Adventure at Tobaqom

Here I am posed in front of the chapel at the mission (in need of a haircut, too!)

Yesterday I went to Tobaqom (pronounced “Toe-bah-comb”), an indigenous village 40 km outside of Asunción, with the goal of interviewing a couple of patients that had various infections. The priest supervising the village informed me that a 3 p.m. meeting would work the best. Knowing that myself and one of my co-workers would be going by public transit, we prepared to leave early.

After eating a typical lunch of empanadas and (my personal favorite) a lomito, we picked up Line 34 out to the bridge that separates the city of Asunción from the Chaco region. To say that the bus was packed would be an understatement. Like sardines in a tin can, we stood for the 40 minute ride and got closer to the people around us. Then we got off at a dusty bus stop with a concrete overhang to shade the waiting travelers. My co-worker didn’t know how much it cost, but we weren’t surprised to know it cost slightly more than the city buses. After all, we’d be heading to Cerrito, which is about 30 minutes by car… buses take much longer. So we got on “the colectivo” and took the ride. Where panes of glass should have been, there was flapping thick coarse fabric pinned to the windows, which hit my head whenever I rested it on the seat in front of me. Because of my affinity for sleeping on bus rides, I spent a semi-lucid hour watching palm trees go by.

Reaching the Chaco

A sign on the facade of the mission, which reads, "To be where no one wants to be; to do what no one wants to do."

When we got to the nearby school, I phoned Padre and he came to pick us up in his battered old subcompact. A short ride took us to the off-road rally (or the road system that connects all of Tobaqom…. take your pick), complete with all sorts of obstacles like muddy ruts and pools of mosquito-breeding standing water that seemed all but impossible to forge in Padre’s small car. But we made it and rolled up to his meager property to greet the recently arrived American nurses that would be volunteering there for 6 months.

Once we chatted, the nurses and I received a grizzled older man in a cherry red cowboy hat, dirty sky-blue sports shirt, and leathery hands who was suffering from hypertension. While I’m definitely not a nurse, nor a doctor, nor anything that requires years of formal medical training, through my translating, I felt like I was seeing a patient. Looking him in the eye and telling him what was happening and what medicine he needed to take, telling him that his issue was cause for concern but not life-threatening, and developing an impromptu bed-side manner all felt natural to me, but at the same time completely foreign. Natural in the sense that the case was basic enough for me (with a degree in biology) to understand, but foreign in the sense that I saw what I’ve never seen before: the nuances of a patient’s expressions, how they shift in their seat and wring their hands. It piqued my interest in the hands-on side of the medical field, one that I may never pursue but one which definitely captivates me. It was a unique experience of the kind that one can only experience in a foreign land, as a different person, on a different planet. Yet I am me, this is Paraguay, and as far as I know, I’m still on Earth.

The adventure intensifies

After the short consult, we all went to the clinic following Padre through the calm afternoon air on a cool Paraguayan day. However, the breeze proved to be the only calm thing as suddenly, a group of locals came running with news that a young woman had seized and was in serious condition. She had been unconscious for 5 hours without medical help. One of the nurses went off with Padre to see what could be done while one stayed with me, my co-worker, and a young boy with a foot infection that I had managed to pull aside for a short interview.

The interview with the boy, traversing three languages, was a testament to the power of the human mind. I would come up with a question in English, think of how to ask it in Spanish, and then pass it through my co-worker, who would translate it from Spanish to Guaraní. The shy boy would think for a few moments, head down and hair covering his forehead, and then spit out a short answer in Guaraní, that my co-worker would then translate to Spanish, I would comprehend, and then write down in English.

As the interview was finishing, I heard the struggling thump of an an old engine turning over as a beaten up old Jeep passed the clinic with the young girl who had seized earlier in the truck bed, resting on a cot. The nurse that had attended to her hopped off the vehicle in front of the clinic and entered to give me the details. The afflicted girl was being taken to a hospital that had more powerful medicines in injectable, drip-bag forms. No confidence in a positive prognosis though, the nurse recounted. The race was now against time, since she had been in a coma for over six hours and her brain was oxygen deprived. Solemnly nodding my head, I told the boy I was finished with the interview and he hurried out of the clinic. At this point, the sun had begun it’s descent deep into the horizon, casting purple hues along the ramshackle huts.

Ubiquitous disease

The boy, as I found out, was afflicted with pico, an infection that many of the locals suffered with frequently. It was a form of soil-transmitted protozoan parasite that enters through the foot and colonizes the toenail and nailbed areas, presenting a black char and cracking the nails, turning them rusty. Through the help of my co-worker, I learned where this boy was from, how the symptoms feel, how long he had had it, etc. Thinking back now, I realize that this was my first experience gathering epidemiological data.

Afterwards, walking along dirt and cobblestone paths I felt like I was in Africa tending to the ill as a missionary back in the early 1900s. Except for the oddity of secondhand popular American clothing that is everpresent in the developing world, little modernity could be perceived. All huts were fashioned by hand, all wells dug by the community. We went to visit an old woman that had been bitten by a spider and was experiencing a moderately high degree of inflammation.

The angular face of the elderly woman with the same leathery skin that I’d come to expect here greeted me with a nod. No smile — the same nervous affectations that are ubiquitous among the reclusive indigenous American Indians when they are in the presence of  a foreigner.

Through another set of translations, I gathered that she had been given anti-inflammatories for a few weeks and had been waiting on the next set of antibiotics. Padre helped administer wound sterilization and then told her the indications and daily dosage for the antibiotics I brought. Her daughters spoke to me shortly about the infection and how common it was as well, with large numbers of insects and arachnids coming out and about as it warmed up.

The trip home

Awhile after the sun had been down, Padre and I were bumping along his stretch of land to make it to the bus station so that my co-worker and I could make it back to Asunción. Waiting on the bus in the dark in a foreign country is an interesting experience. We asked the driver when he and his rickety old bus were leaving for Asunción and he said it would be half an hour. So while we were waiting, we walked up the road to a bodega to get a beer. Talking to the shop owner, I learned that her daughter married an American soldier. All of a sudden, my Spanish comprehension sputtered to a stop as it often does, so I couldn’t tell you anymore about what she said. Anyways, my co-worker and I took turns drinking the 40 oz Pilsen so typical of Paraguay and just as we were finishing, the bus driver came out and shouted for us to get on.

The ride back followed the same semi-lucid pattern of wakefulness and sleep. I finally shook myself awake as we reached the road in front of my house. I thanked my co-worker for coming along and with my notes from the day in hand, I stepped off the bus and took the 8 block walk back home.

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