A Nurse’s Visit

“You must go with the doctor and take some students with you! There is a mother in the community in serious condition.”

This is how we are greeted Tuesday morning by Morena, the Public Health Promoter for the canton of Las Delicias in the department of La Libertatd in El Salvador.

“We have a change of plans,” says Morena, “follow Lucita and the doctor.”

Lucky for us, we have a nurse (Carline) accompanying our volunteers this year.

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We begin our dusty walk away from the canton into the hilly fields. The dust in Las Delicias swirls in the air with every step. In the dry season, this is an extremely dry country. The grass is dry (and usually on fire). The air is dry. The roads are dry. The pilas are dry and the fine grey dust rises up to your nostrils coating the inside and mats with all your mucus. I can only imagine what is happening to my lungs. The people who live here most certainly have a layer of dust at all times inside their lungs. Bronchial problems are one of many health issues in this canton.

“¡Buenas! Tienes un chuchu?!” Lucita yells into the yard of where we stop. You must always announce your presence before entering someone’s yard or their dogs will charge. Asking if someone has a dog is always a good idea.

Inside the home is a new mother, recently discharged from the hospital the day before. She’s in pain and cannot walk. Laying on the bed the young mother is in great pain. The doctor who is with us begins with some questions – “Where do you hurt?” and asks to do an examination.

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The young woman is embarrassed and wants to be cleaned. Her mother removes her shorts, the soiled underwear and explains why her legs are streaked with blood they are using monte as a pad to catch the blood. Many people cannot afford to purchase pads, or diapers or other basic hygiene needs and so in this case the young mother is using grass and leaves in her underwear to absorb the blood. She is dirty and embarrassed.

The house has only one room with three beds. Each bed has a curtain offering only a slight bit of privacy. Through the back door Carline and I spy a young girl in early teens peering through another curtain. What must she be thinking hearing her sister in pain, her mother completely unable to understand the daughter’s pain and incapable in her lack of education to assist or advice, and now these strangers in her home?

The doctor asks Carline if she would care to do a limited exam (because of the pain) of her pubic area to figure out what was causing the pain – could it be an infection or it could be trauma to a nerve causing the numbness into the leg post-delivery.

Carline put on latex gloves and attempted to just take a look. The woman cried in pain and embarrassment and Carline tried to reassure her.

“Look at me,” she said sternly but softly, “Look into my face.”

Carline touched the area to see where the pain originated and felt the need to clean her, for dignity’s sake.

“¡Aigh! ¡No juanto!,” screamed the young mother.

She cried that she could not stand the pain. The agony cut right through me and I began to shake.

Questions swirled in Carline’s mind and began asking me questions to translate. Had her milk come in? She needs her breast milk to come in, it’s so important. If this woman can’t afford to buy sanitary napkins then she can’t afford formula. Is the mother feeling detached from the baby? Why was she discharged with a fever? This woman needs to be in the hospital. How will she get and can she go soon? This birth was a traumatic event and compounded in this particular environment Carline worried about the acute needs for this woman that none of her basic needs were being met. The trauma of delivery (a tear) combined with the use of grass and leaves as a sanitary napkin was a perfect storm for infection.

Interpreting this Experience

This hands-on experience of acute trauma under the conditions of extreme poverty forces so many questions about the hierarchy of needs (Maslow’s Hierarchy of Needs).

Basics:

–       Food

–       Shelter

–       Water

Maslow states that without meeting that basic level of needs you cannot proceed to the other level of self-awareness, self-esteem, education, self-accomplishment or ultimately fulfillment. While his theory that this barrier to personal/social development cannot be applied cross-culturally it’s not a bad place to begin an understanding of what is happening in El Salvador with a majority of its population.

If you are too busy trying to meet just the basic needs its impossible to find time, hope, or energy to move beyond.

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Blaming the poor for their condition serves no purpose and helps no one. Dr. Paul Farmer discusses passionately how the structure of society – including everyone rich and poor – often confines and perpetuates this abusive model of living. You can’t get out of it, because society has conditioned poverty. This is unacceptable. How do you ever expect people to change if society doesn’t allow it? Moreover, from the bottom how you convince people that they could conceive of a different world and not just complacency.

This is important work, work to change a life, a community and the world. Image

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