By Tom Palmeri (1989)
In a remote barrio of a small island in the Philippines, Alex, a nine year old boy with a hugely swollen neck, cried out, in terrible pain, “Mam Diane, help me! Mam Diane, help me!” His mother held him to her and rocked him and said, “Yes, it will be alright, Mam Diane has already helped you and she will help you again soon.” But Mam Diane would do no more for Alex, for these were his last words.
Diane is my wife, a registered nurse from Iowa , in her mid-forties. We have worked together with children in the Philippines for the past fourteen years. And as I sit writing the story of a nine year old boy who died with her name on his lips, I am driven to wondering where it all really began. In real life, things happen continuously, events simply flow from one another, and we are hard put to know where anything begins. But there are certain moments in our lives that at least clarify for us who we are and what we are about. One such moment for Diane and myself came in Saigon in late 1973.
Some friends of ours had put together an organization to work with severely malnourished children. They wanted to build a center and also to help improve the conditions in orphanages. Diane and I had first met at a small hospital in the Central Highlands in 1969, so we knew our way around. We would set up the project and run it for one year until they found replacements for us. It all seemed so simple. We would find hungry children and feed them and make them well. We thought we knew our way around. Actually, we knew nothing. And it all turned out very horrible.
We were involved with the Ministry of Social Welfare, and soon after our arrival, they assigned a vehicle and one of their workers to take us and another woman around for a day to some of the orphanages. To this day I pity the person who took us. She was one of their staff, but she had obviously never done this before; she simply knew the names and addresses of the places. She was Vietnamese but by the end of the day she looked white; all the blood had drained out of her face. It was all of the shocking things one occasionally reads or hears about and forgets. In one place, teenagers who were crazy were chained and padlocked to their own beds to protect themselves and others. More commonly it was little children that we saw, babies and toddlers, enormous numbers of them, left in their own excrement, rhythmically rocking, sometimes even pounding their own heads against steel poles as workers for whom it had finally become too much stood there with mops in hand, staring off into space like zombies.
In one great place, some distance outside the city, that housed twelve hundred children of all ages, we were finally ushered into a nursery where there were a dozen small babies. The room was hot, but someone immediately flicked on an air conditioner. We moved up and down the rows of cribs. Then the nun drew our attention to one crib in particular and undressed the baby lying in it. She was a little girl who had neither arms nor legs; her back was slightly arched; everything else seemed normal. We asked her name and were told it was Marie, a name commonly given by the nuns to girl babies who were abandoned with no name. It was late in the day and our tour was nearly over. We drove back to Saigon in silence.
For two more days we busied ourselves with one thing and another but continued to have almost nothing to say about our tour. On the third evening, we were sitting on the tiny balcony ourside our second floor apartment with our feet up on the railing. It was a tiny street but crowded at this hour because it was a short cut between two main arteries. Across the street, in front of a small restaurant, an old woman spat red globs from the beetle nut she was chewing onto the same sidewalk where she was hacking apart a large block of ice. We sipped our scotch and were grateful that we made our own ice cubes. Finally, I broke the silence with a question, “Can you think of any good reason why we should not adopt Marie?” There it was, out in front of us, what had been eating away at both of us. The idea of adoption was not new to us. Diane had given birth to our Paul two years before and we had brought him with us to Saigon . Diane could have more babies, but it seemed more to the point to care for unwanted ones that already existed than to add new ones to the population. We were planning on adopting a baby when the right opportunity occurred. Because Diane was a nurse, we felt we could handle a child with a medical problem that someone else might not be able to deal with. But we also might remain in Asia for many years and live in places where sophisticated medical care would not be available. So there it was. What about Marie? For twenty minutes we ran through all the good sensible reasons for not adopting Marie. She would need such special care and attention and could benefit so much from being with people who could provide her with everything. She should be in the States, near a major city. She should have this, she should have that. And after we let it all play out, perhaps to prove to ourselves how sensible we were, we came to the bottom line, which we had known from the very beginning. No one else was going to do anything for Marie. If we did not take her, she would be left where she was to rot away for as long as she lasted. It was us or nothing. And it was decided just that quickly. We would take her. With a great sense of relief, we poured another stiff scotch.
As soon as possible, we went back to the orphanage where we had seen Marie. We were told that the nun who was in charge of the nursery, and who apparently guarded her charges very jealously, was not around. And none of the other babies in the nursery were available for adoption at all. But the little sister who spoke to us did say with wide eyes that she thought the baby Marie might very well be able to be released to us. We inquired about her medical situation and were told that there was an international medical team that visited the orphanage regularly and handled all of that. We went to see Marie again and finally left in great excitement.
When we got home, Diane began phoning the doctor who was the head of the medical team. When a child has one abnormality, there is always an increased risk that there are others. Marie could have internal problems that would not let her live more than a brief time. If that were the case, we saw little point in taking her. But if nothing more was wrong than what was visible, she was ours. After many calls, Diane finally reached the doctor. She told him of our interest in Marie and that we would like him to examine her as thoroughly as possible. Diane was on a long time, haggling back and forth. When she hung up, she said, “He agreed to examine her, but he thinks adopting her is a very bad idea.”
“Then lets not ask him to adopt her.”
“He says children like this are always unhappy as teenagers.”
I thought on that a moment and replied, “Have you ever known a happy teenager?”
A few days later we had still not heard from the doctor. Diane tried to reach him but couldn’t locate him anywhere. Finally, she called the orphanage. They said that Marie was doing poorly and seemed to have pneumonia. Diane offered to come out and take her to a hospital at our expense. They said they could not authorize that; the doctor would have to see her first. When would the doctor see her? They did not know. Filled with frustration, we didn’t know what more we could do except wait. After a few days, Diane finally reached the doctor. He had not examined Marie thoroughly. There was no need. She had died at the orphanage while he was our of the country on a three day vacation. He was very sorry.
Of course, we knew that he was not sorry at all. It was exactly what he had wanted. Now there would be no unhappy teenager to remind all of us of our common lot. At the time, we felt very bitter about what had happened. At a distance of fifteen years, I am sometimes tempted to think that the doctor was probably right. But one of the few things I have learned is that what passes for the wisdom of age is often only cowardice. I resist the temptation.
Bad as we felt, we also knew that in the moment of our decision we had clarified to ourselves what it was we were all about and had passed a turning point in our lives. We knew what the stakes were in the game we were playing, we knew what we were prepared to take on. Or so we thought. In any case, it was time to get on with our work.
And work we did. An ancient Canadian Redemptorist priest just about gave us the keys to one of his orphanages. We set about rearranging things; stopped the babies from getting baths at 5:00 am; broke open boxes of badly needed clothing that were stored away unused, awaiting some unknown crisis; hired and trained two new cooks. But in the end it was all futile. New babies poured in every month and they died nearly as fast as they came. It was impossible to deal with the volume, given the staff and the facilities. It was the first of many hard lessons we were to learn about the limits of what we could do. But it was during this time that we got our Christopher. The orphanage staff knew we were interested in adopting a baby and one day they brought us a four day old boy who seemed in fairly good shape. The old priest said we could have him, and he also wanted us to take home, just for awhile, a tiny baby girl, “so she would have a chance to survive.” Our Paul came with us to get Chris, even helped to pick him out, and then screamed all the way home in the front seat of the taxi. Our interpreter thought Paul was jealous, but we knew better. He stopped screaming once we got inside the apartment and gave him Christopher to hold. Christopher was soon deathly ill and was in and out of a hospital twice. But he finally recovered and remained healthy after that.
While we tried to supervise things at the orphanage, we also moved out on our own. We rented a lovely two story private home from a Vietnamese Army Colonel who had a wife and one child. We moved into it ourselves and within a few months were caring for fifty babies in it, cases from many orphanages that would simply not keep where they were. The U.S. Congress authorized some special funding for children, part of which became available to us. With the help of that, we rented a four and a half story apartment building, hired a British nurse, and put another fifty children in with her. We kept the youngest and worst cases for ourselves. The atmosphere can perhaps best be gotten from one incident. We had a large staff, working two twelve -hour shifts. Diane and I slept in an air-conditioned room on the second floor. If there was a problem at night, one of them came pounding on the door and we bolted out of bed. One night the pounding started and Diane got to the door just as I sat up. After speaking to the worker, she turned and said, “It’s for you, thank God, we’re being robbed again.” Then Diane stumbled back into bed as I bounded out the door and up the stairs with a club in my hand to chase some son of a bitch over the flat roof of the adjoining building. There were only two reasons why the staff ever woke us at night. Robberies were my department; a baby going critical was Diane’s.
So there we were, our own operation going at full blast and Christopher adopted. Then one day the orphanage we worked with brought us a two day old tiny premie that had just come to them and that they knew they could not handle. In the tropical heat of noon-time Saigon , she could not maintain her own temperature. She had been completely abandoned and was definitely available for adoption. Diane and I undressed her and looked at her. She was so incredibly tiny. Perhaps her smallness was exaggerated by the fact that she had no left arm at all and that her right arm ended in one finger just above where you would expect the elbow to be.
Our organization was not an adopotion agency but there was interest in it and we had finally agreed that our people back in the States could try to find homes for children who had special problems and who would be particularly hard to place. So we told them about the little girl with no arms and a dwarf and another one that was missing something or other, I can’t remember what, maybe his head. After some time had passed, the poor social worker in charge wrote and asked if we couldn’t give her something easier to start with. I wrote and told her that we were not an original manufacturing plant and could not produce defects to order. We were just middlemen and simply passed on the merchandise that became available to us. I was not surprised to have no reply, and she never did come up with anyone interested in any of the three children. After some time had passed, Diane and I looked at each other one day with that silly grin we use for all our big decisions. Stuff our social worker in the States. We would keep the little girl with no arms ourselves. And we would name her Marie. Just imagine how wonderful. She had legs. Someday she would be able to walk and run and dance, all the things that the other little one cound never have done. And so she has, far beyond our dreams. She is fourteen years old now, can play cards and wash dishes with her feet, writes with one foot (the best penmanship in the house) , rides a two-wheel bike, and can dive and swim. She is, of course, a teenager and has been doing some serious stocktaking of her situation, and I believe she is unhappy. Welcome to the club. But for us, taking care of her has always been a piece of cake. For we have always been just as much aware of the legs she has as of the arms she is missing. Something few people have ever known is that to us she has always been Marie II, and we have never forgotten our Marie I.
Our year and a half in Saigon ended with Diane, myself, Paul, Chris and Marie leaving on April 3, 1975, on one of Pan Am’s last commercial flights. Not heroism. We had finally found an American nurse to replace us and were leaving more or less on schedule. But things were crumbling far faster than anyone had expected. Within a few days after we left, the orphanages collected all of their babies from our centers so they would have them with them at the end. Our buildings briefly became refugee centers as people from all over the country poured into Saigon . The American nurse who took over from us ended up sleeping overnight on the runway at Tan Son Nhut as she awaited a military airlift flight out. And the organization that had sent us there was soon out of existence.
Our own flight was a short one, just three hours to Manila . The next day we watched the TV news report the crash of a cargo plane full of babies just after takeoff from Saigon . Our families, watching in the States, were wondering if we were on it. But we were headed south to the city of Cagayan de Oro on the big island of Mindanao . Of the ten years I had been a Jesuit, I had spent the last six teaching and studying in the Philippines . I wanted to come back and to bring Diane there. There was enormous poverty, and yet because of the very low value of the peso, I knew a great deal of good could be done with very few U.S. dollars. As it happened, very few dollars were exactly what we had.
I got a job teaching Philosophy with my Jesuit friends at Xavier University . It paid $1,000 per year, slightly less than the rent we were paying for a simple house right by the sea. But we had some savings and we decided to gamble them on whatever would come next. The Philippines has very few zoning regulations. Beside the mansions of the very rich often live the terribly poor, divided only by a high cement wall, topped with broken glass, and a security guard with shotgun in hand on the other side. We were living in no mansion, but the kids who came to play with ours certainly looked miserable enough. One day I looked at the kids and then at Diane and said, “Start making peanut butter sandwiches.” It was a humble beginning and not very practical, but soon it grew into a daily feeding program, eventually for one hundred children, with a free medical clinic and lectures on hygiene and nutrition for their mothers. I think we must have saved the lives of many children. Some of them have even now had babies of their own who are in the feeding program, which still goes on. It is very depressing. The number of people in that neighborhood has doubled. Things have not gotten better.
While I was teaching six courses of Philosophy at the University, Diane was visiting the city’s hospitals and prowling the neighborhoods, doing what she’s so very good at, turning over stones to see what will crawl out. Part of what she found was abandoned babies, not nearly so many as in Saigon but still in desperate need. We had vowed never again to run the kind of operation that we had in Saigon ; with our best efforts and a large (if poorly paid) staff, it was still an institutional zoo. But that didn’t mean we couldn’t help a few babies. We adopted two, our Jay and Monica, but then we knew that had to stop. We would simply provide temporary foster care to others in our own home. The Department of Social Welfare was delighted to have our help and we were licensed by them and presented with our own copy of License #0001. We set a limit of five foster children at a time, determined not to let the atmosphere become institutional. Together with our own Paul, Chris, Marie, Jay and Monica, that made ten. Some of the babies moved through quickly, but more often they stayed for up to two years. The record holder was a little boy who spent four years with us, supposedly because he had been turned down for adoption by several couples to whom he had been offered.
With Diane’s qualifications and the experience we already had, the Department of Social Welfare gleefully brought to us their very worst cases. One was Bobby, a boy who was ready-made to haunt your dreams. If he had been any worse, he would have been in a coffin. He looked like his skin was made of papiermache and would crumble at your touch. Almost all his hair had fallen out. No one knew his age for sure, probably four or even five years old. He was suffering from severe malnutrition (marasmus), all sorts of parasites and TB. Both of his eardrums were ruptured. His neck was swollen where the TB had attacked the glands. We are not camera people, but have felt compelled to take some pictures for the sake of publicity and fund-raising. We have an amazing slide of Bobby just after he came to us, sitting on a swing, naked except for a pair of white socks. We had unbundled Bobby from blankets just long enough to take the picture and didn’t want to waste time getting the socks off. None of the children usually wear socks. But in the mid-morning tropical heat, Bobby could not maintain his temperature. He also could no longer walk and would not smile. He had even lost his appetite, one of the worst signs. When a starving child no longer wants to eat, you know you are near the end. It was because of this that Bobby did me a wonderful favor. We had to carry him from one place to another and hold him on our laps to feed him. We looked for foods he might like and got some dried fish because he was from a coastal town. For years I had wondered how anyone could eat dried fish, but of course, I had never tried any. Then one day, as I held Bobby in my lap and put bits of food into his mouth, bored at how slowly it was going and getting hungry for my own lunch, I began to nibble on some of his dried fish and what a tasty discovery it was. Ever since we have had dried fish on cheese and crackers as hors d’oeuvres. But the hand feeding did not have to go on for long. Bobby was so severely anemic that our pediatrician finally decided to give him a blood transfusion in spite of the risks. Half-way through the transfusion, he sat up in the bed and ate the tray of food that was waiting beside him. The next day he smiled for the first time. The road to recovery was very long but he was on his way. He began gaining weight; his muscles gradually regained their strength though his first steps were like those of an old man; he developed an open draining TB fistula in his neck that required daily dressing changes for seven months, but it gradually grew smaller and finally closed. We have another slide that shows him after he had been with us for one year, as chubby as any boy his age would want to be and dribbling a basketball in our driveway. He was adopted by a family in Virginia . Both his eardrums were operated on and he now has hardly any hearing loss. His new family has sent us the last slide of Bobby that we are ever likely to need. He is at center court, in full basketball uniform, playing for his high school team. He also plays on baseball and soccer teams. He has become quite an athelete. There are some days that you don’t care if all of your programs are failures and everything simply gets worse. It’s enough to know that you’ve helped some individual to escape.
In addition to the feeding program, free clinic and foster care, we began kindergarten classes for eighty children from very poor families, something they would never have been able to afford themselves. Then, five years ago, we made a major move. As Cagayan de Oro continued to grow, it became more crowded and filthy. But there was a small volcanic island, named Camiguin, a four hour trip away. We had often vacationed there for a few days at a time. Camiguin was primitive and beautiful and clean. Its seventy thousand people relied almost entirely on coconut and were very poor. We decided to keep our programs in Cagayan de Oro going with the staff we had built up but to move our family and the foster babies to Camiguin.
On Camiguin, we have become very involved in education. School attendance in the Philippines is not compulsory and there are many children who do not go even to elementary school. Usually, the reason is poverty. The public schools are free, but the needed supplies are expensive. So we now provide sponsorship for over three hundred children in ten different schools, giving them all the supplies they need on a monthly basis. But even this we have come to realize is not enough for some. We are very strict about attendance for those whom we sponsor and we became very alarmed when we noticed one boy had been absent for three weeks in a row. We finally learned the reason. He had only one outfit of clothes; it was the rainy season and his clothes were sopping wet; he stayed at home without clothes on until the rains stopped. A teacher complained to us about another boy who was always coming to school filthy. We discovered he had been dumped with an old grandmother who hardly knew what she was doing. It wasn’t clear whether the poor old woman was taking care of him or he was taking care of her. Prompted by these and even worse situations, we are embarking on our largest project yet, an elementary level boarding school for children who are so destitute that they cannot go to school at all in their present circumstances.
Diane has not given up her medical work, however. For the past two years, she has been attempting to identify every child on the island of Camiguin with a physical handicap and every person with an eye problem. She has found hundreds of cases, some of them terrible ones about which nothing at all had been done. Some of the worst are the children whose spines have collapsed and been bent far out of shape by TB. Little can be done on Camiguin for any serious problem, and so we have been sending these children all over the country to major hospitals. It was while doing this work that Diane discovered Alex, the boy with whom I began. Alex had an enormous swelling in his neck. Diane arranged for him to come to the Camiguin Island Hospital . The doctors there started him on TB medications and wanted him to get a biopsey done in Cagayan de Oro. Diane was going to bring him with her, but his family failed to catch the boat. One of our pediatricians thought that if the swelling got smaller under medication we might assume the TB was the cause. And the swelling did begin to recede. But then Alex had to stop his streptomycin injections because he was developing symptoms of toxicity. Alex grew very thin and pale, and the swelling began to increase again. Diane advised his mother to take him to Cagayan de Oro for the biopsy, but his mother had to wait two weeks for someone to return who could watch her house. Finally, she took him. They had to wait a week for his stitches to be removed. A week after that Diane told his mother the results, fibrolipoma, and said she would arrange for him to go to a hospital in Cebu for surgery. His mother was to see a social worker the next day to get a letter of referral saying they were indigent. But Alex could wait no longer; he died that evening, calling for Diane.
Beginnings and endings occur in fiction. In real life, perhaps the only beginning is birth and the only ending death, at least for the one who dies. If so, the story of Alex has its ending for him. But for the rest of us, we remain where we have always been, caught somewhere in the middle. Robert Frost has a fine poem, “Out, out –“. About a young man who accidentally cut off his own hand with a buzz-saw late one afternoon. It ends as follows:
He lay and puffed his lips out with his breath.
And then – the watcher at his pulse took fright.
No one believed. They listened at his heart.
Little – less – nothing! – and that ended it.
No more to build on there. And they, since they
Were not the one dead, turned to their affairs.
So it is, so it must be. For Diane and myself, turning to our affairs means seeing that the next child with a swollen neck is gotten to in time.