Thoughts from an Alumni – Betsey Doherty, MD
No sonrias, Diana! Do not smile! Amazon Promise coordinator, Rosa, coached our young patient before our foray into Nauta and Iquitos seeking care we could not give in her village. Diana exuded a happiness and willingness to engage with the world despite her markedly swollen and painful leg and her periodic fevers and fainting; Rosa, Amazon Promise trip coordinator and patient advocate, wanted to avoid any misinterpretation. Diana and her family had struggled enough and could not afford for the Peruvian doctor receiving her to think her smile meant she could wait, could go home… read: could linger, could die.
Like Diana, her cousin, Alex, sustained a significant injury and debilitating complications after their collision on the soccer field. He reached clinic by wheelbarrow. He was losing weight. He was a young adolescent already coping with pressures to conform; he clearly stuck out, and no one in the village knew if he would use his leg normally again. The children had been injured 2 months prior to the Amazon Promise clinic. As it turns out, they both had pyomyositis and developed osteomyelitis. Neither had received antibiotics or surgical intervention when first assessed in Nauta a couple of weeks after the accident. In the village, we were able to do ultrasounds and start antibiotics for Diana; Alex’s case was less straight forward, but we knew he needed orthopedic evaluation.
The day before our group’s last day at Yacumama Lodge (and the day after we met the children), I traveled with Rosa, Diana, Alex, and their families to Nauta (the smaller hospital and necessary checkpoint per Peruvian healthcare policy). It was already Thursday and we all hoped to have the children “plugged in” to Loreto Regional Hospital in Iquitos before the weekend when our group would leave the country. In retrospect it is ironic that Rosa and Patty thought an American doctor’s presence might carry weight in expediting care. In fact, it was Rosa’s tenacity, her daily efforts and diligence that secured the extensive care needed for these children.
Rosa shepherded our group to the hospital at 5am on Friday and insisted on a same-day appointment when registration tried to schedule Diana for the following week. She tried repeatedly to call the trauma surgeon’s attention to Diana (whose distress mounted through the morning) despite his stern refusal to actually triage his clinic patients. She trained the children’s moms in navigating the Peruvian healthcare system (getting multiple copies of the children’s records, finding the clinics, getting doctors’ orders stamped at the insurance office then purchasing equipment and meds at the pharmacies), doing all she could to ensure their competence to aid other family or fellow villagers in future.
Because the public hospital viewed Alex’s case as less urgent, Rosa coordinated a visit with a private physician who ordered the necessary studies same-day. Because of her initiative, Alex was able to start needed antibiotics days sooner than he otherwise would have as his diagnosis came to light.
Rosa moved swiftly and deftly through the hospitals of Nauta and Iquitos in service of these patients and their mothers. The Peruvian healthcare system is inefficient and far from “patient-centered,” and without her, Patty, and the whole Amazon Promise team, it is likely these children would have died or at least suffered permanent debility. Other examples of Rosa’s work included finding suitable and affordable housing for the children’s families, arranging transportation, giving allowances for food and other necessities, purchasing medications and equipment not covered by SIS (Seguro Integral de Salud), the public health insurance program, and being at the children’s bedside as much as possible in order to insist that they received needed care… In fact, at one point the hospital stalled for days in facilitating an ambulance transfer to another facility to obtain CT scans for Diana. Rosa had to jump through numerous hoops, and in typical fearless fashion, she took the case to the hospital director to voice her concerns and get the studies done.
Many of the Peruvian physicians we encountered showed interest and compassion, but – for complex reasons – they also seemed to function under the mandate of “first, ensure payment.” Eventually both children received surgery as well as blood transfusions and the IV antibiotics they so badly needed. They survived and returned home with hopes of good functional recovery thanks to the tireless advocacy of Rosa and the steadfast support of Patty and Amazon Promise. What an honor to work with these warriors!
Update: As of March 2021, Diana continues to undergo physical therapy and will have another surgery later in the year. She travels with her mother from her jungle village to Iquitos twice a month.