Although it will not be reflected in this writing, translating for this medical mission was one of the most profound experiences of my life. I have no medical background, I’m just a guy that can speak the local language. But that put me dead in the middle of women learning their young daughters are being molested, an old woman finding out she had a throat full of melanoma, liver and congestive heart failures, suspected prostate cancers and a endless progression of STDs. I was as much a councilor to these people as translator. A large percentage of them, especially the older ones, could never afford medical attention of any kind elsewhere. That is why they got in line at 4am and then stood there for the next 6-8 hours. For the first 2 patients my Doctor saw, he scribbled up referrals. I told him to stop doing that because they are never going to see that other doctor. This is it. They have no money. We’ll have to do what we can for them and then send them back out into the world, with or without improvement.

         As the day would progress, the temperatures would soar and people in line began fainting. A little 3 (or so) year old girl with an already extreme fever went into seizures in the hot sun. We ran her into a room and poured bottled water over her while the doctors cleared the foam from her mouth and did doctor stuff. It was touch and go, but she lived. In our more cynical moments, when we became frustrated at the magnitude of the problems versus the child’s play medicine we were capable of doing under the circumstances, we had at least that one little girl that we knew would have died had we not been here.

         In the beginning, each patient was a human being. We investigated every complaint and sent them packing with detailed explanations about the specific states of their illness, plus whatever medicine/advice we could give them plus referrals and prescriptions just in case. However, we soon realized that it was a waste of time diagnosing people intricately. Yes, they felt much better learning for the first time exactly what has been plaguing them all these years, but they would never follow up on it and the longer we took with each patient, the more people we would have at day’s end who had stood in line all day and not been seen. So we lowered the bar. Terribly at times. The lectures to women about STD’s and brothels dried up. Our patience for prudish euphemisms and beating around the bush about vaginas and constipation ran out. We came to grips with the fact that we could do little more than throw Motrin at most problems. Patients stopped being treated quite so human. We began rushing through legions upon legions of patients and they still never ran out.

         In addition to the discouragingly scant health improvements we knew we were causing, we encountered massive amounts of made up complaints from people seeking free medicines. Even people with real complaints would throw in a few fake ones at the end. As this whole medical mission was ultimately just a big PR stunt, we were not really allowed to tell people they couldn’t get their freebies. Yet each day, we would run out of medicine before we got through all the patients. We knew that much of our medicine was going into the hands of fakers. Wait, I might not have ever said why this mission is little more than a PR stunt. A while back, the US and Ecuadorian military were conducting some kind of joint exercise on the island of Puná, the story goes. Some local kids later found 2 unexploded grenades and took them home to play with. They were throwing them around the house when one detonated and wiped out a family of 5. The Ecuadorian military “took the fall” (those are the exact words the Navy Commander said to us) for the incident and now the US military wants to return the general vicinity to do lots of high profile good stuff so the locals wont build up anti-US sentiments. That’s sort of the Peace Corps secret reason for existing as well (however, I dare you to find a single “patriot” among PCVs. We ain’t on board). Anyway, the true mission of the medical exercise was to give lots of free stuff away and look good. In spite of how that came into direct conflict with all of our natures, it is eventually the level we stooped too.

         So the above stuff was just general medicine. Over in dentistry, they were ripping out decayed teeth. People were only allowed to have 1 tooth pulled. Other problems such as cavities had to be ignored altogether. Even fully decayed and abscessed teeth 2 through 25 had to be ignored. You were given one complaint only. The dentists all spoke Spanish and needed no translators. They were all either Ecuadorian, from Spain or South Texas. Pediatrics was really boring to translate for. Children visiting doctors fully lack personality. Concerned moms are tiresome. Most of the kids had nothing wrong with them. Nothing but a cold or something. As kids haven’t lived long enough to develop the myriad of human maladies suffered in Ecuador, their few true illnesses are always from among the same 2 or 3 complaints. I did next to no work in Pediatrics.

         Ophthalmology was a great place to take a break from General Medicine, and vice versa. The Lion’s Club apparently collects mass amounts of unwanted eyeglasses in the US. The glasses are then zapped by a machine that can tell what prescription the glasses are, the glasses are put in a ziplock bag and labeled with their prescription, and then the full gamut of prescriptions is assembled from negative 4’s to the positive 4’s plus a number of outliers in the 5’s through 10’s. I do not need corrective lenses so I did not know anything about positive or negative prescriptions nor that the Lions club collects glasses. But it’s a great service the Lion’s Club is doing. One never thinks about how unaffordable glasses might be to poor people in the developing world. One probably never thinks about anyone going decades without addressing their blurry vision. Imagine that you’ve gone so long- your whole life perhaps- with blurry vision that you don’t even remember that vision could be any other way. Then you go to a free eye doctor, they zap your eyes with a laser gun that can read what prescription you need, and 2 minutes later someone plunks a pair of glasses on to your face that wipes away 50 years of foggy vision. Never mind that those glasses are giant Sally Jessy Raphael glasses from 1984, you can see and that is damn exciting. I cannot not tell you if UNICEF or the WWF really do all that much actual good in the world, I would say its debatable whether Plan International is using its donors dollars effectively, I couldn’t even tell you if the Peace Corps makes effective use of its $330 million worldwide budget, but I can tell you that whatever the Lion’s Club is paying to work this eyeglasses gig is money VERY well spent.

         Until you would encounter some mumbling imbecile that would wear you down through 10 minutes of contradictory feedback on whether or not they could see clearly (the laser gun did not always hit the nail on the head and we spent lots of time testing out neighboring higher and lower prescriptions and saying “can you see better with these glasses or the last pair we tried”), Ophthalmology was pure pleasure to work in. When it wasn’t someone being overjoyed when the correct prescription fell before their eyes after years of blurry vision, it was constant shenanigans and play, both with the really cool eye doctors and with the patients. My favorite gag was to present fairly “with it” individuals with the most ridiculous 1980’s fashion victim frames I could find and then deadpan while they eyed the glasses in silent horror. Then I would prod them to get them to say or do something amusing from their awkward predicament and then ultimately I pulled out the real glasses while we all laughed our asses off at the prank. I taunted people endlessly with ugly frames but then secretly bent the rules searching the boxes for acceptable frames, for young women especially, because it’s important for them to feel attractive. Ophthalmology was great. It was pure play. One almost never gets the opportunity to tactfully joke with hordes of giddy strangers. One almost never gets to be present at such a crucial moment in the evolution of a person’s self image, which they can so positively affect by dropping a well hewed compliment about their new look. Over and over and over. Ophthalmology was the bomb. But then, so was General Medicine.

         Dermatology and Vaccinations were entirely Ecuadorian and needed no translation.

         Due to our inexperience in managing our numbers of patients, triage and registration had let too many people in to the schoolyard before the front gate was closed. For this reason we had to keep working until around 6pm. Then we all boarded our Military bus and cruised back to the hotel. After showers, we held a meeting on how we could improve our performance for tomorrow and the future. Then we all ate in the hotel restaurant. After eating, we trickled off to bed one by one.

         I was woken up sometime around 11pm by the hotel manager coming to get me for a phone call. Ela was on the line. She was trying to make it down to Playas to join the medical mission but had hit 1000 snags along the way. She thought she might be able to make it to Playas by tomorrow night.

         At the end of the day, someone did something to touch off a mini riot in front of the Ophthalmology door. It was our last day of free medical attention in Playas and a bunch of women already inside the compound but without any paperwork from registration were desperate for glasses. The mini riot must have been a gringo’s fault. An Ecuadorian guard would never have let it get to that point. A bunch of random glasses were thrown out the door and the crowd of women were largely pacified, save for the handful of lowlifes that can never be satisfied as long as lying and whining and persisting after being told ‘no’ may still net them something free.

         We all returned to the hotel. One of the Ecuadorian dentists had been placed in Ed’s and my 2 bed hotel room. We busted in on him changing when we arrived. He had not known anyone was in our room (despite our baggage?) and we were very surprised to discover him in our room. He left to find out at the front desk just what the hell was going on.

         A large number of people wanted to go back into town to eat. I wasn’t sure if my per diem could be used outside of the hotel restaurant and since I was tired and the Lomo a la Milanesa in the hotel restaurant was so good, I felt no big push to hunt down food in town. The only other person to stay back at the hotel was the very strange and sort of mean Chinese Ophthalmologist. I was unsure whether I was disturbed or delighted when she walked into the empty dining room and pulled up a chair at my 2 chair table. By the time we were done eating, I was still not sure.

         Ed, the EcuaDentist and I ended up moving rooms to a triple. I intercepted Ed in the lobby when he returned from town to let him know what had happened. That’s when the phone rang and was handed to me. Ela calling. It was her 4th call. She had been told each time she called that I was out with the group that went to town. The jury was still out as to whether or not she could make it down to Playas.

         When the doctors wanted me to ask what had happened to him, the kid mumbled vaguely and evasively. We persisted and asked him yes or no questions pertaining to every possible way he might have damaged his arm. He said ‘no’ to every proposed scenario, claiming his injury had “just happened little by little”. I looked into the kid’s face; he did not appear to be altogether “in there”. I told the doctors I thought someone was possibly kicking his ass and refusing to let him get medical treatment. Something about the way he too readily responded to positive attention but never made eye contact or gave direct answers, reeked of abuse. Why didn’t he just invent a harmless scenario to pacify us with? The kid said he had been to a doctor once but had refused treatment because ‘they wanted to cut him’. Of course now his options have likely become, due to neglect of the situation, amputate the arm or die. The doctors were surprised the infection in his arm had not done him in already. There was little we could do for him. We sent him away, either to die or to become a medical miracle.

         I was pissed at the nasty box lunch I was given at lunchtime, so I walked into town and bought food.

         After we were done for the day, and back in Playas, I went out to a restaurant in town with the rest of the group. My per diem covered it. I was wiped out and worthless for any conversation. After eating, the group had our bus driver search the town for an internet place. Everything was closed.

         Back at the hotel, the Spanish doctor, a general medicine doctor and I hung out on my room’s porch until 10pm. Ela never showed, nor did she call.

         After we finished the medical stuff for the day, we piled into the bus and drove to the docks of Pasorja to check out and load our medicines onto the boat we would be using tomorrow to go to the island of Puná. The boat was not there but lots of happy dolphins were. We rode back to the Hotel. Ed and I did held our usual discussion about how messed up our respective days had been and then we went to eat in the hotel restaurant. Then to bed

         The dock in Puná was full of locals come to await the medical mission’s arrival. Numerous locals were loaded up with boxes of medicine and a large caravan of us wound through town to the school grounds where the event was to take place. The day was begun with a flurry of super bizarre medical ailments, such as elephantitis, crazy rashes, atrophied muscles and rotten flesh. The doctors took pictures of many ailments they said they had never seen before in real life. Puná, is little more than a town on a large, fully undeveloped island. It is markedly hotter and more humid than Pasorja and Playas and very isolated, it would appear. There is a 4 hour ferry ride from Puná to Guayaquil once a day, but based on the numerous untreated and uncommon ailments we saw, the ferry ride does not appear to help much with the island’s isolation.

         We ended the day at 3pm. I was tired and everyone was pissing me off. The stupid locals had been whipped into a frenzy by the end-of-day-freebies, such as all the hand soaps and toothbrushes we did not need to take back with us, and were behaving like a bunch of animals. The stupid gringos, for their part, would tell the rudely persistent throngs of kids “No more freebies! Step back!” for 5 straight minutes and then give them more freebies, ostensibly to satisfy them and get them out of the way. Of course, giving them freebies after telling them ‘no’ for 5 minutes only taught them to ignore the word ‘no’ because with persistence the freebies came anyway. The more the people crowded in and obstructed our packing up supplies, the more the stupid gringos tried to pacify them and get them out of the way with more freebies. The scene devolved into confusion and chaos with communication becoming next to impossible. No one listened to me screaming to quit giving freebies if you want the crowd to back off. Confused kids, frenzied by the free-for-all, openly tried to stick their hands in my pockets. I threw them aside without a word. I was livid with the all around stupidity and was on the verge of creating some medical problems for every local that cast a glance at me.

         As the boat pulled away, youths on the docks demanded freebies and tried to tell us we were “bad people” for refusing to give them stuff like our watches. This is the kind of situation handouts create. You get an idiot culture of dependency, like Tambo, where no one will never attempt to do anything without a ridiculously generous handout from an NGO. In Puná, you are called a bad person if you do not sweeten your free medical care with a free watch*. I hoped the dock would collapse and take all those human pieces of excrement and their ingratitude to the bottom of the ocean.

         Almost everyone fell asleep sprawled all over the boat on the way back to Pasorja. Once back on dry ground, we attempted to buy 60 lbs of shrimp from the shrimping boats that unload in Pasorja, but none had yet turned up. We headed back to the hotel to do nothing of great interest for the rest of the night.

*Which is not to suggest we gringos are immune. In the US, parents create little monsters by similar means. The more freely you give, the less you can expect gratitude.

         Our first stop in the peninsula was the fish market in Libertad. The group was again after their 60 lbs of shrimp. When they saw what as being offered in the market, they opted to just eat at a restaurant in Salinas instead. I thought this was a fine idea. When we dropped Lonne and Sally off at the mall (because it was on the way to Salinas and the duo wanted to check their mail before going home to Olon for the weekend) the group of Gringos decided they wanted to hit the mall too. Another fine idea. I tried to make a call to Julio from the mall’s phone cabinas, but the phone lines in Tambo were still having problems. I had been trying unsuccessfully to call Julio since the 2nd day of the medical exercises. I had gotten through on the 1st day to tell him he could come out and get reading glasses, but he did not know, for whatever reason, if he was going to be able to make it. I told him I would call him back to find out if he was coming and to tell him how to find us, but never again got back through to him. I also tried to call Ela from the mall’s phone cabinas, but there was no answer at her house. Neither was there any email explaining why she had never shown up. That was unsettling.

         I bought a roast beef sandwich in the mall food court because it was 2 pm and I did not know how long it was going to be before we would have our real meal in Salinas. Our real meal, as it turned out, was the very next thing on the agenda. However, instead of going to the superb quality restaurants on the beach, the bus dropped everyone off at the worst, filthiest EcuaEstablishment it could find. I did not know this dump even existed in Salinas. A fly infested, sticky spilt soda encrusted, plastic table and chair picnic area lookin’ DUMP. Street animals scavenged beneath tables. Luckily I had just eaten, so I skipped the free meal and went off looking for a phone. This time I called Lorena. As it was Saturday afternoon, I knew that at any minute she would be leaving her job in Libertad and going home to Tambo. I had brought with me a backpack full of extra stuff I was planning to ditch the group of doctors and take home to Tambo so I wouldn’t have so much stuff when I left Playas at the end. But I had changed that plan to handing that stuff off to Lorena, who was much closer to me than Tambo. Lorena said she would be leaving work in about a half hour and she could meet me wherever. I told her I needed to first go to the naval base in Salinas so I would know where to catch up with the group again before the bus went back to Playas. Since I didn’t even know if it would be possible to leave the base in Salinas and return, I told her I would call her back on her cell phone when I found out more.

         At the naval base, the bus went through so many security checkpoints and made so many disorienting circles that there was no way I could have ever hooked back up with the bus even if I could have cut out to Tambo. I was on my way to find a phone to call Lorena and tell her to forget the whole deal, when I encountered….. Lorena? She had somehow managed not only to get into the naval base, but to find me inside the massive complex. I think she had bribed someone leaving the base with a box of wine to get her inside and drive her around the base until they found me. She brought her coworker with her. I had no idea what the hell was going on. It took a long interrogation just to get something resembling an explanation put together and even then I wasn’t sure it was altogether truthful. Lorena, her coworker and I sat down on the beach somewhat near where the doctors were playing on the beach and I told them my tons of medical yarns that I had accumulated in the past 5 days. Our conversation was still going strong as the doctors began packing up their stuff. It was still going strong as the doctors began boarding the bus. When the last doctor boarded the bus, I said I had to go and climbed in as well. Long after the bus pulled away from the base, I realized that I never given my backpack of stuff to Lorena.

         The bus then made a 2nd stop at the mall. I attempted to call Lorena there on her cell phone in the off chance that we had beaten her to the mall, which she would have to pass on her way to Tambo in any bus. If I could catch her in time, I could still hand off my stuff. The reception she was getting inside the noisy bus was horrendous. She couldn’t hear anything I was saying and told me to just call her back when I got to Playas, which would hardly have been necessary by that point. About an hour later, we all re-boarded the bus and headed back to Playas in the dark.

         Jimmy told us that the part of Ecuador where one finds Playas (much, much greener than Tambo, incidentally), had been considered a dead and worthless place by indigenous folk for eons. Then, during a period of lots of wars and general head smashing, tattered bands of vanquished tribes began trickling into the area fleeing certain destruction. These people, in turn, began fighting and smashing each other’s heads. The P.O.W.s of these conflicts were taken to a rock formation, thought to look like a giant dead guy on his back, where their heads were duly smashed and blood drank.

         The rock formation, which would only look like a dead guy to people bent on smashing each other’s heads, was considered a very sacred place by these people of antiquity. Therefore, predictably, the site has since been hijacked by the catholic church and the obligatory Mary and Special Edition Postpartum Jesus statues erected. We hiked up a long staircase to the rock formation, had our pictures taken next to Jesus, remarked about what a nice view we had from our little observation platform, privately cursed our out of shapeness and then piled back into the bus.

         The next stop (if you exclude all the churches and crap along the way) was the dock from which dolphin tours disembark. Half of us were giddy with the prospect of petting dolphins from a boat, and the other half of us were old fuddy duddies who wanted to retreat to the hotel and sit on our big fat asses. As the dolphin faction among us had not come properly attired to be cooked by the equatorial sun out on the ocean, we all agreed to drive back to the hotel to dump the fuddy duddies off and grab dolphin viewing hats and sunblock. However, we made a little stop along the way in Playas to eat lunch. After lunch, the dolphin faction crapped out and betrayed the friendly little dolphins by defecting to the fuddy duddy faction and opting to sit on their big fat asses.

         Back at the hotel, much sitting around on asses commenced. My ass’ personal bout with sitting around was disrupted by the maids, who got the brilliant idea to come clean my room in the middle of the afternoon. But, being a college graduate, I outsmarted them by resuming sitting on my ass by the pool.

         Later, we cruised out again in our bus to Playas for internet and then to a pizza joint. We got back to the hotel around 8pm and had a meeting inside the bus about how the medical mission could be improved the next time around. My suggestion was thoroughly discounted and beneath my stoic exterior, I pouted.