Funds for this grant were provided by PEPFAR. Kristen Kaper solicited the funds and with Laura Geiken we wrote a proposal for a team of 13 Health Care professionals to offer free rapid HIV tests to an indigenous community without ready access to prevention basics like condoms and education. This is the story.
On the 14th of March, in Kusapin, I got an email from Dr Jurado at Fundacion ATENAS. He offered a thousand discuplas, but the boss was traveling overseas and had not authorized the use of the lancha for the ten planned days of our HIV tour. Could we reschedule. I thought not.
The Alcalde had offered his lancha in service to the project, so I knocked on his door, and told him I’d lost my boat. He said Archibold just gave Mendez, the Toro. Ask him.
The Toro is a big baby blue panga that used to run between Bahia Azul and Chiriqui Grande. Old Man Archibold used to run it a year ago, or have his sons. But the motor kept breaking down. He’s not getting any younger, and he likes to spend his time in town, away from his wife in Bahia Azul. The Archibolds are also notoriously difficult to do business with. The first time I ever saw him, on my site visit, he told Sergio and me his was the only boat to Ensanada. This was a lie. His nose flattened by some long ago fight gave him a fatherly look. He tried to overcharge us. The boat had to turn back because the sea was too rough, the boat so overloaded water was coming over the gunnels. And he yelled at me to bail.
So I went to Mendez, Son of Archibold. And said, You have a boat and a motor, will you help.
He said he’d like gas plus $50 a day.
I said no way. $500 total. You’ll be doing a favor to the whole community. He agreed, if I promised not to tell anyone he was doing it for so cheap. I could agree to that.
We shook hands and I told him I’d send him the first $50 by note if I needed to be picked up at 11am, Tuesday, the 19th of Feb. His hands are small and meaty and very strong. His arms hang akimbo—musclebound or because of his big belly. Bole kri in Ngabere. He’s an Archibold.
But so is the Alcalde.
On the 15th I met with Dr Jurado in David. He did not look well. I asked him if he’d been out all night—a joke. He said he hadn’t, he had a cold, a fever. He said he might not be able to go. He’d find the people. His boss was new and mixing things up. He looked under a lot of stress. On the way to buy the medical supplies, I made small talk, asked of his family. He told me he rarely gets to see his wife and kids because she works in Colon. Later, I asked him what the chances were that he would make the gira. He said, Fifty.
I can respect that.
In the morning I got an email that said that he couldn’t make it. And neither could any of the other nurses, or public health workers, or doctors. In fact nobody would come. That’s what que no podre asistir a la gira al igual que las personas que contacte de parte de atenas ya que tienen otros compromisos means. It’s an amazing thing the last minute excuse: impossible to attend, other previous commitments. He excused himself from any inconvenience. I like the guy, I felt like he is still on my side. Even though.
On Monday the 18th—the MINSA office alive inside the dark painted walls, the hum of an airconditioner. People coming and going, Dr Gantes pulled us all together, we sorted out all the particulars, transportation, supplies, reorganized schedules. We were down to one Doctor, Jenny, for three days starting tomorrow, one nurse, surely, and Uriel, the lab director for the Comarca, for four days. And four cases of Rapid HIV tests. Each worth $6000 wholesale.
All that really mattered I suppose.
Dr Gantes was on board. I called Roda, she fave the phone to Enrique, he promised to take to note to Mendez with the $50, the boat would pick us up. I could get these tests to the dock. Things were moving right along.
And then momentum kicked in. Kristen, from the Peace Corps office, offered us a ride in a White Stallion. Mysha Sissine, a Master’s student from North Carolina arrived to collect data for her International Public Health Thesis; which should shed light on the question: What motivates a Ngabe to want to take an HIV/AIDS test in the first place?
The next morning Uriel showed up outside Kristen’s Hotel, but the Doctora didn’t, We waited an hour or so on the busy streets of David. She probably had a previous commitment.
Half an hour late getting into Chiriqui Grande, Mendez, right there at the dock feigned indignation about how long suffering he’d been waiting for us. And he wanted everything up front. I told him no, $50 a day. He said he had to buy gas right now. 60 gal. Plus oil, $304. I said there you go. We walked his tanks over to the pumps, I made sure the receipt was signed.
We were five in his big panga, with his 40hp Yamaha, the most efficient balance of power and consumption of the outboard motors. Kristen, Laura Geiken, the GAD coordination and coauthor of the grant, Mysha, Uriel, and me. In a boat planned for 16. It was light and skimmed across the water into the dark ominous sky. It would rain for most of the next ten days.
In Bucori Mendez said, Oh, we sure used a lot of gas. He rattled the read five gallon tank. Eight gallons he said. A third of the way, I thought, He can’t complain. Probably use between 30 and 40 gallons total. He’d sell the rest at $6 a gallon. He asked for $20 walking around money. I gave it to him.
Bucori. Rhian was waiting in the drizzle. The local medico in the Puesto de Salud happy to see us. We stashed the boxes in the backroom, carried our bags to the office where we’d stay, rolled out or sleeping mats, hung the hammock and went back to give a quick charla. Later, laughter, stories over a huge plate of chicken and rice cooked by the medico’s wife.
In the morning we tested many more women than men. Rhian, from Detriot, lives in Bucori, explained what Adquiera means, the A in SIDA. It was a tough task. Men asked questions, he put a condom on four fingers. Showed them how to pull it off, tie it up, not throw it on the ground where anyone might find it. He’d use that joke again and again.
We tested 77 people that first day. The tests were run inside the puesto, results read in private, with follow-up counseling and questioning. This would have been the task of the doctor, psychologist, or nurse. But it fell to us in the Peace Corps. A huge learning moment. For us and them. If they didn’t have a question, I would ask, How can you guard yourself against HIV? Answers were mostly half condoms, half fidelity. The women said they were faithful, but only one said she knew that her husband was too. Most of the women would take some condoms.
For dinner we had lobster and daichin, a delicious purple tuber that eats like a lavender potato and tastes delicious. With lobster.
That night I puked. I wouldn’t be able to eat heartily for the rest of the tour. No coffee no soda no asprin half portions. Discomfort. Loose five pounds. I tried not to be too dull. I had to nap now and again.
Playa Verde. Evan was waiting for us. We set up outside the school after outwaiting the rough weather. Mendez asked me for another $20. He said he’d had to pay for room and board. You told me he was your uncle! I said. He said, Yeah, but you are gringos and he thinks I’m making a lot of money off of you. I said, Then it’s up to you to disabuse him of that notion. I gave him the $20.
We tested a good amount of folks. The Floating Doctors arrived, but didn’t have the necessary permissions to run a full clinic and therefore couldn’t do much but watch Uriel pricking fingers and running the tests. Dr Ben had brought a few pounds of beef so we had a delicious beef dinner and left them with their hammock hanging under the eves of the public rancho.
Our boatride to Bahia Azul was beautiful. Rainbows and massive kettles of raptors. Rosendo was outside his house burning trash. I thought, excellent, he’s waiting for us. I walked up to him and he had this strange look on his face. He said, Oh, I didn’t know when you were coming. You didn’t give me a date. I already rented out the house you were going to stay in to the teachers.
I pointed to the bills posted on the front door of his store. The flyer that said Bahia Azul, with the date of March 23rd. I said, This is the date we agreed on. This one posted on your door.
I like the guy. He’s always been good to me. I asked him where we might stay for the next four days. He pointed to a rough house on the corner and said it was open. I talked to the owner, explained that we were here on a gira to give HIV tests, and asked him if he would let us use his house, help us out. He said absolutely. Mendez’ brother waddled over to help hammer some rungs on the joists that had been the stairs. A rapid fix.
Mysha said Rhian was teaching her how to tell an Archibold by his bole kri. Bahia Azul: Archibold central.
Rosendo let us use his shower, his flush toilet.
Punta Sirain. Kristen left us early in the morning, in the middle of a rainstorm, bitten by chitras. We had breakfast up at the only little public spot in town, coffee, eggs, crema.
We boated to Punta Sirain as the sun came out. Up on the hill a slow day. Entertained by Mamacita—an old lady who told funny lies and floated along elegantly—asked us to guard her crema. We tested a little over 20 people.
The sun came out, empanadas for lunch. Laura said I couldn’t ask Uriel to stay another day, it would be unfair. He had already worked so hard. It was true. But tomorrow we’d loose half the day, and Bahia Azul would prove to be a big testing site. And what if the next lab tech never showed?
What if I asked real nice? I offered. She shook her head. I kind of had to agree. I joked that she loved MINSA so much, she’d defend Uriel to the end. We laughed.
Mendez had us wait for a half an hour on the dock, motoring back from around Punta Valiente. Took us back to Bahia Azul where the ladies had a chicken dinner waiting for us. I ate little and made it through the night.
Bahia Azul. The next morning at six I told Uriel the boat was coming. He said he’d decided to stay another day. I was surprised and pleased. Laura said as much herself.
We set up shop in the offices of the school while Rhian and Laura gave the charlas in the cafeteria.
Mendez pulled me aside and asked me how much I still owed him.
$90 I said.
He said, Oh oh. 90 palos for six more days! I’m loosing money on the trip. He said he had a business to run, and he needed to send some money back to Kusapin. He said he just couldn’t afford to take us the rest of the way without more money up front.
I had expected this. I was already spending money on food for him and his son, his helper.
He said, If you give me $300 more dollars I can do it.
I said, That’s not what we agreed on. I told you in the beginning that I would not pay $50 a day. And I’m not even using you all the days. Plus this boat doesn’t weigh and you’re using less gas.
He said, Oh no! I’ve already used up more than half the gas!
I told him, I’ll give you $100 more. $200 right now, so he could take some money back to his wife. And that I’d pay $50 when we get to the dock in Chiriqui Grande.
He agreed. Told me not to tell anyone.
Whitney and Tito, the lab tech from Kankintu arrived on the afternoon boat. Now we had a crew! And we tested 78 people. The most yet, admittedly with mine and Whit and Laura’s thrown in. Rhian said those tests didn’t count.
That evening we went to Cantina Archibald, where my bills were still posted on the wall. We all had a couple of beers, and I played Juni at pool. I dominated the table, beating him even at his own game. We played for the table. And I must admit, it felt good beating an Archibold at his own game.
Punta Alegre. A beautiful morning. Laura and Uriel left on the first boat.
The owner of our house came by and wanted to talk to me. He said I owed him $5 a person for the use of his house. This was $25, for a house that might rent for $40 a month. I told him I’d give him $15. He feigned indignation, which kind of upset me a little. I went in on him. I told him that I understood that he had offered us his place to help us out, to help out the community. We could have stayed in the artisan’s house for free. And now he was trying to take advantage of us, because why? He thought we had a lot of money? We were gringos? I told him we’d leave today, move out directly, and he would get nothing. $25 dollars? Who did he think we were?
And all this in front of Tito. The man paled.
After breakfast I came back and gave him $10. Told him I felt abused. An Abuso! He said I wasn’t being abused. I told him he had to tell me his terms up front! $5 a person! For that house! I would have told him, NO from the beginning. That’s not how business is done, and didn’t he have any sense of community?
We packed our stuff, stored it in the artisan house and left for Punta Alegre. Tito asked me how much I was paying Mendez. $650 I said. He said that was plenty. I said I thought so, and told him about doing business with the Archibolds.
Tito said Mendez had asked him how much I was paying him; that he was fishing for more money. Tito said, I told him he wasn’t paying me anything. He started calling him bole kri.
Punta Alegre went well. Lots of church going folk came by for tests. Whitney and Giro giving the charlas. It was quite in the afternoon, a stalled boat drifted past. The Kusapin corregirador, essentially the local judge, gave me some of the sweetest coconuts I’d ever tasted. My stomach was acting up. I felt horrible. He took pitty on me, thanked us for our work. The church group gave us a thick chicken soup in thanks as well. I couldn’t eat it.
Mendez came and picked us up. An half hour late. We went to Bahia Azul, had another dinner, and left for La Ensenada and my little house.
I put up Whitney, Mysha and Rhian. Tito slept in Roda’s house. He seemed well received there.
I told Mendez to come pick us up in three days, at 8am. Told him not to be late.
La Ensenada. In the morning Whitney left us. I was worried that we would be short handed for the rest of the gira. We PCVs were covering a lot that had been intended to be covered by the doctors and pshycologists. This made me a little sad.
La Ensenada would be the worst turnout. My own site!
First thing in the morning Anesio brought in his three and a half year old granddaughter in to get tested. Her mother had died of AIDS soon after she was born. The little girl had been getting treatment ever since.
She tested negative.
I read the test results to Anasio and his wife. She put her arm around my shoulders and pulled me in and said softly to me in Ngabere, What you have done is good. Very good. Ka koin. I felt the wave of love pass through her embrace. The little girl held the cotton ball on her pricked finger.
Further good news. Another young man that has been struggling with an unknown disease, very similar in symptoms to tuberculosis brought his wife in. Both tested negative. He told me his brother had died of AIDS in Bucori, and that he had lived a very reckless life a few years ago. Now he was one with God, and gracias a dios we had come with these tests.
The other members of my community pretty much let me down. Refused to get tested. Hid behind a door in the new school. His brother came though, and a couple of the other young toughs.
I talked to Dr Gantes on the phone. I told him that no doctors had arrived. He seemed surprised. I told him they probably had other commitments. He told me he would see what he could do. None would ever show.
We ate granja chicken and fried yuka for dinner.
Guacamayo. A rollicking good reception! We set up in the Puesto de Salud and Alexi was there waiting for us, with a crowd. We had hiked up to Guacamayo from La Ensenada and weren’t there for fifteen minutes when Osi, aka Maggie from Playa Balsa showed. I put her to work immediately reading results and asking folks if they had any questions.
I was extremely please that she came out. It was difficult to fill out the forms, run charlas and give results with only two volunteers. And now the balance was back, two women, Mysha and Maggie, and Rhian and I. I remember feeling that now, for the first time, that it was all going to work out.
We had an excellent turnout. Many of which were in the 15-40 year old range, muchachos. Laughter and attention paid to the charlas, running smoothly. Gave out more than a hundred condoms, kept Tito busy. Had a wonderful walk home, a beautiful day, Tito and Mysha taking photos along the way. His first time out here on the Peninsula.
Playa Balsa. We got up, and started packing. At about 7:20 I heard my name yelled with indignation. Tito came by and told me Bole Kri wanted my attention. I walked out and he shouted, pointing to his watch. I made some vulgar motions towards him with my arm and thumbed him off with a cry equally loud to his. The folks in my community laughed.
Breakfast, crema, fishy eggs. I gave him two of my ojaldras. He and his son ate them with pleasure. We loaded the boat at 8 o’clock and headed out.
As we were passing by Punta Valiente a group of people flagged us down. Mendez looked at me, I nodded, and we pulled the boat it. 15 or so folks jumped in and we motored into Kusapin. It was the day when the Red de Opportunidad was paid out. Everyone stacking their cash.
We pulled up at his business, which he pointed out to Tito proudly, and unloaded the people. His wife yelled out to make sure they were all charged for their ride. At $2 a person…you can do the math.
The cut through the reef into Playa Balsa was known to Mendez. Even so, as we approached, the swell sucked the reef dry on either side, with twenty feet to pass through. We unloaded just before the rain and tested as high a percentage of folks as we had yet, a back of the envelope figure: nearly a quarter of the residents.
For dinner we had a simple meal of rice and lentils. Tito slept in the guest house, we slung our hammocks at Osi’s (aka Maggie).
Cayo Paloma. We walked in the rain to the Puesto de Salud. Leopoldo, the local medico, was waiting for us, and assured us when the rain let up, we’d have a steady stream of people to test. And we did.
Our work getting smoother and smoother, we gave out condoms and presented our charlas. Momentul building, more and more folks.
Hot johniecakes for lunch. And a pleasant walk home.
Julian, our host in Playa Blasa told stories of ancient Ngabe lore. The white monkey that climbed the tree in a lightning storm and when the lightning struck, turned him black, from head to foot, all except for his monkey testicles, which he was holding in his hand. And that is why, to this day, a howler monkey junk is not black!
Tobobe. Our last stop. Rain squalls in the morning, Julian spotted Mendez racing out front of the line. A great boat ride, stormy, Mysha grinning, a solid swell running, shot a photo of me and posted it on Instagram. The technology that happens while I’m gone!
Another Red de Oportunidad day, lines down in the sidewalk, people standing, mired in mud. The crowd awaiting us at the puesto larger than any we had seen. Dora, the doctora, smiling and waiting for us. We tested over a hundred people throughout the day. There had been concern that HIV had reached Tobobe.
Tito called me in, showed me the result, a small red line next to the HIV mark. Our first positive. I called the young man’s name, after a few other negative results. I told him he would need to get his blood drawn.
He hung his head.
He said, I knew it.
Tito took his blood during a break in the testing, no one the wiser, and the handsome young man walked off down the sidewalk. He would be the only positive of the entire gira.
I bought Mendez the last lunch, and he broke out into a grin. A plate for his son too. Sweet buns and johniecakes for us. We worked late, Mendez whistling and hooting for us to mind the time.
The sun sets fast in the tropics.
Epilogue. Maggie and I returned to Tobobe a couple of weeks later to find our young man. Lab tests had confirmed his HIV status. We talked with Dora and she said she had a boat but no gas. So I bought five gallons of gas and the Corrigedor drove us.
We motored across incredibly clear water, glass and a low swell. Once we’d managed to locate his house, his sister told us he had paddled to Tobobe. We found him on the sidewalk right where we’d put the boat in. He had a huge smile when he saw me.
He said he had seen us pull out, but didn’t think it was for him. He said thank you for coming. I told him the lab test had confirmed his status, and he told me again that he had suspected as much.
He told me he understood the treatment process, had a friend in Changinola that was getting treatment. He told me he was waiting to get paid so he could go to San Felix and start treatment. He said he would go Monday, if he could.
Incredible sweet. A magnetic personality. I told him we would help him, cover his expenses to San Felix this one time so he could talk to the doctor, the psychologist; figure out how to get his meds in the future. He smiled his handsome smile, sitting there on a beached dugout canoe.
I gave him $60, boat and bus fair round trip. Directions to the clinic, phone numbers.
He said, Thank you, Thank God you came.
I shook his hand. Maggie shook his hand. I think he would have
Mil gracias, he said one last time, A thousand thanks.
On the negative results of the little girl:
October 6, 2011 (Chicago, Illinois) — The loss of HIV-specific antibodies can lead to false-negative results on rapid HIV tests in children and adolescents after successful long-term antiretroviral therapy, according to results presented here at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).