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Colombia, Day 23

There’s this place back in the ancestral hometown where you pull right up with your car, get off, walk in, pick a fish from a huge freezer, and sit down. Fifteen to twenty minutes later, the fish arrives, deep fried and surrounded by delicious rice and beans. You get to pick your own salsa, and, if you’re lucky, some mariachis will come over and sing you a song (for a nominal fee). The fish is fresh from a nearby lake created by a dam on the river, or so they say. It’s delicious, so I’m sure it’s plenty fresh.

I remember being a kid and having my dad pick a fish for me because I couldn’t see over the top of the freezer. He would also help me eat it because he wanted to keep me from getting a fish bone. Most of the time, I wouldn’t finish the fish because it was such a huge meal… But I grew into that.

Today, we went south of Barranquilla to a town called Palmar. As usual, the heat was brutal, but I’m very much used to it for the most part. We arrived in Palmar around 10am to investigate a case of hemorrhagic dengue fever. The case was a woman in her late 20s who had given birth not too long ago. She started feeling sick last Saturday. By yesterday morning, she was in a hospital in Barranquilla, in intensive care.

We arrived at the house and talked to the woman’s family members. They reported that 11 of them lived in the two-bedroom house. Again, like on my trip to San Joaquin and around Barranquilla, the house is more like several walls holding up a hot tin roof. Seriously, you could feel the heat radiate down from the roof.

In an alternate dimension, the house would be located in a vacation paradise. There were palm trees everywhere, loaded with coconuts. Mango trees lined the street, and you could even smell a hint of mango if you were brave enough to lower the window in that kind of heat. There is a rather large river that providers plenty of fresh fish of different kinds. And the beach is only an hour drive away.

But this is not an alternate dimension. This is a poor neighborhood in a small town in Colombia. The roof is made from tin. The residents in almost every house have to have a concrete pool in the backyard to collect water because the town’s potable water is not available 24/7 (despite what town officials claim). The houses are run-down, and there are plenty of standing water sources (besides the concrete pools) for mosquitoes to breed in. Sure, there is cable television, and some places advertise access to internet (and smartphones are ubiquitous), but it’s not paradise… It’s not even close.

As we walked through the case-patient’s house, we came upon the backyard, where a woman was washing clothes from a bucket. She sat under a tree and washed away. She was very welcoming of us, but then she started crying. She was crying for her daughter, worried that she wasn’t going to make it. Others in the family and in the neighborhood had succumbed to dengue previously, so she was scared that her daughter would pass, leaving two young children without a mother.

I tried hard to hold my own tears because it was very hard to hear someone suffer so much. She asked how it was possible for this “plague” to come upon them if she, when she was young, would play with mosquito larvae all the time. She asked why would mosquitoes be bad now when they weren’t back then. As best as they could, the two physicians in our group tried to explain to her the concept of a virus.

We ended the visit by interviewing the husband of the case-patient. He was very detailed in when his wife started feeling ill. He seemed to know enough about dengue and how to prevent it, but he also seemed powerless from doing anything about it. After all, the whole neighborhood is filled with homes using uncovered concrete water pools in the backyards. That, and his main worry was making the trip up to Barranquilla (a couple of hours away) to see his wife.

Of course, there are other details of the story that I can’t divulge due to confidentiality. However, let me tell you one thing. A lot of the things that I saw — the good things — would probably be non-starters in the United States. Different cultures care for the sick and needy among them in different ways.

After the visit, we picked up two other physicians who needed to get back to Barranquilla. All five of us pulled into a restaurant by the side of the Magdalena river and ate a delicious meal of fish soup and deep fried fish. The fish came with yellow rice, some lettuce and tomato, and fried yucca. As I ate the fish just like my father taught me to, I thought back at something that he said to me when I first started working at the lab fifteen years ago. He said I had a big heart, and that he was proudest of me for caring so much about people I’ve never met and would probably never meet.

From that little kid that needed his fish cut and deboned for him to this big Mexican guy who is in Colombia getting to know how public health is done on a shoestring budget, I think I’ve come pretty far. And the best payoff is having my parents, siblings, and wife be proud of what I’ve done… And what I hope to do.

I’ll be back in the States in less than 72 hours. If I get a chance, I’ll write some final thoughts before then… But I will definitely do so afterward.

I was able to eat all of this. Thanks, dad!

I was able to eat all of this. Thanks, dad!

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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