A First-Year Medical Student Reflects
After returning from my August adventure with the Amazon Promise team, the many incredible and vivid memories, stories, and ideas never seem to stop resurfacing: learning about medicinal plants in context of Belen market remedies or of the shamanic wisdom of Don Humberto, playing soccer in the Amazon rain on a beach beside a dolphin swimming hole, watching village children dashing after bubbles, stickers, and colored pencils; whether arguing about the pronunciation of "vit-a-mins" with the sole Brit on the trip or laughing at a half-naked pediatrician flirting with Patty's great horned screamer bird, whether spotting amazing wildlife at some obscenely early hour or swatting away giant crickets and moths to stay up for another round of "Casino" cards -- an unforgettable scrapbook. And then there are the patients: children with protruding bellies and open red sores punctuating the entire body - sometimes too painful to sit down; a man with swollen inguinal lymph nodes, a woman with a right breast hemangioma; an infected leg wound eating away at the Achilles tendon, bloodshot eyes sunken into dark blue rings in a case of whooping cough; one emaciated woman with uterine cancer, another with relapsed TB; receiving a rooster from a grateful Jaldar village neighbor whose feverish baby girl we treated . . .
And from all of these memories, I'm always struck with the depth of comprehensive, committed care that Amazon Promise provides to every patient, despite a lack of resources. In Iquitos, Javier gives anti-fungal cream to a 14- year-old girl whose father died one week prior, but especially takes the time to listen to her worries, to emphasize the importance of eating well and caring for her own health and not only for her younger siblings. In the Amazon villages, Dr. Alex astutely diagnoses among a motley of rashes, pustular infections, scaly scabs and clusters of red sores on hundreds of different patients. And whether in the city or jungle, Patty efficiently and accurately organizes and distributes the medications, explaining clear instructions for each type of pills, of syrup, to each patient.
Whether we were giving IM injections to a patient lying on the dusty second level of a wobbly stilted home, or using camping headlamps to illuminate a pelvic exam, or hoisting a "stretcher" hammock to rush a man with a strangulated scrotal hernia to the boat, these AP experiences certainly give us pause in defining what truly is quality health care. When medicine is stripped of all its extraneous accessories like fancy radio-isotope scans, MRIs, sophisticated lab tests, or some cutting-edge technology not yet named, one sees right into its most fundamental purpose: to listen to, to care for, and to heal the patient. While such procedures and tests are of course necessary in many settings, too often do health care providers get entangled in these procedures -- whether in building an immunity to lawsuits, or in the biomolecular analysis of a patient's illness -- and forget the patient herself. I would even go as far as to say that in many respects, the medical care that I have seen AP provide has exceeded the quality of care that some patients receive in even the best U.S. hospitals.
But that being said, the lack of resources in the Peruvian Amazon is still very real. While the Amazon Promise pharmacy will always be running out of vitamins, Ibuprofren, antibiotics, exam gloves, and other supplies, the people in both Belen and the Amazon are still lacking basic needs that would lead to a much healthier lifestyle. In the jungle village med clinics, we noted a great need for sunglasses, wide-brimmed hats, eyeglasses, soap. We also encouraged patients to stretch before and after a full day of hard labor (some doctor even demonstrated "el gato" stretch on his hands and knees), and to bring a container of water or fluids to drink while resting in the shade during work breaks -- small interventions that will help in the long run with easing chronic body pain and dehydration-related ailments. Also, perhaps a space for female health promoters can be created one day to fully address women's health needs, as well as involving more women with community leadership. (After all, it was interesting to find that in some villages, a large group of mostly women greeted us in the early morning to help carry the heavy AP supply boxes from the boat to the schoolhouse, while the men were still in bed, groggy from last night's sugarcane rum.) But the current village health promoters' enthusiasm about their community's health renews the importance of incorporating more health training/education in future medical expeditions; undoubtedly, many exciting projects and opportunities for improving community health are down the line for future Amazon Promise medical trips. We will return.
But above all, it is the actual AP team that gives such depth to quality health work -- what a rewarding experience to be part of such a dynamic, well-coordinated team! A huge thank-you to Patty, Javier, Alex, Luisa, Gina, Jose Luis, Segundo, Altar, Simon, and Cem, and to the greater "team" of AP friends and alumni who continue to support the expeditions. Thanks to all for providing an enriching perspective on medicine, or perhaps more accurately, on humanity.
Eleanor Chung is a medical student at Albert Einstein College of Medicine. She was an Amazon Promise volunteer in August 2004, when she conducted a valuable baseline study of the Belen population for the organization.