I woke up to the sound of Three Little Birds by Bob Marley blaring out of my phone next to my head at exactly 5:30 this morning. I had gotten so little sleep I had forgotten that I set the alarm. It had seemed I had just went to sleep. Not even light yet, I pushed the mosquito net back and climbed down out of my loft bed onto my makeshift bamboo latter. I put all my weight onto it this morning not worrying about it breaking where each piece of bamboo is hung by the next with a piece of twine. I learned twice before that the string wasn't strong enough, but I guess the third time is the charm. As I sifted through my sealed food containers looking for the powdered milk and granola, time seemed to go in slow motion as my body started to wake up. I made the concoction that would be my breakfast and tried to pretend it tasted good as it went down. I had been any more awake I would have thrown it out. After gaining enough strength to get my jean pants and peace corps shirt on I fixed my hair and laid in my hammock as the sun came up over the mountains and stole the cool air to replace it with its hot and unbearable opposite. I closed my eyes and thought to myself that I could probably catch another five minutes of sleep only to open them 2 minutes later. As I refocused on the day I noticed her out the corner of my eye and I knew she had been standing there for awhile just watching me. Waiting for me to see her. She was ready to go and as started to roll off the hammock to great here I notice Nico, the taxi driver walking to his taxi down below. I made no hesitation and yelled across and down to him using the first voice of the day and the only Spanish I could muster on that much sleep and at that time in the morning. “Esperate” “Wait”.
Katia, her mom Marta, and her mom's 2 year old boy all got into the back seat where I was already sitting. As we picked up another passenger on the way out of the community, I tried explaining to Nico that we were all going to the Hospital in Almirante. Silence took over the cab I started to feel more energy fill my body. We arrived at the hospital and I paid my share to Nico as they paid theirs in an awkward exchange of loose dollar bills and change. As we walked in front door I quickly noticed that not as many people were in the waiting room as I thought should be. I was quickly approached by a women who seemed to work there but had no identifying badge or clothes. I was asked what I needed and for a moment I froze. I had made it here only by instinct and now was time to preform. Only after a short scramble in my brain did my Spanish start tumbling off my tongue and into coherent sentences. I started to explain that I was part of the Peace Corps and that I was working with American doctors that had came to my community and had done an ultrasound on her the day before. I then went into how the baby's head was not only large and that this was her first baby, but that the baby is positioned feet down and that she is ready to give birth any day.
As we were ushered over into the Emergency Room I thought to myself that no matter what I will not leave this woman’s side. Only 4 months before I had witnessed two births go bad in my community where the women had had checkups and had tried to give birth in the hospital. The doctors were wrong. The doctors weren't there. The babies died on the way out from strangulation. Not again I thought to myself.
As soon as we entered the ER I noticed two very large people sitting to my left and the TV blaring up above. It looked out of place. There seemed to be no one attending to people. The room small, musky and downtrodden. Paint peeled from the walls. The brand new flat screen TV keeping the waiters minds somewhere else. That's when an incredibly large black man sitting down turned and started speaking what I guessed was Spanish. The man was so large I almost didn't notice him and his Spanish seemed to be from a different planet. Dressed in plain clothes the man asked what we were their for. As I explained the situation he shrugged and said what I could only make out as “tranquilo”. My first challenge of day and the reason I was there. There is something that happens in developing countries that is a phenomenon. As soon as someone else has even a little more schooling than someone else, they start giving the orders. As I found out, put that same person in a hospital, they are king.
I started my speech about how it was not ok and that she absolutely needed to see a doctor now. The man stood up and easily switched to English. Towering over me and outweighing me by at least 200 lbs I stood my ground and demanded that she be seen. It worked. She got in. And I didn't leave her side. They told her mother to wait outside as I followed her in and presented my self to any and everyone who walked by. At this time more than ever I was glad to be wearing my nice clothes and my Peace Corps shirt. An hour went by and I was notified that she needed to go to Changiunola in the ambulance, a good hour away. Marta, her baby, and I started our walk through the now deathly heat of the day through the concrete and twisted metal that makes up Almirante on our way to the bus station to meet her.
Only stopping for the little one to drop his pants and pee in the middle of the street, we made it through the heat and into the comfort of the air conditioned bus. The cool comfort of freon chilled my sweat soaked back as I leaned onto the headrest in front of me. We arrived in Changiunola about an hour later and made our way to the hospital. The mid day heat now bearing down on us like a furnace. After a brief talk with a couple different people I was ushered in to the emergency room as Marta stayed in the waiting area with her kid. At first glance, this placed could have almost passed for a hospital in the states leaving out the fact that their were no computers and all records were done by hand.
As I glanced over at the far wall I could see that Katia was sitting in a wheel chair with a gown on staring into the distance. I approached and could tell that she was glad to see me. She hadn't been there long but they had already done x-rays and sonograms so I decided to talk with the doctor in charge. A rude stocky Afro-Antilian lady, the doctor would only give me the answers to the questions I asked and nothing more. I could tell that she had told Katia. I went over and over it wit her. “So you are saying that the baby needs to come out within the next couple days and that we have to make an appointment for that at the end of the hall right?” Katia put her clothes back on and we made our way down the hall. Her 18 year old face looking panicked as I explained to her that they might have to cut her stomach to get the baby out.
As we continued down the hallway I noticed the lighting getting increasingly worse as was the condition of the building. We finally made it into a large room which felt like an underground betting ring in someones basement. This was obviously the old building and it didn't look like they were about to tear it down anytime soon. Groups of people stood in what were supposed to be lines in front of various windows that showed dilapidated names of the doctors they were supposed to see. We waited and when we got to the front of the line the confusion started. “This says that you have to come back in a week to make an appointment” the droopy eyed Latino woman pronounced. “No! She has to see a doctor today. The other doctor just told us” I jumped in before Katia could speak. It was at this time the woman next to her leaned over to say “Ya, it says they can do it today”. We were soon sent to another window to make our appointment.
If this place was a betting ring, then the next window we visited was where you would place your bets. In the very corner of the room with no sign and small glass slider, this was where we were supposed to wait to make our appointment. An hour went by and as we waited patiently I could see the rows and rows of records all hand written some sitting in disorganized stacks. We finally made our appointment and were told to wait at door number 2 which ended up being the kind of door you would think was a sliding door that someone had wanted to be just a normal wall so they nailed it shut and painted the same color as the rest of the wall. We waited. Kids played on the plastic seats in the hallway and Katia stood as I could help but thinking that her feet must be sore by now from caring all that extra weight.
Soon a maintenance man opened the door so he could connect an electrical chord from the doctors office to the bathroom where he was using a power tool. Then, a woman emerged from the doctors office to use the other bathroom. As I was now thinking that we would be waiting for a long time, the woman using the bathroom and wearing street clothes started to ask Katia what she was there for. As with the other nurses, doctors, and administrators she talked to her like she was 5 years old and overpowered her in the conversation. I stepped in and raised my voice explaining how the American doctor and mid-wife had seen the baby and said that it was not only in a bad position but that it had a larger than usual head and that this being her first baby, there was a great chance of problems if nothing was done. The lady took note and looked at the paperwork Katia had in her small trembling hand. “You have to make a copy of this before we will see you” the woman said. “Why, can't you do that here?” I responded. “No we can't. You can go down to the Chinese market or downtown to get it done. Come back and knock on the door when your ready” she came back.
I grabbed the paper and told Katia to wait there and to go in if the chance permitted. It only took me about 20 minutes to get the copy and we went right into the “Specialist” room as soon as I got back. As soon as I saw the doctor I could tell what type he was. The type that takes no shit from anyone, and tells you how it is. A tall white Latino man hunched over his desk making marks on the medical history sheet we had copied while listening to the radio strategically placed next to his hear on the shelf, I could tell this would be short. I explained the situation and how the American doctors thought that the baby was in grave danger. He looked as the documents and shrugged. About 5 minutes and a couple questions later he gave his recommendation. “The baby is in a bad position, but that could change. The head seems normal. Make an appointment for the end of month to come back and we will see how it goes” he said as if this were the final word. I boiled inside and could think of nothing more than to ask if he was sure. “Of course” he said. “Do you have a contact card” I asked. “This is a hospital, of course not” he shot back. I asked him his name and we were ushered out.
Not knowing what to say or think I called the American doctor to report back and also find out why the first doctor had given Katia two prescriptions for something. “What, that lazy motherfucker” the doctor yelled over the phone. After he confirmed with the mid-wife he was sure that the doctor just didn't want to deal with the problem. He also explained to me how the medication from the first doctor we saw didn't apply anymore because it was a crude drug that suppressed birth. The verdict was in and I had the executioners name if need be. I was livid and couldn't help but think that my neighbor's baby along with many others before it had been lost due to the same ignorance and negligence. I asked one more question and stated my response before I left the doctors office. I said “So if she goes into labor in the community, she will have to wait for a taxi to Almirante, and then wait for the ambulance to take her to Changiunola to the emergency room at which time the hope is that someone will see her and that the baby hasn't suffocated? You think that will work?” “It should be fine” I was told.
I walked with Katia, her mother, and her mothers baby to the corner where the bus was to pick us up. We hid behind the little shade available as I explained that everything we did today would help because now they knew more information about the baby and she agreed. Sweat beaded down her young face as she looked out into traffic and smog ripped through our lungs. She would not sleep well tonight or the following nights until her baby was born. Hopefully alive. She placed a hand on her stomach and looked up at me as she quietly said thank you. Another truck went by spewing more black smoke singing my nostrils as I thought to myself that one day these people will have more. Its the patience they posses that keeps them sane. It keeps them alive.
