by Brian Kevin
“None of this was here twenty-five years ago,” George said on the way out of Asunción, gesturing out the windows at what still felt like a pretty central part of town. “A lot of the road we’ll be driving on today wasn’t paved either. This country’s made a lot of progress since Stroessner.” He paused. “Well, in some ways. Less progress in others.”
Also in the truck were Dr. Laurel Parker, a twenty-eight-year-old ER doc from Connecticut, and Cessar Fernandez, head nurse at the clinic in the village of Cerrito, which would be our home base for the next week. George had introduced Cessar as his “Paraguayan brother,” a stylish guy of thirty-five with blond highlights and a silver chain around his neck. Cessar had greeted me warmly and tossed my backpack into the bed of the truck, next to two huge, tattered suitcases filled with prescription drugs and supplies. Meanwhile, Dr. Laurel—as the other two called her in front of patients—was a childhood friend of Andrea’s. This was her second volunteer trip to Paraguay, her first since finishing her residency the year before. She and George had managed to get the drug-filled suitcases into the country without any customs hassles, which George assured me was an auspicious start in a country famous for its vast and often corrupt bureaucracy.
East of Asunción, the Paraguayan landscape took on the color and character of the Kentucky hill country. Low forested ridges and humplike buttes interrupted vast fields of sugarcane—row upon row of wild green tufts bursting from woody stalks. A few cattle wandered around in open pastures. Paraguay is an overwhelmingly flat country, with no great mountain ranges to speak of, but after a couple of hours, we came within sight of Cerro Peró, a wooded peak that’s the country’s highest point at just shy of 2,800 feet.
“In Guaraní,” said George, “they call that mountain Yvytyrusu, which basically means ‘big pile of dirt.’ ” He chuckled contentedly. George speaks fluent Guaraní, and he seemed happy just to have the strange words rolling around in his mouth. Every so often, he shouted a guttural phrase or two at Cessar, and they both laughed liked crazy.
We stopped for lunch at Cessar’s sister’s place in a city called Villarrica, a small agricultural hub about 100 miles east of Asunción. Fifty years ago, George told me, the town was the terminus of the paved highway east of the city, very literally the “end of the road,” beyond which the country would have looked much like it had before the Jesuits showed up in the sixteenth century. Thompson had come here to attend a meeting of a banned opposition party in the lead-up to one of Stroessner’s sham elections. He didn’t have much to say about the town back then, only that the revolutionary assembly there didn’t amount to much. The dissenters in Villarrica were “quite sincere,” he wrote, but four out of five of them were teenagers, and many seemed just as eager to get out of Paraguay as they did to overthrow the dictator.
To hear George tell it, simply attending an anti-Stroessner meeting back then took some balls. His recollection of Stroessner’s Paraguay is a world full of corruption and paranoia, where the government paid citizen-spies to report on their neighbors’ political and personal “crimes.” Pyraguës, a Guaraní word meaning “hairy feet,” was the nickname for such trolls. One acquaintance of George’s worked in the Paraguayan Forest Service by day but moonlighted as a snitch, spotting and reporting homosexuals gathered in the city’s main plaza. Then there was the old man who ostensibly hawked brittle, yellowing magazines from a newsstand in front of the Peace Corps offices.
“The guy never sold a single issue,” George said with a laugh. “He just sat there watching who was coming and going.”
Stroessner has been out of office since 1989, when he was finally overthrown by a military coup, but Paraguayans are still living every day with his legacy. George mentioned, for example, how “El Excelentisimo” prevented the import of iodized salt, part of a calculated effort to lower his nation’s collective IQ and keep the population docile. As a result, George said, we were likely to see many patients with cretinism and goiters in the coming days—hyperthyroidism affects Paraguay more than any other nation in the New World. The country’s bloated bureaucracy is itself a holdover from the days of the dictator, when political cronies were rewarded with cushy jobs in post offices that never actually sent or received mail. George also warned me to be subtle about taking notes, since many of the older folks might still panic to see a stranger standing in the corner with a notebook, listening and jotting things down.
We left the pavement at a town called San Juan Nepomuceno, named for the patron saint of silence and flooding—two pretty common phenomena in the sparsely populated and low-lying countryside. Thereafter, the road wasn’t even dirt, just a red and soft-pack clay so sculpted with ruts and divots that the truck had to veer back and forth to make any forward progress. George worked the clutch like a cartoon witch stirring a cauldron. Eventually, the road itself became little more than a rut, a kind of surreal corridor hemmed in by palms and other shaggy matter. Hanging from the trees were what seemed to be wisps of white garland, and I asked jokingly whether somebody was putting up welcome decorations.
“It’s cotton,” George said. “Paraguay’s first cash crop. Middlemen load it up in dump trucks to take it to market, and they always leave some behind when they graze the trees.”
The branches stretched out over the dirt path, forming a shaded corridor with cotton dangling everywhere, like threads off a torn cloud. It was beautiful, really, and I said so.
“Well, you can call them welcome decorations if you want,” said George. Just then, the truck careened through a particularly yawning trough, sending the front bumper bouncing, a cascade of mud over the hood, and the four of us slingshotting forward like crash-test dummies.
When the truck righted itself, George turned around and grinned. “Welcome to the campo,” he said.
By late afternoon we weren’t far from Cerrito, but before arriving at the clinic, we had a house call to make. Three years earlier, on her last visit to Paraguay, Dr. Laurel had seen a young patient with a congenital heart defect whom she’s since taken to calling “the Blue Boy.” Thanks to a lack of oxygen in his blood, the Blue Boy’s skin was the color of cobalt. He was distinctly blue from head to toe, a condition called cyanosis that indicates severe valve and/or vessel damage. Without a risky and expensive heart surgery, his life was unquestionably in danger. Recently, though, Dr. Laurel had swapped e-mails with a surgeon working for a Paraguayan nonprofit, and the surgeon had agreed to operate on the Blue Boy for free. So our first task in the campo was to find the Blue Boy and have a talk with his family.
We stopped the truck in front of a cinder-block schoolhouse, where a few dozen wide-eyed kids ran to the fence to have a look at the gringos. George and Laurel’s arrival was already the talk of the township, and most of the students had probably felt the chestpiece of Laurel’s stethoscope during her last visit. The kids pointed eagerly up the road to where the Blue Boy lived, and within a few minutes, we were parking in front of a crooked clapboard house with a corrugated tin roof. Outside, bags of cotton were piled up next to a lime tree, waiting for the dump truck to haul them away. A tall teenager looked up from the moped he was fiddling with and stood up to greet us shyly. His parents weren’t home, he apologized, but they’d be back soon. He asked for us to wait outside while he fetched his brother.
So the four of us stood quietly in the yard, surrounded by a menagerie of chickens, dogs, and one shockingly white kitten. When the Blue Boy stepped out of his house a few minutes later, he was wearing plastic flip-flops and the striped jersey of the Paraguayan Fútbol Association. He was unmistakably blue. Not solidly painted, like one of those performance artists, but tinged and vampiric, like a comic-book villain who might shoot ice out of his fingertips. His features were fine and angular, and his dark hair close-cut and spiky. He looked to be in his very early teens, although I suppose his growth may have been stunted. The Blue Boy looked delicate, but not frail.
“Buenos tardes,” he said to each of us with a shy smile and a handshake. When
it was my turn, I half expected his hand to feel clammy, but of course it didn’t. He seemed to recognize at least George and Cessar, and he talked quietly with them for a few minutes in a mixture of Spanish and Guaraní. How had he been feeling? Had he been going to school? The Blue Boy said he had a toothache recently and showed Dr. Laurel a small infected spot on his jaw. Nobody mentioned why we had come, and after a few minutes, the conversation hit a lull. The Blue Boy leaned quietly against the lime tree while George and the medics conferred in English. Everyone agreed that he looked slightly better than the last time they’d seen him. I took a short inventory of the detritus lying around the yard: a naked and armless baby doll, a pile of roofing shingles, a toy truck made from woodblocks and bottle caps.
When the Blue Boy’s dad pulled up in a rusty pickup, he didn’t seem surprised to see us. Cessar had been on and off his cell phone all day, speaking Guaraní, and I’m guessing that the father knew we were coming. He was exceedingly polite, shaking everyone’s hands and asking his sons to bring some wooden chairs from inside. At a nod from his dad, the Blue Boy excused himself, and we all sat down.
For the next few minutes, George and the father did most of the talking, with the occasional word from Cessar. They spoke mostly Guaraní, but I picked out a few words of heavily accented Spanish, and George played the conversation back for me later. Your son’s condition is very serious, George told the man, probably not for the first time, and he needs an operation or else he will die. The father looked George in the eye, seriously and respectfully, while George told him about the surgeon in Asunción. George was calm and not the least bit pedantic. He sat with his knees splayed and used his hands for emphasis, his palms faceup in a way that said he was offering advice and not giving orders. We can find a way to get you into Asunción for a consultation, he told the man. We can do something to fix this.
The father wore a baseball cap and what had once been a white dress shirt, now faded to a dingy brown. He smiled very slightly as he spoke. The last time the medics had proposed something like this, he said, it was very expensive, a hardship on the family. In Spanish, I heard him use the phrase “heart machine.” They had taken his son to the city to use the heart machine, and nothing had improved. He was describing an echocardiogram, George and Laurel later explained, a test to see the extent of the boy’s valve damage—not a treatment, but that distinction had been lost on the family. No, the father continued, his son was a smart and capable boy. He had to stop and take a breath sometimes when he walked more than a few meters, but he was going to be OK. He didn’t need any difficult or risky procedures.
George countered exactly once with another pitch, but the father held firm, politely repeating that his son was a smart boy, a good boy. He just got tired sometimes. That was all. The boy’s dad stood and shook all of our hands again, thanking us sincerely for our time and concern. Just think about it a little more, George and Cessar insisted, and they gave him Cessar’s phone number in case he changed his mind. We walked to the truck past the bobbing chickens and the splayed cotton sacks.
“He doesn’t understand that it’s a miracle the kid has lived this long,” George said, handing Cessar the keys and climbing into the passenger seat. He was clearly frustrated. It occurred to me that the Blue Boy probably wasn’t much older than his daughter had been when she died. Cessar turned the ignition, and the truck started with a feline growl.
“What will happen to him?” I asked. “I mean, what’s his prognosis without any surgery?”
George swiveled his head to look at Laurel.
“He’ll develop congestive heart failure with a few years,” she said, sadly but calmly. “Without surgery, there’s really no other outcome.”
“It’s a death sentence,” George said, and he sighed.
We pulled out onto the dirt track. As we drove off, I looked back just once to see the Blue Boy and his dad, waving to us from the doorway.
I slept on a gurney in the clinic that night while George and Laurel crashed at Cessar’s house next door. The clinic in Cerrito is a single-story rectangle of brick and plaster, about 2,000 square feet on what passes for the farm community’s main drag. The bricks were made on-site with local materials. The poles carrying the electric lines were hewn from nearby woods and pulled to the site with oxen. Local communities contribute about a third of the overall construction costs to get each Andrea Ritz Clinic off the ground, providing materials and/or labor. I settled into one of two bare-bones exam rooms before poking around. There was a small dental office, a few bookcases’ worth of pill bottles, and a dozen or so public-health posters in Spanish and Guaraní, describing the symptoms of STDs, discouraging bare feet to prevent hookworm, and offering tips on how to avoid snakes (of which eastern Paraguay has some of the world’s most venomous).
It rained so hard overnight that the roof leaked. I sank ankle-deep in the muddy roadway on my way to Cessar’s the next morning, and the rest of the crew was just waking up when I arrived. There’s no driving in the campo after a storm like that, so we settled in for a couple of hours, just waiting for the roads to dry out and killing time with chitchat and mate.
Britons’ devotion to tea, Scandinavians’ love of coffee, Americans’ fondness for milkshakes masquerading as espresso drinks—none of these compare to the fervor with which Paraguayans drink tea from the leaves of their native yerba mate plant. For most Paraguayans, consuming mate is both an elaborate ritual and an unconscious habit. In his tiny kitchen, Cessar prepared our morning drink, and I watched as he first filled a cup with dried, ground leaves, then inserted a long silver straw with a filtered tip, called a bombilla. The cup itself was a smooth wooden chalice, but more traditional drinkers use a hollowed-out gourd. Cessar poured hot water from a thermos onto the tea leaves, then sipped from the bombilla until the empty straw made a slurping sound. As he refilled the cup, George explained to me the social rules of mate drinking among friends: One person is in charge of refilling the water and passing the cup (usually the youngest in the circle). It is always given and received with the right hand. Counterintuitively, saying “thank you” is an indication that you’ve had enough and want to skip your turn. This last one gave me trouble in the days to come, not just with mate, but more vexingly, with beer, which also tends to be consumed in a social circle from a shared glass.
Mate has a floral, slightly bitter taste and a caffeine level somewhere south of coffee but north of black tea. I liked it very much, and on a continent where you can’t find a decent cup of joe to save your life, it makes a better morning alternative than the ubiquitous instant Nescafé. In Paraguay, drinking mate with cold water is equally popular. In that case, the beverage is called tereré, and the vessel is typically a cup made from a bull’s horn, called a guampa. Many Paraguayans wouldn’t dream of leaving their house without their three-piece kit of a thermos, guampa, and bombilla, and to spot a bunch of guys standing around sipping tereré is the cultural equivalent of seeing cubicle-dwellers or construction workers loitering with their white paper cups on an extended coffee break.
Over mate, George and Cessar told me about Pombero, a mischievous Paraguayan gremlin who lurks around the countryside at night, making life difficult for the campesinos. That morning, the power was out at both Cessar’s place and at the clinic, but while I chalked this up to the overnight storm, George and Cessar chided me that this was surely the work of Pombero. Physically, he sounds like a cross between a mini-sasquatch and Gollum from Lord of the Rings—short, hairy, implike. Pombero steals eggs, flattens tires, spooks pets, and generally gets the blame for any other inexplicable annoyance (including, I gather, the occasional unplanned pregnancy). When Cessar first moved into the campo, he told us, he had definitely worried about Pombero, and plenty of grown adults still take the myth quite seriously. The only way to keep him pacified, of course, is to leave tricky Pombero some booze and cigarettes, and I wondered if the Paraguayan demon might be a distant relative of old Tío back in the Bolivian mines.
&n
bsp; By midmorning, the sun had shone long enough that we decided to risk the roads, so we headed next door to grab supplies for our first satellite clinic. Inside George and Laurel’s two suitcases were chaotic piles of prescription bottles, vitamin jars, packaged antibiotics, and tubes of every imaginable cream, balm, and ointment. The luggage itself dated back to the founding of the first clinic, George said proudly, and he estimated it had made the trip about eighteen times. With a haphazard heap of medications spilling out, the worn pleather suitcases looked less like the equipment of a successful medical mission and more like the getaway bags from a drugstore robbery.
I stayed out of the way while the medics packed their travel kits. They debated which drugs to bring and which to leave behind, and overhearing snippets of their conversation was like listening to dialogue from an episode of Star Trek.
“Bring that, it’s a very effective alpha blocker.”
“Did I pack Cytomel 10 or 40?”
“Grab an extra blister pack of Diamox.”
The swampy roads were treacherous but not impassable. We fishtailed here and there, and some of the hills required multiple attempts, but it was nothing the Toyota couldn’t handle. By late morning, we were pulling up to an empty brick schoolhouse in a valley full of small farms. Across the pasture, a straw-bale church with a false steeple was the tallest building for miles. Skinny Brahma cows wandered aimlessly through the street, the mud sucking persistently at their hooves.
George and Laurel set up their makeshift exam space in a Spartan, fluorescent-lit classroom, and again I tried my best to help without being obtrusive. Cessar chatted outside with the school’s principal, and we had barely gotten the medications spread out on the table when the two of them stepped inside to say we had our first house call.
