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.’