Long before we see the face, we hear the crying. Mournful, broken, it expresses general discomfort more than acute pain. In it lies the anxiety of all those children brought here against their will, made to submit to the probing of pale strangers who speak an alien tongue. When the boy and his mother reach our station, it's clear what the trouble is: he has a lump the size of a quail egg over his right eye. An abscess, Nurse Cheryl says. She explains to me in English, and I to the mother in Spanish, that -although the abscess doesn't have to be drained, the child will feel better if it is. What isn't explained, to the mother or to me, is how much pain the procedure will entail.
This is an itinerant clinic, not a hospital. With the exception of a few cold packs, there's no anesthesia to speak of. It will take four of us to hold the child steady on the fold-out dental chair while Pete, the dentist, lances and drains the abscess. I'm assigned the ankles. Even before Pete has removed the scalpel from its package, the boy is bucking. He cries out to his mother across the room. He doesn't know exactly what's coming, but he knows that whatever it is will not be pleasant. It is said that expected pain hurts more than un-expected pain. Pinned down by four foreign adults, a boy might expect some pain.
I'm not watching, but I know when blade pierces skin. The boy's leg muscles lock, he shrieks. Mama! Pee-pee! Pee-pee, Mama! Pee-pee! Mama is crying, but quietly. She means to stay strong for her son. All the while, Pete is saying in a level voice, Almost done, now. Almost done.
And then it is done. Stitched up and bandaged, the boy is released to the arms of his mother. She holds him close, his cries ebb. He hasn't wet himself. The Americans return to their stations.
In the course of the week the clinic sees some 300 patients. Whenever the power fails, which is often, the team works on. My Dictionary of Medical Spanish proves a wise investment. This isn't recreational travel. When I nod my head and say, Si, entiendo, I have to mean it. It's easy enough to ask the patient how she or he feels, where it hurts, what brought them to the clinic today, but I will need to look up some of their responses, words like estrenimiento (constipation), erupcion (rash), sarna (scabies), superacion (discharge). I have always stood in awe of the science of medicine, the biology and the chemistry; now I'm struck by how much listening it involves. Before the science, there is basic human contact. There is asking questions and answering them. There is conversation.
The pharmacy dispenses quan-tities of antibiotics, vitamins, blood pressure pills, toothbrushes, birth-control regimens. Pete pulls scores of bad teeth. Some of the patients are diagnosed with diabetes, many as overweight or hypertensive. The team has noted an annual increase in these kinds of problems-the same problems they confront back home in the first world. Fast food, Nurse Barbara says. We're exporting more than dubbed sitcoms. Constipated patients are advised to eat more fruit, truck drivers with back pain are encouraged to reposition their wallets. With the benefit of a two-dollar pair of glasses, an elderly Dominican will read again.
Other cases make clear the limitations of a temporary clinic. The old woman whose right leg terminates at the knee with a tiny, malformed foot walks out the way she walked in-leaning into a weathered crutch, her diminutive foot steering the crossbar. An epileptic man, heavily scarred from unbroken falls in the street, collapses and seizes up on his way down the stairs. Patients presenting signs of cancer are urged to consult more sophisticated facilities, if they can. It's a big if.
Then there is Roberto, an 18-year-old with cerebral palsy. We meet him on the next to last day, when his grandmother, almost 80 and scarcely 100 pounds, brings him to the clinic in her arms. Outside, something had silenced the jostling crowd. When the old woman enters, we understand what that something is: in her arms she holds a young man whose body is utterly broken, stiffened in an attitude of disaster. His thin limbs and digits are locked in perverse angles; his mouth is twisted and toothless. With what strength she has left, the old woman shoulders him forward, as if in offering.
There is nothing medicine can do, but still the nurses gather round, the compassion that brought them to medicine picking up where medicine leaves off. Nurse Cheryl takes Roberto in her arms, cradles him, strokes his thin hair. Nurse Barbara and Nurse Maria hold the grandmother close. There are no pharmaceutical regimens to dispense, no patient instructions to specify. There is only the impulse to take on, for a moment, an old woman's burden, and soothe a stricken man with the tender touch of a stranger.