Manners

Almost a week after the death of Marco Antonio, we had promised to visit his family in Yapacani. We had been planning to leave Arboleda (where we were seeing patients) around lunchtime, not certain if we'd have lunch before or after the excursion. Since it was our last day in Arboleda before heading back to the real clinic in Palacios, the community prepared us a big lunch, complete with speeches which we were required to attend. Lunch is the big meal of the day here, and this one was colossal, complete with beef, chicken, fish, salad, arroz con queso (unbelievably rich and delicious), yuca, and potato salad.

At about 2 pm with stuffed bellies, Joe, David, Guinda, and I started the 40-minute drive to Yapacani. We were very warmly received and introduced to Marco's grandmother and two siblings (the other was still in school). Then we were sat at a table and fed soup. We all glanced at each other as if to ask "We really have to eat this, don't we?". We did our best and just pleaded that the meal only consisted of soup. I don't remember the last time I've felt that full, but it would have been a terrible display of manners to do anything differently.

I had brought a framed photo of us with Marco at the hospital on his second day there (I think it's in a previous post) and was dreading the tears that would flow when I handed it over. When they started thanking us for our help, I decided it was an appropriate moment. Then Cristina brought out Marco's old notebooks to show us what a good student he was. She brought out all the other photos she has, just a couple of school photos. It was still unbelievable to think that he's gone. Cristina showed us the river near the house where Marco used to play and fish. Then she brought us to see his one-year-younger brother at the school who looks just like him, but very healthy. The visit brought me closure, but made it clear what a long period of grieving they will endure.

Marco

Marco Antonio, the 11 year old suffering from paracoccidioidomycosis, died this past weekend. He was in intensive care for over a week and I got the tragic call on Sunday morning at 2 am. I saw him just 6 hours earlier, so I knew he was in a terrible state and wasn’t going to hang on much longer. The night before he had suffered a heart attack and they had to revive him with paddles. The longer he stayed in the hospital, the less hope I had that he would ever return to full health.

We helped his mother get his body back to Yapacani yesterday, and the burial was scheduled for today. He needed a lot of blood in the last week, and we had a hard time finding someone who qualified to donate—the mother (Cristina), Lisa, Joe, one of the women at Douglas ’ office, and I all tried and were rejected. But a friendly cab driver was willing to donate as long as we would compensate him for the time he spent off the road! We still owe blood, so we're planning to try a new blood bank that might be a little more lenient (the other one they wouldn't accept Joe because he is taking malaria prophylaxis).

While I feel reassured that Marco isn't suffering any more, his mother is certainly devastated. Having our support gave her great hope that she would one day return to Yapacani with her son alive and healthy. She had barely been sleeping or eating over the last week because there isn't a bed for her in intensive care and they staff at the hospital relied on her being there to help them. She has also spent her last 4 weeks away from her three younger children and her mother. She believed that all of this sacrifice would eventually pay off. Cristina (the mother) called this morning wanting us to drive out to the burial, about 2.5 hours away. I probably could have dropped my duties for the day, but decided that she needed most to be with her family and that we would visit later in the week when we were out at the rural clinic (only 30-45 minutes away). It's hard to know how much support to provide without creating a dependence. In this case, we became Cristina's family during the time she was in Santa Cruz, and now we are suddenly far away.

Soccer and Politics

This week after the team from Potosi beat one of the Santa Cruz teams to win the Bolivia national championship, a high altitude soccer match made front page news here, and the NY Times summarized its local political impact pretty well:
http://www.nytimes.com/2007/06/17/weekinreview/17romero.html?ref=weekinreview

Notes from the week

The weather has been beautiful, and they’ve almost finished working on the bridge. Next week we expect to be able to drive all the way to the door of the clinic, but we probably won’t start seeing patients out there until July. While I’m excited to see progress on the bridge, I haven’t minded walking or riding horses from the bridge to the clinic. Horses are very common here, and they can sometimes been seen on the city streets. They’re used for transportation as well as keeping track of herds of horses. Out in Palacios, we see kids riding the family horse to school or to run errands, as well as mothers and fathers riding them to work.

The main crops here are sugar, soy, coca, and coffee and landowners are under more and more pressure to prove that they are using their land so that it won’t be reassigned. This means that they will clearcut forested land to plant sugarcane (even though this won’t earn them much income) in order to prevent it from being taken.

We rushed to the hospital on Sunday when Cristina called us because a tube was being inserted in her son’s abdomen to finally remove the fluid inside. I knew he had very little muscle mass on his body, but it was pretty shocking to see him without a shirt. Douglas finally came to the hospital to see Marco Antonio on Monday and he was moved to the ICU that night. He needed blood, and here that means that we needed to find a donor. Lisa, another volunteer in the house, went to the blood bank yesterday to donate.

Cautiously hopeful

Tonight is our second night at the clinic in Palacios, about 100 kilometers from Santa Cruz. After seeing patients at the village health post in Arboleda yesterday we drove to the bridge and walked about 1 km to the clinic. It hasn’t rained for at least 10 days, so the road was dry and the trek to the clinic was painless. The weather couldn't be any better--all week we've had temps in the mid-80s and blue skies. Joe (the undergrad volunteer here for the summer) was hell-bent on getting the internet to work out here so that he could write to his girlfriend.

Today Bolivians celebrated Corpus Christi, a holiday I had never heard of. The kids were all out of school and the stores were closed.

Marco Antonio, the 11 year old patient from last week, was immediately hospitalized at the main public hospital in Santa Cruz, Hospital Japones (built by the Japanese government). The pediatrician who saw him Friday morning ordered a bunch of lab tests, and said she felt it was likely he had a type of cancer, probably lymphoma. Then on Saturday we found out he was diagnosed with coccidioidomycosis (aka valley fever), a fungal infection. Joe, the college student who is here volunteering for the summer, bought him a story book, and David brought cards so that we could stay and keep him busy for a bit. On Monday he was on oxygen and appeared to be in more pain when he sat up. We came to see him while the doctor was doing rounds, and he let us know that we weren't welcome while he was there. We left for Palacios yesterday before I got all of my questions answered about his medical status, so I hope things turn around before I get back tomorrow.