Vaccine Campaign Day 1

29 March 2012

It’s Friday and I’m sitting in my bunk, in our wooden boat. We took off from Polako’s balsa at 6 am today. Brian, Padre, Laura, Bill and I were waiting for the boat to arrive. We saw a woodenboat with a straw roof float by, as it was passing us, it made a U-turn and started approach. “Could all 9 of us be traveling in that?” I wondered. I had seen this boat before and wondered how people could possibly travel in it. It seemed very narrow, maybe 4 feet wide, and I imagined a board along the length of each wall that might fit 8 people it they sat squished together in the dark damp vessel. I was shocked when I boarded. It was enormous inside. The boat is about 8 feet in width and dividing the front and back it small kitchen, complete with propane stove and shelves stocked with food. In front, there are three foot wide benches on both sides with two big coolers full of vaccines and another full of medicine. A pink pasley hammock hangs in front of the door, which remains open for our entire journey. Behind the kitchen, there are bunks with rolled mattresses on both sides, where 8 can sleep very comfortable. Further back are another set of doors, and hidden from sight behind two barrels of gas is the motor. I quickly get used to the hum of the motor and water splashing on either side of the boat. All the water I drank was catching up to me. I ventured to the bathroom, beyond the motor in the back of the boat. There are two narrow boards on either side of the motor the shimmy back on. The motor with its loud hum churns the orange glowing water below. One wrong step and the motor eats you. I safely make it to the bathroom, and I find a toilet seat on a bucket that falls right into the river. The driver takes note that I’m back there and slows the engine to relax the river water under the toilet, which keeps my bum dry. Walking back to the front of the boat, I notice the intricate handmade roof of oja jirapay- palm leaves twisted around a stick. This roof will keep us dry and cool for our 10 days up river.

The sights are beautiful. The dark water is rich in nutrients (and mercury and lead) and the green walls of jungle flora on either side house thousands on animals and insects, many have yet to be discovered. One of those animals is the “motelo” and happens to be our dinner tonight. This large turtle was sold to us by a family in Sumallspa. As we head up river, we stop in each community we plan to vaccinate. In Bandeja Isla we ran in to a large extended family with at least 10 kids running around. They we walked into their chakra (field) where we saw a sajino named pancho, a pichiquo (tiny monkey), a turkey, dogs playing among the yucca, peppers, and peanuts.

Our first destination was Caja Marca where everyone got situated. We set up a table for Victor Hugo the renaissance man who played dentist today. Limber and Jisseli were in charge “programas” which vaccinates kids and pregnant women and follows childhood growth and development. Bill had his computer to see if patients were registered with SIS, a local public aid, and if not, he instructed them how to do so to get discounted meds and care. Manolo had his solar powered microscope and was able to do Malaria smears, stool studies, and testing sputum for tuberculosis. Almost everyone has ascaris and trichuris (worms) and we only had one patient with giardia. No one had malaria. Neo helped fill out SIS forms and was the pharmacist for the day. I set up shop in a classroom where I diagnosed lots of parasites, headaches, low back pain, common colds, and two sisters with what looked like cerebral palsey- walked on their toes, developmentally delayed, spastic… but to have CP in both sisters with an uneventful birth history is maybe less common than a hereditary muscular disease. There is no physical, speech, or occupational therapy here so the diagnosis is unlikely to lead to clinical improvement. I saw a handful of pregnant women. One has 10 kids at home and is on #11. Another is pregnant with her second child but has a transverse lie at 28 weeks… hopefully the head moves down or she may need to travel to Santa Clotilde for a Cesearian Section. Another had 10 but 4 drowned in the river. She looked sad, and her story explained why.

We continued boarded the boat and headed back downriver to Sunullacta… and yes, one of God’s creatures was served up for lunch. The motelo turned into soup. It really was delicious! For some reason, a turtle is much more appealing to me than cute fuzzy animals and monkeys. We stopped at the first sight of an orange tree to buy oranges, and picked up some puhuayu and passion fruit while we were there, and the family bought some rice from us. The barter system is commonplace and very convenient.

We had discussions on what we might do differently next trip and how we could streamline data entry- instead of using a paper book, we could use an Excel spreadsheet that would allow us to filter and pool data for quality assurance. We have a couple options for systems, but we’ll have to discuss with someone who has more experience than Bill and I.

Sunallacta has a similar feel to Caja Marca. I learned that neither of these towns have active health promoters. One moved and the other wasn’t empowered because they lacked continued trainings. I also confirmed what I learned in Santa Clotilde, that 90% of babies are delivered at home by a family member with NO formal training in labor. I would love to identify experienced members of each community and provide basic trainings on how to recognize signs of alarm and how to deal with emergencies. The multigravid patient I spoke to said that there had been no bad outcomes in Sunallacta, although there was a women in Caja Marca last month who went into labor with a transverse lie and the arm came out, and the baby died by the time they arrived in Santa Clotilde. It takes two days to get to Santa Clotilde on pecke pecke, the local mode of transportation. A trained person may have been able to save the babies life.

Sunallacta we headed to Rumi Tuni, where I am sitting now in the health post. After spending and hour filling our paperwork for insurance, I decided to type while I charge my computer and camera. There is otherwise really no electricity, although we could light the boat with the motor if we decide to do so. I walked into the sparsely furnished clinic to find swarms of mosquitos, and on a happy note an actual shower! I’m fresh and clean and covered from head to toe I clothes. I learned on my last three day trip up the Tambor River to bring “mangas largas”- long sleeves. The heat is tolerable, but the biting flies and mosquitoes are not. I’m in my cozy black pants and green t-shirt with Brian’s long socks and long sleeve white pullover, and my flip flops. While style is never really my main goal, it’s nice that here I have nothing to be embarrassed of since the main objective is just to cover your body.

I have yet to do laundry. We wash in the dark brown river water, which I’ll have to do tomorrow… or maybe pay Julia our cook to wash while we’re working? What a great idea!

Toni