ONE

Tugatog Public Cemetery, Manila, Philippines

Tuesdays were clinic days at the cemetery. To an outsider
it might have seemed odd that a mobile health clinic would
choose a municipal burial ground as a base of operation,
but to the slum residents of Malabon City in metro Manila,
Tugatog was something of a safe zone. At least during the
day. At night druggies scaled the walls and hung out among
the concrete graves stacked in the air like condominiums,
shooting up, smoking, snorting, doing deals. But daylight
ushered in tranquility, and the poor and the sick felt
protected and cloistered among the dead and their gentle
mourners.

The Health In Action mobile van was parked in its usual
spot near the main gate on Dr Lascano Street. The small
staff of humani¬tarian volunteers – doctors and nurses
dressed in the organization’s light-blue polo shirts – was
midway through a six-hour clinic when a teenage patient
wearing thick glasses made it to the front of one of the
lines. She was accompanied by her mother who looked so
young she might have passed for a teenager herself. The
girl was given a plastic chair under the van’s shaded
canopy where she sat listless, a little on the floppy side,
wilted by the heat.

The nurse – a Tsino, a Chinese Filipino – glanced at the
long line of patients leaning and squatting among the
graves. She didn’t have time for niceties.

‘What’s your name?’

The girl was slow to answer.

‘Come on, child, do you see how many people are waiting?’

‘Maria Aquino.’

‘How old are you?’

‘Sixteen.’

‘What’s the matter with you?’

Maria was slow off the mark again and her mother answered
for her. ‘She’s been sick in her stomach.’

‘How long?’ the nurse asked.

‘Two weeks,’ her mother said. ‘She’s throwing up all the
time.’

‘Any fever? Diarrhea?’

Maria shook her head. Her hair looked like it hadn’t been
washed for a while. Her t-shirt was dirty.

‘What time of day does she vomit?’

‘Mostly in the morning,’ her mother said, ‘but sometimes
later.’

‘Are you pregnant?’ the nurse asked, looking the girl full
in the face.

‘She’s not pregnant!’ her mother said, offended.

‘I asked her,’ the nurse said.

The girl answered strangely. ‘I don’t know.’

The nurse got testy. ‘Look, have you had sex with a boy?’

Her mother pounced. ‘She’s only sixteen! She’s a good girl.
She goes to the church school. What kind of a question is
that?’

‘It’s a question a nurse asks a girl who’s throwing up in
the mornings. When was your last period?’

The girl shrugged.

‘When?’ her mother asked.

‘I don’t pay attention.’

The nurse went to a shelf and took down a plastic cup.
‘Maria, go inside the van and pee in this cup. Bring it
back to me and wait over there. Next patient!’

The nurse blitzed through three more patients before
remem¬bering the cup of urine. She took a plastic testing
stick, the kind that pharmacies sell to people who can
afford them, and dipped it. Seconds later, she called Maria
and her mother over.

‘OK, you’re pregnant.’

‘She can’t be!’ her mother said angrily.

‘You see the blue stripe. Pregnant. Remember having sex
now, honey?’ She didn’t say ‘honey’ sweetly.

The girl shook her head and that made the nurse shake hers
too.

‘Let’s have one of the doctors see you. Christ almighty,
I’m never going to make it through the whole line.’

Inside the van, behind a privacy curtain, the doctor,
another Tsino, glanced at the nurse’s note and asked Maria
to hop on to the small table. After a minute or two spent
trying to see if the girl understood how one got pregnant,
he gave up and raised the stirrups.

‘What’re those for?’ Maria asked.

‘Put on this gown and take off your underpants. You put
your feet in those and you spread your legs. That way I can
examine your reproductive organs.’

‘I don’t want to.’

Her mother told her it was all right. It was what women
did.

The doctor put on gloves and a head lamp. He had to almost
force her legs open wide.

Peering under the gown he grunted a couple of times then
raised his head.

‘OK, you can get dressed.’

‘What? That’s it?’ her mother asked. ‘That’s not a proper
exam.’

‘There’s no point in doing a manual exam or using a
speculum,’ he said. ‘She’s a virgin. Her hymen is intact.
There’s enough of an opening to let out her menstrual flow
but this is a virginal hymen.’

‘So she’s not pregnant?’

‘She can’t be. It must be a false positive. We’ve got a
rapid blood test I can do.’

‘I don’t like needles,’ the girl whined.

‘It’s just a pinprick. Don’t worry.’

Five minutes later, the doctor parted the curtain and came
back in with the nurse. Both looked puzzled.

‘The test was positive,’ the doctor said. ‘You’re six to
seven weeks pregnant.’

Her mother almost jumped out of her chair. ‘But you said—’

‘I know what I said. I’m afraid this is beyond me. I’m
going to send her to the Jose Reyes Medical Center to see a
specialist. There’s got to be a good explanation.’

When mother and daughter left the van clutching the paper
to present to the hospital, the nurse asked the doctor what
he really thought was going on.

He confessed his complete bafflement and laughed nervously.
‘It’s been two thousand years since the last Virgin Mary.
Maybe you and I just saw a goddamn miracle.’