“The schedule [for surgery] is full.”
This was another negative development in the life of Anita Gajardo, whose life is absolutely more full of negative circumstances than anyone I’ve ever known. This is the story of a girl from the mountains around San Pedro Sula, Honduras. The patient was kind enough to teach the surgeons a lesson regarding the complexity of South American politics and culture.
The naiveté of the “bleeding heart type” American surgeon. Of course, there are four types of American surgeons. First, there are the ones motivated by overwhelming compassion. The second are surgeons whose purpose is to build up gold coin in heaven by proselytizing and converting souls; they make an exchange, quid pro quo, of “join my religion, my philosophy,” in exchange for surgical care. Third are those from developed countries whose motive is neither compassion nor religion but a deep spiritual way of life. Fourth, like those from Stanford, who formed Interplast for the medical purpose of finding advanced human pathology, are those who follow their mandate from Hippocrates, “perfect the science and skill in yourself, and apply it for the good of the other person.” It is probable that all four of these surgical types would be subject to the guiles and social skills of the other culture.
Little did we know that our culture, only 300 years old, was unquestionably inferior to a 3,000 year old culture, springing from Aztec and Inca wisdom, and modified by the Spanish cultural soup. Our culture was hopelessly in-equipped, poorly matched for the situation. Arrogance, imperiousness, neocolonialism. We had been taught to follow the rules, do a complete social history, follow holistic principles. Be sure you’re doing the right thing. What would Hippocrates do? What would your mother do? What would Jesus do?
Anita Gajardo’s sponsor was the pastor of her church. The pastor was stumped by our saying that we were currently filled, to go home, and to return the next day with the patient, making sure she did note eat in case there was a vacancy. The pastor had to reach deep into her bag of tricks in order that her own purpose could be satisfied. She was successful in defeating our rebuke by adding drama, almost repulsion to us do-gooders.
She also heaped on to the plot, her way of mining the compassion in us: this defenseless girl lives in a wood shack with a locked door, she doesn’t have key, it’s kept by men who rape her repeatedly, she doesn’t have a job. It was such a compelling story that I not only wanted to do the case immediately, but the other 6 surgeons in the team immediately volunteered and insisted that they be the surgeon. We were dreaming of becoming the hero in this drama and perhaps, we subconsciously thought of newspaper, radio, television, spotlight and self interest. We all were proud that Dr. Furlow, who we worshiped as the most experienced and wise surgeon, should be our champion. He did the case.
After this was done, Fran Falces, wife of one of the plastic surgeons, went over and interviewed Anita. She got the back story and data, and to our surprise, came back laughing. There’s no raping, she has job doing laundry, she does contribute to society in that way. In a way, she needed no rescuing, her own culture had already found a good place for her. It was story made up by pastor. She even told our translator that she was a pastor of the Church of Satanical Practice. Nurse Falces was suspicious that the pastor would go back to the mountains telling people that she had made a miracle for the patient by being able to access the devil’s power. Latin American politics is more complex than we could ever imagine.
What did we learn by this? We must remain humble and discard our arrogance. Arrogance is our enemy even though it is an extension of our skill and knowledge. An extrapolation we must avoid. All people are equal, a lesson we hope the residents and students who were present also embedded into their body of social and surgical skills.