“If It Isn’t Fun.” – A Special Night in the Tropics
Garfield Evans brought our entire clinic team to the Oriente hinterlands for a full day’s tour of the United Fruit sugar plantation and for a night in a jungle hammock at the rambling hacienda of Don Thomas, aka Mr. Townes. The Don, a native of Georgia in the States, after serving as foreman at the mill for many years, has become famous as a fruit and flower cultivator. At 85, he seems forgetful, childish, and sometimes belligerent, but his presence remains commanding, matching his leathery face, immense sombrero, and intense concern for the well-being of the sugar workers. He showed us first-hand examples of bagassosis, the lung disease caused by prolonged exposure to an atmosphere heavy with microscopic cane fibers, or bagasse, the residual after the juice is pressed. But the locals say that Don Thomas is probably deluded about having discovered a rare mutation in an orange tree.
Following a tour of his grove and rose garden, our host served us by lamplight a pleasant evening meal of which I recall only the broiled plantains; much too acid and acrid for my taste. Then we chatted quietly on the porch of his extraordinary dwelling perched high on stilts. It utilizes traditional tropical architecture of French windows and a ceiling vent for circulation. He regaled us with plantation stories that I no longer recall, after which we each made a quick trip to his very ordinary outhouse and then retired.
In my elegant high-ceilinged bedroom, I lay enchanted, in a four-poster bed under a billowy canopy of mosquito netting. The tropical stillness was broken only by the occasional squeak of a windmill, a birdcall, or the thud of over-ripe mangoes dropping from great heights. I dozed off to the soft slow beat of my ceiling fan. This morning we loaded up with fresh limes and mangoes proffered by our eccentric host as we bade him adieu.
En route to the clinic we were called aside on an urgent consultation to a nearby country home. There a young father complained that he was troubled, among other frightening hoodoo persecutions, by voices he had begun to hear in the fields. It turns out that he also has very real grand mal seizures. Apparently, in a trance state, he has made homicidal attacks on colleagues. Four well-kempt children played about the clay floor that was still soft from recent showers. Water coursed directly through the house; there was no attempt at trenches. The common room contained two beds for the family of six. I saw no outhouse.
My medical experience was clearly inadequate to be any help.
Down the road, we visited the home of a local nurseryman, one of many in this region who have apparently been made self-sufficient through the benevolent influence of Mr. Townes and his introduction of new varieties of fruit trees and flowers. A pallid young woman emerged from a side room where her 27-day-old babe cried weakly. By custom in this rural area, women must stay in a darkened room for 40 days after childbirth, presumably to insure the infant’s care but also to segregate the mother from other wifely obligations until she is fully healed.
We are now settled for a period in our main missionary dispensary back in Holguin, a trying place to work in day after day. I see 50 to 60 indigent patients a day, three days a week, and make home visits on other days. This means that I will care for more than 700 people in the course of my summer visit to Cuba.
X-rays, stool exams, and drugs are paid for by the mission or in part by the patient if he is able. Patient compliance is poor, presumably out of ignorance, distrust, and poor support at home. The soluble problems, malnutrition and intestinal parasites, are the more common ones, but nowhere are they addressed effectively.
For example, it is useless to treat one child in a family living in bohios having dirt floors. This should be handled by treating all in the family, then repeating the treatment after two weeks to take care of reinfection from the dirt floors, and followed up by a yearly family-wide treatment thereafter. These simple steps, plus sandals and wood or concrete flooring, could change the whole bleak picture of growing up for rural Cuban children. Their nutrition could also be vastly improved using locally grown foods now shipped to larger markets, that is, chicken, leche de baco (goat’s milk), legumes, bread, bananas, and citrus fruits. Instead, the tradition here is to feed children mainly refined cornmeal or rice.
Guisa is a village of 1200 in the foothills of the Sierra Maestra, the more Godforsaken of all villages we have visited so far. Again I am staying with Dr. Santiago Bueno, educated at the Sorbonne and in Pennsylvania and Havana. His Pennsylvania-born wife seems less than well-adjusted to her admittedly poor situation, while the doctor is a saint whose beatitude is stained only by a touch of disillusionment. He is very astute and practices medicine carefully, empirically.
We saw today a newborn with a testicle in the perineum, a female child with anasarca presumably from nephrosis, and a boy in the 19th day of typhoid infection, his clinical diagnosis based on a persistent afternoon fever and brown-coated tongue with red margins, but without lab. confirmation. There is great difficulty getting the family to feed the patient adequately, or to administer the chloromycetin we provided. Isolation is non-existent.
What a wretched life it must be for Dr. Bueno when his own people place more confidence (and reward) in the hands of spiritualists than in such a good man.