NEWSLETTER FROM THE SIERRA MADRE #9
APRIL 1974

Concerning Project Piaxtla, a personal endeavor providing medical and
related aid to villagers in the mountainous reaches of Sinaloa, México.


Dear Friends of Project Piaxtla,


Upon reading this newsletter, you may wonder that I carry on at such length about mules. Remember, however, the unique importance of these sure-footed animals to the actual delivery of health services in roadless wilds where the ambulance is still as fabulous as the unicorn. Remember also, that here in the barrancas what is often most crucial to patient survival is not great medical know-how, is not a wide spectrum of medicines, but is getting to where one is needed in time. In the middle of the night on a narrow canyon trail too dark to see, one learns to rely not on stars, but on hooves; one humbly admits that where life hangs on edge, cognitive horsepower often carries less weight than brute strength.

It is, therefore, with awe and debt that I devote this newsletter to the strongest member of our clinical team, her labors and their consequences.


THE SAGA OF SUPERMULE

If ever a mortal has had to bear the burdens of the world on her back, such has been the fate of the Project's newly acquired mule, Heraclia. Yet she is mightily endowed to do so. Like her namesake, Hercules, she is massive, as strong as an ox, mild as a lamb, bullheaded and dumb like a fox. With 250 pounds on her broad back, Heraclia will stoically trudge up a steep winding trail into the high Sierra Madre without perspiring or even breathing hard, leaving far behind the other mules with lesser loads who, bathed in sweat, sighing and farting with their ordeal, must stop every few labored steps to catch their breath . . . What is more, Heraclia can be as swift as she is strong. At first, Miguel Angel, our young village "dentic", scoffed at her renown, knowing full well that in mules, largeness and lethargy usually go hoof in hoof. One day, however, as a joke, he raced her against one of the faster horses in Ajoya . . . and won! Upon dismounting, he shook his head in near disbelief and admitted, "¡Es muy buena, la mulona!"


Not only is Heraclia as fast as a horse, she is, when she chooses, as gentle. To prove this when he was selling her, her previous owner, Daniel Zamora, stood directly behind her and spanked her stoutly on the rump. She didn't even slant back her long ears or hump her back, much less kick. For a mule, such forbearance verges on the unnatural.


But when she chooses, Heraclia can be as ornery as the mongrel she is. As a rule she responds to the slightest touch of rein or spur. Yet she has a mind of her own, be it small for her bulk, and when she decides to use it no tug on the bit can restrain her. Like all mules, she is quick to judge the relative capacity of her rider. This February, when I was taking Lynne Coen and Sue Brittingham, two young American volunteers, to set up a new clinic far back in the mountains of Durango, Sue -- who is quite small -- was riding Heraclia. Around noon we stopped for water at a ranchito called El Jiote. (E1 Jiote means The Ringworm!) When we remounted to continue our journey, Heraclia moved ahead a few yards, then abruptly cut file and trotted back to the hut, where she stopped as if to say, "Sorry sister, this is as far as I go!" Sue spurred the big mule and tugged at the rein with no more
response than if she had been straddling a rock. Not until stout Cuca, the matron of the rancho, approached the mule waving a stick and accompanied by her snarling dogs, did Heraclia slowly turn and reluctantly follow the others. A hundred yards ahead, however, at the main trail junction, Heraclia did a right face and took off like a homing pigeon back toward Ajoya. Sue tugged on the rein with all her might, burning and tearing her hands, but the burdensome beast trotted on, oblivious. I galloped after her on my fast mule, La Coloradita (Little Red), but the trail was too narrow to pass. Finally, I plunged La Coloradita through a briar fence, galloped along a short cut across Enrique's cornfield and emerged again on the main trail a quarter of a mile down and just ahead of Heraclia, who came trotting contentedly toward me, with Sue still aboard, tugging futilely at the bridle with bleeding hands. Encountering one blocking the trail, the big animal stopped short, befuddled. I could feel her mulish mind hesitating as to whether to try to barge past or turn back up the trail again. A sharp swat of the lariat across her muzzle decided her. She turned, and once again the obedient "supermule" caught up, in no time, with Lynne. That day she gave us no further trouble.

Among her many equine attributes, Heraclia can jump like a steeplechaser. Fences with her are pointless. When she wants to stay around, she stays; no fences or corals are necessary. Turn her loose at sundown and at sun up she is at the door, sputtering and muttering for her basket of corn with that asinine noise mules are cursed with, half way between neigh saying and bray saying . . . but once she gets it into her skull that she wants to leave, she leaves. No fence, however stout or high, can contain her. When I first brought her here to El Zopilote (the upper clinic) I had, unfortunately, run out of corn. Likewise, the corn shuck fodder had still not been cut and stacked in the "tasolera" (pyramid shaped haystack on stilts). Consequently, the big mule had to rely on what she could forage in the large fenced-in "potrero", or grazing area surrounding E1 Zopilote. Heraclia was obviously displeased at not being handed her customary dinner in a basket. That night she jumped the fence and trotted back to Jocuixtita, 3 miles away, arriving at the but where we had given her corn leaves in passing the day before. Next morning two young boys, Lalo and Abraham, led her back to El Zopilote. The boys and I spent the day reinforcing and raising the fence. I even borrowed corn from Juan in El Llano, so as to entice Her Majesty to stay. But by this time, Heraclia's mind was made up. She was so set on getting out that she barely touched her corn. The first we knew, there she was on the far side of the fence, trotting up the distant ridge toward Jocuixtita. The boys took after her like rabbits; ignoring the trails, they bounded down the slope, crossed the ravine, and sprinted 300 yards up the steep flank of the ridge to cut in front of the retreating mule. Lassoing her, they led her back, laughing with excitement. That evening we decided to hobble Heraclia, an act that so vexed her, she refused to eat at all. Next morning, of course, she was gone. Three days later Fausto found her, still hobbled, grazing on corn stubble in a field the far side of Jocuixtita.

But home is the place you keep going back to, whether you want to or whether you have to. Returning from my last trip to the high sierra of Durango, when big Heraclia, of her own accord, took the cut-off back to El Zopilote, I knew the battle was won. On arrival, I fed her until she was full to bursting and turned her loose unhobbled. Next morning found her standing expectantly beside the clinic. On seeing me emerge, she impatiently began to sputter and mutter her half-horse, half-ass noises. Obediently, I filled her basket with corn, then hurried to throw down from the tasolera several big bundles of corn shucks, making sure she had enough to keep her happy. And now she sticks
close by . . .

At last I guess she's learned who's master: Unfortunately, so have I.


* * *


THE "WINE" THAT TURNS TO BLOOD

The mule, Heraclia, has long been the bearer of burdens critical to man's fate, for better and for worse. Since becoming a stable member of our clinical entourage, her burden has become, in a sense, the gift of health and life. She serves as a stalwart emergency vehicle, standing on call day and night, the bearer of medicines and medics across the mountains to the ill and injured -- truly a furred, four footed Florence Nightingale.

Before the Project purchased her, however, Heraclia's burden was anything but salubrious. In fact, I strongly suspect that some divine or whimsical Justice fated her to the deliverance of health services as atonement for having been for three years the bearer of a portentous cargo that, too frequently, abetted injury and death.

Heraclia's former owner, Daniel Zamora, has for years been the main supplier of "vino" in the barrancas. Here "vino" means not wine, but a very hard liquor distilled from fermented "maguey" (agave), and actually a form of mezcal or crude tequila. Its sale, like that of all alcoholic beverages, is prohibited in the barrancas. The result is, of course, a thriving bootlegging operation. Most of the moonshined "vino" comes from La Noria, near Mazatlán. It is transported in trucks at night to San Ignacio and from there, Daniel Zamora shuttles it by mule train to Ajoya and points beyond. I have often passed him -- his clandestine cargo stowed in burlap sacks crowned with innocuous pottery
-- winding his way up the mountain trails to Chilár, Jocuixtita and Verano.

Where alcohol goes, festivity -- and sometimes fatality -- follow. The villager who "buys-up" Daniel's firewater is usually quick to throw a dance, so as to divert his neighbors and, in the process, make a killing on the sale of liquor. Too often the killing turns out to be literal. In the barrancas, it has become part of the ritual of the dance for every post-puberty male who can get hold of a pistol to carry it tucked in his belt, the larger the caliber the better. The pistol, like the moustache, is apparently a sign of virility, a priapal totem whereby the young man can indulge his primeval need to display. Unfortunately, alcohol gives the rustiest firearm a hair-trigger, as testified by the many casualties at dances and fiestas. Here in the barrancas, "dancing accidents" are the major cause of serious injury and death in males from adolescence to middle age, although women and children are by no means exempt. The toll of the dance in the Sierra Madre can be compared only with that of the highway in the U.S.A. (where, also, young people try to display their budding manhood, not with guns, but with equally lethal souped-up cars and "choppers"). In the dance, as on the highway, the role of alcohol is equally disastrous.

The toll is high. Last year, in the area of our clinics, there were at least seventeen shootings or knifings, ten of them fatal. Two of the dead and three of the injured were women or girls. Eleven of the incidents took place in dances and/or fiestas and would almost surely have been avoided but for the faulty judgment or poor coordination caused by drink. Half the shootings were accidental. Other years it has been similar.

***

The suffering, the deprivation, the hunger, the hate, which come in the wake of all this pointless bloodshed is legion. A father stuffs his pistol into his belt, hugs his wife goodbye, and takes off for a "baile" in a neighboring rancho. His young wife, several months pregnant, tucks their four small children into the only cot, builds a fire in the doorway and sits in sleepless wait. Sending her man to a dance is like sending her man to war; she never knows if he will come back. But she tells herself, "It happens to others. It could never happen to him." She puts a thick log on the fire and stares into the night. As a rooster crows its first warning of the still distant dawn, she sees through the lackness, the faint flicker of a pitch torch approaching down the trail. She jumps to her feet. It is he!... But no, the flame bobs too much. A runner . . . A boy arrives, sweating. Her heart pounds.

"Chano?" she says.

"Dead." he replies. "A bullet right here . . ."

Excitedly the boy tells her the details, "He and Marino . . ."

But the details have ceased to be vital. They are not those which now matter. The cornfield has to be timbered for planting. The beans have run out. The children must eat. They can live on corn alone, for awhile. She can plant tomatoes. She can wash clothes in exchange for beans. She can sell the burro. And when the corn runs out? The planting? The baby already stirring in her womb?. . . The long nights . . . Her man is gone . . . Lost'. . . . The firewood: She has burned up the last of the firewood in waiting: With dawn so near . . . If only dawn would not come: If only the chickens would lay! If only dawn would come quickly:

More bobbing torches. Again the rooster crows.

This same night in another but another woman greets a runner.

"Lico?" she cries.

"There was a gunfight at the dance. Lico shot Chano and . . . "

"Is Lico all right?"

"Yes, but . . . "

"Where is he?"

"Se fué." (He left.)

There is a finality in that "Se fué" which is as irrevocable as death. When a man kills another in the barrancas, he leaves. The law almost never catches him, and for that matter, rarely pursues him unless the family of the killed has money. Yet bullets are a cheaper way to justice. The family of the killed will take the law into its own hands if the killer ever returns. He rarely does. For his wife and children, he is as good as dead. Thus, for each killing in the barrancas, often, two families are wrecked . . . that of the slain and that of the slayer . . . And then there are the parents, the brothers, the sisters. The feuds which follow.

But the people are basically good. Basically sensible. They do not want more bloodshed, more suffering by the innocent. They restrain their vehemence, their righteous anger, their urge to strike back at the family of the killer of their loved one. They control their hard feelings . . . until the next dance.

And so it goes on.

GUNS + ALCOHOL = INJURY AND DEATH. It is as straightforward as that.

The biggest "tragedy" is that there is no Tragedy. All this bloodshed and suffering result not from any great personal conflict, not from any soul-tearing struggle between good and evil, no Indian wrestle between Hubris and Nemesis, no tragic flaw, no stroke of destiny, no greatness worthy of man's blood. The slain are not martyrs; the killers are not criminals. Both are good hearted, fun loving, hard working, young men who, like drafted soldiers, have been swept along in a social ritual which everybody pretends has to be.

No. There is no greatness nor even great weakness involved -- simply habit, custom, the self-perpetuating pressure of peers on peers. Moustache, cigarette, pistola, vino. "The Surgeon General has determined that toting a pistol can be hazardous to your health" . . "Got your gun, brother?" . . . "You bet your life'." . . . And so it goes. No one takes the danger seriously until it is too late.

All this bloodshed is so pointless: So futile: So absurd: A human being is a temple. Even a human being with a dull slow mind. A tree is a temple: When I see a tree cut needlessly, carelessly, my heart cries out at the desecration. The waste: What, then, of man? And of man's family?

But the paths are well beaten. The habits persist. The young man who sees two of his best friends shoot each other at a dance may weep at their loss, but he will carry his pistol at the next dance and drink with his buddies until he's drunk -- then fire joy shots through the tile roof -- for that is the only manly way to be. He means no harm.

These are good people. These are strong people. These are people full of wisdom and feeling. Why are they not willing to stand on their own two feet and say, "Let's stop this nonsense:"? . . . But Man, even more than to tobacco and alcohol, is addicted to Nonsense; it is a part of his Genesis. If I did not love him, I would laugh.

Sometimes I laugh anyway, to keep from breaking.


* * *


CHRISTMAS '73

In our backwoods clinics, the Holiday Season is anything but a holiday. Often we pass days and nights without sleep in our efforts to patch together the results of other people's festivities. In a previous newsletter, I related how Miguel Angel, Martín and I "saw in" one New Year stitching together the severed tendons of a young man whose wrist had been slashed in a knife fight in Ajoya. In a later newsletter, I told of the Christmas night I rode to Chilár to patch up a total of 18 bullet holes in 3 men, plus a little girl struck by ricochet . . . A year ago, Christmas Day, dawn broke upon us as we were excising the bullet mangled testicle of a musician who had been playing that night at a dance in Chilár. He had been hit by a misdirected "vivo" (joy shot) of an artificially cheerful youth with a wooden leg, the gun having gone off in his pants as he tried to draw. The wooden leg, I should explain, was the consequence of a Christmas night gunfight three years before.

Our clinical records show that by far the most dangerous night of the year is Christmas Eve, ironically referred to as La Noche Buena.

It was with some trepidation, therefore, that I watched the dappled vermilion sunset fade as dusk settled over Ajoya this last Christmas Eve. As dark fell, the breeze dropped and it began to rain, a gentle, welcome rain -- the first since late September. The trampled dust and dung of the village streets lapped up the heaven sent moisture, exhaling such a vital, virile odor that mules and men alike unwittingly flared wide their nostrils, the better to savor the primordial scent, as if the moist aroma had awakened some germ of passion long asleep. The rain -- not the date -- made the eve holy, and everyone felt it, and was glad.

Miracle of miracles, the peace and quiet remained. There were no brawls, no "panderas" (wild processions), no shooting of "vivos". I would give credit to the rain. But the rain was not the biggest damper on the traditional bacchanalian festivities of La Noche Buena, for in spite of the cloudburst, Ajoya remained "dry"!

This remarkable circumstance was due to the fact that, a few days before Christmas, Daniel Zamora got "busted". The Judiciales (State Police) had ambushed his mule train en route to Ajoya, had confiscated 72 liters of "vino" -- more than enough to have made it a very merry Christmas indeed -- and had thrown him, although briefly, in jail. As he has done many times in the past, Daniel promptly bought his way out. Once liberated, however, he was so deeply in debt that he was forced to sell everything, including his lead mule. And that is how, a few weeks later, Project Piaxtla came by Heraclia.

The rain on Christmas Eve did not last long. After it stopped, the air was too fresh, the night too glorious to remain inside. I had a sudden eagerness to be alone. To those who recently arrive from California, Ajoya seems the end of the Earth. But after they have spent some weeks in the yet more remote ranchos of the high sierra, Ajoya becomes "the big city.” At night at my mountainside clinic of E1 Zopilote, I have grown fond of having no other company than the stars, of hearing no other voice than those of insects, owls, whip-poor-wills, the breathing of the pines and the muttering of the mules. It is here (for I am writing this in E1 Zopilote) on this mountainside, alone in the common
bond of night, that I feel closest to other people. Conversely, in Ajoya, surrounded at night by people, I often feel distant. I need the pines and the huge silent sky. I suppose I have become so familiar with solitude that I soon grow lonely without it. Man has strange friendships.

And so, on La Noche Buena, when the rain stopped, I bid leave for awhile of the popular village and made my way to the river. There, on a big rock, I sat in company with the night -overwhelmingly sad, yet overwhelmingly happy -- without asking why. The clouds parted just in time for me to glimpse the world's new comet, like the Star of Bethlehem, kneel down on the westward horizon.

* * *

If Christmas Eve was unnaturally tranquil in Ajoya, it was not so in the little village of Güillapa, two hours upriver. The first we knew at the Ajoya Clinic that something had happened was shortly before dawn, Christmas morning, when someone began thumping heavily on the front door.

"Who is it?", I called out, still half asleep.

"Nasario" called a muffled voice.

Nasario Fonseca, gaunt and in his sixties, is one of the old-timers from Güillapa. He and his ailing wife live by the river in a simple adobe but made majestic by a huge twining bougainvillea that perennially festoons the trellised porch with its flaming wine red garlands. A hard worker, over the years Nasario and his older sons have built up an extensive orchard of oranges, mangos, bananas and sugar cane, irrigated by a hand-dug ditch nearly a mile long, connecting with the river upstream. Each summer, during the monsoons, the enraged river washes out the ditch and, each dry season, Nasario and his sons have the leviathan task of digging it out anew. But hard work, and the
fruit of it, have kept the family close and strong.

Ten years ago, before I had even dreamed of assisting the villagers medically, and the very first time I passed Güillapa, Nasario's son Chano, a thin, soft spoken lad then in his teens, had seen me tramping past with my knapsack and had invited me to lunch. Since then, as I ride by Güillapa on my way to El Zopilote, Nasario, his wife or one of his sons often call me to their shaded hut, sometimes to see a child who is ailing, but more often to give me a papaya or a stalk of sugarcane for the trail. They have grown to care for me, as I for them. They are -- like so many here in the barrancas -- solid, warm, good people.

"I wonder," said Nasario when I opened the clinic door, his voice hard with control, "if you would do me the favor of bringing the bodies of my sons from Güillapa so I can bury them here in Ajoya. I'll pay you what-- . ."

"Which sons?", I blurted out.

Nasario lifted his scarred calloused hands and stared at them. He replied, almost inaudibly, "Marino and Chano."

These had been his two oldest, each now in his late 20s. Both had wives and children; Marino 7 children, Chano.

"What happened?" I asked, already guessing the answer.

"There was a dance in the casa de Cipriano and . . .", Nasario turned his coarse hands upward as if testing for rain. What more needed to be said?

Before we could move the bodies, the scene had to be investigated by Quico Mánjarrez, the Juez Civil (Civil Judge). Dawn had fully broken by the time we had rousted him and set out. In our Power Wagon, with Miguel at the wheel, we bumped and jolted up the riverbed to within a mile of our destination, then proceeded on foot up the peaceful wooded arroyo to Cipriano's small hut. Not two, but three bodies lay where they had fallen, within a few feet of one another and bathed by the friendly winter sun. The third body, we learned, was that of Asunción Gonzáles, one of the four opponents of the Fonseca brothers in the gunfight. Before the dance, they had all been good friends.

Old Nasario, his deep-set eyes dry and his face taut, bent over the bullet ridden bodies of his sons, first Marino and then Chano, their quiet eyes staring upward past his. At last he slowly straightened and in a voice as empty as an echo said, "Pués, ni modo, Madre. ¿Ya que podemos hacer?" (Well, no way, Mother. What can we do now?)

Quico, the Judge, went about his investigation, counting the wounds and judging their caliber and angle of entry. He also asked questions. It was his job to find out who had started the fight, who had shot whom, and who was to blame. Cipriano had ready his succinct report -- Yes, there had been a dance. An argument had started, over what he was never quite sure. No, there had not been much to drink . . .

So said Cipriano. But when Quico tilted up one of the stiff corpses to examine its back for exit wounds, from a .45 caliber hole in its stomach, a clear fluid streamed out as from a keg. The smell was unmistakable. Nobody seemed to notice.

It made me reel. The waste of life, the needlessness of the suffering, the absurdity of the Judge's measurements and questions suddenly overwhelmed me and I blurted out, "Do we really think that one person or another is to blame for these deaths? The blame lies here!" I pointed to the "vino" still trickling out of the belly of the cadaver and soaking into the earth. "It lies in the custom of drinking and carrying arms at the dances. And until the people as a group change the custom, these deaths will keep happening. This isn't a matter for the law, but for common sense'."

My words offered little solace to anyone. Quico gave me a hard look. No one else listened. I shut up. Old Nasario asked me to take photos of him next to his dead sons, which I gladly did. A Gringo must stick to his guns.

We loaded the rigid bodies onto improvised stretchers. Nasario himself forced the outstretched arms of each of his sons to their sides and bound them there with leather thongs to keep them from springing back out. "As if they were animals", muttered one of the spectators, appalled. I marveled at the father’s control. He held his feelings with a grip of iron and did what he must. Eleven years before, two daughters, ages 8 and 9, as dear to him as the river and sun, had died on the same day of what sounded like diphtheria, but what his neighbors had assured him was witchcraft. But whether the will of God or Satan or both or neither, to him it had come to the same thing. Nasario learned long ago that whatever a man's losses are, short of his own life, he can -- and must -- keep going.

Arriving with the bodies at the Power Wagon, we encountered the silently waiting wives and children of the dead brothers. The cadavers, covered with blankets, were loaded onto the bed of the truck and the wives, children, remaining siblings, Nasario, Quico the Judge, the Síndico (Sheriff), and several deputies crowded in around them. As we took off, Marino's wife, Maria, peeked under the blanket at her husband's yellowed face and began to wail. Somebody ordered, "Put back the blanket'." She meekly obeyed. As we bounced along, the children, understanding yet not understanding, crouched like newly caged animals, silently staring at the lumpy, blanket covered heaps . . . Their fathers. Young. Strong and in the prime of life . . . Dead!

And for what?

Tomorrow the children will again perform their chores; within a week they will remember how to laugh and play. They know by instinct what adults have to learn. Go on! Go on!

The wives will suffer longer. And the parents.

Must this be?

* * *

After the burial, things remained fairly quiet until the New Year. New Years, like Christmas, had its usual casualties. In Ajoya, the only mishap was that of a 15 year old boy, very small and underdeveloped for his age, who swiped his father's gun and succeeded in shooting himself in the foot. He took it, of course, like a man. Also, not far from Ajoya in Campanillas, at the New Years Eve dance, a youth with one drink and one pistol too many under his belt, while trying to draw to fire "vivos", managed to shoot two girls with one bullet -- one in the leg, the other in the foot. On sobering up, the young man was very apologetic and offered to pay amends. But with what do you pay an eleven year-old girl who has had a bullet lodge in her ankle and may have received permanent damage?

* * *

EPILOGUE TO THE SAGA OF SUPERMULE
or
CONFESSIONS OF A TEETOTALER

Those who don't know me well, sometimes accuse me of being a puritan. I rarely drink. I haven't smoked a cigarette since I was twelve. I don't use drugs or have any interest in them. Indeed, I'm leery of bandwagons and cults of any kind. Yet my physical needs are enormous; I need forests, mountains, running water (rivers of it), the sun, the moon, the wind and things like that. I enjoy simple living and find solace in solitude. I believe in harmony, understanding, kindness . . . not much else. If I am able in some way to help other people, I do so because I enjoy it and because I need and welcome the warmth of human response which so often returns.

I have no other desire in life than to live fully, and I have found that, for me, this means trying to relate as positively as I can to all which surrounds me and matters to me. There is nothing I enjoy more than trees, beetles, children and lovely things in general; and if I devote part of my life to caring for these, it is because I find gladness and fulfillment in so doing.

Heaven forbid that I be a puritan! A purist, perhaps, but not a puritan. A puritan is one who negates the joys of this life to prepare for living it up in the next. I look forward to no other life than this one and would drink it in, and its joys, to the dregs. I would miss nothing. This earth, this universe, contain such an infinitude of marvels to explore, to unravel, to embrace, that I often wish I were three persons at once, to do all I long to do before these bones go brittle and collapse.

Yes, I am a purist: I will take my life straight, thank you. I will not water it down with alcohol or any other drug. I will not coat my lungs with tobacco tar nor loose the scent of pine woods from my lips. I will keep my mind and senses as sharply tuned as I can to all tunes. I will keep this grossly imperfect body of mine as strong and nearly sound as I am able, as quick and supple as the years and fates permit . . not because I worship it . . . Heaven forbid . . . but because this meager body and the mind it sustains are the best tools I have to explore and delight in the vast, beautiful, physical world. I will run mountain trails, chop firewood, chase fireflies and keep my muscles and heart as hardy as I can.

Physically, I am unwhole, and I have reluctantly come to accept this. I have fairly well learned to compensate for the deteriorating muscles in my hands and lower legs and function tolerably well, if awkwardly, in most activities. Yet I envy, I marvel, at the youth who is complete -- the command of his body and limbs, the grace and strength of his movements, the sculpture of his form, the soundness and uniqueness of his entirety. At their best, the human body and mind are magnificent. They are irreplaceable treasures. If I had my druthers, I would see the wits and senses of every man, woman and child kept as keen, clean and alert as possible, never dulled and insulted needlessly. To me it seems the bitterest shame, the most flagrant waste, that someone with a sound body and mind should squander this wealth. It wrings my soul to see young people I have fostered and loved, carelessly fall into patterns which weaken or neglect their physical and/or mental endowments. I marvel that so many good people find me strange for feeling what I feel as strongly as I do . but perhaps only one who is born defective can fully appreciate the glory of being whole.


* * *


TWINS


After the rain of Christmas Eve, the weather remained dry until the Ides of March, when the sky blackened, thunder grumbled and a few patchy storms fell among the crags of the high Sierra. At El Zopilote, however, the thirst of the dusty pine seedlings was no more than tantalized by a brief sprinkle which dried within the hour. Over Ajoya, as I could tell by looking westward under the dark billow of low clouds, the sun was still shining.

Two days later I left for Ajoya, accompanied by a boy named Amado, whose father had loaned me two mules. These we were taking to Ajoya to pick up a visiting group of American high school students. Around two o'clock in the afternoon, as we neared Güillapa, we passed Chano's wife, who was washing clothes on a rock in the river. She greeted us warmly. Nearby her naked children were bathing, their slender, golden bodies more precious than jewels, gleaming and flashing in the sunlight. Laughing and shouting, they waved as we rode by.

Half a mile downstream, as we approached the point where, on the far side of the river, the wooded arroyo leads to Cipriano's house, I explained to Amado that it was down this very arroyo that on Christmas Day we had carried the bodies of Nasario's sons. No sooner had the words left my mouth than, to my amazement, a swarm of people emerged from the woods, moving toward us down the arroyo. It was like deja vu. And sure enough, in the middle of the group I soon spotted a stretcher. There, also, a little downstream, was the Power Wagon, waiting. I spurred my mule into the river to cross over to the stretcher bearers, and as I did so, I heard the shout of Jasmín Flores, one of our young American volunteers, hailing me, "David! David!"

We converged on the Power Wagon at the same time. Streaming sweat, Cipriano and his son, Isidro, lowered the stretcher from their shoulders. In it lay Isidro's wife, Pancha, who had delivered a baby girl at 3:00 A.M., the first of twins. By mid morning, she had not delivered the second and the midwife, finding the baby transversely situated in the womb, had sent to the Ajoya Clinic for help. Mark Kinder, one of our volunteers who has worked in an ambulance corps in the States, drove the Power Wagon. It was a hard trip. Three times the 4-wheel drive wagon got stuck in sand bogs and had to be winched out. Also, crossing the rocky river bed, the battery broke loose and fell into the fan, chopping a section off of it. Mark succeeded in rewiring the remaining cells and getting the vehicle started again, At last, they had arrived at Güillapa. They found Pancha in good condition. Although there was still a fair chance that the second twin would be delivered normally, our volunteers had decided it was safer to take her back to Ajoya. Roberto, a local apprentice medic, volunteered to ride my mule the rest of the way for me and I accompanied the mother in the Power Wagon.

In Ajoya things went slowly. Pancha's labor pains remained weak and spaced at long intervals until the following morning, when they became more severe and frequent. The baby was still transverse in the womb, and at about 3:00 P.M., the bulge of the amniotic sac appeared at the opening of the birth canal. I perforated the sac and exposed what we had feared -- the biggest dread of the backwoods midwife -- the baby's hand. The small pink hand moved this way and that, as if testing the outer atmosphere. I reinserted the baby's hand back into the womb and, with the help of a village midwife, tried, gently, to turn the baby. Without success. I was leery of using much force for fear of precipitating a hemorrhage which might demand an immediate Caesarean, a procedure which was beyond our capacities. The mother's pains were subsiding again and we decided to make a run for
the hospital in Mazatlán. Mark packed medicines and instruments in case the baby's position should change and it could be delivered en route. At about 5:00 P.M., we took off -- Pancha, her husband, her mother and I, together with a 13 year-old boy named Saul, who had a tumor of the jawbone, of which I wanted to get better X-rays than our equipment could provide. The one day old twin we left at the clinic, where the mother of one of our patients agreed to breastfeed it, having left her own four month old baby at home.

The trip was difficult. Pancha cried out in agony every time the truck lurched. We had to proceed very slowly for the bumps in the rough road precipitated such violent uterine contractions that I feared these might cause a fatal rupture. Isidro knelt at his wife's side, trying to stabilize the jolting cot in the back of the vehicle. Several times I stopped to climb back and examine the state of the mother and the child in her womb. Isidro asked me over and over again if I thought the baby was still alive. Each time I told him yes, he breathed a soft "Gracias a Diós". I marveled at how essential the life of this second, still unborn twin, already was to him. He seemed to be nearly as anxious about it as about the life of his wife, Pancha.

At last we arrived at the Hospital Civil in Mazatlán. There were no doctors on duty, but the nurse telephoned and they came very quickly, both the Director, a kindly middle-aged pediatrician, and the chief resident, a young obstetrician. The obstetrician examined Pancha and decided to try to "invert" the child and remove it through the birth canal, rather than to perform a Caesarean. His confidence was reassuring and he was so friendly that I felt no reluctance to ask him if I could observe the procedure. He cheerfully agreed. We changed into gowns and masks and scrubbed, while the nurses prepped the mother; then we went into the operating room. The Director, also masked, came along to observe. After starting an I.V., the young doctor expertly gave Pancha a spinal block. Meanwhile, the baby's hand had again presented. It had good color and even grasped at the forceps which clamped off the umbilical cord of the first twin. The young resident reinserted the hand and, reaching in up to his elbow, fished for the infant's legs. On finding them, he drew them out of the birth canal. The hips followed. It was a boy. There, the baby hung up. The cervix was in spasm and, try as he could, the young doctor could not get his fingers through to catch the baby's shoulders or mouth. Time was precious now, for the pressure of the birth canal on the umbilical cord interfered with the oxygenation of the baby's blood. The nurses applied larger and larger doses of nervous system depressants in an attempt to relax the contracted cervix. The young doctor twisted and turned the infant in vain and finally, in desperation, began to pull on it, forcefully. The sweat ran down his face and dripped from the end of his nose. He twisted and tugged harder. Finally he succeeded in slipping through his fingers and hooking the baby's right arm, which he tried to manipulate down through the birth canal. The Director advised him as to how to turn and lift the body, but still the infant remained stuck. The desperate young resident gave too strong a tug at the infant's arm. There was a faint snap of bone, accompanied by a gasp of horror on the part of the doctor. It made me recall how, when I was first learning to pull teeth, I sometimes had become flustered with an extra obdurate molar, applied too much force, and broken the crown off the roots. There was the sickening snap, then the sense of failure, of inadequacy, which follow. I felt sorry for the baby, but I felt, perhaps, even sorrier for the young doctor. He had done no more than try his hardest. I regretted that the Director and I were watching. The Director simply said, "Broke?", and the young doctor nodded and kept working. Now it was easier to extract the child's arm and, while the Director was scrubbing up to lend a hand, the baby's shoulders and, finally the head, emerged. By now the baby was limp. The cord was cut quickly and the nurses began to aspirate the mucous from the baby's mouth and to flick its backside, but the baby did not begin to breathe. A tube with oxygen was run into the baby's nose, but to no avail. At this point the Director stepped in, listened for a heartbeat, and then began to give the child mouth to mouth respiration. In the meantime the young resident manually removed the two placentas from Pancha, who was nearly unconscious from so much medication. After applying mouth to mouth respiration for about a minute and a half, the Director listened again to the infant's heart, then handed the stethoscope to me. I listened. Irregular and barely audible, the beat was still there.

The Director shook his head, a look of sadness in his gentle eyes. "It's hopeless", he said. "The respiratory failure is due to the depressants given the mother to relax the cervix. What a shame'. . ~ . such a big, healthy looking baby for a twin:" He stood there looking down at the dying baby and said, with finality, "Too bad!"

But the child's heart was still beating, if barely, and its color was not all that bad. I thought of Isidro, the father, sitting in the hall, the anxious look in his weathered eyes, his humble voice asking again, "Is the baby still alive?"

"Do you mind," I asked hesitantly, "if I continue giving mouth to mouth respiration for a moment longer?"

"Go ahead," replied the Director, "but you're wasting your time."

Using the mask I wore to filter my breath, I bent over the limp body and began to breathe for it, at the same time willing -- willing life into it. After about two minutes, I paused and listened to the baby's heart. "Still there!" I said to the Director, who stood by, watching. The baby still showed no signs of breathing.

"The baby is done for," said the Director, a slight irritation in his voice, as if my amateur attempts were an insult to his judgment.

"He is probably right," I said to myself. "Furthermore, I am intruding. He has been patient enough to allow me to go this far. I should respect his judgment." Yet I muttered, "I'll try a little while yet," and bent once again over the limp infant. The Director left the operating room and was soon followed by the young resident. A moment later, Pancha was wheeled out by the nurses. I remained in the operating room alone with the infant, lending it my breath and my will. Every few moments, I monitored its heartbeat and paused long enough to see if there was any attempt by the infant to breathe on its own. There was none. But little by little, the heartbeat grew stronger, the baby's color richer. "Live:" I demanded, as if its life were my own.

But I was also fraught with doubts. If the baby survived, might it not have permanent brain damage from the long period without oxygen? Did it not already have a broken arm and who knows what internal injuries as a result of the traumatic birth process? Was it in any way needed in this world? Its parents already had six other children, one of which, born but two days before, would receive but half its mother's milk if this little boy survived. What a fool I was to invite the ill feelings of the hospital staff by questioning their death sentence on the child. They were probably right anyway, if not from one point of view, from another . . . yet the baby was alive'. A potential soul. A potential human being. Outside in the hall, I would meet Isidro asking, "The baby?" What joy it will give him to learn it is a boy . . . if he lives: Human life has never been a question of wisdom, but of passion. We live and we will to live, not with our mind, but with our entire body and soul, with our 50 million years of evolution, with our blood:

"Live!" I begged the child. "LIVE!" And I poured my breath and spirit into his.

After ten minutes, the baby's lungs jerked once . . but only once. I continued to breathe for him. At fifteen minutes, he took one deep breath . . . one only. At twenty, he began to breathe on his own. I stood by, marveling, my hand on his head, unwilling to remove it lest it, somehow, be an umbilical link between my soul and his. No father could have experienced more joy or more love. "You are alive! You breathe! And you are my doing!" I felt as if I had just painted the Mona Lisa.

The Director reappeared, in his street clothes and ready to leave. "Well," he said flatly, on finding me still standing over the infant.

"Look!" I said.

The Director drew close and stared at the small, heaving chest.

"Oh," he said. "It really looks like it might live." There was a touch of something near to resentment in his voice. He could not have been human if there were not.

The door opened again and the young doctor came in, also in his street clothes. Without looking around, he began to screw closed the valves of the oxygen tanks from which a tube led to the tiny nose of the infant.

"You'd better hold off on that," said the Director. "The baby's begun to breathe."

"But I already filled out a certificate that he was dead!" exclaimed the young resident, then suddenly burst into an embarrassed smile. The smile lasted but a moment and was traded for a very firm expression, mask-like, self-controlled. I felt that he, too, resented my intrusion and was, at the same time perhaps, shocked at his own resentment. He had injured the baby in birth. He had brought it into the world broken and imperfect. If he had not willed its death as such, its death (as he supposed) had in a way been a relief. Babies are sometimes born dead, even in the hands of the greatest obstetricians . . . but they're not alive with broken arms. When other doctors should see such a baby in the ward, its pathetic arm in traction, what would they say? . . . Such thoughts are not the noblest . . . but they are the most human. We all know them well.' I was not surprised that the young doctor, who had been so confident, who had been so friendly to me as an intruder, did not even come to look closely at the child. A moment later he politely said, "Buenas noches," and left.

My joy at having extended my life into the child's suddenly was wrought with a sense of doubt and guilt. It is a huge burden to have sentenced life on one so young. I felt like a fool who had played God, had breathed Life into clay -- and erred. I said meekly to the Director, "I guess I've created a lot of new problems . . ."

The Director looked at me with his sad kindly eyes and said, a little patronizingly, "That's all right, in this place we have problems all the time." When the nurses re-entered, he told them to take the child below and keep it on oxygen until it fully regained consciousness. As if listening, the baby opened its eyes. The Director and I shook hands, and he went home. I asked one of the nurses for a ribbon to tie off the umbilical cord, from which the clamp still dangled . . .

I found Isidro and Pancha's mother waiting in the hall. He had been told that his wife was fine but that the baby had never breathed. He had been given no further report and had assumed the little boy was dead. When I told him the contrary, his face lit up. "¡Gracias a Diós!" he exclaimed. "Was it the effect of medicines that brought him back to life?"

I shook my head. "No," I said, "to the contrary." I did not go into more detail.

We left for an all night pharmacy to fill a prescription the young doctor had made out for Pancha. An hour later when we returned we found Pancha in good condition, exhausted but content with the new baby at her side. She moved and the infant awoke and began to cry. What a great sound.'

As the back window had fallen out of my Jeep camper on the rough roads, I did not want to leave it alone. Isidro and Pancha's mother chose to stay in the hospital, so Saúl and I decided to sleep in the Jeep next to the hospital. We had no sooner pulled into the quieter end of the lot, however, then the police appeared and ran us out. So we drove outside the city and slept near the beach.

Next morning I took Saul for X-rays and then to the office of Dr. Guzman, a very capable surgeon in whose opinion I have increasing confidence. It was afternoon by the time we returned to the Hospital Civil. There, a young intern told us that Pancha was doing well, but that the baby had died at nine that morning. I asked him what had happened. He shrugged his shoulders and said that the baby had appeared to be doing well and then, from one moment to the next, he had just stopped breathing.

I looked at my hands and said, "Oh." And yet I wonder . . .

At least I am no longer responsible . . . to that one.


* * *


RESPONSE TO DONDE NO HAY DOCTOR


Some aspects of folk medicine are favorable, others detrimental. One might think that in time the harmful elements would be weeded out through trial and error. But not so; for folk science is grounded less on empiricism than on faith, dogma and fear of the uncertain. Traditional cures, even when blatantly injurious, are simply not to be questioned . . . and woe to the outsider who would question them. I speak from experience.

Since I first came to the Sierra Madre, in talking with patients I have tried in vain to counter some of the folk myths and home remedies which are most clearly pernicious . . . for example:

· the use of human feces, euphemistically called "yerba sin raíz" (herb without roots), for all sorts of tonics and poultices.

· the 40 day "dieta" (diet) of the post-partum mother, during which most nutritional foods, as well as bathing, are strictly taboo.

· the treatment of "caída de la mollera" (fallen fontanel), whereby the curandera tries to lift the brains of the dehydrated baby back to normal position by sucking on the child's crown, pushing upward on its palate and slapping the soles of its feet while hanging the infant upside down over a dish of boiling oil.

· the flogging or killing of "witches" as treatment for a wide variety of bizarre and frightening ailments such as cirrhosis of the liver and testicular cancer -- thought to be caused by hexing. (In the period I have been in the barrancas, four women have been killed as "brujas" and several others injured.)

For eight years, I have talked myself blue in opposition to these damaging, but time honored traditions. Always the villagers have listened politely, but a little amused, as if to say, "Poor Gringo, he means well, but he is so naive:" And of course they are right.

This was brought home to me by the incident of Micaela and the orange. Old Micaela is the matriarch of the household where I set up our first dispensary in Ajoya years ago. She, like other villagers, believes that to eat citrus fruit when one has a cold will cause a deadly attack of "congestion". Micaela has heard me explain to dozens of patients the merits of orange juice for colds (admittedly, a bit of American folk mythology). Yet, one day when her son offered her small granddaughter a section of orange, old Micaela snatched it away and snapped, "Do you want to kill her, eh?" Turning to the old woman, I said, as gently as I could, "Micaela, how many times do I have to tell you that oranges do good, not harm, when one has a cold?" The old woman smiled and replied, just as gently, "I don't know. How many?"

So much for the value of oral repetition.

The written word, on the other hand, is Law . . . especially for those who can barely read: For me this has been a recent and -- for my own purposes -- happy discovery. The following incident helped me to realize this. A few days ago a young man arrived at E1 Zopilote asking for a hunk of copper to use, he said, in finding buried treasures. He explained that by heating the copper red hot and pouring "vino" over it, the "vino" would flare up and this, in turn, would cause a burst of flame to appear directly over the spot where gold coins lay buried. Like a fool, I told him I thought it wouldn't work and he laughed, good naturedly, at my simplicity. After giving him a piece of copper tube, I asked him about his chronically ailing mother. He replied that she was doing poorly, that for years if one part of her didn't hurt, another did; that she couldn't sleep, etc. Knowing the family's weakness for blaming everything and anything on witchcraft, I asked him with tongue in cheek if he didn't think his mother had been hexed. To my amazement, the young man not only refuted this, but earnestly explained to me that the power of the hex is simply the power of suggestion, that a person who doesn't believe in witchcraft can't be hexed, etc. His lecture was such a reversal of roles that my jaw fell open. I asked him where he had heard such stories. He assured me that this was no story, for he had read it in a book.

The book was, of course, my own. The first chapter of my new medical handbook for villagers, Donde No Hay Doctor, (Where There Is No Doctor) is devoted to folk remedies, helpful and harmful, and includes almost word for word the comments on witchcraft which the young man had just recited back to me. I was delighted.

* * *

In general, the reception of Donde No Hay Doctor has been far better than I had dared to hope. As only about half of the villagers can read, and most of these so poorly that they never do, I had imagined that at best one or two persons in each small village might take interest in the book and, perhaps, mediate its information to others. However, to my joy, the book is not only selling like hotcakes, it is being read and used and gossiped: Visitors at El Zopilote pour through it in small groups, pointing to the drawings and reading aloud and haltingly the adjacent information. What is more, some have begun to follow the book's advice. Several times now, when I have begun to tell mothers whose babies have diarrhea to give them "suero para tomar" (boiled water with sugar and salts), they tell me they are already doing so. And once, when a young mother remarked that her baby's diarrhea was due to "caída de la mollera", another mother volunteered, "The book says that "fallen fontanel" doesn't cause diarrhea, but that when a baby has real bad diarrhea, he loses more liquid than he drinks and that makes the fontanel sag."

Oh, how fine to hear her say that! After eight years of having repeated the same message in vain, all it took was putting it in print. . . There is no greater thrill than being heard!

Beyond doubt, the hundreds of pictures are what make the book "readable" for they make it fun. Even in the line drawings, the villagers recognize each other. "Look'. Here is Jacinta's little boy, Matías, when he was covered with scabies. Poor creature:" . . "No, that's not Matías, it's Maruca's son Loli; look how his nose is pointed."' . . . "Well, let's see what it says . . . "

And so, in bits and drabs, the book gets read . . . and heeded.

The new medical handbook is a step toward our goal of encouraging "self help" among the campesinos in questions of health and hygiene. A few months ago, several small villages and rancherías on the upper reaches of the Rio Verde -- an area out of range for most of our medical services -- petitioned us to set up a clinic in their area. While this is more than we feel we can take on at present, Mike Carstens, one of our young American volunteers, has gone to the area and is now giving classes to adults and children, using Donde No Hay Doctor as a text. Following the recommendations in the book, he is helping the community to set up a comprehensive medical kit and understand its use. After Mike spends several weeks at Rio Verde, he plans to go on to other communities which have, likewise, petitioned our help. We hope, in this way, to help improve health conditions in areas beyond those which we might otherwise reach.

Donde No Hay Doctor also promises to have some impact on other parts of México and Central and South America. We have been swamped with requests, many from projects and persons we have never heard of. For example, a Profesór de Mirjyn, of the Academía Hispano América in San Miguel de Allende, writes that for five years he has been training a group of ten paramedics on a nearby rancho and that he finds the handbook "just exactly what is needed to fill the void in the smaller rancherías of Bajío which do not rate high enough on the State scales to merit a Centro de Salud or a pasante." Although the book is not designed as a text for paramedics, one backwoods health program in Guatemala is already using it as such and another group is considering doing so..

* * *

The handbook has been the fruit of hundreds of hours of volunteer work on the part of so many persons that I will not mention each by name. I would, however, especially like to thank Dr. Val Price, who went through the text with me word for word, both for content and for clarity. Also, I am enormously grateful to the American drug company which underwrote the cost of publication, thereby placing the book within financial reach of our villagers. (The drug company chooses to remain anonymous.) My deepest admiration and appreciation go to Myra Polinger, whose tireless effort on the book, as well as phenomenal patience with its author and his cohorts converted Donde No Hay Doctor from an ugly duckling into . . . well, at least, a duck.