Musings on mercy and medicine

 

Gracias’ castle is near downtown, elevated to offer a view of the whole town. Although there were saws renovating various statues around the castle, the site is a spacious and quite place that offers spectacular views of the mountains and town. I hope to find myself there several more times.

The Celaque mountain range reminds me of the Shenandoah Valley. I am eager to go to the villages in these heights next week with a dental brigade.

Meeting mercy on the plaza:

After Saturday morning's recorder lesson at the evangelical church, I decided to try spending some time on the plaza, rather than returning home in a hurry to my dark room or the quiet sleeping house. On the plaza, I tried not to be conscious of locals looking at me (I realized that a gringa leisurely reading a book may look especially conspicuous to local eyes). One thing to mention about my walk up to the church that morning: A middle-aged man near a truck parked close to the road folded his hands in a prayerful position and said, as he leaned towards me, "buenos dias, princessa." I smiled and tried to look friendly as I replied, "buenos dias" and kept going, either subconsciously or purposely not glancing at him. What could such a greeting mean from his side and towards mine..."princessa"? He might not take much care to explain if I asked, but I suppose I am seen as a spoiled royal.

Anyway, back to reading on the plaza....an elderly plaza-sweeper greeted me but passed. Then, another middle-aged man came by with some boxes, selling something (to which I said, "no, gracias"). Finally, a third man came by, squatting by my bench. He started by excusing himself for bothering me and explained that he was diabetic with some other acute health condition and was not in the condition to work (or else he'd be on the floor) and had to pay some government agency 200 lempiras and he had kids but couldn't work because of his condition...and that he went to the church (he pointed to the catholic one near the plaza) to pray to the saints that God would provide in his desperate situation. He said something about empanadas (a common food sold on the streets) and oranges...and my help. I asked if he had visited the clinic (knowing that San Lucas won't make a sick man pay if he can't). He said he'd been there and had many examinations. I couldn't tell if he had been prescribed medicine that he couldn't afford or had simply stopped going to the clinic. I was eager to blame him for his misfortune, thinking that he could do SOMETHING without overexerting himself or that he could get initial treatment and work to repay the cost. Not ready to involve myself in his labyrnith of troubles, I chose to act simply and in a way that I could clearly explain, saying that I needed to buy oranges (something I had planned to do on the way home) and that we could go together to buy some for him and me. I should have said fruteria (where I planned to go) but he said mercado and I followed him. On the way, I told him (upon his asking) that I was from VA (he has friends or relatives in the Carolinas) and that I was returning (or leaving from Gracias is all that concerns him) in February (never mind that it is at the end of February). He greeted many people on the street as we passed through el centro and I was slightly annoyed at having to stop the mission at hand for friendliness that didn't concern me (although begging may not be a task of great dignity for him--or perhaps others clearly knew this drill). In any case, he led me far into el centro (where I had never gone before) to the market, which is a small area saturated with merchants under a low dark roof and narrow isles. I decided that since I was already uncomfortable so far away from the streets I knew well that I didn't want to enter the small busy spaces. Not waiting for the man to lead me into the market, I approached a woman at the corner and asked for two bags of oranges. I said "aqui esta señor" handing him one of the bags. He thanked me and said "Dios le bendiga." I replied with the same and "adios," heading across the street and in the direction of home.

I stopped at several papelerias, looking for index cards (as I had planned to do), with half the intention of being sure that he wouldn't follow me. No index cards were found and I trekked home, comforted that no one was following me. I wondered if I should have bought some beans for him (for oranges might not be suitable for diabetics). I also wondered if all he'd told me was true or if he even cared that I had believed him. Would my oranges or my 'act of kindness' (no matter how awkwardly or stiffly effected) help him? I contemplated the other two men that had spoken to me on the plaza. They were doing their jobs (sweeping or selling), yet I had spent my lempiras in response to a beggar. Was I thus fueling this occupation? Should I have required him to make a straw box or woven bookmark in exchange for my mercy?...would this validate my mercy or give him a sense of self respect--is one or both necessary? I am not certain how the Biblical instruction of not turning away a poor beggar is to be put into practice...that is, how prudent or picky one must be. I don't think I should have acted differently (I couldn't have rejected him altogether, for sure). In reflection of the incident on my way home, I thought, 'Just in case mercy-giving could be a dangerous enterprise, as I felt a bit uncomfortable following him to the big market, I would choose to return from flute lessons promptly and not linger on the plaza.'

As I passed the town's hospital and neared home, I saw many cars parked at the building in which I am told women await to give birth if they come to the hospital early. On several of the trucks' beds were stacked boxes with "Samaritan's Purse" clearly and largely printed. I tried to think from where I remembered the organization, but supposed that these were donations to the hospital, birth-awaiting-house, or maybe just to everyone (hence the many cars parked on the street). I wondered if this was the way mercy ought to be given: professionally, formally, safely...impersonally. I remember being in Mexico and hearing criticisms of such "mass mercy" efforts: "The people have food...they don't need stale rice and beans and expired canned goods. They have clothes...they sell the donations on the streets. These mercies cause more strife and theft amongst communities than good." These were the described realities of poor neighborhoods in Mexico. The communities needed different 'mercies"--perhaps something more personal...something that would approach, acquaint, and know the need before rushing and forcing action or 'help.' Maybe that is what my experience on the plaza lacked--the assured knowledge. While personal, my 'mercy transaction' did not feel genuine or informed, nor did I feel content with the outcome. While I hope that my action has benefited, I have no way of knowing. Maybe it is okay that one does not 'check back' to make sure that assistance is justified, but prior knowledge of the situation and need is a different thing, I'm sure. 

...So I'm seen as a princessa, which is approached in hopes that she'd be willing to give up a few lempiras. Seen as belonging to the kingdom of the States, I am branded as some sort of money-containing purse (be it a Samaritan or ignorant/naive wealthy tourist). If it is within my power and choosing, I would rather be identified with a different kingdom--that which descends and dwells with...that which is able to trust and be trusted...that which might provide beyond the momentary and material.

Dra. Raquel invited me to lunch (yes this is a verb in Spanish, for sure: almorzar) at Villa de Ada. There is a hotel, several meeting rooms, pools, a small lake, and a restaurant. The lake houses a fish farm from which the restaurant prepares meals. I’m not sure if the ducks ever end up in the kitchen.

After forty minutes of waiting on the lakeside, our fish meal appeared. When Dra. ordered, she said ‘’fried fish.’’ However the meal was accompanied with Honduran sides that could stand as a meal on their own. The fish were as good as anything deep-fried and salty gets.

Quotes to sort as you please (I'm not sure how I've categorized/attached them, yet):

"I always lose. I don't know why I'm still playing," my host brother, Jonathan, said, describing his experience with playing marbles (and other games) at school with other boys. The struggle with being a 'cool' fifth-grader is so near to humans of all ages, even if 'cool' takes on a different character.

Annals of a Quiet Neighborhood, by George MacDonald (I have shamefully misspelled his last name in my last posts--apologies) Nonetheless, some quotes from a great novel:

"When God comes to man, man looks round for his neighbor."

"...the way to make indifferent things bad, was for good people not to do them."

"I think one safeguard is to encourage one's friends to borrow one's books—not to offer individual books, which is much the same as OFFERING advice."

"I know I am cowardly. But if I cannot dare, I can bear."

"No time can change the relation of cause and effect. The poison that operates ever so slowly is yet poison, and yet slays."

"The world will never be right till the mind of God is the measure of things, and the will of God the law of things. In the kingdom of Heaven nothing else is acknowledged."

The castle has four of these towers (one at each corner) with openings, much like those on the walls of the castle, for looking and battling out from. The first Honduran president is buried in the tomb on the left (no other tombs are visible)..

I wonder if this style gate was placed after the castle forfeited its military use. It looks too delicate to keep out the enemy.

It seems that even the stone flooring has strategic patterning.

These folks consented to a picture. You might understand better when I say it is difficult to describe a Honduran (since their appearance and heritage is diverse). The older gentleman is Ananias, my host family’s ex-neighbor. When we visited them on my second day in Gracias, he enjoyed relating his Navy experience in Russia to my nationality.

The road to the castle is uphill and still simply dirt (with rocks here and there). I wonder if this reflects the castle’s authenticity (there is no paved road for tourists—they must, if they ever do, hike up the hill).

The castle dog (as I will call him) was very amiably allowed me to take his portrait as he surveyed the Celaque mountain range.

Musings about patterns in medicine and dentistry:

I was never drawn towards pursuing a career in medicine. The act of diagnosis and pharmaceutical prescription as a way of dealing with health problems (to me) hinted at a futile cycle of some sort. Hence I pursued dentistry, a realm I considered separate from mainstream medicine. The 'hands-on' approach to addressing problems in one or two appointments seemed like a very satisfying way of actually alleviating ailments. During my undergraduate shadowing/assisting experiences, I had begun to realize that dentistry is a bit more complex than initially met my eye (and that it resembles its close relative, medicine, more than I thought). Here in Gracias, I have found that most dental patients' oral health (and associated dental treatments) are very vulnerable to a cycle of recurring disease. Under such circumstances, dentistry can lose the shine to which I was initially attracted.

Like many ailments, dental caries are caused by bacterial infection. The resulting damage and prolonged bacterial persistance is augmented by certain environmental inputs or alterations. That is, bacteria chew away at your teeth, and what you chew might help them continue to do so. Most patients from Gracias and neighboring towns (country villagers only have access to dental care--extractions, at that--when brigades come to visit) are diagnosed with 4-16 cavities. Some decide to treat anterior blemishes in several days' appointments but leave posterior teeth to exract when they cause pain. The pity is that the bacteria flourishing in posterior teeth have little troube settling crevices where resin meets tooth. Eventualy, the restoration fails and filling cavities becomes almost as routine as a dental check-up. This reality crushes my beloved idea of dentistry as a skill empowered to permenantly 'fix.' There seems to be a missing link (or several) that causes difference in the way dentistry functions in Honduras as opposed to middle-class America. I think part of this difference lies in the existence of public health sectors in the States. Following are accounts that lead me to so infer:

One hot afternoon in the clinic, Dra. complained of wrist pain "from too many extractions" and said she was tired of being a dentist. [This is quite an alarming statement if you are about to begin training in the profession!] She said she'd rather be an actrress or soccer player (it turns out Honduran soccer players receive salaraies similar to government officials). Then she asked me what I would do if I wouldn't be a dentist. Not being very creative, I told her I would likely work in public dental health at least part time as a researcher in the lab. I had to explain to her that public health is concerned with the causes, progression, and intervention of various diseases in particular areas (towns, counties, states). I explained that there is special training for such a profession. She pointed out that the government must fund these projects, to which I insufficiently responded, 'yes,' neglecting to bring up the topic of tax dollars. In any case, no such thing as public dental health exists in Honduras, and people come to the dental office at their own discretion, asking for treatments they deem suitable, which the dentist might consent to give. I have heard Dra. explain several times that a dental cleaning and check-up does not (to patients' surprise) take care of cavities. She often instructs to brush after each meal and prescribes floss or mouthwash for some patients, but this is as far as dental education goes.

I'm not intentionally critiquing Dra. for insufficient instruction/education or the Honduran health care system for the same, but I would like to observe how much easier and more enjoyable an American dentist's job is as a result of public health dentistry's efforts. In the struggle against oral infection and disease, dental clinicians are on the front lines. [I recognize that it is problematic to turn health care into warfare but find the figurative positions of various groups noteworthy.] Public health dentistry is the supplier (or catalyst if you want to go chemical) of necessary actions and implementations that decrease the load on front-line clinicians. Populations are equiped with the knowlege and incentive to keep themselves healthy. Schools, towns, counties, and states are encouraged to adopt certain policy (no soda machines, water flouridation, etc). Clinicians, also, are given feedback from a single source on the situation of the area within which they serve. Also, new findings about clinical conditions often emerge from public health dentistry. When such support does not exist, dental clinicians cannot effectively treat populations (as the chair only seats one patient at a time). Untreated oral infections often overflow into the neighboring front-lines: medical practice. Shadowing with Dra. Julissa, one of the general medics at the clinic, I witnessed diagnoses of various facial skin, ear, tonsil, and throat infections attributed to oral Streptococci, as "his/her mouth is full of cavities." It seems that both medical and dental clinicians in Honduras would appreciate the efforts in which, as far as I know, public health sectors engage.

I have fully recovered from last week's cold. I am hopeful that Amazing Grace will be played in church by a recorder choir this weekend. Next week, I look forward to going with a dental brigade to the villages (Oh, finally...the mountains!). Pictures throughout this post are from today's fish meal with Dra. Raquel at Villa de Ada (a mini lake/resort) and a visit to the town's castle.