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One week off with Dad and then in Antigua, Guatemala

My schedule here allows me to work for 21 days in the community and then take a week off to explore. For this reason, I was able to spend 4 days with my father who visited from New York to see a small piece of Chiapas, and then I spent the latter 4 days in Antigua, Guatemala visiting Lorraine, the Ob/Gyn doctor with whom I worked in Hospital Altamirano, and her husband Miguel. Dad and I explored San Cristobal and the Chiflon waterfalls near Comitan. With him, he brought enough cookies and brownies to throw a grand party, as well as several books I’d been lacking. Despite his altitude sickness and frustration with the omnipresent evidence of poverty, we had a good visit and I hope he went home more worldly for it. From San Cris, I took a 12 hour van across the Guatemalan border to Antigua. On the road, Guatemala’s differences with Chiapas are well pronounced beginning with the famous Chicken buses and continuing with their more sophisticated farming methods. Unfortunately, the border road is very dangerous, although much safer since the police increased their presence a couple years back. The Chicken buses, our old American yellow school buses, are the primary method of public transportation in Guatemala. Completely absent from Chiapas, they are painted in vivid colors and when parked, have a artistic beauty that can only be contrasted by their bat-out-of-hell approach to driving and their exhaust which in itself is reminiscent of the 19th century British Industrial Era.

Antigua, like San Cristobal, is a colonial town with colorful houses lining the cobblestone streets. It stands alone, however, in its architectural achievements and ubiquitous church ruins. From the 16th Century, Antigua had been the center of Latin America, and as such, every church group flocked into to establish their cornerstone. The earthquake of 1773 destroyed nearly all of them and left beautiful ruins on nearly every other block of the city to explore just as the people, unable to move the stone blocks of their city undone, moved the capital from Antigua to Guatemala City. Miguel is heavily involved in preserving Antigua’s cultural heritage and casting a spotlight on Guatemala’s artistic traditions. He and Lorraine have a gorgeous house with a fountain they had designed and a rooftop garden view of the ever prominent Volcanoes.

During my stay, I hiked up Volcano Pacaya (my first volcano – and part of the way with a 2 ½ year old Australian boy named Jessie on my back) a semi-active volcano that smokes sulfurous fumes daily and occasionally spits fiery rocks. The view from the top was incredible but more fun was skiing down the volcanic ash. Also, I went to the market in Chichicastenango (Chichi, (CHEE-CHEE) for short) where colorful Guatemalan textiles collide with colorful Americans from the cruise ships who are bussed in and bussed out without ever having to learn a word of Spanish. That cultural shock aside, it was a very good visit and I left to return to my clinic in Belesario yesterday with a deep appreciation for Antigua and a lasting friendship with Lorraine and Miguel.

into the communities

I spent one of my last weeks in February in a series of small communities on the edge of the Sierra mountains and over an hour off the paved road ways. To get there the health promoters I had gone to support and I hung on to the back of pick-up trucks as we spun around the curves and through the dust of yet another part of Chiapas that has only had electricity for three years. As there is a deprivation of medical attention, we set up shop in three small towns and worked for about 6 days. At my insistence, the health promoters set up consult rooms in their homes or in mud-brick houses with an examination bed and a desk. They stayed with me to take blood pressures and I talked to them about the patients’ medical conditions.

It was really a pleasure to support the health promoters by showing the communities that they are working with a doctor and to see them taking such good notes on my questions and on the differential diagnoses I had discussed with them. In all of the communities, families cooked for us and gave us a place to sleep. The real adventures of the day revolved around the 1-2 hour long hikes, hitchhikes, and walks to the nearest city’s phone to call Ines.

Also, there were a few house calls we made into the mountains. Often, to my surprise, patients would come in with ultrasound results and medicines from other doctors. The people of those communities have a lot of faith in the Guatemalan doctors. One theory on why that is is that the Guatemalan doctors prescribe more medicines and injections than even the Chiapan doctors. Many patients want injections and vitamins. They trust injections more than pills in fact and it is very hard to get them to change. I saw many people with chronic back problems, unsolved colitis symptoms, and rashes that come and go since the hurricane. The rashes I hypothesized were due to the dirty water they are filling their buckets to bathe with. The colitis had already been treated with a buffet of medicines for everything parasites to bacteria so the best I could do was to tell them to avoid the troubling foods. The back pains and aching feet are a more difficult problem. These people do more physical labor than most of us with poorer conditions and the only real solution is a package of painkillers and a long cruise vacation, neither of which I could sufficiently offer.

The whole trip was very educational and I will most likely go back to support the health promoters in march.

from Chiapas

Just a quick note. I have been back in Chiapas for over a week now. I am working in Belesario, where I will stay until April. We still have a high patient load, and I am seeing them alone, which means playing doctor, nurse, registrant, and that nameless person whose job consists of escorting them into the consult room.

Most recently, I have been rented out by my group to a small community called Honduras (the town, not the country) that is somehow 7 hours from here. I will be there all of next week, living on little more than beans and tortillas I believe. Thankfully, I have chocolate to take with me. And maybe I will pick up a box of corn flakes so my american palatte can go untainted for at least one meal per day.

Most patient complaints these days consist of the basic fungal infections, coughs, cold-like symptoms and muscular pains. I have started giving some injections to the adults who seem interested in receiveing them. I still refuse to give them to kids.

All of my photos thus far from Chiapas, as well as Ines and my photos from Germany and Norway are now on Ofoto. If you would like to see them, please e'mail me at any of my accounts and I will add you to the list.

Going Home for the holidays

After 10 long days in Belesario, I left this morning with Leonel to make my journey home. In 4 days now I will leave for the United States. From there, Ines and I will go to Germany for Christmas on the 21st and then to Norway to see the Aurora Borealis over New Year´s. I will head back to Chiapas for part II of this experience on the 11th of January. Until then, I will put the blog on hold unless there is interest in the comments section in reading about our trip to Europe. Until then, happy holidays!

Leonel and I fight the dust with our Cubrebocas!

Belesario

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 burst 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.

One Terrific week with Ines

As some of you know, Ines and I had a week long vacation together around Chiapas. I think her blog (click “Mein Fraulein” on the right column) summarizes the trip very well although I thought I would just add some pictures. My favorite part was the Chiflon waterfalls where we had no expectations because it is not in the guidebook and found ourselves at the top after an hour´s hike dripping wet and surrounded by rainbows.

Who´d a´thought i´d get the white horse! This was taken after our ride to the indigenous town of Chamula and before we realized we could not walk. See, her horse was biting every other horse the whole time. It fit her personality well though!

Chiflon. Note that rainbows don´t come out in Sepia mode. We had individually climbed to the higher deck where the water raced around us.


If Ines were Mayan this would translate to a lazy Friday on her back porch. The clouds were not friendly and 10 minutes later we were caught in a bad rainstorm on the opposite end of the ruins without a plantain leave to be found for shelter.

Agua Azul (blue water), literally Agua brown this time of year but it was a nice walk in a trip infiltrated by water in one form or another.

Goodbye Altamirano

I had originally planned to stay at the Hospital San Carlos until I flew home for Christmas but as my work continued, the politics changed. When I had first come, I was told by the coordinating doctor that I should start in consult rooms with another doctor until my Spanish improved. As the first week progressed, I changed my role from observing the patient visit to doing the physical exams only, and then to interviewing the patient as well. The other doctors were very patient with me and gave me room to work with the patients as we alternated interacting with our patients. Finally, by the second week, I started the hardest part: writing the patient histories in the chart. So many words were new and that was a completely different education. For example, I did not know that “Costo-verterbral angle (CVA) tenderness” is “Giordano positivo” or that our “pitting edema” is “Segnas de Goethe.” Nevertheless, I learned a lot and by the end of week 2 was confident enough in my patient visit to start seeing patients on my own. This continued until about week 6 when I was called in by the oldest nun and scolded for not giving a patient with a viral throat infection some medicine. I tried to explain that it is viral and we don’t give medicine for that and that I did tell the patient to take tea with honey for her cough but that was hardly good enough. It seems the sisters are very keen on giving out some medication, even if it is only vitamins. This, I refused to do because the patients have to pay for their medicine. I suppose she spoke with Sor Maite, the head of the hospital because the next day, I was called up to her office and told I was not allowed to practice solo anymore – that I was a student and therefore not responsible for my patients legally. Although the idea of a lawyer coming to Altamirano is as funny as a liposuction clinic starting shop there, she had a point about legal responsibility. Unfortunately, she did not trust any of her own doctors enough to let me continue seeing patients on my own and presenting them to that doctor for their signature. In my mind and in the mind of the United States medical system, once a licensed doctor signs a patient history he/she is legally responsible for that patient. But that is not the mind of Hospital San Carlos. Dismayed and not sure if I could continue – for if I weren’t going to be on my own then I was not being helpful and I am past the level of training where being in general consult with another doctor is the least bit useful to me – I walked down the stairs of her office and followed, feeling like a puppy dog, into another doctor’s consult room.

me, intubating one of the cleft lip kids

That day, however, the coordinating doctor told me I could start on my own again with his signature on the charts. That continued through part of that week until an American Family Practice resident came down from California. He had wanted to observe consults so I invited him in with me, thinking I could use his “medical doctor” signature on my patient charts. We saw one patient and then I was called out and invited to a special meeting between one of the doctors with whom I was not close and Sor Maite. Sor Maite, with a very worried expression, repeated that I was not to be solo. Then the other doctor, aligning herself heavily with the Sor, diminutive the American doctor and told me that working with the new resident was unacceptable because they did not know his credentials. Thinking it unlikely that a plumber or hair stylist would make his way down to hospital San Carlos in Chiapas and then pose as doctor, I dismissed this error as an honest mistake. I didn’t know he was a hair stylist!

Then the other doctor accused me of using an incorrect dosage of an antibiotic. That really hurt me because the thought of doing that is really scary. I had looked up the dosage and I was pretty certain that I hadn’t but Sor Maite, who has no medical training became even more worried about my practice there. Now, forced to stay in the room with someone else, I felt like was wasting my time staying at San Carlos when I could have been helping teach the health promoters and seeing patients in Amatan. Still not ready to leave though, I decided to start working outside of the hospital in the community and had a couple very educational experiences as I have previously posted.

Finally, I made a deal with Lorraine, the older Ob/Gyn from Massachusetts, who had felt very isolated in Altamirano and had asked me to stay until she left, that if I were going to stay, she had to take me under her wing, let me assist on all of her surgeries and teach me. She agreed and I had a very good final week as an Ob/Gyn apprentice. To her credit, she had confirmed that the dosage of the antibiotic I used had been perfectly acceptable and in fact was the dosage she used all the time. She even told Sor Maite that much but after that point, there was no going back for me. Hospital San Carlos is a beautiful hospital that does many terrific things for the indigenous people.

The sisters who run it are very caring people but they are not without their faults and with my independence and normal problems with hierarchy and authorities it would not have been prudent to stay. That is why I am now in San Cristobal, having seen Lorraine off today and waiting to go with my group to the disaster zone of Hurricane Stan to work in a clinic down there. In order for me to stay in Chiapas, I need to feel either useful, helpful, or like I am learning something. Without a combination of those three, I would be wasting my time and feel like I am on a vacation when I do not wish to be on a vacation.

As a side note, Lorraine was nice enough to give me her digital camera for my remaining 3 weeks here so pictures will follow – although I am not sure if internet will be available near Tapachula. Until Next time, Ryan

Thanksgiving and First failed Experiments in Aviation

Today was Thanskgiving; they translate it as El Dia de Gracias but they don’t celebrate it and I’m pretty sure Cortez never shared a meal of brotherhood and understanding with the Aztecs. Then again, neither did the Pilgrims exactly – exchanging influenza for syphilis over cornbread is not what I call a satisfying postre. Anyway, it is my favorite holiday of the year – a non-religious, family-oriented celebration of the fall. Personally, I think it should happen in the beginning of October and outdoors but as I have not been requested for hire as an independent consultant for Hallmark yet, it remains traditionally on a Thursday and in late November. As there it stays, Thanksgiving has become an important marker for what has now become more than a month of Christmas. Although Christmas started on the 25th, a variety of interest groups have been proselytizing and baptizing the previous days from “the 12 days of” to the “2 weeks before” until “the month of…” They seem to be blocked in their concept for the Christmas year by Thanksgiving though and it looks like it will end there unless Easter creeps forward. Anyway, I was never very good with dates and have always depended on my family to remind me when Thanksgiving will be every year. When this year, someone told me it was going to be on a Thursday again, I asked another American doctor, Linea, what we will be doing to celebrate. I remember 12 years ago and in Belarus being invited by the U.S. Embassy to have an official state sponsored turkey dinner, so naturally I imagined being called in by the town council of Altamirano, Chiapas for a special celebration. Instead, Linea said she had planned on making a pie and had indeed already bought all the Plantains she needed. That’s when the poor idea of making our family’s apple pie entered my head. So after a myomectomy and the delivery of an ovarian cyst the size of a small watermelon, I walked down the central street to find apples.

In the one market that had apples, the owner tried to sell me a type called red delicious but I would sooner make an apple pie with fig roots than with red delicious and I think my father would agree. They are soft and watery and sweet apples, really. They are the simple man’s apple. People who enjoy red delicious tend to also own golden labs, enjoy watching golf and drink Budweiser beer. They also eat Chinese food with a fork in case you are still confused. The other option, however, was another red apple. Smaller and bruised, they looked like they had already been thanked for giving by a angry gang of worms, perhaps pawed over by the wild dogs and then used to fill a flat tire on the way to the market. It was a very political decision but I decided to go with the battle-wounded that resembled a cachectic form of what stood out in my childhood memory of a perfect apple for a pie.

Next I had to find orange juice for the crust. I walked to the largest market in town only to find that although I could easily buy peach or guayaba juice in cans, they had no orange juice. Of course I could have squeezed my own but I did not want to spend my entire afternoon making juice as well – which is bound to be nearly as sour as lemons anyway. What they did have was Ju-Mex – a Sunny D-lite/Tang like drink with “real orange flavor.” Seeing as I had already accepted the leprous apples, I bought the orange flavor and went to Juan Manuel’s kitchen to “experiment.”

Assembling the crust proved to be the hardest part. Aside from the OJ imposter, I was faced with no measuring cup, no real bowl, and butter instead of the Crisco that the recipe requires. Linea said I should use 2/3 of the amount of Crisco in butter and I was going to use the full ¾ cup so I decided to split the difference. Because it was cold, the butter had to be melted on the stove and then I mashed it with a fork but I could not get it to mash right and was left with whole chunks of butter buried in flour. So I added more butter. Then more Ju-Mex.

During this whole time I was reminded that my mom used to make clay for my brother and I on rainy days from flour and water and salt. With that thought, I was acutely aware that whereas I had wanted to make dough, I may have been assembling clay instead. Well I mixed everything and it still did not work. So since you cannot subtract in the kitchen, I kept adding until I could finally assemble a ball of dough. Then, worried that the next time I saw it may have turned into a solid sphere (I imagined myself having to explain ‘instead of a pie I made a globe of the world to show you all where I live!’) I wrapped it and put it in the refrigerator to let it think about what it had done.

About that time, Lorraine, our American Ob/Gyn came to help me peel and cut and excise the ulcers from said apples. To my surprise, Odile, the Swiss doctor had shown up the day before with a jar of wheat germ. This wheat germ, an inferior distant cousin to our wheat germ, however, was tasteless and so small and powder-like that if you breathe at it the wrong way, you could scatter it into the wind and make someone sneeze in Guatemala. But since I was making the best of it, I decided to use it anyway, and in fact use twice as much. Even if the apple pie tasted like a box of Kleenex, it was at least going to contain all the right ingredients.

Next, I called the dough out of the fridge and rolled it on the table using an empty jar of jam for my rolling pin. The dough had the distinct resemblance to a stretchable eraser, but subject to enough abuse, it was able to get it into a large enough size for the pie pan. I hurried to transplant it and let it stick to the pie pan before it snapped back into a ball of dough and perhaps rolled itself back into the refrigerator to hide.

Pie completed, I placed it in the oven, lit several matches, and set the oven on level “5” for “hotter than 4.”
When finished, it looked pretty, and people enjoyed it after I had carefully explained to the other doctors in my Spanish that Thanksgiving is the time of the year when the Pilgrims and pumpkins got together and ate the Indians. But in reality, it tasted like apples in a cardboard box. No one noticed, though, and no one tried to top their pie with beans and salsa which was a sure compliment to the chef that they enjoyed the flavor --- or at least the change from the beans and salsa they had piled on top of the beans and salsa that was our dinner.

Making things more authentic for the Thanksgiving experience, the electrical company shut off the power for the entire town at 2pm because the municipal had not paid their bill so we sat ate our dinner by candlelight. There we sat, three people from the United States with the modern versions of native Mexicans, passing apple pie pieces and beans and salsa (though not together) – it was so metaphorically perfect, I may have had tears in my eyes – if you could only see them in the dark!


Yesterday, what started as a simple lantern made of paper by a nurse developed into an intensive origami training program in Lorraine’s room until I would not stop before a hot air balloon was generated. We mastered the paper balloon over our lunch break and I quickly decided to expand to a larger piece of newspaper. Then I taped a plastic cup to it with dental floss below the opening and placed it aside, proud of my accomplishment. Frightened by my concept of filling the cup with gasoline, Lorraine kept the balloon well hidden until tonight when, bored and sitting in the candlelight, I decided it was time to take it to the air. The gasoline stores closed, I filled the cup with tissues and headed outside, my aviation glasses and silk scarf in place. Lorraine followed for the momentous occasion as my “co-pilot,” I said – “chaperone,” she said. After several takes, I finally succeeded in burning the entire balloon, plastic cup and then reluctantly, the tissues. Well, that happened to the Hindenberg too but that doesn’t mean it wasn’t great. A car passed us as we watched my dream of escape turn into a small fiery flare in the dark street. Although I will next be heading to the disaster zone of Hurricane Stan, near Tapachula (where the floods are that had been on the news in the U.S.) and she will be heading to her home in Massachusetts, we both have two days left here in Altamirano and we are both ready to leave. “If the car stops,” I said to her, “tell them we got lost in Texas and our car broke down but we were on our way back to New York and could they give us a ride as far as the border.”

This morning I woke up without electricity, without hot water and without cold water. It is 48 degrees inside during the night and this week my new digital camera was stolen. I don’t know what the pilgrims were thinking, but I would not mind going back to the United States for a few days. At this point it is three more weeks until my break. Currently, however, I am looking forward to that warm Tapachula sun about which so many popular American folk songs have been written. Happy Thanksgiving!!