We have to believe that even the briefest of human connections can heal. Otherwise, life is unbearable.
-Agate Nesaule 
The patient arrived at the rural clinic near Guazapa, El Salvador, in his mother’s arms with a mouth gag tied in place and his hands wrapped in bandages. As his mother put him gently onto the examination table, his muscles twitched hard, tearing the paper bed cover and forcing the gag out of his mouth. “Be calm,” his mother whispered to him in Spanish. He remained contorted but visibly quieted as our pediatrician, Dr. Mike, held him.
Oh, oh, I thought. We are miles from a hospital and a three-hour plane flight from anything familiar. We have a very sick kid on our hands. How will we handle this?
While I watched from my exam station across the room, the mother shared her story. What I initially assumed was an emergency turned out to be just another day in the life of this family. The patient had been born in the final years of the Salvadoran civil war in a poor, rural community with no functioning infrastructure. Severe oxygen deprivation during his birth caused significant brain damage. It is safe to assume that he received almost no medical care as an infant; only the love and care of his family had allowed him to survive at all. Now, 21 years later, his mother was bringing him to a medical mission clinic staffed by volunteer North American physicians, nurses, pharmacists and healers.
During his childhood, his family had found that cloth gags and hand wraps could keep him from inadvertently biting and scratching himself. The mother calmly related the joys and challenges of his life. Dr. Mike had helped care for patients with this same diagnosis back home and I am certain that he was mentally cataloguing all of the potential treatments and support options that would be offered to this family back in the States. What did we have to offer here that would make a difference?
Julia interpreted. Nurses Kathi and Jean helped. Nurse Practitioner Gail brought her experience. Dr. Mike supported the patient while performing a gentle, thorough examination. He peered in the ears and throat, listened to his heart and felt his abdomen. He pressed the muscles of the arms and legs. He warmly complimented the mother on the exceptional care she had provided for her son.
The mother smiled. Despite the challenges, this child was the biggest joy in her life. But, she wanted to know, can you help him? His biggest problem is sleep. Can you help him to sleep?
We had arrived in El Salvador with only the most basic medications; we had things like vitamins, calcium, iron, anti-parasite pills, mild pain medications, and basic treatment for coughs and colds. Well, Dr. Mike said, we could try giving him one of the cold medications at bedtime to make him a bit drowsy. That might help.
Thank you, the mother said. Suddenly, the patient’s arm flew up around Dr. Mike’s neck, surprising everyone. What was wrong?
He is giving you a hug, his mother told Julia. He wants to thank all of you, too. Dr. Mike held the young man in his arms for several seconds before passing him to my wife, Kathi.
Most of the patients we saw during our days in El Salvador came to us with routine concerns: coughs, headaches, and sore throats. Watching this family, though, reminded me powerfully that, no matter how severe the problem, there is power in touch and value in just being there. As the examination wrapped up, the mother repositioned the mouth gag. After hugs, good wishes and thanks to everyone in the room, the mother and her son were soon on their way back home.
