Butterfly Land

After a week of office work in Apartado, enjoying the good life with air conditioner and even a swimming pool, it was time to leave and get to work again.

First we had to go back to Rio Sucio, the flooded town. The bad news is that the road had deteriorated further in a few crucial places, a bridge almost collapsed completely, the river had gone up even more, and our MSF clinic was flooded too. The good news is that we were able to make it into town despite de road (God bless whoever invented land cruisers), there were more “bridges” made for walking around town, and the electricity was on, which meant I had a fan (life is always better when you have a fan). 

Even though the soccer field had flooded, the children where still playing. Something like a water soccer game. I guess there is never bad weather for children, is there?

Part of our team stayed in Rio Sucio. I left early the next day to another mobile clinic, this time by boat. Our destination: two isolated communities along the river Domingodo.

The first part of the trip was a real treat. Going fast along the Atrato (a large river that works like a highway here), wind on my face, i-pod blasting in my ears, life was good.

For the second part of the trip we had to switch to a smaller boat in order to ride through the smaller river. The natives from one of the communities met us with a long old and leaky canoe. I had my doubts that it would stay afloat with all the gear we had to load it up with, and with the water that constantly leaked in (one had to be constantly throwing water out with a little bucket), but somehow it did.

I went on the “bigger” MSF canoe, quite comfortable sitting on a plastic chair (thank you MSF logisticians). The ride was absolutely beautiful. The forest closing in on us, as a big hug from nature, the rich green leaves filtering the sun beams, producing amazing colors. But the most beautiful thing were the butterflies. So many of them! Orange, yellow, blue, they were just everywhere! I thought to myself “This is the best ride to work I have ever had”.

Well, there were obstacles, of course: branches zooming by your head just as you duck from them, floating logs and fallen trees. Thankfully somebody thought of bringing a chain saw (thanks logistics again). Just as one of our guides was cutting a big tree branch out of the way, and I was thinking “what a wonderful invention this machine is” one of my friends tapped me on the shoulder and said “ You know, there was a time when in this area they used to kill people with that, member by member”. A shiver went through my spine. It amazes me the capability of men to transform just about anything into some sort of weapon or something bad.

We have arrived in Chicao early in the evening.  It is pretty much a ghost village in a very beautiful area. The population fled from here in 2002, when the chainsaw massacre was going on and only a handful of families came back. It is a good location for MSF to set up the clinic because people can come in from several communities nearby and where access is more difficult.

We set up camp for the night, had our river bath and relaxed the rest of the evening, listening to the rain drops on the tin roofs and telling jokes.    

Until next time, Urada.

Written I can't remember when anymore, posted today.

I woke up early with the birds making noise. Actually, it was one specific
bird that literally screamed us awake. No need for alarm clocks here, more
useful are earplugs. This morning, knowing that the chances of bathing in
the river later were very slim, I quickly grabbed my stuff and went off to
the river. Cold water in the morning is actually quite nice. The river was
wonderful and I felt I could be there all day, but today we needed to do
things better, start earlier and see more people. We were expecting the
pregnant women from another tribe near by to come today, so even more
patients.

I assumed my post at triage again and got to work, holding children down to
take their temperatures, giving out pills, listening patiently and trying to
make sense of histories half told in Spanish and half told in Embera,
calculating weight/height tables to assess for malnutrition, etc, etc.

We made more progress this morning and I even had some time to go help with
the lab, testing people for malaria. In total we found 5 people with
malaria, all children. MSF gave them medication and mosquito nets. One of
the little ones (2 years old) was too sick and malnourished to stay and we
decided we needed to take him out with us. The whole family was very poor
and his 2 brothers were also showing sings of malnutrition. A process of
coordinating and transport with the local hospital was started using the
satellite phone (which is a tricky thing to do). It was decided that they
would leave with us the next day.

We saw a total of 62 people that day, 20 more than the first day. Finished
late again and still had to pack everything for the next day.

That night again the mules came to make us company all night. This time when
I needed again to go to the washroom in the middle of the night, one of them
was actually inside the washroom. Luckily I didn't have much trouble sending
it away with my flashlight.

We woke up at 5am with the punctual gentleman that brought more mules from
Pavarando to carry our gear. Also several men from the community came to
carry our backpacks for us. We left the two high quality water filters we
had brought with us as a donation for the school, in hopes that they will
use it to drink clean water.

This time I used a walking stick to help me walk in the mud and only fell
once :) Also, without the weight on our backs we made it back in only 2
hours!
The family we took out with us was taken to the local hospital and MSF
provided them with an allowance to survive the hospital stay. Later, the
whole family was sent to Medellin, for higher level of care, and our social
workers helped organize with other NGOs for accommodations. The last news I
had was that they were doing well.

Careful with what you wish

We got up early the next day to set up the clinic the best we could with the supplies we had. The men of the village got up even earlier to go get the rest of our boxes and I was pleasantly surprised when I saw the mules crossing the soccer field with our boxes covered in mud. Time to get to work.

Our team had 3 nurses, one doctor, one psychologist, 3 logisticians, and 1 translator. I was appointed to be the triage nurse, which is something I quite enjoy doing. We started late, since besides the delay of our supplies, we also had a lengthy meeting, were everybody that was present from the tribe wanted to introduce themselves.

Urada has no access to treated water. They use the river, which is clean and nice, but not treated. Therefore I was not surprised to find out that just about all the children I triaged had symptoms of intestinal parasites. I was giving out Albendazol like candy when they came back holding their prescriptions. It surprised me their attitude when taking the meds. I was ready for the usual fit that I see in north American kids whenever they need a Tylenol, but most of them did not make a fuss at all about it. They just took the pill and chewed it after their parents told them to.

The children were so beautiful and sweet. They seemed quite happy and loved. They were not the starved for attention type of children that I had found many times in Brazil. I could tell that these ones lacked a lot of material things (including food), but they did not lack love. My favorite ones were the little babies, who got so upset when I had to get them naked and hang them to be weighted. I must have done that procedure a million times, but the women would always laugh and make jokes in their language whenever I did it. It was quite cute to see them hanging on this grocery-bag kinda device.   

Most people did not speak Spanish at all and understood very little, which made my work twice as hard. Simple questions such as “what is your name” were often met with a blank look. But the most difficult question of all was “how old are you”. Most people simply didn’t know and didn’t care either. Some of them would pull out their ID for me to figure it out for them (when they had one), but a lot of them simply pondered for a while and then gave me some estimated age. I thought how wonderful would it be to grow old and never realize it or really think about how old you actually are. Age is an invention of the modern world, of the busy men running around the rat race with their watches tightly wrapped around their wrist. Here, age didn’t seem to mean anything of importance. I learned something then.

Talking about age, the oldest person I saw was about 60 (looking more like 75). A little old lady that negotiated the narrows steps to climb up the house where we had triage set up. Most people were young, on their 20s or 30s. I thought what the life expectancy would be here. Probably around 50 I would estimate.

Another major problem we discovered, was the lack of registry. Most people did not have any record of birth or of existence. Without that paper, they can not get registered for health insurance either. So one problem leads to the next.

Vaccinations were also severely late and missing. Most children simply did not have a vaccination card, and the ones that did were behind on their schedules.

We saw about 40 people that day. We finished too late, when it was already dark, and therefore I could not go to the river, scared of meeting a snake and not seeing it. Fortunately it rained and a small shower was created from the water coming down the roof. So we bathed with that.

That night something funny happened. You know that saying “careful what you wish..” Well, in one of our meeting we had agreed that it would be nice if we had the mules available 24hrs, in case of an emergency situation or evacuation. Well, that night the 3 mules that live in the village paced around the room where we were sleeping all night long, clunking their feet on the concrete and pounding their tails against the walls. I woke up with the noise and desperately needed to go out to the bathroom. That’s when the paranoia kicked in. What if  there were men with the mules waiting outside for the first victim that gets out. I thought I heard steps. I laid with my eyes open paralyzed on my hammock, thinking what I should do. Should I wake somebody up to go with me to the bathroom? That seemed awfully stupid. I mustered enough courage to lift up my head and look outside. My gaze was met straight on with the mule’s and I jumped on the hammock. Phew… the mule was alone and it was quite happy to go somewhere else when it saw me. I made my way safely to the washroom with no further incidents.

The next day I found out that my colleagues experienced similar fears, so I didn’t feel too embarrassed. Our native translator was quite sure it was the guerrilla invading the village and started to pray. Anyways, moral of the story: careful with what you wish.  

Kiamombre (Good day in Embira)

Today we set off to Urada, an aboriginal village isolated from everywhere else (don’t get it mixed up with the afro Urada, I have been told). Despite weeks of planning, we are still not sure of what to expect. This is the first time MSF is going to set foot there. Contact with the community leaders has been difficult, but they are the ones that asked for our help; therefore at least we know that we are welcome. We know we are supposed to meet them at Pavarando, where there will be an x number of mules (despite insistent questioning we were still not sure how many mules would be available to carry all our gear).

The road to Pavarando was the usual gravel, muddy, holy and narrow road. At times I felt like we were driving through the bed of a dried stream, with the thick forest around us. Beautiful drive, and I would have enjoyed it even more if I were not dying with the heat.  “Doctors without air conditioning...” I thought to myself, oh well, I survived.

At Pavarando we made a stop at the local health clinic in which MSF worked for quite a while and helped set it up. All looked well and the only thing I had to complain about was the big rat I saw by the bathroom. Oh well again..

The aboriginal women were waiting for us - on their bright and colorful skirts and shirts -  ready with their baskets to help us carry our supplies. The men showed up shortly after, with ONE mule. Well, considering that we had at least 10 big boxes to take, 3 small coolers, food AND water… well, we had a problem. Not realizing the amount of gear we had, one of the men asked if all the mules we needed were for us to mount! I wish…  Oh well again.

Unable to find any mules to rent at this time of the day (it was now past noon), we decided to take whatever we can and leave the rest behind at the health clinic, and the men would come back for it first thing in the morning, rent some mules and bring it up. So we set off with our backpacks, heavy sun hitting our backs. I prayed for rain.

We had been told the walk was rough and swampy. But that’s describing it lightly. By swampy, they were referring to one foot deep, thick slimy mud. The kind of mud that when your foot sinks in you need help to be pulled out. And no other way around it. Just thick deep forest all around. My favorite part was crossing the rivers, were I could refresh my face and arms with the cold water.

As I walked though the narrow path, precariously trying to keep my balance hanging on to leaves and whatever I could find (I only fell 3 times), I remembered that in Canada, one time I saw this bridge that the government maintained despite only a handful of people using it. But those people lived on the other side of it therefore the bridge was needed. A whole community, left with a muddy walking road, would just not happen in Canada. Somebody would protest, a road would be opened and maintained.

I also looked back at our MSF training in Germany, when we had to walk for 5 hours in this park carrying jugs of water for a “team dynamics” exercise, and thought with humor how I had found that hard.  That was nothing! Now I was doing the real thing, with 30 plus heat and sun, on the mud and a heavy backpack to carry. Oh well again

Three hours later and water supplies exhausted (except for one jug) we arrived. I whish I could have taken a picture of our team, mud all the way up to the eyebrows, but all happy (MSF security policy does not allow pictures at the moment).

The village, was comprised of scattered houses, made of wood, with straw roofs, built elevated about 5 feet from the ground, with chickens and pigs walking around peacefully. In order to get up to the house one has to climb a little log, carved every 7 inches or so with a hole for your toes to fit. The village also had a soccer field and a school.

We were taken to the school, where we would work and live for the next cpl of days. I was impressed with it. By far the nicest building, organized, well built and planned. It had 3 large classrooms and even 2 bathrooms (real toilets, with a flush and everything). As everything else, it was made with large wood boards, except that these ones were stamped with “Bolivar lives, the fight continues” signs.

We set up camp, hang up our hammocks and the MSF banner, explaining who we are, what we do, etc. Then all the women in the group desperately set out for a bath in the river, and oh, what a nice surprise! What a beautiful river with clear crystalline water, so cool and refreshing. My spirits were renewed, and I stayed in there until the light went down; then put on my rubber boots again and set out for dinner and my hammock. Fell asleep, tired but happy, listening to the frogs sing, "reading" with my ipod and thinking about what we would find the next day.