27 March 2012
I am tired. We worked in Rumi Tuni today, one of the bigger towns we’ll vaccinate. The clinic structure is beautiful, but inside is sparse. We didn’t even have chairs for the patients to sit on today. From 8am-5pm, I saw over 30 patients. Seeing Mari was a highlight today. She is 3 years old and had a congenital bowel obstruction and 8cm of small intestine removed. After her incision stopped draining stool, she was transferred to Santa Clotilde where we watched her gain weight for a week before we sent her home. Today, she came in with a fever and cough. Her complicated surgical history and skinny little body worry me a bit. She may have nothing more than a cold, but she got ibuprofen and erythromycin and I’ll see her in three days when we travel to her town. I also saw Valentin and his wife, who brought me two eggs. He was hospitalized in Santa Clotilde for severe hypertension and possible stroke, and sent home with a diagnosis of hypertension, Parkinson’s, and bells palsy (that he’s had for decades). His dizziness limits his functioning and that is his main concern. The hypertension and tremor don’t matter much to him. Again, I saw a handful of prego’s who deliver at home with their mother in law. It would be great to have group prenatal classes here, where the woman brings the person who will attend the birth, and teach them to recognize signs of alarm.With the scarcity of furniture and millions of mosquitoes, I wouldn’t think to ask them to deliver at the health post until/unless some big changes are made. By the end of the day, I just wanted to speak in English and not have to think too much. Luckily there is a phone here, so I did call Brian twice today. People here have asked, “tiene pena?” aka “are you sad” being away from Brian. While absence makes the heart grow fonder, 10 days will be a challenge.
For lunch (at 5pm) Rober Figueroa made a delicious big fish grilled in a banana leaf with some spicy cocona salsa, plantains, and rice on the side. It was dusk and within 10 minutes, the room filled with mosquitoes and you could literally hear the humm of mosquitoes coming out to graze.
I’m back on the boat, which has no mosquitos. The generator is running to power the three high-efficiency light bulbs along the ceiling. I am tucked away in my bunk surrounded by our green mosquito net (generously gifted by Dea and Jim for Christmas). My eyes are getting heavy. We will pull out of RumiTumi tomorrow morning and be awoke by the sound of the motorist starting the engine and water rushing along the sides of the boat, all while tucked away neatly away from the mosquitoes with my eyes closed.
It came as a surprise to me how much deforestation and illegal lumbering that occurs here on the Napo River. This is something I never thought about prior to my arrival here in Peru. One often hears about how the rain forest is being wiped out, well let me tell you a little more. Precious wood such as cedar and mahogany grow here in the rain forest. Obviously people pay top dollar all over the world especially the US to have a nice wooden table or cabinets.
The story begins, as has occurred over hundreds of years, with the poor being exploited without their knowledge. The local people know where the trees are and a “padron” will come speak to a small group in the communities or have someone gather up a crew and offer them a set amount for their work over a few months. There is no contract, only an informal agreement. Some of these workers come up river from Iquitos to work as well, not just locals. The lumber men then come up the river after it is gathered and take the wood, often telling the workers they will pay them after they sell the wood in Iquitos. As you can imagine they often never come back to pay the workers and walk away with hundreds to thousands of board-feet of wood. In the US, one board-foot of cedar costs about $15.00 for you or I to purchase. The workers have no rights and they cannot complain to anyone because there was no formal contract. They also have no idea how much the wood is worth. The workers if they do get paid get 1 sole per board foot or $0.38. The wood/logs gathered are pushed down the river by a boat. They have to pass a police checkpoint and right next to the port in Iquitos is the Naval base. None of the people have permits to lumbar in the region, but a small bribe and nobody sees anything. The wood is then cut in Iquitos and the lumbar sold to dealers. There is never a new tree planted and no re-forestation projects to prevent the loss of the rain forest.
Furthermore lumbering is very dangerous!!!!!!! We see accidents almost weekly and last week 2 men died, one whose brother Victor we know very well. Victor works here for the clinic has been working with Toni on the vaccine trip. It was a very sad day as the entire vaccine group went to the small town for the funeral so Victor could attend and see his brother one last time before the burial. 3 weeks ago a purchaser from Iquitos brought his adolescent son along to help out. As their boat was pushing the wood down river, there was a log-jam and their boat hit the logs and flew on top of the wood and flipped over. His son’s head went right into one log and he had a deep massive laceration on his scalp that took me an hour to sew back up. If he had lost consciousness when the boat flipped he would have drown in the river. The dad also has no formal contract and the lumbar companies do not pay for health care if there are any accidents. There is no training for the workers, no hard hats, nothing. There are probably 1-2 deaths a month from trees falling on people. I thought; how can you get hit by a tree? After helping carry the cross made out of 2 logs for one station on Good Friday this week I can now see how heavy a large tree would be, if you take into account the size of the tree, the fact that there are several surrounding trees and large branches that never get cut off first the risk is tremendous.
I am not saying to not buy lumbar, but make sure when you do ask if it is certified lumbar. Certified lumbar should have a stamp on it indicating its source or where it came from. Certified lumbar means that the companies have a legal right to cut the lumbar, their workers are trained and have contracts and they re-forest the areas that they take the lumbar from. More information can be found at illegal-logging.info.
12 APRIL 2012
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!
Thanks to Dan and Katherine we now have excellent coffee. They were reading our blog and saw I was surviving on instant coffee and they came bearing gifts: a French press, coffee grinder and 3 bags of coffee!!! So who are Dan and Katherine anyways? Well it is quite a nice story, and you can read Fr. Mauricio’s version on the PANGO website (www.pango.pe). In short, their son Nathan was a tourist coming down the Napo river several years ago from Ecuador and no one told him wearing contacts several days in tropical weather was a bad idea and he developed a corneal ulcer. The boat he was traveling on stopped to make sure he received treatment here in Santa Clotilde, and Fr. Jack took care of him, called his mother and he was flown home and followed up with Dr. Rebecca Bartow an ophthalmologist. Dr. Katherine Kaplan was moved and grateful for Fr. Jack’s care that she offered her expertise to Santa Clotilde and she has been trying to make the trip annually since.