“I knew I wanted to go to a tropical or sub-tropical area—since I was already interested in tropical diseases. The summer before I graduated from Tulane, I got an internship in Ecuador with the river blindness program, and worked over in the dome of gloom with a surgeon carving parasites out of people. In 1997, Elizabeth and I and our little daughter, Gabriella, moved to Quito. Already I was determined to commute from there to wherever I’d be working, so that the gringo doctor wasn’t the face of the organization—it had to be Ecuadorian-driven. If the hospital were thought of as a “gringo place” then we’d have a harder time convincing people ‘we did this ourselves—and for ourselves.’
“The decision to work at one remove was a departure from the Carroll Behrhorst model. It’s unusual for an outsider to be an invisible catalyst. But we’re not a flash in the pan and we’re not a traveling circus, here for a couple of days and then gone. Instead we’re building a relationship with the community, a continuity. Of course, not living nearby meant I was out of touch whenever I went home, since back then the only person in our Quito neighborhood who had a phone knew someone who knew someone who knew the president. There was one spot in the kitchen where sometimes I could stand and make a call on a wireless phone.
“But where could we set up shop? If I went east, down the Andes to the Amazon region, it would take too long to get there. If I went west on the southerly route, that went through Santo Domingo and I swore I’d never go to Santo! It was such a big morass. So we wound up in PVM, which was west of Quito but on the northerly route.
“We were so sure our little storefront clinic held the keys to the kingdom—selective primary health care, oral rehydration, immunization, and family spacing, a polite term for birth control. In our two rooms, each about 10 feet by 20 feet, we had antibiotics, an exam table, a delivery bed, a desk, a stainless steel table with some surgical instruments, a glass stand with medications and injectables. What more did we need?
“Then, as I told you, the lightning bolts struck, showing us our helplessness – we might as well be out in the Gobi Desert. Alfredo, the seven-year-old boy who got bitten by the equis, the kid who told me, ‘Doc, voy a morir’—‘Doc, I’m going to die.’ Roberto, the nine-year-old whose right leg had become a piece of dry charcoal after he was mistreated for an equis bite. The young father-to-be whose wife died at home from a preeclampsia seizure and who could only tell us, ‘She fell asleep. Can you fix her?’ The people and things you never forget. The grim understanding of what happened to people we couldn’t help and had to send off to Quito. Like Isabel, 17 years old, with acute appendicitis, and 43-year-old Gustavo, with a broken femur, ironically the longest, strongest bone in the body, both of whom died on the way to Quito because, well, we couldn’t operate on Isabel and we couldn’t set Gustavo’s bone properly.
“Not that getting all the way to Quito meant help was guaranteed. José, a 40-year-old farmer, was brought to us one afternoon in the back of a jolting, bouncing pickup truck. He couldn’t move his legs or even feel them. He and a helper had been chopping down trees when a large branch fell on his back, knocking him to the ground. When he couldn’t get up, his helper ran away. When he didn’t come home for lunch, his wife went looking for him and heard his screams. There was no choice—his breathing was worsening, and I had to use the same pickup truck to have him transferred that night to Quito. Unlike the young farm worker I once had to ship off to Quito with acute pesticide poisoning and who died there, unattended, in a hospital emergency room hallway, José survived but was paralyzed for life. I still think his ride to the capital in the back of that pickup truck actually worsened his spinal cord injury.
“Clearly, Pedro Vicente Maldonado needed a hospital. We’d been told that, even before the lightning bolts. We hadn’t listened. Erik had been in Ecuador a few months before I got there and conducted a survey of the townspeople, a feasibility study with some USAID money. They said they wanted a hospital and would pay for its services although they couldn’t pay as much as people in Quito did. But we were tone deaf, locked into our preconceptions, thinking they just didn’t understand their real needs.
“Meanwhile they didn’t know how to listen to us, either. This too was our fault. I realized then I had to become tri-cultural—know how to think like people in Milwaukee, like people in Quito, and like people in Pedro.
“For instance, I could see that 70 percent of all the women and children in Pedro were iron deficient. Now, the best way to get iron is to eat meat. Beef is best, though pork, itself a rich iron source, is just as widely available. But in the Ecuadorian countryside, when people get a bruise from a fall or a cut from a machete, they’re always told, ‘Don’t eat pork—it’ll make it infected.’ I’m not sure where this comes from; it’s not exactly Biblical. They have nothing against eating pigs as a rule. They eat guinea pigs, for that matter, cuy as they call them, native to the Andes and the main source of protein before cattle were introduced. But no pork after a cut. I think I spent five years reassuring people, saying, ‘You know what? Don’t worry about this pork thing.’ They would kind of look at me funny. After a while I stopped mentioning pork, and finally I started saying, ‘Hey! Make sure you don’t eat any pork because you might get a secondary infection.’ Then people said, ‘Eh, the gringo’s finally learned something. Now I believe this guy.’”
I couldn’t help asking Gaus if they were eating pork now.
“No,” he said. “But they’re actually coming to see us for other stuff. Which is a much better outcome.”
(excerpted from chapter 18)
