Sex, Drugs, and Public Health

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.

I needed some local money. Bolivianos. The hotel directed me to the nearest bank. A National Bank of Bolivia. Sounds good, top of the banking heap.

Outside were three heavily armed, stern faced adolescents in uniform. Taking their bank seriously. I fought back an urge to tell my name was not Butch.

Inside, a mob. Really. Twenty chairs for waiting, all full, and another 20 milling around. No lines leading to tellers. Episodically, someone got up to go to a window. “Ping” went a sound. Another person got up. Oh, oh. Do I need, like, a ticket? As in “take a number?” New people streaming in, and surrounding a small, well dressed girl gave me the answer. I worked over to her, but a half dozen folks who came in after me now had numbers before me. I sat, clinging to my ticket, and watched a screen telling each number which window to approach.

After that, it went like this : wait ; cop marches over and tells me to take off my sunglasses (I fight an urge to tell him my name is not “Sundance” either) ; I get called ; “we do not take Traveller Checks at this window. You need a different number” ; get a different number ; wait ; new window ; “I will need to talk to my supervisor” ; she disappears ; wait ; finally, “we do not take Traveller Checks. “Buenos dias” ; ·Can I get cash from my VISA?” ; “give me your passport” ; wait ; “sign here – – and here – – – and here – – – now write in your passprt number here” ; “but you have a COPY of my passport. Why do I need to put the number?” ; I get a vacant look implying I just asked a really stupid question ; I write in my passport number ; get another number ; sit down ; wait ; get called ; “where is the duplicate of this form?” ; “this is all Paola gave me. You can speak to her. She works right over there” ; she looks confused, but tries to hide it ; she shrugs and counts out the money ; as I leave, I pass the cops again but do not worry. By now it is too late for sunglasses.