August 28, 2010. Isla Roatan, Honduras.
On Wings Of Angels
A few days ago we did a house call from the RBC Center to a lady who was 6 weeks post stroke. The family’s house was at the top of a 35-foot steep slope, and she had pretty complete right sided paralysis. Her speech and cognition were affected badly; she seemed unable to understand questions and had no speech. She had a permanent indwelling catheter, and could eat and drink when fed but her swallow was affected and she seemed to be aspirating a little bit (saliva or fluid entering the lungs). Like most elderly or infirm family members in the developing world, she was being cared for at home.
There was not much I could do to help her improve, although her stroke was so recent that it was impossible to say how much spontaneous improvement she might experience over the coming weeks. We told the family to interact with her as much as possible and Annee demonstrated passive motion exercises the family could do with her to help prevent contractures and blood pooling, and discussed turning and bedsores. We talked about signs of urinary tract infection (always a danger with permanent indwelling catheters). And the folks from the RBC center are going to try and help out. Overall, the prognosis was not good, but there is one thing this lady had going for her that many elderly patients in the US and Europe never enjoy.
In the US and Europe, the general tendency is to stick elderly family members in nursing homes and visit them occasionally, usually out of some kind of guilt or obligation. I worked in Care of the Elderly in Ireland and I saw it everyday. The first time I did a house call on an elderly woman in Africa, who coincidentally had also had a stroke, I was ashamed of how we treat our elders in the developed world. Here in Honduras, as in Africa and Haiti and everywhere I have been, older people live with and are cared for by family members in their homes. They do this for two reasons—first, because they have no choice; there are few nursing homes to deposit and forget elderly family members. The second reason is because the culture in most developing countries has much more respect for the older generation, and elderly people get home care and attention from their families simply because that’s the way it is.
The granddaughter of the elderly stroke victim hovered over her grandmother, stroking her hair and talking to her. The family washed her and cleaned her, emptied her catheter bag, fed her and talked to her and interacted with her. Lying there paralyzed, she received the most tender care and inclusion in the life of the family. There may have been no advanced tech available but this lady was being wonderfully cared for. And a week later, she got some of her comprehension and speech back, and some control over her right side mobility. With love and more care, hopefully she will recover enough to regain some measure of independence, but if not I have confidence in the care I know her family will provide if she remains permanently disabled.
The RBC Center, para los ninos con incapacitados, is staffed and run by people who have extended the kind of care they would provide a family member to the kids and people in the community who have cerebral palsy, have had a stroke. Ashleigh has been there nearly every day she was with us, providing Occupational Therapy and Physical Therapy and helping the clinic workers learn new techniques of therapy.
I am amazed, and very proud of what Ashleigh has accomplished at the RBC Center. She and Annee started a Yoga class for the mothers of the handicapped children, many of whom have bad backs and joint pain from carrying their immobile grown children everywhere. The women who come to the center love the class; one 57 year old woman said it was the first time she had ever exercised, and she was so proud of herself. Peggy from Clinica Esperanza gave us a couple of children’s walkers, and a few days ago a 7-year old boy walked for the first time, and a 9 year-old boy wrote his name for the first time.
Ashleigh does movement therapy, sensory therapy, passive massage; pretty much everything—Supertherapist! Fridays are my favorite day…on Fridays I always go to the RBC Center and see patients, young and old. I treat a lot of gastritis and arthritis there; the moms of these kids have lots of stress and physically challenging lives. But on Fridays, when I am there seeing patients, I get to see what Ashleigh and everyone is doing—giving attention to the children, giving the mothers a desperately needed rest from the constant care they have to provide, helping people get their mobility and independence back. Annee, Sky, Noah, Sirin, Rachel, and Nick have spent many days working with the people at the RBC., and I love when we get to all work in the same place.
It is wonderful what can be achieved when you are helping somewhere long enough to learn the lay of the land and what the real needs are, and make the friends and connections necessary to undertake more ambitious projects. Of course, you also need outstanding individuals like the volunteers that have come out to help us. Ashleigh was amazing in action; when she went home it was a sad day for us and also for the clinic staff and patients and families.
The clinic closes for an hour at lunch, and we usually walk down the road to our friend Sherman Arch’s Iguana Park. Sherman is caracol, meaning of white descent but an islander who speaks the patois of the island. He is second generation here, and on his property iguanas are not allowed to be killed, so over the decades they have congregated. He takes in rescue animals, including monkeys and coatimundis, and does turtle rescue. He often feeds us at lunch and sometimes gives us rides back to the boat in his truck or the 37-foot skiff he made himself. He has been enormously kind to us, esta un bueno hombre, another angel we have met.
High in the air during a night flight across the dark ocean a week or two ago, I suddenly remembered a story I read years ago that seemed appropriate for the moment. It happened on the way back from a patient transport in the helicopter to the mainland, and I was sitting in the back thinking about what Floating Doctors became after starting so long ago as a decision made on the plains of East Africa, when I decided to go back to the developing world with more help. I contemplated the path we followed to make Floating Doctors a reality; I thought of all the heartbreaking setbacks and the glorious triumphs that were achieved by the goodwill of people who seemed to come out of nowhere to help pick us up when we fell, and encourage us to keep going, and who worked side by side with us.
The story I remembered is about a man climbing a tall, steep mountain in his dream. After a desperate struggle, he makes it nearly to the top…then falls. The story says that when it comes to the dreams perched high atop the mountains of your mind, it is sometimes a mistake to climb to reach them—but it is ALWAYS a mistake never even to make the attempt. If you climb, you can either succeed or fall. And sitting there in the helicopter, thousands of feet above the dark, luminous, serpent-haunted sea, I understood in a very literal way the third option mentioned in the story: sometimes, when you fall during the climb to reach your dreams, you find out you can fly.
There have been many angels who caught us when we fell and who helped Floating Doctors continue forward. I know I talk about it a lot, but I don’t care. I wanted to thank you all again very much, and to know how much it means to me that you believed in us and helped us and worked with us to make Floating Doctors fly—both in spirit and, riding the clouds over the gulf of Honduras, in literal fact.