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The universe will have its way

I'd been hoping I wouldn't have any reason to explain the role of the
good government juntas in placing volunteers, but things didn't
turn out as I'd hoped. Basically, the Zapatistas decided that the
Zapatista Army of National Liberation, their military, was having too
great an influence in civilian affairs in their territory, so to counter
this in 2003 they set up administrative bodies called good government juntas (juntas de buen gobierno). When they founded these juntas they also gave them the responsibility to determine where to send foreign volunteers so that they could have control over people who come to help them. Which is all well and good if you're Joe Schmo, First World radical, who up and decided to go see the revolution and you need some direction from people who know what's going on, but I'm here through the Chiapas Support Committee, an NGO that’s been working in solidarity with the particular autonomous municipality of San Mañuel for 12 years. They're trying to send me to San Mañuel and nowhere else. But to go volunteer in San Mañuel I first needed to go to the capital of the caracol of La Garrucha to tell the good government junta, "Hey, I'm an international volunteer and I'm gonna go to San Mañuel and see whether the autonomous council there wants me to teach their kids or lay their bricks or what." Now, I'd known that the last two volunteers sent by the Chiapas Support Committee got mixed up at the junta and got sent somewhere else, and to avoid this I had a letter of introduction from Mary Ann of the Chiapas Support Committee to say "Hey, this is our volunteer that we’re sending to San Mañuel." I also told them very clearly that I'd come to go to San Mañuel. Unfortunately I was having trouble understanding what they were saying to me because 1) I'd just met them and wasn't used to their voices yet; 2) several different new people were talking to me in turn; and 3) I was nervous because I didn't want them to send me to the wrong municipality. I walked out thinking, Damn, if my med school interview had been in Spanish I might have had a heart attack. The junta ended up deciding that because I'm interested in Zapatista medical care, and because the clinic in San Mañuel isn't finished yet, I should stay here and volunteer in this clinic. I was none too pleased about that, and neither was Mary Ann. Fortunately there's gonna be a change of administration in San Mañuel in early October, and Mary Ann and others from the Chiapas Support Committee are coming down for it. So when she gets here she'll probably be able to straighten out my junta problem and get me to San Mañuel just a couple months later than I'd planned. In the meantime I'm at the clinic in La Garrucha, where I'm learning a lot and living rather pleasantly but not doing much that's of any immediate use to anybody else. My first day here I wandered around for a couple hours looking for work, but there really wasn't any. There is one doctor and about nine health promoters here, with others regularly arriving for short rotations from their communities. The place is very generously staffed by the criterion of how many people who know how to take a blood pressure are on hand at any given moment, although I would guess that if you were to add up every day of formal medical training of everyone here you'd get a total under one year if you excluded the one doctor. On that first day I saw one guy sand a board, and I thought, Oh, I could help with that, but then I ended up being one of four guys standing around watching him, as if to say Yup, he’s sanding a board all right. (Somehow this reminded me very strongly of being back in Wisconsin.) Then on my second day they put me in the consultorio, where they see patients. Patients told me about their symptoms, and then health promoters looked at me and asked me what medication I thought was appropriate, and I was like, Shit I don’t know, ask a doctor. I've studied fundamental things like the order in which electron orbitals fill as you move across and down the periodic table, and the evolutionary history of biological diversity (which is always presented in this certain self-important and teleological way: bacteria, eukaryotes, multicellular life, sponges, starfish, lampreys, real fish, amphibians, reptiles mammals, primates, hominids and then finally, Ta-da!: Humans, the Goal of Evolution.) I don’t know how to tell whether a 3-year-old's diarrhea is caused by "bacteria," "amoebas" or "parasites," I just know that all three of those are astonishingly broad diagnostic categories that among them include several thousand pathogens. After an hour of a patient health promoter named Mario having to mollycoddle me through every answer they were trying to get out of me there was finally a break in the flow of patients. I was able to say, "Look, I've got an undergrad degree in economics, I've studied chemistry and biology, I've been accepted to medical school but I'm taking a break before I start, and I've been a volunteer in American emergency rooms in rural Wisconsin and New York City where I moved patients, brought them food, made phone calls for them, did EKGs, cleaned beds and ran samples over to the lab, but if I would have tried to diagnose illnesses or prescribe medications there would have been lawsuits and rightly so. I'm here cuz the junta sent me here when I was trying to get to San Mañuel, maybe I should go back to the junta and say 'Look, I'm only getting in the way, can I please go to San Mañuel to teach 12-year-olds how to divide fractions and write complete sentences now?' " But then the doctor said, "Ah, I see, no, no, stay here and learn for two months, we'll teach you, little by little." He says that a lot, poco a poco. He's a very patient guy and I really like him. He's an UNAM (National Autonomous University of Mexico) grad and former MSF doc who's very sweet with the patients and is commonly called "Doc" or "El Doc" even though he's rather aptly named Ángel (MSF is the French and Spanish acronym for Doctors Without Borders.) At meals he'll sometimes just take bites off the jalapeño pepper on the table without bothering to dice it into his food, and some days after every other bite of dinner he'll say "Mmmmm" as if he's just realized something unsurprising. In talking to him I learned that he went all the way through medical school at UNAM for less than I'll pay to go to Mt. Sinai for one year, and that while the clinic gives out condoms and birth control pills when patients ask for them, it's uncommon for them to do so. I asked if that was because of the influence of the Catholic church, and he said, no, it's just expected to have five or six kids. When there are patients I sit in the consultorio and watch either Ángel or a health promoter take the patient's history, or no, hmmm. It's not really a history. I mean they don't ask do you smoke, when was your last period, the big laundry list you get in an American doctor's office. It's short and tightly focused on the immediate problem, sort of halfway between a patient history and an illness narrative. (An illness narrative is designed to bring out a patient's beliefs about the causes and proper treatment of their illness. It's supposed to be a very useful tool for when you're treating people who may believe that they're sick because the old lady across the street bewitched them, and antibiotics are all well and good but really everyone knows that you can only drive out the demon if you smear a bit of the blood of that same witch on your left earlobe under a full moon.) The procedure seems truncated to me because it goes symptoms, __________, prescription, with no diagnosis step in the middle. That's probably because a very few ailments account for a very large proportion of the visits here. I don't know anything about what happens in the other examining room, where the female health promoters take women patients with obstetric or gynecological problems, but from the non-OB/GYN stuff that I do get to see I'd say at least a third of the consultations start with a complaint of diarrhea, usually but not always a mother complaining of her small child's diarrhea, and end with a prescription for metronidazol, which kills amoebas and girardia parasites. I'm using the word "prescription" pretty loosely. They've got a stack of like 4" x 5" pieces of paper that are blank on one side and look like the scraps they have at a library reference desk for you to write call numbers on. A health promoter writes on these, often in pencil, the patient's name, the date, the name of a medication, a dosage, a frequency, a time period, and maybe her own name, and then the patient carries that piece of paper twenty feet to the Zapatista pharmacy where they pay a few pesos for their metronidazol or amoxicillin or whatever. Or sometimes the health promoter hands that piece of paper to me and then I hand it to the patient. Anyway, it's absolutely great that this astonishingly basic system exists, it's lifesaving work that's not at all difficult or expensive to do but often goes undone anyway because saving the lives of poor people is not important under capitalism. (Capitalism means that you determine production priorities according to what people with money want to spend it on, a new iPod for me is more important than a measles vaccination for cute little Luis Ernesto who lives at the clinic and isn't afraid of me anymore. By the way, lots of little children here are afraid of me because I'm real funny-lookin'. I'm white. I've got blue eyes, over which I wear glasses. I've got pretty much blonde hair, and what's more, it's arranged in a funny haircut, long and pulled back on top and short on the sides and back. I've got a beard that covers cheeks and chin, something I've never yet seen on a Mayan man. So every one of those things is different from what the kids normally see, and two- and three-year-olds will give me this look like Holy vaca, that looks just like a person, except different.) Anyway, I was gonna try and describe what would happen if they weren't here to give out metronidazol at 64¢ a box, but it turns out that Save the Children has compiled a handy little 8-fact summary of global child survival. So I'll just copy and paste that, boldfacing what this clinic largely does: * Each year 10.1 million children die worldwide before reaching the age of 5. That's 28,000 children a day. Despite a 60 percent reduction in under-5 child deaths between 1960 and 2000, progress has dramatically slowed or been reversed in many countries. [If this weren’t already the third overlong e-mail in a row, this'd be a perfect place to explain the deceptively bland phrase "structural adjustment."] * One death in every 5 in the world is the death of a child under the age of 5. * Every minute, a woman meets her death during pregnancy or childbirth. * Every year, 2 million newborn babies die on the day they are born. * Nearly all child and maternal deaths (99 percent) occur in
developing countries where mothers and children lack access to
basic health care services.
* The biggest killers of children worldwide are newborn
complications, pneumonia, diarrhea and malaria.
* Using existing tools and knowledge, we could save more than 6
million of the 10 million children who die every year from easily
preventable or treatable causes.
That's what doesn't happen here, or at least that's what happens
considerably less than it would if the health promoters weren't here
promoting health. I would guess there's a lot of unidentifiable kids
out there who aren't sick now but would be if the Zapatistas weren't
treating every case they can. A sick patient is often an infectious
patient, and more specifically a 3-year-old isn't necessarily very particular about getting to the latrine. Also, I assume that most of the latrines I've seen in the four caracoles I've visited have been built since the uprising started in 1994, though I haven't asked anyone about that yet. (A latrine is a hole in the ground with a shelf over the hole and a shed over the shelf. It keeps your feces out of your drinking water and thus breaks the life cycle or infection strategy of several nasty parasites. If you run a metal pipe from the shithole up into the air above the shed then your latrine becomes a ventilated improved privy, or VIP. I thought that was the funniest thing I learned in South Africa.) So anyway, because the Zapatistas had the good moral sense to build and staff this clinic, a lot of easy medical work gets done that otherwise wouldn't. And they also put microclinics out in the other municipalities, a health promoter in every village, and two lab technicians per municipality. One of the technicians here is a very nice guy named José Enrique who let me watch him test a stool sample for parasites, and I got to see girardia cysts under the microscope. I found it extremely interesting, but I won't describe it because you probably don't want to read in detail about the process of refining shit. Oh, I will say, though, that from what I could tell, his training, given in the caracol of La Realidád, is extremely, um, shall we say, *pragmatic*. He can tell who has parasites and who has amoebas, and other diagnoses that I can't remember right now. But when I correctly guessed the Spanish word for "meniscus," he didn’t know what I was talking about because, though he's a lab tech, he'd never heard that word before. I think I learned it in 8th grade science class, but if his job doesn't include precisely measuring out small quantities of liquids then I guess he doesn't need to know it. (A meniscus is the curve in a the top of liquid in a test tube, concave up for water and most other stuff but concave down for mercury. In a test tube marked in milliliters you have to read from the bottom of the meniscus.) Anyway, it's great to see all this basic work that needs to get done actually getting done. I talked to a health promoter with 12 years experience about what things were like before the uprising, and he said, well, you could stay in your village and hope you got better, or you could try to make it to the government clinic in Ocosingo, which was a trip of varying difficulty depending on where you lived and how sick you were. This improvement has provoked competition. By fulfilling the functions of the state, the Zapatistas make the state look bad, so now the Mexican government spends a fair chunk of money on social services in rural Chiapas (I'm afraid I don’t have a number). "Oh, you're a Zapatista? Well if you stop being a Zapatista and start voting for the PRI we'll give you a corrugated tin roof for your hut, we'll give you a nice big pig, a brand new plow, wouldn't you like to be a PRIsta?" (The PRI is a political party based on corruption and patronage, sort of like the old American system of machine politics, Tammany Hall and all that. The initials stand for the oxymoronic name Institutional Revolutionary Party, and under that banner, by hook and by crook, they held the Mexican presidency from 1929 to 2000. The Economist says, "Having lacked any coherent ideology for decades, the party became a means of winning and exercising power.") From all I've heard they did nothing like that before there was a Zapatista uprising to bribe people away from. On most days that handoff of giving the prescription from the health promoter to the patient has been about the extent of the work I've done, but then today I finally got to work a bit. First, they had me help move a bunch of boards out of a storeroom for a new building they're adding to the clinic. The boards were something like 2 x 6s, very heavy, and an absolutely lovely reddish sort of sunset color. Someone told me that they were caoba wood, and then I looked that up and said, Damn, they’re building a clinic out of mahogany. But that’s not extravagant like it would be in the States because mahogany grows wild here, although even so each of those boards is a little under five bucks. That sounded like a lot to me, but then I don't think I've ever bought a 2 x 6. Then they told me that the 20th of the month is inventory day, and I helped a guy called Enoc count medications in the pharmacy and the storeroom. I did a double take the first time I saw Enoc because unlike everyone else here he looks very military, with a crew cut, obvious muscles and a sleeveless shirt, like the Mexican Army guys who sometimes pass by in American Hummers out on the highway. He told me his name was Enoc, and I said, "Oh, that's interesting, is it a Mayan name?" and he said, "Oh, no, it’s a war name." (nombre de lucha). So I don't know what his real name is, but then I don't have any reason to, either. He's a very nice, low-key, slow, patient guy, though. Actually, everyone here strikes me as astonishingly patient and relaxed, probably because I lived in New York for four years. Anyway, this was the first time that I felt like I was doing something better than anyone else here could, or at least faster. He would sit in a chair, say "mebendazol" and point, and then I'd be, like, twobysixmakestwelveagainistwentyfourandtwois "veintiseis botellas de mebendazol." So we did that for their whole stock of medications, and then I did a bunch of data entry in Excel and showed him how to make it calculate how much they've bought, sold, and still have. They've got the better part of a thousand dollars in medication inventory, and I have no idea if that's a lot or a little relative to comparable rural clinics. Then finally I figured out that, while the black ink in the printer doesn't work, the red ink does, so we were able to print the inventory for everyone. But other than today I've mostly just been an observant bum. When I got tired of looking at the same five clinic buildings and the same ten clinic people I went out walking on the road. That's something I've always done wherever I've lived since I was a kid, probably because I'm an introvert at heart and it used to be my job to walk the dog. I like walking. So I walked maybe a mile up the road from La Garrucha, remembering how Zoey, my predecessor, had told me that she felt safer in Chiapas than she did in Ocosingo. Then I met a nice farmer with a small boy and a large machete who said, "Hey, are you just out walking alone, without a machete? You know last week a campesino was walking, and just right over there on that hill he met a group of bandits and soldiers who cut his head off [or maybe they just slit his throat, the verb agollar is ambiguous that way, and so was his hand gesture]. It's dangerous to walk alone." So I said thanks a lot for telling me and headed back to the clinic. The next day I told the story to Ángel and asked him if there was any truth in it. He said no, none at all, whoever told you that, nothing like that has happened here in a long time. So I don't know, each seemed pretty credible when I was talking to him, but they can't both be right. I do trust Ángel more than some random farmer, though. I decided that at least it's okay to walk on the long straight stretch within sight of La Garrucha, where there's people hanging out in the road. Pretty strange all the same, though. Oh, and one other strange thing: I'm having a recurring nightmare about missing a plane to Moscow from varying airports. I don't think I've ever in my life wanted to go to Moscow, but now it's getting so that during the dream I remember that I've had that dream before, oh, no, not again, these tickets are so expensive. (I've always been skeptical of the idea that creative speculation about dreams yields profound insights into otherwise hidden personal truths.) I originally decided to come because I wanted to see Third World medicine done without a horde of social status differences dividing healers from patients, and though at first I was bummed about not getting to go to San Mañuel, on the whole that's exactly what I get to see every day here. (Except Sundays, when they only see urgent cases, or maybe emergent cases, I'm still not sure which is a better translation of urgencias.) So really, this surprise two-month interlude has worked out pretty well from my point of view. Another very nice thing is that they feed me, and they don't charge me rent to sleep on a little mat on the cement floor in a corner of a storage room that has not only an electric light that works as long as you really let the light switch know who's boss, but a computer as well. (A computer in the room where I sleep, how First World is that? And it's actually a better computer than the dying laptop I have at home.) So anyway, in the past week I've bought a bar of soap, a roll of toilet paper, a little bag of tasty Mexican junk food snacks called Takis, a box of metronidazol (I had the runs till the runs ran out), two ears of corn and ten sheets of printer paper to make flash cards with. I think all that comes to around $3.12, which is a damn cheap way to live. And then with the money I'm not spending on food I'll be able to buy some more stuff to give to the health promoters in San Mañuel. I've already got them 12 boxes of amoxicillin and three of metronidazol, and a Spanish edition of Where There Is No Doctor for Women (or actually I think the official English title is Where Women Have No Doctor), which they have here in La Garrucha but not in San Mañuel, but they need more than that. You'll hear more on that subject from me shortly. So if I don't have any real work to do, what have I been doing apart from observing consultations? Well, I've spent a fair bit of time talking to the health promoters about how they do things, and I read my English copy of Where There Is No Doctor in English so as to be a bit less ignorant of my future profession, but mostly I've been reading Spanish and memorizing new words. I'm reading Where There Is No Doctor in Spanish to learn useful vocabulary like "dehydration," "family planning," and "worms," but I can only do that when no one else is using the book, and because I don’t want to take it out of the consultorio I can only read it when there aren't patients. I've read the first three chapters of El Hobbit by Tolkien, which has given me more practical vocabulary than I expected, stuff like "leather," "cane," and "good-natured." When I got tired of banging my head against a foreign language I read the first part of Ulysses, and I found that all that Spanish makes Joyce seem by comparison, hmm, well certainly not easy, but at least not opaque. It's a book where Joyce manages to reproduce on paper the disorganized experience of human consciousness. Sometimes I think, Wow, That's amazing, reading this book is like thinking inside my own head, except pretending that I'm an alienated apostate in Dublin in 1904. And then I think, You know actually I've lived my entire life inside of a human consciousness, it's really the most familiar and unremarkable thing in the world to me, this isn't really any more interesting than if a sculptor were to recreate the experience of wearing pants, will this book develop a plot eventually? So mostly I've read the first four chapters of 100 Years of Solitude in Spanish and learned around a thousand new words in a week. The tough part was that a ridiculous number of those words are non-cognate verbs that start with the letter "a." Right now I feel like most of the Spanish verbs that look nothing like their English equivalents start with the same letter, and many of them closely resemble each other, like apresar and apretar, asar and atar, acopiar and agobiar, arrasar and arrastrar. I finally made flash cards yesterday to keep them straight and found I've learned 73 of them; 7% of my new words are non-cognate verbs that start with the letter "a." Why can't they have some more verbs that start with the letter f, or v, or n? Anyway I read a few paragraphs of Marquez in Spanish, looking up lots of words and writing them down to memorize later, and then I read the same paragraphs in English. And my comprehension has improved noticeably. When I read the English translation now I mostly just think Yeah, I know, I just read that. I'm having fewer and fewer moments when I'm like, Oh, that's what's been going on for the last three pages, I had no idea. It's a very slow book for me to read in Spanish but a very, very fast way to build vocabulary. Here's one of the few short paragraphs: "José Arcadio's companion asked them to leave them alone, and the couple lay down on the ground, close to the bed. The passion of the others woke up José Arcadio's fervor. On the first contact the bones of the girl seemed to become disjointed with a disorderly crunch like the sound of a box of dominoes, and her skin broke out into a pale sweat and her eyes filled with tears as her body exhaled a lugubrious lament and a vague smell of mud. But she bore the impact with a firmness of character and a bravery that were admirable. José Arcadio felt himself lifted up into the air toward a state of seraphic inspiration, where his heart burst forth with an outpouring of tender obscenities that entered the girl through her ears and came out of her mouth translated into her language. It was Thursday. On Saturday night, José Arcadio wrapped a red cloth around his head and left with the gypsies." So I'm learning lots of very highfalutin' verbs, nouns, and adjectives. I figure that if I can get to a point where I can usually pretty much follow Marquez then I'll have no trouble with any written communication that I actually need to understand, sort of like how a distance runner may train wearing weights so that when they take the weights and run normally it feels easy. And I've learned enough to do the following three translations, in which I've left the words I haven't come across yet in English. When I come back I'll owe three beers to the first person to e-mail me saying what all three of them are. I've probably screwed up some grammar, but it's nice to know the words. 1. Veía las mejores mentes de mi generación destrozadas por locura: muriéndose de hambre, histéricos, desnudos, arrastrando ellos mismas a través de las calles de los negros al alba buscando un fix enojado, hipsters con las cabeces de los angeles ardiendo para la unión anciano del cielo al dynamo estrallado en las maquinas de la noche. 2. Nosotras que creemos en la libertad no podemos descansar. Nosotras que creemos en la libertad no podemos descansar hasta venirlo, hasta el matar de hombres negros, los hijos de madres negras, es tan importante como el matar de hombres blancos, los hijos de madres blancas. Nosotras que creemos en la libertad no 3. Mientras fui caminando ese listón de carretera, veía arriba de mí esa via sin termino en el cielo. Veía debajo de mí esa valle dorada: esta tierra fue hecho para tí y mí. Andrew

Source: http://kmkat.typepad.com/Andrew_in_Chiapas/2_The_universe_will_have_its_way.pdf