Turning from the young mother with the sleeping baby cradled against her chest, Gabriel, with a puzzled look translates her concern,
“She says her baby turns blue whenever it cries.”
Unfamiliar with more than rudimentary medical symptoms, babies turning blue is dismissed by Gabriel as an aberration of the cumbersome translation process. But, after three hours of the show and tell of skin rashes and foot infections, the point and palpate of muscle and joint pains, and a variety of symptoms which truly were lost in translation, this sounds like a pediatrician’s kind of problem.
Eyes downcast, the sixteen year-old mother is obviously intimidated by the three of us seated in a semi-circle around her. She has bravely walked since dawn from her remote village. José, the compassionate mayor, translating between the Chatino Zapotecan native dialect and the limited Spanish he knows, is seated next to her (Chatino, what the natives call their language, means “difficult word”). Gabriel, one of the three young men from Manos de Ayuda based in Oaxaca, often guessing at what he thought the mayor meant, is the Spanish to English interface.
I learn the baby is about six months old. The mother calls her Lupé, presumably short for Maria Guadalupé, the most common female name in these mountains. She began turning blue with crying episodes about a month ago, the mother relates tearfully.
I ask if I might be allowed to examine the baby. Reluctantly she releases her protective grip. Pushing aside the threadbare blanket, I detect a faint bluish tinge around the baby’s mouth. I also note the ends of her tiny fingers appear widened, the nailbeds dusky, medically described as clubbing. It is seen in cardiac disease. After lifting up the graying, well-worn baby shirt, I use my palm to warm up the flat portion of the stethoscope before gently placing it over the left side of Lupé’s chest. Moving it around I listen to the sounds of her heart while she begins to stir.
My fears are confirmed by what I hear. As she wakes, her eyes open, she looks around, and seeing a strange white face for the first time in her life, extends her arms and legs, and begins screaming. Within seconds her eyes become large, her screams seem frozen in her mouth, and her skin turns profoundly blue. Gabriel’s eyes also become big as he recognizes what the words meant, translated faithfully but with doubt only moments before. Fear and panic cross his face. Helplessly imploring and wordlessly pleading, the mother looks from one of us to the other.
In that moment it is clear to me the baby has been born with Tetralogy of Fallot, a complex of four associated heart defects. It is the most common congenital heart problem causing cyanosis, or blueness. Around six months, babies with this condition develop “tet spells,” or sudden severe blueness when un-oxygenated blood is shunted through the defect in the heart’s pumping chambers. Crying or straining can cause these spells. Eventually they can become quite harmful, even fatal. Squatting, or drawing up the knees to the chest, will temporarily reverse the abnormal shunting of blood, stopping the “tet spell” and the blueness.
Pulling Lupé’s little knees up to her chest, after removing the bit of old cloth serving as her diaper, restores her to relatively pink color. The mother’s relief is evident, Gabriel exhales audibly, and the mayor looks like he is about to cry. And, I am struck by the God-sized dilemma on my hands. This is no ordinary problem – its natural course is fatal – and we are extraordinarily far from any medical facilities on this last stop of our medical tour of villages deep in the Sierra Madre del Sur Mountains.
After being pounded by torrential rains, the region had been devastated by earthquakes the last six weeks, and, like the flooded delta of the previous week, cut off from medical care. Just getting here has been arduous, testing and fatiguing us. We had driven south-east on the Internacional Highway 190 from Oaxaca the previous Sunday. In a remote village we had overnighted in an unfinished hotel. Our night was blessed – or cursed depending on the perspective – by an all-night Marian vigil. With an Oom-Pah-Pah brass band, enthusiastically playing the same melodies outside our window from ten p.m. to six a.m., accompanied by boisterous singing, laced with shouts of,
“Maria, Maria, Maria,” assuring we did not dare doze off, Dennis, Dan, and I started the week sleep deprived, and perhaps a bit cranky.
More hours on a deteriorating main road awaited us; then a dirt track heading into the mountains, gullied and even washed out in places by torrential rains which had started when the earthquakes did; high-centering twice, sliding off the track once, finally leaving the smaller of the vehicles in one of the many villages whose name began with Santa Maria, we arrived at a clearing where we were met by several kind Native American men with two burros and a horse. With all our supplies precariously strapped to the burros, the irrepressible Augustin, a young interpreter from Oaxaca, led the way on the horse with Pam our nurse seated behind him. Dan, Dennis, and I followed on foot since our riding experience had been confined to the “quarter” horse in front of the Safeway.
Five hours of hiking over 9,000 foot mountain ridges, interrupted by valleys and streams lined with mango and tamarind trees, brought us to the first village. Conducting clinic until well past dark by the light of a kerosene lamp, resuming at first light of day, then setting out on the next five hour hike to another mountain village, had become our pattern. A wall-rattling earthquake one night, a pack of local dogs stealing our food, and critters of the night challenged our commitment to bring the joy of the Lord to the people of the earthquake.
Now, at this village which does not even have a name, with over a hundred gentle native people still waiting, and one sick child with a mother expecting an explanation, and perhaps a cure, I am stuck. Explaining the child’s diagnosis through two interpreters into the native Chatino dialect is daunting. Dealing with the death sentence it represents in this remote outpost of human habitation is overwhelming. Stalling for time, I rub my chin pensively and nod my head, aware three sets of eyes are focused on me; silently I pray for wisdom; and I realize how extraordinary it is for God to allow us to be here at this critical moment in this child’s illness – any sooner and the problem would not have been apparent, any later and it would be too late.
Complex as it is, corrective surgery for this condition has been available at major medical centers for fifteen years, but none of them are near here. Stop-gap surgery, known as a Blaylock-Taussig procedure, would buy time until Lupé is an adult. It has been effectively used for over fifty years. Maybe even in Oaxaca.
With Edgar’s help, tears well in his eyes when I explain the natural outcome awaiting Lupé – his loves for these kind people is so apparent – we devise a plan to transport her to Oaxaca. Manos de Ayuda will find a way to fund this, Edgar assures me. The mayor’s Chatino style translation of the plan is greeted with a tentative nod, an unsure smile, and a sense of bewilderment by the young mother, really no more than a girl, faced with a worry few her age have to face.
* * * * *
At 5 a.m. the next morning, the hard floor, and a rooster serious about his work make further sleep unlikely. Walking through the quiet village I pray for the mayor, his family, the starving people of these mountains, and, most of all, the sick baby and her mom. After using the leaning village outhouse, not as visually compelling as the leaning tower of Pisa but ergonomically at least as challenging, I notice a man wearing a leather Fedora, typical of the local men, coming down a path leading into the village. A dim flashlight strapped to his hat barely lights his path. Since I am the only person about, he approaches me. I have no idea what he is saying, but his tone of urgency, bordering on desperation, is inescapable. I wake Edgar who in turn finds José, the mayor, so we can do the two-step translation drill.
As soon as the visitor introduces himself, a wave of recognition rolls over the mayor’s face. With his arm around the man’s shoulder as they sit on a bench in the early morning twilight, the mayor listens, nods, and explains. Halfway through his labored translation into Spanish, Edgar nods in understanding, turns to me, and says,
“The man walked all night from his village. He wants to know what you said to his daughter yesterday to upset her. He is the grandfather of the baby who turned blue.”
Touched by the grandfather’s deep concern for his family, tears well up in my eyes. After shaking his callused hand I sit down next to him on the bench. Slowly I attempt to reduce the baby’s diagnosis and the needed treatment to a series of short sentences illustrated by diagrams on a piece of paper. The mayor and Edgar, appearing to understand most of the explanation, translate it into the Chatino dialect for the grandfather. Relief finally settles on his lined, weather-beaten face when Edgar assures him he will try to come back soon for his daughter and the baby.
With obvious gratitude in his eyes the grandfather pumps Edgar’s right hand up and down with both his hands, and then shakes mine as well. Now it is his turn to have his eyes fill up. I tell him we serve an extraordinary God, sovereign even in the remotest places. He has a long history of intervening at just the right time. When this is translated into his dialect, he nods, bows his head, and in what is probably the only word of Spanish he knows, says,
After drinking some water, eating my last Power Bar, and taking some Starburst candies for the road, the concerned grandfather heads back up the trail to his people, impromptu diagram tucked in his pocket, satisfied his family will be well taken care of.