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It started raining just after four am. We hadn’t had any rain for over week - a rare thing in Payamino. I had just moved back into the community’s dormitorio, a large empty barn of a building, built from wooden planks with a zinc roof, after a couple of months sleeping in the National Park offices while we refitted the dormitorio to accommodate volunteers and tourists, transforming it through the creation of six bedrooms, a kitchen, a common area and a terrace.

It had been raining up in the sierra, so the Payamino River was full to bursting, the chocolatey water thick with sediment washed down from the hills. The smaller rivers, on the other hand, were nearly empty from the dry spell. I was starting to worry about running out of a decent supply of drinking water if rain didn’t come soon, so it was a relief to be woken by the scattergun rhythm of rain on the zinc roof. I dozed, then woke, then doze and woke again, the sound of thunder and the downpour disturbing my sleep. I can’t remember if I was awake or asleep when I heard the footsteps entering the building and approaching the room I was sleeping in.

“Wawki Paul, Wawki Paul, estas ahi?” I recognised Ernesto’s voice. What the hell did he want? It was still dark. If he was coming begging for money at this time… I considered ignoring him, then thought better of it. “What can I do for you Ernesto?” As I sat up on my musty mattress he garbled something from the other side of the door about needing a candle for a mother and a baby and someone nearly dying. I tried to get my brain switched on enough to figure out what to do next. So someone was nearly dying, what’s new? Whenever someone gets ill in Payamino they decide they’re nearly dying, especially if it’s a baby. I haven’t yet figured out if it’s because they are a bunch of drama queens or if it’s because death is such a common occurrence, especially amongst babies, that as soon as anything worse than a cold hits, they come to expect the worst. 

I got up and opened the door. Ernesto was there with Jose, his youngest son. “What’s going on?”

“Mariana’s given birth, but the baby came out the wrong way round; only one leg came out at first. She started at midnight, my wife was looking after her, and now the baby’s come out and it’s dead. Mariana nearly died too.”

I tried to process what he was saying, but I was still fuzzy with sleep, so I switched into autopilot instead. I dragged my feet over to the far side of the house, where I’d left a candle the night before. Not knowing what to say, I just stayed dumb, feeling stupid, and handed him the candle. He thanked me and hurried off. Still trying to rationalise the awful depth of what he had told me, I went back to my room and got dressed. I guessed it must have been about six o’clock, the night was just fading to grey; I checked the time on my mobile phone – just after six: it was getting up time anyway.

The bad news refused to sink in as I prepared and ate my breakfast and watched from the terrace as Payamino moved about in the rain, figures under tarpaulins and plastic ponchos, scuttling back and forth between Ernesto’s house and that of Elias, Mariana’s father. I saw Mariana’s brothers and another figure in the red, white and black cammo uniform of the fire brigade, which I took to be Francisco. He avoided military service by spending a year in the fire brigade instead, hence his attire and nickname: Bombero. He was carrying a wooden box, about the right size and shape to be a baby’s coffin. Oh God, I thought to myself, this is really happening, isn’t it?

Keeping myself in autopilot, I left the house, heading next door to Ernesto’s. Bombero and Ernesto were visible at the top of the steps leading into the house. They beckoned me inside, and I followed. Ernesto invited me to sit down at one end of the room and pointed to a bench at the other. There was a bundle of cloth, maybe half a foot long, with a candle at either end. He sat down by one end and pulled the cloth aside. A miniature human face emerged, its tiny nose barely mushrooming above the skin in the space between its lips and closed eyes. The candle cast its glow on the face and it looked so peaceful, like a toy, its skin far too pale to be Kichwa. The closer the truth became, the harder it was to compute. I felt that awkward, almost guilty sensation that you get when you are faced with someone else’s grief and you just can’t relate to it, however hard you try; something so strong, so definitely there, yet so intangible.

I asked how Mariana was doing. Ernesto pointed to the bedroom and said she was in there. I could hear the voices of Ernesto’s wife and daughter (Mariana’s aunt and cousin) coming from the room. I think Ernesto was hinting that I should go in, but I ignored it. I was way out of my depth. If this were England, then maybe I could pluck up the courage to go in, say something stupid and useless and Englishly stiff about being oh so sorry, with a comforting hug and so on, but this wasn’t England. This was Payamino, where women greet you by barely touching their fingers against yours and without looking you in the face; where women sit at the back in a separate group from men during community meetings; where women eat only after all the men have been served their food; where women run away giggling when you talk to them, and where no one displays any kind of emotion or affection, ever, unless drunk, and then it’s usually only anger from the men and tears from the women. What on Earth are you supposed to do? I remained seated, feeling more and more stupid by the second and barely clinging on to the safety of autopilot.

Bombero was working away at the coffin, using his machete like a lathe to even the sides down and making a lid to fit. “Is that the coffin?” I asked, stupidly. Stupid, stupid, stupid. I asked about a burial and Ernesto said they would have to wait until Thursday, in two days’ time. Eliberto, the baby’s father, was a ranger for the National Park. He was away in Tena at the National Park headquarters, and wouldn’t be back until then. The baby would remain where it was until his return. Ernesto’s wife appeared with a bowl of chokula - stewed ripe plantain – which she gave to me. I was full from breakfast, but accepted it anyway, my utter breakdown of Kichwa protocol preventing me from being able to say thanks, but no thanks.

However hard I tried, I couldn’t shift my attention from the tiny corpse in front of me, my eyes kept on wandering over to it. It looked strangely beautiful, lying on the bench in a dirty wooden shack, the two candles towering over it.  Ernesto must have noticed, because he covered it up again after a while. People came in and milled about, none of them showing any sign that anything untoward had happened. Some joined in on the coffin-making; some started to pass round the cachigua. Occasionally someone would walk over to the bench, lift the cloth, peer inside, then put it back again, while others would go and stare through the door into the bedroom. They exchanged greetings and pleasantries in Kichwa, and chatted amongst themselves; I could understand just enough to tell that they were talking about anything but that which had happened. I could sense no grief, no sorrow, just a great void of emotion in the room. Unable to understand the lack of emotion, or my own inability to bridge the gap, I made my excuses and left.

There was a community meeting scheduled for that morning. I went into the casa comunal and helped Victor, the newly elected community president, put the chairs out. People started to drift in and sit down. Manuel came over, sat next to me and started telling me about his daughter who was ill. He wanted money to pay for medication. I’d had a few similar requests of late and was starting to get tired of them: the Ecuadorean government provides free healthcare and medication, yet every time a Kichwa goes to the health centre in Loreto, they get sent to the chemist to buy medicine. I was convinced that there was a scam going on; someone somewhere had to be getting commission from this. I said as much to Manuel, I told him that he had to demand what the state has promised him. He then told me that his son had been bitten by a lancehead viper a while ago, and he’d had to buy the medicine for that, as well. I was furious. This was the second time this had happened to someone from Payamino. This was a whole different ball game from a virus or a gut bug, here we were talking about matters of life and death, and the health centre was still milking these people for money they didn’t have.

There is a small health centre in the village at San Jose de Payamino. Last year it was staffed permanently by a medical student, Rosa, an Afro-Ecuadorean lady from Esmeraldas, on the north coast. She was carrying out her year-long practical, or la rural, as they call it. Rosa was just what the community needed: a red-blooded battle axe who wore her ethnic heritage like a suit of armour. She was bossy, pushy, stubborn as a mule and intolerant of any kind of misbehaviour. She could sniff out an ailing Kichwa from miles away and wouldn’t rest until she’d got some medicine down his or her throat. In a place where people are terrified of anything they are unfamiliar with, including a modern health service, she even managed to convince three women to get onto family planning programmes. She could go a bit too far at times, but generally, she was nothing short of a miracle worker.

In addition to Rosa’s presence, we also used to get once-monthly visits from the doctor and dentist from the health centre in nearby San Francisco. Rosa’s placement finished in December and we hadn’t seen the doctor since November. The health centre was unstaffed, except for the occasional flying visit from Rodolfo, a Kichwa nurse who had a greater propensity for sitting around drinking cachigua than he did for getting any work done. From what I’d managed to find out, there was no sign of a replacement for Rosa coming any time soon, but the doctor was due in for a visit that day, and I was damned if I wasn’t going to get some answers from him, so when someone came into the casa comunal saying that he’d turned up, I left the meeting and went out looking for him.

I found the vehicle that had brought him in outside Ernesto’s house. I went in to find quite a crowd gathered there, the smell of cachigua hanging heavily in the air. Mariana was evidently still in the bedroom, the doctor in there with her. Rodolfo was hanging about, so I went over to find out what was going on. He told me that they were trying to convince Mariana to go into town to get checked out properly, but she wasn’t having it, she just wanted to stay where she was. I decided there was no point trying to bother the doctor just then, so I went back to the meeting.

The meeting dragged on, as Kichwa meetings always do, with people arguing interminably about things that don’t matter, and refusing to listen to people talking about things that do. If only these people could learn to filter and focus, and to ignore their own petty, selfish gripes in favour of the greater good, this community could have been going places a long time ago. At one point Elias came in and made a beeline for me, “I’m taking Mariana into Coca, but I’ve no money. Have you got twenty dollars you can lend me?”  I looked in my wallet, there was only ten dollars in there, but I handed it to him. At least it should cover him for getting some lunch and pay for some medicine if they needed to buy it.

After the meeting was over I had a lot of chasing up to do: I needed to catch up with the managers of the three microcredit groups to arrange their first quarterly progress check, I had to get photos of all of the members of the new community management board for the project website and get them to come up with a vision statement for the community, and there were a few bits and pieces of my own borrowed money that I needed to get paid back. Then there were the pots and pans that I’d lent the ladies to make lunch with; I needed to reclaim these before anyone walked off with them. If you loosen your grip on any one little thing in Payamino, the whole community slips away from you. It was getting late by the time I had got everything in order and could turn my attention to the doctor again. Fortunately, the teacher had taken the whole school along for a check up and was only just finishing up as I made my way across the muddy football pitch to the health centre.

I asked him how Mariana was doing. “She refused to go into town for a check up. Her family were no use at all; they should have persuaded her, but they didn’t say a thing. You’ve got to talk to them and get them to see sense.” Not a great start. “That’s the problem with people here, if they get ill they won’t do anything about it until it gets really bad. The kids are all malnourished, which only makes things worse. They don’t help themselves one little bit.”

I asked if there was going to be any permanent presence at the health centre this year. There was no news as yet, he said, and the government had cut their transport allowance, which meant that at best he might be able to come in once every six months. My mood started to sink. Deciding to cut to the chase, I asked him about all the medicine that people had to buy in Loreto. I told him about the snake bite incidents.

“The government say they are going to provide free health care, but there’s a big difference between what they say and what they do. There’s no money. We receive our budget every four months; the current budget is already running out, and we’re only just at the beginning of February. There’s not enough medicine to go round. If we don’t have the stock, what can we do? We can't provide people with stuff we don’t have.”

“So there’s no scam going on in Loreto?”

“No, they just don’t have the resources. At the moment we have to beg the parish council for funding to visit communities like this one, because we don’t even have money for transport. We’ll be lucky if we get out here more than once this year” He shrugged his shoulders and raised his palms in a gesture of defeat. Packing up his equipment into the vehicle he drove off, leaving me standing, alone with the sunset, feeling slightly helpless.

The following evening I was just starting to prepare some food when someone called at me through the doorway. In the light of the candle I could make out Elias Chico, Mariana’s younger brother. “Paul, can you come, please?” I went over and found Mariana’s mother standing outside the door, her youngest baby, the most recent of ten, in her arms, its mouth clamped firmly onto her left breast. That baby just missed out on the chance to be a very young uncle. I asked how Mariana was.

“I want to know if you can lend me some money, para poder sobarla” – so she can see a traditional healer. “Ernesto knows how to heal, but I don’t have anything to pay him with.”

I showed her my empty wallet. There was nothing in there. “I’m sorry, but I gave my last ten dollars to your husband when he said he was going to take her into Coca yesterday. I’ve got nothing left.”

“Elias went into Coca today, and he’s not come back yet. I don’t know where he is, and Mariana’s husband hasn’t returned either.” I had spotted Elias disappearing in a pick-up truck at dawn. I had a feeling I knew where he was, along with my money: at the bottom of a glass of cachigua. It struck me as ironic. Here we are, trying to find a way to improve the livelihood of these people, yet Mariana - the wife and daughter of the only two people in San Jose de Payamino with a steady income, both of whom have more ready cash at their disposal than I do, is still helpless in a situation like this. Payamino needs so much more than just an income. Do we really have what it takes to help them?

She repeated herself, “I want to get her seen to by a curandero, but I’ve no money.”

“I’m really sorry, really, but I don’t have any either. There’s nothing I can do.”

She turned away and walked off into the darkness. An angry mixture  of frustration and pity welled up inside me and bored a hole in my guts. This was Payamino in a nutshell: each foot in a different world, with not enough of either and a little too much of both. I wanted to grab her by the shoulders and tell her exactly what I thought, but I didn’t have the words, or the heart: your daughter’s given birth to a corpse; you had the chance to take her to hospital, but didn’t take it; your husband took the money I gave him to take her to town and is now getting drunk with it and now you want more money to take her to a curandero? I’m sorry, really I am, but do you know what? It’s going to take a whole lot more than a miracle from a faith healer to mend your broken daughter.