Usually Lupe (the doctor) takes off from her part time teaching job to travel with me the whole time I’m visiting the communities. This time, because I was there for so long, she stayed in Guayaquil to work during the week and only came to the communities on the weekend (as is her usual practice when I´m not there). I missed spending time with her, because she is energetic and fun, and also invaluable in terms of problem solving and communication in the communities. But, it was also good to be there without her. I realized that both I and the local folks rely on her as an intermediary, and having to negotiate and organize everything directly made me feel closer to people, a
nd I think made them feel more comfortable with me. Another huge benefit of being there for so long was that I spent more time than ever before just hanging around and talking with people. I encouraged people to lead us on some “ecotourist” trips. Several of the proms worked many years ago with another NGO that trained them as nature guides and tried to help them set up infrastructure for ecotourism. The project never took off, but they often hearken back to it.
In that vein, we went on several hikes, cut sugar cane, crushed it in a water-powered mill to release the juice, and boiled it down to caramel. Digna is the most entrepreneurial of the proms, and the one who did most of the guiding. She took us to her parents cane fields. Her mom is one of my favorite people in the communities. She must be almost 70, but is spry and witty, and never without a huge machete and a fashionable straw hat. The day we visited, she set out to do some ditch digging as we went to cut cane. She returned at lunchtime to help cook and ply us with her homemade cane liquor. Lupe says she herself doesn’t drink, but she has coquettishly offered me her personal brew every time I’ve visited. This time with a little sugar water to take away the burn - very tasty.
We also learned how to milk cows. It’s harder than it looks! And I’m feeling traitorous to my Moooove to 1% milk campaign, because here there’s no such thing as low fat milk, and I have to say I’m enjoying every drop of whole milk I’m tasting: rich milky coffee, hot cocoa, fresh yogurt, homemade cheese….especially after the tiring task of milking, I appreciate it even more.
One hike Sarah, Alison and I took with Wilson and an old man from Chacanceo nearly had an unpleasant end. There are mining companies trying to survey in the area, with hopes of extracting various minerals. It is very controversial, with most people very opposed to even letting them enter the area. The companies promise all manner of things that people desperately want: roads, schools, jobs. But, people are well aware of the environmental and health consequences of mining, and so are not taken in by the companies’ (often empty) promises. On that day we hiked about an hour up a hill overlooking Chacanceo, through property owned by a local family. When the owner saw us there, she stormed out of her house and shouted far up the hill “You are not welcome here, get out! Watch out or I´ll shoot!” She thought we were from a mining company. Our guides (who knew her well) approached her to talk. She shouted at them for at least 20 minutes about their nerve to accompany such evil-doers onto her property. They calmly heard her out, and eventually convinced her that we weren’t miners, but it was quite hairy for a bit.
Chacanceo now has electricity. It was the talk of the town the whole time we were ther
e. And not without reason. The government paid for the materials, but it was the task of the community to bring in the posts and run the wires over many miles from the nearest power source. Everyone told tales of arduous hikes up and down mountains, 15-20 people carrying 10 meter wooden light posts. They would point out to the horizon and say, we had to walk from there, all the way carrying posts. It’s mountainous. I’m talking jagged peaks. What an incredible force of will! They talk about how different it is, now that they have electricity. Clearly it’s a great leap forward for them. For me, it was a mixed blessing. Now everyone is in possession of my least favorite modern amenity: television. From 5:30 in the morning and late into the night people now have TVs blaring, in what used to be peaceful, wide-open silence. I tried to smile when they proudly showed off their new “screens” but inside I felt a sense of sadness and doom. Incessant marketing of garbage, manufacturing desire for things no one needs, and promoting lifestyles that are unsustainable. Such is modernity.
On our last night in Chacanceo they threw us a dance party in the casa comu
nal, now with the possibility of CDs played on a boom box. People appeared, food was proffered, CDs were on hand. We had electricity; there was a functional light bulb in the building. But alas, we discovered no where to plug in the music. Not to worry. A group of young men disappeared and shortly returned with some lengths of wire and wire cutters. In a matter of minutes they had jerry-rigged some sort of connection for the music!
. . . .
The promotores in Manta Real have talked about the need for potable water in their community since we first started working here. They have piped water to all the houses, in a system built 2 years ago by a water agency called ETAPA. The problem is, the system is full of leaks, the holding tanks have no tops, and there is no chlorination or water treatment. The problem is complicated by bureaucracy and fighting in the community, a huge debt they owe to ETAPA, and bureaucracy and profiteering at ETAPA. We have tried in the past to understand the situation and help them move forward in resolving it, but with limited success. This time, with more time to spend, momentum from Lupe and the proms, and a new community board (the first female president, secretary, and treasurer in Manta history!) we made amazing progress. The past community board had lost or refused to turn over any documentation related to this issue, so it was unclear what the community owed or what ETAPA was contractually obliged to provide. The women of the community board were at the point of resigning, feeling overwhelmed with the water problem and very unsure of themselves as leaders. In contrast, the promotores of Manta (also 3 women), are very self assured and eager to push forward on the problem. Lupe did some amazing pep talking, and convinced the president to collaborate with the proms and take a trip to Cuenca, to meet with ETAPA. (Which ARSE financed). In short, this resulted in two engineers from ETAPA visiting the community, inspecting and agreeing to fix the problems in the system by August, and clarifying the unfulfilled responsibilities of the community: purchasing a small plastic tank for chlorination and sending at least two people to a free two week course in Cuenca to learn how to operate and maintain the whole system. One of the proms agreed to go, along with the young man who now is in charge of maintaining the system, and we agreed to pay their expenses. (The reason no one ever went initially was lack of money).
The experience was all at once fascinating, frustrating, and very rewarding. Negotiating community dynamics, helping people prepare to meet with ETAPA and advocate for themselves, analyzing the confusing contract, tromping around with the engineers inspecting the tanks and talking about water systems, helping the proms write project plans and budgets to get money from us for their trips…it was public health in action!
On a completely different level, I had a breakthrough with one of the proms in dealing with a mental health issue he has been struggling with for many years. Javier was 19 when I first met him in Manta, and he was in the first group of promotores to be trained. He has stood out for every ARSE person who has visited, because he is incredibly intelligent and hungry for knowledge about everything from anthropology to biology to philosophy. In a way that’s notably different from others, he seeks us out to talk about the “big picture” of community health, about the conflict between modern developments in biomedicine and traditional practices, and the role of people like us who come to the community to help. From the beginning we also heard from Lupe about strange problems in his family, where various siblings (he has 11!) have exhibited unusual and socially inappropriate behaviors. Many people in the community attribute such things to witch craft. Over the years, Lupe told us that Javier too had started hearing voices and occasionally behaving strangely. He never spoke with any of us directly, and continued to be involved as a promotor, but more and more often seemed disconnected or zoned out. This time when I arrived he was in Cuenca; his family reported he was receiving treatment for “psychological problems.” He reappeared a few days before I was to leave, and I asked Lupe if she thought I could ask him directly what was going on. She said yes, and that same night he appeared outside my room to talk. At first when I asked, he changed the subject, but eventually returned to it, and described what seemed to me to be psychotic symptoms, including one acute episode that lasted several days in which he basically became childlike and unresponsive to those around him. He hears voices, sees things that aren’t there, feels like his head is burning inside, and feels depressed and hopeless – like he’s dying. Terrible.
His family has been sending him to a traditional healer for 4 months, something that appears to have helped his siblings who he says are all better now. But the baths and medicines are not working for him, and he had no idea what to do. I described schitzophrenia, how it often begins at the time he started having symptoms, how the symptoms are similar to those he describes, how the cause is not known but probably a combination of genetic and environmental factors, how doctors attribute the symptoms to an imbalance of chemicals in the brain, and how many people successfully treat the symptoms with chemical medicines. He was very interested and relieved. The next day we went into town, and I printed some information from the internet (which he was reluctant to read because people told him one cause of his problem was that he worked his brain too hard). So I read it to him, basically repeating the things I had said the day before.
By this time his affect was completely different, and he seemed comforted and hopeful to have another explanation for what was going on and a hope of making things better. He asked if I could help him talk to his parents, to convince them to let him stop going to the healer and seek some other form of treatment. While in Manta I had been eating all my meals with his family (his sister Ruth is also one of the proms) and had gotten to know them much better over this trip. His father was the president of the community at one point, and their family is very influential. Anyway, although the task of talking with his parents was daunting, we had developed a lot of affection for one another over the month, and I felt like I was in a good place to offer support for Javier and also help his parents understand his problem in a different way. I explained my perspective on the situation, and suggested that medical expertise and medication might be helpful. Ruth was very supportive, acknowledging the problem was bigger than they thought. His mom was still in denial, wanting to take him to spiritual healers (“like you see on TV!”), or some local Gregorian Brothers. She compared his feelings to tough times she had suffered in her youth, which she cured herself of by keeping busy and having a positive attitude. His father was mostly silent. Eventually they agreed that the current treatment wasn’t working and asked me to help them find a psychiatrist in Cuenca who could offer a modern medical treatment. I agreed, and told them how lucky he was to have a family who supported him and clearly wanted to help him get better. The next day was my last one in Manta, and several times his mother asked me to please help them find treatment for Javier. I’m really glad we all spoke directly; Javier and I both acknowledged we should have done so long ago. I was afraid of intruding on a personal problem or imposing my view of the situation, and I think he was terrified to acknowledge what was happening. Luckily, I think we were successful in getting support from his parents for a new kind of treatment, and hopefully he can get it and it will be helpful. That’s all for now.
Next episode: Gapalagos.
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