probably not very convincing. Her interview didn’t go over too well. I suppose the fact that she was obviously by herself and kept using “we” didn’t gain her much confidence either. They sent her inside to talk with the police. Covered in mud from her bike falls, limping with a bloody knee, hair and pajamas askew, the promotora raced into the police station. In her excitement she didn’t identify herself and went right into the story. “You are drunk aren’t you?”… ”What?? No!” When she mentioned where she worked they relaxed a bit and listened to her story, which she fired off rapidly, with growing concern. She knew someone was sick and that she had sent me in the general direction of “al tope!”…”Are you going to help me?…there is bleeding! If you aren’t, I’ve got to figure out something else to do”…The police agreed to help, and she reiterated that she wasn’t completely sure where this house was. They climbed into the big pick-up quickly headed back to our home. “Ahhh! Where are you going? Her house is that way!” I guess they still weren’t sure about her sobriety and decided to dump her back at our house and be done with the whole event. I don’t know what was said, but they finally agreed to turn around and help her search the town for our sick friend’s home.

Amazingly, I saw a shadow of a man moving up ahead. Sweaty, mud-covered, in the thick of darkness, I sped over to him. On hindsight, in the middle of the night…this might not have been really prudent…“Do you know where Doña C. lives? The cook??”

He was initially thrown off and confused, but as he began to start a reply I saw a truck cross the road a ways behind me, but headed in the general direction where I thought our cook’s house should be. I didn’t wait for his response; I spun around, thanked him over my shoulder and started to chase it down. It was moving steadily, and it had lots of distance on me, but it was impeded by the puddles. Despite its lead, it was hard to lose as there weren’t any other cars on the road, especially with working tail-lights. When it was still blocks ahead of me, it turned a corner. I eventually got to the turn, sped around the corner to find that I had gained! The truck was 50 yards ahead, but now in reverse. I pedaled up to the driver’s side of the truck. Letters on the door spelling “La Policia” reflected brightly from my headlamp…I just realized that I will likely never again have the opportunity to approach the driver side of a police truck and be able to shine a bright light into the driver’s eyes…Nor did I think to ask for his license and registration…missed opportunity there. “Buenas noches…Do you guys know where Doña C. lives? I am a doctor…”

”Hey! Yep, yep...that is my friend!” A voice erupted from the backseat. The promotra, who had been describing a here-to-fore fictional back-pack-laden, bike-mounted North-American with a head-lamp sat back and smiled in her instant credibility. I threw my bike in the back of the truck and we headed off.

Still lost, however…We called the number back of the woman who called me to get more specific directions. We used home colors, a school and a phone tower as reference points. “All our lights are on” the family reassured us. “Get out front and wave a flashlight around!” We turned the corner and our headlights lit up a thin old man waving a flash-light over his head. The few lights that they possessed were on, but they didn’t have many and none were outside their home. We ran into their one-room house. Doña C. was pale and shivering on her bed, under her mosquito net. She was sick, but it wasn’t immediately obvious that she was worse than she had been earlier. The more I examined her, the more nervous I became. She needed to go to the hospital immediately (again?...still?). The family had no means of transport. In the past year, our town has been fortunate to not only obtain a serviceable ambulance, but also to find a responsible driver and a local doctor that approves its use. The ambulance is a basic revamped pick-up with an elevated cab cover over the truck bed. When in use, the construction prohibits verbal communication between the driver and the patient. Usually a family member rides in back and taps on the glass for any concerns. We are often teaching the family the basics of intravenous lines and fluids as the ambulance is pulling away. Having a vehicle of any sort reserved for transport of sick people is a luxury that often is unsuccessful here for a variety of reasons. In our town, the system is functional and effective…that is if the approving doctor answers her phone…another strike…she doesn’t live locally, and as we are the only people who handle emergencies here at night, she is usually available to us. Not tonight. M, the promotora, asked if anyone knew the ambulance driver’s phone number. She used his first name, preceded by the polite “Don”. M’s head nearly exploded when one of the policemen asked, “what is his last name?”…Desperate…she called back to our house where another promoter was sleeping. He answered his phone! But to say that she was able to wake him up would have been a complete overstatement. She finally shouted “wake up…I need your help! Brian wrote the driver’s number on a letter…it is on…”

”I can’t find it…it isn’t here”

“I didn’t tell you where it is yet…”…Though his lucidity improved, he didn’t end up finding the letter nor the number. But the daughter of the patient said she might know where the driver’s home is…everyone ran out of the house, leaving Doña C., her husband, and me alone. I started fluids, checked vital signs and arranged her for transport. I looked around their home. They lived rustically; they had a roof over their head and they had each other. The husband entered the one-room home and I realized he was dressing up to go to the hospital. He was tucking a clean, pink, collared shirt which had frayed elbows into a pair of thread-bare pants. He looked at me as he tried to arrange his hair in the mirror-less room. “Thanks for coming to help.” Something about the man dressed in his nicest clothes, in his dark home as I am preparing to send his wife to the hospital really resonated with me. This man and woman are poor for reasons outside of their control, but have maintained their dignity, kindness and generosity. I don’t know how I got so lucky to have an opportunity to be here experiencing real life in a different culture. I also am not thankful enough to have been given the freedom and the opportunity to make choices in my life and to pursue a career that I want to follow. I was pretty shaken.

The moment was shattered as the ambulance arrived. People flooded into the home again. The boys: the weary-eyed ambulance driver, the prepared husband and I stepped outside and waited for her family to change Doña C into clean bed-clothes. The night was clear and not too hot. I learned that our bikes were now at the ambulance driver’s home. I memorized the location and repeated it back. I wasn’t taking chances. By 1:30, we were walking our cook toward the awaiting ambulance. It wasn’t easy. She was tired, weak, and still really sick. The IV was cumbersome as we helped her along. We kept sending people back to her bed and closet for forgotten items. Finally she was in the ambulance, covered with a blanket, extra clothing and materials, ready to go. I looked at the ambulance driver, he didn’t seem too bothered to have been woken up at this hour, but he still had a long drive to the hospital ahead of him. Doña C asked for us to send her to a hospital further away because she didn’t want to cross the river. The nearest referral hospital requires a short ferry-trip. A bridge has been planned for years, but hasn’t come to fruition. We convinced her she would be safe, and started to close the doors. “Aren’t we going to O’s house??”

“Doña C, you need to go to the hospital…and who is O??”

After another short discussion, we learned that C was using the proper first name of her partner in cooking, that few people ever called her.

“She is asleep C, you can call her in the morning and she will come visit.”

“She is ready, I know it.”

“Have you called her? Is she waiting?”

“No, but I know she’ll get ready quickly when we wake her up.”

We kissed her and closed the ambulance doors. We were dropped off at the main road. The truck continued off toward the hospital as we finished the walk home and quickly passed out asleep under our mosquito nets.

This happened just over two weeks ago. Doña C has just gotten back home. We haven’t been by to visit yet. I found out today that O had sensed something was wrong that night. She had indeed
been waiting…in her doorway, watching the dirt road, packed bag at her feet.

See you soon,
brian