By the end of August there was new hope in the barrancas of the Sierra Madre. Heavy storms had been lighter than usual during the summer monsoons, and seldom had the river left its banks. Yet the rains, though gentle, had been persistent, and the campesinos had begun to rejoice at the prospects of a bumper corn crop. On the slope
below my new upper dispensary I, too, had my own small patch of corn, planted for me in appreciation by villagers of E1 Llano, about a mile away. Fertilized with bat
guano from a cave high in the crags above my dispensary, my "milpa" was superb, the
stalks dark green, taller than I could reach. Each day new tassels burst from their
leafy cocoons to fan skywards, and tender ears of corn had begun to swell within
The first days of October passed without rain, skies clear. A flood of wild flowers spread across the mountain slopes. One afternoon a number of farmers, returning from their highland fields, came to rest beneath the large Royal Pine in the patio of my dispensary.
"All we need is one more shower," they were saying, "so that the kernels swell full upon the ears. Just one more good storms.."
"And the rain is coming," predicted one of the weather prophets, pointing to the wisps of mare's tails that hovered over the jagged peaks of the high sierra.
How right he was: Next morning the sky was heavily overcast. Dawn came late and slow. A "quitar-frio" (small flycatcher whose song is said to predict rain) sang incessantly from the margin of the pine forest. By mid-morning the normal, drone of insect life was oddly subdued. By mid-day night began to fall, or so it seemed. Each minute the sky grew darker. A chilly breeze began to blow. Then, down from the high sierra and across the distant valley of the Rio Verde, there came a strange roar, faintly at first, then louder, closer, descending from sky earthward as if angry gods stampeded. The wind swept up from the deep valley, driving raindrops in explosive gusts. Pine trees flailed like wounded birds. Oak trees groaned and snapped. Above the roar of the storm thundered the crash of broken and uprooted trees.
I cowered under the strongest beams of my dispensary, peering out at the enraged world. The two-foot thick trunk of the pine in my patio literally flapped. Heavy clay roof tiles of my dispensary lifted like dry leaves, some from the upper level crashed upon the lower, showering broken pieces. Muddy water from disintegrating adobe streamed down the clean walls of my newly whitewashed clinic. The driving rain struck first from one side, then the other. I looked out at my corn lashing this way and that. Strong gusts from below carried huge branches and entire trees up the ravine bordering the cornfield. Leaves flew everywhere.
The wind subsided a moment, then roared again, bringing another blast more violent than the last. The hurricane lasted several hours. At last, shortly before dusk, the sky grew lighter. The wind and rain subsided.
Next morning my best friends came to see how I had fared. Many had warned me to fell the pines closest to my dispensary, but I had left them, unwilling to sacrifice their beauty for my security. But miraculously, not a single branch had fallen on the house. More miraculous still, as I soon discovered, was that my little corn patch, wind whipped as it was, alone was left standing after the storm. The rest of the milpas of the barrancas had been flattened as if by steamrollers. From many, stalks had been ripped out by the roots. In Jocuixtita several huts had also been toppled. These could be quickly rebuilt, but the crops were the big loss.
The bumper harvest was now only a dream. The campesinos shrugged their shoulders. Bad years in the barrancas are more frequent than good. Two years ago the crops were destroyed by drought; last year, by floods; this year by the wind. Again there will follow severe shortage and prolonged hunger. But the campesinos are used to tightening their belts.
THE WATER SYSTEM
At last, after nearly four years of problems and delays, Ajoya has a pure water system. For the first two years the struggle centered on raising 15,000 pesos, which the village had to contribute to get government assistance. But the wealthy land barons were adamant that rich and poor contribute equally, which was impossible. This stalemate lasted until a year and a half ago when Mrs. Mary Kerschner, determined that the water project succeed, donated half the required money on condition that the villagers contribute the other half. At last "los ricos" rallied, raised the money, and a committee from Ajoya, together with the Municipal ,President and myself, presented the funds to the Water Commission in the State Capital. The Commission promised that the water project would begin at once: the government agreed to provide engineers, masons, pipe, and pumping system; the villagers to provide crude materials and manual labor.
Then came the big put-off. The old government, on its way
out, had apparently
squandered all funds designated for village projects. We would have to wait until the
following November, when, with the new government, new funds would be available. In November, 1968, when the new government entered, we were again put off, month by month. In Ajoya the disillusioned villagers began to kid me wryly for my stubborn confidence in-eventual success. "We'll all be dead first!" they insisted.
Then, one day last June, at the start of the rainy season, the engineers arrived, planned the layout, and the project began. But again there ware endless setbacks. The first supply truck, climbing one of the steep hills on the dreadful road to Ajoya, tipped backwards, on end, spilling eight tons of pipe, cement, well forms, etc. into the roadbed.
A greater problem resulted from bad timing of the project.
The rainy season is the planting season, when all able-bodied males over
six years old work from dawn to
dusk in the cornfields. Many of the campesinos were reluctant to give even one day a
week to the water project, for in one day during the tropical monsoons the weeds can
take over. A further discouragement was the fact that a section of three foot deep ditch which took all day to dig would, when a tropical storm hit, fill up again with mud in half an hour. Were it not for an unusual dry spell of nearly two weeks in July, the ditches might still not be completed. Even this calm spell, however, caused dissension among the villagers, we feared for their crops. Word was passed that Dona Nacha, an intelligent and spirited old widow who has been one of the strongest promoters of the water system, was using black magic to make the rains stop and thereby expedite the digging. She did this, it was whispered, by hanging a small effigy of San Gerónimo (patron saint of Ajoya) by the feet in a dark corner. Had the rains held off a few days longer, Dona Nacha might have fared badly.
The biggest problem of all, one which almost caused the government
to shut down
the whole project, was the difficulty in getting rock and sand from the river to the
hilltop where the storage tank was being constructed. This water tank, the walls of
which are six feet thick at the base, required over 100 tons of rock alone. It was
more than half a mile to a spot where good rocks were available, and the prospect of
moving .all that stone on mule back -- while less formidable than building the
Pyramids -- was sufficient to discourage the villagers. What was more, mules were in
as great demand in the fields as were men, and, at best, four or five mules could be
counted on each day. The team of masons, who worked by contract, could lay in half an hour the rocks it took the mules all day to bring. Finally the masons became so
disgruntled they left. Days later, a government lawyer arrived to break the contract.
We begged for another chance and were granted it.
We decided the only feasible way to get the rock and sand
to the hilltop was by truck. This required building a road, which, with
a spurt of cooperation by the Villagers, was completed in a week. 1,000
pesos were raised among wealthy families most interested in the water, and
paid to a truck owner in San Ignacio to shuttle the
sick. However the truck broke an axle on its first ascent. The truck owner spent the
1,000 pesos on repairs and vanished, leaving the village with neither vehicle nor
It was then that the children of Ajoya saved the day. We decided
to use my own
Jeep pick-up. I was too busy in the dispensary to spend much time driving, and the
only other person in the village able and available to drive my Jeep was 15 year old
Miguel Angel Mánjarrez, one of the boys for whom I arranged studies in the United
States. On back roads I had often given Miguel a chance at the wheel, and he had
become quite proficient. Miguel tackled the job with unbelievable perseverance. He
shuttled rock and sand for up to 16 hours a day, creeping back and forth over the
rough track in temperatures reaching 110º in the shade and 20º to 30º hotter in the
cab. His first assistant in rock-loading was a strong and energetic worker named
Jose. But unfortunately, after two days José put a bullet through his own hand and
was disabled. Miguel had to turn to his young friends for help. From then on, child
labor took over. Work gained a festive quality as more and more children pitched in.
They fought with each other for the right to go in the truck. Sometimes in the evening. hours when the children were all back from the fields, as many as 30 crammed
inside and on top of the camper on return trips from the hilltop. In all, Miguel and his young comrades made over 100 trips, and completed in 10 days what the men of Ajoya with their mules might not have completed in ten months.
Today, from a 25 foot deep well far enough from the river
to insure adequate filterage, water is pumped to the massive storage tank
overlooking the village, from which it flows by gravity to public taps distributed
through the main streets. Last mouth, when Dr. Donald Laub and his fellow
surgeons revisited Ajoya two years after their last surgical mission to
the area, it gave me a good feeling to hear Dr. Laub comment that the village
was visibly healthier than before. With the new pure water system, the village
has promise of greater health to come. And, to a large extent,
the children are to be thanked.
For the last four years Project Piaxtla has had two medical
dispensaries One in the
larger village of Ajoya, and the other some thirty miles of burro trail further into the Sierra Madre. Until a year ago, however, it was impossible for the two dispensaries to function at once, for apart from occasional visits by United States doctors. I was the only person tending the dispensaries. For most of this year, however, the dispensary in Ajoya has been manned independently by dedicated volunteers.
Last winter Robert Steiner, his wife, Dorothy, and their 16 year old son, Bobby, came to Ajoya for several months. Mr. Steiner had worked with LAMP, a medical aid program centered in Mexicali, before joining Project Piaxtla. In order to improve our methods of diagnosis, he apprenticed at the Stanford Medical Center in diverse lab techniques before coming to Ajoya. The Steiners, working as a team, have done a remarkable job in the dispensary. Their great care, and deep concern, coupled with quiet friendliness and endless patience, have won the confidence and love of many of the villagers. Their presence has made a great difference in the lives of the villagers.
During the six months while the Steiners were in the States, the dispensary in Ajoya was taken over by Joe Humphry, a third year medical student in San Francisco. Joe worked seriously and selflessly. He often traveled miles on foot or mule back in the difficult rainy season to serve patients in outlying villages. Joe has a deep sense of human justice, is a careful worker, and will make a dedicated doctor.
This Fall the Steiners have returned to Ajoya, and intend to stay through Spring. In Ajoya the patient load is enormous, the work endless. I am tremendously grateful to the Steiners for relieving me.
The Steiners’ presence in Ajoya has allowed me to devote
more time to the
upper-barrancas, a rugged and remote area where the need for medical aid is great, and where I would much prefer to be. Because my early dispensary in Verano -- tucked in a dank old grain shed which I had reluctantly shared with rats, roaches and roosting hens -- had certain disadvantages, a year ago I began the search for a new location. I found at last an ideal spot, nearly 6,000 feet in elevation, at the edge of a pine forest which crowns a steep ridge overlooking the valley of Verano, 2,000 feet below.
A ragged panorama of the high Sierra Madre towers beyond. It is a quiet spot and isolated, the closest but being half a mile away as the raven flies, yet nearly a mile by trail. The larger settlements lie still further down, thousands of feet below in the valleys. Yet the new dispensary, situated to one side of the mountain pass where trails to several villages converge, is centrally located to the population of the Rio Verde watersheds Verano lies south-east; Los Pinos, south; La Higuerita, south-west; Amarillo and Caballo, north-west; La Tahona, north; El Oso, north-east; La Quebrada, east. On emergency calls I can reach any of these villages (except Caballo) within an hour and a half on the down hill run.
Although its central position well justifies the distance of my new dispensary from the scattered settlements below, I must confess ulterior motives. I have found that when a free dispensary is located inside a village, many of those arriving for medication come either with conditions too trivial to treat, with invented ailments in order to pack-rat medicines, or simply for the pleasure of complaining. On the other hand, when the dispensary is placed on a mountain top, the patient thinks twice before making the journey or sending for aid. There is less waste, for treatment is no longer free - the patient or a relative must perspire profusely in order to receive it. (And frequently, on call, so must the medic, but the scenery is beautiful down the mountainside, and I enjoy the hike.) Expending such energy, I find people are much more appreciative of benefits received. Often they volunteer to chop firewood, haul water from the spring, clean house, plant flowers, etc. The majority bring token gifts of thanks: a chicken, a couple of eggs, a papaya, venison, armadillo meat, wild bee's honey, etc. Upon these gifts I rely for my "daily bread".
I confess yet another motive for the remoteness of nay new dispensary. I find I need this isolation for my own well being. In three years of living in the villages I had almost forgotten the glory of being alone. In Ajoya I lived with a family of 12 in a no-bedroom house. By choice I would live so far from the beaten paths of humanity that every knock on my door would make my heart skip with delight. At my new dispensary - which more nearly fulfills this condition - I find I enjoy both other people and myself a great deal store. Some days I have time to study the bird life, to paint, even to think a little and write poor poems; things which I dreamed of doing when I first came to stay in the Sierra Madre four years ago but never found time for, until now. Day by day I perhaps accomplish less, but in the long run, I think, more.
Construction of the new dispensary has teen an adventure in itself. Men and boys from the surrounding villages have come to help build, and women to carry water. A number of young people from California have also assisted. To help construct a log cabin, now a store room, came Michael Bock (son of Dr. Rudolf Rock, who performed eye surgery here two years ago). He was followed by Marc Silber and John Grunewald, .who helped build the adobe "clinic" and a small second floor "study". John also fashioned a magnificent staircase of split pine logs. A small group of boys and girls from Pacific High School cane fox- three weeks to lend, at times, a hand. Bobby Steiner came up from Ajoya and became a master tile-maker, and in June Steve Hogle and Eric Dueker came to help with finishing touches, doing an excellent job.
Located nearly 30 miles from the closest road, the new dispensary was, of necessity, built from the most basic materials - trees, earth and rock - using hand tools only.- Main beams are hand hewn. Planks for the upstairs study/bedroom, and timbers which flank the adobe pillars of the veranda, are all hand-sawn from pine logs. Adobe bricks we made from soil right on the site, but clay for roof tiles was brought from E1 Oso, three miles away. Line for white-washing the "clinic" was dug from the barks of the distant Rio Verde and socked with prickly-pear pads to keep it from powdering when dry. Rocks for the foundation, flooring, and the retaining wall of the forward paths we brought on mule back from over a mile away. Bricks for the central fireplace and chimney we did not make ourselves, but hauled from the remnants of an old mining project in Jocuixtita, defunct for over 100 years.
The final result is a curiously beautiful structure combining aspects of an adobe hacienda with early American log cabin. I put heart and soul into its creation, and have never felt more at home.
For many days I pondered over what name to give to my new
dispensary and home-
stead, but every appropriate name I thought of seemed trite. Villagers, impressed by
the landscape, suggested names like "Buena Vista", but such names called to my mind images of tract houses with picture windows overlooking busy freeways. Then one
days as I paused to look out over the blue valley, I could not help but marvel at the
perfect design and graceful flight of the vultures as they glided on the eddies of
air that rose through the gullies from the valley. Every day vultures are wheeling
and soaring there, part of the landscape. What better name could I find for my new
home than El Zopilote - "The Vulture"? And yet, for a medical dispensary, what name
more shocking? The temptation was more than I could pass up, and with tongue in
cheek I christened my new dispensary "El Zopilote".
The response of the villagers on first hearing the name is invariably the same: "El Zopilote! How ugly!"
"But just look at them out there," I reply. "How beautifully they soar!"
"Close up they look revolting!"
"But why not judge their actions, instead of their looks?"
"Their actions are revolting! They eat dead animals!"
"As do we," I reply, with mock seriousness. "But vultures don't kill them first. And that is precisely their virtue. How few animals there are which, like the vulture, don't take a single life, either plant or animal, to fill their stomachs, yet provide such worthwhile clean-up services for the rest of us. If only we human beings would learn from the vulture ... which is surely one of the most wonderful of God's creatures!"
Having said which I pause for a moment, then laugh. Whereupon the villager breaths a sigh of relief and laughs with me, graciously putting from his mind all I have said.
But the name, "E1 Zopilote", has stuck.
EDUCATION: PROGRESS AND PROBLEMS
The two boys from Ajoya who were given the opportunity to study in the United States both did very well, academically and socially. Last year both boys had the good fortune to live with exceptionally fine American families, who took great interest in, and became very fond of, their Mexican protégés. Martín Reyes stayed with the family of Thomas Prosser in Cupertino. Miguel Angel Mánjarrez, with the family of Dr. Murray Walker in Palo Alto. In spite of their excellent experience in the United States, however, by the end of the school year last year both boys were tremendously eager to get hone. Far from lessening the attractiveness of their native village by comparison with the far more complex and "advanced" culture in California, both boys seem to be more passionately bonded with their native village than ever.
Martín, who had only completed the fourth grade in
Ajoya when he entered the 7th grade of Kennedy Junior High School in Cupertino,
by the end of his first year was holding his own both in the new language
and in his classes. By mid-year in the eighth grade he had made the honor
roll. His cheerful good will and eager participation in both curricular
and extracurricular activities won for him the
"Friendship Award" at the end of the year. As Martín's goal in education has been
to return to the villages as a teacher, we agreed that after the eighth grade he
should continue his education In Mexico. Martín's teachers at Kennedy Junior High
spearheaded by Mr. Gene Schneider, the librarian, were so impressed by his enthusiasm and accomplishments at Kennedy that out of their own pockets they raised a scholarship fund of over $600 for Martín to continue his studies in México.
Back in México, however, we had a rude awakening. Although
we had previously
checked with the Director of the Secondary School in San Ignacio, who had assured us that Martín should have no problem entering the equivalent of the ninth grade in the Mexican system, when we actually tried to enter him it was a different story, It
turns out that all primary and secondary education in México is federally controlled,
and that the Federal Government leaves no opening for evaluating or recognizing
studies completed in other countries. Everyone we talked to, from the Federal Director of Public Education in the State Capital to the Chancellor of the University,
was apologetic, but insistent: Martín would have to enter the fifth grade!
We tried private schools, everything. No luck. At last I came
to a "friendly
agreement" with the Directors of the Primary and Secondary Schools in San Ignacio
whereby I made a substantial donation for improvements of the school buildings and
creation of a playground, and Martín was admitted into the first year of Secondary School (7th grade). The Primary school certificate will somehow be arranged during
the course of the year.
So Martín is in the 7th grade in San Ignacio, as ever at the top of his class. He has a school office, and is enjoying himself thoroughly.. He has taken the setback far better than I.
Although everything was set up for Miguel to return for another
year at Terman
Junior High School, the experience with Martín made us think twice. At present
Miguel is enrolled in the Colegio Cervantes in Culiacán, where he lives with his
married sister, Adela. He, also, is doing very well.
Project Piaxtla is also sponsoring another boy at the Colegio
Cervantes. Juan Sanchez completed the 6th grade in Ajoya last June with
very good grades. He is from a poor family in a small village several hours
on mule back from Ajoya. His father, Manuel, is a relative of Chui Vega,
the wealthiest land baron in Ajoya, and young Juan had resided in Chui's
household when school was in session. Juan had done well in school, and
one day early this September when he came to the Ajoya dispensary for
medicine, I asked him if he had plans for continuing his education. He told me no,
his father couldn't afford it.
"Wouldn't Chui Vega help out?" I asked. The boy didn't know.
I arranged a conference between Chui Vega, Juan's father,
and myself. The net outcome was that between the three of us we agreed to
see that Juan continued his
education. Manuel said that his son could stay with an aunt in Culiacán. He agreed to
pay for Juan's transportation and .clothing, Chui and I (or rather Project Piaxtla)
agreed to split down the middle Juan's tuition, books, and other expenses. It was too
late to enter-Juan in the over-crowded public secondary schools in Culiacán, and we
therefore enrolled him, along with Miguel, in the Colegio Cervantes.
1 was particularly delighted that Chui Vega agreed to sponsor
Juan, for it was another step forward in encouraging the land barons to
assume responsibility for the betterment of the campesino's lot. From the
first, Chui Vega has been a leader in
this regard, and has repeatedly added both moral and financial support to the water
The pact between the three of us to sponsor Juan's education
was short lived, however, due to a tragic event. As ever, it centered around
a dance, where there
was drinking. Whatever the precipitating factors, Juan's father, Manuel, murdered
Valdo Vega, not only a cousin of Chui Vega, but the chief body guard and foreman of
his ranch. Chui was so infuriated that he not only cut short his sponsorship of young Juan, but sponsored instead (or so it is rumored) a posse of State Police to track down Juan's father. After several weeks Manuel was apprehended and is now in jail in San Ignacio. So now Manuel, also, is unable to help out towards his son's education. Rumors of his father's misadventure had reached Juan by the time I went to see him in Culiacán. The boy was distraught, the more so for fear that he would have to leave school. I assured him that even if I had to go pick grapes in California, he would continue his education. Poor kid!
On the more positive side, educational possibilities in the
Upper Barrancas are
considerably improved this year. Whereas last year, as usual, the school teacher
of Verano remained only part of the year, and the teaches. of Jocuixtita left
definitively after only two weeks, this year both villages have been sent new young teachers who are exceptionally dedicated. The teacher in Jocuixtita is a particularly sensible young man who has agreed to compromise with the Jehovah’s Witnesses in the village over the question of saluting the flag, rather than fight with them and finally leave town, as have so many of his predecessors.
For the school in Jocuixtita, Project Piaxtla has recently
obtained a number of
illustrated children's storybooks and a children’s encyclopedia to add to the small
library started by my students six years ago. Project Piaxtla has also cooperated
with the parents to raise funds to cement the dirt floor of the school room.
E1 Zopilote has also become a small nucleus of education,
for grown-ups and
children alike. I keep a small collection of carefully chosen books available for
browsing or lending. These books (many from the Time-Life series in Spanish) are
well illustrated and diagramed, as many who come to "read" can't read. Volumes
include such diverse titles as "Health and Sickness", "Birds", "The Universe",
"World History", "Bible Stories", and "Evolution". Having often tried to explain
the sun's movements' the moon's phases, etc., using oranges and lemons, I finally
brought back a globe which now provides endless fascination to young and old alike.
On Sundays a number of the young adults, who would otherwise be looking for a card
game or a drink, climb the mountain. to El Zopilote to browse in the books, spin the globe, and shoot the bull. A flock of teen-age girls from Jocuixtita also makes occasional visits to plant flowers for me, "read" books, and enjoy the view. Two little boys, whose fathers don't let them go to school, drop by sometimes on their return from the fields to help with hooves ;r. exchange for lessons in reading and writing. Part of the beauty of El Zopilote is that I find time for the healthy as well as the sick.
While medical care is still far from adequate in the 400 or more square miles of the barrancas in which Project Piaxtla pervades services, progress has been definite. Nutritional diseases, especially, pellagra, have been greatly reduced. I have not encountered a single new case or paralytic polio since the vaccination program was first initiated. Whooping cough epidemics have been restricted to the smaller populations near Ajoya, which as yet haven’t been vaccinated. And in the last two years I have not been confronted with single case of tetanus, except neonatal, which is still a problem.
Infant and maternal mortality have been considerably reduced,
due partly to
increased pre- and post-natal supportive care, and partly to the fact that I have
encouraged women with severe parturition problems and multiparous mothers generally, to begin birth control. For the most part, the women are not only willing, but eager. Along with other medication, the Direct Relief Foundation in Santa Barbara has supplied Project Piaxtla generously with oral contraceptives, which has allowed us to maintain an ever increasing number of women on the "pill". Some of the women are now on their third year. So far no pregnancies have resulted and to date there has been only one case of minor complications. As a foreigner in a Catholic country which does not even allow the Peace Corps, I am sticking my neck far out in sponsoring birth control, but I can see no alternative. In an area such as the barrancas, where economic and subsequent health problems are directly related to population pressure, it would be a costly mistake to conduct a program which saves lives without concomitant efforts to limit proliferation.
Problems of oral hygiene have also been ameliorated, due partly to the introduction of the toothbrush and fluoride and partly to rudimentary dentistry. When first I began extracting teeth three years ago, some of the mouths which opened for treatment were unbelievable, for most had never been seen by a dentist. There were many chronic abscesses, some draining externally, and cases where gross infection had limited jaw movement, caused blindness, or caused disfiguration. Some days I had to extract over 50 teeth. But now the chronic cases have mostly been taken care of; patients come earlier for treatment, and the number of extractions which Bob Steiner and I must perform has been reduced.
One of the severe diseases against which I have made little headway is infectious hepatitis, for there is no specific treatment and prophylaxis with gamma globulin is too costly to consider. Since I first came here, minor epidemics have struck the upper barrancas periodically. This Autumn, El Llano and Jocuixtita have been hit hard by a particularly virulent strain. The virus, passed in human feces, is spread principally by the busy noses of pigs, The problem is one of hygiene. I have tried to encourage the idea of an outhouse, but the villagers think it smells. (Some have them have visited relatives in the slums of Culiacán and Mazatlán, where the rank outhouses foul the entire atmosphere of the neighborhood. Villagers regard the pig as the more sanitary system of disposal. And if the pigs were not given free entry into the houses, they might be right.
Weddings, dances, and religious holidays -- whenever alcohol
flows freely – still not infrequently lead to bloodshed. The fiesta
which saw in the New Year of 1969 ended with a knife fight which presented
me with one of, the most delicate surgical problems I have had to tackle.
A young man's wrist had been slashed and several tendons severed. With the
help of Miguel and Martín, who were back in Ajoya for the holidays,
we succeeded in tying off the vessels and reuniting the severed, tendons.
Healing eras surprisingly successful, and today the young man has complete
movement of the hand.