Years after being in Guatemala, I had the opportunity to know many people who had served in the Peace Corps. I realized that prior to going to Guatemala, we had no preparation about the culture, and when we returned, we had no debriefing. In retrospect, this was a serious mistake. In some ways, I think we’re still debriefing. A Vietnamese nurse who worked for the Red Cross after the tsunami in Thailand told me that after working with so many people who were experiencing severe trauma, the Red Cross had two weeks of psychological debriefing with the workers who were leaving their work. I think we could have used that. But that sort of professional preparation and debriefing, with people who were professionals in Guatemalan culture and helping people integrate traumatic experiences just wasn’t available to us.
Fairly early during the time I was in Guatemala, there was an election in Guatemala City. There were armies with machine guns and tanks on the streets. It turns out this wasn’t the government army to ensure a fair election. They were private armies owned by the few powerful families that controlled most of the land and wealth of the country, and the armies were there to make sure the wrong people didn’t enter the polling places and vote. After seeing that, I said to myself, “Oh now I have a better understanding of what a democracy is” — because I’d seen what it is not.
In the first few days of being in Guatemala, I looked around for signs of extreme poverty, because I’d heard how poor the people were. The children looked like they had round bellies and round faces, and I said to Mary Louise, “The children don’t look skinny, they don’t look malnourished.”
She said to me, “That’s protein malnutrition.” I learned that kwashiorkor, lack of protein in the diet, gave children bloated stomachs and reddish colored hair — but it was truly malnutrition. I was in India in 2009 in a village with no electricity or running water and there were only footpaths to the village, no roads. I looked at the children closely. Everyone in the village was thin, very slender, not cadaverously thin, and their skin was beautiful and glossy. The children, though thin, didn’t have any of the signs of kwashiorkor. I asked people about that, and the villagers told me that the Indian Government gave the children lunch every day with lentils, and that’s how they got their protein. The children in that village in India looked very different from the children in Guatemala in that respect, because the Guatemalan children were bloated, with reddish hair, and didn’t look skinny. I learned over the time I spent in Guatemala that the debilitated state, especially of the infants and children, made them very susceptible to death from diarrheal illnesses, which were endemic.
Speaking of diarrhea, someone in our Plenty Guatemala team got a Walt Disney film, which I think was produced in the 1950s or 60s. It was a cartoon showing a poor family living in Latin America in a hut. The father went to the fields and because there was no bathroom, he defecated in the field. The cartoon showed flies landing on the waste, and then flies flew into the huts and landed on the food. In typical Walt Disney fashion, they zoomed onto the food and showed the bacteria that grew on it. The bacteria looked like monsters from the imagination of a creative genius. The family didn’t wash their hands before they ate or or after they peed or pooped — there were no latrines — and they became ill with diarrhea. When we showed the film to villagers, which we showed over and over, their eyes became very wide. It made an unforgettable connection between building a latrine, washing your hands after using it, washing your hands before eating, and covering food so flies couldn’t land on it. I really admired whoever was behind the creation of that Walt Disney cartoon — it taught so vividly and much more effectively than a blah, blah, blah verbal presentation could have done.
A group of us Plenty workers who were heroes to me were the lab techs. They did their work quietly, and it wasn’t dramatic or charismatic work. But they never looked at a stool sample of a Guatemalan person that didn’t have at least two types of parasites in it. They let the Guatemalan person look into the microscope and see the parasites microscopically. All of this was the first introduction the people had to the world of microorganisms and germs. There was plenty of Coca-Cola in the shops, but education about germs and how to prevent illnesses hadn’t been imported from America. I think this was very important work.
Most of my clearest memories involve the medical cases that I was involved in. One day, someone from San Andrés Itzapa came to get us because a woman who was pregnant and due to deliver was bleeding. I went to her house and listened with my hand-held Doppler fetoscope. There were so many roosters, chickens, cows, dogs, and people around that I couldn’t hear anything. Despite the background noise, such a silent uterus is always ominous because with a living fetus, there’s the sound of the fetal heartbeat and also the sounds of blood swishing through the umbilical cord. I felt that this was a fetal death but I couldn’t be sure because of all the noise in the house. But in any case, the mother was bleeding. So we put her in the ambulance and drove her to the main public hospital in Guatemala City. It was like something out of the middle ages. Women were in all stages of labor, just sitting and rocking on hard wooden benches in the waiting room. I made it clear that the woman I was accompanying needed help and couldn’t just sit in the waiting room to await delivery. So they brought me with her to a small examination room.
A doctor rushed in, listened for the fetal heartbeat and said, “Yes, the baby is dead,” and rushed out. No one returned — they just left me alone with the woman. There were examination gloves hanging on a line to dry — they used the exam gloves over and over, and then washed them. Obviously, they weren’t sterile, and surely weren’t even high-level disinfected. In any case, the mother labored until she delivered a baby that had been dead for at least several days. A few people rushed in when the baby was born, took the baby, and rushed out. I delivered the placenta and massaged the mother’s uterus, but she kept bleeding. Finally, the bleeding was so severe, it was seeping up her back toward her neck and she started slipping in and out of consciousness. I realized that, despite the fact that I was with her, the level of inattentiveness at the hospital could cost her life. I made a mental decision to forget politeness, forget rocking the boat, forget everything except getting the attention of the medical personnel. I walked into the hallway and I projected in my loudest, most authoritative voice, “If someone doesn’t get in here and attend to this woman, she’s going to die!” Everyone was so startled to hear this small gringo woman yell out in such a commanding way, every movement came to an abrupt standstill. Immediately, a team of doctors and nurses rushed in and whisked the woman away to give her IV fluids and blood transfusion, thus saving her life. The fact that I was American and could get the attention of the hospital personnel saved her life. If she’d gone to the hospital alone, I think she would have died.
Mary Louise and I once helped at a delivery in a very distant village. The earthquake had knocked out roads (many of which were dirt lanes in the first place), and diverted rivers and streams. The one-lane dirt road to the village had knife-edge borders that were cliffs with drops of hundreds of feet, crowded on the other side by the mountain. There seemed to be one way into and out of the village and absolutely no way to turn the four-wheel drive jeep around.
Much of the time during deliveries, the mother and mother-in-law were with the woman in labor. The women were very stoic. Of course, there was no such thing as epidurals or any pharmacological pain relief, and their lives were hard, so they bore childbirth mostly in silence and without complaint. I once asked someone about the peoples’ ability to bear pain. I was specifically asking about the huge baskets of goods women balanced on their heads and carried to market many miles distant. Often people would leave their villages long before dawn to get to a road, catch a bus and get to the market town early in time to set up their goods. Then they had to walk many miles back up the mountain to their village. The Guatemalan person who I asked told me that the gods of the mountain were displeased if people complained, even if they complained in their minds. Thus, they had learned to endure physical hardship without complaining.
The woman in labor was having her second baby and all went well until she started pushing. We could see the top of the baby’s head, but despite several hours of effort, the head didn’t descend any further. We tried having her squat, positioning her on hands and knees but her position didn’t bring the baby closer to being born. Many of the women spoke only Kaqchikel, their indigenous language, although many of the men spoke some Spanish. Despite that, I always remember that we were able to communicate perfectly well during childbirth. There’s a universal communication in childbirth that seems to be beyond language. At any rate, Mary Louise and I conferred and we agreed that the baby’s head must be in an asynclitic position, which means that it wasn’t facing directly down so that the narrowest part of the baby’s head, the biparietal diameter, could fit through the mother’s pelvic bones. It was in the birth canal at a slightly off-center angle, presenting a wider diameter through the pelvic bones and the mother couldn’t push the baby out. We had no options. The nearest hospital was about six hours away and even getting her down the mountain would be difficult. I had lived on one of the Farm’s outposts in Wisconsin and had seen a big strong doctor in a similar situation put on long sterile gloves, wedge his hands between the baby’s head and the mother’s pelvis and apply all his strength using his hands and arms as virtual forceps. I remembered his physical strength and the way he had braced his foot against the exam table. This was the only option we had up our sleeves. I put on a pair of very long sterile gloves and wedged my small hands between the baby’s head and as far up the mother’s pelvic outlet as I could get them. We urged the mother to push and I applied all my strength with my hands and arms to wedge the baby’s head through the pelvic bones. Finally, I could feel some give. The widest part of the baby’s head made it between the narrowest part of the mother’s pelvic outlet and the baby was born. Both the mother and baby were doing fine.
We were very happy, but now it was twilight and we had to make our way down the mountain. We couldn’t go back the way we had come because as I said, there was absolutely no place in the narrow, tiny road to turn around. So we had to go out a new way, not sure if the road led to a better road, or what we’d find ahead of us. What we did find a few miles down the road was a river. We stopped the jeep and looked at each other and talked about what we were going to do. We didn’t really have an option. I said, “I can put it into four-wheel drive and we’ll make it across the river.” Mary Louise said, “Are you sure?” Of course, I wasn’t sure, but I’d already accomplished something that day that was a must-do, have-to-do, gotta-make-it-work type of situation, and my attitude by this time was, I can get this jeep across the river. I put it into four-wheel drive and although we got buffeted around by the current, the water didn’t flood the engine and we made it to the other side. After that, narrow dirt lanes with ditches and precipitous drop-offs eventually led us to a better road.
Lest I make myself sound like the heroine of this story, for the record I have to say, and everyone knows, the multitude of situations in which Mary Louise’s strength and infinite compassion is what pulled us out of very tight situations, both in childbirth and otherwise. It’s still common for me to have dreams in which she represents my conscience and my touchstone for compassion and wisdom.
But our help and presence weren’t always enough to save lives. A family brought a young pregnant woman to our camp; they were very worried about her, and with good reason. She had a 104ºF fever, had not been able to urinate for several days and was delirious. She was about 7-8 months pregnant. Her bladder was very distended and it was late at night. I took care of her all night until we could take her to the hospital the next day. I catheterized her to empty her bladder, and her urine was coffee-colored, which meant that it had blood in it. The next day, we took her to the hospital in Antigua, where they said she had a urinary tract infection, gave her antibiotics and sent her home. People dreaded bringing their family members to the hospital because it cost money to get the bodies out of the morgue, which many people simply couldn’t afford. They primarily looked at hospitals as places where people died, and then their bodies couldn’t be returned to the village for proper burial. Almost a week later, the family brought the pregnant woman back to our camp and said she was still very sick. She was very sick. We took her all the way to Guatemala City, where they said she had hepatitis, that it was not an interesting case, and they would not admit her but she would get better. The family was so upset and disgusted with the lack of help; they took her home. Their little village was far away and it was a village I hadn’t ever been to, so we didn’t know where to find her. We just had to wait to see if they would bring her back or if we would ever hear how things turned out. Finally, a week later, they brought her back and she seemed at death’s door. We took her to the one Western-caliber hospital in Guatemala City and begged them to admit her. They had a small wing set aside for indigent cases and admitted her there. She died later that day of miliary tuberculosis; tuberculosis that had spread throughout her body.
Another woman in Itzapa was in her late 30s and was due to have a baby. She herself had advanced TB. She would have to bottle-feed her baby instead of breastfeeding. They were both doomed to die; the mother because she had advanced TB and didn’t have the physical strength to care for a baby and nurture it. The baby was doomed to die because the families didn’t have enough money for infant formula. If they had some money for a little formula, they watered it down so much, it wasn’t enough to nourish an infant. Combined with the watered-down formula, water that wasn’t pure, and a sick mother, the baby was doomed, and so was the mother.
I was involved with a mother and baby and I’ll always wonder, “Could I have done more?” “Could I have done something differently?” I’ll never know, but the guilt and pain of being in such situations is exactly why debriefing is so important after working in a trauma zone, which Guatemala certainly was. This woman had several apparently healthy babies who had died shortly after birth. We hadn’t delivered the baby, but Marjorie Nott, one of our Plenty team and someone who had literally saved lives through her devotion, told me the woman’s story. She had seen the baby and said the baby looked fine, and asked me to assess the baby. I wondered if perhaps the babies had been born with a genetic defect or heart defect that had caused them to die (a situation I later experienced with the Amish in Tennessee). The woman was fine but seemed very concerned about her baby, which would be the case with any woman who had lost several seemingly-healthy babies shortly after birth.
In Guatemala, there were many what we would call myths about the causes of illness. Remember, the people didn’t have any understanding of the germ theory. So they thought that illnesses were caused by aire (air). If a child with a fever was exposed to air, this would make them sicker and perhaps even cause them to die. So everyone sick was wrapped in many, many blankets. It was a struggle to get a child with a fever out of its blankets and sponge it down to bring down the fever. That made the mothers just beside themselves with anxiety. This mother with the newborn had the baby swaddled in 10-12 blankets. I had to peel back blanket after blanket to get to the baby. I examined the baby, listened to its lungs and heart very carefully and did a physical exam. The baby seemed perfectly normal, but I was worried that the baby was wrapped in so many blankets it would have trouble breathing. I explained to the mother over and over again that the baby needed to breathe, and tried to demonstrate what that meant. Maybe I should have wrapped my head in so many blankets and had a hard time breathing, and then asked her to do the same so she would understand first-hand that you have to be able to breathe. But I didn’t do the demonstration; it didn’t occur to me. I left thinking I’d explained to her the importance of leaving some space for the baby’s mouth and nose so he could breathe, but the next day Marjorie visited them and told me that the baby had died.
I know a lot of people in the U.S. have opinions about vaccinations, but after seeing children die agonizing deaths from whooping cough (pertussis) and polio, I’m a strong believer in vaccination. Widespread population vaccination would have saved many, many lives in Guatemala.
The people in Guatemala loved firecrackers. In some ways, hearing the shots and booms of firecrackers all through the day and night was an auditory metaphor of the violence of Guatemala. A devastating civil war was in its early stages; every day we heard of the assassination of a university professor or labor organizer. The indigenous people were so oppressed, as I said before, they weren’t allowed to vote, and there were armed guards at banks and libraries to prevent their entry. Although on one hand I believe in nonviolence, I’ve always wondered if my tribe was so oppressed and was being killed by death squads, would I become a guerrilla fighter?
When we left Guatemala and returned to the Farm, Ronald Reagan was running for President. The violence of Guatemala had affected me. There was great beauty there and a deep reservoir of wisdom, intelligence and strength of the indigenous people, but I never really felt safe there. When I returned to the Farm, the Farm itself felt like an oasis of peace and safety, but a feeling of fear stayed with me. I was very worried that Ronald Reagan would start a nuclear war with the Soviet Union. So although I hadn’t felt safe in Guatemala, I didn’t feel safe in the U.S. either. A few months after returning, I went to a very, very serene birth on the Farm and that healed me. Of course I was still concerned about the political situation in the world, but the underlying sense of dread was gone.
Grief is the price we pay for love
My last editorial comment is that most of us were in our very early adulthood when we founded the Farm and during those early years on the Farm and Guatemala. We were in way over our heads in life-and-death situations. The angels were with us most of the time, but in other cases, there were devastating losses. I don’t feel we ever gave ourselves permission to grieve; for some reason grief wasn’t quite acceptable, and we disdained professional counselors or mental health professionals of any type. After returning from Guatemala (and after some of the other terrible losses on the Farm), we needed to grieve and process. Queen Elizabeth, who one doesn’t ordinarily associate as someone wise in the ways of the emotional life, said after September 11, “Grief is the price we pay for love.” I think the love we had for each other helped us survive and helped us be resilient. But when I say we’re still debriefing, I mean that very seriously. When we get together, we still talk about the pain of some of the things we experienced because for whatever reason, debriefing after a difficult birth or a death just wasn’t part of our world. Now, we’re wiser. When we talk about these things, we cry together, thirty-five years later.
There’s also joy in my heart that I got to know the people of Guatemala because they had far more to teach us than we were able to impart to them. Their “we,” rather than “I” world-view is such a different consciousness than the prevalent consciousness in the Western world. I also experienced and to some small extent, entered into the “we” consciousness with the Amish Mennonites, and since then with the Nepalese. It’s a true privilege. As with the prairie pioneers (such as my homesteading grandparents), the Guatemalans, the Amish, and all people in the developing world, the weak die and the strong survive. Those who survive the high rate of infant and childhood mortality, the lack of medical care and poor diets, oppression and struggles, have much to teach us about resilience and gratitude for life.