Look, Listen and Learn: A Little Farther Up the Volcano Road

 We hiked back up the rocky trail to the highway, back to our vehicle.  We drove a bit further up the road to our next location.  Not too far off of the highway, we found the 3-year-old girl who was the next one to be weighed and measured by the health promoter.  Before we could attend to the little one, the child’s mother and her sister began to tell us of their own health issues.  One of the young women complained of extreme stomach pain and had a leg injury.  We could tell that she was very swollen around the middle, and the dressing on the leg looked pretty scary.  Promoter Yani was very patient, listened, gave the sisters the speech about HIV and the need for yearly pelvic exams, and helped the sister with the injury to make an appointment at the hospital for the next day.  Yani looked around the large yard and identified a few plants which the family could harvest to improve their nutrition.  Overall though, there were not many fruits or vegetables in sight, though there were various herbs and greens.  The small corn field seemed to belong to someone else and maybe as the caretakers, they were allowed to keep some of the corn.

It was time to examine the little one.  The first order of business was to dump the urine out of the girl’s plastic sandals and to take off her wet panties.  Yani hung her spring scale in a tree, lifted the little girl and placed her into the sling.  She read the weight, scooped her out, gave her a hug, and set her back down to play before recording information in her medical log.  All the while, Yani spoke to the sisters, “It’s important that your daughter learn to use the latrine.  When she has an accident, you need to bathe her.  Wash her bloomers and when you hang them up to dry, be sure to hang them right-side-out so flies do not land on the inside and leave germs which can contaminate her vagina.”  Yani spoke kindly, but in a way that let the sisters know she was serious.

We shared hugs and playful moments with the little girl.  We left worrying that the sister with the swollen belly and leg injury would not keep her appointment at the hospital.

We walked to the highway and went a little further down the road to visit a family with a preschool girl and a 5-year old boy.  The boy was a little gentleman, chasing the two diligent guard dogs to a safe distance and then sitting calmly on the porch in his 5-year-old-sized chair.  His sister was afraid that she would get a shot.  This is one of Yani’s challenges – convincing children that she is more than just the “vaccination lady.”  After the children were weighed and determined to be healthy, we learned about the family kitchen.  The mom and her sister talked about the great amount of time the generations of women in the household spend cooking and telling stories in the kitchen.  Deb and I could feel the love centered within the family kitchen, and thought about how in our own homes, generations of women gather together to cook, share recipes and wash the dishes. 

 

 We visited a family compound which housed more than 25 people, sons and daughters, grandsons and granddaughters with the Grandma and Grandpa heading up the household.  Little ones were weighed and measured while older children got ready for school or watched us with shy smiles.  Moms did laundry – there was laundry hanging everywhere – all washed with collected water.  Water totes, cisterns and barrels were tucked into every corner amidst squash plants and herbs.  The system was designed to catch every bit of rainwater via a system of roofs, troughs and gutters.  The only source of water for this family, as for most of the families who live on the side of the volcano, is the rain.

We walked below a large and low trellis, home to cucumbers and lorroco, and ducked our way into a little patch of sun and into the next home.  A pink bike was parked in the sun, next to a crouched old man.  “Is he OK?” we gently asked Yani.  “He’s just cold,” she replied.  As in every home, we were treated like dignitaries.  Benches were cleared so we could sit.  The grandmother and two young mothers sat and chatted with us.  The grandfather crouched, his feet flat on the ground, his arms clasped around his knees, his head down – he did not move.  The six-year old boy turned the bicycle upside down in the yard.  He turned the pedals and checked the chain.  The babies were weighed, the mothers were counselled, the grandmother chopped onions, and I was mesmerized by the boy with the bicycle.  He went over to a white tool bucket and took out a small tool or two.  Pretty soon he had the bicycle chain off and then on again, had tightened a couple of screws and was riding in tiny circles next to the grandpa.  When it was time to leave, the grandmother presented Deb and I with two big bags full of bananas which they had grown themselves.  We graciously accepted the gift, hugged the adults, kissed the babies, congratulated the bicycle repairman on his excellent work, and bid farewell to the grandfather. 

We made one final stop in a home with another new mom and an adorable baby girl.  The home was located in a small family compound and the family had sufficient resources to purchase a few more fancy items for the baby.  A male relative who had been drinking stood outside and Yani closed the door.  Yani gets her amazing energy by being with her children.  She hugged and cuddled the last little baby girl for a good long time, resting up before heading over to Yani’s satellite office. 

Most afternoons Yani returns to her home community and has office hours in the small clinic there.  The community is just a tiny hamlet with one rocky dirt path, just barely navigable by vehicle.  The community school is just up the hill from the clinic, so as Deb and I sat on the porch, we were able to greet the school kids as the shifts change at midday (little kids go in the morning and big kids in the afternoon).  Yani snuck off behind the clinic to her house to cook us some lunch, so Deb and I poked around the clinic a bit.  We were pretty impressed with the amount of educational material she had, as well as basic medications, an exam table, scale, wall posters and the mandatory wall map of her promoter-zone.  Pretty soon Yani appeared with two plates full of fresh, scrambled eggs, beans, tortillas and crema.   We could not contain our admiration for Yani’s work nor our humble gratitude for her generosity.  She showed us her log books and the way in which she records each patient’s information.  She updates her records every afternoon and is often interrupted by people coming by for advice on a health issue, a check-up or to pick up some condoms.  Yani runs educational workshops for the community, and treats emergency cases until an ambulance arrives.  She is trusted by everyone in her care-zone and beloved in her community.  After lunch, she walked us to her own home, and gave us a tour of her garden.  Cutting bananas from her own tree, she presented us with a gift of fruit.  This is how we said good-bye.

Yani and her patients taught us about life on the side of the volcano.  They taught us about survival in remote places, dependence on family and community, and the vital place health promoters have in in the lives of families which have extremely limited access to healthcare facilities.