The ones who were turned away

Peruvian-American photojournalist Sara Fajardo and Missouri freelance writer and editor Tracy L. Barnett worked as volunteer medical translators for nearly two weeks at the Ayacucho Mission. The work offered many opportunities for insight into the human condition.

“Tell me, where does it hurt?”
“Dime, ¿donde te duele?”

The flood of words that followed was overwhelming at first, both for Colorado pediatrician Joni Weiss and for me. It was our first venture into the world of the medical mission, and we both had much to learn.

My role was to serve as the bridge between the doctors and the aching stream of humanity that crossed the threshold of their tiny consultorios. The daily work was good for the heart, despite the self-effacing Dr. Weiss’ almost certain conclusion in many cases that her remedies were too little, too late.

I watched as small miracles worked their healing magic in these parents, longing as they were for some modicum of reassurance that their child would be okay – and underlying that, an even greater longing to know that their own parenting skills were adequate, that despite everything, they themselves had risen to the occasion. In this respect, Dr. Weiss’ every word and gesture was a healing balm. During my time with her, not a single patient left her office without a smile on his or her face.

But for me, the greatest realization came on the fourth day of the mission, when I left the sheltering walls of the hospital and ventured into the sea of people milling around the triage tents. This was the place where hospital staff had to winnow through the masses and select the lucky ones who would be accepted into the mission. The others would be sent away with a bag of vitamins and aspirin. In two weeks’ time, there was simply no way for the doctors to see every one of the thousands of souls who presented themselves at the hospital doors. So in three green tents in the hospital parking lot, workers like medical resident Luis Gonzales quickly took one history after another and practiced saying “no.”

It was Luis’ job to determine whether the patient was truly needy, or whether he might have some type of insurance or other resources that would cover his or her illness; whether the Mission had a specialist who could handle the case; and whether, after all was said and done, the doctors would have time to take his or her case.

“Doctorcita, Doctorcita,” came the plaintive cries of the indigenous women reaching out to touch my arm – dressed as I was in pink scrubs, it was an easy mistake to make. Typically I tried to make my way through these crowds quickly, assuring them that in fact I was not a doctor, I was only a translator. Quickly, because of the fear that in stopping, I would have to confront my own utter inadequacy in the face of this sea of human suffering. Because I didn’t want to be drawn in by a pair of sad eyes into a depth of pain that terrified me, pain that I could do absolutely nothing about.

But this time was different. This time I was ready to know. So I stopped.

“Doctorcita!” I fixed my attention on one particularly insistent middle-aged woman, dressed the typical knee-length pleated dress and colorful striped shawl native to the region. Standing behind her was a blind woman, wrinkled and worn – her mother, I soon came to know.

They had been three days traveling to the Mission, she told me, and her mother had been ill for a year. They had been waiting in line since sunrise. How is it that the Mission could turn her away and ask her to come back the next day? It didn’t seem fair.

I honestly didn’t know the answer to the question. So I set off to find out, searching for Liliana Lopez – the head nurse who was coordinating the entire triage operation. Liliana was the face of God that two weeks in the parking lot of Huamanga Regional Hospital. To the people waiting in that interminable line, she might have seemed the capricious God of the Old Testament, alternately magnanimous and wrathful; bountiful and generous with one hand, punishing and indifferent with the other.

Liliana pulled me aside, away from the crowds. In a low voice she explained to me that there was simply no way to help these people today; the doctors would already be working late into the evening to take on the patients they already had, and these folks had simply arrived too late. There were literally dozens of people in their predicament, she told me. They would simply have to find a place to spend the night, and come back early in the morning.

I understood. I had been at the side of those doctors the three days previous, finally leaving the hospital in the twilight hours. We would go find a hasty meal, return to the hotel and collapse, exhausted, into a dreamless sleep before awaking at 6 to start all over again.

I decided I had seen enough. I was ready to go back in and translate, where I could actually do something useful to combat this overwhelming feeling of powerlessness. I left Liliana and waded back into the crowd, trying make it to the hospital door before the anxious daughter and her mother came after me seeking an answer I couldn’t give them. Cowardly, I realized, and stopped in my tracks a few feet from the relative safety of the hospital door, turning to face the crowd that trailed me.

“Señora!”

This time it was another middle-aged woman who had been trying to get my attention since I first ventured out the hospital door that morning. She appeared slightly more well-off than the peasant women, dressed as she was in a sweater and dress pants. She was also more articulate – and she was angry.

“Please,” she said. “I know you are very busy. But can you please just give me a moment of your time? I really need to speak to someone.”

“Dime,” I said. Tell me.

She had been waiting in line since 1 a.m. for a doctor who could see her about a urinary tract infection she had been suffering for weeks. The day before, she had shown up at 8 a.m. and waited for hours, only for the intake staff to tell her she was too late, and she would have to come back the next day. That, she said, she understood. But what had happened today was beyond understanding. Today, after two days and a sleepless night of waiting, they told her she couldn’t be treated because she wasn’t poor enough.

“What do they mean, I’m not poor enough?” she asked, her voice raised. “I live in Ayacucho! If you live in Ayacucho, you are poor – punto. Nobody here has any money.”

A young man stepped forward from the crowd that had begun tightening around me – all of them, apparently, people who had been turned away by the intake staff. “She is right,” he said. “We feel like we need to go put some dirt on our clothes just so we can look poor enough to get medical care. It’s not fair.” He also stood out from the crowd, with his clean white shirt and trim haircut.

I had pulled out my notepad by that time and was jotting down some notes.

“Who are you, anyway, and what is your role in all of this?” he wanted to know – how can you help us, or are we just wasting our time with you? was the unspoken subtext, respectful yet self-assured. A worthy question. I answered as best I could, explaining my plan as a journalist to go back to the States and let people know about the Peruvian-American Medical Society, and the Ayacucho Mission, with the hope that next year, more doctors would come and more money and equipment would be donated so perhaps more people could be served.

“That seems like a good thing,” he said, apparently satisfied. “So how can we help you?”

“Tell me your stories,” I said simply.

The woman who had approached me first stepped forward. “What do you want to know?”

I looked around me at the anxious faces, perhaps 50 who had gathered by now. I knew if I asked for details, I would be there for hours.

“Tell me your name, your age and your illness,” I offered, somewhat lamely.

“Virginia Quispe Socos,” she said. “40. Urinary tract infection.” I wrote it down in my notebook.

That was enough. She thanked me sincerely, a look of relief on her face, and turned to make her way through the crowd. But there was no time to bid her a “You’re welcome,” or to wish her a “Que Dios te bendiga.” A chorus of “Señoras was already ringing out. I nodded at one, a Quechua woman, as were most of the people surrounding me.

“Felicitas Medoza Torres,” another woman spoke up. “42. Urinary tract infection and kidneys.”

“Merced Muñoz. 36. Ovaries and gynecological problems.”
“Martha Gutierrez. 24. Ovaries and gynecological problems.”
“Eduardo Pumanga Garcia. 52. Urinary tract and liver.”

Each of them watched intently as I wrote their data in my notepad. A few stayed on to watch as the others told their stories. Most, like Sra. Quispe, headed out to the congested, air-polluted main street to resume their lives. Many, without even a sol for the bus fare, faced long hours of walking. But they left with something, at least. Each of them, upon telling their brief stories, relaxed visibly, grateful for the gift of having been listened to, acknowledged, written down in a red spiral notepad in the hand of a U.S. journalist.

“Nelia Arcel. 40. Pain in my ovaries and my stomach.”
“Celestia Bautista. 30. My head hurts.”
“Daria Izarra Cardenas. 52. Taquicardia and back pain.”

Their pain began to penetrate my boundaries and I choked on the tears. Still I listened, and still I wrote.

“Angelina Tamaya. 23. Urinary problems.”
“Alicia Ure. 27. Urinary problems.”

The catalog of pain seemed to go on and on. But finally the crowd had dispersed, and the last patient – a slight young woman, carrying her baby on her back in a shawl in the indigenous way, stopped to thank me before she turned and went away. “Que Dios le bendiga, Señora,” she said softly. May God bless you.
I returned the blessing and headed for the doctor’s restroom, where I could lock the door and have a good cry before I threw myself back into the vastly easier, and somehow enormously comforting, work of translating.