alerio and Jose walked into clinic room number four and quietly greeted us “buenas tardes.”
Valerio, the father, wore a cowboy hat, a light lime shirt and dark, dusty black jeans. His ornate belt secured his heavy pants. There were intricate patterns sewn on the brown leather, which was worn out and dry. At first glance, he just looked dusty.
His son, Jose, also had that dusty look about him. He wore a red fleece sweater over a bright orange collared shirt.
He sat with his hands clasped on top of his knees, twiddling his thumbs. Jose’s right thumbnail was halfway missing, a short yellow stub cutting off the portion of where his nail should have been. It looked like it was rotting.
Both men looked frail, with thin limbs and hollow cheeks.
Nurse practitioner Cathy Ford and her student, Sherri Reutlinger, stepped forward and introduced themselves in the best Spanish they could muster.
This was the third consult I had sat in for that day. I was shadowing a group of nurse practitioners that had come to Guatemala from Wisconsin to treat patients in Refuge International’s San Raymundo mission. I had seen a boy with a broken jaw, women with abdominal pain and other patients with various ailments they had come to get treated for.
Valerio and Jose arrived at the San Raymundo clinic to be treated for diabetes. Valerio, in his 60’s, and Jose, 38, had been diagnosed a couple years before and had been taking Metformin, a diabetes medication until he could no longer afford it.
Since then, Valerio’s symptoms had escalated and today he complained of pain on his side and trouble breathing. On many nights, he said he would wake up feeling like the air in his lungs escaped him. He massaged his legs as he explained to “las doctoras” that his veins popped out of his skin and his legs burned. Defeated, Valerio admitted that the diabetes had taken away his strength.
Valerio, a former agricultural worker, begged for something to take away the pain caused by the bursts in the veins of his legs.
Maries Montoto, who had been translating for Valerio and Jose since the consult began, pricked Valerio’s finger to test his blood sugar levels. His blood pressure had been taken earlier and was high. A drop of blood and a few minutes later, Valerio found out his blood sugar levels were way above normal.
Cathy proceeded to examine Valerio. She asked him to remove his jacket and open up a couple buttons of his shirt. He ended up taking off the shirt completely, lost in translation. I looked up from my notes at Maries and smiled.
Valerio sat half naked on the examination table across from the plastic chair where I sat. His bones were pronounced against his tanned, paper-thin skin. His rib cage and collar bone largely protruded out of his chest.
Though he looked skinny and frail, his body showed traces that it was once strong and muscular from years of labor in the fields.
Cathy put on her stethoscope, disinfected the chest piece and placed it on Valerio’s chest. She heard a steady heartbeat and determined his lungs were healthy.
As his father was being examined, Jose spoke up. He asked Maries if he could see an eye doctor. His vision had recently turned cloudy because of the diabetes and couldn’t see much anymore.
“I’m having a hard time reading my Bible,” he said.
Maries told him she would ask, but she didn’t make any promises. She then turned her attention to Valerio so she could explain the medicines he was being prescribed.
A patient’s medication is included in the consultation fee. In Valerio’s case, he would receive a supply of medicine to last him for three months until the next medical group came.
Maries handed him his prescription and asked if he could read. He couldn’t, but said he would have his son read him the instructions on how to take his medicine at home.
It was Jose’s turn to be examined. He sat in front of me, talking to Maries about the symptoms he was having. He carefully cuffed the bottom of his pants to show the bulging veins in his leg. He was weak without energy and his mouth was constantly dry—clear symptoms of a diabetic.
The young Jose had been diagnosed with diabetes three years ago. He had been prescribed Metformin like his father, but had not been taking the medicine consistently, as he should have. Jose explained that he lived in a constant state of illness. Some days the Metformin would help, but on the worst days he would give himself an insulin shot that was hard to come by.
As he sat on the examination table, Jose was the image of frailty. At about 5 foot 5 inches, he weighed 110 pounds, five pounds above his lowest weight of 105. A year ago, Jose had quit his job because he wasn’t strong enough. He had gone from weighing 180 pounds to a mere 105. When Maries had pricked his finger to test his blood sugar levels, the machine had not been able to read such a high number.
Jose sat there, ankles crossed. He mentioned he had worries about taking insulin. He had heard from a friend that insulin was bad, so he had discontinued his daily shots.
But because they did help him feel better, Jose would save the insulin for the days he felt especially ill.
After listening to Jose’s heart and lungs, Cathy began to talk directly to Maries. She spoke about what diabetes is—the inability of the body to properly produce or use insulin.
Insulin is necessary for the cells in the body to retain vitamins and nutrients, even for brain function. Because Jose wasn’t receiving aid from the medicine, his body was not processing the sugar he was supposed to acquire from food and it was all accumulating in his blood.
Cathy said his body was basically starving itself to death. She said in order to stop his body from starving, Jose needed to be put on a combination of the Metformin drug and insulin.
The look on Maries’ face said it all. She knew there was no way Jose or his family could afford insulin in a country where insulin is a luxury. She voiced her frustration to Cathy. Maries held back tears as she told Cathy there was no way he could afford insulin.
My throat ached and my eyes watered as I listened to the exchange between nurse and translator.
There was no way this man could be dying of a treatable disease like diabetes. Some shots of insulin and a couple of pills were life and death for this man.
One of my closest friends has diabetes at a young age, and for her, diabetes is just an inconvenience. For this man, diabetes was the thing that had robbed him of his life.
He no longer had a job and couldn’t take care of his wife and two babies. He sat there, desperate for something that would give him his life back. He placed what little hope he had left on these two nurses, hoping they could give him back his life.
No matter how much the doctors said he needed it, for Jose, insulin would be a rarity.
Maries kneeled down in front of Jose and put her hands on his knees. “Mire mi Don,” she said. She explained that because his body needed help in being able to receive all the nutrients from food, he needed to take both insulin and the Metformin.
She told him to forget any notion that insulin was bad. She explained that to a normal person, insulin could be dangerous, but to someone like him, it was the opposite. It was needed.
She told him they didn’t give out insulin at the clinic because it was too difficult to bring there. Instead, they would double his dose of Metformin in hopes that it would help. If and when he could buy insulin, he should use it as much as possible.
As he heard this, a look of desperation flashed in Jose’s eyes. Without the insulin he would never be back to normal.
I felt a rush of anger overcome me as I realized this man was dying and losing himself and his life. I hated to think of his family and the pain they must feel in seeing their young husband, father and son in so much pain—a pain that could be fixed if only they had the means to do so.
The pent up emotion I held in my throat was really tough to hold in. I had told myself I wasn’t going to cry during my time in the clinic. I had told myself I was going to keep it in, because people need happiness and love and grace during tough times, not mightier than thou sympathy.
I was rock solid until Maries turned to Jose and asked: “Usted cree en Dios?”
“Do you believe in God?” He said yes.
Maries asked if she could say a prayer for him and then turned to Cathy to make sure it was all right.
“Only if I can join you,” Cathy said.
Maries then turned to me and asked if I wanted to join. I immediately shot up and said of course.
So there we stood, in a circle, my hand holding Maries’, and my other holding Valerio’s, both complete strangers. I struggled to get a good grip on Valerio’s hand, because three of his fingers were occupied as he clutched his sombrero.
Maries began an energetic and passionate prayer in which she thanked God for the day and the doctors that came to give their time and help the people. She asked for the health and recovery of Jose and his father Valerio.
To my left, Valerio repeated a hushed “Thank you, God” as Maries prayed. There was also a soft whisper coming from Jose’s direction.
I buried my head in my chest and closed my eyes tightly. All of a sudden I could no longer hold back the tears. They spilled from my eyes to the floor. Even in my thoughts, all I could muster was, ‘Please God, help this man.’
I wished someone could have done something for Jose. I wished I could have done something.
I wished I could have given him the medicine he needed to live with the illness and be free from pain. I wanted to take every ounce of strength I had from my body and just hand it to him right then and there. I wish I could have given him the final cure for his diabetes.
Then I realized only God could do that for him.
Maries ended her prayer with a deep sigh and an “Amen.”
I opened my eyes, they were filled with tears and I couldn’t see. I wiped my eyes on my sleeves, and looked up. Mostly everyone was crying, but my eyes settled on Jose.
He had also buried his face in his hands and was wiping away his tears on his red sleeve. He looked at each one of us with glossy eyes and wet cheeks and said thank you.
I don’t think I’ll ever be able to forget the gratitude in his eyes as they met mine.