A Grief Observed

The public health care system in Guatemala is a hellish nightmare. Peace Corps would rather us travel hours on a camioneta to the capital to seek medical attention or go to the tremendous cost of transporting us in a helicopter if the seriousness of the situation warranted it than to ever leave us in the care of one of the free regional hospitals. In the early hours of this morning, I discovered first hand why.

A little after 3:00 A.M., I received a call. It was a cell phone number I didn’t recognize, but in my half asleep stupor I answered it. It was Aura’s husband, Carlos. They had taken Aura to the hospital in Cobán by ambulance a short while past midnight, and now her situation was “grave.” He wanted to know if I could go to Cobán and help.

I called my friend, Fernando, who is the chief of police here to provide transport. We picked up my sitemate, Carlos’ parents in Chijacorral, and later another volunteer who lives in Cobán and went to the Cobán Regional Hospital. The facility was absolutely horrifying. When we arrived at about 4:30 A.M., all the doors were locked, including those to the emergency room, and there were huddled masses of people sleeping on the concrete all around the outside of the building. Through a window we saw Carlos, and he let us inside. The sick and dying were all over the room lying on beds, cots, mattresses on the floor, and benches. There was not a single doctor or nurse anywhere in sight. The only hospital personnel present were a security guard and a janitor.

Carlos took me to Aura’s bed. She said the left side of her body had gone numb and the other side was affected by frequent uncontrollable tremors. They had been there for over four hours and the only medical attention they had received was from a nurse who attended to them upon first arriving. This nurse had given her an injection (God knows of what) to calm her down, but she was still worked up in a complete frenzy. I set about trying to find a doctor or a nurse. I asked both the janitor and the guard as to where I could locate a medic, and I received the same uninterested reply from both of them, “All the doctors and nurses are resting.” This is an emergency room!

I went back to Aura’s side to talk through her symptoms again while waiting for someone to wake up. It was at this point that Carlos and Aura sheepishly informed me of the manner in which they were hoping to receive my help. They asked of me the “huge favor” of transferring Aura to the private hospital in town and paying for her medical treatment there. I was put in a very difficult situation. The options in health care in Cobán are free at the dilapidated regional hospital or exorbitantly expensive at the private one. A short stay at the private hospital could easily consume one or two months of my Peace Corps living allowance if not more. I explained this to Aura and Carlos, that I receive just enough money to live off of and certainly not enough to cover hospital stays. They already “knew” this, but it goes without saying that a white American signifies “rich” here and in comparison to the meager resources they have, we really are.

Although I certainly didn’t tell them this, if I had honestly thought Aura’s situation was “grave” I could have probably found money to pay for her to be treated at the private hospital. But as harsh and uncaring as it sounds, I didn’t. In my year here, I have gotten numerous phone calls and reports from people about friends and/or family members that have been rushed to the hospital on the verge of death only to find out a day or two later that they are fine back in their houses. It makes it very difficult to parse out real medical emergencies from the false alarms, and even though from the beginning when I received Carlos’ call I slightly questioned the gravity of Aura’s situation, I wanted to go to Cobán to see her state for myself. I had brought the other Peace Corps Volunteers, Mike and Michelle, with me for this very reason—to help in logically assessing the situation (I owe them both dinner and some beers for dragging them out of bed so early).

Our first thought was to call the Peace Corps Medical Officer, but then we realized even though she was willing and ready to assist volunteers at all hours of the day or night, it is not her job to help Guatemalans, especially not before 5:00 A.M. on a Sunday. So with no professionals present, the three of us did our own amateur medical assessment. Although Aura said the left side of her body was numb, she felt pain when pinched, and she had feeling and movement in both sides of her face, so we ruled out the possibility of a stroke. She was speaking lucidly, and although she was warm, most likely from just being in a state of agitation, she didn’t appear to have a fever. It seemed like to us she had worked her herself up into a state of frenzy and agitation as all the grief and tension over the death of her baby she had pent up inside her was finally being released through her body.

The hospital finally began to slowly wake up at around 6:00 A.M. Nurses started turning on the lights and slowly meandered into the ER. I cornered each one I saw and led them over to Aura’s bed, but they were of absolutely no help. At the first site of a doctor, I tracked him down and insisted he give attention to Aura. Truthfully, I don’t think Aura would have received any attention had a gringa not been with her. One of the nurses told me there were only three doctors on duty for the whole hospital until Tuesday. This is a regional hospital—the only place well over half a million Guatemalans in the vast area can afford (because it is free) to seek treatment. Three doctors.

Two of those three doctors (I never saw the third) were attending to Aura. They took her heart rate, measured her blood pressure, and took a blood sample for testing. After the exam, the doctor confirmed to me what we had originally thought. He believed Aura’s infirmity was “psychological” resulting from “nerves” caused by the death of her child. Her took her blood as a precautionary measure to run tests to make sure there wasn’t any infection lingering from the pregnancy. They also gave her another injection (of what?) to once again try to calm her down.

Now I completely understand Guatemalans fear and near complete avoidance of seeking medical treatment. What medical treatment? Aura told me when Mynor was born the nurses were too afraid to even touch him, so she had to wrap his head up with a cloth herself. When the nurse inserted the receptacle in Aura’s hand to give the injection, he stuck the bloody syringe in the plastic bed while he was doing other things. He didn’t even make the effort to wipe the area clean when he removed it and threw it in the trashcan full of other bloody syringes and rags next to the bed.

As if some kind of sick joke, there were signs posted on the wall stating the patients’ rights. First and foremost patients had the right to “quick and comprehensive service.” If patients didn’t have the “highest quality of service” there was a number to call to log complaints. I wondered if anyone actually believed in the sincerity of the banner and made a call. I doubt it. Poor Guatemalans don’t know what it is like to receive real medical attention. All they know of hospitals are these deplorable regional ones where people go only as a complete last resort. They are not places of healing; they are places to die.

I felt horribly guilty about leaving Aura there, but she had finally started sleeping and with the doctor’s diagnosis, there was nothing else for anyone to do but to let her continue to rest. I left my business cards with the doctors and told them to call me if anything suggested to them Aura’s illness was being caused by anything more than nerves. Exhausted, we returned to Tactic at around eight in the morning.

With the horrifying images of the hospital and all that I had just experienced still fresh on my mind, I wrote the first portion of this post right when I got home. The following is what occurred later this afternoon.

At 2:00 P.M. I received a phone call from Beti, another Nu’Kem weaver. Crying hysterically she told me that Aura was dying. The doctors at the regional hospital weren’t doing anything to help her so they brought her back to the house, and now she was dying. I needed to get there as quickly as possible.

Not knowing what to expect, I threw on my shoes grabbed all the money I had and my ATM card and rushed out to Chijacorral. I could hear Aura’s screams long before I reached her house. The mud path to her shack was clogged with people, about 30 community members were surrounding her house and another 20 or so of her closest friends and relatives were packed inside. Everyone was crying. Upon the sight of me, the message started being passed along, “The Seño is here! The Seño is here!” The crowd parted to make room for me to go to Aura’s side. She was on the bed, thrashing about uncontrollably and screaming. Her face was blank and expressionless. I was scared to death.

With tears streaming down their faces, everyone turned to me and frantically asked, “Seño, what do we do? She is dying, Seño! What can you do, Seño?” What can I do!? I pulled Carlos aside outside the house and a huddle of people followed us. Completely distraught, he looked at me imploringly for direction. I told him, “I don’t have the money for the private hospital. I don’t know exactly how, but I will find some. We are going to the private hospital. We are taking her to Galeno.”

Once again I called Fernando, and he came to Chijacorral in his police patrol truck. Chijacorral is located up in the mountains, and there is only access to it by foot. Fernando parked the pick-up at the highest point he could, and Carlos carried Aura down on his shoulders. We placed her in the back seat and eight family members and friends piled in the back.

As Aura screamed and writhed in the back seat on the way to Cobán, all I could think was that I had made a huge mistake—that I had erroneously thought she was suffering from emotional distress when something much more serious was wrong. I felt angry with myself and incredibly guilty. I just wanted to get her to the hospital as quickly as possible. I had never been in a situation like this before, and like so many other times in this past week and a half, I was completely overwhelmed.

When we arrived at Galeno there were no doctors there. There were no doctors at the private expensive hospital. Upon seeing a group of obviously poor indigenous people, the receptionist said, “This is a private hospital, and it is expensive.” I told her I was paying for it. She got on the phone and started calling the doctors, asking if they could “please” come in and attend to Aura. We waited. During that time I went to an ATM to take out all the money I could, and I sat outside alone and cried. I cried tears of distress and tears of guilt. Tears of anger and tears of helplessness.

It was 45 minutes until a doctor arrived. Other community members from Chijacorral had made the trip to Cobán in a microbus and were gathered outside of Aura’s room. Aura had calmed down considerably, and the doctor performed an exam. He took her blood pressure and heart rate—both again normal. She said her arms were numb, but through some simple tests, the doctor realized that was not actually the case. The doctor came to the same conclusion as those at the regional hospital—Aura was suffering from severe emotional distress but she had no other seriousness life-threatening ailment. She needed to eat and rest in a quiet place. I was relieved.

Even though it was the same diagnosis as before, coming from a doctor at the nice private hospital, it held more weight. People here go to the regional hospital because they have no other options, but they never really believe the doctors there. And, honestly, given the condition of the facility and the manner in which things are run, I wouldn’t either. But now here was a “real” doctor at a “real” hospital saying that Aura was not dying, and people took note.

The doctor administered another sedating injection and gave Carlos the information for the medicine he needed to buy at a pharmacy in Tactic. I closed out the bill, and we all piled back into the patrol truck to go home. It was almost 7:00 P.M. when we arrived in Chijacorral. Dozens and dozens of crying community members were waiting outside in a complete downpour at the base of the hill when we pulled up. They all rushed over to the truck and followed Carlos as he carried Aura up the hill, this time to the house of her mother where she would have more privacy.

People were crowding around Aura’s bed, crying and inquiring about her condition. I managed to get everyone out of the room leaving just Carlos, Aura’s mother, and Fernando. In the adjoining kitchen, I addressed the gathering. Over the commotion, I began to talk. Mothers hushed their children and all conversations stopped. “The Seño is speaking.” There was complete silence—silence and inquiring eyes waiting for my words of “wisdom.” I told everyone that Aura was going to be fine. She was extremely emotionally upset about the death of her baby and now all the grief was leaving through her body. She needed to rest in a place without any noise. And although everyone there was very concerned about Aura’s wellbeing, the best thing they could do for right now was to leave her alone.

I can’t imagine the all-consuming sorrow Aura is experiencing. I can’t imagine the overwhelming heartache she is enduring. I can’t imagine a grief so intense that it consumes the whole body.

I left Chijacorral to the chorus of gratitude. But their gratitude is so undeserved. They think “the Seño” knows everything and is in complete control, when the reality of the situation is that I was, and am, in way over my head. I was scared to death that Aura was going to die. I was scared to death that it was my decision as to the course of action for which everyone was waiting. I do not belong on the pedestal on which they have put me. And it is only a matter of time before I fall bringing their hopes crashing down with me.