Thanks to Patty Webster and her innovative NGO AMAZON PROMISE, I spent part of September 2007 in remote areas of the Peruvian Amazon, part of a medical brigade performing a needs assessment of communities of the Aguaruna people.

With the support of PetroPeru, who flew us in Peruvian Air Force helicopters, we offered medical clinics in 6 communities, traveling by canoe between them.  It was an amazing adventure - helicopters and canoes! - and our presence we greatly appreciated by the people we served.  In several villages we were greeted by dancing, singing natives wearing traditional clothes who painted our faces  with scarlet berry-juice as a way of welcoming us. The young "Alcalde" (Mayor) of the region, a indigenous man named Claudio Wanpuch, is responsible for 43 communities, both indigenous and mestizo, and is well respected in  the region.  He was proud to host us in his home village and the neighboring communities.  In several more vilalges we delivered medical supplies to the local health workers.

We gathered in the northern town of Piura, and from there a 5-hour bus ride took us to PetroPeru's Station 7, from where a helicopter flew us 90 minutes to Station 5.  After an overnight there, we were helicoptered further into the jungle, and offered clincis daily in villages to which we traveled by canoe. After 3 days of this we were picked up again by the helicopter, taken back for a night at Station 5, and again airlifted into the jungle for 2 more nights, arriving finally at Saramariza, a half hour by road from Station 5.  Bad weather delayed us an extra day at Station 5, which allowed us to join the kind and caring (and musically talented!) staff in their nightly Karaoke fun.

When we were not at PetroPeru's rather comfortable Station 5, we slept in tents in the local schoolhouses or Puesto de Salud (health posts).  I got rained out one night and everything I had got soaked - passport, money, journal - but eventually dried out.  As I always say,  "if the fire don't get you, the water will!"

In the clinics we treated people with various conditions with which I had little previous experience.  A snake bite caused a young man's foot and lower leg to rot off progressively. We were not able to bring him to treatment in the larger  town - he disappeared! Snake bite takes a large toll on forest people.  As a snake-lover, I was sorry to see this, since it makes even harmless snakes unwelcome, and targets for extermination.

  Another man had cut his large toe almost off and left a festering wound which threatened to consume his foot. Several other people has large open sores of Leishmaniasis, caused by the bite of a sand fly which deposits a parasite. The sores get progressively large, are painless, and do not heal for many months unless treated with a specific medication, which the government will only administer if they test conclusively positive for the parasite. Unfortunately, the scraping method used  produces many false negative results, and the best way to confirm the diagnosis is a blood test, only available in the larger towns.  Hence, 6 people came to Saramariza, the town closest to Station 5, to have their blood drawn and sent to Piura for analysis.   (I'm watching a sore on my back which continues to look suspicious.. Nonetheless, we enjoyed our swims in the rivers, despite the flies, after a hot day in the clinics.)

    Another woman who pretty obviously had tuberculosis (years of bloody coughing, fevers, weight loss) was unable to get treatment for this because her sputum exam was repeatedly negative for TB.  The government program only treats positive cases who treat positive. This is understandable where resources are limited.

    One of my first patients was a 6-month old girl who was pathetically thin - weighing only 2.5 kilos, under 6 pounds.  Unable to nurse from her young mother's empty breasts, she didn't have much chance for survival. "Pellegra" said Dr. Milagros, the Peruvian doctor with our team who was performing her post-medical-school year of government service in Saramariza and who traveled around the region to the various health posts:  Severe malnutrition.  We had brought some powdered milk to offer in such cases, but in retrospect it might have been better for the poor young mother to drink this to bolster her own nutrition along with the vitamins we gave her.  To feed a child with a baby bottle in such an impoverished tropical setting can condemn it to an early death from diarrhea.  We did not have much hope to offer this family.  Another sad young woman had just given birth to a full-term child who was in a breech position and died before birth.  It turns out she had lost 2 of her previous 3 children - one at several years from diarrhea, and other shortly after birth form an infected umbilicus. She and her husband had apparently not taken advantage of what little prenatal care was available at the local health posts. Her husband was playing soccer in the neighboring village when we visited.

     In one village, the young people were being encouraged to drink ayahuasca in large quantities, to "regain their warrior spirit" and reclaim pride in their culture. This visionary shamanic forest brew is gaining a following worldwide, and some of our group who had not yet experienced it were interested, but lost heart after seeing the unappetizing spectacle of 10-year-olds standing in their own vomit.   The kids seemed pretty miserable, retching and swooning.  The ceremonial hut was in the heart of the village and obviously an imporatent part of the life of the community.

     In this same village an older man with very high blood sugar was referred for treatment but died some days later on the way to visit a "witch doctor" (brujo) after being airlifted by helicopter to Station 5 and then to the provincial center.  It was remarked that the families always seem to have money for the traditional healers who might be very expensive, rather than relying on the free services available to them through the government or PetroPeru, and this often with disastrous results.

    Many of our patients had aches and pains for which we could only offer analgesics.  Hard work in the chakras (plantations) supporting many children makes their aches understandable.  In some villages everyone complained of intestinal parasites and ameba for which ample treatment was given.  I only met one patient, a man with gastritis, who admitted to smoking tobacco, most likely because of the economics involved:  few people had enough cash to buy commercial cigarettes.  I am always happy to use the "teachable moment" to encourage people to stop smoking :  "you have gastritis? Do you smoke?  That makes it MUCH worse!".

     We passed out a few condoms and counseled people about HIV and STD's, and also discussed family planning for those with large families who were ready to limit their reproduction.   Contraception services were supposedly available through the local health posts.

    It was good to have Dra. Milagros and another Peruvian doctor,  Juan Carlos, with us, to confirm the local standards of care and to consult with on patients with conditions with which we were not familiar.  The pharmacy was well stocked and managed by Patty Webster and a pharmacy technician who was with us.  

    The Peruvian staff who accompanied the mission, Segundo and his 2 sons and the cook all kept things running smoothly, from running the camps to registering the patients.  Overall, the whole mission ran smoothly and was a pleasure to be part of.   We found an appreciative population who welcomed the notion of return visits, if only annually, and Amazon Promise may be putting this region on their schedule for the future.

     "Si no vive para servir, no sirve para vivir!"  If you don't live to serve, there's no point in living.  I was happy that so many of the people we met have this attitude (and knew the Spanish saying)!

      On the way to Amazon I was part of a mission of Airline Ambassadors to deliver aid to the "damnificados" of the recent earthquakes in Peru south of Lima.  This will be an ongoing effort, every few weeks, to support he recovery of those lucky to have survived the quakes which killed more than 500 people.   I hope to be able to return to Peru and work with the excellent and motivated people I met there.