Sunday, January 10, 2010

Being born and dying in Chiclayo

Somehow during my first visits to Peru I formed the opinion that being born involved a mother lying in her own bed attended to by a mid-wife and surrounded by family members while the father boiled water or nervously whittled on a chunk of wood. I envisioned the act of dying in much the same way…the central figure peacefully lying in bed, a beatific smile on their face as family and friends provide comfort and expressions of love, while Gucho the family burro poked his head in the window; a dewy eyed expression of sorrow on his face (okay, the Gucho thing may be stretching it). I was wrong on both counts. I’ve learned that 95% of births and deaths from illness in the Lambayeque region occur in a hospital or clinic.

Hospitals have consistantly denied us permission for photos the past 18 months, but we felt we needed a nursery photo for this post so tried the hospital Regional Las Mercedes, which services poor people. Permission denied. Now, Maribel has a way with people and before too long she was talking with a woman whose daughter gave birth to triplets. Following a few more minutes of conversation grandma was insisting to the staff that we be allowed to accompany her into the nursery to take photos of her grand children. This is the result…twenty-one year old mama on the left; four day old triplets and grandma.

There probably isn’t enough difference about being born in Chiclayo to write about, though you may be interested in a few details. Pre-natal care involves the same medical care in terms of examinations and frequency of hospital visits as in the States. When delivery time arrives, if everything proceeds normally mother and baby are home in 24 hours. If delivery is cesarean the hospital stay is 5 days. During and immediately after delivery the mother will be attended to by a gynecologist, obstetrician, pediatrician, 2 registered nurses and one student nurse. I’ve been told circumcision is never done. The total cost can range anywhere from $0 for the poor at the national hospital to $1300 for a 2 day stay at a private clinic. If the mother has been contributing monthly to the national insurance program and has her baby at hospital Naylamp (ESSALUD), beside there being no charge the government gives her $700 for having the baby. I have no idea why. The standard follow-up care applies in Chiclayo also.

Customs associated with dying in Chiclayo follow the same general path as in the States with some interesting deviations. The biggest surprise for me was learning that a terminally ill patient is not told they are dying. Medical personnel will absolutely not do that nor will family members. Even if the dying person asks the question or voices the opinion they are dying, everyone will deny it. There was a recent death in the family of a friend. As I understand it the following is the sequence of events.

The individual died in a hospital at 3:15am. A number of family members were present and had been for several days. After spending a few minutes alone with the deceased, the body was taken to the hospital morgue and the family was given a temporary death certificate. The family returned home to inform others, and by 5:00am four of them were at a funeral home (in Chiclayo most are open 24 hours) to make arrangements. Decisions were made regarding which cemetery, the coffin, church or home viewing, number of cars needed, and above or below ground burial or cremation. No arrangements can be finalized without the temporary death certificate. This apparently prevents a person from maliciously making burial arrangement for someone who is living but whom they don’t like.

Incredibly, by 7:30am the funeral director had the body on display in the coffin at the person’s home (they had no money for a church funeral). This individual had died only 4 hours ago. Also at this time friends and family began arriving with flowers and expressions of sympathy. They continued to come and go non-stop through the next 48 hours. It is customary to serve lunch and dinner to anyone who happens to be in the home at the time and to have snacks for odd hour visitors even at 1:00am. In the case of poor people it is typical to serve only coffee.

I am told that, unless mutilation has occurred it is mandatory for the body to lie in an open coffin for a minimum of 48 hours. This practice apparently exists to allow the deceased a chance to ‘wake up’ if they are not really dead. This requirement, plus the custom of hiring people to inject the body with some substance during the first hours of viewing (I'm told to prevent odor) leads me to conclude that no embalming process or refrigeration took place, at least in this case.

Following the viewing a funeral procession takes place. First is the funeral hearse, followed by family members who carry the coffin 5 or 6 blocks to a predetermined destination (in this case it was a home where the deceased had formerly lived as a child). Behind them march the rest of the mourners. Traffic must yield to these processions. A brief ceremony takes place after which the coffin is placed in the hearse and driven to the cemetery. The procedure at the cemetary is almost identical to those I've seen in the States.

Chiclayo has 1 public and 3 private cemeteries. The public cemetery is huge, very old and dilapidated. To me it is depressing. I am familiar with only one private cemetery – Jardines De La Paz where Maribel’s mother lies. It is actually very beautiful and peaceful. It is one of the few places in Chiclayo where you can see acres of green grass and listen to birds singing – not a bad place to finish life’s journey.

Tom & Maribel

Ps… If you’re curious this is the url for the cemetery pictured above. It’s in Spanish but lists the options and prices.

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