Ni modo...?

Hi everyone,

I realize it's been a little while since I last wrote, and I think that has been for two reasons:  I haven't had the time to do so, and I haven't known what to write about!  The latter is not for lack of material or experiences, just my ability to make sense of them.  (This situation is made worse, of course, by lack of time to stop, think and write.)  So today, hopefully I am breaking this vicious cycle and teasing out some experiences of the past week.

The students have been in their praxis site for almost two weeks now -- half of their time here!  The time goes by really quickly; one month is just enough time to get your feet on the ground.  The hospitals I think are really challenging the students..  There is an overarching lack of respect for human dignity, and the sites they see sometimes leave them reeling.  The hospitals are seriously underfunded (1.5% of El Salvador's GDP goes for health care), which translates into a serious lack of supplies and medication for patients.  During one of our site visits, for example, we saw a patient in need of a ventilator being kept alive by hand by a medical student pumping an oxygen bag.  Simply, there was no ventilator to use.  (Or, someone did not think it worth it to bring one to the patient's side.)  Another time, a friend who is a medical student here told us of a procedure to remove glass shards from a patient that, without tweezers available, had to be taken out by hand.  Her resident in charge that night, she said, had instructed the interns to do whatever they needed with the patient; he didn't want to have to deal with it.  Tweezers?  Needless to say, without these most basic instruments available, more sophisticated technology is mostly out of the question.  "Here," she said, "you learn to diagnose with your hands and your eyes."  This student is learning to gauge liver function by comparing the color of her skin to the color of patients' skin to test for jaundice.  Students another day were called over to a patient's bedside (who was "skin and bones") to help put is adult diaper on correctly; the nurses, he said, hadn't done it right and he couldn't wear it.  

In and of themselves, these examples seem....  bearable.  So you make do without tweezers, find someone to pump the oxygen bag, adapt your diagnosis skills...  But what is it to constantly concede the ideal for the mediocre, or worse?  To always go slightly without what you need, to always compromise, to wait and have your ambitions be derailed?  I feel like in the reality of El Salvador, this is what happens at every turn.  Annie and I were talking about this a few days ago; those seemingly benign and inevitable moments of resignation that we see every day.  What sparked the conversation was a friend traveling out to see his mom; there had been two assassinations that afternoon just feet from his family's front doorstep.  The bodies of two vendors had been left for the community to see.  It's a challenge for his family (who is raising five children) to live there, because now, to see or hear a crime is a danger.  Witnesses easily become victims.  In the conversation before he left, he said "Pues, ni modo.  Asi es la vida."  (It doesn't matter anyway; such is life.")  Ni modo...  Ni modo...  the expression is too common here, a bottom line.  

I stopped to think about this, and asked Annie later, after he had left, "Can you imagine if there were two murders outside your front door?  What would your family do?  How would you deal with it?"  Undoubtedly, for many of us, it would rock our world.  We might even move.  But in my friend's community, these were the second and third assassinations this week.  His family doesn't have the resources to move.  Ni modo. 

And I feel the need to clarify here: the friend I am speaking of is not an individual inclined to resignation.  On the contrary, he is one of the most hard-fighting, committed individuals in the country that I know.   I take his statement above therefore as a reflection of the powerlessness and vulnerability that characterize the matrix of poverty, and not his own sense of fatality.  More subtle than corpses in the street - and perhaps more insidious in its own right - the frame of mind that a chronic lack of resources creates is really one of the hardest monsters to fight.  In the field of psychology  this is called learned helplessness (one of the few terms I remember -- ha!).  The keyword here is learned.  When a lack of resources forces people to concede fulfillment of basic needs and rights  -- physical and mental safety, ample medical care, food, opportunity for growth -- at every turn, material poverty teaches the notion that what is in front of you, right here, right now, is all that there is, problems without solutions.  Don't ask, the answer is no.  There are no extra funds, no tools to make the diagnosis, no extra food, no other options.   How many chances are missed to make small improvements?  I think that this is the saddest type of violence - the one against the human spirit that teaches people not to fight for themselves, and others, to secure life.