I would like to relate to you now an event which Mark, the young French doctor, experienced in the Ajoya Clinic, and subsequently related to me. Of all his arguments for a simpler approach to medicine, this episode, I think, is the most convincing. Not uncommonly, visiting doctors or medical students have felt stymied medically because they have been at a loss culturally. For example, the patient may simply not permit a pelvic or rectal exam which might be important for diagnosis, or may interrupt a critical course of treatment because of some taboo, or switch to an old folk remedy. As Mark makes clear, there are times when the village-born paramedic, who knows only too well the strengths and foibles of his fellow campesinos, can handle certain health problems more effectively than the medical professional who, for all his technical skill and good will, remains a stranger.

“Have I ever told you about how Martín saved the life of a baby after I had failed?” Mark asked me.

“No,” I said. “How?”

(Martín, for those of you who don’t know him, is our chief village medic. Now 24, he first began helping at the Ajoya Clinic when he was 14. We sponsored him through secondary school, including two years in California (See here and here) and three in San Ignacio, and later helped arrange for him to study for a part of two years as a “contaminant” (unoffical student) in a unique practical medical training program conducted by Dr. Carlos Biro in Netzahuacoyotl—the huge slum metropolis outside of México City. Today, Martín is the mainstay and “coordinator” of our Ajoya Clinic. Although at one time he had his heart set on becoming a doctor, he is now strongly dedicated to his less impressive but more progressive role as a pioneer in village paramedicine.)

“It was a Sunday morning in the middle of the rainy season,” began the young doctor, “And unbelievably hot. Being Sunday, the Clinic was supposed to be closed except for emergencies. But this young couple showed up with a sick baby, about a year old. They said his name was Filiberto and he’d had diarrhea and was vomiting for three days running. It was, in fact, an emergency; the poor infant was dangerously dehydrated. His eyes were sunken and dry, and his skin was all shriveled like an old man’s. They said he hadn’t peed since the day before. I explained to the parents that the baby needed intravenous solution right away. The father got anxious and said he thought the baby was too weak to resist it. For some reason, his misdirected concern annoyed me. ‘Resist it’.' I hollered, ‘It’s the one chance we’ve got to pull the baby through’.' He said, ‘Oh.’ So he took little Filiberto to a back room and I began to hook up an I.V. The mother and father helped hold him while I tried to get the needle into a vein. I tried every lousy vein in his thin little arms and his scalp, but no luck. You know how hard it is with a baby, and dehydrated at that. Believe me, I was sweating it. And so were his poor parents. They kept begging me to stop hurting him, and just give up. The mother started to cry, which made me all the more nervous. I realized that if I didn’t get some fluid into the baby’s veins quickly, he was going to die. And for all I knew, his parents would blame me.” The French doctor smiled nervously. “I tell you, I was damn scared! In a big hospital it’s different. You don’t have the parents as your assistants. You’re not put on the spot in the same way; you’re more insulated; you’ve got nurses, consultants, anesthetists and tons of equipment; you can avoid getting so close … You know what I mean?

“I decided my only chance of getting into a vein was to do a cutdown.” Mark continued. “I brought in gloves, forceps and a scalpel from the surgery room, and began to prep the child’s ankle. Before cutting, I explained carefully what I was about to do and why. But the mother suddenly cried, No! that her baby had suffered enough already. I tried to argue with her, insisting that if we didn’t get in the needle the child would die. Instead of replying, she snatched up her baby and ran out of the Clinic. The father, before he followed her out, turned to me and said, ‘Thanks, in any case. I guess we brought him too late.’ ‘Wait!’ I protested, ‘the baby can still be saved!’ … However, they were on their way.”

The young doctor made a frustrated gesture, and went on. “I felt angry and foolish. I thought of getting a court order, or some such, until I remembered where I was. So I went to talk to Martín, who had come in with another patient a few minutes before. On hearing what had happened, Martín ran out of the Clinic to look for the parents and the baby.

“Well,” Mark gave a long sigh, “it was the next morning before Martín showed up again. His eyes were all red and he was looking weary. ‘Is the baby dead yet?'” I asked him.

“‘Not at all.’ Martín said with a big smile. ‘He’s still got the runs, but he looks a whole lot better. He’s not dehydrated now. He’s begun to piss and shed tears.'”

“I couldn’t believe my ears. ‘You did a cutdown?'” I asked him.

“Martín shook his head. ‘No, I spoon fed him water.'”

“‘But didn’t he just vomit it up?'” I asked him.

“‘Oh yes,’ Martín said sleepily. ‘But every time he vomited, I gave him more. I gave him one spoonful of water with sugar and salt in it every 3 or 4 minutes all afternoon and all night long.”

“‘All night long?”

“‘All night long. I learned a long time ago that when it’s a matter of life and death, you can’t chance leaving it to the parents, no matter how carefully you instruct them. They either give too little or too much. You’ve got to do it yourself…'”

The French doctor paused and spread wide his expressive hands, “Voilá! So there you have it.”

“The baby survived?” I asked.

“Yes” said Mark. “Thanks to Martín and his patience and understanding.” He grinned at me. “So your village paramedic has taught me something I never learned in med school. As a matter of fact, he’s taught me a lot.”