The Poor Endure

Poverty looks the same all the world over: tin roofs and tarps, panhandlers and street-side vendors; wood smoke, diesel exhaust, trash burning; something rotting somewhere. Emaciated, short-haired dogs darting across the road—or sleeping in it. A ragtag fleet of vehicles, a collection of spare parts rather than a singular vehicle. A family of five rolls by on a moped. Chickens pick through roadside trash. Old school buses rumble through impossibly narrow streets. Clothes hung out to dry. People walking, often without a particular urgency or destination. Tiny store fronts selling snacks and soda, but no one buying. Footpaths disappearing off into a maze of cinderblock dwellings. Randomness is the dominant architectural theme: it looks this way because.

Last October I traveled to Guatemala with a surgical group. On our first day, Sunday, people from out in the country—some as far away as a 12-hour bus ride—found a chair in the hallways of the rooftop clinic of a local Catholic hospital and mission. The cinder cones of three volcanoes—Agua, Fuego and Acatenango—supervised our work and loomed over the valley, a constant reminder of the power of time and history. Everything is change, particularly on a fault line.

These people were screened weeks or months earlier, at home in their villages, to see if their particular health problem had a surgical solution. They were here now to confirm that the proposed surgery would be the fix, and to make sure they were healthy enough to tolerate anesthesia and the operation.

We had a general surgeon, two obstetrician/gynecologists, a reconstructive and hand surgeon, and the anesthesia and operating room staff to make it all work. They had stone-filled gallbladders, disfiguring scars from childhood trauma and burns, pregnancy-worn uteruses and sagging bladders, fused fingers and extra fingers (a vestige of the local gene pool). For people who labor, hernias—a weakening of the abdominal wall—seem to be as common as arthritis.

In the pre-operative clinic, these prospective surgical patients were nervous, wide-eyed, and resplendent in their best clothes, the details of which are often specific to their particular region. We ran around cackling, trying to get everyone into the right room with the right interpreter (some of the most rural patients spoke only K’iche’, a Mayan dialect). The locals remained calm. They can be patient. They have been waiting for a long time, maybe all their lives, and time is the only thing they seem to have plenty of.

After surgery, later in the week, they were grateful and stoic. If they were in pain, they did not complain, and their blood pressure and pulse (which rise with adrenaline) often did not betray it. They are used to putting up with things.

Everywhere, all over the world, the poor endure.