DB Peru
March 2007
I would like to catch us up to date with our work in the jungle on the Napo River. As usual, it has been a remarkably busy, and an overall productive time.
During the 2 week trip in March, we had the pleasure of taking with us la doctora Margiory from the jungle clinic in Orellana. She is a delightful, energetic young woman who did an amazing amount of work in a short time. She was accompanied by Clotilde, the technica, who was equally competent and worked as her assistant.
We visited 12 villages, approximately 2000 people. In the hierarchy of the medical system in Peru, six villages were overseen by the Mazan clinic, and six were overseen by the Orellana clinic, although technically Orellana reports to the Minister of Health through Mazan. Margiory graciously gave of her time to care for the sick people in the 6 villages of Mazan, completing the proper paperwork required, and then she did complete exams and evaluations of the all the people in her 6 villages, which included birth control and well check-ups.
This was particularly important for us since it has not been easy to find a doctor to accompany us. Not only did many people get seen by a doctor, but I was able to collect statistics about the general health of the people, information that I had wanted to know for some time.
I do not know the exact numbers of people who presented themselves for the exams, but using San Pedro as an example, a community of 300 people, approximately 30 received care. Most of those were problems that might be expected:
Back pain and arthritis (men and women work physically hard), bronchitis and colds, infected cuts, urinary tract infections, and mastitis.
Out of the 12 villages, Marjorie found 20 people who needed further care:
12 cataracts
3 hernias (2 babies and 1 male)
1 man with Parkinson’s disease
1 woman with a pelvic tumor
1 possible eye surgery (Lima)
1 baby who needed cardiac surgery (Lima)
1 teenager who may need foot surgery
Our two volunteers this trip, Don and Anita Anderson, are from Knoxville, TN. They came all the way to Iquitos, but were not able to go with us on the trip due to the dreaded giardia (diarrhea). Due to poor planning on our part, they had gone first to Cusco to see Machu Picchu. Unfortunately Cusco is also a bit famous for giardia as well, and it ruined the last, but most important leg of their trip for them. Anita is a nurse practitioner and was all primed to do diabetic screening, bringing all the supplies with her. The diabetic screening was never accomplished. I am told that there is little diabetes in the jungle, but I doubt if anyone has ever tested this group of people – ever. So with a willing volunteer, it would have been a wonderful project. Maybe soon this will be done.
And I am told that there is little cardiac disease as well due to the very low cholesterol diets. However a simple blood pressure check will be on our agenda for another trip. Norva Achenbaugh recently donated 2 automatic blood pressure machines to us for this purpose, among numerous the other supplies she had collected.
In November 2006, we received a shipment of 600 pair of shoes from Mona Purdy and the Share Your Soles charity in US. They had chosen shoes especially for us, appropriate for the jungle, like tennis shoes, sandals, and soccer shoes, almost all in smaller sizes. Due to problems with the shipping agent between Lima and Iquitos, we were not able to take the shoes until this March trip.
Renzo and I had the “special” job of fitting the shoes to the wiggling, dancing, excited children. The younger ones were relatively easy if you could just find their sizes. But the older girls must have decided that it was a shoe store, and wanted to try on different styles and colors. We did our best to be of good humor as the heat and humidity were fierce, and we had sweat dripping from our bodies. But in each village we would lay out approximately 60-80 shoes on the tables, and eventually all 600 were fitted to the children to protect their little feet from injury and fungus and parasites.
Scott Dennis, from the US, who donated our reading glasses, also donated sunglasses. So on this particular trip, we gave out the sunglasses to all the men who wished them. Although sunglasses are a bit of a luxury in the jungle, the sun glare is fierce and apparently this can contribute to cataracts. So we were pleased that the men did indeed want to protect their eyes. We have a very cute photo with the men in one village lined up in sporting their new sunglasses and wearing the donated ball caps given to them, big smiles on their faces.
Just a note: This is not a typical scene. Over the years, the men in the villages have gotten to know us and are much more relaxed and friendly with us. But when we go to a new village or one not frequently visited, usually it is the women and of course the children who approach first. The men hang back, except for the leaders, and sometimes there is a bit of awkwardness to it. The teenage boys still have little use for us.
We also had a huge amount of fabric and sewing supplies, donated by Harriette Hahn in Fort Myers and her friend, Lyn Bolinger. Every single woman in 6 villages received a large amount of fabric and supplies from this donation. Although this is not in the realm of healthcare, clothing is the one and only item that people request from me. Since it is becoming difficult for me to bring clothing due to stricter weight requirements from the airlines, I have tried to respond by bringing fabric and sewing supplies, when I can, as they go a good deal further.
In addition, we have spoken to the government teacher in Orellana, where there are classes in sewing for young women. Apparently the government has seen the need to place and pay a teacher to instruct, but not given her anything to work with. There are no sewing machines. So the young girls in class have to learn their skills on the 2 machines in the small town that are in private homes. So I have written a grant to Miracles In Action charity to buy 2 pedal-type sewing machines for this class.
Don and Anita Anderson also had brought lots and lots of toys, most collected by Chris Jessie in Knoxville. So we were able to give every child in every village a toy. It is always amazing to me how the little boys know how to play with toy cars when they have never seen a car. But there they were, on the floor of the huts, racing the cars around with each other. I wonder what the anthropologists would say about this situation.
This must have seemed like a “Santa Claus” trip to the people because in addition to the above, Susan Ebert had donated lots of baby clothes, school supplies, soaps and shampoos, and lots of etc, which we distributed. Since most of our trips are to deliver the medicines and medical supplies, and to see how things are going, this was definitely a special treat for the people, as they continuously told us thank you.
Because of our shipping problems in December, we did not have access to our cartons and could not deliver our medicines. So in March, we had a huge amount of medicines from Heart to Heart International charity for each village. I went ahead and left more than usual since some of the medicines would be going out of date. Doctora Margiory used our medicines for the 6 villages that were Mazan’s, but brought her own medicine from Orellana for her 6 villages, so all worked out well.
With a grant from Peg Meyer and the Miracles In Action charity, we organized another 2-day seminar in Mazan for the lay health workers called promotores. They were 14 in the class, 11 men and 2 women, from 13 villages. We had invited 17, so that showed a great interest in learning and pleased me tremendously. The nurse practitioner, Jessica Portocarrero, the nurse, Ruth Lazo, and the dentist, Edward Reategui taught the class, targeting differential diagnosis. In other words, if a person comes to the promotor with the problem of diarrhea for example, what would be all the things that the promotor should consider, and how would he treat it, if at all. This is a great way to teach about the body, both anatomically and physiologically, and introduce the medicines associated with treatment. It is much more focused and real-world, than just learning anatomy alone or learning medicines alone. All the promotores were presented with certificates of learning when the class was finished, as well as small gifts to the instructors as a show of appreciation.
It always puts a smile on my face as I enjoy the real world taking charge of situations: Without any fanfare, the nurse practitioner gave a class a brief recess while she excused herself to deliver a baby in the next room. Of course if this was a class for the midwives it would have been a nice opportunity for teaching. But being promotores, they leave that work to the midwives and just waited quietly until the baby was born.
Back in Iquitos, we continued our work. We made deliveries of medical supplies not appropriate for the villages to two hospitals, Hospital Apoyo and Hospital Regional.
Both hospitals are very conscientious about not charging the people for the items donated by us, so it really does help many people.
We visited the offices of the Minister of Health to find out about buying our medicines from them. Apparently this may be possible with a proper letter of introduction and request of medicines needed. Our problems with Customs continue and the new President of Peru has not been able to change anything as promised in his campaign speeches. Bringing things into Peru from US is more and more a problem.
We made contact with Monty Eggett from the Hope Alliance charity in US. He was in Iquitos on his own business of healthcare, and we discussed doing some activities together.
We also made contact with an eye surgeon in Iquitos, Dr. Maruja Limachi from the Asprece Eye Clinic, who will do the cataract surgeries for free, with the exception of paying for the eye drops. She said she will be available in June and part of July. This seemed too good to be true, but exceptionally good news.
We also had a new aluminum top put on the boat and had the entire boat repainted. I tried to explain to the young men painting the boat which colors I wanted, but finally gave up and just let them have at it. I might say that our boat is now the most colorful on the Amazon – yellow top, green bottom, and orange in the middle, with some white racing strips, and a red and white Peruvian flag painted on the roof with the name “Lady Di” on both sides. (I have a friend in Fort Myers who used to call me Lady Di, hence the name on the boat).
We transported 2 children and their families from the jungle with us on the boat. The first was a stanch little boy of 5 years old, Roberto Carlos, whom we found lying in a bed in the Orellana clinic when we arrived to take Clotilde back home. His symptoms were an abrasion on his right ankle, with heat, pain, and swelling up the leg into his groin. I felt his back and even his flank felt warm. His story was that he fell off a log yesterday and hurt his ankle. His abrasion was not large, but the swelling made it difficult to see. But if this was an infection from the wound, it was spreading fast. We decided to take him to Iquitos for help as they could not administer IV antibiotics in the clinic. We immobilized the leg and found a heavy blanket, wrapped him up like a burrito, and put him on a wooden stretcher board. Then, because it was raining the typical cats and dogs downpour, we put plastic over the entire thing. It would have made me claustrophobic, but he was brave. He was carried several blocks to the dock, where, to our dismay, the steps had caved in, so people were wading in the high water to get him near the boat. At last we were all in the boat, all soaking wet, except for little Roberto. His mother, uncle and baby sister were with him, as well as Dr. Margiory. As we got underway, I found some cookies and sent them back to him first and then shared more with everyone on the boat.
As the story unfolds, when he started urinating blood at the hospital, they investigated a bit differently and found that he was bite by a not very nice snake, which means he either fell, and was bit, or was bit and fell. After 2 weeks in the hospital, he returned home, good as new. Thank goodness we were at the right place at the right time.
The other child was a bit more complicated. The promotor at Centro Unido approached us about a baby that needed heart surgery. The baby was a 16 month old baby named Roldan. His parents had taken him to Iquitos several months prior and the cardiologist had told them he needed heart surgery. He didn’t walk, had an odd facial affect and almost didn’t cry or eat. When he did cry, he turned rather blue and had trouble breathing. Apparently the parents had not taken him back to Iquitos for follow-up, for reasons that were not clear to us, but probably to do with lack of money. Or possibly lack of understanding.
Although both Renzo and I had reservations about doing this, we did agree to take Roldan and his mother to Iquitos on the boat to have the further evaluation. They were to stay with the sister-in-law in Iquitos during their time there.
When the day came to go to the hospital, we went to pick up them in a moto-taxi, using the address given to us of the sister-in-law’s house. We both thought we had seen some pretty bad areas of Iquitos, but we were not quite prepared for the slums that we were taken to. It was basically an area of rows of stilted huts, built side by side, but with no plumbing, we quickly saw that the long trenches dug in front of the huts were being used as the toilets. The moto took us a far as he could, but then we had to go on foot. None of the adults we talked to were at all helpful, so Renzo used a tactic that he has employed in the past - ask the children. He laid out the story for them to ask about a woman from the jungle who would have arrived in the night with a sick baby. Off they scampered on their hunt. Meanwhile, we quickly found out that the rows of huts/streets did not have names posted and the huts did not have sequential numbering, so although we had the number of the hut, it was a bit useless. Two very hot hours into this, just when we thought we had lost the mother, a little girl came running, saying she had found them. And indeed she did. But the nagging thought in my mind was how a baby could survive here or in the jungle post cardiac surgery.
Without taking up any more of your reading time or my writing time, I will just tell you that getting through the red tape of the health system was mind-boggling. We returned day after day to the hospital in Iquitos, and maybe starting to understand why the parents never returned. But Roldan did eventually get his evaluation to come to Lima for the surgery. All children in Peru have government health insurance, so as long as we followed the government procedures in the health system, the surgery would be paid for. However there were costs associated with the surgery which were not covered – flight to Lima for the mother, hotel and food for the mother, diapers. After agonizing about whether to be more involved with this family, we eventually put out a special request by email for funding for the associated costs. Many people responded and Roldan came to Lima for a month. Renzo put the mother up in a small hotel near the hospital so she could walk there and made a special arrangement at a restaurant for her to eat. The baby had to have diapers since they don’t use them in the jungle. The baby saw the cardiac surgeon, with subsequent heart cath and testing. Then he also had to go to a general doctor, a pediatrician, and a dentist. By now Roldan was taking medicine to breathe better. After his second formal evaluation, the doctors said it would be 4-5 months before the surgery could be performed since there were sicker babies that came first. Roldan looked pretty sick to us, but at any rate, he was sent back to the jungle to wait. We will continue to check on him as we make our routine trips, and the parents know to bring him back to Iquitos if there is any major change. Probably as we all know, it is in God’s hands.
In addition to those mentioned above, I would like to thank:
Karen Johnson for allowing us to stay at her jungle lodge for free
Raul Pettit, for storing our supplies in his home and helping with numerous small favors
Circo, for being the best motorista in Peru, caring for our things as if his own
All the people who made a special donation for Roldan (there are monies left to either be used for him in the future or to be returned)
Rev. Ralph Ranney and the First Christian Church in Geary, OK, which due to a special donation, helped defray the major costs of this 2 week trip. Literally thousands of people were helped by the generosity of this congregation.
And of course, a big thank you to all the people who continue to share with us your interest, your energies, your information, and your donations for the people of the Amazon jungle.
Diana Bowie - President
Renzo Peña - Vice President
