Sex, Drugs, and Public Health

Déja vu; déja vu.I wasn’t gonna wait for it to hit me. I went searching for it. My eyes glommed onto everything that had not changed in 40 years., digging thru the New Asunción for memories.

Campesinos flooding into the capital looking for jobs and foreigners seeking cheap retirement in Paraguay have spawned uncontrolled growth of the city. But I found some goodies.

The Panteon de los Héroes still honors past dictators in crumbling plaster, protected by adolescents in military garb wearing serious faces too young to shave.

And right across the street, the Lido Bar, packed with customers both inside and at tables on the sidewalk, offered us batidos de durazno, grilled chicken, but no mandioca (I can’t believe I actually wanted some). They were all out of the tasteless, stringy root. We had to settle for potatoes.

A couple of blocks away I caught a glimpse of a name painted on a building, the paint so faded it nearly matched the sooty plaster of the wall. But it was legible : “Munich.” Maybe it’s closed, I thought, but I’m gonna get a picture anyway. I know some folks back home who might like to see it.

But it wasn’t closed.

Dinner that nite, on the patio of the Munich, did include mandioca. And beer. And stars glittering thru the vines of the overhead arbor. The cathedral bells gonged our time there, in warm and perfumed nite air.

The Hotel Guarani got a visit from us, but not our business. The visit was to its roof, which offered a good, but precarious view. No railing; demolition underway for remodeling. But we looked down upon the Plaza and the flowering tops of trees: orange and yellow blossoms. Down upon the lazy river that winds past the city, no more urgently than in 1972 (or, I imagine, 1872).

The other Plaza – Uruguaya – was littered with crude tents, smoldering fires, and heaps of stuff resembling garbage.

“Indiginas,” we were told. “From the North. “They want land.”

The next day,we walked thru the Plaza, and found just that. Families living a very dirty and marginal life. They had brought the distant campo right into the downtown. I squatted and asked a nursing mother where they were from.

“Alto Paraná.”
“What group? Aché?”

She shook her head: “Guaraní.”

ABC Color, the local newspaper, ran a very short article buried on page 30. They referred to the occupiers only as “Indiginas.”

Deja vu, indeed.

Tiina insisted that we buy some food for her and her family. A good idea. It would probably be very difficult for the woman to take any money I might give her and shop with it. We brought them a picnic of chicken barbecue, a carton of milk, juice, crackers. A good meal for one day, but they need something else. And that’s in the hands of Paraguay’s government. Again. Still.

Home for our two days in Asúncion was the Gran Hotel del Paraguay. Refurbished, but still the sprawling century- old home of Madame Lynch, with its ten foot high doors, tile floors, hardwood trim, and brass beds. The staff behaved as if it were the 1920’s; the food was good; the pool was big and decorated by the breeze with floating leaves and twigs. The diesel belching cacophony beyond was muffled, and the heat defeated, by gardens of flowers and fruits I’ve never seen before, where a macaw and toucan live.

I warned Tiina that, one of the endearing things about Paraguayans was their innocent recurring irony of trying to be classy and up to date, but planting little surprises there to which they were oblivious. Like the modern glass paneled shower stall in the hotel room wherein the shower head was aimed right at the hinged part of the shower door, so that the floor of the bathroom was flooded by the time you stepped out. Or the large script letters painted on the exterior of the downtown icon proudly proclaiming it the “Hotel Guarani Splendor” but with paint peeling in large sheets from the wall just beneath the letters.

The final deja vu, amid the concrete and glass sprawl of the New Asuncion, was the Paraguayans themselves. Self proclaimed historians who laughed at my jokes told in Spanish and who bubbled about the glories of the country’s multiple wars of wholesale slaughter. The geologist who was born in the Chaco (Filidélfia) and discussed at length the need for a quality education for Paraguay’s future generations and also for birth control. And, finally, the cab driver who pulled over from the random traffic after I’d tried to wave down a cab for half an hour.

“The city has grown since I lived and worked here 40 years ago,” I opened.

“Forty years? Mucho tiempo. Where are you from?”

“The E.E.U.U.”

“No me diga. Before I drove a cab, I used to work for North Americans. The Cuerpo de Paz. You know it?”

“Uh-h. yeah. What did you do?”

“Messenger. And driver. From 1985 to 1992.”

“Well, I worked as the Peace Corps doctor in the 70’s, and bought a car from the driver. His name was Francie.”

“Francie?! I know him! He is a friend.”

I felt the warm flow of Deja vu like a swallow of caña, from my heart all the way up to my smile.

There is a bird whose morning conversation, we have conjectured, may well have inspired the melodies of human songs. He lives in a tree among the flowering plants of the Hotel´s garden. Attempting to transmit his vocal pattern via prose will cheapen it, but I have no recorder.

With crepuscular light over Asuncion, he whistles a high / low / high / low pattern which jumps up a half octave after a few repetitions, then down for a few more. It´s so distinctive, it stands out over all the other birds´jabbering into the early morning, even the piercing caw of the caged macaw.

Notice the onomatopeoia in the bird´s name?

They speak two languages here: most Paraguayans speak Spanish, imposed on them by gunpowder and steel from Europe 500 years ago; all of them speak Guarani, the language of the original dwellers of forest and savannah who must have learned from the birds how to communicate.

Now the Spanish here has taken on the melody of Guarani, the melody of the animals. It is smoother than the Quechua infused Spanish of Peru and Bolivia, and certainly softer than the arrogant trills and sibilants of Argentina, the looming big brother who casts his shadow over Paraguay in many ways – most currently, on T.V.

This city has doubled or tripled in size since I lived and worked here long before my hair was grey, bringing plenty of Public Health issues to feed my synopsis to come. But the bird in the garden tree ignores all that and speaks with his original voice – his only voice. The voice that taught some of us to speak.

We could all benefit by listening more to such organic sounds, and a whole lot less to the electrionic sounds that have taken over our world.

It was an accident of sequencing, driven by arbitrary things like moving north to south without backtracking, and scheduling of the nurses training in Cochabamba with work in Mariposa, but it all looks so organically logical now.

We began high in the mountains where the Quechua have lived for centuries, even after the murder of their revered king, the Inca. Explored the bare rock skeleton of their magnificent city in the clouds, long devoid of plaster, gold and silver fixtures, and colorful textiles, but still breathtaking. I stood looking at it, fighting back tears. Elsewhere in the mountains, we walked on stones they laid over 500 years ago; we stepped over the mountain spring water still running in their ancient stone canals; we heard them speak their language, and then speak Spanish with strong Quechua pronunciation.

Sitting at a table on the plaza in Ollantaytambo – which name implies it was a resting place for the Inca runners who carried messages thruout the Empire – we saw a Quechua man in a red poncho bend over one of those open stone canals, dip in a plastic cup, and drink. As would have a runner over 500 years earlier. (Sans plastic).

Then, moving south, Cochabamba: an old town of Spanish buaildings which are slowly being consumed by algae and dissolved by rain. Everywhere, you see both races – the Euorpean faces of Bolivians who run businesses and create the local art scene, and the Quechua, still wearing sandals and traditional textiles, speaking their language until forced to speak Spanish. Their faces are still bronze, muscular and proud.

Both groups call themselves “Bolivians” but – - -

Now, here in Santa Cruz, its hard to feel that we are still in Bolivia. The second language here is Guarani; Quechua ponchos and colorful dress are rare. When I was here 40 years asgo, it was a sleepy Spanish farm town. Ox drawn carts on main street. Main street made of mud. Now, the city sprawls like a large Fresno or a small but growing L.A. Million dollar mansions and flashy sports cars rule, and the hot humid air makes you take off your poncho, but also spurs the trees to flower. Flowers so bizarre and colorful, nothing we have ever seen is like them. Even locals cant name them for us.

Yesterday we were assaulted by macaws and a toucan, looking for food. Butterflies everywhere.

So we have moved from the South America that existed before the Spaniards came, to streets where the two races intermingle, and now we watch as California – style agribusiness and cocaine dollars pave the formerly muddy streets and raze the sleepy haciendas to re-create Miami.

Leaving today for Paraguay, country of Jesuit missions, aboriginal forest people, and millions of memories.

Far from the city of Cochabamba, sometimes a couple of hours walk from the last bus stop (because there is no road in) are several dozen health clinics where the nurses from todays class work. Where sometimes major trauma from auto accidents, where bites from venomous snakes, and where complicted labors occur and there is no ability to medicallly evacuate the patients.

Where there is only one doctor assigned and he is sometimes absent.

Upon these briefly trained people falls the responsibility of being sometimes the only medical professional for miles around, and for every medical need.

With these folks I walked thru an investigation of a disease outbreak, hidden within the routine patients they see every day. Cholera lurks in the northern section of town, and the first three cases show up, among the routine sore throats, tuberculosis, and pneumonia. I planted nine envelopes at desks in the classroom, and, as the nurses in those seats open them and read aloud the description of each of the 9 cases, I urge them to begin to suspect an emerging outbreak. With the Power Point, we re-arrange the data, and the pattern emerges. I praise their detective work and warn them to be vigalent. Epidemiology 101.

Next, I discussed (at Dr. Zegarras request) the Social Determinants of Health. I urged them to think beyond their clinic walls, to see how the source of water, how getting prenatal care, how drinking (“chicha” is a favorits alcohol here) and driving result in Bolivias high mortality statistics. In short, I urged them to also do Public Health.

But what they seemed most interested in was to hear the Gringo doctor sing a song from this “California” place. They asked for it. They got “Folsom Prison.” Bush and Cheney would replace waterboarding with my singing, if they could, but it sure broke the ice. I hope they rememmber the Public Health lessons more than my croaking.

Dr. Velasquez picked us up early (5:30 A.M,) and headed up, out of the valley, toward the rising sun. Thru the rolling hills of small family farm plots and eucalyptus forests, we found our way onto increasingly narrow and infrequently used dirt roads. Eventually we drove into Cotani Bajo, a very small village of Quechua speaking farmers.

Their only health facility was an old adobe structure, crumbling back into the earth from which its bricks had been formed, decades before. It was dark and cold inside. Flashlite and parka. The waiting chairs were bare metal. A wire of 220 volts hung menacingly from the shower head in the (frankly disgusting) bathroom. But it was the “Sala de Partos” that was most telling.

Women were put into the rusted metal beds covered with tattered blankets, to labor their children into the world of Cotani Bajo. Paint peeled from the walls. In the middle of the stark room loomed a metal delivery table. No bassinet. No incubator. In the ceiling over one of the two beds was a gaping hole above where a mothers head would be.

Bolivia has an Infant mortality rate more than ten times that of California.

Its Maternal mortality rate is over 300 deaths per 10,000 live births, twenty times that of the U.S,

The townspeople, who came out to greet us in the cold dawn at 9000 feet, had requested that Mano a Mano help them build a new Health Center. They had a site, a plan to provide electricity and running water, and were already building a plaza of carefully laid stones. Altho crude, I could see in their rock work the visual echos of the work of their ancestors – the Classical Incas.

We shook hands with all the coca chewing men, walked around the grazing cows and sheep, and drove on to our next stop, the trucks heater blasting.

Later, in another town, we stopped to inspect an operating Mano a Mano Health Center. The doctor was busy with patients, all smiles, working in his well-lit, clean, brick and tile building. The dentist showed off his new Brazilian dental chair, hydralics and compressed air and integral plumbing. He had just bought colorful toothbrushes for the local school kids. For contrast, I looked into the Sala de Partos. Clean, well lit, an incubator waiting, clean bed, sterile equipment. A cheerful room.

Since the new Health Centers construction, Infant and Maternal mortality stats have begun to fall.

When Cotani Bajo gets its new Health Center, it will be Mano a Manos 125 th over the past 15 years.