E.E. Freeman, MD PhD
We pull over on the dusty track. The health technician opens her door. I look around expectantly, but all I see are a few cacti. She points up the scree slope, and I see a small goat track winding it�s way through the cacti. I follow her up the hill, a thirty minute scramble between rocks and shrubs, and then suddenly we pop onto a plateau, and there is a long mud hut, a roof of sticks, a small garden, and a goat pen.
An old man, wool cap and rubber boots in place, is lying on a sheep skin next to the hut, looking out over the valley. He does not see us, so we call out to him, but he does not hear, and remains still, pondering his view.
And suddenly there are kids, and dogs, and hubbub. �Welcome, welcome,� a tiny shrunken woman hidden behind years of wrinkles greets us. �This is the doctora, she comes from the University to check on the uta [common name for Leishmaniasis],� the health technician explains. �Well well,� the old lady replies, �we have plenty of that here. You are most welcome.� She gestures at a vacant spot on a sheepskin. She lines up her grandchildren, each of them with large scars across their faces. �We all have uta here,� she explains. �Even me - � she gestures at a scar on the tip of her nose. �All of my children, all of my grandchildren, they have had the uta.� One of the young boys, the only one with red, active ulcers, has a thick white cream on his cheek. �What is that?� I ask. �Egg white to help with the swelling,� his grandmother replies. The health technician chimes in, �this little on was treated at the university three times, but he failed treatment. We are out of ideas, and his mother is sick of trying to bring him down to Lima when nothing helps.�
What is it about this place, that every single member of the family has been affected by leishmaniasis? The grandmother is more than happy to show me around. She shows me her garden, her favorite herbs she uses on the children�s faces to help with their wounds, her many goats, 42 to be precise. I look at their dogs, hosts for the leishmania parasite, checking their noses and their fur. I am still without an answer, other than that this farm must be the perfect combination of elevation, plant, and animal life for both the sandly and the leishmania parasite to thrive.
After my walk around the farm I return to the sheepskin. The old man sits next to me. He�s been deaf for allegedly two months, though I guess it is longer. The local health technician started him on ampicillin, just in case it�s from an ear infection. A bilateral ear infection in an elderly man with no other symptoms? Instead I talk to the old man about getting his hearing tested, maybe getting evaluated in the city, but he grins and shakes his head.
�How old are you?� I probe.
�Six grandchildren!� he motions across the sheepskin proudly, grinning.
�No, you deaf fool! How OLD are you? How OLD? That is what the doctor is asking!� his wife yells.
�I�m a deaf fool? You can barely see!� he shakes his fist at her, her eyes cloudy from cataracts.
�What can I do with him, what can I do,� she shakes her head, not unkindly.
His children came for him one day, up from Lima in a car, which is a feat in and of itself, to bring him down to the hospital for an exam, but he refused to go. �I�m 81, why would I go to Lima? I�m old, I�m meant to die here. No need to waste anything on me. I don�t have too many years left.� So he stayed. She was scheduled to have her cataract surgery done in Lima, but she heard about a woman across the valley who went blind after eye surgery. �It�s safer not to.� So she stayed. And here they sit, on their farm infested with sandflies, with a beautiful view across the Andes and their 42 goats.
My biology student hands me a pad and a pen. �You should write it down. They�ll listen to you. You�re a foreigner and a doctor.� I write in huge letters in Spanish: �GO TO LIMA FOR TREATMENT.� They laugh at me, and I laugh with them. They will be sitting here on their sheepskins, of that I am sure, watching the clouds roll in, tending to their farm, until death comes to take them. It does not matter what I write.
