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.