Thoughts from an Alumni – Steve Smith MD
After reading fellow ER physician, Judith Tintinalli’s EPI journal article about her Amazon Promise (AP) experience, I immediately knew it was my destiny to make this trip. Patty, the founder and President of AP has recruited a remarkable team of diversely talented and wonderful people on staff in Peru, and needless to say, this program attracts a very interesting group of volunteers. What an awesome and powerful bonding experience to be with all these wonderful folks day and night, working and living together in open-air jungle huts in the village of San Jose, for two weeks, then a busy week in the city of Iquitos providing care in impoverished neighborhoods on the outskirts of town.
First, we all gathered at the AP house in Iquitos to get acquainted with one another and organize for this trip. Then we traveled by bus 1 1/2 hours to the jungle town of Nauta on the lower Maranon River. From there we took our boat down the Maranon River then up the Ucayali River to the small village of San Jose. This became our home for the next two weeks. We slept in our tents on the wooden floors of open air palapas provided by the community. I was constantly entertained by all the beautiful kids in the village! Over the next two weeks we traveled up various rivers both large and small and set up our clinics (generally using the schoolhouse) at different small villages where Amazon Promise has been working for many years. Some required hikes to get into the villages. We ran clinics in 9 villages in total.
As we were preparing for our first clinic of the trip in the village of Castilla I was called away to do a house call. It turned out to be an extremely sick woman with sepsis. She was too weak to walk, high fever with rigorous chills, tachycardic, hypotensive and very dry. It was caused by a large abscess on her back. My first thought was we have to get her to a hospital, but I quickly realized we were the highest level of care she was going to receive. We gave her IV fluids, IV and oral antibiotics, pain/nausea meds, I&D’d her abscess, and continued and to watch her through the day as we ran our clinic. She was showing some improvement and although I really had a hard time leaving her there in that small hot hut, they assured us they would let us know if she became worse.
We returned three days later to check on her. What a relief to see her smiling face! She cried uncontrollably out of thankfulness for our services. She was sure she was going to die before our arrival and treatment. This one experience made the whole trip worthwhile for me and there would be many more incredible experiences to follow.
But there were sad times as well. There were a number of patients that you knew, despite all our efforts, weren’t going to receive the higher level of care that their condition demanded because it just doesn’t exist in Iquitos. It was tough but you just had to do your best and move on. Amazon Promise goes to great lengths to try and meet these special needs and provides follow-up throughout the year. AP administrative coordinator, Rosa Aranzabal, works tirelessly to help arrange specialty follow-up care.
It was amazing to me the wide range of problems we were able to treat with minimal technology. There were URI’s, bronchitis, pneumonia, asthma, gastritis, anemia, UTI”s, pterygiums, presbyopia (gave out lots of reading glasses), conjunctivitis, vaginitis (BV was a big one in the city), skin fungal/bacterial infections, parasites (pin worms, ascariasis, giardiasis), piranha bite to the toe, orbital fracture with EOM entrapment, fish spear through the leg, etc. I must confess, even after 30+ years in the ER I was still a bit nervous about what I was getting myself into treating these remote patients with minimal technology. But luckily that thought faded quickly once we got started.
We had a well-stocked pharmacy, some basic lab and in the city even had a very talented microbiologist that read our stool/urine/vaginal slides in house!
The dental crew stayed quite busy doing fillings, extractions, and cleanings. They had their own generator to power all their equipment.
The water collection/purification systems and composting toilets that AP has helped install in each of these villages were quite impressive as well. The impact of clean water and proper sewage makes a tremendous difference in the health of these villages.
On our off days we provided patient follow-up and did a rigorous jungle hike. But the highlight of our off time was our frequent visits to a very magical swimming hole on the Ucayali River. A massive river with an expansive white sand beach and a small cove where we swam with the pink dolphins that came to feed on small fish.
After returning to the city of Iquitos, we had two busy clinics in Belen, an extremely poverty-stricken area, and provided care to over 350 people. We also provided care at a home for children and adults with HIV, and an orphanage.
The hardest part of the entire trip was having to leave all these wonderful people! It fulfilled a lifelong dream of mine, so yes, I will return. I’m truly grateful to Amazon Promise for offering me this incredible experience.