I reached Belesario after waiting an extra day in San Cristobal for the keys to the clinic (yes that means I am on my own) rather indirectly. If you can find a map of Chiapas it would make more sense when I say I took a collective from San Cristobal to Comitan, from Comitan to Comalapa, from Comalapa to Motocintla, and then from Motocintla to Belesario. That last collective actually goes to Tapachula – the area that had been the center of the news from Chiapas during hurricane Stan. The effects of the flooding are difficult to believe unless you have seen a likewise tormented land. From Motocintla, the river winds its way calmly in the valley below. It is maybe 20 feet wide, has a muddy color and a good clip. Every 5 minutes or less there is another wood-on-rope bridge that crosses the river and leads up to the communities in the hills on the other side. What is most striking is that the flat rock river valley is well over 200 feet wide and the bridges are equally long – an indicator of what the river may be like in its wild months during the rainy season. Along the roadway above, the affects of landslides take their toll. Construction crews are actively rebuilding the roads that are no more and a few times we need to stop because only one lane is open. When we finally pass through, dust kicks up and surrounds us and we can no longer see that the forestry above has been washed away and the free, dry dust, continues to slide albeit at a slower pace.
Belesario is one of the many small towns that was chopped up on by sides by the floods. By the river, whole houses were cut in half. Road bridges stand alone with no road on either side. Cars remain dust covered and washed up like flotsam. Huge six foot holes have been pushed through people’s houses and roofs lay collapsed inside. The clinic is up on the hill in the central part of town that remains undamaged if you discount the dust covers the streets, is kicked up by passing cars, and is thicker than that which Ines and I found in my apartment when we moved out (read: excavated) my furniture. It is a two story structure. Upstairs lives 
the Padre Abel, a friendly, quiet middle-aged Mexican man with a goatee and pants that always appear to be about to fall down. He has a couch, television (with more than 2 channels!) computer and telephone. Also upstairs is the bathroom I use to brush my teeth. It is the only bathroom in the clinic with a sink and toilet seat although there is not yet a mirror. Downstairs, is my sleeping quarters, a pharmacy room, a kitchen, a consult room, and two rooms where lives a family who lost their house after the hurricane.
Manuel, a twelve year old boy with a cast on his lower leg is the only one there when I arrive. With no crutches, he is happy to hop around and give me the 5 peso tour, resting from time to time between hops. Dona Isabel, his grandmother is the cook for the clinic while they live there and is happy to cook for me. Her husband, Paco, a tailor who lost his sewing machine and all of his equipment in the hurricane as well as part of his vision, dances around and tells dirty jokes (which usually end in me asking “what is a [insert dirty word in Spanish here]?’ My question only makes it funnier to them.) Their story is sadly, a typical one. Their entire house collapsed in the floods. They lost everything they owned. Dona Isabel had 5 children. She lost one of her daughters along with all four grandchildren who were living in their separate house. The youngest was 42 days old.
The clinic is a disaster in it’s own right. After the hurricane, medicines arrived in boxes and bags. Many boxes burs
t open and the consult room became a sea of assorted medicine boxes. I begin my work immediately, cleaning and restocking the pharmacy shelves. The next day, the patients arrive. They had heard that I was coming. Many had checked the clinic in the early afternoon on the day I had arrived and had come back the following day to see if I were doing consults yet. Consults start at 10am and go until 9pm. That said, I am woken up at 7am by patients talking outside my room. I try not to listen as I try to not to every day, but I can’t help it. The cement walls are too thin. I roll out from under my mosquito netting and climb off the floor where my mattress lies and see dozens of people waiting.
I quickly find that I have to do everything myself and I have never done everything myself. For example, I have never been taught how to check somebody temperature 
– how you have to shake the thermometer first. I decide whose blood pressure I want to take and whose weight I want to guess. Then I examine the patient, often by kneeling on the floor because we don’t have an exam bed and go to the pharmacy to decide which medicines I want to use. I also discover how to mix suspensions with pure water to make medicines and in that process recall the tastes of the ones I liked and disliked when I was a kid. (I know now, for example, that it was Ampicillin that I loved for my ear infections, Amoxicillin that was a disappointment, and Erythromycin that tasted terrible.) In my first day I see over 35 patients, some who have waited for over an hour and others who walk away and decide to return the next day. Every day I see 30-35 patients. Dona Isa tells me when to eat and I listen. I like to think I’ve made it through all the patients waiting before I eat, but the truth is Paco, who I call the chief of the waiting area tells them to leave and come back later.
Mostly, I see a lot of coughs and flu’s. There are rashes and superinfections of rashes. Scabies is prevalent. Many people come with many types of abdominal pain. Everybody thinks it is parasitosis in the same way that we think it is indigestion. There is some post-traumatic stress disorder that manifest as insomnia and living in constant fear for ones loved ones as well as in various pains. Most mothers want vitamin injections for their children and an anti-parasite medicine. Normally, I try to explain why I am refusing their requests. We don’t charge at the clinic but I do get gifts. One woman gave me a bag of bananas after a consult. Another gave me a couple tamales. Still another woman gave me 10 pesos to buy a soda. Everyone just calls me “doctor” and nobody seems to care to listen as I introduce myself. In Mexican Spanish they diminutize everything with “ita” such that taco becomes taquita (little taco). I think it is really funny when they call me Doctorcito.
Today, I went with a man named Armando to see his daughter, Yasmin. He lived between the roots of the mountain above us where most of the valley between was washed away so we have to climb up on a dirt path and over the hillside to get there. We walk across plank bridges and along a narrow path. I had asked him if I should put my boots on because there would be mud, but he assured me there was no mud, so I continued to follow him in my sandals. On the way, he talks about Yamin’s medical history.. When she was three years old, she had a fever of 42 degrees (107.6 F) and started convulsing. In the medical world, call them febrile seizures. They are common and are insignificant – unless they repeat within 24 hours or continue without a break. The next day the fever repeated. Because the family lived so far from a hospital, it took them until the second day to get to Tapachula. There, they did a lumbar puncture, started antibiotics, most likely thinking it was Meningitis, and gave several vaccinations.
But the fevers continued as did the convulsions and by the third day, Yasmin had stopped recognizing her own mother. She stayed in the hospital for 40 days. For most of the time, they were switching antibiotics, trying to control the fevers and seizures and with little success. When she was discharged, her parents were told she had an area of her brain permanently damaged – burned by the fever, they had said. That was nearly six years ago. She is 8 now, can not walk, talk, or even eat. When I arrive, her mother is holding her. Her mother feeds her with a syringe, bathes her, changes her diapers, and holds her head up because her tongue falls back. Her arms and legs are as thin as the handle of a tennis racket. Her left hand has contracted inwards and her right hand is on its way to doing the same. I examine her and ask for her medical records. They had kept them for 5 years and then all was lost in the hurricane. I tell them they have done an amazing job caring for her. She is clean and well-dressed. She darts her eyes back and forth as we talk. Her hair is in two long braids.
But still, she is wasting away. Syringes are no longer sufficient and they have no access to nose-to-stomach tubes. I tell them the bad news, which they already know but have not accepted. Their daughter will no improve and there is nothing we can do. I tell them the contractions will continue and explain to them how to do simple exercises for her. Then I reassure them that even if she were in the United States, the same thing would have happened and there would be no way to improve her functions dramatically. This is not completely true because no one in the United States needs two days to get to the hospital and most people have Tylenol to reduce the fevers which most likely caused the convulsions, but it is true enough for them to hear. The mother starts crying. She is with Yasmin day and night, caring for her and the thought that her littlest of four children will not improve is still hard to accept. That’s what the doctor had said years ago, she says. But Yasmin is still having gran mal seizures – once or twice per day. This, I say we can improve and maybe prevent a respiratory infection that with her condition is bound to be more fatal. I hug the mother and walk out with Armando, telling him to stop back at the clinic tomorrow. Back at the clinic, I count anti-seizure carbemazipine tablets. She is eight years old. She probably weights about 35 pounds. She will need at least 300mg per day. We have enough for 80 days. But then what? I told the parents I did not want to start a treatment if we cannot continue it. I have made it my mission to get her enough pills and either nose-to-stomach tubes or a high calorie diet solution.
It is situations like these that make looking at the third world so difficult. You can teach people to wash their hands and use boiled water to prevent parasitosis even though in practice it is difficult to do. You can go and cure coughs and give diabetic medicine. But you can not attempt to treat Yasmin without leaving part of yourself in the third world as well. It is difficult to explain, but anyone who is reading this and not thinking ‘how can I help Yasmin?’ already understands.
the Padre Abel, a friendly, quiet middle-aged Mexican man with a goatee and pants that always appear to be about to fall down. He has a couch, television (with more than 2 channels!) computer and telephone. Also upstairs is the bathroom I use to brush my teeth. It is the only bathroom in the clinic with a sink and toilet seat although there is not yet a mirror. Downstairs, is my sleeping quarters, a pharmacy room, a kitchen, a consult room, and two rooms where lives a family who lost their house after the hurricane. 
t open and the consult room became a sea of assorted medicine boxes. I begin my work immediately, cleaning and restocking the pharmacy shelves. The next day, the patients arrive. They had heard that I was coming. Many had checked the clinic in the early afternoon on the day I had arrived and had come back the following day to see if I were doing consults yet. Consults start at 
– how you have to shake the thermometer first. I decide whose blood pressure I want to take and whose weight I want to guess. Then I examine the patient, often by kneeling on the floor because we don’t have an exam bed and go to the pharmacy to decide which medicines I want to use. I also discover how to mix suspensions with pure water to make medicines and in that process recall the tastes of the ones I liked and disliked when I was a kid. (I know now, for example, that it was Ampicillin that I loved for my ear infections, Amoxicillin that was a disappointment, and Erythromycin that tasted terrible.) In my first day I see over 35 patients, some who have waited for over an hour and others who walk away and decide to return the next day. Every day I see 30-35 patients. Dona Isa tells me when to eat and I listen. I like to think I’ve made it through all the patients waiting before I eat, but the truth is Paco, who I call the chief of the waiting area tells them to leave and come back later.
