By DONALD C. DRAKE
    ii,ou,rer .Ifr,dtcnl Kr'rter
SANTO DOMINGO, Domini-
can Republic-The ragged lit-
tle street band filled the warm
evening ;vith a scratchy Latin
rhythm as one of the singers. a
IO-year-old boy with a dirty
shirt and forlorn voice, begged
centavos from diners in tthe
open-air cafe.

"Dinero para la musica,"
the boy pleaded again and
again, as people turned to
avoid his insistent eyes.
"Dinero para la musica."
At that moient in Phila-
W-h, l.jzo miles to tile
north, two other Dominican
children were being fllssed
over and treated in one of
the lvorid's finest medical fa-
cihtics - the ultra mo<Iern
Intensive Care Unit (I(-:`) of
Children's Hospital
Altagricia and fla `p /   i-
WL  the bewitching
month-old Siamese     15
                 LW1113,
were getting even more at-
tention than usual because in
two days they wnuld be dis-
charged and taken back to
their home in the hills, 75
mdcs southwest of here.

Las Auyamas is 1,700 leet
up in the hills, a village of
reed shacks arid tin-roofed
huts. It is without running
water, electricity or sewers,
and the only form of trans-
portation  IS Lana   nnver
buses because `tie roads are
frequently washed out by
rain.

Las Auyamas is where the
twins live.

From here, you drive in-
land toward San Cristobal, a
fading town with a decaying
luxury hotel that no one
seems to use anymore.

Dipping  south arrd + then
west, a macadati rozid*car-
ries you past boys riding
donkeys so an%5akd that
their ribs are showing, and
girls balancing M-gallon tins
of water on their heads.

Further along, after pass-
ing Bani, the roads deterio-
rate, with gaping holes every
100 hundred yards or so.

Ahead, though, are the
strikingly beautiful Black
Mountains with a thick white
haze obscuring their tops,

Into the hills, the scenery
becomes .even more beauti-
ful, with 40-foot coconut trees
bordering the road. The car
was soon struggling with the
incline as it climbed higher,
the driver taking a curve
here, and hugging the road
there to avoid an oncoming
truck. One more turn and
suddenly there is the Valley,
rich lvith green foliage and
in the distance San Jose de
Ocoa.

School traa just oroken Ior
the day in San Jose and the
streets were filled with chil-
dren - dressed in blue or
brown uniforms.

Those in brown attended
Escuela Luiza Ozema Peller-
ano, an  attractive school
with 1,000 students up to 14
years nid. This is where the
twins will go if they get past
the first six grades taught in
their @ool in Las Auyamas.
The class rose as a unit

when the strangers walked in
inquiring about the Rodri-
guei Family. "Do vou know
where the twins live?" the
teacher asked the class.
"In Philadelphia," a girl
yelled from the front row.
A few blocks away was the
San Jose Hospital. It has 50
bcds,`equipn?ent for only the
Simplest surgery and a staff
of five general practitioners.
L It. was here that the twins
`were born. Dr. Ricardo Ve-
lazquez remembered well the
caesarean section he per-
iormed on Mrs. Rodriguez
because she was having trou-
pie delivering.
L "I reached in to bring the
babies out by their feet and
discovered they were con-
hected," he said, adding with
understatement, "It was a
`?erp big surprise." He told
the father that they probably
tiouldn't survive, but they
here still alive two days
later so they were sent to
Santo Domingo. I
; Actually, there was every
reason for people here to be-
lieve the twins would not sur-
vive.

Where Children~Starve

Clara and Altagricia'Rodrig&
                        --.


They come from a country
&ith an average family in-
come of $430 a year, where
70 percent- of the citizens are
inalnourished and, therefore,
susceptible to disease, and
tihere the life expectancy is
58 years, compared to 70 in
the United States.

They come from a country
vith an `&rage family in-
`ome of $430 a year, where
0 percent:of the citizens are
nalnourished and, therefore,
usceptible to disease, and
vhere the life expectancy is
8 years, compared to 70 in
.he United States.

; The infant death rate is 50  The infant ,death rate is 50
per 1,000 live births, almost
three times that of the jer 1,000' @e births, almost

United States, and 46 percent bee ; timq. that of: the
$f all deaths occur among >nIted State&and 46 percent
           gf; afl'"d&hs occur among
thildren under four.    :hildren under' four.

1 Whooping cough, measles,
fetanus,  tuberculosis  and
diphtheria are all major child
killers. But undcrlyinr! most
of the illness is malnourish-

Whooping cough, measles,
etanus, : tuberculosis  and
liphtheria are all major child
:illers. But underlying most
d &d'iliness is malnourish-
neat.
It makes the children SUS-
:eptibie to internal disorders,
iraining water from their tis-
ues, forcing them to vomit
nd eventually killing them
because of dehydration.
Diarrhea, which is not a
bediatric problem in the
Jnited St@, accounted for
D percent of dl Dominican
leaths - child and adult I-
n 1971.

At the sobert Reid Cabral
Iospital, the 310-bed chil-
pen's hospital in Santo Dom-
ngo where the twins were
aken twd days after their
Grth, the Rodriguezes were
:old that little could be done
:or their daughters in the Do-
ninican Republic. The coun-
?y's medical system just
;ouIdn't handle it..
Y`fie~inedical director at the
lospi&l is Dr. Hugo R. Men-
Iqza, -a soft-spoken man with
:entle eyes and a slight air
f sadness. The government
avs him $300 a month as
@Cal dire&r, so in the
fte&ioti he `keepi private
!fifice" h&s' `2. a' common
ractice here.
Dr. Mendoza was giving a
sitor a tour of his hospital.
`hen he got to the swinging
w)rs  of the emergency
am, he paused. "What do
)LI say in English?" he
;ked. "Ah ,yes . . . Here is
lr Dante's Inferno."

Dramatically, he swung
len ?.he double doors. Inside
ere ~30 cfyir& moaning ba-
ies. They were lying on five
,ng tables, a half-inch board
cparating .' one from the
[ext.

On one side of the long ta-
<I --  -.I..-w ct.,. o..-.thrrr f-In

the other side, hanging from
iverhepd pipes, were the bot-
tles of dextrose. A tube led
kern p&h bottle to the fore-
bead, qf a child where it was,
limpEati&d in a vein.
f &hydration. These were
the -babies who were so sev-
$-ely dehydrated by their diar-
FheQ &at they needed emer-
P endvycare or else faced the
ike@ood of dying. One case
% week like tl'is would be un-
irr,$l,;-in the United States.
Her&,$ere were 30.
1: Mar& months earlier, when
%he :twins arrived at Chil-
hrer&`:Hos$ayl for their op-
+ati&      to%
1 PornFiat dedydrated,  were
                   ane-
.mic %i7d had vaginal infec-
&ions! :'

`: In the future; though, the

hunization. known at Chil-
yren'%' HoSpital, and Dr. C.
Everett Koop, who led the
hp.@$ team that separated
?hem. .h.as made snecial qr-

`cangements with the Medical
lq tissistanti. Program, a non-
brofit &ganiz.ation funning
`health and fpocl programs in
4? countries,, for the twins to
&et vitamin and protein sup-
tpiements. .`.,(

5 .Ve: few Americans, of
%
tours ; get the kind of medi-
cal attention the twins re-
ceived in-~Philadelphia.. For
@d@, until t!!eir release on'

Thanksgiving, they were
watched constatitly by one
and sometimes two highly
trained pediatric nurses.

Uitm-Modem Aid

The most modern medical
equipment  and a skilled
team of surgeons, physicians
and nurses were required to
separate them in an opera-
tion that took 10% hours.
The cost was all donated.
But under ordinary circum-
stances the fee would have
been $200 a day per child, or
$32,800. And that doesn't
count the cost of physicians '
jand ancillary services.
! BY Way of contrast, there,
is the' 3OO-bed Hospital Dr.'
Dario Contreras, the only or-
thopedic hospital in this
Zountry and thus the facility
to which the twins will be
sent if they suffer any se&
ous bone-related maladies. It
is one of nine hospitals here
p offer free medical care for
the poor, and most natires
are poor.

Only recently has it in-
stalled an intensive care
unit, but, it is equipped with
none of the beeping elec-
tronic  monitors,   suction
pumps or oscilliscopes com-
mon in the United States.
"The only thing we moni-
tor here is blood pressure,"
said Dr. Donald W. Ross, of
California, a CARE doctor
teaching orthopedic surgery
to Dominican physicians.
Dr. Ross stode past the
r;ooms full of patients, joked
with a couple of men who
were in  traction, saying
something in broken Spanish,
and then went down the
stairs to the Sala de Ninos,
the pediatric ward.

Strnr~gel~ Quid
The unit was strangely
quiet,  for malnourishment
makes children quiet. One
room had 10 cribs, and al-
most every one of them con-
tained a child with a cast on
one of the limbs.

"Osteomyelitis," Dr. Ross
explained, holding an X-ray
film up to the light. Even an
untrained eye could see the
gauges and holes in the
bones. -Osteomyelitis, a sev-
ere infection of the bones, is
not a major pediatric prob-
lem in the states, but mal-
nourishment impairs a child's
ability to fight off the infec-
tion which eats the bones.

Another room was filled
\vith children with big bel-
lies, spindly arms and huge
pleading eyes, the hallmarks
of the malnourished. Many of
the  children had burns,
another common problem be-
cause open fires do the work
of the safer electric or gas
rtrrvrc  IICPA  in thrr llnitd


The twins will sleep with
their parents. The other five
children sleep in the second
bedroom.

Still, the house is neat,
more substantial than most
in the small, isolated con-
munity.

Many people leave Las AU-
yamas to work in Santo
Domingo or Puerto Rico, but
most return when they have
some money. It is home and
they like it. There are no
locks on the doors, and the
people all know each other.
They travel to San <Jose on
weekends when there is a
good band in town.

At the hospital in San Jose,
where the t@ns were born,
the people said it would be
difficult for the strangers to
find Las Auyamas. So some-
one came along to guide.

Hard surfaced road had dis-
appeared by now, replaced
by a gutted dirt road. The
beauty was breathtaking.
Royal palms, as high as six-
story buildings, reached up
into the sky with huge white
birds perched on the heavy
leaves. Cows stood on the
hillsides at what seemed like
impossible  inclines  eating
grass. Wooden shacks with
brightly colored walls popped
up in clusters here and there.

A two-foot deep pocket of
water cut off the road near
Las Auyamas and the last
half mile to the Rodripluez
house was made on foot On
all sides,  reaching steeply
upward, were the lush hills,
almost obscuring the sky.
Here and there were coffee
bushes or an orange tree or
heavy palms.

Smile of Welcome

The twins'  father was
standing at the counter of his
open, roadside produce store.
Recognizing me from his trip
to Philadelphia, his eye;;
opened v&+e in surprise and
his face filled with a huge
smile.

The twins' house is made
of wood with a concrete floor
and a corrugated tin roof.
The walls are bright green
with red trim. On one wall is
a picture of Dr. Koop.
The house consists of two
small bedrooms, a small liv-
ing room and a kitchen.
There is no electriciiy, no
sanitation.

Sickness, Yovqtg

There is sickness and pov-
erty., In August, when it be-
comes very hot, diarrhea
strikes and sometimes a I
child dies. Six months ago,
one of the babies died of
diphtheria. But the people
here say there is also love
and friendship.
It seemed incredible that

from this remote part of the
world,  the word of the
Siamese twins. could spread
to  Philadelphia.  It had
passed through a line of rela-
tives to Puerto Rico, and
then to Mrs. Diana Zimnoch
of Warrington, who brought
it to Dr. Koop in Philadel-
phia.'

And now, one day before
Thanksgiving, the day the
twins would be released from
the hospital, Rodriguez asked,
about his famous daughters.
He knew that `Ladies Home
Journal was going to pay
$10,000 for exclusive rights to .
their, story. But he didn't
know ,&at they would be re-
turning in only. a .few more
days.

He said he hopes to use the
money for a house in San
Jose. He'd keep the business
in Las Auyamas, and com-
mute on weekends by Jeep
bus.

By now,. night was begin-
ning to fall, the moon clearly
visible in the poor village
with the green house.
It was hard to grasp that
the same moon was shining
in Philadelphia. .