|
|
|
|
It was a game of cat and mouse, a chess match played out on city streets The main road out of town was blocked by two semitrailer trucks parked diagonally across the mad at an angle that left no doubt about their intent. Perhaps a smaller road might be open, or the little road that only the locals know? The word came back: no, those, too, were closed.
It was 6:30 a.m. on our first full day in Cochabamba, Bolivia, and we were trying to get out of town to visit a primary care clinic built by Mano a Mano, a Minnesota-based nonprofit organization. We were up against one of the well-publicized, peaceful, but effective labor actions that take place in Bolivia-the bloqueo ("strike"). It involved, very simply, blocking all access in and out of major cities in Bolivia–in this case, for just a day. The date and time of the strike were an open secret; Mano a Mano staff knew about it and had tried to get us on the road in time to beat it. We had discussed it with a cab driver the day before. He had found it ironic that the new president, Eva Modes, used to man the bloqueos himself before he was elected. Now, laboring folks felt they needed that same tool in order to bring his attention to their needs. At the time, I wasn't sure what to make of the bloqueo. It was, at the least, a nuisance and might have spoiled our whole day.
Finally, a grass-covered path off a rough, little-used, pock-marked road let us circumvent the blockade and proceed to Chapisirca, home to one of the 67 clinics built by Mano a Mano. The project in Chapisirca that Mano a Mano was now sponsoring was a new school and housing for teachers.
Mano a Mano was founded 13 years ago by Joan and Segundo Velasquez. Joan had served in the Peace Corps in Bolivia and had known Segundo there. It was not, however, until he came to study at the University of Minnesota that they became a couple. Segundo worked for Northwest Airlines and one of his brothers, Jose, was (and still is) a pediatrician in Bolivia. Each time Segundo visited his brother, Jose would ask him to bring him medical supplies that were hard to come by in Bolivia. As time passed, the list grew longer and longer, until it seemed obvious that a more organized approach was needed. Thus was Mano a Mano conceived.
The Velasquezes recognized that the medical waste stream in the U.S. was enormous and frequently consisted of old, out-of-fashion, but perfectly good equipment and supplies that were usually headed for the trash. These very same items would be highly valued in Bolivia, where they were in short supply or not available at all.
My own interest in Mano a Mano had originated two years earlier when I picked up a brochure describing their work. The idea of recycling medical waste from U.S. hospitals, nursing homes, and doctors' offices seemed too perfect an idea to pass up. I signed up as a volunteer and began working Saturday mornings at the Mano a Mano warehouse whenever I was able. We packed and stacked and boxed and stuffed those supplies onto pallets-work that was, by itself, quite satisfying. Now I was about to see the effect of recycling all that discarded equipment; we were on our way to visit one of those faraway clinics that until now had seemed almost mythical.
A village at the road's end
The road to Chapisirca was long and difficult, accessible only by four-wheel-drive vehicles. I was told that because of the remoteness of the clinics, vehicles were only sent in pairs in case of mechanical problems. Once we got past the bloqueos, it took three to four hours to get there. Chapisirca was, literally, at the end of the road, traveled only by those who clearly intended to visit that particular town. The clinic was a plain but sturdy affair that stood out from the rest of the town's architecture because its bright red brick structure and newness contrasted with the adobe buildings in the rest of the village. As we visited other Mano a Mano clinics, we would come to know the floor plan by heart: hallway/waiting room, exam mom, dental office, toilet, doctor's sleeping quarters, nurse's sleeping quarters, lunchroom/lounge, kitchen, birthing room, and doctor's/nurse's office--nothing more and nothing less. The facilities were always very clean, but spare. The medicine cabinet held some bandages, the narrow range of antibiotics supplied by the government, some surgical and dental tools that had been donated from the U.S., and aspirin. A few clinics had microscopes, and an occasional clinic was lucky enough to have an "ambulance"-maybe an old station wagon used to transport patients with medical problems that could not be handled at the clinic.
It was difficult to imagine that before the Mano a Mano clinic was built, medical help was four hours away by automobile-and no one in the community had an auto. On our road to the clinic, we came across a resident of the village a short way out of Cochabamba, walking along the road. He was a Mano a Mano volunteer and had been at the festivities to welcome us to Cochabamba the night before. He was heading home the only way available to him. After he got into our vehicle, he told us that the walk usually took eight to nine hours.
Interestingly, the difficulty in maintaining teachers in a place such as Chapisirca has less to do with the remoteness than the lack of adequate housing. The old teachers' quarters resembled something out of the Middle Ages-dirt floors, little light, primitive furniture, and no visible source of heat. The situation with doctors is that Bolivia produces an excess of doctors-there are more doctors than facilities available in which to practice. Medical students finishing school might commonly end up driving cabs. As a result, recruiting them to a Mano a Mano clinic, however remote, is relatively easy.
We watched the work crews-a combination of paid craftsmen and volunteers from the community. Wisely, the Mano a Mano facilities are built only upon a community's request. The members of the village pledge to contribute as many hours of unskilled labor on each project as Mano a Mano contributes hours of master craftsman labor. This agreement ensures that the facilities will be viewed as belonging to the community-not bestowed upon them by someone from the outside.
We ate lunch that day with the volunteers. The simple meal of boiled potatoes and hard-boiled eggs was served up in a plain, large pan that was passed around for each to serve himself or herself. We ate the food by hand, with a green salsa as the only condiment. After-ward, we were shown the kitchen where the meal was prepared-the same kitchen where the school lunches are prepared. It was a bit like the teachers' quarters-smoky, ill-lit, with a dirt floor and no equipment save for a 20-lb. propane tank attached to a propane burner and some large pots for boiling the water that cooked our potatoes and eggs. For lack of a table, the propane tank and burner sat on the dirt floor-a bit like primitive camping.
The building of the school in Chapisirca was supervised by an architect who was assisted by another of Segundo's brothers, Ivo, a construction worker and heavy equipment operator. The Velasquez brothers are the "perfect storm" of talent-Segundo in charge of gathering supplies in the U.S., Ivo in charge of building roads to the facilities and erecting buildings, and Jose in charge of manning and supervising the clinic staffs.
Community involvement
In 13 years, Mano a Mano has built and staffed 67 clinics in Bolivia and it is working on 70 more. The clinics are successful because of the forethought and planning involved. When Mano a Mano is invited to a community to build a clinic, strict requirements for community involvement are laid down. Government guarantees are secured to ensure that doctors will be available and paid, and certain supplies are given to each clinic. Mano a Mano pays the salary of a doctor and the local government pays a nurse's salary for the first three years. After that, the local government assumes responsibility for both providers, and Mano a Mano continues to furnish supplies as they are available. By involving the community from the beginning, Mano a Mano ensures that a plan for continued maintenance of the facility is in place.
One impressive statistic concerns perinatal deaths. In very rural areas of Bolivia, 10 percent of children die at birth or within the first month, and a third of the children die in the first year (of preventable illnesses). At the Mano a Mano clinics, there have been no deaths in childbirth in their total of approximately 4,300 deliveries since the first clinic opened in 1997.
We visited three other clinics in the next few days, all in remote villages high on the altiplano of Bolivia. We were there for the dedication of a clinic or school in each community, and it was an occasion for a real fiesta. Garlands of flowers decked the archway to the plaza, musicians played, dancers danced, plaques were hung, and the national anthem of Bolivia was sung (first in Spanish, then in Quechua). Gifts were exchanged, bubbles were blown, speeches were made, chicha (corn alcohol) was served up, and little children crowded around to have their pictures digitally taken and immediately viewed.
At each of the dedications, Jose gave a speech that was congratulatory and celebratory but contained an important caveat: this clinic-school is now yours, and we expect you to keep it up-keep it clean, keep it repaired, and treat it well. We will be checking back on this from time to time. We do other projects-water supplies, sanitation, etc., but if you do not care for this one well, we will not be back to do more.
Pondering a final question
The remote villages on the altiplano are in the vicinity of the city of Potosi, but we did not visit there. We did learn that Potosi had once been the largest and richest city in the Western Hemisphere. The Spanish discovered a "mountain of silver" there, enslaved the indigenous population to mine it, and sent the riches hack to Spain. It is estimated that as many as 9 million indigenous people died in the mines of Potosi. When the mines gave out, the Spanish left and the Bolivians were on their own minus their most obvious natural resource.
After I learned this, my feelings changed about the bloqueos and their simple, straightforward purpose. Having been left out of the world of commerce for many centuries, these people understood the importance of it to themselves as well as others and knew that their simple strikes were a sure way to get the attention of those in power in a peaceful but direct way. For a moment I questioned whether or not we should have "run" the blockade or respected it for what it represented. I reminded myself, however, that had we not done so, we would have missed the chance to meet the wonderful and unforgettable people of Chapisirca.
Galen Stable, M.D., is a psychiatrist in private practice in Deephaven.