Saturday, 22 March 2014


Photo: S. Dalby
Travelling abroad is a luxury that I know many cannot afford. I'm fortunate enough to be able to do it. Sometimes I go to places that restore me. Other times I travel to see something different. To wake up my mind and senses and perhaps get out of my comfort zone a little. To "go see".

Recently I opted to "go see" and volunteered on a medical brigade in Peru. We took a retired UK Navy ship down remote tributaries of the Amazon River system stopping in small villages to provide medical care. The boat has clinic rooms, a dentist suite, a pharmacy and surgical capacity as well as cabins for volunteers and crew. There is also a suite for the midwife who provides obstetrical and well-woman care. 

Volunteering NPs and doctors are joined by a Peruvian team. There are nurses who provide well baby assessments and vaccinations. A dentist, a midwife, a doctor, a clinic nurse, translators for the volunteer providers and a complete crew who operate and maintain the boat. The boat heads out every 2 weeks from Nauta.  Sometimes they carry general practitioners like myself. Other times they travel with ophthalmologists who perform eye surgeries and procedures.

There are two messages that I carry home with me from this trip. These aren't messages to you the reader. They are messages to me from the universe. Call them lessons perhaps. The images, thoughts, and interactions that bounce around my brain reverberating until I notice a theme.

The first is that sometimes humanity is capable of goodness and great things despite challenging circumstances.

The task to provide care in remote areas is not an easy one. This part of Peru is accessible only by water. Villages are rudimentary at best. There is very little infrastructure and just getting to where people live is difficult. Once in the villages working conditions can be hard. Think heat, mosquitoes, and crowds of people who need to be seen. Sometimes communication with villagers is challenging even for the Peruvian staff since locals may be unaccustomed to outsiders and are literally rendered speechless.

The Peruvians worked hard and did so with dedication despite the sacrifice to their personal comfort. They are not volunteers. They are paid professional staff who could, presumably, work at other jobs that if not easier would at least allow for a warm shower and dinner at home with their families each night. The Peruvian team were patient and kind with both volunteers and patients.

They were also very organized and efficient. Every village we stopped at the villagers were processed. "All hands on deck" so to speak. Even the boat crew would come out and help move people through stations or assist them to fill out their triage forms. I was immediately impressed by the nurses sent by the Ministry of Health.  They saw all the children, gave vaccinations, and provided vaccination record cards for each child. This might not sound so fantastic to Northerners. But there are many nations who don't even attempt to immunize people in remote communities let alone give them a vaccine card. So I was appropriately impressed. Then they went to the next level.....

We reached the part of the river where the waters are too shallow for the ship to pass. Time to turn around? Nope. Not these folks. The Peruvian nurses, midwife, and doctor struck out from the ship on a fishing boat for three days to sleep in tents in the jungle and provide care.  I don't need to tell you that its hot and humid in this part of the world. The mosquitoes travel in clouds. And the variety of wildlife that could crawl, fly, or slither into your tent is incredible. This gang weren't messing around. They were going to see everyone in the 'hood no matter what. 

In a world where people seem to find lots of excuses NOT to care NOT to work and NOT to bother, this Peruvian team are a refreshing reminder of what is possible.  They did the work and did so with grace. I have to admit that I felt my own contribution paled in comparison.

Breakfast with the team before the Ministry staff head up river  in smaller boats. Photo: S. Dalby.
The second message I gleaned may or may not surprise you. It's a reflection on quality of life and resulting priorities. I've received this message before on other brigades in other countries. I come from a wealthy country and want for little in my own life. Conscious or not my priorities revolve around things like my career, my house, the things I own, how much I worked out this week, or how many grams of fibre I ate. Like many I take my excellent standard of living for granted. It takes little time in a developing nation to feel pretty silly about what tops my daily list as important.

Developing nations have vast swathes of "have not" communities where lack of infrastructure alone makes basic tasks like eating and washing into all-day work. Let me be clear. Peruvian villagers have lived like this for generations. Many are quite happy with how they live and do not seem to desire change. They prefer village life to the alternatives and seem to enjoy very strong community ties. Others leave for the city and a so-called better life which often means a low paying job in Iquitos and perhaps living in a shack in the slum known as Belen.

Garbage floating under a typical house in the Iquitos neighbourhood called Belen. Photo: S. Dalby.
Belen, where many Amazon villagers end up in their search for work and a "better life". Photo: S. Dalby.

In the villages we visited most houses are boards on stilts or dirt floors on the ground. Roofs are made of grass or sometimes corrugated metal and there are usually no walls. There is often one mosquito net that is shared and used for the person in the village who is sick or delivering a baby.  There is no plumbing or running water. The river is used for everything including transportation, fishing, washing, toileting, and drinking water. 

Some villages have a generator and electricity but it seems to be tricky to keep the generators working. Some villages have concrete sidewalks from one end of the houses to the other  - rumour is that the sidewalks and satellite dishes are installed by governments seeking votes.  There might be a school house although no education beyond primary school is ever available. There are occasional nursing stations where people can access basic treatments for acute disease like malaria.

Village on the shores of the Amazon River system. Photo: S. Dalby
Many village homes are on stilts to allow for rising water levels in the rainy season. Photo: S.Dalby
Villagers eat what they hunt, fish or harvest. Cooking is done on an open fire. Sometimes there is a small shop operated out of a persons home. Often not. People work on farms seven days a week with little automation carrying heavy loads with no "retirement age" in site. They suffer sore backs, lots of headaches, machete injuries, cataracts, aching joints and lots of infections including malaria, dengue fever, giardiasis, and amoebic dysentery. Dermatological conditions are rampant. There are some chronic diseases like hypertension and treatment for these is patchy at best. 

Women often have their first baby as soon as they begin menstruating (we made a house call in one village to a 14 year old girl who had just delivered a baby). It's not uncommon to see young girls married to men at least 20 years their senior.  Most people look about 15 years older than they actually are. We saw very few people over 60 years old in the villages and were told that people simply don't live that long in the jungle.

Suffice it to say most folks here aren't concerned with renovating the kitchen this year or if they managed their 10-12 servings of fruit and vegetables today.

I'm not drumming out any messages about "the simple life". Villagers in the Amazon work hard, die young, and have limited choices in life. I don't envy their lack of access to education, health care, wages, or clean drinking water. But to visit them and see how they live is a sharp reminder that not everything we think of as crucial in the "developed world" is necessarily all that important. Sometimes our priorities are simply "first world problems" and nothing more. 

I will probably keep tracking my fibre intake. It's likely that I will renovate the bathroom this summer. But I think I will be a little more mindful about how lucky I am that these are the things that concern me and worry just a little bit less about the details. 

Thanks for reading Getting Healthy with NP Sam. Comments welcome - please click the pencil icon below. 


Tanya said...

Wow, Thank for bringing home your experience and sharing. We all need a reminder of what truly matters. Thank you Sam

Cait Lynch said...

Thanks for shedding some light on your journey with us, Sam.

I love that I know and care about someone who is curious and willing to venture not only out into the unknown--but also into the 'damed uncomfortable!'

And, all on behalf of the greater good--for yourself and the universe.

Someone (we both know) said to me once, when I was poo-pooing my own, small issues that 'it's all relevant.'

And, I believe it is.

Living our own best life, accepting help when we need it and raising others 'up' when we have the skills, desire and compassion along the way...that's what it's about for me.

Blessings to you for your work and your reflections. We missed you!


Stephanie Cudmore said...

What an incredible journey you had, Sam!

Thank you so much for sharing - both your skills, energy and self to the Peruvian people, and also for sharing your experiences with us. You are inspiring!

Robin English said...

Thank you so much for sharing your experience Sam! I am reminded of my experience in the mountain villages of Nepal and humbled once again of the wealth in my world. I applaud your efforts to make a difference!!!

Mal said...

Great blog Sam- observant and thoughtful.

Can we have another one please?

Perhaps there's a book in there somewhere.....

G said...

What a remarkable journey - thank yo for sharing it with us. Very thought-provoking. I'm very much enjoying your blog in general with it's healthy tip. I've just gone gluten and sugar free!