I stumbled and caught myself. Leena turned. “You okay?”

I stared at the sign, the color draining from my face. “Yeah.”

She returned and placed her index finger on my wrist, quietly counting. After fifteen or twenty seconds, she let go but her suspicion had returned. “You sure?”

I waved her off. “Yeah. The truth would take too long.”

“Let me know if you’re feeling faint.”

I was feeling a bit more than faint, but I decided not to let her know that.

Moments later, we cleared the trees and walked out onto what would become the plateau on the shoulders of Las Casitas. Before me stood two tin-roofed, barnlike wooden structures. Two stories and thirty doors on a side. Leena spoke as we walked. “Families work the coffee. They make a dollar and a half a day. The skilled workers, the sifters, make two dollars.” She pointed at the buildings. “They live in these rooms. Sometimes as many as six to eight people will live in a six-by-six space. No ventilation. No heat. No cooling. They have no school here, no medical care, and most will never leave this mountain. But it’s better than the alternative.”

“I’d hate to see the alternative.”

She echoed my words. “You’ve been sucking on it the last hour or so.”

“Sugarcane?”

“The curse of Nicaragua.”

“How?”

She waved me off. “The truth would take too long.” She pointed to the work ahead of us. “We collect medical supplies and food from churches from Valle Cruces to León and then bring them here. It’s not much so we stretch it.”

“Is that why you were in León?”

“Yep.” She pointed at a small table beneath a gigantic tree off to our left. “We’ll be here for an hour or so. Let the healthy come to us. Once they thin out, we’ll go to them.”

By the time we took off our backpacks, a quiet and well-​mannered line of about sixty people trailed off around the tree and toward the closest building. Most of the adults were looking at me. Paulina picked up on it. “Most have never been this close to a gringo.”

The first woman had a gash in her hand. Dirty. Paulina spoke to her while she washed the woman’s hands in warm water. As she spoke to the woman in Spanish, she translated for me. “I’m telling her that she needs to wash it in warm water several times a day. She doesn’t really understand germs so it’s an uphill battle.” While she worked, a group of twenty or so kids circled me with quiet fascination. Leena said, “You’re probably the first white man some of these kids have ever seen.”

Most of their noses were snotty. The mucus ran in streaks down their faces. “What’s with the runny noses? Seems like everybody around here needs an antihistamine.”

She laughed at my ignorance. “They live in homes where everything is cooked over woodstoves. They don’t ventilate them because the smoke keeps out the mosquitoes, so most kids around here grow up with an excess of smoke inhalation. Most of their lungs are inflamed, and about half are asthmatics. We’re working with them to ventilate the smoke, but they say ventilating a house lets in the ghosts on this mountain.” She pointed to the kids milling around me. “You can’t tell, but they’re actually a good bit healthier now than they have been in recent years.”

“How so?”

“Their stomachs. They’re not swollen.”

“What’d you do?”

She pointed to our water jug. “Added bleach to their water.” She eyed the mothers. “Educate the mothers and the entire plantation changes. A few years ago, I started bringing bleach and slowly adding it to their water. They didn’t like it, but then the worms stopped showing up when they changed diapers and the kids’ stomachs returned to normal. Now, they listen to me and add bleach to everything.”

A pregnant girl—maybe fifteen—walked up and spoke quietly to Paulina. Paulina listened, holding both her hands, and spoke in hushed tones. She gave her a bottle of children’s aspirin and the young mother walked off. An old man stepped up and began pointing at his hip. Leena again listened, her eyes staring intently into his. Isabella sat just to her left, giving each patient a piece of candy. The kids were milling around her, taunting her for candy, but she paid them no attention whatsoever.

“Where do they get their water?”

She pointed to a creek that ran through the property. “Who really owns this place is a bit of a mystery to all of us. We do know the planting rights are leased, but to whom is anybody’s guess. Whoever it is employs a foreman to run interference. Over this hill, whoever it is pastures his cattle—and his pigs. Every horrible thing known to man floats down that creek and right through here. Including some really nasty parasites. The families who live up here have to walk several miles down to get clean water, and then they’ve got to climb back up here, and when they get done working, most don’t have the energy to do that so they drink what’s at hand.”

“What about a well?”

She pointed to our left. “Just over that rise. Took two men more than a year because they had to dig it so deep. Used four lengths of rope making it over three hundred feet deep, which is a long way for a hand-dug well.”

“Was the water any good?”

“Some say God himself drank from that well.”

“What happened to it?”

“Charlie’s mudslide.”

“Why don’t they just dig it out? Seems like the hard part’s already been done.”

“Awful dark for the man at the bottom of that well, and nobody wants to be the man at the end of the rope. Besides, people here think the devil will own their soul if they dig out a well that God filled in.”

“You don’t believe that, do you?”

“I believe there’s a connection between that well and this mountain.”

I scanned the squalor walking around me. “But wouldn’t it help these people to have clean water?”

She answered without looking. “Yep.”

I spoke as much to myself as her. “That doesn’t really make much sense.”

A chuckle. “Welcome to Nicaragua.”

The third patient was a woman who might have been in her fifties. She was skinny, had lost about half of her teeth, and she had been beautiful before the sun weathered her. Her hair was turning gray, and whenever she smiled, her lips hooked on two of her remaining teeth. Paulina hugged her when she saw her. The woman spoke quietly but quickly. Leena listened and then reached for me. She said, “Charlie, I’d like you meet my good friend Anna. She’s lived here twenty-seven years.” I held out my hand and she shook mine. Her hand was frail, calloused, and tender. Leena handed me a pair of needle-nose pliers and ushered Anna toward me. “She’s got a tooth that’s giving her some trouble. I’m going to run in here and check this little pregnant girl to see how far along she is, and Anna needs you to pull her tooth.”

With that she turned and began walking off. “What!”

She laughed over her shoulder. “Don’t worry, she’ll show you which one hurts.” She held up a finger. “And don’t pull the wrong one. She doesn’t have too many left.”

Leena disappeared through one of the worn wooden doors, and Anna stared up at me with beautiful blue eyes and hands crossed. I held up the pliers and asked, “Which one?”

She wrapped her hand around my hand, which held the pliers, and gently pointed to a top rear molar. Then she opened wide and stood waiting. Isabella stared up at me, sucking on a piece of candy. Paulina had disappeared, and a line of hopeful, tired, and sick people waited on me to pull Anna’s tooth so that I could get to them. I opened her mouth wider with my left hand and gently placed the pliers on the tooth in question. “Is that the right one?”

She made no response.

I asked again. “Sí?”

She nodded.

So I gripped what remained of the abscessed tooth and tightened the pliers as best I could. The smell coming from her mouth could have gagged a maggot. I held my breath and tried not to. Careful not to hurt her, I pulled gently. Thankfully, the pliers gripped, and the rotten and infected tooth slid from its hole in her jaw. As the blood and pus drained, she took the tooth from the jaws of the pliers and slid it into her pocket. Smiling, she spat, patted my shoulder, and walked off. Over the next hour, I pulled nine teeth while Isabella watched in muted curiosity.