1993, rural El Salvador. Just three weeks there, for an internship in tropical medicine. Friday morning I wake up with a stomach ache. Walking is uncomfortable and going to the bathroom provides no relief.
There is an increase in complaints within hours. No other doctor present. Consultation with and research by my colleague, after which it was decided not to stay in this very remote place this weekend, but to go to the capital, four hours away, just to be safe.
However, the mayor was away in the village’s only communal car. No one knew where and he could not be reached. After all, there were no cell phones or other telephones there in 1993. Fortunately, he showed up in the late afternoon, but that brought the next dilemma that it would be dark during the trip, which was uncertain. The peace accords had only been signed the year before. Many soldiers were out of work and living in poverty. They controlled the street in the dark.
However, the pain was increasing so I decided to go and get some local nurses at the local hospital to mediate if needed. There you can also warn the internship supervisor in the capital by telephone. It was a long drive on mostly unpaved roads. By the time I arrived in San Salvador, I was an expert in ‘transportation pain’. We briefly considered trying to get to America, but the same argument applied: safety on the streets and planes don’t fly at night.
The Paris-trained surgeon also suspected appendicitis. But also the costs of the operation. Then it is nice/safe/luxury to have plastic money and immediately be mistaken for a foreigner with such a credit card. And to be able to go to a private clinic. Not because of the skills, but because of not having to share a bed with another patient after an operation. Surrender to the situation. It helped enormously that my co-cos kept ‘watch’ in the waiting room.
Surgery went well, own bed, glad to be out of pain. But I didn’t fix it. After ten days I couldn’t even walk the two hundred meters to the fresh juice stall. Ten days later it became clear why; a scar abscess that disappeared spontaneously. Direct fitter, antibiotic, rinse. My money flew through for bandages. But it also meant that I was not allowed to return to my place of employment because of the poor hygienic conditions there. (This place consisted of mud huts with a corrugated iron roof, packed sand on the floor. No running water except over the floor when it cascaded down the hills in the rainy season.)
I kept this up for six weeks, then returned with one last piece of dehiscence. After all, I had come to learn and work. Whatever happened. Had the time of my life where I learned a lot. Medical, social, cultural and political.
Another tricky tail. At the last follow-up visit, the surgeon advised to take another HIV test six months later. Usually there were enough surgical sets to serve two operating theaters at once. He wasn’t sure if that was the case with me though. “End of work week, Friday night, tired.” When it turned out to be a false alarm back in Holland months later, some tears were shed over champagne.
What impressed me the most though was people’s reaction when I returned to my post. I hadn’t run away like a gringo. Not to my own safe country. But they stayed, and although they are described differently above, they still felt that I had experienced their circumstances. So they didn’t feel abandoned. Gratitude washed over me. It was mutual.
Angeliek Zwinkels, rehabilitation doctor