Keep Walking

Long before we see the face, we hear the crying. Mournful, broken, it expresses general discomfort more than acute pain. In it lies the anxiety of all those children brought here against their will, made to submit to the probing of pale-skinned strangers who speak an alien tongue. When the boy and his mother reach our station, it’s clear what the trouble is: he has a lump the size of a quail egg over his right eye. An abscess, my father says. He explains to me in English, and I to the mother in Spanish, that although the abscess does not have to be drained, the child is certain to feel better if it is. What is not explained, to the mother or me, is how much pain the procedure will entail.

This is an itinerant clinic, not a hospital. With the exception of a few cold packs, there is no anesthesia to speak of. It will take four of us to hold the child steady on the fold-out dental chair while Pete, the dentist, lances and drains the abscess. I’m assigned the ankles. Even before Pete has removed the scalpel from its package, the boy is bucking. He cries out to his mother across the room. He does not know exactly what’s coming, but he knows that whatever it is will not be pleasant. It is said that expected pain hurts more than unexpected pain. Pinned down by four foreign adults, a boy might expect some pain.

I’m not watching, but I know when blade pierces skin. The boy’s leg muscles lock, he shrieks. Mah-MAAAA! Pee-PEEEE! Pee-PEEEE, mah-MAAAAH! Pee-PEEEE! Mamá is crying, but quietly. She means to stay strong for her son. Where is the priest? All the while, Pete is saying in a level voice, Almost done, now. Almost done.

And then it is done. Stitched up and bandaged, the boy is released to the arms of his mother. She holds him close, his cries ebb. He has not wet himself. The Americans return to their stations.

When my father first asked me to go to the Dominican Republic with the medical team he assists each year, I wavered. The work is sponsored by the Episcopal Church, and neither religious nor especially healthy, I wondered exactly what, aside from a little Spanish, I had to offer a “medical mission.” More to the point, I wondered what a medical mission might think it had to offer me. Would bibles be a-thumping?  My father said not to worry; this was not that kind of group. I could expect more medicine than religion. He allowed there might be a few awkward moments (his words), but figured I could handle them. I’d never been to the DR, and I like hanging out with my old man. I signed on.

An early awkward moment: the issuing of team shirts, which we are expected to wear on the trip down so as not to lose one another en route. Creamsicle-orange, of a stiff knit blend, and featuring the church crest, the shirt is not by a long shot my standard expedition wear. Normally I like to travel under the radar. Creamsicle-orange makes a distinct blip on the radar; worn by fifteen proximate people, it makes a blorp. I’ve seen uniformed groups abroad — Mormons, school groups, rotary clubs — and always I have kept my distance. Now I am one of them. I am an American shipping out with other Americans. In matching shirts.

Curious what a change of scenery can do. Leave the airport lounges and graded highways for the twisting dirt byways of the developing world, and the style of your shirt may begin to matter less to you. See the lanky curs slinking about for scraps, the weathered women staring blankly from windowless sills. Pass a featherless gamecock tied to an abandoned engine block; a naked toddler hugging two large, empty beer bottles against a distended belly. When every doorway looks like a portal to ruin, the color of your shirt may cease to concern you. You have a shirt.

The church is a squat block building in a neighborhood — a nation — of squat block buildings, and is identified as a place of worship by crude crosses spray-painted on the door. Inside, the team heads upstairs to the second floor to set up shop. Some haul and unpack trunks, others start cleaning — mopping the floors, scrubbing the toilet and sink — while still others tend to the finer strokes of interior design, organizing the floor-plan and table-space, fashioning the necessary signs (MÉDICO, FARMÁCIA, SALA DE ESPERA). Crooked old blackboards-cum-wheels are used as partitions; emptied trunks are stacked to make tables. Over the course of the afternoon the vacant, musty storage area becomes a kind of field hospital, complete with triage station, examining rooms, a pharmacy, and a waiting area. It’s impressive, this transformation, and I’m struck for the first of many times by the notion that whatever else may be said about them, these people get a job done.

Later, after a supper of gallo pinto, fried eggplant, and cold Presidente beer, the group is summoned to evening worship. When my father and I enter the designated room, members of the team are already seated in a tight circle on the floor, singing to the guitar stylings of a big nurse named Barb. There are hand-outs with liturgy on one side, song lyrics on the other. If I’ve never heard the song the group is singing, I’m familiar with the type: Christian, campfire, huggy-huggy. Out of some vague sense of duty, I pretend to sing along.

The service is an abbreviated version of the Eucharist I heard, and as an acolyte helped serve, most every Sunday of my childhood.  Two decades later I find myself reciting by heart the Nicene Creed, the Prayers of the People, the Great Thanksgiving. I believe in the Father, the Son, the Holy Ghost… I’m saying the words now just as I said them then, without a thought as to what I am actually articulating, only the vague hope that if I join in, it will all be over with sooner.

New to me are the whispered appeals certain members of the group offer up when the priest is praying. Sibilant and urgent, the whispering is the sound of mice scurrying behind a wall, and but for the occasional please-Jesus-thank-you-Jesus, is not at all intelligible. I wonder just what I have gotten myself into, here. Only a few folks are engaging in this behavior, and maybe they are whispering precisely because they don’t want to scare or offend anybody with a hearty PRAISE JESUS!, but even so, this feels bizarre, cultish, creepy.

I know my father is not big on this kind of thing. He’s more smells-and-bells than speaking-in-tongues, more Debussy than James Taylor. Still, at no point in the proceedings do I look to him for direction. I don’t look at anything but the floor. Even when it’s my turn to offer a hope — towards the end of the service, everyone in the circle offers a hope — I offer it to the linoleum. I say that I am looking forward to working with my father, which, if it is not really a hope, is the truth. It’s not the whole truth, of course. I withhold the fact that at the moment what I am most looking forward to is the conclusion of evening worship.

Those many Sunday mornings in church may have spoiled religious ritual for me. For a child, ritual is obligation, not transcendence. From the outset it was all so mechanical. There is no mental space for inspiration. I’m all blocked up. Spiritually constipated. Any faith I have in me to lose may well be lost here, amid the rites of faith.

In the morning none of this will matter. While the first patients are registered my father outlines the process for me: each patient will see a triage nurse, then a physician, then the dentist, and finally, a pharmacist. “Oh, and it will get loud,” he adds. “If it gets quiet, you’ve gone deaf.”

Soon enough it gets loud. Patients are moving through triage and then to the doctors, and we are all doing the work we came here to do. My Dictionary of Medical Spanish proves a wise investment. This is not recreational travel. I’m not ordering a beer, or looking for the bus station. I can’t be satisfied with the gist of things. When I nod my head and say, Sí, entiendo, I have to mean it. It is easy enough to ask the patient how he or she feels, where it hurts, what brought them to the clinic today, but I will need to look up some of their responses, words like estreñimiento (constipation),  erupción (rash), urticaria (hives),  sarna (scabies), superación (discharge). I have always respected my father’s work, but I have never known just what it requires. How much listening, for one thing. I am sure I could not do it, hear out the details of bodily complaints every day.

Some of the patients are diagnosed as diabetic, many as overweight and/or hypertensive. My father explains that he has noted an annual increase in these kinds of problems — the same problems he confronts in his practice back home. “Fast food,” he says. “We’re exporting more than dubbed sitcoms.”

When I translate the first of many requests for birth control, I worry that I may be in for an awkward moment. “Do we have birth control?” I ask.

“You’re damn right we do,” my father says. “We’ll run out quickly. But at least they’re asking. At least people are thinking along those lines.”

Not everybody. Later a 22 year-old mother of three flatly refuses a prescription when I ask if she would like one. Her tight pink tank top says “I LIKE NICE BOYS…” on the front, “…BUT I LOVE BAD BOYS” on the back. Her cotton short-shorts read “BEACH BUM” across the bum. Whether she gets the English or not, the young woman seems ripe, in a manner of speaking, for birth control. I’m sure I can be excused for venturing, but she snubs the offer with such scorn that I won’t venture the same again, with anybody. Anybody who wants birth control will have to ask for it.

“Maybe the poor will inherit the earth,” I say after Beach Bum and her three toddlers are gone.

“How do you mean?”

“That’s who’s having most of the babies, right? The poor?”

“Don’t know if that’s what Christ meant, exactly. The idea was to give some comfort, I think. Not sure it still works. Who wants the earth?”

“What?”

“You’ve seen the local garbage dump?”

I have not. He tells me to take five, have a look behind the hog shed across the road. “Don’t fall off,” he says.

The hog shed across the road sits atop a cliff that looks out over verdant hills patch-worked with small farms, a postcard Dominican landscape. Looking down into the ravine, a less photogenic scene presents itself: the river below is choking on garbage. Acres of it. The occasional updraft is noxious. My father’s point — who wants a ruined earth? — is taken, then privately expanded upon: with every new child to diaper, feed, and entertain, the earth that child stands to inherit has less to recommend it.

Still we keep bringing them into the world. Every sixty seconds, a few hundred more. Some wanted and cared for, others left to fend for themselves. Of the latter, I meet more than a few in the DR. That afternoon three young siblings who arrive sans adult. The oldest of the three, Belén, is 12. I ask where her mother is; she does not know. I can guess where the father is — gone — but following protocol I ask anyway. “No lo sé,” she says. “Se fue.” I don’t know. He left. And so it has fallen upon her, a twelve year-old, to gather her siblings and take them to see the American doctors. They are children — big-eyed and gangly limbed, dirt-smeared and goofy — left to bear adult burdens. Left to bear themselves. For the time being at least, they appear to be doing so. Belén is in good health. Prescribed the usual vitamins and anti-parasite medicine, she is escorted to a nurse for “the talk,” in hopes that this time next year she will not be strapped with a child of her own, whose aunt and uncle will not yet be ten years old. Her sister María, save a few scrapes on her leg, is healthy. Antibiotic lotion, vitamins, anti-parasiticals.

The brother, Joél, has a more immediate concern, even if he himself does not call attention to it. His left eyelid is closed shut, and seems oddly slack. When I ask him what happened, he shrugs, smiles. “Fue un balazo. Por la calle.”

“What?” my father says.

“A gunshot. In the street.”  Youthful bluster, maybe — he may have run into a tree limb — but if bluster, the more disturbing for that.

“Better have a look.”

Gently, and without protest from Joél, my father lifts the lid with an upturned pointer finger to expose a small, scooped-out hollow backed by flesh. The socket is marbled through with blood vessels, moist with internal fluid, and it is the simple, unadorned meat of the sight that shakes me.

My father musses Joél’s hair, grins.

“What’s wrong with it?” I ask. “His eye.”

Making notes on Joél’s chart, he says, “Well, it’s not there.”

“What?”

“There is no eye.”

“Holy sh—” I stop short of the expletive. I’d not learned to cuss under my father’s roof.

Waiting across the room, Joél’s sisters engage him in sibling sport. María points at him, whispers to Belén, they giggle. Joél smirks, points back. With or without attentive parents, this is a family.

At evening worship they are prayed for, the Joéls and Belens and Marías. Prayer picks up where medicine leaves off. By day, science and medicine; by night, faith and prayer. In between, cold beer.

In the course of the week the clinic will see some three hundred patients. Whenever the power fails, which is often, the team will work on. The pharmacy will dispense quantities of antibiotics, vitamins, blood-pressure pills, toothbrushes, birth-control regimens. Pete the dentist will pull quantities of bad teeth. Constipated patients will be advised to eat more fruit, truck drivers with back pain told to reposition their wallets. With the benefit of a two-dollar pair of glasses, an elderly Haitian will read again.

Other cases will make clear the limitations of a two-week medical mission. The old woman whose right leg terminates at the knee with a tiny, malformed foot will walk out the way she walked in — leaning into a weathered crutch, her diminutive foot steering the crossbar. An epileptic man, heavily scarred from unbroken falls in the street, will collapse and seize up on his way down the stairs. Patients presenting signs of cancer will be advised to consult more sophisticated facilities, if they can.

And then there is Eugenio, a twenty year-old man with cerebral palsy. We meet him on the next to last day, when his great-grandmother, almost eighty and scarcely a hundred pounds, brings him to the clinic in her arms. Outside, something had silenced the jostling crowd. When the old woman enters, we understand what that something is: in her arms she holds a young man whose body is utterly broken, stiffened in an attitude of disaster. His thin limbs and digits are locked in perverse angles; his mouth is twisted and toothless. With what strength she has left the old woman shoulders him forward, as if in offering, certainly in hope.

But there is nothing to be done. Gathering around, doctors and nurses lose the clinical detachment required of and engendered by the art of healing, which is in many ways a mechanical art demanding, finally, a mechanic’s approach. There is nothing medicine can do for this man, and understanding this, some members of the team break down. A PA retreats to a side room so as not to betray tears. A nurse takes Eugenio in her arms, cradles him, strokes his thin hair. Another hugs the grandmother tight. The compassion that brought these men and women here, that perhaps led them to medicine in the first place, is all that they have left to work with, and it consumes them. There is nothing medicine can do.

The team priest, bored and restless all day, steps up and begins to pray.

That night at evening worship, I offer something. The service has gotten less awkward with time. Knowing what these folks accomplish by day, it’s not so easy to judge what they do by night. I’ve learned to quietly play along, more bemused than irritated or threatened by the Jesus whispering and campfire singing. But tonight I feel compelled to ask the obvious, age-old questions: why Eugenio? What did he do wrong? Why not me? What did I do right? Nobody has answers to these questions, and I’m not long in feeling ashamed for having asked them. I feel I have called into doubt the work the team is doing. Anyway, you do not have to go to the hard-luck barrios of the DR to doubt the existence of a well-meaning god. (Jump across the border into Haiti for a real dose of doubt.) You can simply live long enough; one sickness or another will visit someone you love, will visit you.

“They’re good questions,” my father says from his bunk that night.

“Maybe, but I’m sorry I asked them.”

“Don’t be.”

“Do you?”

“Do I what?”

“Ask those questions.”

“All the time.”

Meaning he does not have an answer for me. He, who has always had an answer for me, since I first could ask. How planes get off the ground, what makes the tide follow the phases of the moon, why the prom queen falls for the quarterback. But this, why Eugenio and not me, no. I can be sure that if I took the question to its root, asked him why any living thing has to suffer, he would respond, Because it is living. I have heard him say that life is trouble. I might thank him for working, down here and back home, to make it less so. I might thank him for fighting, with biology, the basic facts of biology. I might, but he’s already snoring, sleeping off a long day’s work.

Wide awake, I revisit a conversation between my younger brother, nearly slain by lymphoma at the age of eight, and my mother. When at last my brother had recovered from the whole horrible hell, my mother would try to persuade him to attend church with the question, Who do you think made you better? The implication being, God. To which this boy of eleven, exposed already to the random horrors that can attend a life on earth, responded, Then who made me sick? The implication being, God. I know of the exchange, this concise expression of a most fundamental theological question, only because my mother herself retells it from time to time. Unhinged by her son’s inquiry, she now maintains that medicine, and medicine alone, cured him (just short of finishing him off, as cancer treatments will).

Yet faith endures, as persistent as the atrocities that both inspire and test it. I think of an earlier trip, to Nicaragua, a newspaper report about a gas-station fire that took the lives of two young brothers. Their mother had gone inside to pay the bill; seat-belted in the car when an underground tank caught fire and exploded, the brothers burned alive. For some reason or other, I clipped the article and underlined what a priest, presiding over the funeral for the two boys, had to offer: “Este no es el momento para pedirle explicaciones a Diós, sino mas bien para aceptar su consolación.” This is not the time to ask for explanations from God, but rather to accept his consolation. The priest added that we should trust in God’s ability to “transformar una situación de dolor y sufrimiento en una situación de gracia.” To transform a time of pain and suffering into a time of grace.

If only I could. My loss, maybe, that I cannot. It might be oddly liberating to embrace the 12-step platitude “Let go and let God.” To admit that I will never comprehend, and in the same breath leave that concern behind. But when I read of two brothers burning to death, my instinct is to shake my head and reach for a stiff drink. It’s true that a “time of grace” sounds infinitely more appealing than a hangover. But turning to, actually adoring, a sentient power that would sit idly by as two brothers burn to death, a schoolyard bully strips the wig from my chemo-wracked brother, an 80 year-old woman bears her great-grandson’s broken body through dust and ruin…I cannot do it. I often wonder what it would take to turn me. Cirrhosis?

To be sure, it will take more than a medical mission. I’m certain that was not my father’s intent, to make a regular churchgoer of me, but I wonder if it was not perhaps mine. Clipping that newspaper article years ago, I might have been hoping that I would come to understand or at least accept it one day. As yet, I don’t.

So that we may break bread with the Dominican bishop, we are flying out of Santo Domingo. The bus ride down to the capital has a celebratory feel. Nurse Darla has a boom box; there is singing to Tom Petty and Sheryl Crow. Conversation takes a tack homeward, to children and spouses, hot showers and dependable electricity, plumbing capable of handling toilet paper. From the back of the bus, Pete the dentist tells an occasional joke.

“Y’all know why Baptists don’t have sex standing up, don’t you?”

“Why?”

“Afraid it might lead to dancing.”

Outside, along the highway, trouble persists. We pass a long-dead horse in the median, its belly bloated near to bursting, four thin legs stiffened in perfect alignment. When our bus rushes by, a blast of hot diesel wind elbows the corpse. We barrel on, air-conditioned and anticipatory, forward looking.  Past the remains of catastrophic wrecks left untended. Past an elderly man on a motorbike carrying piglets to market in burlap saddle bags, their exposed heads pressed so tight together it is impossible to say whether the pigs have already been slaughtered or simply cannot move.

In Santo Domingo the mercury is pushing 100 degrees, but our hotel room is arctic, the window-glass dripping with condensation. Tending to personal affairs, I discover that the toilet is high-powered, carries out its duty with a quick, violent SCHWOMP.

“Can we flush the paper here?” I ask from the bathroom.

“Yes. Please do,” my father says.

“What about the tap water?” I ask.

“Drink up. We won’t lose power, either.”

“Generator?”

“Massive. Kicks in before you even know the grid has failed.”

“The Zona Colonial, hey?”

“The Zona Colonial.”

One could hardly design a more marked contrast to the life we have been living, let alone the lives we have been working with. In a morning we’ve gone from the developing world to the developed, from the squalid to the sterile. Oddly enough, now more than at any other point in the trip, I want home.

After communion with the bishop, there is a last group meeting. A “debriefing,” the session is called, and it involves first cataloguing the team’s accomplishments, then circling up to share our final thoughts. Sorrow prevails—for how much there is left to do, how much there will always be left to do. I want to ask, Why not stay? Why not give up the SUV, the big house? If you really believe, why not dedicate your life to this? I want to point out how much more we might accomplish without all this Church business. But the notion is irrelevant. Without all this Church business, few would have come here at all.

On the road to the airport, billboards hawk automobiles and airlines, beach resorts and shopping malls. Every couple of miles a dandified Johnnie Walker, ornamental cane in hand, invites us to Keep Walking. On the shoulders of the highway many locals are doing just that. Hunched under the weight of produce, rag-pickings, and infants, they keep walking.