The Footloose American: Following the Hunter S. Thompson Trail Across South America (37 page)

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.

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.

“An old man with some kind of pulmonary symptoms,” Cessar said. “Not far from here.”

“He’s pretty sick,” added the principal. “He smokes and drinks a lot.”

So we followed her directions up a nearby hillside to a
ramshackle homestead at the edge of a barren field. At the gate out front, George clapped his hands three times (“the Paraguayan doorbell,” he said), and four ageless women toddled outside to welcome us. We were led to a small livestock shed out back, a brick building sized somewhere between a large chicken coop and a small barn. Inside, an old man lay prone across a foam mattress sitting atop two wooden pallets. As we stepped in, he squinted in the light from the doorway.

The old man looked bad. At first glance, his hands and feet were grotesquely swollen, like latex gloves used as water balloons. He was wearing only a tattered pair of canvas shorts, and his chest rattled as it rose and fell. Even in the darkness of the shed, he looked pallid. George greeted him warmly in Guaraní, and Dr. Laurel crouched with her stethoscope. The old man’s Darth Vader breathing filled the room.

“Strong signs of pulmonary edema,” Laurel said, listening to his chest and gingerly examining his hands and feet.

One of the women brought in a dusty X-ray slide, and Laurel held it up in the weak light of the window.

“Long-standing COPD,” she said eventually, “either emphysema or chronic bronchitis. Let’s give him a bronchodilator.”

Cessar grabbed an inhaler from the travel kit, and he and George tried to explain in Guaraní how to use it. You just put it up to your mouth, Cessar told the old man. First you exhale, then squeeze the trigger while you inhale. The man looked at him like he’d been handed a fish. He held the inhaler a few inches from his mouth and squeezed, and the puff hit harmlessly on his lips and tongue.

“Close,” George said, and he showed one of the women how to use the inhaler instead. She held it up to the old
man’s mouth and got him to put his lips around it, but when she pushed down the cartridge, he exhaled hard.

“No, inhala!”
she insisted.
“Inhala!”
Everyone in the shed began making deep-chested inhaling motions, trying to show him, but the man just looked confused. Then George took the inhaler and pantomimed using it.

“Like a cigarette!” he said loudly in Spanish, and a light went on in the old man’s eyes.

“Ah, como un cigarrillo!”
he croaked, nodding.

Everyone chuckled at the irony, but that first patient in the shed illustrated for me just what George and the medics were up against. It wasn’t just that these people had no access to medical care. Many of them hadn’t the slightest notion of how even the most rudimentary elements of medical care worked. All the same, that sad old man in the shed seemed to trust George implicitly.

Back at the schoolhouse, the line outside was already a dozen families deep, and it tripled by noon. I pulled up a desk in the corner of the exam room, from which I could watch and listen as I helped split pills, filled little baggies with painkillers, and generally tried to make myself seem useful. Patients sat down one at a time in front of Dr. Laurel, describing their symptoms. George and Cessar translated Guaraní as she took temperatures, measured blood pressures, listened to chest cavities, depressed tongues, inspected rashes, felt ribs, admired ear canals, tested reflexes, examined mucus, and generally poked and prodded her way to exhaustion. Laurel consulted not only Cessar but also George, who’s built up an impressive knowledge of medicine over the years, and both men kept busy testing urine samples, mixing salves, and filling prescriptions as the young doctor requested them.

I sat back and enjoyed the cadence of their banter. In the
absence of complex tests and medical equipment, making a diagnosis seemed like a very Socratic process, heavily reliant on Q&A, and I could almost picture the decision tree that Laurel must have followed in her mind. This was probably a lot like how medicine used to be practiced in the United States, I thought, a century ago or more. George had a bedside manner that many veteran MDs should envy, and he joked lightly with patients who came in looking tense.

“Forty-five years old! It can’t be!” he’d exclaim, drawing blushes from
campesino
women.

“This one’s a heartbreaker!” he would announce, disarming a nervous-looking teenage boy.

“One every ten months, eh?” he joked with a pregnant woman, who came in trailing five wide-eyed kids, all seemingly under seven years old.

Sometimes, it was clear what an advantage it conferred to speak a common language that your patients do not. Often enough, George and Laurel were able to consult frankly on a grim diagnosis that they might not have discussed candidly in front of an English-speaking patient. They reached slow consensus about prescriptions, taking time to ask questions that they might not have if their patient had been able to understand them. Should we give forty milligrams or would eighty be better? Are you sure about Thalitone? Why not Sectral? It also allowed them to take bets on how high a patient’s blood pressure was going to be, then to exclaim (like true Mainers), “Holy shit, that would kill a moose!” when it surpassed even the upper end of their wagering.

Sometimes, though, I wondered if the patients could guess what we were talking about. One young pregnant woman sat down across from Laurel and told her she just wanted a checkup, to see how her baby was doing. A three-year-old boy in a blue sweatsuit clung nervously to her leg.
The woman wore a white cotton T-shirt and a blue pleated skirt, and her right eye was clouded with blood. Dr. Laurel felt the woman’s abdomen and moved her stethoscope across her belly. Everything sounds great, she told her, but she wanted to take a look at that eye. While Laurel grabbed an ophthalmoscope and asked the woman to lean forward, Cessar excused himself quietly and stepped out of the classroom.

“That could be an infection,” she said in English, shining her light around the woman’s eye, “or sometimes the blood vessels pop during morning sickness. I should know if she’s puking extra hard.”

Cessar stuck his head in and asked George to come outside. George stepped into the waiting area as Dr. Laurel gently prodded the woman’s eyelid, asking in Spanish whether it hurt. The fluorescent lights buzzed softly in the fixtures overhead. I smiled at the little boy, who grinned back at me shyly, and I dug around in my pocket for some of the candy I’d brought along.