Whenever I dismounted at Lydia’s home of gray boards and dried palm grass, her son hastened to hitch and water my horse while Lydia offered me lemonade and a spell of rest. Then she would walk with me among the shacks of her community, introducing me to other villagers and discussing her concerns about the health needs of her town. Upon returning to her home, she always fed me. I was always famished from the morning on horseback and foot in the relentless sun. She would sit me at the small table in her simple kitchen, where she toiled over the fire, serving me heaps of black beans and rice, fried platanos, and coffee made from beans she had just toasted in a clay pot.
Most of what I learned about life in Nicaragua, I learned from Lydia. Not five feet tall, she was a wiry woman of indigenous ancestry. She took me into her care from the very first time I visited the impoverished town of Las Pilas. She was sunbaked and wrinkled beyond her forty-seven years, always in a dress that was ragged and worn but freshly pressed with an iron she heated on a wood fire. Despite her diminutive size, she was the fiercest of advocates on behalf of her village.
I was a Peace Corps volunteer, and it was 1970. I had come into adulthood on the swell of Kennedy-era idealism intent on changing the world and had no idea how the world beyond North American shores would change me. Nor how the experience would cause me to ponder the oppressiveness of fences even fifty years later.
My horseback commute took me to remote villages on the isthmus between the two volcanoes that composed the Ometepe island in Lake Nicaragua. I worked with campesinos, providing them with health education, distributing donated food, and monitoring the health and development of their children. From lunches with Lydia, I learned that half the children in Las Pilas died from malnutrition, parasites, or infectious diarrhea early in life. There was no source of potable water. Getting water required villagers to walk several miles down muddy trails to the shores of the lake, where they bathed, watered their animals, washed their clothes on lava rocks, and filled their tins with water for cooking and drinking. The burden of getting water fell on the women and children, while the men tended their small plots of frijoles or wielded machetes for land-owning patrons. Children dropped out of school to attend to the chore on bare feet.
Safe water was only possible with the added burdens of gathering wood and boiling the water—luxuries of time and resources that few could afford. I knew without asking that Lydia always boiled the water for the lemonade or coffee that she served me.
When I arrived one afternoon, a humming throng of men and women was gathered outside Lydia’s house. Amid the commotion stood Lydia, uncharacteristically agitated. Turning to me, she explained that the patron who owned the land on either side of the trail between Las Pilas and the lake had erected a fence across the trail, blocking the only direct access to water from the village. A young man had cut the wire fence to restore access. He had been arrested and taken to jail in the nearby town of Altagracia.
Lydia dug her tiny feet into the dusty ground. Raising her voice to address the crowd, she spoke, her voice quivering with barely suppressed rage. “I may be poor and meant to be poor, but I am a human being and I have my rights!” On the heels of this pronouncement, she waved the crowd toward a bus leaving for Altagracia. By sundown, the mass of protesters had reached the mayor’s office. The prisoner was released, and access to water was restored.
Lydia had never heard of the Universal Declaration of Human Rights, but she understood in her bones the link between health and human rights. She knew where a fence should not be.
In those days, Nicaragua was tightly controlled by President Anastasio Somoza Debayle, whose family dynasty—with US support—had ruled the country since 1937. His pseudo-democracy was toppled by the Sandinista revolution of 1979. Subsequently, under Daniel Ortega, the country established a system of socialized medicine that achieved significant decreases in infant mortality and increases in longevity. These gains were fleeting, however, cut short by the US-backed Contra War that resulted in the defeat of the Sandinista government in the elections of 1990.
Twenty-three years after completing my Peace Corps service, I joined a delegation to study health care conditions under the new government of Violeta Chamorro. Our group visited the country’s only public psychiatric hospital on the outskirts of Managua. There, I encountered another fence.
The hospital buildings were shabby, stucco structures scattered over several acres of dusty grounds with occasional mango trees. The medical director escorted our group around the hospital, commenting as we walked. The dormitory for patients was basic: open to the air, mattresses bare of sheets, few chairs, no reading material, no television. Patients wandered by, vacant and disheveled, some muttering and gesticulating in a language that I recognized as more psychotic than Spanish. It was hard to imagine what people could do besides wander. There had been a half dozen assaults on staff the previous month, a problem the doctor attributed to the lack of antipsychotic medicines to subdue agitated or hallucinating patients. I winced at the sight of a machete lying on a table within easy reach of anyone.
In the room dedicated to pharmaceuticals, we found none of the psychiatric medicines that would have been standard stock in the United States. No antipsychotics or antidepressants. Incomprehensibly, Fleet enemas were in abundant supply.
Conditions had deteriorated since the defeat of the Sandinista government. Under the Sandinista government, our guide explained, there had been more medicine. Now-extinct teams of family and occupational therapists and foreign delegations had offered training in innovative approaches to the mentally ill. No one from the new health ministry had taken enough interest in this public hospital to even visit, although desperate families continued to abandon family members to their care. The morale of his reduced staff was low. Privatization of facilities was the new priority, encouraged by US business interests and the policies of the International Monetary Fund.
I thought our tour was over when I spotted the fence: new, chain-linked, six feet high and made taller still by strings of barbed wire. On the other side of the fence stood what looked like a generously sized home that encircled a courtyard where several ornate wooden rocking chairs sat empty, their beauty reflected in the polished tile floor. We peered in while the doctor explained that this was a new private hospital—for people who could pay. Here, people could receive therapy with psychiatrists and social workers, medicines of all kinds, and programs of occupational therapy. There were currently few patients, he offered, because most people with resources still preferred to fly to Miami for treatment. I knew that, if in a world where Lydia and I needed psychiatric care, we would end up on opposite sides of this fence.
My fingers lingered on the chain links as I contemplated the obscenity of the view—from either side of the fence. Obscene but honest. There was no geographic cushion separating the realities of the haves and the have-nots. Just a fence, and one you could look through, at that.
And I ponder. If Lydia, born into crushing poverty that she could never escape, could use the full force of her personality to take down an unjust fence, what am I called upon to do?
Jeanne Parr Lemkau served in the Peace Corps in Nicaragua from 1971 to 1973 and considers that experience the most formative of her adult life. She is now a practicing clinical psychologist and professor emerita of the School of Medicine of Wright State University. There she taught behavioral science and introduced global health and international service to medical students. She is a student of the health care system of Cuba, an activist against the US embargo of Cuba, and the author of a memoir called Lost and Found in Cuba: A Tale of Midlife Rebellion. Jeanne lives in Chapel Hill, North Carolina.
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