Riding in a mototaxi towards the Amazon Promise clinic in Belen was an experience I will never forget. I had visited the Belen Market days before. A tourist inundated by sights, sounds, and smells. But that sensory overload didn’t prepare me for what I was about to feel. As we wound down the narrow streets, the reality of life in Belen weighed heavy upon me. It was poverty that I had never seen before. Open sewers. Clouds of exhaust. Endless mounds of garbage. Ramshackle houses. Poverty that many late night, US commercial pleading for donations to help the less fortunate around the world had tried and failed to adequately portray. To describe it in words is truly a futile effort. I refused to take pictures. What was the utility in that? Solely likes on social media? Unacceptable. The notion of “poverty porn” was never so clear to me.
A group of patients were already waiting when we arrived at the clinic and many more soon followed. Five stations of volunteers including doctors, advanced practice providers, nurses, and us students began seeing the patients, who presented individually or in large family groups. They came with a variety of ailments: upper respiratory infections, lower back pain, migraine, anemia, and parasitosis were most common. In addition to treating acute complaints, we provided education regarding hydration, nutrition, proper antibiotic use, and dental care. We moved at a steady pace into the early afternoon when the initial flood of patients slowed to a trickle.
Towards the end of the day, we got word that another patient had arrived and triage indicated he was quite ill. I offered to meet with him to see what help we could provide. He came with a chief concern of fevers over the past year, combined with recent coughing and vomiting blood. As he sat down at our station, I was instantly concerned; he was pale, diaphoretic, and gaunt. He had a fever and elevated heart rate. On exam, he had marked abdominal pain when I pressed on his liver. I asked him about his HIV status, to which he divulged that he had tested positive 9 months prior. Antiretroviral treatment is free for Peruvians but one can only be treated in their home region. Because the man was now living in a separate part of the country and had yet to notify the government, he never received treatment. My mind raced with the numerous potential opportunistic infections and other complications this man may have had. If it were up to me, I would have paid for a mototaxi and accompanied him to the hospital immediately. However, Amazon Promise partners with a HIV outreach organization and a wonderful patient advocate had joined us for the trip. She arranged to escort him to an HIV clinic the following day.
I remember feeling frustrated by the patient’s situation. One of my rotations in physician assistant school was at an HIV clinic. I was amazed how stable those who strictly adhered to their antiretroviral treatment were. Other than the burdens of taking daily medication and the unfortunate stigma that accompanies the virus, many patients were leading normal lives. This man was not predestined to be in this condition. I’m unsure of the outcome of the HIV clinic appointment but my thoughts are often with the patient and I hope he is receiving the care he needs. (Update: this patient is now enrolled with the local TARGA program and receives free HIV treatment)
As the day wrapped up, I remember standing on the balcony of the Amazon Promise clinic building. I looked across the football field at children laughing and playing. In the distance, women worked feverishly around kitchen stoves. Men were repairing homes or carrying large satchels on their backs. Despite my shock arriving hours earlier in Belen, I realized that life continues there just like any other community I had visited in my life. With the help of organizations like Amazon Promise, the people of Belen and other communities in need are able to receive medical care that will allow them to flourish a little more. I consider my brief month with Amazon Promise as a life-changing experience. Before I arrived in Peru, I saw it as a once in a lifetime opportunity but it turns out I was wrong. I’ll definitely be back.
