Cultural Differences in Paraguay

Paul Jacquay – Paraguay

November 2nd (my birthday) was a smooth tranquil day for me. I started out by skipping clinic at Friendship Mission and walking downtown. I had received 2 letters from Indianapolis that explained that Marianne and I are here under their support. These had to first be stamped by the Paraguayan Consulate in New York at a cost of $30.00 each before they could be mailed. Here they have to be stamped by the Departamento de Interior at a cost of 227 guaranies each (about $40.00) before the Immigration Department will accept them.

Paul Jacquay – Paraguay

November 2nd (my birthday) was a smooth tranquil day for me. I started out by skipping clinic at Friendship Mission and walking downtown. I had received 2 letters from Indianapolis that explained that Marianne and I are here under their support. These had to first be stamped by the Paraguayan Consulate in New York at a cost of $30.00 each before they could be mailed. Here they have to be stamped by the Departamento de Interior at a cost of 227 guaranies each (about $40.00) before the Immigration Department will accept them.

At any rate, when I walked into the place to get the letters stamped I was surprised to find just one person waiting in front of me. Usually it has been a serpentine line snaking from the front door to the teller. When I paid the guaranies I asked if it would be 2 hours before they are ready, and the man held up just 1 finger! I then went to a local park where there are lots of craft shops and bought some goodies for my daughter, Helen, in honor of her 24th birthday. I took these to the post office, and was very surprised when they did not take everything out of the package to inspect it. When I had done this to send stuff to Sean they had taken everything out of the wrappings and then I had to put it all back together. Then went back to get the letters and they were just ready actually a little bit ahead of time! The afternoon marked our first trip to Lambare to do clinic there. As we got close to the church (where we hold the clinic) I was surprised to encounter a traffic jam and police directing traffic. The church is across the road from a very large cemetery and November 2nd is the “Day of the Dead” similar to our Memorial Day. We had just three patients show up for clinic and figure that this holy day activity was a partial reason why. Had a quiet evening at home with Marianne to include ice cream and cake to round out the day.

This is a very different birthday this year because of the location and culture. But I must say that in general there is not a lot of difference here. We have cable TV, including HBO and Cinemax, which are in English with Spanish subtitles. There are other channels that carry American programs such as ER, Scrubs, and Medium. ESPN carried the World Series with Spanish broadcasters. Traffic laws are pretty much the same, but there is no enforcement, so drivers do what they want. This means I have to be careful at every intersection and watch for someone speeding through, even if there is a green light. Especially on Sundays red lights don’t mean anything. One difference here is the fruit venders at busy intersections. We do buy our fruit from these people because it is cheaper and better than what is offered in the supermarkets. One difference in the supermarkets is that a lot of stuff is in bulk form. We pick out our own carrots, potatoes, tomatoes, popcorn, peanuts, etc. from large bins and then have them weighed and stamped with the appropriate price. Since Marianne and I are cooking for ourselves we pretty much eat the same diet as in the states, but with much more fresh fruit.

My major project, MAESTRA, started with our 1st clinic in the church at Luque. We saw 25 patients. The next week we had obtained medication to treat whatever needed to be. But have run into some difficulties over charging for this. The people at the churches were under the impression that this would all be “Gratis” (free). It was explained to me that this is a cultural thing because the politicians give away goodies such as beer and food, so the people are accustomed to receiving free stuff. We worked out a compromise by giving each patient a choice. They could have a consult only for 2000 guaranies, or get a consult plus medicine for 15000. (5300 g = $1.00). This will cover our average cost for medicine, but if a patient needs more than one medication, we lose money. We still have much to learn with this project, and I hope we can figure it out so that it can sustain itself and also treat those who cannot afford it.

Our other current project is visiting the Disciples Churches in Paraguay. So far we have been to 5 of the 10 that are here. While the format is the same, the presentation differs. Some services are sedate and others are more on the wild side with dancing and shouting. I am getting over the anxiety of talking to each congregation to explain about what Marianne and I are doing here. No one has complained about my Spanish speaking abilities so I guess I’m over that hurdle.

A very delightful bonus for me here is basketball. There are courts at Friendship Mission and a group of neighborhood men play 3 on 3 every evening. Some of them are pretty good! But I have been able to hold my own with them, and enjoy playing twice a week or so. Sometimes they get a bit rough, and then argue about fouls and stuff, much more than I have experienced in the states. But it is good exercise for me. They are quite amazed that I can play as I do at my age (and so am I!).

One Friday evening I spent some time at the Urgencia Clinica. Dr. Liliana Ramos was on call and she invited me to see and learn more. I was immediately surprised because the level of the infirmaries was much more severe than anything we would see in an urgent care clinic in the U.S. Three of the patients were sick enough to be delirious. One of these was a woman with a tense, bloated belly from a postoperative infection. The other two were receiving antibiotics for pneumonia. I told Liliana that these were more appropriate for intensive care and she said that intensive care was full, and so they could not send them there. The hospital has no supplies. Relatives of patients are given prescriptions for everything they need. This includes not only medication but also catheters, IVs, needles, syringes, bandages, medium for blood cultures…everything. There is one monitor that is part of a defibrillator and one pulse-oxymeter to serve 10 beds. After a couple of hours I told Liliana that I needed to go and she asked me what my impression was. I looked around at the facility and the old gurneys and equipment and didn’t have to think long to respond that it reminded me of the hospital that I was at in Vietnam in the 1960’s.

Shalom to all of you.

Paul

Paul Jacquay serves as a long term volunteer at Mision de Amistad (Friendship Mission) in Paraguay. Paul works as health consultant for the medical department and is a nurse trainer at the Mision de Amistad School of Nursing.