El fin

8-1-08 – Esmeraldas, Ecuador

In two weeks I’ll return home to Iowa, the land of milk and honey – to green fields and rows of corn, where farmers wear overalls and strangers say hello. For the most part people will be courteous to each other, and intentional with how they spend their time. I will also be intentional with my time, hiding in the Kalona bakery until the Amish concept of peace washes dirty old Esmeraldas out of my bones.

The grit here brought a patient in last week who was unaware of a bullet in his leg. The story he told put 9 millimeters in his chest but a machete through his groin. Crouching down, however, to look at the bullet mark in his leg, I astutely declared “Sir, I think you have a bullet in your leg.” That it was even plausible to mistake a machete slash for a gunshot gives me the eebie jeebies.

But as any good NRA card-carrying member will tell you, guns are not always used for evil; this allows peacekeeping officers to both serve and protect. Except that last night for shits and giggles a police officer snuck out the back of the ER with a doctor to fire artillery over the roughest neighborhood in town. It was kind of like rousing up a bees’ nests or throwing smoke bombs in crowds of drunks – not the brightest idea.

Speaking of bright ideas, the pharmacist has a couple good ones. One of my favorites involves smoking cigarettes in the hospital regardless the patients in respiratory distress. He stays in his office, though. I’ve seen another walking down the hall with a cig dangling off her lips like she was in the garden of Eden and unashamed.

Racism also rears its ugly head on the coast. I have not yet talked about it because I don’t quite know what to say other than it is here and it is awful. One of the nurses of Chinese descent is called China. I asked someone once what her name was but they didn’t know. Two months ago a big black guy came in with his face split open from his forehead down through his nose from a motorcycle accident. He was in discomfort as he came to and understandably uncooperative. “Stop moving,” barked the surgeon, who was trying to suture shut the wound, but the patient continued wrestling about. “Negro, NO!” Thwap – and he hit the dude hard on the side of the head with a pair of pliers.

Another doctor just utters “f***ing n*ggers” when he wishes to express his distaste. Black people are violent, he says. But it didn’t take long for me to point out a few exceptions: Malcom X, Martin Luther King Jr, or any number of black doctors and nurses on our staff. So he adjusted his stance to say that from his experience, on the whole, black people are more prone to committing acts of violence. To this I contested, “But Doc, black people also make up a higher percentage of the population – their violence is in proportion with their numbers.” He disagreed. So partially out of my own curiosity, and certainly to prove him wrong, I secretly began tracking cases of violence by race, putting gunshots, stabbings and bottle slashings in separate categories. But now I don’t know what to do because in the last three weeks the only tally I have outside the black-aggressor column is from a mestizo man who shot himself in the shoulder. Hoping for a different spin on the obvious, I asked a black police officer if black people in Esmeraldas really were more violent than the others. He looked at me like I was stupid - of course they are more violent. He didn’t say why and I got pulled away before I could ask.

A few days later three black men in their early twenties were shot down one block from the hospital. In spite our best efforts, two of the three died minutes later in our ER. After a long operation, the third pulled it through – but in the middle of the case someone started snoring. I looked up from the table and in the corner of the room the anesthesiologist had fallen asleep cross legged, arms folded, sitting on the floor with his back to the wall – an intentional decision. There is no way to tell for sure, but I wondered whether he’d have fallen asleep if the patient was of any other race.

My hope was to have left this place better than when I found it, having encouraged my colleagues to also want improvements in their services and in themselves. Toward that goal, we have become noticeably more efficient as a team in response to trauma cases, and we have even developed a trauma kit so that in true emergencies we have the resources to be self-sufficient. And we are getting better. But the system needs more than a kit, and more than three months of effort. On an individual level, I know I have contributed good – delivering babies in the back of taxis, sewing tendons, closing faces, and racing all the time for oxygen – but the macro level remains a mystery. Whether or not bigger changes will last is beyond me, but at the very least I know I come away richer. These have been tough months, but through them I’ve gained confidence in myself, and that confidence I trust will carry me through the years to come. I have enjoyed my time here but am ready for home, ready for the next challenge. Thanks for reading, BH