Hernan has just returned to Caracas from his medical internship. It has been seven hours of travel by river and ten hours by road from the mission of San Francisco de Guayo. Exhausted, he speaks with pause, weighing the words, like someone who needs to discern between the experiences and some somber reflections that occupied him during these months.
The Guayo mission gathers some 1,500 indigenous people of the Warao ethnic group (people of the canoes), who live in palafitos (constructions on stakes on flood-prone land) on the banks of the Orinoco delta, in the extreme eastern part of Venezuela. It has a small hospital, a church, a school and little else. The mission hospital serves about twenty small communities scattered in a labyrinth of water and jungle. They do not speak Spanish. In their palafittes without walls, the Waraos have no drinking water other than what they collect from the rains. They feed on fish, tubers and corn arepa.
The Waraos are the most peaceful of the pre-Columbian indigenous peoples. They dispersed throughout the delta fleeing from the warrior tribes. The men dedicate themselves to fishing and the women take care of the children and make handicrafts that they sell as best they can. Despite the growing enculturation, the gap between the two worlds remains huge. This is what haunts the young doctor as he describes Guayo's mission below.
In critical conditions
There is no permanent doctor in the village. Only those of us who are on internship. The continuity of medical care relies on three nurses, two of whom are Capuchin missionary nuns. The nearest general hospital is several hours away. Sometimes we see more than a hundred patients a day. Some of them come rowing for more than three hours from their settlements scattered throughout the delta.
Gradually we were taking charge of the situation. These communities are in serious survival problems. Some have been wiped out by two prevalent diseases: tuberculosis and HIV.
Almost half of those born will not reach five years of age. The very high infant mortality is due to dehydration, mainly caused by diarrhea. In addition, the water brought in by state tankers is not entirely healthy.
The general situation of shortages in public hospitals is cruelly exacerbated in Guayo. Treatment for tuberculosis and HIV is expensive and scarce.
Little by little we understood that it was a patient struggle: we had to keep the illusion burning despite the difficulties and do everything we could. The waraos are not very effusive in their expressions of gratitude. At first we were shocked, compared to what happens in the rest of the country where patients, grateful, do not fail to repay the doctor in some way. But even though we did not fully understand this cultural difference, we were driven by the desire to serve.
We had long conversations with the villagers. We would enter the palafitos to share and enter their world. In Guayo, time flows intermittently. There are periods of intense activity in the hospital or in the extreme communities, and very calm hours at dusk.
The attractiveness of the service
However, we should not imagine a gloomy outlook. The difficulties are interwoven with hope. It is paradoxical, but Guayo is a magnet for big hearts. On the opposite bank lives a French couple. Louis is a doctor and Ada an anthropologist. They have been in the village for twelve years. They love the waraos and they have done a lot of good. They ran an inn where they had a water treatment plant that also supplied the town. As tourism declined, the government confiscated the plant. Now they make do with a tiny facility.
There is never a shortage of trainee doctors. One afternoon, on my way back from my rounds of some communities scattered along the canyons, absorbed in my thoughts, I almost stumbled upon some children drawing pictures on the boards of the walkways between the palafitos. It was a contest to win gifts for Epiphany. It had been organized by Natalia, a medical student who, after her internship, had returned from Caracas with a shipment of clothes, medicines and toys. Natalia did her medical internship in another community, but she used to come to Guayo to lend a hand.
Capuchin Tertiary Sisters of the Holy Family
The mission of San Francisco de Guayo was founded by Father Basilio de Barral in 1942. A scholar of the Warao language, he published a catechism and several didactic works in this language. The Capuchin tertiary missionaries arrived later and have given permanence to the mission.
Sister Isabel López arrived from Spain very young, in 1960. She came with nursing studies and has practiced for several decades in the delta. She has seen the town grow and evangelization expand. Today the hospital in Guayo bears her name, but that doesn't matter much to her. I was very impressed by Sister Isabel. As she walks leisurely through the village, she spreads optimism and hope all around her. One afternoon I was coming back from a tour of the communities, deflated; grotesque images and memories were swarming over me like a cloud of mosquitoes filling a mangrove swamp at sunset. Isabel saw me coming and pretended to meet me. I don't quite remember what she said, but it restored my enthusiasm. I am still amazed at the skill with which she handed out candy to the children who tugged at her habit as we chatted.
Some confidences
Natalia was able to record some of Sister Isabel's confidences in an improvised interview that I transcribe here.
Said the sister: "Look, without the love of Jesus Christ I would do nothing. Jesus is the center of my consecrated life, of my spiritual life and of my community life. Without Him I would do nothing. He is my support, that's why I'm here, and look how happy I am, with the age I am. It is an extraordinary thing. Listen to me, doctor: if I were born again, I would be a Capuchin Tertiary of the Holy Family and a missionary. One hundred percent missionary, and with a smile, because I have always been very cheerful and I have never lost my smile. A little older, yes, because one is older, but the smile is not lost.
The initial motivation for coming here was evangelization, to make Christian people, because in Guayo there was nothing. The current motivations are still the same or even greater. I have a lot of hope, a lot of concern for the people, for what we are seeing in Guayo: the sickness, the poverty, the children who are dying.
There are those who criticize the missionaries for being too paternalistic. But I can't help it, that a child comes to my house and I don't give him a piece of candy? Children and the elderly are my predilection. And the little ones look at me and see something: affection. I would like to have many things to give to children, even if they say I am paternalistic or maternalistic".
Natalia then asked Sister Isabel what her fears or most difficult moments had been. She responded as follows: "I have not had many difficult moments, I have been very happy and I always feel happy. Difficult moments? Well, seeing such great poverty, seeing people dying. The river impresses me a lot. Seeing the water, you get into a boat and you don't know... I have experienced many dangers on the river. But very few difficult moments. I have had a lot of joy, very happy, very dedicated.
I'm not tired. People say Isabel is a goldfinch. But I am seventy-seven years old and sometimes my strength is lacking. It shows at work, but of course, very well. I don't feel old. I feel the same. I was telling you: after 56 years, it seems like yesterday and I haven't done anything. I haven't left the Delta.
A doctor in the Orinoco delta
In order to practice medicine in Venezuela, each student must complete a year of supervised internships. These are generally carried out in poor areas, but there is the possibility of working in the city and receiving some financial compensation. There is no shortage of students looking for the toughest areas and conditions in the peripheries.
Alfredo Silva studied medicine at the Central University of Venezuela, in Caracas, and is about to finish his internship working for the indigenous people of the Orinoco delta, in that tangle of canals where the river melts before reaching the Atlantic. We asked him a few questions.
Why did you decide to do your internship here? -I came to the delta for the first time during the Easter vacations in 2006. It was for a volunteer program organized by my school. We did social work and catechetical activities. The place and the people won me over.
I went back for two months in 2014, during my sixth year. I brought with me Jan, a fellow student. It was very enriching. We felt useful. We saw how our efforts paid off. We could help a lot and give opportunities to those who had none.
At the beginning of 2015 we decided to do our final year internship here. It was not easy. We were short of money. Other destinations offered financial benefits, while coming here requires raising funds and always putting something of your own. But medicine had gotten deep inside us and pushed us to serve. For years I have been thinking of joining Doctors Without Borders, an NGO that provides humanitarian aid in areas affected by war or natural disasters. But here we have faced situations comparable to those in terms of mortality, food conditions and serious diseases.
How have your motivations evolved during these months? -A professor suggested that we launch a study on the tuberculosis and HIV that devastate these communities. The academic aspect calmed many of our relatives, who were worried about the difficulties we would face. The results of the study could give us access to postgraduate studies.
As the months passed, the misery we touched daily reaffirmed our motivation to serve as we advanced in our research. It is the way to face this sad paradox: the Waraos live in the destitution of the indigenous world, but they are plagued by the evils of today's society.
What have been your best moments? -It's something you don't look for. Rather, you are surprised to be happy, fulfilled, working in the most miserable places. The need of others makes you feel useful.
Months ago we visited a family where mother and daughter were suffering from tuberculosis. The eldest son was suffering from malnutrition. We made the necessary arrangements to get the necessary medical treatment, which took a long time to arrive. When we returned to the site, only the son had survived. In this grim condition we were able to save the boy. It is very hard, it takes time to sink in, but it can also be very enriching.
What have been your fears? -When you witness such strong situations, you want to help and do things. It is the fear of not being able to help, because you are fighting against something that is beyond you. This involves a constant struggle to stay motivated. It's scary to think that when you leave, it will eventually collapse.
The Waraos are very receptive to our help, but resources are insufficient. They always need more. If you serve a community, they will expect you to come every day. But medicines are limited. The nearest hospital is too far for them to paddle a canoe. If I were to try to describe the Waraos, I would say they are born survivors. They have few tools, but a lot of patience to cope with today's world. Yet they struggle with the joy and simple charm of the pristine. They are still trusting, noble, welcoming.
If you went back in time, would you go back? -Yes, of course, totally. I have no regrets. Many good things have happened and I have learned a lot. You realize that you don't need so many things to live.
Caracas
