| January 31, 2005 |  Patients arrive by the truckload on the first day of clinic at Hacienda San Carlos |
 Patients wait outside the hacienda gate for their turn to enter the clinic
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We arrive to find long lines of people already waiting patiently in the morning sunshine. Sister Margaret Jane goes down the line, greeting everyone, cuddling children, welcoming them to the clinic. Everyone who has come for treatment is dressed in their best clothes; one woman is wearing high heels and a black velvet dress, a newborn is resplendent in a green frilly dress, knit cap and baby booties, bright red. And we are looking bright and clean ourselves, in our brand new PazSalud t-shirts. |
| Treatments begin. Rod treats a gentleman who grunts in pain as he cleans the wax from his ears. Dale tells a woman she is a wonderful grandmother for caring for her grandson and bringing him in for what turns out to be a serious condition. Kathy Garcia fills a prescription for a woman with a dental infection. A smiling woman gets a demonstration of the proper way to use her new reading glasses from Alicia. |  Dr. Rod Beaver and patient |
 I enjoyed watching these gentlemen try on each other's sunglasses; they laughed, and I laughed too. |
A group of gentlemen stand in a circle, comparing their new sunglasses and laughing. Little girls are smiling as they finger their new beads, two little boys shout with delight as they race their new matchbox cars in the dirt. One child has pneumonia. Rod demonstrates to an elderly gentleman the best way to lift heavy objects without injuring his back. The ‘figurine’ eye chart is being used with some frequency. A little girl and her grandmother on the eye care line charm Barb. Jonathan is pleased to see a long line at gynecology, which has not been the case at previous clinics. |
As lunchtime nears, the pediatric line becomes a giant moving picnic, as mothers buy food to keep the little ones happy. Local vendors outside the gates are selling ice cream, pupusas (stuffed tortillas), cucumbers, and shaved ice and are very busy. We take turns breaking for a delicious lunch. The break is welcome and much needed.
The crowds are not letting up, and it is hot, trying the patience of even the tolerant Salvadorans. People are getting tired and cranky waiting for eye care, and the line for pediatrics and general medicine never seems to get smaller. More strings are going up in an effort to make the lines more orderly, as frustrated people try to move ahead. Exhausted children are napping in the shade, their best clothes covered with dirt. I decide to stop taking afternoon photos, for although it helps distract the children, I don’t want to add to anyone’s frustration.
I recognize one woman; she is wearing a top with one shoulder strap. I had taken her photo outside the gates this morning. She and her baby have made it to the pharmacy. It’s almost 6 pm. She is clutching her bag of medicine, bouncing her baby, smiling. Another problem has arisen; many of the patients come from towns that are a great distance from El Paisnal. They came in groups on buses, and were supposed to be seen first so they could start the long journey home. It has not happened and now in late afternoon Sister Eleanor has to help these families get to the front of the line so they don’t miss their bus. With the lines still long this is not too popular. While in pediatrics, I am approached by an older woman, who is politely telling me something that is obviously of great import. Lesley interprets; we learn that she and her family are from Torredor, far from here, and she sees no one else from Torredor still at the clinic and is worried they have missed their bus. I inquire at the front gates and learn that, yes, the bus has gone. Lauren treats the four children in pediatrics and Jonathan gives me the Ok to get their prescriptions filled quickly so they can start the long walk to the market, to wait for an evening bus. But there’s a hitch; the elderly woman wants her daughter, the mother of the four children, to see the gynecologist but getting her in to see Dan ahead of the others is just not possible. Jonathan and Eleanor explain this to the family, and they understand…and say they are coming back on Friday. They have been here all day and are coming back again. They are not upset; the older woman takes both of my hands in hers and thanks me over and over again for helping them. Her daughter does the same, as does each of the children, except for 2-year-old Dolly who is tired and wants to take her new little stuffed animal and go home. They tell me they will look for me on Friday. Even if I could speak enough Spanish to tell them how I feel, I think I would be at a loss for words.
| We thought it was hectic, and we were right. They registered well over 700 people for today’s clinic, no other Paz Salud clinic has seen this many people in one day. Eleanor said they ask the local authorities to limit the number of people registered to 200 – 300; since most patients visit more than one doctor that would be about 600 consultations a day. With this many people registered, the number of consultations done in this one day is staggering. |  Despite the heat and crowds, this handsome couple stayed calm and composed |
It is now 6 pm, and the ends of the lines are finally in site. Everyone is dirty, sweaty, exhausted and happy.
It is now 7 pm; all clinics are still treating patients. The gates have been closed for hours but people still wait patiently on each line in the dark; pharmacy is of course the longest line since it’s the last stop for everyone. I’ve checked in with each specialty, and everyone repeats the same phrase, don’t turn anyone away. But Dale jokingly says he wants to double his salary!
Nearly 8 pm. General medicine and pediatrics join forces to treat their last patients, eye care is shutting down, and gynecology is almost done too. All remaining patients are at pharmacy. More than 60 people crowd around the tables clutching their prescriptions, eagerly thrusting them into the hands of anyone wearing a now grubby Paz Salud t-shirt.
Finally on the bus, 9:15 pm. They are holding dinner for us at the restaurant, and this group will definitely want mucho cervesas. Conversation on the bus turns to medicine, as the doctors compare stories of patients they treated. As exhausted as everyone is, there is a feeling of great satisfaction from having helped so many in so short a time.
Dinner was excellent. We feel somewhat spoiled by the amount of food we are offered. Dinner discussion concerns ideas to make the clinic run more efficiently; move a general practitioner over to pediatrics to treat the parents? Block off certain areas to ensure a more controlled traffic flow?
It is almost midnight when we walk back to our hotel; along the way a small contingent of heavily armed officers appear on a side street; Sister Eleanor chats with them pleasantly for a few moments. It was a quiet moment, but a little unsettling.