These two little guys, whose pictures from almost a year ago are still posted, were at the CRN Christmas party last month. Luis, at left, is now at a normal weight for a one-year-old, according to his mom. Marcelo, on the right, is likewise at a normal weight, but his blindness remains. When an ophthalmologist friend from UK was visiting, she helped us confirm the cause--lack of vitamin A in the weeks after his birth. He is going to have an operation, but the prospects for much improvement are very slim.

One of the high points of Kate and Liz's Christmas visit was our hike around Cuycoche, the volcanic lake in the background.

Sometimes

Sometimes, like yesterday when I was out walking, hopping off and on the broken sidewalks filled with people and commercial activities (motorcycle repair, tent making, chicken roasting), I’ve found myself fuming with righteous indignation. This city is filthy, broken down and without basic infrastructure (not to mention usable sidewalks)…. A few examples: .....There are open manholes everywhere, because thieves sell the covers to scrap metal dealers, both parties acting with impunity….. A woman died one night last year when she drove her car into a three-story-deep, 50-yard-long hole in a street close to our apartment; the hole was unmarked and unguarded, and remained pretty much the same way for another seven months before city workers finally filled it in after completing whatever construction work was involved….. Rather than households being connected to a central water supply, water is delivered three times a week, with different neighborhoods taking turns receiving it……Sewage? I shudder to think what happens to it, since I haven’t seen or heard of a processing plant nearby, and the fact that nowhere is the water potable is no doubt related…..The traffic is out of control, pedestrians running for their lives when they have to cross a busy street or hop off a sidewalk…..

What a way for 400,000 people to live!!

And yet they get along, and are generally very good-natured about it all. Only someone like me gets crabby about such things. Ecuadoreans seem impervious, I think because experience has taught them that government is of little use in their lives. It saddens me how often people say that everyone in government is corrupt, using a tone of voice implying inevitability.

On most days the concept of “inevitability” goes against my grain. We wouldn’t be down here trying to do something about injustice in the world if I we dwelled too much on inevitability. Anyway, it reminded me of a poem I ran across in November when we were in Kentucky spending an evening with friends, and I’ll put it here as a nice way to begin 2009.

Happy New Year.

Sometimes

Sometimes things don’t go, after all,

from bad to worse. Some years, muscadel

faces down frost; green thrives; the crops don’t fail,

sometimes a man aims high, and all goes well.

A people sometimes will step back from war;

elect an honest man; decide they care

enough, that they can’t leave some stranger poor.

Some men become what they were born for.

Sometimes our best efforts do not go

amiss; sometimes we do as we meant to.

The sun will sometimes melt a field of sorrow

that seemed hard frozen: may it happen for you.

Sheenagh Pugh, b. 1950

Taxis

I’m getting to know the taxi cab community here in Santo Domingo pretty well. Every morning I flag someone down on the busy corner of Latacunga and Guayaquil. After I tell them that I want to go to the barrio of Carlos Ruiz Burneo, a pretty rough place, they almost always hesitate a moment and look at me briefly, as if to ask, “why would anyone want to go there, particularly an aging gringo like yourself?”

Since this has been going on for over a year now, I’m now regularly flagging down taxi drivers who I’ve had before and they greet me like an old friend. Sometimes, if they spot me walking to the market, they honk and wave, though they have yet to stop and offer me a ride. Rita came out to the clinic last week for a little birthday celebration for Mercedes and got into a little fight with the driver. He was going to charge four dollars and she complained that I only pay three, to which the taxista replied “Your husband is an amigo mio and I give him a deal.” They finally agreed to $3.50, but she had to throw in one of the brownies that she was bringing to the birthday party.

Honking is important here. It’s a friendly place and the drivers are forever tooting at someone they know on the street or in another cab. Honks can also be a declaration of intent, like “I’m coming through this impossibly small space at a rapid rate of speed despite all this chaotic traffic, so you better watch out, because if I hit you, since I was the first one to honk, it won’t be my fault.” These sound like this: beep-beep, short and in quick succession. Also there are lots of angry honks directed at anyone doing something hasty, nasty or stupid. Because this happens pretty frequently there is always a background of angry honks wherever one goes, night or day. Angry honks are louder and sound like this: Beeep. Beeeeep. For a group of people who are so warm and welcoming face to face, they are incredibly rude on the road.

The taxistas favor seat covers made up of that deep pile shag carpeting that was really popular maybe 30 years ago in the US; carpeting over the dashboard, too, for some reason, but not much in the way of personal safety protection. Seat belts are for sissies and their use is thought to reflect a lack of confidence in the driver. It took me more than a week to figure out why I was arriving at work each morning with this big swatch of dirt running from my right shoulder to my left hip. With all the pollution, dust and grime in the air, seat belts tend to get pretty dirty when not used and since I apparently was the only one in town using a seatbelt, I was getting pretty dirty. I decided in favor of clean over safe but am prepared to admit that this might not be the best decision, especially in Santo Domingo.

Something

Who said: “I can't do everything but I can do something.”?* Whoever it was, it’s how we steer our star down here in Santo Domingo, Ecuador.

I met Rene, a little boy 6 years of age, a couple of months ago. He has spina bifida, a birth defect involving the spine, which has left him paralyzed below the waist. He can’t use his legs and can’t control his bowels or his bladder. In addition Rene has hydrocephalus, which occurs frequently with spina bifida. In the US, he would have had an operation for it by now, a “shunt”. Here in Ecuador, the family couldn’t afford it--about one year of dad's salary--so it hasn’t been done and his head is therefore bigger than you’d expect. He’s an engaging, bright-eyed little guy who loves attention.

Spina bifida is certainly a tough go for families, even in the US, and much more so down here. Mom, dad, Rene and his older brother Diego live in a little apartment behind dad’s automobile repair shop in a neighborhood near the clinic. He was getting around in the apartment by rolling around on the floor. While we were talking with his folks about his problem that first time at their place, his mom began to cry quietly and Rene looked confused, not understanding why the fuss.

Jamie Strawser, a friend and physical therapist, brought Rene his first wheelchair last month. She was here as part of a brigade made up mostly of faculty and students from UK. It was quite an event, and a little crowd formed in front of the clinic as Jamie adjusted the chair, passing on instructions and tools to dad, mom crying in the background—she wasn’t the only one—and Rene, he was smiling, happy and excited about his new wheels. It wasn’t everything he needed, but it was something.

*Frederic William Farrar (1831-1903), canon of Westminster and later dean of Canterbury. The complete quote is : “I am only one, but I am one. I cannot do everything, but I can do something. What I can do, I ought to do. And what I ought to do, by the grace of God, I will do.” This quote has also been attributed to the American Everett Hale (1822-1909), religious thinker and writer from Massachusetts, who also said (my favorite): “If you have accomplished all that you have planned for yourself, you have not planned enough.”

Nieve in Ecuador - Rich Letter #2

If you turn right out the front gate of our clinic, right again where the sidewalk ends, and walk carefully four blocks on the muddy road lined by hibiscus bushes up the hill, after a turn or two, you’ll come to Nieve’s house. The first time Mercedes and I visited her, Nieve couldn’t get out of her bed. She could hardly move.

I love doing these house calls with Mercedes, our community nurse. She’s in her element out there and everyone seems to know her and love her. Your patient list has a way of growing when you’re out visiting homes with Mercedes. Recently she recruited me to visit a little girl badly burned on her leg but when we finished with her, 2 or 3 more folks needed a visit. Knowing you are in the neighborhood, people will flag you down and off you go.

Anyway, Nieve is better now, on medication for her severe rheumatoid arthritis, provided through the help of our generous benefactors back home. She now limps on her walker the four blocks to the clinic every week to get her methotrexate shot and have her blood pressure checked. She’s a very positive person, doesn’t complain much about her lot in life. We aren’t able to solve all of her problems, but she’s grateful she can walk again, and so are we. Thanks for making it possible!

Letter from Ecuador #1 (Rich)

June 22, 2008

We got caught in a torrential rain the other day while Cristian, my colleague at the clinic, was driving us home. He’s our young, excellent and hard-working Ecuadorean doctor who sees the adult patients while I see the children. Driving through the rain, he observed good-naturedly that we really weren’t supposed to get rain like this now that summer, theoretically the dry season, had arrived. The passage of the (two) seasons here at the equator, however, is a pretty nebulous concept. Winter and summer are pretty much interchangeable. Winter is warm, humid and rainy, and summer is warm, humid and slightly less rainy. I joked that really the only two seasons in Ecuador were mud and dust and everyone laughed in the usual Ecuadorean way. There is so much here to laugh at, they get pretty good at it; the weather, the water supply, the economy, the crime rate, the corruption and the many unpaved roads being only a few of the possibilities.

Despite it all, or maybe because of it all, Ecuadoreans are hopeful people and our days at the clinic are filled with hope. Rocio, our nurse, and I were talking last week about the unacceptable number of children we are seeing with malnutrition—24 children just in the month of May. We have a supplemental feeding program which keeps most of the kids 6 months to 3 years of age reasonably well-nourished, but still some are falling through the cracks. She thought that organizing group meetings to provide education and support for the families with malnourished children would be a good idea. We’ll also be doing monthly weight and infection checks. Mercedes, our new community outreach nurse, will be visiting the families at home, checking to see whether the family needs food and how the feeding is going. We also have a little money to buy food in emergencies when families are going through rough spots. Hopefully—there’s that hope again—we can start getting these kids back on track nutritionally. Thank you, friends and family back home, for helping to make our hope possible.

Marcelo and Maria

Marcelo, who is four months old and blind, went home on Friday. He and his sixteen-year-old mother Maria came to CRN five weeks ago, following his two week hospitalization to recover from malnutrition. I don't know the cause of his blindness; local doctors are saying he needs an operation within the next few months in order to save his right eye, and that the left eye is a lost cause. Hoping for a miracle if not a possible mis-diagnosis, I have sent pictures to an ophthalmologist friend in Lexington, hoping that she might have a suggestion or lend some insight into why the medical advice has so far been very inconsistent. Marcelo is a real peach -- good natured and pretty straightforward in communicating his needs: a real stroke of luck, since his mom required some major on-the-job training. Thankfully, Maria rose to the task, learning a lot from being with other mothers and the CRN staff. She and her son are a disarming pair, and I'm looking forward to seeing them both at his first check-up (today!)