Anti-Romántica

Middle photo by Drake Meaney, PharmD.

If it’s yellow,

Let it mellow.

If it’s brown,

Flush it down.

Don’t forget!

Toilet paper goes in the trash.

–– Outdoor Bathroom Maxim

There is nothing romantic about a cold shower – outdoors, beneath a corrugated metal roof, your feet flush against the rough stone floor. There is nothing enviable about icy water dripping down your back, the squelching of your soles as you scoot towards your towel. There is nothing remotely elegant about the hop-step-shimmy required to pull on pants above sopping wet ground. For what fool would idealize a glacial hell?

Medical brigades are often described in rosy clichés: as “life-changing experiences,” “bracing returns to simplicity,” and “reminders of what really matters in life.” When you set off for a brigade, your friends wish you luck. They tell you the trip sounds “so exciting” and eagerly request photos. Some may even express envy. The truth is: hardly anyone used to a privileged lifestyle is prepared for the sparsity of a medical brigade. I had traveled to Perú once for a service trip with a group from my university, so I thought myself prepared. Back then, however, I had stayed with a local family, in a well-furnished home with reliable electricity, WiFi, and my own private bathroom. My time in Honduras has been something entirely apart.

We rode to the clinic from the San Pedro Sula airport in a caravan of open pick-up trucks, perched atop wooden benches strapped into the flatbeds. Sheets of dry wind whipping our faces, we clutched the railings for dear life. Our truck wove uphill towards the village, kicking up dust from the treacherous mountain roads – little more than narrow dirt paths lined with deep furrows, into which muddy rainwater drained downhill. The pick-up truck ahead of us bore a teetering stack of suitcases, strapped down by rope, which jostled dangerously at every bump and blind turn.

The tropical warmth was a welcome change from the senseless cold of Pittsburgh. I’m going to love it here, I thought, inhaling deeply, the sun soaking into my skin. Towering green foliage rose up along the road, blanketing the mountainous incline on one side and, on the other, the steep drop-off into the valley below. Parallel rows of maize and bean trees criss-crossed the hills as cattle grazed lazily along the lush ridges. My Californian eyes had never seen so much greenery. The clear blue sky above melted into a watery pastel as it reached the distant peaks. At sunset, the faintest hues of lavender and blood orange trickled into the sky. A streak of salmon descended over the mountains. I began brainstorming increasingly puerile titles for this post: “Into the Wild,” “Back to Basics,” “I See Trees of Green”…

One hour later, all fanciful thoughts had evaporated. A nighttime chill had settled over our caravan as the drivers urged their trucks ever upward. The tires bounced along the ridges and dipped into the furrows, occasionally catching on half-buried stones, and every jostle drove the metal railing into my hip. My nostrils and lash line were coated with a thick layer of dust. My hair was matted under my hat, and my fingers had begun to burn from the effort of gripping the railing. Don't fall off, don't fall off, I mentally willed the truck as it navigated another precipitous turn.

At the last rays of sunlight, we reached the clinic in San José. I hopped off the truck last, so I missed the front end of the rushed orientation and tour of our dorm, which adjoined the clinic by a covered outdoor walkway. At a glance: one room for men, one for women, wooden bunk beds, no ladders, outdoor toilet and shower stalls, mosquito nets piled in the corner. My inner child began to weep at the memory of the painful red wheals mosquitoes would inflict on me during the Indian monsoon (wet season). The last mosquito net left was a travesty: tangled yellow mesh, adorned with several tears, topped with a plastic ring that fell far short of the concrete ceiling. Balancing on the naked wood of my top bunk, I surveyed the room in desperation and increasing panic, my mind bleary from hunger and exhaustion. A resident and an attending took pity on me. With their help, I retrieved a sinewy rope slung from the ceiling above an adjacent bunk, fashioned a rudimentary harness for my mosquito net topper, and yanked the sides down over my bed. It caught on the wooden posts. Suppressing a scream, I clambered down gingerly via the wooden posts and board edges, on every move picturing myself falling backwards and breaking my neck. I bet if I did spine surgery on myself, they'd let me into residency.

The kitchen and dining room were in a separate building on the other side of the clinic. Naturally, I got lost on the way. Dinner was bracingly hot, served by a line of kindly Honduran women who ladled chicken legs, mixed pickled vegetables, pico de gallo, and small flat tortillas onto our plates. While we ate around a long dining table topped with plastic sheets, our brigade leader inquired about everyone's first impressions. I bit my tongue. Diplomacy was beyond me at the moment. At least the chicken was char-broiled to perfection with crisped, beautifully seasoned skin. I lowered my head and concentrated on the back-and-forth motion of utensils slicing meat.

After dinner, we began organizing the pharmacy in earnest: counting all pills left over from the previous brigade, unloading the boxes of pharmaceuticals we had ushered through Customs, and arranging the facilities for the next morning. When I had reached the end of my frayed patience, I excused myself for a shower break. There were four metal stalls behind the dorms: two with toilets, two with shower heads, all equally uninviting. On the inside of each toilet door, inscribed in Sharpie, was the following:

If it’s yellow,

Let it mellow.

If it’s brown,

Flush it down.

Don’t forget!

Toilet paper goes in the trash.

Well. At least the toilets stood upright. The last thing I needed was to be fished out of a floor toilet in the dead of night. The one from my grandparents' old house in India had fueled my childhood nightmares.

I was already inside the rock-floored shower when I realized I had forgotten my shower slippers. I hung my pajamas on a bar perched precariously on one wall and turned the faucet. Jets of freezing water thundered onto my head – so cold my scream went mute. What followed was a delicate dance in which I stuck one limb at a time under the cold water and scrubbed vigorously until I was clean. "Why did we do this to ourselves again?" I grumbled to one of my classmates later that night. "It's gonna be a long two weeks," she answered.

I knew exactly why. I had always nursed a strong interest in global health disparities, planted by my Indian ex-patriate parents who took my brother and me to India every other year to visit our extended family. The summer I spent volunteering with sexual violence survivors in Cusco, Perú, after my freshman year of college became the most formative experience that pushed me towards medicine. So, naturally, when the opportunity arose to rotate at a Honduran community clinic for my Family Medicine clerkship, I snatched it up without thinking. On the surface, it seemed the perfect opportunity to maintain my track record in global healthcare work – and to escape the frigidity of Pittsburgh in February. As the year wore on, however, I began to see it as a chance to reignite my affinity for medicine, which had occasionally flickered and waned amidst the pressure of clerkship year.

Honduras is a small bicoastal nation situated at the knuckle of Central America. The former Spanish colony boasts fertile land and a tropical climate with alternating wet and dry seasons, enabling agricultural exports of sugarcane, palm oil, milk, corn, coffee, melons, oranges, beans, and (most notably) Chiquita bananas. Nearly half of the country is forest (43.5%), with another quarter (28.8%) reserved for crops and pasture (CIA World Factbook). Notwithstanding their abundance of natural resources, the majority (52.4%) of Hondurans live below the international poverty line, per the 2017 standard: that is, they earn less than $2.15 USD per person per day (World Bank). Their Human Development Outcomes – encompassing health and education, along with other metrics – are among the lowest in Latin America (World Bank). Our brigade of 15 volunteer physicians, pharmacists, and healthcare students had arrived to conduct a biannual exchange of medications and services, founded on a twenty year long collaboration between the University of Pittsburgh School of Medicine and the Clínica Hombro a Hombro (Shoulder-to-Shoulder Clinic) in San José. Whatever gaps we could shore up, we would.

None of this is comforting when you're standing under an icy shower, questioning your life choices and desperately missing American WiFi. The first stretch of any major change is spent in survival mode. You learn how to breathe through a cold outdoor shower. You learn to bring exactly what you need, and no more, to the communal sink. You learn the most effective way to climb into your bunk bed to minimize head and spinal trauma. Bit by bit, you develop systems and routines that carry you through the day. Wake up. Climb down. Shower. Eat. Work. Eat again. Hike. Shower. Eat. Moisturize. Climb up. Sleep.

Chalk one up to practicality.