It is June 2015 and I’m riding in the smallest of cars on a highway leading out of Barranquilla, Colombia. I’m in the car with an epidemiologist from the state health department, and we are on our way to a place far from the city in a small town in the jungle. The temperature outside must be in the triple digits (Fahrenheit), and I can feel the blast of cold air from the once-in-a-while functioning air conditioning in his car. He’s telling me all about Colombia and how it is not at all like they describe it in the movies. He tells me that everyone is not addicted to cocaine nor trafficking it to the United States. He explains to me that none of that would be a problem, either, if the Americans stopped being so addicted.
Fifteen years before, I’m in El Paso at a party for a friend and her friends who are not my friends. They’re all jumping in and out of the pool and having a blast. Her father is looking down from the balcony to the master bedroom, smiling. Earlier in the day, he had hugged me and told me how much he loved me and wished me the best. I would be leaving El Paso in a few weeks now that the job in Pennsylvania was all lined up. His daughter, my friend, was having her birthday celebration and invited me in part to say goodbye. I didn’t quite like her friends — a bunch of privileged kids with more money than they know what to do with — but I’m also a sucker for green eyes.
Two hours later, we’re all standing outside the bedroom as emergency medical technicians and paramedics are taking care of the patriarch inside the bedroom. He overdid it on the cocaine, or maybe the cocaine had something in it. Or maybe he’s been overdoing it for too long. Either way, he had a heart attack or an arrhythmia or something. We don’t know. We just see them roll him out in a gurney and onto an ambulance. He had an oxygen mask on his face, and the cardiac monitor read that his heart rate was in the high 100s and into the 200s at times. My friend cried all the way to the hospital. I would never see her again.
Back in Colombia, eight hours after leaving Barranquilla and six after arriving at our destination, we are sitting in a restaurant by the side of the road and by the side of the river. The Magdalena looked very brown, filled with silt. My colleague tells me it must have rained upstream, making the water that color. I nod and agree. I have seen the rivers in Mexico look the same way after big thunderstorms hit the mountains above the desert and wash all manner of things into the causeways cattle ranchers use to get to their land. I remember seeing a pickup truck being carried by a flash flood and wondering if the passengers made it.
We were joined at the restaurant by other people from the local health department. We had all just finished visiting a very, very, very poor neighborhood in Palmar. A woman there had become sick with dengue virus disease to the point that she died. She already had a complicated pregnancy, and the virus didn’t make it any better. She developed the hemorrhagic version of the disease, and she passed away at the hospital, away from her family because they could not make the trip to Barranquilla to see her. Only her body was returned and had been buried quickly.
We walked in the searing heat to every home in the neighborhood where the woman lived to talk to her family and her neighbors about dengue and how to prevent mosquito bites. Most of the homes had no screens on the windows. They didn’t need to, the walls were separated from the roofs and pretty much open to the elements. It was the best way to keep things cool in that heat. As the hot air escaped through the gap, the cool air from the dirt floors would rise and cool things off. To keep that effect going, they would throw water on the dirt floors. The water would come from cisterns in their backyard as they saved the running water for drinking and making food.
Thirty years earlier, I was growing up in a little town in northern Mexico. Like that place in Colombia, my ancestral hometown was hot, but it was a dry heat. The desert was all around us, and big Sierra Madre mountains rose on either side. It would rain heavily in late August and early September. It would rain scantly the rest of the time. June and July were hell on earth because it was so hot, but us kids didn’t care. We’d go to the irrigation ditches for the farms nearby and have the times of our lives. Both my grandmothers would use similar methods to those in Colombia to keep the houses cool in the summer. It was some variation on evaporative cooling.
When I asked my dad how that all worked, he explained to me that the water molecules would take the energy from the air. That lack of energy, lack of heat, was felt as coolness by our skin. It’s why sweating worked, too. Since the air was dry, the water vapor would be diluted in that hot air and now come back on to our skin. I’d learn about hot and humid days the hard way in Baltimore, and the really hard way in Barranquilla. It was so hot and humid there that the temperature could be in the mid-80s but the heat index would easily be in the 110s. For that reason, the people in Palmar used a lot of cool water and moving air to keep cool as best they could.
One of the women in one of the houses in that very, very, very poor neighborhood asked us why we thought the larvae in the water cisterns was bad. She told us she used to play with them when she was a child. We tried our best to explain to her the concept of a virus and how it was transmitted by mosquitoes, but I very much doubt she understood. She almost immediately told us about her neighbor across the street who was a hoarder. It was her understanding that the cat and dog feces in his house is what caused the dengue fever in her neighbor, the woman who died. Instead of talking big words and giving out reading material to people who could barely read that level of Spanish, she suggested we go over to the hoarder and clean out his mess, and euthanize the animals.
At the restaurant, later that afternoon, my colleagues tell me about how hard it is to bring something like dengue or chikungunya or that new “Zika” virus that everyone was talking about in Brazil under control in a population with no flooring and no refrigeration. When you lack basic necessities, you kind of don’t listen to a lot of people about a lot of other things. Your only worry is food and water and a safe place for your children and yourself. Everything else is secondary. Or, if you’re unlucky enough to be human, you seek refuge from the hardships in some chemical that addicts you to it and doesn’t let you go.
Sometimes, it is not your choice to be addicted. It just kind of happens.
A year later, I am in Puerto Rico, chasing the Zika epidemic along with colleagues who became friends. We work from 7am on Monday to 5pm on Friday, and then we get the weekends off to explore the island. One of our bosses gives us the strong suggestion that we make sure to spend all of our per diem stipend on local businesses. It revolts me to think that a place so economically depressed is part of the exceptional lone superpower in the world. It hurts me to think that Puerto Rico is abandoned because they look like me and speak my native language. So I spend as much as I can, and then some, hoping that money encourages others to spend and to have a little bit of a better life.
As we sit in that restaurant in Colombia, a small cat comes over and mews at me to give it a treat. I grab some of the fried fish and toss it at the cat. It mews some more, probably thanking me. Minutes later, it is laying on top of my foot, purring loudly. We sit around picking at the fish and talking about our adventures in epidemiology. One of my colleagues tells me that his son wants to go to medical school in the United States, so he asks for any advice. I tell him that I don’t know what the process is to go from Colombia to the US, but that I was pretty sure he would need a student visa and, for that, he would need to get accepted into a school in the US first.
Twelve years before that, while working at the little hospital in Pennsylvania, one of the physicians there asked me if I was at all interested in going to medical school. I tell her that I had thought about it once or twice. Frankly, I had thought about it a lot before working at the hospital as a lab tech. Once I saw the trials and tribulations of being a physician, the whole thing did not appeal to me anymore. I wanted to help people, not endlessly fill paperwork for hours on end after the patient had already left my care. Yeah, being called doctor sounded attractive, but the actual work of being one did not.
Still, she said that I would probably do well if I took the MCAT test, the test given to see if one is medical school material. I signed up to take it and bought a book at the bookstore to prepare for it. A lot of the concepts were familiar to me from my medical technology studies. Physics was the only subject that gave me trouble. A few months later, I was waiting at a testing center to take the exam along with about 300 other students. They were all so young and so nervous.
As I took the exam, I was not worried at all about my score. I was already convinced that I was not going to go to medical school. I just wanted to see what my score would be. That was not the plan for a lot of the other students, however. Many of them were visibly shaking as time ran out, and they had not answered all the questions. One stood up and walked out of the exam, crying very loudly, almost wailing. Others sniffled as they shared stories during the lunch break. They told the rest of us how everyone who was anyone in their family or their town or their church was a physician and how they had no other option in life. I felt very, very, very sad for them. They were babies just out of college, and they had such enormous weights on their shoulders. There were a lot of tears shed that day.
On our way back to Barranquilla, I asked my colleague what the plan was given that the people in the neighborhood around the dengue case had been so cold to our suggestions about controlling standing water and preventing mosquito bites. He told me that there was not much more than that to be done. Some people listen to the advice from experts while others did not. Some people did not listen because they could not listen; they were not in the right frame of mind to listen. Other people just didn’t want to listen.
And some people want to see the world burn, I guess?
Two weeks later, I joined a team from the local university who would go out to the jungle to help investigate an epidemic of chikungunya virus. We went to a place where the men all worked in the fields while the women stayed home. Very few women had the mosquito-borne disease while most of the men had it. It was clear that the men got it while working, and it was also clear that the women worked hard to get rid of standing water around the house. They listened to the advice that the local nurses and physicians gave them about mosquitos, but that still was not enough and many of the men who worked hard to bring home some food were laid out at home with seized muscles and intractable pain.
Along with us came a regiment of government soldiers. They told us that the rebels were in the jungle and that the rebels would not hesitate to rob us or kidnap us if they thought it was to their advantage. But it wasn’t like we didn’t already have to bribe a couple of police officers who stopped us on the way there. A bus full of men with medical bags and supplies attracts attention in the poorest of places.
We handed out vitamin D and acetaminophen to the people who were sick. The physicians had evidence that vitamin D helped with the aches and pains of the disease, and the acetaminophen made it tolerable enough for the men to get back to work. They also took blood samples to test for the disease and the antibodies their bodies made against it. By the end of the day, we all would be at the house of one of the women who offered to make us dinner… For a nominal fee, of course.
As we sat around and drank hot beer while eating chicken with rice and carrots, the physicians started showing me text messages from their colleagues in Brazil. Their colleagues had seen a new mosquito-borne disease there that was known to be Zika. Some of the entomologists in our group said that it was only a matter of time before it spread like wildfire. They told us no one in the Americas was immune to Zika. Not only that, but they said something that was kind of scary. They said some of their colleagues had reported more children being born with microcephaly than expected, and that all of their mothers had Zika disease during the pregnancy.
It would be months before CDC and other public and private laboratories would confirm that, yes, babies infected with Zika while in the womb would be born with severe microcephaly.
One year later, in Puerto Rico, my wife would tell me that we were expecting, and I was scared at the thought that I could bring Zika back with me and somehow infect her and the baby. We tested me as soon as I got back, even though I never had any symptoms. All the tests were negative. Eight months later, a wonderful baby girl would be born, and she was perfect in every way.
Dozens of children in the Caribbean and hundreds in South America were not as lucky. They are living in a nightmare, with special needs that will probably not be met by their poor parents or their corrupt governments ever in their lives. And most of them born that way — born at all — because things like birth control are taboo to some people. Some things you just don’t speak about, or you punish those who do severely.
Twenty-five years earlier, I would find a pill on the floor of my cousin’s bedroom. It was not just any pill. It was THE PILL. She had been on birth control for a while because her menstrual cycle was irregular. At the behest of a friend, she got the pills in Juarez, Mexico, across the border from El Paso. When my uncle found out, he beat the living twilight out of her. He made her swear to him and to God that she was not having sex, and he made her throw out the pill. A few weeks after that, her menstrual pain kept her from school for several days, and my uncle could not care less. Two years later, while still a teenager, she became pregnant.
A shotgun wedding would ensue.
This was the same uncle who criticized me for not being married at 27. He said I had wasted away my life and not behaved like a man. I told him that was his opinion, but that he was sorely mistaken. That summer, I had met a girl. Two years later, I would propose to her. Two years after that, we would get married. Seven years later, we would have our perfect child, and that perfect child will not be physically punished for taking care of herself or relieving her pain. She would be loved like few people are loved in the world… Like most people should be loved in the world.
That baby born to a teenage mother is now an adult, primed to make the same mistakes because we don’t learn and because points of views were reinforced with physical punishment and lack of understanding. Me, also born to a teenager mother, have come to see the world in a much different way, and they have not forgiven me for it. They said I was a goody-two-shoes, someone who wanted to make sense and bring balance to a world not meant to be brought into line by men but by their version of a supreme being that allows them to be the anathema to what is preached on Sundays to their very, very, very large church. Bad things happen to bad people, according to them, and it is not our job to make things right because that job is up to the big guy upstairs.
One of my last days in Colombia, I was riding a cab to my rented apartment from the university where I was teaching and doing my research. The driver pointed out to me that a young woman was being followed by a suspicious man. We were stuck in traffic and moving at their speed as they walked on the sidewalk by the side of the avenue. The man kept pace with the young woman, and the driver said the man was probably about to snatch her bag.
Well, that was enough for me to give him some cash and jump out of the car and jog towards her. I said hello and asked her for the time. She looked at me like I was a grasshopper on a salad, but she read the time from her cellular phone anyway. I looked over at the man who was walking behind her. He had stopped and was looking at us as he looked around, up and down the avenue. Riding between the cars was a pair of police officers on a motorcycle. I flagged them down.
I told them that I was a stupid tourist from Mexico and that I was looking for directions back to my apartment. They gave me directions. All the while, the young woman walked away from us. I casually nodded at the man. He had started walking in the opposite direction from where he was coming, but he was still looking back at us. When he saw me nod, he broke into a fast jog and crossed the avenue between the cars.
I never really said anything about him.
I thanked the officers and walked toward my apartment. The young woman was at a bus stop filled with people and jumped into one of the most crowded buses I’ve ever seen. I continued to walk, grabbing my cellphone and calling my wife. “Your husband did the whole superman thing again,” I said. We then chatted about our day and about what I did while I walked to the apartment. She told me all about the people she helped in her job as a physician assistant.
Nine years earlier, as we sat in her living room, I watched television while she studied for her physician assistant certification. I knew she was going to pass it. She didn’t have the weight of the world on her shoulders about it because she was confident that she had learned everything she needed to learn to pass the exam. I knew she would pass because I had come to learn that she was incredibly smart in the weeks we had been dating. She joked about me becoming a PA.
I told her that I could never be a PA. It came out totally the wrong way. She looked at me like in a way that told me that I had insulted her, that I had said it as if I would rather be a physician than a PA. It was then that I told her about the MCAT test, about not wanting to be buried in paperwork — or worried about lawsuits or patient ratings — instead of actually helping people. And I told her about my public health studies and how that master of public health degree would help me help entire populations of people at a time.
Three years earlier, a friend of mine from El Paso came up to visit me with her sister and her sister’s boyfriend. As we talked about our future plans, I told her about the physicians at my job who told me I should do more with my life. She said she had looked into public health, and that maybe that would be something I could do. Weeks later, I logged into the online self-paced course on the basics of epidemiology from CDC. Weeks after that, I applied to go to George Washington University and was soundly rejected. Days after that, I went to have a chat with someone in admissions and was admitted on a probationary basis. A year after starting to date the woman who would be my wife, I had my MPH degree and a job at a state health department.
A lot of women have guided me on my way through life.
I’m sitting tonight next to a little girl who will one day be a woman like her mom, or maybe even better. I have high hopes for her, and I love her like I love no one else in the known universe. Her brown eyes, clones of her mother’s stormy blue eyes, look at me and wonder why I smile as she rubs them. She’s tired from a long day at school, playing with her friends and learning about this life she’s barely started to get to know and understand. Oh, the places she will go… And I can’t wait to read her 3,800-word rants about her adventures and her thoughts on life. Just like you read mine just now… If you made it to the end.
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.
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