Leynis is one of our técnicas. I think the term would be equivalent to “medical assistant”, but these técnicas have so much knowledge and experience. Last week, a man arrived in the tópico after getting kicked in the face at a soccer game. His nose was clearly broken, crumpled over to the left. Kristen and I consulted the medical books we found lying around in the consultorio. ENT consult, they said. The fracture should be reduced within six hours. But no practical advice on how to do so. I asked Lleni, one of the técnicas. “With the padres, ” she told me, “they would just put on a glove, and some gel, and stick one finger up inside the broken nose, and pop!”
“What kind of anesthesia?” I asked. “Tylenol,” she said cheerfully. And so, with the guidance of the técnicas, we popped that nose back into place.
Tecnicas can also be cultural translators for us. We admitted a pregnant patient recently with falciparum malaria, the severe form. Cuántas veces ha estado embarazado? I asked the patient. How many times have you been pregnant? She stared at me blankly. “Does she speak Kichwa?” I asked Leynis. “I don’t think she understands me. Leynis took over. “Cuántos hijos?” she asked the patient directly. “Cuantos muertos?” How many children? How many deaths? The patient answered Leynis. Eight living, no deaths.
Leynis was the one who received the phone call that there was a baby in a neighboring community who had not nursed for two days. Her husband is running for mayor of this town; maybe that is why someone reached out to her. We sent Dr. Williams out to Rango Isla, a neighboring community, to pick up the 8 month-old baby. When baby J___ arrived at the tópico, he had a high fever and was dehydrated. He was so sick that he didn’t whimper or withdraw when his IV was started.
Young children often perk up pretty quickly after rehydration. J___ did not. After almost 24 hours, he produced some urine, but he never really woke up. What had seemed to be a feverish sleep seemed more like a coma; he would withdraw from noxious stimuli but he did not wake up. When I lifted up his tiny arm, it dropped limply to the bed, with no resistance at all. Meningitis?
“Su papá mató boa,” the mother confessed to me, by way of an explanation. She and her husband spoke Spanish, but they had the polite reserve of indigenous people here. They told me that the baby’s father had killed a boa constrictor when the baby was two months old, and that this had doomed them to bad luck. They wanted to bring in a curandero to help.
I asked Jens, one of our técnicas, what she was talking about. “It’s really true, what she says. Killing a boa will bring you bad luck,” he told me. “My grandfather killed a boa once, and some really bad things happened to our family.” I looked at him strangely. Jens is 27; he is young and hip. He has a large “Johnson” motor for his boat, and he likes to take the visiting gringos on boat rides on the Napo River. He has a huge parlante, a portable speaker that blasts reggaeton as we cruise by peaceful villages. I was fascinated that Jens, too, believed in the powerful bad luck of killing a boa constrictor.
That night, the baby had three small seizures. They each lasted less than a minute, but we started IV seizure meds and decided to transfer him to Iquitos in the morning. The family told us that the curse of the boa constrictor was clear: look at the serpentine movements of his little arms; the spirit of the boa is taking our child away.
We made the arrangements for transfer and bought the gasoline. The baby had been grunting and moaning all night, but in the morning, when it was light enough to travel on the Napo River, he seemed much weaker. He needed oxygen. “We will not send our baby to Iquitos; it is too late, the spirit has gone out of him,” the father told us, tearfully. I thought he was right. I did not want the baby to die on the river, on the six hour boat ride to Iquitos.
Every other Thursday, Hermano Pedro comes to say mass at 7 am in our hospital. Toward the end of mass, Nelly whispered to me, “the baby is desaturating!” I went to the bedside. “Can the padre baptize our baby?” the father asked me. I asked Leyner look for some water. He left quickly and came back with an open tupperware container of water, a delicate pink flower floating on top to make it more sacred.
Hermano Pedro touched the baby’s head softly as he sprinkled the holy water with his other hand. Afterward the medical team stepped away, to give his parents to say goodbye, but we could still hear the beeping of the pulse oximeter, slowing and finally stopping. When the beeping stopped, the mom picked up her dead baby and began to cry. A mournful, sing-song, two-tone soft wail that I will not forget. It sounded like something from another world, the desolate keening of a mother who has lost her baby.
So sorry, dude.
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