Hay Suficiente

A New Understanding of ‘Enough’


Written by Kim Grahl, M.D. 

No hay suficiente. “Su-fees-ee-N-tay.” I had repeated the word over and over again on my drive to work last week as I listened to tapes trying to brush up on my (woefully insufficient) Spanish before departing on this mission trip. I didn’t remember this lyrical, but difficult to pronounce word. On the rare days when I need use Spanish in my clinic back home, I’ve been using the word “bastante,” apparently incorrectly, when I ask, for example, whether someone is getting enough sleep. Bastante, as it turns out, is a harsh way to say enough, as in “Stop, enough already, no more!”  It carries a suggestion of nearing excess. The word I should have been using is suficiente.

It is now Tuesday evening, the third night of our mission trip. The surgeons are tying a few last sutures. In the halls of San Juan de Dios hospital, families who have been keeping anxious vigil in plastic chairs just outside of the operating room door now spring to action, tending to their loved ones as they wake up from anesthesia. Surgical patients go right back to their cots in the communal rooms. Tonight, wives and sisters will roll out mats and blankets - brought from home - onto the floor of the waiting room, where they will spend the night.

Hay suficiente. There is enough. I wish that were true. I wish that there were enough resources to go around, here in Santa Cruz, Bolivia, back home in Chicago, everywhere that human beings struggle to survive. I wish that everyone in need of surgery or medicine or a pacemaker could get what they need as soon as they need it. I wish that being poor did not ever have to mean dying young due to lack of access to a life-saving treatment.

General Surgery Mission Trip

Today, our team operated on a man who not only has intestinal damage caused by Chagas disease, but who also sustained a severe head injury a few years ago in a car accident. Becoming disabled, as a fifty year old man in Bolivia, can have a devastating effect on an entire family. The kinds of social safety nets that many take for granted in the U.S.- disability insurance, worker’s compensation, social security - are not nearly as available in Bolivia. Family support is essential, literally, for survival. We visited this man in the hospital a few days before surgery, his wife at his side. We found out that after his car accident, when they could no longer afford more physical therapy sessions, his wife learned how to carry out the therapy regimen at home. She showed me how his right arm, initially completely paralyzed, had recovered some strength.

He remained wheelchair bound with complications affecting his bowel and bladder function. Even with the best of care, patients like this almost inevitably suffer some breakdown of the skin that they are sitting on all day. His skin, however, had remained intact. His wife described how she had, with wooden beams and a hammer, rigged up some kind of parallel bar system at home that allowed him to get himself around while she went out to work, like a DIY home physical therapy contraption. Our surgeon, Magued, praised her for being an amazing wife. “Es un hombre bueno,” was all she said. He’s a good man.

Suficiente, it seems, can also have another connotation, and one that I find myself embracing this week. It’s the idea that we have to work with what we have. Pull out all the stops to get what our patients need - pacemakers, surgical equipment, medicines, a slot on the operating room schedule - but when it’s still not enough, we have to make it sufficient. Do the most we can with whatever we have to work with. I don’t know if I have many patients back home whose spouses could single-handedly bring them back from a devastating injury with so few resources.

I am told that going on mission with Solidarity Bridge changes a person. I suspect that when I return to Evanston, if ever I find myself frustrated at not having the resource that I think I need, I will think of this patient and his wife. Hay suficiente, I will say to myself, and perhaps look around for a hammer and a few good pieces of wood.  

Dr. Kim Grahl is a specialist in Internal Medicine. She is affiliated with NorthShore University HealthSystem in the Chicago suburbs. This is her first mission trip with Solidarity Bridge. She is serving as internist and chaplain. 

This mission trip is a part of our General Surgery Program. Throughout the year, our Bolivian partner surgeons perform gall bladder and hernia surgeries for impoverished patients identified through our Bolivian partner offices in Cochabamba and Santa Cruz. Mission trips give Solidarity Bridge the opportunity to deliver vital equipment and supplies and provide ongoing training. Our goal is to continue to advance skills in these procedures and expand competencies in these and other high-complexity surgeries such as megacolon and various oncological surgeries.