About eight years ago, when my five children were between the ages of 9 and 18, I had my first opportunity to go with my husband to the Dominican Republic on a medical mission. It was a little scary to leave the children, because we would be incommunicado for a while. We also knew there was some personal risk involved. There was a chance of exposure to illnesses that are not usually a danger in the United States. We would have to adapt to no running water, electricity or indoor plumbing, and the true hazards of our adventure we could not then fathom. But we had traveled regularly most of our married life, and I had adjusted well to entrusting our children to my mother’s efficient care for a few days at a time.
Upon our arrival at the village of Juan de Herrera, much closer in many ways to the poorest part of Haiti than to touristy La Romana or historical and powerful Santo Domingo, we were immediately greeted by the townspeople. Each missioner or couple had been assigned to become a member of a family for a week. A member of our new family met us in front of the Catholic church with a kiss, grabbed our dusty belongings with a wide grin and bade us in Spanish and sign language to follow him home. Our hearts beat fast as we said good-bye for the night to the rest of our group and walked the dusty, rutted roads and paths to begin our new lives.
As luck would have it, we were assigned to one of the best homes in the village. Solid and brightly painted, it had concrete floors, a tiny balcony and a tin roof. A bare bulb hanging from the living room rafters glowed on occasion, perhaps when someone in the capital remembered the poor souls of this town and felt up to sharing a few kilowatts with them. The outhouse was spacious, well built and very clean. There were two bedrooms, a tiny kitchen with a wood stove and a sink without running water facing a window that opened to the dirt yard and the neighbors’ house a couple of yards away. The living/dining room, simply decorated with old black-and-white family pictures and unpretentious furniture that sparkled clean, stood proudly in the middle of the little house. We slept in the front bedroom, and the rest of the family, perhaps up to five or six of them, slept in the back room.
This house belonged to a middle-aged widow, the mother of four grown children and a teacher at the local school. Her employment allowed her to live in relative luxury and raise a couple of the neighboring children, who kept her company while her daughters were away at college. Her husband had passed away unexpectedly from a heart attack almost five years before. She still dressed in black and would not allow her daughters to cut their hair, go to parties or dance out of respect for the deceased. For the occasion of the medical mission, her two older daughters had come to Juan de Herrera to help with logistics and hospitality.
The rooster’s crow the next morning threw me back to my childhood days when I visited my dad’s aunt on a coffee farm in Utuado, Puerto Rico, and was gently awakened by the news of the imminent sunrise in their authoritative song. I remember my joy as a little girl running around the countryside with my older farm-girl cousin, playing in the creek, feeding the chickens, gathering eggs. That day in Juan de Herrera we were gradually introduced to the job we came to do.
It was my luck to be entrusted with the pharmacy in Sabaneta, a tiny village about a 20-minute bumpy ride away from town. I don’t remember exactly, but it seems to me that each doctor saw about 50 patients in one day. Most of those patients went through the pharmacy to pick up some prescription, often vitamins or Tylenolwhich they thought were gifts from God. My young assistant and I saw practically every one of the hundreds of patients who came each day to our clinic.
These people were desperate for medical care. Having no access to doctors or medicine all year long, they rose before dawn and traveled by foot or mule for hours to get to Sabaneta. There they waited in lines for most of the morning or day in order to have someone at least show some interest in their ailments. A son brought his 80-year-old father on a motorbike, who was having a heart attack. A frail and shriveled woman, who seemed to be in her late 60’s but turned out to be in her 30’s, was suffering from tuberculosis. Mothers with prolapsed uteruses (just under 30 years of age, some had had as many as 10 or 12 pregnancies) waited with infants in their arms and toddlers hanging from their skirts for hours on end. They needed treatment for parasites, gastroenteritis and skin infections that required the whole family to be treated. They suffered as well from malnutrition, asthma, thyroid insufficiency due to a lack of iodine in their diet and heart disease. (Also, their straw huts needed to be disinfected.)
My experiences were powerful and varied. An old man brought in a stool sample in a tiny glass bottle with a cork stopper (a collector’s item in the United States) wrapped up in toilet paper. Before I sent it to the lab, I decided to open it to make sure it was properly labeled. As I removed the paper, the cork popped up, and I was instantly covered in disgusting yellow liquid. There was a mad rush at the clinic to get me disinfected. But I was in such shock at the time that I thought it was quite funny.
One heartrending incident involved a young mother who brought in her three-month-old daughter. The baby had diarrhea and had been prescribed an oral rehydration solution. They had waited already for five or six hours and neither of them looked well. I tried without success to explain to her how to feed the solution. I brought her inside the room, which had barely enough space for the four-foot by two-foot table where we kept all our meager supplies. She sat down in a rickety old cane chair with the baby in her lap. She was nursing the baby, she said, but was afraid she did not have enough milk. I gave her some purified water and tried to help her nurse the baby, but her withered breasts hung sadly from her chest, and the baby could not open her mouth. She seemed comatose and was running a fever. I asked for a nurse to put a butterfly needle in the baby so we could get an IV going, but we had no such thing. All our needles were too big for this little dying angel. We found a driver to take mother and daughter to the emergency room of the nearest hospital, an hour or two away by car. Without an American escort she would never get any attention there. When I said good-bye I knew that the discouraged mother’s beautiful, emaciated baby would not live.
By the grace of God, I survived that terrible, powerless week. Yes, I could order the town policeman around. I could distribute life-saving medications or placebos. I could teach people in Spanish that the only spoon they had in their home was way too big to use as a teaspoon measure. I could disinfect myself and laugh about my brush with a terrible infection. But I could not save a baby’s life.
I was overjoyed when I was offered the chance to give a talk on breast-feeding. This was something I could do well, and it could have a big impact on these babies, who so often died of gastroenteritis. I had come prepared. I had experience giving this talk in Puerto Rico. I had dozens of manuals in Spanish.
A middle-aged woman came in just before the talk, asking for formula for a seven-day-old baby. The mother could not nurse because her nipples were bleeding. I told the advocate we would give her some formula if the mother came in and listened to my talk. I was pretty confident I could get the mother to nurse successfully, but I started getting a little nervous.
The eight-by-eight room was crowded with mothers, each with a baby in her arms and a toddler at her feet. The room was silent. They believed I held the key to life and happiness. You could hear a pin drop. My stomach turned and I said a quick prayer, Holy Spirit, use my mouth to spread your word. I smiled at my 50 women and they shyly smiled back. Which one of you, I asked, is holding the most beautiful baby on earth? They all eagerly raised their hands. Oh, no, you are mistaken. My babies are the most beautiful ones on earth! They all laughed in unison and at that point we were bonded to one another forever.
The talk went well, and afterward the mother who could not nurse her new baby was brought to me. Her protector wanted to give me the scoop: this mother should not feed her baby from her cracked breasts that gave only blood, because the baby would die. I know what I am talking about, she insisted. I had 10 babies. I tried to nurse my first five but I had only blood to give them, and they all died. My next five I fed with formula, and they survived! I could see the look of terror in the girl’s eyes. The baby she was holding was a beautiful eight-pound boy with lots of black, floppy hair. She opened up her blouse, revealing enormous breasts engorged with milk. They were warm and tender and so full that it took a while to get the milk flowing abundantly. But the beautiful baby was limp. He could not suck. It was too late for him, too.
Twenty-four hours later I was visiting my in-laws in San Juan, Puerto Rico, in shock at the thought of how easily I had brought five perfectly healthy babies to the world, breast-fed them, taken care of their ailments, given them nutritious food and lots of intellectual stimulation. Even when I had been near a nervous breakdown because of the overwhelming responsibilities of raising five kids born within 10 years’ time, I had never gone through a fraction of the worries, pain and suffering that the Dominican mothers went through on a daily basis. Yes, my babies sometimes got sick, they had their share of strange ailments and accidents and childhood illnesses. But not one of them died. They were all gordos y colorados, which was evidence that they were well-fed and taken care of: fat and red-cheeked.
I picked up the phone as soon as I went into my mother-in-law’s house and called home. One of my daughters answered. Hi, Mom! she chirped. I broke down in sobs. My husband had to take the phone and explain.
