Marisa

When Marisa came to the clinic that stifling October afternoon, she didn’t say much.  But then she never did.  If not for the village gossips, I would not have known how she suffered.  

“They live upriver all alone on that island, and her man almost never lets her leave the house,” they told me.  “They say he beats her when he gets drunk and sometimes he hurts the children too.  He refuses to buy her any maternity clothes and always makes her wear jeans just to shame her.  We don’t know if he is a little slow, or just plain mean.”    

                Upon entering the clinic she needed no gown since her eight-month stomach protruded from below her cute blouse and above her fitted jeans.  I gently performed her prenatal exam and ran through my standard questions.  Because so many of my prenatal patients were teenagers, my questions were basic, designed to educate and make sure the mother-to-be was planning and preparing for the birth. 

When I asked how she was planning to travel out to the hospital she hung her head and quietly stated that as much as she would like to obey me, she didn’t think her husband would allow it.  My heart sunk.  Her island was an hour upriver from my clinic which was three to four hours and across a river from the hospital.  The only midwife in the area was eighty-five, illiterate, and blind. 

Thinking over the times she had already refused offers from me and other to help her leave her man, I knew she didn’t believe she had many options.  I wasn’t qualified to deliver her baby, and neither was anyone else on this side of the river.  Even though I was convinced that the natural childbirth most of my patients experienced needed no intervention, we were just too far from the hospital to risk the complications that could appear mid-labor.  I explained that by planning to give birth so far from a hospital, she was risking her life and the life of her baby. 

Unwilling to discuss the subject further, she gathered her things and paid the small consult fee of 5 Quetzales.  The equivalent of 85 cents, the consult fee was designed to avoid charity and did not include any necessary medications.  I filled a small black plastic bag with the standard: prenatal vitamins, iron supplements, and a few sheets of patient information that explained the benefits of colostrum and encouraged mothers to nurse their babies immediately after birth.  As she left, with the bag in her hand and her children by her side, I wondered if I would ever see her again.  Would she end up being just one more statistic of Guatemalan maternal/fetal death? 

I sent a short prayer heaven word on her behalf and then returning my attention to the small stack of charts and group of waiting patients.  I knew that if I allowed my heart to get too wrapped up in one case, I would useless to everyone else.  Still, pushing thoughts of her from my mind wasn’t easy as I focused on the wide eyed eleven-year-old with a tooth infection in front of me. 

Marisa and her husband arrived at our dock in a small boat just a few weeks later, and I confirmed that she was in labor.  

“I’ve come to take you back up river to deliver the baby,” her man strongly asserted to me.  “She’s going to have this baby at home just like the last two.” 

Marisa’s man had never spoken to me before, and I wondered if all the things they said about him were true.  He didn’t raise his eyes to mine, and there was no clue in his quick, loose body movements.  What was his story?  How did he see himself and his beautiful little family?  A new contraction of Marisa’s stomach cut off my ponderings, and I considered her options. 

While Marisa had no signs that suggested complications, the idea of labor and delivery in a dark little home of sticks didn’t appeal to me.  I quickly reassessed my feeble midwifery skills.  No formal training, twenty hours of study on the subject, and participating in less than ten other births; no, it didn’t make sense to travel in the opposite direction of the hospital.   

Her pleading eyes, set in that strong, young face started to sway my decision.  Obviously, the hospital was the best option, but she was headed back up river with or without me.  Should I go with her to support her? Should I make myself responsible for any problems or complications, when I wasn’t even sure if I would recognize them?  Or should I let her on her own with two preschoolers and the man who had a lousy record of taking care of her?

Feeling myself start to lean towards helping her, I called my superiors for advice.   ‘’The ultimate decision is up to you Ashley, but it certainly isn’t the recommended course of action,’’ was the response I got from everyone.

Finally, I decided to put into words the prayer that had been running through my mind.  ‘’Lord, what should I do?  I can’t bear to say no.  If something goes wrong and she or her baby dies, I will always ask if I could have done something to help.  But if I am present, and something does go wrong, am I strong enough to face the guilt and the certain recriminations?’’

In the past, I had an unfailing track record of following my superiors’ recommendations.  I trusted Holly and Norma implicitly, and after all, that was why I had called them.  But the sense of stillness, of peace and the assurance that my hands would know what to do made the decision for me.  The security that God would get me through, not only the birth, but also through whatever followed, overcame my heart.

I ran to the river’s edge to the waiting couple in the boat, and asked them to give me just a few minutes more to collect some supplies, and get Yalonda.  I rushed to the clinic and grabbed the large, almost suitcase-sized, plastic, mickey mouse printed bag I had packed for emergency deliveries.                

Always game, Yalonda hopped into the small wooden boat behind me.  We sat opposite each other balancing our weight on the sides of the boat, and settling in for the sixty-minute ride up river.  I alternated between prayer, and worriedly watching Marisa shift uncomfortably on the bottom of the boat.  “Just not in the boat, Lord, please not in the boat.’’

The boat finally slid through the reeds at the river’s edge, and bumped softly against the mud.  We were here.  Her home was even less than I hoped for.  It was indeed one dark room.  Strips of light shone through the saplings that formed the outer wall.  The alternating shadow and light was disorienting and my eyes struggled to adjust.   

A few minutes into my assessment and preparation of the scene my one consolation was dashed.  I heard the motorboat being started and driving away.  

Apparently, considering this women’s work, her husband decided he would rather be off with friends, abandoning us to the island with no transportation in case of emergency.  My last link to help and civilization gone, I asked Yalonda to search the island for cell phone service.  She was no novice and had become adept at climbing trees and waving the clinic cellphone around.  Then I repeated with wide eyes what would become such a common instruction, “And Yalonda, keep praying.”

It was nearly 1 o’clock, and Marisa seemed more concerned with being hostess than birthing a baby.  She started a fire and began patting out the toasty warm tortillas to go with the boiled potatoes she served us.  Her movements were the fluid almost subconscious movements that come with a task so often performed.  Every few minutes, she would hesitate, almost stopping as she leaned against the elevated platform where her fire was located.  I recognized these hesitations and started timing them.  Every suggestion of mine to lie down, or to head to the bed was countered with a soft, ¨Not yet.¨

I started to wonder if she would insist on finishing the tortillas before giving birth.  Just how strong was this woman?  Continuing to eat my potatoes with salt, and completely enjoying getting acquainted with her two dark eyed beauties; suddenly her eyes locked onto mine.  My heart started to pound as I realized that there was no turning back.                               

Without a word, she moved towards the bed with me close behind, a prayer on my lips and my prayer warrior Yalonda on my heels with the oversized Disney bag.  As I adjusted her on the small string bed, the large square of light provided by the open door went dark.  Unfortunately, we were not the only ones to enter the house.  In behind us walked a six-week old calf who nudged Yalonda’s back, almost knocking her over.  Marisa pointed to the oversized bottle filled with milk, and was pleased that the calf’s feeding time had so coincided.  “That will keep the children busy,” she murmured.  

No more than ten minutes later, I was holding a most precious little black-haired bundle.  Suctioning they baby’s nose and mouth, I wrapped her gently in the flannel Yalonda handed me from the delivery packet.  Passing her to Yalonda, Marisa and I delivered the placenta quickly.  After getting Marisa and the baby comfortable, I went outside to stretch and quiet my mind from the still running danger scenarios.  Allowing mother and baby to rest, Yalonda swept her little yard area and played with the children while we waited for her husband to return.  

A few hours later he appeared, apparently unconcerned and obviously intoxicated.  On the ride back down river, we were surprised to feel how much the satisfaction of the safe delivery and the deflation of our worry had tired us.  It was a thankful prayer and a sigh of relief that filled my heart that night when I crawled under my mosquito netting just before the generator went off at 9.  My worries for the day were over.  My hands had been guided and new life had come to the little island home.  For tonight, at least, I would fall asleep without worrying about tomorrow.  I’ll let it in God’s hands.  I’ll just show up.

In the next few weeks I noticed a growing confidence in my medical practice.  I stopped questioning my own judgement, and I started trusting God’s guidance.  My best was all I could offer these people, and it was enough. 

Hearing nothing from Marisa for several months, I was pleased to see her waiting on the bench outside the clinic one afternoon.  Her husband had come to town to drink, and had brought her along so that she would help navigate the boat through the rapids on the trip home.  Taking advantage of the trip, she came for a well-baby checkup.  To my delight everything was fine, and the baby seemed to be gaining weight.  

I’ll never forget, how just before she left, she looked at me with a little sparkle in her eye (the most emotion I had ever seen from her) and said, ¨You know, the children say that now they know where babies come from.

Soon the news had spread among the children of the village too.  They had figured out what no adult would tell them.  The origin of new babies was no longer a mystery. 

“Keep an eye out for the Mickey Mouse bag.” the children whispered among themselves.  “If the Gringa ever visits your house with that bag, there will be a new baby when she leaves.”  

Elena

Whenever I wasn’t busy with patients, I was entertained by the children of the village.  They spent their afternoons teasing me, hanging from the big squeaky, swinging gate in front of the clinic.  They begged to come inside, and I looked for ways to expand their minds beyond the little village.  I searched eBay, stretching my missionary budget to buy Spanish children’s books by the lot.  We spent hours reading the books, looking at the pictures and making up new stories to go with the pictures.  The fruit trees behind the clinic and the church also were a great attraction, and many a little thief would bring me a ripe grapefruit as a peace offering for the dozens he had stolen.  The adults of the village were busy with daily tasks; besides, they were not nearly as interesting as the Gringa in the clinic.  My impromptu classes of tooth brushing or wound care, which were followed by small gifts of bandages or small tubes of toothpaste were very popular.   

Elena was among the many children who hung around the clinic.  Pixie faced and slight for her four years, she constantly readjusted her little sister on her hip. Talkative and bright, Elena’s comments became more disturbing as our relationship grew.  While watching me count out pills, or prepackaging bandages, she casually explained that she had to bring the baby with her since her mother was sleeping.  Her mother spent her nights fishing or crabbing on the river with different men of the village almost every night. 

I had already noticed that the women of the village barely spoke with Elena’s mother, and I found this information troubling.  I decided to investigate further.  My friend and neighbor girl, Suri was always a trusted source to explain the dynamics of the village.  I spent my lunch break in a hammock on Suri’s porch trying to understand.   Suri carefully explained that Elena lived with her mother, and little sister.  No, there was never a father.  Because of the shameful nature of the situation, I had to be especially direct to get the answers I needed out of Suri.  Sadly, my assumptions were correct; Elena’s mother was the village prostitute. 

The inescapable loneliness, shame, and responsibility that this little girl faced angered me.  At the first opportunity, I spoke with her mother in private.  Breaking all the rules of convention, I verbally acknowledged her business and then tried to convince her of the love of Jesus for her and her girls.  Assuring her of God’s promises to care for the husbandless and orphaned, I pledged to support her on her journey, should she decide to change her life.  She thanked me, but she remained unconvinced that God could forgive someone like her.                          As we talked, I was astounded to learn that Elena’s mother was only twenty-two years old, even though her face showed the worries and cares of someone who had lived much, much longer.   She told me of the many women of the village who berated her angrily.  The women were jealous, not only of their husbands’ attentions, but of the money wasted on this woman when their homes and children were barely scraping by. 

After several attempts to alter Elena’s mother’s thinking, I decided to focus on Elena, while continuing to show love and support for her mother.  One day, Elena confided how scared she was at night alone with her baby sister.  She told me how she didn’t know what to do when the baby cried all night.  Sometimes there was milk, and sometimes there wasn’t.  Angry that anyone would force such responsibility on a four-year old, I determined to improve her life.  I invited her and her little sister to stay with me in the clinic any night that she felt scared.  

Too poor for candles or a flashlight, there was often no warning of Elena’s arrival at my door since the area existed without electricity.  Soon, our impromptu slumber parties of three took on a life of their own.  I dreamed of the day I could keep her with me and save her from her hardships.  I wanted to offer her everything she and her little sister deserved.              

One afternoon after only a few weeks of our new arrangement, she came running to the clinic without the baby in her arms.  Her rapid-fire Spanish explained that she didn’t have permission to come and see me, but she couldn’t leave without saying goodbye.  The pressure from the town women was too much to bear and her mother was moving the family several hours away to La Libertad. Business was poor in the village, and by moving to a larger town, her mother could take advantage of the groups of immigrant travelers on their way to El Rio Grande. 

The tight hug from her strong, skinny little arms was almost more than I could bear, but I held back the tears for her sake.  Hurried by her predicament, I grabbed a bag, and filled it with vitamins and a package of cream of wheat for her to take with her.  Including a clinic business card with our phone number, I implored her to call if she ever needed help. 

Two months went by with no word, but I wasn’t surprised.  However capable she may have seemed, she was only four years old.  It would be impossible for her to dial a phone or even know exactly where she was.  However, one sticky afternoon during rainy season, I received an alarming phone call from her mother explaining that Elena was very sick.  She had a high fever for several days, and now she wasn’t taking any food or liquids.  Hoping for a prescription, my quick response startled Elena’s mother. 

“Give me two hours, and I’ll be on my way,” I said.  “Just tell me where you are.”

  She gave me hesitant directions to a bar/brothel on a back street of La Libertad, instructing me to park at least block away and to call before coming in to make sure that the man in charge was not around.  My housefather, Dave supported my hasty decision, and 90 minutes later, we were parked, hearts pounding, a block from the brothel.  I called the number and heard the fear in her voice as she told me to come quickly. 

Worried that the truck could alert unsavory people of my presence, Dave dropped me off at the front door and pulled away.  I walked through the front doors of a saloon for the first time in my life and looked around.  Inside, nothing was as I expected.  Three women with faces as worn and hard as that of Elena’s mother were cleaning the bar of last night’s partying, hosing down the concrete floor and plastic tables and chairs in the main room.  This was no life of luxury.  Elena’s mother quickly directed me to her “room.”  The main room was lined on three sides by doors every eight feet or so.  Opening her door into what seemed like a closet, I saw her cot sized bed touching three of the four walls.  Between the door and the cot, there were only two feet of space where she had an end table with a small pile of folded clothes.  Elena lay on the bed drenched in sweat.  The apprehension in me grew as I looked down at her listless body.  I was sincerely concerned, but not too concerned to keep myself from wondering, where does she go when her mother is working?

Shoving this thought aside, I checked Elena’s pulse and temperature.  She was alive, but she was burning up. 

Suddenly, I was filled suddenly with a courage and purpose not wholly my own. I turned to Elena’s mother. 

“This is no place for her to get better,” I asserted.  “I’m taking her home with me, and you can come get her when she’s better.”                     

Waiting only an instant for her to nod her assent, I began stuffing my thermometer back into the bag.  I scooped Elena into my arms and walked out, past her mother, past the women cleaning the main area, and through the front door.  I prayed for protection even while wondering what the consequences of my actions would be.  I knew that stealing a working girl from her pimp was a murdering offense in this town, but what about Elena?  Surely, she hadn’t been working.

I loaded Elena into the tuk-tuk, and we drove towards the ferry where Dave was waiting with the truck.  The drive home was tension filled as I tried to explain what I had seen.  I didn’t understand how anyone could live in those conditions.

Once home, I focused on rehydrating Elena and decreasing her fever.  A few days later when her mother showed up, Elena was playing with the other children, good as new.  With her hair neatly combed, and wearing a long dress, an onlooker would have been unable to guess that she hadn’t grown up Mennonite.  Her mother had brought her clothing, and to my surprise, her little sister.  Not yet walking, the baby’s smile and almond eyes were irresistible.  My house mother and I promised to care for the girls while Elena’s mom straightened out her life.  We assured her that while we wanted nothing more than to provide her girls with a stable safe environment, they needed their mother.  She agreed to try to start a new life and promised to be back for them in a few months. 

Over the next two months, the girls fit into our life as if they had always been there.  Their smiling faces welcomed me to the breakfast table, and I cuddled them in their flannel pajamas after bath time for a bedtime story.  It was to my surprise and dismay one afternoon that I received a phone call at the clinic from my housemother Christine. 

“Elena’s mother came and got the girls,” she cried softly.  “She and a man with a gun just showed up and packed them up and they’re gone.  I don’t know where she is taking them, or if she has her life figured out, but she didn’t look good.  She almost seemed a little high.”

We mourned the loss of the girls for several weeks, but comforted ourselves with the knowledge that they were with their mother.  While my fellow missionaries and I thought that adoption was beautiful, we believed that children should be with their parents whenever possible. 

Then the stories started to float back through different sources.  A woman had gotten to Elena’s mother.  This woman offered money for the girls.  She insisted that the gringos were stealing the girls.  She insinuated that Elena’s mother might as well sell them and get something for them if she wasn’t going to be with them.

We barely believed the stories even though everyone in town assured us of their veracity.  It wasn’t until two years later that I saw Elena’s mom at the clinic again.  She was pregnant, and her story confirmed and exceeded my worst fears.

She confessed that the rumors were true.  She had sold the girls.  She had been reassured that they would be adopted out to American families who desperately wanted children.  Badly in need of the money, she caved, telling herself she was giving them a chance at a better life while freeing herself from the clutches of her pimp.

Unable to live with what she had done and having been told by other women that this was an unforgivable sin, she had traveled to the city to try to get the girls back.  The baby was long gone, but the woman in charge assured Elena’s mother that the baby had gone to a nice family in the states.

                  Elena, however, was too big for adoption.  Childless couples in the United States wanted babies.  Elena had been put to work instead, caring for the babies who came through the house on their way to homes in the states.  Elena’s mother was allowed a few moments with her daughter before she was told she could only redeem Elena by providing them with another baby to sell.  Elena’s mother returned to La Libertad, and now, six months pregnant, she knew she was only a few months away from buying Elena’s freedom. 

“This baby,” she said, touching her stomach, “is how I’ll get my Elena back.”  And sure enough, four months later she and Elena returned to our village alone.  Elena looked older than her now six years. She was sadder than I remembered.  She was glad to see me, but there was none of the freedom in her expression and her heart was closed off from me.  Her mother was soon pregnant again and delivered yet another baby girl. 

                Once more, Elena’s face became a regular at my clinic window, as she brought her new baby sister for weekly checkups and for the free weight boosters we provided to underweight infants.  Hesitant to describe her time away, she did tell me that her time as a slave wasn’t so bad.  After they sold her little sister, they brought other babies, and Elena took care of each baby that came through the home as if it were her lost sister. 

                Elena’s mother continued to work at night in our village, but she never had enough money for food.  I soon found out that even the cream of wheat meant to bolster the baby’s weight gain was being exchanged at the local store for cigarettes. 

This information initiated me into one of the saddest practices I was to adopt during my time as a nurse in Guatemala.  Every week when Elena brought her baby sister for a weight check, I opened the bag of cream of wheat with my scissors, nullifying the resale value, and then taped it shut.  I reviewed the instructions for preparation with Elena, now eight years old, and I gave her a week’s worth of vitamins. 

                In the days and months that I worked with Elena and her mother, I constantly assured them of their infinite value in God’s eyes.  But mine was one small dissenting voice in a chorus that chanted their worthlessness and their doom.  Perhaps I’ll never know if my presence as a witness, a bystander in their story ever made a difference.  I tried to show Elena love, but she didn’t believe in love anymore by the time she came back to me.  She must be close to seventeen as I write this, and I am haunted by the fear that she is out there somewhere working, just as her mother taught her to.  And somewhere else in the world, there are two little girls who will never know just how loved they were by me and my fellow missionaries and by Elena who gave everything she knew how to sacrifice for their wellbeing.

My Writing Process

           This semester I undertook the task of beginning my memoirs with the help of Mr. Dan Glass.  It became a journey of self-discovery and self-understanding as I set aside time to reflect on my past experiences and what they mean to me.  It feels good to remember and record the many people who have influenced my life.  While the rush of my busy life in the present usually occupies most of my thoughts, it is important to look backwards occasionally to consider where we have come from and to contemplate where we are headed.  Often, I, like others forget that my past is a big part of my present.  This time of focused remembering has healed some pain and helped me polish up some of my treasured memories. 

My writing style is just beginning to evolve.  I tend towards dry recounting of facts and forget all the details that my reader doesn’t know.  Much of my storytelling deviates little from the conversations I have with friends about my past.  While I don’t yet know what my writing style is, I am certain about what I want it to be.  I want my stories to be an honest portrayal of the people I met and of those who gave me access to their lives.  I want to give a voice to those who felt like they had none.  There are so many people who have limited choices for their future.  I want those of us who have many opportunities to recognize them, be grateful for them, and use them to increase the options for those who have none. 

This journey has taught me many things.  I learned that I have something to say, and that there are people interested in my story.  I learned that writing well is possible if I am willing to dedicate the time to learning this art.  Writing for me begins with not only a clarity of mind, but with a clarity of soul.  Sorting out the feelings from an event is crucial before I can write and share it with others. 

I received great encouragement from interviewing two writers and one editor.  They, and the books I read, demystified the writing process and gave me hope that I may someday be happy with the writing that I produce.  Mr. Glass’ gentle guidance has improved the clarity of my writing, as well as expedited my somewhat arduous process. 

I felt an incredible lifting of my soul after putting some of these stories to paper.  I did not realize that I was still carrying some of the sorrows of the beautiful people I met.  There are so many stories still trapped inside that now I know I must write them out, even if they never get published.  This act of writing liberates a part of my spirit and honors the memory of the people that I love. 

The past sixteen weeks has only scratched the surface and I would like to spend quite a bit more time learning what makes writing good, and how to express myself in a way that the general public understands what I am trying to say.  I am grateful, however, for the opportunity to have dedicated time to learning the writing process and to studying my past.  

Chapter 4

The first few days running my new little clinic were so full of cleaning and organizing the medicines that I hardly noticed the lack of patients.  The Petén was home to some of the largest rats I had ever seen, and during the last nurse’s absence, they had broken into the supply of laxatives and subsequently spread them and other unidentifiable materials over all the other shelves.  Every bottle had to be carefully wiped down and checked for expiration date. 

While I worked, I practiced my new Spanish vocabulary and tried not to jump at each new scratching sound in the thatch roof.  My clinic was inhabited not only by the rats, but by small lizards, innumerable bugs and the occasional tarantula or scorpion.  Focusing my thoughts away from the strange sounds, I dreamed of the many people I would help here.  The babies who stop crying, the smiling children, and the adults I would counsel.

I was content setting the little clinic to rights, but as the hours started to drift slowly by, I could only spend so many hours studying medical books and praying for the patients that God had sent me to care for.

You can imagine the thrill that came to me when I heard the slapping of running flip flops outside on cement porch and the call of “Buenas!”  God had finally answered my prayers.  My moment had come.   The moment I had sacrificed so much for, and prepared for, and dreamed of.  My moment to ease someone’s suffering and be their savior.

I hurried to the pharmacy.  The brown face staring in through the window was much smaller than I had expected, but I didn’t have much time to register this before the little girl cried,

“Mom says to come quickly.”

 My heart leapt.  Was my first case to be a real, live emergency?  When she saw my confusion, her words slowed down, but the urgency did not leave her voice. 

Slipping my feet into my rubber flip flops, I looked anxiously around my tiny clinic, adrenaline impeding my ability to choose supplies decisively.

“What’s wrong with your mother?” I demanded from the anxious little face, desperate for a clue as to what should be my next move. 

“It’s her goose.” she replied, “The neck is flopping.  It’s my brother’s fault, he hit it with a stick and now it might die!   Mom wants you to come and massage it.” 

My eyes widened and my face flushed.  My excitement turned to indignation.   Did I hear the word correctly?  Could my Spanish be the problem here, or did these people really think I had traveled 3000 miles to attend to their poultry?  

I grabbed my Spanish/English dictionary, but yes, ganso was the word, and yes, she was talking about a bird. 

“I am not a veterinarian,” I replied tersely, but then I suggested that when her mother had time, perhaps, she could bring the family by for a routine checkup and vitamins.  I saw the dread creep over her little face as she realized she would be conveying the bad news.  She turned and headed up the dirt road towards home, much more slowly than she had come.

I plopped back into my small plastic chair and retrieved my cumbersome textbook, but I was now unable to focus on the signs and symptoms of renal failure.  I had niggling thoughts all trying to get in around my concentrated effort to learn and prepare myself for future patients.

Finally breaking, I listened to the small voice asking me if pride was what was keeping me from attending the goose.  I admitted that my pride was hurt, but I was certainly not qualified in this type of medicine.  The longer I insisted that God could not possibly be asking this of me, the more convinced I became that I was turning down the first open door I had seen in a week. 

I slowly started looking at my supplies and questioningly began adding this and that to my bag. What do you need to massage a goose’s neck anyways?  Are they fuzzy?  Furry?  Feathery?  I had never seen a goose up close and it certainly wasn’t on my bucket list.  Little did I know that someday my list of actual life experiences would be much longer than my bucket list. 

A few minutes later I arrived at the simple home of saplings and tin.  This family of six had two small rooms for sleeping and cooking.  At the time, it seemed insufficient to me, but I did not yet realize how much of life in the tropics is lived outdoors. 

With little questioning on my part, a child pointed to a dark corner where the goose lay, with its distraught owner crouched at its side. 

She looked up at me with pain in her eyes and asked, “Is it a goner?” 

I felt a pang of fear and inadequacy as I realized I had no idea what normal goose vital signs were, or where to find them.  I clawed through my mental space realizing there was no box labeled ‘goose’.  For the first of many times, and I pulled my professionalism around me like a cloak and used the phrase that would become an old standby. 

“Well, now, let’s take a look.” 

I had no hope for this goose, and even less for my reputation, but I reached out my hands and touched the limp neck.  It was fluffy and feathery, making massage difficult.  After a few moments of awkward stroking, I wrapped it carefully in an ace bandage.  I then introduced myself to Doña Mima and her little tribe of adorable children.  A talkative woman, she explained to me how she spent her weekends selling tacos and other small food items at her mother’s store to make ends meet.  After many months of working and saving, she purchased this goose and was fattening it for Christmas.  Losing the goose would be a terrible loss for her family and might mean no celebration in December.  How could she and her family face Christmas without tamales?

As I started to realize the importance of the animal lying at my feet, I said a quick prayer that God would heal the sprained goose’s neck so this family could reap the benefits of their mother’s hustling.  After several cups of fresco and another forty-five minutes of chatting, I returned to the clinic to scrub my hands clean and try to re-gather some of my dignity.  I hoped this would be the last I would hear of geese.

The next morning, I had only been in the clinic for a few minutes when I heard the slapping of many flip flops on the front porch. 

“Buenas!”  shouted Flor, their oldest daughter.

   Five smiling faces with hair slicked back and perfumed with baby oil smiled in at me from the bench on the front porch. 

“We’re here for our checkups,” said Flor, “And my brother has some weird skin patches that Mom wants you to look at.   Oh, and by the way, the goose was up and walking around like new this morning!”

Over the next several weeks, new patients dribbled in as Doña Mima spread the news to her taco customers the new nurse cared about patients.  I never again was called on to treat a goose, but I am thankful for the goose that gave me the chance to spend my first hour in a village home.

 I learned that things are often more than they seem, and when in doubt, follow your patient’s lead.  Had I allowed my pride to win, I may have never found my way into the hearts of the people of Santa Rosita.       

El Chal

My hands shook as I once more pulled out and tightly re-rolled the new cape dresses trying to fit one more rice crispy treat or granola bar into my suitcase.  There were 10 dresses total, sewn in a flurry over the past three weeks by Mom and Gramma.  Five plain white ones for nursing duty and five with small floral print and sleeves below the elbows to comply with the stricter dress code of the Mennonite mission. 

“It doesn’t matter how many more granola bars I stuff in here,” I thought to myself.  “It’ll never be enough to keep me alive for six months.”

The members of my congregation had been surprisingly dismal when I announced my decision for a short-term mission trip. 

“You’ll never make it,” and “What will you eat?” were comments I heard more than once.  While it was very strange for my church not to fully support a young person’s mission dream, it made sense when you took into account who they were talking to.  It was no secret that at church potlucks I ate only from the dishes my mother prepared.  My unwillingness to try even the most basic foods made it hard for them to imagine me thriving in another culture.    

I knew they weren’t crazy to wonder how I would survive my six-month commitment to the Guatemalan jungle clinic.  I wasn’t prepared for this.  Aside from a single ten-minute phone call to the pastor of the small church in El Chal, I had not spoken to, much less met the missionaries with whom I would be living for the next six months.  I patted the epi pen carefully stowed next to an emergency supply of antibiotics and several bottles of bug spray.  Having no idea what I was getting myself into, I clung to the one thing I knew for sure. 

“This was what God wanted me to do.  Surely, he would provide everything I needed, including the faith to get me there.”  But even this knowledge didn’t keep my hands from shaking as I folded and repacked everything once again.

A few days later upon arrival at La Aurora International Airport in Guatemala City, I located a small cart for my two 50 pound suitcases, a 40 pound carry on and an overloaded backpack.  Reaching the curb, a small man talked rapidly at me in Spanish, and I tried to ignore him.  He then graduated to wild gesturing, until I understood that I must leave the cart at the door.  Physically unable to move with my mountain of luggage, I created a small pile on the sidewalk and settled myself to wait.  The foot traffic flowed around me, child vendors, taxi drivers, and other unknown parties accosted me from various sides.  Armed with only one year of high school Spanish and my lack of local currency limited my interactions.  I didn’t know what my ride would look like, but I was sure whoever was picking me up would stand out from the crowd.  Anabaptists don’t tend to blend in anywhere with their blatant head coverings and long dresses. 

                With my ingrained German-American background, I couldn’t imagine being late to pick someone up at the airport, let alone an international arrival.   Maybe they weren’t coming.  Did they forget?  Trying not to think about the fact that I didn’t have a phone number for anyone in Guatemala, I alternated between mounting worry and calming prayer to control my panic.  Just slightly short of an hour later, a van pulled up and out jumped Holly Long, the LPN that I would be working with.  Her arms were full of roses which she placed in my hands.  They seemed ludicrous to me at the time as I was barely able to manhandle my luggage and now I had an armful of flowers.  I never understood why cut flowers, slowly wilting away and dying, were considered beautiful by most people.  Recognizing this as a demonstration of welcome, however, I knew enough to keep this thought to myself.  Holly, the mission driver, and I hurriedly climbed in and pulled away from the crazed pickup zone.

The traffic of Guatemala City was just as I remembered it.  The smog and motorcycles swirling around the tightly packed vehicles made me feel slightly dizzy.  Deciding it was better not to look, as our vehicle repeatedly screeched to a halt inches from the bumper in front of us, I tried to focus on the conversation coming at me from Holly and the young man who was driving.  The awareness that this was real, that I was 3000 miles away from home and that I had to navigate this on my own, hit me even as I tried to politely answer the general travel questions. 

Holly was sincerely excited to get to know me, and had carefully executed all her medicine shopping before my pickup.  The errands caused the delay, but she knew it was worth it as we now could head straight to the mission headquarters for me to get some rest.   She purchased overnight bus tickets hoping to sleep on the trip back before her full clinic hours the next day.  This was my first exposure to mission life.  With outposts 6-8 hours from the city, doctor visits and supply runs were packed into one day to minimize Holly’s absence from the clinic. 

Previously two or more nurses always staffed the clinic, but recently Holly had been left alone when Charlotte G married.  Elizabeth M, a local, who started working in the clinic as secretary and then chose to enter nursing school, would be graduating in the next month.  To replace her as secretary, Holly hired a 14-year-old neighbor girl who, a few weeks before my arrival, abandoned her job and family to run off with a man.  Mark Andrew, the missionary’s son was temporarily filling the position until I could take over.  My head swirled from all the new information and names of people I didn’t know.  The night on the bus passed in a haze of exhaustion and culture shock. 

Arriving in El Chal in the wee hours of the next day, Holly directed me to a room across the hall from hers where I registered nothing of my surroundings except the warm, humid air as I crashed onto the bed.  Waking several hours later, I wandered downstairs to be greeted by Norma G, the house mother.  A woman with 30 years’ experience in Guatemala, I must have seemed a truly raw bit of help.  She offered me some reheated scrambled eggs for breakfast, but they were laced with green pieces of something.  Having never seen cilantro before, I hardly touched them, and instead asked about Holly.  She had slept only a couple of hours before heading over to the clinic to see patients.  Norma encouraged me to take some time to make myself at home in my room before checking out my new workplace. 

My bedroom was small and bare, but very clean.  I had never seen a bare room before.  My mother always decorated my room attractively with increasing input from me as I aged.  I unpacked my belongings, and what had seemed like so much luggage when I was hauling it through the airport now barely made an impression on the room.  The one decorative detail, a woven textile on the wall, drew my attention.  As I fingered the warm, beautiful colors so foreign to my culture and so telling of the one I was entering, I remembered the warnings of friends from home about tarantulas and scorpions in the jungle.  Wondering if this could be a hiding place, I gently pulled the tapestry away from the wall, exposing to my surprise a large hole in the wall, studs exposed.  How was I going to sleep tonight, not knowing what could crawl into my room from the depths of the house?  I turned away in shock and considered the worn sheets on my bed and the simple furnishings.  While my Anabaptist parents were never extravagant, I realized I was facing a much more frugal lifestyle.  Evident in every decision was Mark and Norma G’s careful consideration of God’s money.  They administered it frugally, pinching pennies wherever possible even when it meant their own discomfort. 

My meager belongings were soon distributed around the room and it still didn’t feel like mine.  Who was I without my pink ruffled curtains and Himalayan cat? 

No answer immediately forthcoming, I decided to check out the clinic.  Twenty yards from the mission house sat a small building with a porch full of milling people and a sign, Clínica El Buen Samaritano.   The clinic was small, with two exam rooms, a pharmacy, and a reception area.  Seeing me in the doorway, and sensing his time in the clinic might finally end, Mark Andrew quickly brought me to the small table and filing cabinet that consisted the reception area. 

Handing me a carefully printed sheet with questions in Spanish, he hoped I would immediately jump in and take over.   He was sadly disappointed.  Even if I could have read the questions in Spanish to the patients without feeling self-conscious, understanding their answers was impossible.  Not comprehending my limited Spanish, they digressed, explaining symptoms, and trying to impress upon me the importance of being seen soon since they came from so far away.  I was unable to distinguish these speeches from the information I sought, leaving me wholly overwhelmed. 

My responsibilities included checking each patient into a log book and then locating their chart from a previous visit or creating one.  This was quite a bit more complicated than it sounds.  Many considered themselves long time patients, however, extended searches revealed no chart in their name.  Family relationships also were much more complicated than my brain could comprehend.  In my world, the lines of mother, father, children, and extended family made for easy identification.  Guatemalans, however, as I was later to discover, had a much more fluid understanding of family.  Many children lived with their grandparents or aunts, especially if their mother was working ‘in the States.’  Sometimes, aunts or even uncles who had errands near the clinic would offer to bring the child while the mother stayed at home, limiting the medical history we could obtain.  Some children born to the same mother had different last names.  Our filing system of nearly 10,000 charts depended completely on each individual complying with the cultural norm of two last names.  As many of our patients were illiterate, they were unable to help me with the spellings.  

After several bumbling weeks of practice, my job became easier.  I learned which questions to ask, and what possibilities to consider.  Weighing each patient before admitting them to an exam room helped me fix the Spanish numbers in my head.  Some days focusing was hard as visions of C & C’s pizzas danced through my head.  I couldn’t remember a time when I had missed my family’s weekly ritual of takeout from our favorite local restaurant.  What I would give for a hot slice of pepperoni pizza.

After the first few days of finding cilantro in everything, I worried over my quickly depleting stash of granola bars.  I noticed that the corn tortillas were served with almost every meal.  Still unconvinced that I could learn to like Guatemalan food, I decided that my survival depended on my ability to tolerate tortillas.  Valiantly forcing myself to take a tortilla each meal, I graduated from swallowing ¼ of it to ½ and in a few weeks, I was consuming an entire tortilla with each meal.  I didn’t know it then, but Norma was sincerely worried about my calorie intake.  Considering herself responsible for my health and unaware of my secret stash, she prepared special family favorites that I only picked at.  I felt only disapproval from her and tried to hide how little I was eating even while she (a nurse herself) tried to monitor my intake.

A few months later, I became aware that I was not longer forcing the tortillas, but enjoying them, and the small bits of rice and eggs, and even black beans were going down easier at each meal.  Now I could focus my energy on language learning and medicine study.

From the beginning, Holly asked me to study what seemed to me to be large amounts of medical information.  To my surprise, my LPN training seemed to be of little use here.  Had I realized that just a year later I would be prescribing medication, I would have paid more attention in pharmacology class.

 Because all of Holly’s time was occupied in patient care, the pharmacy was cluttered and confusing when I first arrived.  On three walls, there were bottles and tubes, inhalers and sample packets, boxes and labels.  She soon assigned me the task of organizing the jumbled shelves.  This organization appealed to my obsessive side, and while she was grateful for the help, Holly had another motive.  Reading each of the labels, I slowly learned the most common medications used in her practice and I realized that while Holly didn’t prioritize straight lines, there was a definite order to the chaos.  The antibiotics had a shelf of their own, as did the anti-hypertensives and the antipyretics. 

Before I was ready, she had typed up a list of questions for me to ask each patient in Spanish.  I memorized the questions, but panicked the first time I was alone in the exam room with a patient.

The patients just didn’t seem to understand my limited abilities.  When asked “Tienes tos?” “Do you have a cough?” rather than answering with “Si” or “No,” they would run off into long paragraphs where I was quickly lost.  Politely allowing them to finish, I then repeated my question.  “Tienes tos?”   While a confused look was common in the beginning of each interview, most patients soon realized I was only looking for yes or no answers.  This documented partial-interview was then handed to Holly for her to complete along with a physical exam, diagnosis, and prescription.

I learned to hold down squirming three-year-old asthmatics for nebulization treatments, to test urine for pregnancy and infection with dipsticks, and to anesthetize and remove ingrown toenails.  I watched Holly clean machete wounds before stitching them up.  Since many of her patients came from far away, they often stanched the bleeding by stuffing the wound with the nearest substance.  We scrubbed out toothpaste, coffee grounds, medicinal herbs, and even dirt that patients had used as a temporary bandage until they reached the clinic.    

I also began to fill prescriptions from Holly’s notes, counting out the pills, preparing the bottles, and handwriting the labels.  Elizabeth picked up the slack when my Spanish was insufficient to verbally explain the medications.   

Elizabeth’s patience was unending as she put up with my faltering Spanish as well as my occasional superior remark.  Ignoring my ethnocentric behavior, she taught me, gently corrected me, and became my friend.  Her years as secretary in the clinic as well Spanish being her first language put her light years ahead of me in ministering to patients.  However, both she and Holly saw the potential in me that I in my arrogance never doubted. 

Most days there were overwhelming numbers of patients to be seen, and all three of us, as well as the newly hired secretary Silvia worked until we were exhausted.  We became a team, and as I grew in knowledge and cultural understanding, the work became less overwhelming for all of us.     

Chapter 1

In 1985, I was born two years into my parent’s marriage when my mother was just 20 years old.  They brought me home from the Reading Hospital to the old tan house that my father renovated during his engagement to my mother.  Brought up in an Anabaptist community, both of my parents, during their teenage years, had made a personal decision to follow Jesus Christ and a public decision to join the Dunkard Brethren Church. 

Occasionally in public they were approached by excited strangers, thinking they had spotted their first Amish family.  While both groups reject much of mainstream American culture, the Brethren church is very different from the Amish.  Both groups have Anabaptist roots, consider themselves to be evangelical Christians, and promote a close family culture.  Both wear plain clothing, and head coverings but avoid television, divorce and remarriage, and violence. 

The Dunkard Brethren Church is considered more liberal, allowing the use of technology such as cellphones, computers, vehicles, and electricity.  Many of the members also wear store bought skirts and blouses rather than homemade dresses. 

The churches are small, usually one hundred members or less plus children who gathering each week to worship, pray for each other, and listen to a sermon preached from God’s word.  This lifelong commitment to God and each other creates a community and safety net where joys are celebrated together and sorrows are shared.

In the weeks that followed my birth, family, friends, and members of the Anabaptist community came to visit, usually bringing baby gifts and a home-cooked meal.  My grandmother and aunt came in to assist with the housework and hold me while my mother napped.  All of this was meant to ease my mother’s burden as housewife and new mother. 

However, the scene was not idyllic.  For the first four months, I tortured my parents, crying inconsolably during every waking moment.  The pediatrician dismissed my symptoms and said they were due to colic and a nervous mother.  This difficult time eventually resolved itself, and soon I was developing as expected. 

Growing up in an Anabaptist community, my mother had ample experience babysitting the children of other members of the church.  After surviving the traumatic initiation of my first few months, my mother began to recognize my behaviors as strange.  Now looking back, she thinks the first clue was when, during my eighth month, she rearranged my nursery furniture.  While most infants wouldn’t notice such a change, I screamed, unable to be calmed.  Desperately trying to figure out what set off this particular crying session, my mother mentally reviewed our day.  Nothing stuck out to her until she considered the new layout of the nursery.  She rushed around the room until everything was moved back into place.  The effect was immediate.  My sobs subsided into hiccups, and I gently fell asleep. 

This was not the end my panicked tantrums.  Fiercely opposing any uninitiated change, the transition from one season to another was especially traumatic during my early years.  As my first and second summer ended, fall brought on violent battles between my mother and me.  Resisting shoes and long sleeves, I fought and bit my arms until she feared for my safety. 

In 1985, few people had heard of the term Asperger’s Syndrome, and it is doubtful that even now a baby so young would be correctly diagnosed.  So, without the plethora of books and articles by qualified and experienced, my mother faced my abnormalities alone. 

Heartily blessed with practicality, she did the only thing that made sense to her.  She removed and replaced the clothing that caused the new sensations for five minutes at a time until my panic subsided.  Then, by incrementally increasing the time frame, I slowly adjusted to the new apparel.

This scientific pattern of her empirical understandings for introducing me to change by measured degrees characterized my childhood.  She announced every event of my day, hours ahead of time as well as all possible differing scenarios.  This time to process and question our schedule prevented the huge discussions that were necessary to deviate from the plan later.

She claims I was conversing as clearly and complexly as a teenager at 18 months of age, and I had an attitude to match.  When at two and half years I was reciting entire verses and the Lord’s Prayer without prompting, my mother thought I was a little genius, until upon reaching kindergarten the lopsidedness of my abilities became apparent.  I enjoyed the tasks and tests, and I related well to the teacher, but the other children remained a puzzle to me. Every day after school during my afternoon snack, I recounted verbatim the conversations of the day.  Seeing my confusion, my mother patiently explained what the other children meant by their comments, and we ran through the various scenarios of ways I could respond. 

She got another glimpse into my ‘strange’ little mind at the beginning of second grade.  On one of the first days of school my new teacher spent some time reviewing nouns and adjectives.  I told my mother I hadn’t felt prepared for the day as I hadn’t yet unpacked the box in my mind where that information was stored.  When she questioned me further, she learned that all of first grade was stored in boxes in my head, and that each box had many files.  Over the summer, I had moved many of the boxes from first grade to the back of my mental room.  That night, while I lay in bed, I mentally checked each box to see what I might need for tomorrow.    

My little brother was born when I was two and a half, and as he grew, my opportunities for social learning increased.  No matter how rough my day at school was, his presence assured me that I would have a friend once I got home.  We spent our summers in the woods around our house, acting out the few scenes of cowboys and Indians we had managed to watch in the electronics section of Walmart.  Our winter evenings were full of Legos, rubber band guns, and the Farming Game. 

One spring evening, my mother, father, little brother, and I sat around the kitchen table, wolfing down the roast beef, carrots, and baked potatoes my mother prepared.  Anxious to get outside and start enjoying the lengthening daylight, my brother and I focused on cleaning our plates when my mother cleared her throat suspiciously.  My head flew up.  At nine years old, I had noticed her declining health.  My brother and I were worried about the vomiting that had become a new part of our supper routine.  Unwilling to prolong my torture, my parents decided to tell us the news and risk our disappointment if things didn’t work out.  

                Not suspecting that my years of pleading for another sibling were at an end, my heart leapt with the news.  It was a miracle.  We were expecting not just one baby, but twins!  With one for each of us, my brother and I wouldn’t have to fight or take turns.  

                Their safe arrival was as marvelous as my brother and I had always known it would be.  Our family finally felt complete.  The twins were born in October, and my mother no longer had to struggle to get my brother and I ready in time for school.  Knowing that if we got ready in plenty of time,we would be allowed to give the babies their 8 am bottle was all the incentive we needed.  My morning Lucky Charms were consumed in record speed, and I waited in front of the bathroom mirror for my mother to wind my hair up into a bun underneath my white prayer covering.

+++

The pleasure my family took in watching the twins develop offset my continued social difficulties at school.  In fact, the ever-increasing anxiety from social disparity with my peers caused my mother to withdraw me from my private school for most of sixth grade.  While few believed that this would remedy the problem, the break from social pressures was just what I needed. 

The mornings in my room with my schoolwork and the afternoons playing with the babies somehow gave my brain the space it needed to mature.  My return to school at the beginning of seventh grade wasn’t without difficulty, but now somehow, I was able to form tentative friendships with the other girls. 

+++

In February of my seventh-grade year, when I was fourteen, my parents took me with them on a 10-day mission trip to Guatemala after Hurricane Mitch displaced 730,000 people with mudslides and flooding.  Our days were spent purchasing supplies and­­ distributing donated items to small refugee villages. 

 Growing up in an Anabaptist home and church, I regularly heard and read about mission work. My childhood dreams of being a veterinarian or horse trainer quickly morphed into more humanitarian desires as I witnessed real people struggling to survive. 

I saw how the Guatemalan government provided four posts and two sheets of tin to each family uprooted by the weather.  Those who had no additional materials to add found this devastatingly flimsy structure no match against the rains and winds that constituted the aftermath of Mitch.  The refugee children lit up at our gifts of stuffed animals even though the parents’ tired eyes rested with gratitude upon the sacks of rice and jugs of oil.  It was as I watched them haul their new possessions back to the saddest of makeshift dwellings that I felt the first tug.  It was then that I knew I could never live contentedly in the USA and accept the suffering that was inescapable for so many in the rest of the world.  I realized that my idyllic life in the Pennsylvanian countryside was not the standard.  This new knowledge created a sense of responsibility and a determination to change the world. 

Once back in Pennsylvania, I was unable to forget the devastation and suffering I had seen.  My life as a seventh grader, which focused on tests and birthday parties seemed to lack meaning.  I began to plan my return to Guatemala.  Astounded by my determination and foolishness, my parents convinced me that I could do much more good in the world if I would first finish high school.  All I knew was that God had called me to Guatemala, and I wasn’t very worried about the particulars.  I reluctantly agreed to finish high school and graduated through an advanced track from my private church school at age sixteen.

Much to my parent’s relief, I was unable to find a mission willing to take on a sixteen-year old girl.  My parents then persuaded me that the best way to prepare for mission work was to become a nurse.  Lebanon Valley Career Technology Center had an eleven-month program that fit the bill.  Nothing had prepared me for the culture shock of my non-religious classmates view of life.  Growing up without a television and limited contact with the outside world, their loud recounting of weekend parties and custody battles felt like another world to me.  Their disrupted lives seemed full of unnecessary pain and selfishness as I compared them to the peace and unity of my community.  They discussed their tattoos and piercings, as well as past lovers and ex-husbands without shame.

 I welcomed their questions about my clothes, abstinence, my hair covering, and even my cosmetic use (or lack thereof).  While my Anabaptist upbringing was just normal life to me, their looks and questions were my first inclination of how strange I seemed to the rest of the world.  I freely shared my convictions and opinions, convinced that just knowing how good my life was would immediately convert them by the dozens.   

My dozens of converts never materialized, and I began to suspect that missionary work might not be straight forward.  Newly fitted with my license as an LPN, I was accepted by Mennonite Air Missions for a temporary six-month trial.  A conservative Anabaptist mission established 30 years prior, my family and I had only learned of its existence a year before.  The fact that they were willing to overlook my age, two years below their 20-year limit, was a testimony to their need for nurses.

I was to join another LPN at a clinic in the wilds of Petén.  I knew nearly nothing about the mission or what my job description was to be, but I was determined, and my naivete was as powerful as my determination. 

My parents worried themselves sick even as they purchased the plane ticket, and my church gathered for a going away party/commissioning service.  There was no detaining me now.

Suddenly the knowledge I had about the mission field felt incredibly sparse.  Could reading about Amy Carmichael, Mary Slessor, and Elizabeth Elliot really help me at all in Guatemala?  What did missionaries really do? What did they do on a day to day basis, in between the incredible events that they told when they got back home?