I'd arrived in South America with Doctors Without Borders, an independent relief organization that provides medical assistance to victims of war, natural disasters, and epidemics in more than eighty countries. As an intern based in the organization's Los Angeles office, I knew that on the trip to Costa Rica and Peru I'd be primarily an observer, along for an educational ride. But I couldn't help hoping I'd somehow be useful.
Our first stop in Peru was the Apurimac River, where I boarded a rickety motorboat with Guy, the regional Doctors Without Borders coordinator. Overflowing with chickens, sardines, and locals, the boat headed upstream against the strong current, rocking violently. After the perilous two-hour ride, we met up with Pedro and Jesse, Peruvian nurses who constitute one of the traveling medical teams that provide primary care in Ayacucho's remote communities. The four of us hiked into the jungle in sweltering heat, passing bamboo huts and fields of coca plants. On the way, a little girl standing outside one of the huts caught my eye. Surrounded by rotting fruit rinds, gar-bage, and broken toys, she looked to be only three or four years old, but her abdomen was extremely distended, a sign of repeated infection from worm disease.
There were more kids who looked like her in Pediatro de Sorza, where we arrived just as the sun was setting. That night we met with village leaders to discuss the public health situation. Among the biggest problems, they said, were the human feces and trash decomposing in the fields around the village. Knowing that Pedro and Jesse would be kept busy the next day with the needs of patients, I quickly offered to help build a latrine. My enthusiasm abruptly turned into fear, however, when I realized I had no idea what to do first. But Guy and Pedro did, and with four villagers who volunteered to help, we drew up a plan.
At eight o'clock the next morning, before the day became too hot, we found a spot of high ground a safe thirty meters away from the nearest water source. Using a machete, a shovel, a pick, and a hoe, we dug a hole 1.8 meters deep, one meter long, and one meter wide. With a few of the villagers I knocked on doors to ask permission to cut branches from people's backyard trees for the latrine's floor and walls. Everyone was generous.
As we began putting up the frame, an army of schoolchildren on their lunch break ran over to see what we were doing. I asked if any of them knew what this was. Amid the whispers and shuffling feet, I overheard several boys say it was a hole to throw their friends in. Not quite, I explained: the latrine was where they should "do their business," because it would help prevent the spread of disease. Squatting over the hole, I demonstrated - with appropriate noises and facial expressions - proper latrine technique, in the process triggering loud laughter and lots of giggles.
Okay, so this wasn't the most dignified part of my premed education. But it did teach me something I could never have understood in the comfortable, air-conditioned classrooms of Brown: international medicine is as much about fighting poverty as it is about treating illnesses. I felt a new passion and commitment to working in communities such as Pediatro de Sorza, and a new satisfaction at arming people like Carlos with the basic tools for good health and better lives.
The latrine took five dirty, sweaty hours to build. As we completed the frame, one of the village men said to me, "You have done enough. Go rest. Now that you have shown us how to build a latrine, we will build more." Hearing this touched me deeply. I had been useful.
