Amazon Promise 2011 Fall Newsletter
Transcription
Amazon Promise 2011 Fall Newsletter
NEWSLETTER Fall 2011 amazonpromise.org HELP FUND OUR MEDICAL BOAT Volunteers Wanted for February Through the generosity of an anonymous donor, Amazon Promise is launching a matching-fund campaign to construct a medical boat. The vessel is designed to safely and swiftly carry medical teams and supplies to the villages we serve, and to evacuate patients and team members in cases of emergency. It will have sleeping platforms for overnight We have 4 openings for our February 2012 medical expedition to the Yarapa River. Whether you are a medical professional, student or simply looking for a giving and rewarding experience of a lifetime, we have room for you! The trip includes clinics in the poorest areas of Iquitos and Belen, traditional medicine, and 13 days at Yacumama Lodge serving the needs of jungle villages in the Yarapa River area near the start of the Amazon. Come for part or the entire 3 week trip. Our Medical Director Dr. Bob Hyzy will be there along with doctors and medical students from the University of Michigan. You will be in great company. Contact Jackie: [email protected] excursions and importantly, a real toilet. We have a preliminary design and have found a builder in Lima. We are seeking out a nautical engineer to donate expertise for the final plans. Please take advantage of this unique matching-fund opportunity by making a special donation to Amazon Promise. For more information contact: [email protected] Share & Connect with Videos and Postings! Reach out to your friends, family and community. Spread the word about Amazon Promise's mission. Get involved and stay in touch. Where Western and Traditional Medicine Meet Last February Danny Bull, a graduate of University of Miami’s Multimedia Journalism master’s program, came to Peru to produce a short film about Amazon Promise’s work. Danny traveled with us to jungle villages along the Yarapa River, capturing the environment, the people who live there, and the dedicated work of our volunteers. The result is a 12-minute production that we urge you to see: VIMEO.COM /23522131 Youtube.com/amazonpromise Facebook.com/pages/Amazon-Promise/193391831901 Copyright © 2011 Amazon Promise. All Rights Reserved. 1 Filling in the Gaps Dorene McCourt Amazon Promise Board Director Boston, MA Her name is Sara Isabel. She is nine years old, and she has cerebral palsy. The volunteer physicians were excited to see her when her mother brought her to the Amazon Promise clinic in Belen. They were excited because Sara had been to the clinic a few months before, and her legs were rigidly contracted. The Amazon Promise volunteer medical team had shown her mother how to work with Sara’s legs to help increase her extension. Sara’s mother had followed the physicians’ advice, and now they could see dramatic improvement. All the physicians gather around Sara, probably making her feel a bit self-conscious. Sara doesn’t speak yet, but her eyes communicate apprehension, concern and sadness. Her leg extension has improved, but there is so much more that needs to be done for her. A professional physical therapist needs to work with her regularly, and Sara should be attending school. She is not getting these services, even though they are provided free or at a greatly reduced cost by the Peruvian government, because her mother can’t afford the transportation to get her from their home to the clinic and school. I heard the volunteer physician say, “I am sorry, but we have done all that we can do for her.” No, I thought, that is just not acceptable. I felt tears welling up in my eyes. Surely, there is something that can be done. What would it take? I approached Patty Webster, the President of Amazon Promise, and asked her what it would cost to transport Sara to and from the physical therapy clinic and school. Patty replied, “Probably $4 a day.” I am thinking, what is $4 -- a Starbuck’s venti soy latte. My response was immediate, “If I provide the funds to Amazon Promise, will you help Sara’s mother get the services that Sara needs?” I couldn’t walk away and not try to help this special, little girl who would otherwise fall through the cracks. It was only a small gap for me to fill but an insurmountable obstacle for her family. Copyright © 2011 Amazon Promise. All Rights Reserved. 2 That was in February, 2011. Since then, my husband and I have been contributing $120.00 monthly to Amazon Promise for Sara’s care. I think of her every day and am thankful to have the resources to make a difference in her life. Sara is progressing nicely, receiving physical therapy essential medical care and education will free Sara from the crippling effects of cerebral palsy. Dorene with Sarah and her mother Cintia at their first encounter during an AP clinic in Belen Feb. 2011 routinely, and attending school. In July, she was flown to Lima to have both her legs operated on. By November, she was walking! I couldn’t believe my eyes when I saw the photos...and what a wonderful smile on her face! She has also started speech therapy one day a week. I am looking forward to seeing Sara and her mother when I return to Iquitos. One day, I would like to have her visit us in Boston. Perhaps we can walk the Freedom Trail together -- symbolic of how Helping make miracles happen My heart was touched by Sara, yet she is just one example of so many other Peruvians, young and old, who are in desperate need of medical and dental care. By joining one of its medical expeditions, I was able to see firsthand how Amazon Promise is filling the gap. I was able to see how appreciative the people are of the expert, thoughtful care provided by the volunteer medical and dental professionals. For 18 years, Amazon Promise has received and responded to Peruvians’ invitations to bring essential care to the jungle villages in Loreto, the largest and most impoverished region of Peru. Trust has been established, relationships nurtured, lives saved. Sarah with nurse Carmen after surgery Copyright © 2011 Amazon Promise. All Rights Reserved. 3 From the desk of Patty Webster Changing Waters What would it be like if the only water you had to drink was contaminated and every time you took a drink you knew it could make you sick? Most of us have never had to think about it, yet this is reality for the one billion people in the world who do not have access to clean drinking water. The people in the Amazon suffer from chronic parasite infestations, and thousands of children die each year from diarrhea caused by contaminated river water. This issue hit home during our medical clinics in October on the Yarapa and Ucayali Rivers in the village of Nuevo Loreto. While distributing medicines to patients in pharmacy, I noticed an increase in the number of patients with Giardia and amoebic dysentery. It’s not unusual to see some patients with these infections in the villages we work in, but not close to the extent I noticed this past October. I had already run out of the medication needed to treat these infections twice during the trip. I asked a woman in the village why she thought her entire family had diarrhea. She replied, “It’s the river. It’s dirty now and we can’t drink it any longer.” I asked her where she was getting her water and she said they were collecting it out of a small clear stream located 10 minutes behind the village and also trying to collect rainwater. Once a beautiful black water tributary of the Amazon, the lower part of the Yarapa River (where villages Puerto Miguel, Nuevo Loreto and Jaldar are located) has recently been invaded by the larger Ucayali River which has broken through, changing the quality of water the people are drinking literally overnight. Copyright © 2011 Amazon Promise. All Rights Reserved. 4 Heavy monsoon like rains have also started washing the banks away where the forest has been cut down for farms, carrying massive deposits of silt into the river. Those living farther upriver are canoeing up the Yarapa beyond the breakage point to collect the darker water they’re used to drinking, but those living farther down river are just too far away. Storm approaching the lower Yarapa Collapsed riverbanks after the storm When I returned to Iquitos I was very excited to hear that a small team from the Sonoma County chapter of Engineers Without Borders (EWB) was scheduled to arrive a few days later to install a rainwater catchment system in a village just outside of the city. Engineers Dave Evans, Kason Grady and his wife Belen arrived November 2nd to investigate where to install this life-saving water system. Accompanying them from Sonoma County was Pam Chanter who has been helping raise funds for this mission, and social entrepreneurs Belinda Quintanilla and Sandra Jordan. Left to right: Belen & Kason Grady, Pam Chanter, David Evans The primary challenge in implementing a project like this is finding the right village to work with. Although every village might want it, more often than not, once it is built it ends up falling into disrepair because proper agreements have not been implemented and villagers have received no education or training to use it correctly and maintain it. The village of Nuevo Loreto seemed a perfect candidate for a catchment system because they were actively looking for rainwater for drinking. After hearing that the village EWB had initially chosen was not going to work out, I suggested Nuevo Loreto to the EWB team and we headed out to the Yarapa November 7th for 4 days to meet with its people. Copyright © 2011 Amazon Promise. All Rights Reserved. 5 The people of Nuevo Loreto were more than excited to hear of their candidacy to receive the rainwater system and cooperated with the EWB team in every aspect of development. Village meetings were held, families were interviewed, proper village assessments were preformed, and soil and water samples taken. Of note: water samples taken from the clear water stream located behind the village showed high levels of bacteria making it unfit for drinking, confirming that rainwater would be their best option. Kason, Pam, Belen and Belinda meet with Nuevo Loreto We are proud to announce that an MOU (memorandum of understanding) has been signed by EWB, Nuevo Loreto and Amazon Promise to install a rainwater catchment system early next year. We’ll keep you informed of the progress! If this project proves successful, other villages on the river will be considered for rainwater catchment systems, enabling Amazon Promise one more way to expand our mission of improving the health of the people of Peru. David and Kason obtaining soil samples next to the schoolhouse Copyright © 2011 Amazon Promise. All Rights Reserved. 6 Threat from a Modern World It seems impossible today, but in the Peruvian Amazon reported sightings of uncontacted indigenous tribes continue. These reports combined with newly discovered ancient ruins and new animal, plant and insect species make Peru one of the most exciting and intriguing places on earth to explore. It wasn’t until 2005 that the stunning 2530ft. Gocta Waterfall near Chachapoyas was officially measured and listed as one of the tallest in the world! One for the bucket list! As recently as October a new tribe was discovered in the Manu National Park. We like to think about uncontacted tribes living serenely for centuries in the Amazon Jungle untouched by outside influences, but the reality is more alarming. Remote indigenous communities are constantly fighting for their very survival against local and foreign intrusions that are forcing them out of the forest. These conflicts often end in murder, destruction of their land, or complete desecration of their culture and way of life. Survival International estimates there are at least 15 uncontacted tribes in Peru, and I imagine more to come. While the previous government of President Alan Garcia auctioned off large tracts of the Amazon to foreign corporations without consent or inclusion of the indigenous people living on them, the new government of President Ollanta Humala appears to be distancing itself from those policies. While most indigenous prefer to be left alone, others are open to dialogue and the possibility of related opportunities for employment and growth. There must be a dialogue. No collaboration can occur unless the indigenous are included in the process and their rights are respected. September 2011 Remote Expedition: Plans Dashed, Connecting with New Peoples Outside influences are not the only cause of the demise of indigenous communities. Lack of any type of consistent medical care is having a detrimental effect on their survival as well. Illness has a cascading effect that can rip through a community. If you are sick, you are unable to provide for yourself or your family, let alone be able to standup for your rights to protect the land on which you depend for survival. In my last conversation with Awajun leader Claudio Wampuch from the Saramiriza region on the upper Marañon River in October, he pleaded with us for information on when our medical teams would be coming back as there hasn’t been another intervention in their villages since we were there last in 2009! The people there are suffering from respiratory ailments, snake bites, anemia and malaria. It’s one of the most remote and difficult places to reach: a six hour bus ride from the northern coast of Peru, a breathtaking hour and a half helicopter ride over the Andes Mountains, and a switch to a second, smaller helicopter that drops us off in the middle of the jungle. Our plan to visit the Awajun in September with our remote medical team came to a crashing halt when 4 days prior to departure, the only public transport boat that travels to this remote region broke down, making it impossible for us to get our medical supplies and equipment up there. Gut wrenching isn’t enough to describe the team’s disappointment. Getting there is often more than half the battle. The good news is that we are planning another trip for May of 2012! In place of working in Awajun villages our September medical team ventured into new territory to hold clinics for the first time in high jungle Chancas Indian villages, then ventured back down into lowland jungle to provide care in Shawi villages of the Paranapura River. Copyright © 2011 Amazon Promise. All Rights Reserved. 7 The Quechua speaking Chancas are a once fierce tribe that escaped Inca domination in the 1500’s. Today they dedicate themselves to farming the rich highland jungle (and drinking chicha). Our teams traveled by pickup trucks into the beautiful high jungle mountains to reach the villages, a first for an AP team. No canoe paddles were necessary and yet were oddly missed! The Shawi are one of only two extant members of the Kawapanan group (Shiwilu being the other with only a few elderly fluent speakers remaining). Despite that the majority of the people living on the Paranapura River are indigenous Shawi, there is great racism against them by the small percentage of Chancas people of Pacchilla, San Martín mestizos living there. Classes are taught mostly in Spanish so indigenous language speakers have less chance of receiving an adequate education. Nevertheless, the Shawi culture remains strong and you still see women wearing traditional dress. Shawi woman in traditional dress Shawi children wait outside the clinic While the Chancas certainly needed medical care, they were visibly in better shape than the lowland Shawi who presented with high rates of anemia and malnutrition. Regardless, both the Chancas and Shawi people were very welcoming and extremely grateful for the medical attention they received from Amazon Promise and have requested our return. Copyright © 2011 Amazon Promise. All Rights Reserved. 8 Murder in the Jungle As with many indigenous areas of the Amazon, there is evidence of competition between religious groups to control these populations. As we traveled along the Paranapura River upstream from Yurimaguas, we couldn’t help but notice large churches with gleaming glass block crosses standing over primitive villages of malnourished, anemic people -- creating a surreal atmosphere. We were shocked to hear stories from local people of brutal assassinations of 14 curanderos / shaman (traditional healers) in the last 20 months. When we questioned the authorities, they brushed off the inquiry, stating that these were nothing but shaman vs. shaman revenge killings. While we are aware that this does happen, it is a rare occurrence. Fortunately, the mystery was already starting to get national and international attention. The prime suspects were soon identified as the mayor of the small town Balsapuerto and his brother, known as ‘the witch killer’. Roger Rumrill, a leading researcher on Amazonian issues, has reported that the murders are related to “protestant sects” to which the mayor and his brother belong (www.peruviantimes.com/05/report-14-shamans-killed-in-loreto-region/13843/). Both men fled soon after being implicated. It is alleged that the mayor ordered the killings after hearing of plans the healers had to form an association to share their knowledge of traditional medicine and healing. The removal of traditional leadership has a devastating effect on culture, physical health, social structure and social wellbeing. Through Amazon Promise’s experience, it is easy to see the differences between indigenous villages with a shaman or chief and those without. Invariably, indigenous villages that have lost traditional cultural leadership are less organized and exhibit more health and social problems. Thus, this systematic murder of curanderos is a crime that extends beyond the lives of those lost and threatens the very identity and future of their people. A Year in Closing Thank you September team volunteers, Dr. Chuck Morrison and wife Lynn (3 time alumni), Dr. Rick Roher (2nd trip), and new volunteers Monica Rabanal, NP, Dentist Sapna Radia, and 4th yr. Medical Students from England Nate Lee and Richard O’Byrne for your patience and true adventurous spirit. It’s not easy to get to these areas (especially those AP has never been to before), and volunteers know they must be prepared for anything and everything. Please check out our website for exciting photos. We held 11 additional medical & dental clinics during our July-August Student Internship serving impoverished neighborhoods of Belen and Iquitos, and villages of the Pacaya Samiria National Reserve. Students from England, Scotland and the US provided medical and dental care to over 1316 people. Thank you volunteers Beth Lineman, Francis Brown, Ben McCartney, Parvinder Shergill, Natasha Liou, Aekta Davda, Bhavana Murthy, Jennifer Park, Mark Bundy (see Mark’s article in this newsletter), Caitlyn Tennison, and Eric Moenter. Carmen Tocca attending a patient in the Belen Clinic A special thank you goes to three-time AP alumnus, Carmen Tocca, RN, for helping lead this trip. Your organizational brilliance and skills as an instructor and medical professional were immeasurably appreciated. Thank you, Carmen! Out of the thousands of patients for whom we provide medical care each year, most are women and children. Of 5354 people we cared for in 2010, 1736 were women and 1571 were children under five. Ten million children die each year in developing countries from preventable illnesses because they have no access to Copyright © 2011 Amazon Promise. All Rights Reserved. 9 basic medical care. According to our Peruvian staff physician Dr. Miguel Pinedo who works in the ER at the Hospital Apoyo Iquitos, maternal mortality is on the rise in Loreto at an alarming rate at 33 deaths per 1000. Infant mortality rates for children under a year are 133 per 1000, mostly due to diarrhea and pneumonia. Basic medical care saves lives, strengthens families and communities, and encourages hope and the pursuit of dreams and opportunities. We are firm believers in this principle. We have witnessed the difference we have made in thousands of lives, in communities that we have served since 1993. Yet, as an organization we continue to struggle each year with the limited funds that we have. By far most donations and grants go to Africa whose constant challenges certainly warrant it even greater attention than it receives. However, very little goes toward basic healthcare, health education, and HIV and malaria prevention for our near neighbors here in Peru. This is a very ancient country with deep poverty and a long history of exploitation of its indigenous peoples. The need here is also very great, and yet so is the hope and so has been our impact. As a member of the Amazon Promise community, you are helping thousands of native people each year. Thank you as always for your ongoing service and dedication, and we urge you to please reach out to others to help Amazon Promise keep its commitment. Patty Copyright © 2011 Amazon Promise. All Rights Reserved. 10 MORE PATIENT UPDATES! Jose, snake bite victim Earlier this year we told you about Jose Da Silva from the small village of Buenos Aires located in the Pacaya Samiria National Reserve (see AP Fall 2010 Newsletter for full story). Jose was bitten by a very poisonous and aggressive Fer-de-Lance pit viper and was brought to us late in the evening after clinic one day. We administered lifesaving anti-venom serum and other medications, watched him overnight, then had him evacuated out to the city of Iquitos where he was hospitalized for over a month. Several surgeries were performed over that month in the hospital to remove necrotic flesh. He received antibiotics, and Amazon Promise staff administered daily wound care in an attempt to save his leg. Good news. We’re happy to inform you that Jose is now back in his village with his family! As is typical with these severe snake bites, the aftermath of several surgeries to save the leg has left him badly scarred, and the removal of necrotic tissue has deformed its shape. Nevertheless he is able to walk and that’s the best anyone could hope for. 1. AP administering emergency care and antivenon 2. Jose’s calf after surgery 3. Jose’s leg finally healed after seven months 4. Jose home and able to provide and care for his family The Circle of Life During that same trip to the Reserve last October 2010, we had just pulled up to the shore in our boat after working a sweltering day in clinic. Everyone was tired and looking forward to cool showers and Luisa’s wonderful dinner. But it would all have to wait. We were immediately called upon to assist a 19 yr. old pregnant woman going through a difficult delivery. We pulled the boat out and headed upriver to the village of Buenos Aires, the same village of Jose Da Silva. As I have talked about many times, most women in the jungle do not have access to prenatal care. These mothers and their babies are at high risk for complications, and in many cases death ensues. The male midwife that had been with her from early morning ‘manipulating’ the baby had disappeared by the time when we arrived, and the family was sitting on the floor around her in their dark hut, lit only by small oil lamps made out of milk cans. We immediately administered an IV to the mother, and with the help of AP volunteers Dr. Rick Rohrer, PA Dorothy McGrath, RN Julia Tayler, staff Dr. Alex Sandoval, and Patty and Rosa, a healthy girl was born ninety minutes later. We are happy to present to you baby Rosa Patty (honorably named) at 9 months of age! Copyright © 2011 Amazon Promise. All Rights Reserved. 11 Point of Service By Robert Hyzy, MD Amazon Promise Medical Director Associate Professor Pulmonary & Critical Care Medicine -- University of Michigan, Ann Arbor One of the things that drew me to work with Amazon Promise when I first became aware of our organization four years ago was that AP brings medical care to the people, not the other way around. For example, our dental services are impressive. Although I have an aversion to the sound of a dental drill, it sure is something to hear that sound in a jungle village in the middle of the Peruvian Amazon basin. When we go to the jungle we bring along a portable laboratory --- and a laboratory technician who assists us in making diagnoses. This is an invaluable aid to the work we do. Although our capabilities are not unlimited we are still able to do a whole lot. Our usual test menu includes: Hemoglobin Complete urinalysis Stool smears for parasites Pregnancy test Malaria smears or rapid tests HIV tests Vaginal smears TB tests Glucose tests Leishmaniasis and other derm tests In addition, we have always had a small portable ultrasound device to evaluate fetal heart tones in pregnant patients. This is about to change. Through the generous support of the Ann Arbor Rotary Club and Rotary District 6380 Amazon Promise will purchase a handheld ultrasound for diagnostic imaging purposes. Point of service testing with a portable ultrasound has become commonplace in the Intensive Care Unit, where I work when not moonlighting with AP. In fact, over the last few years portable ultrasound has been used to provide meaningful diagnostic information in an increasing array of clinical circumstances (New Engl J Med 2011; 364:749). Ultrasound imaging has proven to be very useful in tropical medicine, with an entire textbook devoted to this area (Lutz and Gharbi, Manual of Diagnostic Ultrasound in Infectious Tropical Diseases, Berlin 2006, Springer-Verlag). Likewise, our new ultrasound will prove useful in an array of maladies commonly encountered in our clinics. These include abdominal exams (gallstones for example), abscesses prior to drainage for localization, cardiac evaluation for heart failure or heart murmurs, pregnancy, community acquired pneumonia and musculoskeletal disorders. We at Amazon Promise are very grateful for the generosity shown to us by Ann Arbor Rotary and Rotary District 6380. For those of you not familiar with Rotary International and the Rotary Foundation, they do terrific work at home and abroad, putting “Service Above Self.” I should know. I joined Ann Arbor Rotary in March. Having now established a productive relationship with Rotary International we at AP are hopeful of further collaboration with them in the near future. Copyright © 2011 Amazon Promise. All Rights Reserved. 12 Four Things to Count On Dr. Charles (“Chuck”) and Lynn Morrison Seattle, WA We write to you as participants of the Amazon Promise medical trip of September 2011 – also trips from 1998 and 2007. Last winter as my wife (with training in pharmacy) and I (family doctor) signed a deposit check for our September trip, we looked at each other and said, “this is a lot like jumping off a tall building – an exciting and perhaps breathtaking totally new experience”, once again. … the young mother of five with a hemoglobin of 6 MIGHT have regained enough strength to care for her family without supplemental iron 4. You will return feeling like a better person. Tired yes, but the awareness of the cultures you have been living in, the faces you have seen, the people you have talked with will be a part of your everyday life long into the future. Amazon Promise is a secular organization; however, the care and compassion that are the operational standard would be a source of pride for believers of any denomination or religion. There are four things you can and should count on with an Amazon Promise remote trip. 1. The trip will never be as you expected or planned. There are just too many variables in jungle, weather, rivers and culture. 2. Your safety is foremost and is anticipated by leaders and support staff. One sometimes wonders when you are in a forty foot canoe loaded within two inches of the gunnels, on a raging river, with both caimans and piranhas in it, as it gets dark – or when you pitch your tent on ground previously leased by tarantulas and snakes, and then in the morning shake out your shoes in search of scorpions before you put them on. Incidentally you are sleeping in a village of warm, friendly, appreciative natives whose daily lives include tribal conflict and sometimes cultish or superstitious beliefs. 3. You will feel you made a difference to the people who have briefly trusted you with their health care. Yes, you might cure a few or perhaps save a life and hopefully will comfort nearly all. Examples from our trip last September: … the 18 month old child with an abscess from her buttocks to her mid back MIGHT have lived without drainage and IV antibiotics … the isolated untreated family with three teenagers (the fourth had drowned) with a hereditary disorder of daily seizers MIGHT live a fruitful jungle life without treatment Chuck, Lynn and a yellow bucket Lynn and I have treated indigenous patients on six continents in the last 10 years and have traveled with many groups. Goals, support structure and operational overhead, and even relevance sometimes come into question. Amazon Promise is a “shoestring operation” where available dollars go directly to service with no frills, no financial gain, and lots of staff commitment and sacrifice in between. As my wife and I relive our Amazon Promise trip of 2011 and think ahead of our next trips, we are very much aware of the opportunities that Patty Webster – Amazon Promise President, trip leader and CNN Hero of the week (2010) – has created. Copyright © 2011 Amazon Promise. All Rights Reserved. 13 A Rewarding Experience for Dentists Mark Bundy Newcastle Dental School, England It is a commonly quoted interview question in dental school, “would you say you are reactive or proactive?” If you are in any doubt as to the answer, you probably haven’t been on the journey of discovery that is an Amazon Promise trip. Just after finishing my fourth year at Newcastle Dental School I set off on a two week expedition into the Pacaya Samiria National Reserve with nothing more than my knowledge, a smattering of dental instruments and a whole lot of DEET. After a day meeting the rest of the crew in Iquitos, we took a bus to the city of Nauta from which we would get a boat to our first village. As we left the city farther and farther behind, the landscape slowly changed: concrete buildings were replaced by wooden ones, and everything else by dense greenery. After a few hours travel by road and by river the Amazon transformation was complete, and we found ourselves in the picturesque village of 20 de Enero; it was the most beautiful and surreal place I had ever seen. As a self-indulgent trip Amazon Promise has it all, from swimming with pink dolphins and nipple nibbling fish (surely an experience not to be missed) to brushing up on your volleyball with the locals. The people you live and work with will become Mark practicing dentistry with a portable dental unit your new family, and the wildlife becomes your new roommate as you slowly relax into village life. You certainly start to envy the simple lifestyle and easy-going attitude of the locals when comparing it to living in a bustling city. Just one look at the night sky with the distant chorus of jungle creatures will have you wanting to up sticks and build a dugout canoe. MOH Dentist Neil surround by Shawi Children I had to sharpen my clinical skills quickly out of necessity and was acutely aware of the absence of hovering dental school staff. I was on my own. Doing this with the limited equipment shared between the ever enthusiastic (and Peruvian dentist extraordinaire) Neil and me was challenging but massively rewarding. The working day was spent mostly removing roots of disintegrated teeth and placing simple restorations in the not-sodisintegrated ones. The work was hot, sweaty and physically demanding as dental school rules regarding posture were abandoned in favour of illuminating teeth with my dwindling head-torch Copyright © 2011 Amazon Promise. All Rights Reserved. 14 and wind-up flashlight. There is a great working atmosphere about the place and it is impossible not to get caught up and muck in with the rest of the group. A moment of inspiring ingenuity came during the second week of the trip when disaster struck the dental camp. An all-important air compressor had stopped working, meaning a whole dental unit could not be used ... enter Jose Luis: dental nurse, action man and jungle god. Using the foil wrapping from a cigarette packet he manufactured a fuse and, in the stunned silence of everyone watching, the noisy compressor roared into life. The day was saved. It is impossible to adequately describe how working with the AP affects the volunteer. Dental health is poor in these villages (not least because of the local obsession with the fluorescent green “Inca Cola”) and oral hygiene is pretty much non-existent. Being able to provide restorations in teeth that would otherwise have to be extracted is a major positive, and the portable units which are so diligently transported by AP staff and the locals are invaluable. I was amazed at the speed in which a school building or house was transformed into a working clinic with water-cooled hand pieces and electricity for any piece of equipment a volunteer can bring. Our trip was lucky enough to have the tireless efforts of Harmony, the dental nurse and chief steriliser who worked with bleach solutions and a dry heat oven to keep our equipment as clean as a whistle. There was one prominent issue throughout the two weeks. Fear of dental treatment was shared by a lot of the villagers. Patients referred from the medical centre often went home without being seen despite our best efforts to look cute and fuzzy. To any aspiring jungle dentist out there or any student planning their elective, there is a real need in these villages for education and prevention as well as clinical work. It is an unforgettable place to visit, and more dentists means more patients can be seen in order to make a very real difference in the dental health of these communities. Tropical Medicine in Practice Phil Miller, MD ER Doc in Toronto, Canada October, 2011 I had recently finished the Diploma in Tropical Medicine course through the London School of Hygiene and Tropical Medicine, and a friend there recommended going to Peru with Amazon Promise. Having been on several disastrous overseas volunteering trips dating back to my undergrad years, I did what I could to scope out Amazon Promise – poured over their website and trip reviews, read their newsletters – and it all pointed Phil charming a wild anaconda toward an exceptional organization that was doing a lot of good things for a lot of needy people. A long time ago, I had read a book called One River by Wade Davis, which had forever inspired me to go to the Amazon – and now here was my chance. It was all finally coming together! Getting organized for the trip was straightforward – gathering equipment and supplies, sending off medical qualifications – thanks to Patty’s staff and organization. The transportation and accommodation from Lima to Iquitos was also taken care of by a travel agency that has worked with Patty’s organization for a long time – and this was also very simple. I stayed in a hotel close to the Lima airport and had a flight to Iquitos first thing in the morning. At the airport in Iquitos I met Bill and Lindsay, two of the other volunteers on the trip. Lindsay was in her final year of family medicine residency in California, and Billy was her Copyright © 2011 Amazon Promise. All Rights Reserved. 15 husband – a real estate entrepreneur. He could do everything under the sun: from catching piranhas for lunch, to fixing the water purification system at the Belen clinic, to catching fireflies with his bare hands, and managing the pharmacy and triage desk at all the clinics. We met the other volunteers at the hotel in Iquitos. There were three PAs from Yale: Eva, Julie, and Amelia; and a senior internal medicine resident, David, and his wife Andrea, who was a hospitalist both from Denver. At the Amazon Promise office in Iquitos we met the others on the team – Luisa, our cook; Shego, our all-round logistics man; our interpreters Selvi, Carol, Rosa and Jose; Miguel, the local doctor who would accompany us; and of course Patty, our leader. We spent the first few days in Iquitos – a day at the Belen clinic seeing patients, a day at the malaria reference lab and medicinal plant herbarium - and received blessings from a shaman who had participated in numerous Amazon Promise expeditions. Iquitos is a busy city right at the origin of the Amazon. The only access to anywhere is by air and river, and the only road out of town leads to Nauta, a dead-end port about 2 hours away. We spent the remaining two and a half weeks living at the Yacumama Lodge, about 2 hours by boat from Nauta. There we each had huts with mosquito nets, cold showers and toilets that worked (for the most part). We ate extremely well thanks to Luisa who prepared amazing meals for us daily. At night, we would hang out in the main dining hall playing Uno, charades and other games, sometimes watching movies on a laptop, sometimes just chilling out with a beer. At 9pm the generator would stop, the lights would go out, and it was bedtime. There is something very refreshing about living according to the movements of the sun waking with light and sleeping with dark. Sleeping in the jungle was an experience in itself with all the insect, animal and bird noises, and other unidentifiable sounds that let your imagination run wild. The Yacumama Lodge is nestled in the heart of the Amazon jungle. We saw many tarantulas, snakes, a scorpion – all either in our huts or close to the walkways. On our days off we would go for jungle hikes and see rubber trees, leaf cutter ants, monkeys, stick bugs and a lot of other jungle treasures. After breakfast we would gather our supplies and head out in boats to various villages, each one ranging from 20 minutes to over an hour away. Every morning as we entered the mouth of the river, we would keep our eyes open for the famous pink river dolphins and grey fresh water dolphins. At each clinic we would each have our own tables and stashes of medications to give out. For this trip we had access to a portable lab (courtesy of Daniel) which could do hemoglobin, blood sugar, complete blood count, as well as stool tests for ova and parasites, malaria smears, TB smears, leishmaniasis smears, and urinalysis. At our desks we had easy access to Tylenol, Advil, anti-parasitic medications and multivitamins. We could also mix up amounts of hydrocortisone cream, clotrimazole cream and had gentamicin eye drops. Anything else would be sent to pharmacy – ran by Patty and Billy – which distributed the prescribed oral antibiotics and other medications. For the occasional very sick person we had IV supplies, antibiotics and other medications, and we did use them on this trip. We performed some minor surgical and orthopaedic procedures - such as abscess drainage, laceration suturing, excision of skin lesions, an arthocentesis and a wrist reduction – and had all the sterile equipment that we needed. The medicine was interesting and challenging. Almost everyone who had any GI symptoms likely had parasites which we would routinely treat empirically. Many of the lab stool samples would come back positive for amoebic dysentery, strongyloides, trichuris and giardia. We saw many children with various skin, soft tissue and respiratory infections, and advanced and delayed orthopaedic presentations in older men. There were people with strokes, diabetes and hypertension. There were also some with advanced skin cancer, remote snake bites, STDs and psychiatric conditions. There were children with developmental delay and many pregnant women with no other access to prenatal care. Although we kept our eyes peeled, we didn’t see any malaria or leptospirosis on this trip. Some patients had leishmaniasis. A few youngsters had acute piranha bites. There was also a lot of gastritis, chronic back pain and dehydration-related headaches. HIV and TB are slowly becoming more prevalent in the jungle as well. Overall, everyone was very thankful Copyright © 2011 Amazon Promise. All Rights Reserved. 16 for our care, and we definitely did a lot of good things for many deserving people. My trip with Amazon Promise was awesome. Not only did we get to spend time in the Amazon rainforest and see all the interesting animals, insects and plants of the jungle, but we also provided essential healthcare for people with no other consistent access. The people of the organization were outstanding, the food amazing, and the overall experience was unforgettable. The trip far exceeded my dreams of working in the Amazon. A Sweaty, Thankful Reminiscence Amelia Siani Student Physician Associate, Yale University First, a little bit of background. I am Amelia. I am a Physician Associate student at Yale, and I traveled to Peru with two of my classmates, Evie and Julie, for the November Amazon Promise Medical Trip. I pursued a career in medicine in hopes of having an opportunity to provide care to people in countries that lack the access to healthcare that I have been so fortunate to have. Amazon Promise gave me my first opportunity to do so, and I could not be more thankful. Amelia and fellow PA student Evie Rodriguez with an 88 year-old patient in San Jose When I close my eyes and think about my experience, I picture myself sweating - new sweat on top of old sweat everywhere. I’m sticky. I will never think of my trip and not think of sweat. Though in the same breath, my thoughts are with the lines of mothers, children and the elderly at clinic in the mornings; the hard work that Segundo, Juan, Robert and others have already put into the day so that we can begin providing care when we arrive to the village. As I take a deep breath I return to the vast expanse of the Ucayali River with its sandy banks and swaths of green cutting between it and the sky where full clouds stretch back against the blue. As I exhale I am on the Yarapa river, cruising back to Yacumama Lodge while the last sunbeams of the day linger on the treetops, and occasionally catch our faces. Then I smile and a flood of memories comes over me - Luisa’s meals, playing cards nightly at the lodge, dancing with Karol, Rosa and Selvi on Evie’s birthday in the middle of the jungle, the tarantula that waited for us outside of our room every night, motocarro rides in Iquitos. These memories and so many more are mine, but in a greater sense they belong to the Amazon Promise family, as I was just a small part of this greater experience that has been connected with the communities we visited for years. As a young clinician my experience with AP has given me the tools to separate the sick from the not sick without a lab test or an x-ray but with the skills I was taught in my first year of school: a careful history, thorough physical exam and a watchful eye. Without these skills we would miss the child who had pneumonia rather than the ubiquitous upper respiratory infection caused by a virus. Without a thoughtful approach to the whole patient and process, something might be overlooked when an 88-year-old man comes to clinic complaining of dizziness and poor vision. On one of our last days we encountered just such a patient and found that not only was he suffering from dehydration like many of our patients, but he also had severe conjunctivitis and a urinary tract infection. On Monday morning, three days after I returned from Peru, I began a neurosurgery rotation and participated in a craniotomy in which functional MRI brain mapping was a crucial element. It is a different world here, and I’ve had to transition quickly. I am not sweaty but I miss the daily commute on the river, the simplicity of providing basic care to people who need it so badly, and the Amazon Promise family. Copyright © 2011 Amazon Promise. All Rights Reserved. 17 Health Education, Training & Prevention February 2011 Villages of the Yarapa, Ucayali and Marañon Rivers Please note that all patients receive health education information while being seen by physicians. The following activities represent special organized events. In addition, individual counseling on domestic abuse, STDs, family planning, youth counseling and dietary advice is provided. To ensure sustainability, Amazon Promise trains Promoters of Health (POH) in each village. POH are responsible for continuous monitoring, implementing educational lessons, distributing medication, and representing ongoing issues to Amazon Promise and the Ministry of Health. Village HIV Diarrhea Water Tx Home Rehyd. Latrine Maint. Libertad X X X X X Jerusalem Jaldar Castilla San Francisco Amazonas Puerto Sol 28 de Julio Puerto Miguel Yacumama Employees X X X X X X X X X X X X X X X X X Iquitos X X X X X Hygiene STDs Diabetes/ Diet POH Training / Other HIV Midwife Infant Resuscitation HIV X X X X HIV X X X X X HIV HIV * Other: individual counseling X Copyright © 2011 Amazon Promise. All Rights Reserved. 18 * Other: abuse, domestic violence, mutual respect of partners, human & reproductive rights * Other: individual counseling July-August 2011 Villages of the Pacaya Samiria National Reserve and lower Maranon River Health Instructor: Gina Tello Bardales, Enf. Promoters of Health 20 de Enero Sr. Wilder Tuesta Vasquez Arequipa Sra. Doili Sanchez Murayari Buenos Aires Community Lectures Sr. Carlos Rojas Tamani HIV /STD prevention, diarrhea prevention, hand washing, oral hygiene, sexual/reproductive rights, dietary advice Santo Domingo Sr. Elder Cachay Gonsalez San Pedro de Tipishca Srs. Juan Miguel Nashnato Yumbato, Franciso Torres Tamani, Ruben Mozombite Tananta, Hil Sangama Chasnamote Private counseling to individuals and couples with HIV/STD’s, family planning, domestic violence, sexual abuse Condom distribution and proper use Santa Cruz HIV prevention DVD given to village Promoters of Heath. Amazonas Sr. David Arimuya Macuyama Sr. Juan M. Amias Mozombite Iquitos Lectures only Copyright © 2011 Amazon Promise. All Rights Reserved. 19 CHARACTERISTICS OF NEONATAL AND PERINATAL DEATH IN NINE VILLAGES IN THE LORETO PROVINCE OF PERU Dr. Jamie Warren, AP Volunteer From MPH thesis presented to the Department of Public Health and Preventive Medicine and the Oregon Health & Science University School of Medicine Introduction: The percentage of deaths under the age of five years attributed to neonatal mortality is rising worldwide. Knowledge of sub-national neonatal and perinatal mortality rates (NMR and PMR), causes of death, and risk factors for death is imperative for developing and implementing programs to decrease rates of neonatal and perinatal death. Objectives: Determine the NMR, PMR, causes of death, and risk factors for neonatal and perinatal death for nine villages in the Loreto Province of Peru. Methods: Eligible women were interviewed about pregnancy outcomes for the preceding five years. Women who experienced stillbirth or neonatal death were interviewed using the World Health Organization (WHO) International Standard Verbal Autopsy Questionnaire for death of a child under four weeks of age. Verbal autopsy reviewer agreement was assessed using percent agreement. Univariate logistic regression analyses, using generalized estimating equations, provided estimates of NMR and PMR adjusted for clustering by mother and village. Fisher’s exact tests were used to determine risk factors for neonatal and perinatal death. Results: For nine villages in the Loreto Province of Peru, the NMR was 31.4 per 1000 live births (95% CI: 15.6/1000 to 62.3/1000 live births) and the PMR was 49.7 per 1000 pregnancies (95% CI: 28.5/1000 to 85.3/1000 pregnancies). Percent agreement among reviewers using verbal autopsy was 90.5% (95% CI: 69.6% to 98.8%) for cause of neonatal death, 55.6% (95% CI: 30.8% to 78.5%) for timing of stillbirth, and 38.9% (95% CI: 17.3% to 64.3%) for cause of stillbirth. The main contributor to neonatal death was infection (43%), followed by asphyxia (29%). Risk factors for neonatal and perinatal death were pregnancy with twins (p=0.001), preterm delivery (p=0.003), and delivery by cesarean section (p=0.049). Conclusion: The NMR and PMR for nine villages in the Loreto Province were found to be among the highest of any reported in Peru. Use of the WHO International Standard Verbal Autopsy for death of a child under four weeks of age proved useful for determining cause of neonatal death with high reliability. Characteristics of pregnancy associated with neonatal or perinatal death were twin gestation, preterm delivery, and delivery by cesarean section. Knowledge of these risk factors will assist in targeting interventions to decrease neonatal and perinatal mortality in these villages. Dr. Jamie Warren will work with Amazon Promise in 2012 to begin programs in "Helping Babies Breathe" and "Essential Newborn Care" as well as teaching the traditional birth attendants to record stillbirth or neonatal death in the communities so that we can monitor progress over time. She will also be working with heads of villages to devise emergency evacuation plans to Nauta for medical emergencies. Copyright © 2011 Amazon Promise. All Rights Reserved. 20 January 2011 Trip Report: A Week of Hemorrhagic Dengue Kristina Server Amazon Promise Board Director Washington, DC While I have been on multiple Amazon Promise trips over the last five years, this was my first opportunity to step into the shoes of Patty Webster, Amazon Promise’s president and founder, for a few days to lead one of our medical interventions in Peru. I knew it would be a challenge, not only to stand-in for Patty who has been leading trips for 18 years, but also because there is one thing I’ve learned from all my time in Peru, and in particularly the Peruvian Amazon - nothing is predictable. Upon arriving at the Jorge Chavez International Airport in Lima, we received word that an outbreak of dengue fever was taking place in Iquitos. While dengue is present in tropical areas throughout Latin America and indeed the world, epidemics can take place in urban areas, particularly during the rainy season when water levels are high and the mosquitoes which carry the illness can multiply at a rapid pace. Upon landing we learned that this strain was dangerous hemorrhagic dengue which can cause internal bleeding and even death in some cases. What is more, while mosquitoes carrying non-hemorrhagic dengue typically breed in only clean water, this species could breed in stagnant, polluted and black waters – which abound in the vicinity of Iquitos and surrounding areas. The Amazon Promise team of medical and nonmedical volunteers arrived into Iquitos ready to get to work. For this one-week trip, four clinics were planned: two in Amazon Promise’s clinic in Belén, one of the most poverty-stricken slum areas of Iquitos; and two in Masusa, the main port area. We had a small team of four international volunteers including one doctor, one EMT and two dentists. We also had our own staff of Peruvian doctors, nurses, dentists, interpreters and others to help run the clinics. We knew we would see a flood of patients that week as any sign of fever caused anxiety and panic. The health authorities were undertaking a huge antidengue campaign in the area. All of the local news provided tips on how to protect oneself - wearing long-sleeved shirts and long pants, using repellent, and emptying out areas of collecting water. Halfway through the week the city of Iquitos called for an inmobilización, where all residents were required to stay home and clean their homes of standing water. Schools and offices were closed that day, and anyone on the roads was subject to a fine by the local police. This was likely to be one of several other such days of targeted efforts to eliminate the dengue-bearing mosquitoes in the area. Since we couldn’t hold clinic, the team visited the local psychiatric hospital and spent some time with the patients. Mental illness in Peru is woefully neglected, and little resources are available; Amazon Promise makes a point to visit regularly. Kristina running pharmacy with AP staff member Rosa at our Belen Clinic That week we saw over 800 patients, a record number for just four clinic days. We diagnosed several cases of dengue and immediately referred the patients to the hospital, where the triage and inpatient facilities were overflowing with new cases. Thankfully erring on the side of caution, most of the patients in the area with dengue-like symptoms were going straight to the hospital as the health authorities had recommended. By May the Ministry of Health had reported 24,000 probable cases with seventeen deaths due to hemorrhagic dengue fever. The team also attended to a range of other conditions: a 13-year old learning she was pregnant; a man from a rural jungle community who traveled Copyright © 2011 Amazon Promise. All Rights Reserved. 21 all the way to Iquitos presenting signs of a heart attack; a two-year old boy with spina bifida who, without surgery, would never be able to walk. There were hundreds with respiratory infections, parasites and dehydration; scores in need of dental treatment from simple extractions to fillings. It was particularly great to hold clinic at our new facility in Belén which had recently undergone some wonderful improvements including the installation of clean running water, solar power, and a composting toilet thanks to Engineers Without Borders (NY Chapter). Each day we found our waiting room full of patients seeking care, and while they waited we gave them charlas (talks) on tooth brushing, hygiene, and HIV/AIDS and sex education. After long days interrupted only by delicious almuerzo (lunch) prepared by chef extraordinaire Luisa, the team counted up the patients seen, diagnoses and treatments. Amazon Promise regularly provides this information to the Ministry of Health. As always, it was a true pleasure being part of the team and providing attention to hundreds in need. We were grateful to have had such a dedicated group of volunteers join us for the week. A special thanks to Dr. Enrique Linan who brought his expertise in rheumatology to help many suffering from conditions like bursitis, arthritis and other joint problems; Emily Smith who provided invaluable care and assistance to all of the physicians and patients, including managing the wound care station with ease; and Drs. Ken Shiang and Amy Fung who each made the long trek from Australia to provide expert dental care to over 155 patients that week. Most of all, thanks to Patty Webster and Amazon Promise’s team in Peru for their hard work and support during this week. Hasta pronto! 2011 Patients Seen Date 17-Jan 18-Jan 20-Jan 21-Jan Village Belen Nuevo Punchana Belen San Francisco Trip Total Location Sector 10 Masusa Sector 5 Rio Itaya Patients 182 214 224 202 822 7-Feb 8-Feb 10-Feb 11-Feb 14-Feb 15-Feb 15-Feb 16-Feb 18-Feb 19-Feb 21-Feb 22-Feb 23-Feb Belen Nuevo Punchana Isla Iquitos Belen Libertad Jaldar Jeruselen Castila Amazonas San Francisco Puerto Sol 28 de Julio Puerto Miguel Trip Total Sector 10 Masusa Rio Itaya Sector 5 Rio Ucayali Rio Yarapa Rio Tahuayo Rio Ucayali Rio Maranon Rio Maranon Rio Ucayali Rio Maranon Rio Yarapa 201 300 233 203 173 55 36 132 120 140 131 66 142 1932 25-Jul 27-Jul 1-Aug 2-Aug 3-Aug 5-Aug 6-Aug 9-Aug 10-Aug 15-Aug 16-Aug Belen Nuevo Punchana 20 de Enero Arequipa Buenos Aires Santo Domingo San Pedro Santa Cruz Amazonas Belen San Francisco Trip Total Sector 10 Masusa RNPS RNPS RNPS RNPS Rio Bajo Maranon Rio Bajo Maranon Rio Bajo Maranon Sector 5 Rio Itaya 142 184 111 39 77 49 141 134 166 140 133 1316 13-Sep 14-Sep 15-Sep 19-Sep 20-Sep 21-Sep Pachilla Pachilla Chirapa Irapay Varadero Nueva Chasuta Trip Total 10-Oct 11-Oct 12-Oct 17-Oct 18-Oct 19-Oct 21-Oct 22-Oct 23-Oct 25-Oct 26-Oct Belen Hippolito Unanue Hippolito Unanue Puerto Miguel Libertad San Francisco Jaldar Jeruselen Nuevo Loreto Puerto Sol San Jose Trip Total 2011 Total Copyright © 2011 Amazon Promise. All Rights Reserved. 22 90 137 201 120 167 190 905 Sector 10 Rio Momon Rio Momon Rio Yarapa Rio Ucayali Rio Maranon Rio Yarapa Rio Tahuayo Rio Ucayali Rio Ucayali 133 99 63 136 81 112 54 38 53 107 82 958 5933 Carl Hammerschlag, MD Psychiatrist, Author and … Gesundheit! www.healingdoc.com Every year on the annual Gesundheit! clown trip to Iquitos, Peru with my holy brother Dr. Patch Adams, I spend a couple days doing some psychiatric consultation at the medical clinics run by Amazon Promise. One of this year’s clinics was conducted in a singlestory, brick, elementary school building that’s elevated on 20 foot concrete pillars. It is the only building in the community of San Francisco (across the Itaya River from Belen) that won’t wash away during the annual flooding. The huge room was filled with sick and crying children -- adults who are getting sewn up and infected wounds are everywhere. In the large central corridor there was a registration table, waiting area, three examining tables, a pharmacy, laboratory, a dental area at one end, and me seeing patients at the other end. The clinic took place while school was in session, clowns were painting murals on the walls, and Patch was teaching kids the Bunny Hop in the waiting area. The noise level was intense, the privacy non-existent, but somehow this noisy circus is organized and works. Patients were referred to me if the screening clinician thought they might benefit from a visit, and wrote my name down in the place on the intake sheet marked for referrals to the Shaman. I sit in a small circle talking to them through my incomparable interpreter Rosa. We have been together for a couple of years, and she has the remarkable heartfelt talent to translate my words into a story that means something to her people. There was no privacy, and kids were moving past us whenever the bell signaled classroom changes. The noise level was so loud that we had to sit almost face-to-face, but people had no difficulty getting into their stories with as much intensity as in my private office. The first time I came here I was so overwhelmed by the insoluble problems that accompany poverty and powerlessness that I wondered what service I provided at all. But it turned out that the simple act of spending 20 to 30 minutes listening to people was therapeutic, and the brief, directive treatment I provided gave Rosa tools for when I wasn’t there. I saw the now expectable array of the battered, abused and desperate - a woman in her late 30s who was raped and impregnated as a 12-year-old and relives that trauma every time she has sex. I told her to speak to women who had been similarly traumatized and had found a way to move beyond their suffering. Rosa made an appointment for her to meet with a group at a shelter for sexually abused women. I saw a mother and her 10-year-old son (the boy disappeared moments after we met to mingle with the crowd). Mother told me the boy was inattentive, hyperactive and always getting into trouble. I wrote out strategies for limit setting and how to reward good behaviors. There were lots of depressed mothers whose greatest fear was not being able to feed their children every night, whom I commended them for their resilience and ability to persevere. “Here in Belen, sometimes just being paid attention to and knowing you’ve been heard is enough to relieve suffering.” One of my first patients, Pablo, was a 17-year-old young man who suffered daily episodes of momentary spells during which he couldn’t remember anything the teacher was saying; or, if playing soccer he’d suddenly blank out and not remember what to do with the ball. These spells happened on a daily basis for the last year. He didn’t feel them coming on, and they could last from moments to half an hour. Pablo said he fell and bumped his head 3 years before and wondered if that might be the cause of his current problem. He seemed a bit lethargic and withdrawn but denied sleep problems or suicidal ideation. Neurological Copyright © 2011 Amazon Promise. All Rights Reserved. 23 examination revealed no gross abnormality, and there was no family history of seizure disorder. Pablo hadn’t told anyone about his symptoms, only that he was not feeling well, and it was not pursued further. I asked him if there was anyone he trusted to share his truth, and he said he’d already told us more than he had anybody else in his life. I told him that if he could talk to just one other person about what he was feeling or afraid of then his symptoms would improve. Pablo insisted he had no one; so I told him that before I left, I’d leave him a gift from Rosa and me so that he could talk to us whenever he wanted to again. I bought him a fluffy lion with a note along that said that he had the heart of a lion - because even when he was hurt he remained strong and fearless. Gloria, a woman was in her early 20s, wanted me to see her seven-year-old son (also named Pablo) because of his recent onset epileptic seizures. Gloria went on to say that she believed she had contributed to his problems because for many years she told Pablo that she didn’t want him. She would tell him he reminded her of his father who had abandoned her before Pablo was even born. Gloria lived with another man who fathered her second child (now a 3-year-old son), and was currently 6 months pregnant. A month ago her second man abandoned her. Gloria was working as a waitress, and added that in order to feed her children she also worked as a prostitute. Tears rolled down Rosa’s cheeks as she translated Gloria’s words. My training in psychiatry has not prepared me to deal with these kinds of social problems. Her overwhelming survival needs were not going to be met by insight-oriented psychotherapy or psychiatric drugs. I felt so helpless to provide any meaningful support, and at the end of our 45 minutes together I could only say to her that her son would always love her, and to be the best mother she could so he could love her even more. Before leaving she thanked us - for what I wondered - and then added, “thank you for listening to me”. Here in Belen, just being paid attention to and knowing you’ve been heard is enough to relieve suffering. My last patient was Lupe, an 80-year-old woman who when asked what problem brought her to see me, laughed and said she didn’t have a problem. The nurse asked her if she’d like to talk to somebody about how she was feeling, and Lupe said, “Sure. I always like to talk to people”. She proceeded to tell me she came from humble means, but she was happy with what she had. She’d been married to a good man for many years, raised four children, had 12 grandchildren, most lived close by. “We live together, we cry together, we celebrate and laugh together … life is good to me”. I had tears in my eyes when I hugged her goodbye, and I thanked her for reminding me what it meant to be healthy. Stay connected in loving, supportive communities that inspire the spirit. – Carl Patch Adams encouraging AP volunteers, staff and patients to “clown around” Copyright © 2011 Amazon Promise. All Rights Reserved. 24 The Importance of Reaching Out to Others for Amazon Promise On occasion we have all had conversations with people who are compassionate but aren’t sure how to give. And then there are those that feel that it just doesn’t make a difference in the ‘big picture’. However, if you are reading this newsletter, you are aware of Amazon Promise and know full that we do make a difference. The work Amazon Promise does is amazing not solely because of what we do and how well we do it, but also because we have succeeded with so little. We are not a large organization with big overhead and a budget left over at the end of the year that we race to spend. This is very much a hands-on group of caring volunteers and donors like YOU who make their own sacrifices in money and time to serve the needs of others. In these tough economic times, your support is all the more critical as our organization struggles monthly to meet its obligations. On average it costs us less than $10 to treat each patient. This is admirable under any conditions, but it is especially remarkable when one considers the quality of care we provide and the logistical difficulty and expense inherent in reaching the populations we serve. You can help by making a tax deductible monetary donation. You can also reach out to others to expand our donor pool. Talk to your friends, your companies, your places of worship. Although we are not a faith-based organization, we embrace values of serving the poor, the sick, the hungry, the lonely, the elderly and the hopeless. You can also help by donating in other ways. You can donate frequent flyer miles, you can donate medicine, and you can donate your time. We need help with marketing and communications, public relations, reports, grant writing, locating grants, fundraising, seeking out appropriate strategic partners, and recruiting volunteers. While we sometimes receive offers to donate equipment, clothing and other large volume items, we simply don’t have the funds to pay for the shipping costs and customs duties should they apply; these types of material donations must therefore be considered on a case-by-case basis. Lastly, we constantly need volunteers on our medical expeditions in order to provide the helping hands that serve thousands of poor people each year. Many of you have already volunteered, some of you multiple times. Spread the word. Share the experience. And of course, we welcome you back. You are family. Patty Copyright © 2011 Amazon Promise. All Rights Reserved. 25 Make a Donation Amazon Promise relies on private support to fund operations, expand services and provide a wide range of care to impoverished communities in Peru. Monetary Gifts If you would like to make a tax deductible donation, please mail your check or money order to: Amazon Promise P.O. Box 1304 Newburyport, MA, 01950 USA Or, if you prefer you may also donate via PayPal from our website. However, please note that PayPal extracts a processing fee from the donation. Material Donations If you would like to make a non-monetary donation, please contact Kristina Server at [email protected]. Please note that due to our financial constraints, we are unable to accept certain types of donations that require us to pay shipping fees or customs duties. Other Options Donate frequent flyer miles, air vouchers or hotel vouchers. These greatly help Amazon Promise keep its costs down. Need a gift for the holidays? Visit our Zazzle site to purchase AP t-shirts, mugs, bags etc. 25% of the price goes to helping AP: www.zazzle.com/amazonpromise. You may also purchase gifts or make donations to AP through charity networks GreaterGood Network, Changing the Present and Stuff Your Rucksack . Volunteer Join Us on a Medical Expedition Please check out our website for the new 2012 schedule. We have seven different volunteer medical expeditions planned for this coming year. If you have only a week or so available, join us for part of a longer expedition (excluding remote trips). You can also arrange your schedule to focus on our work in the city or jungle clinics. So pack your bags and join the growing team of Amazon Promise volunteers! Volunteer Your Time As mentioned in our newsletter, we need people to help with website content, marketing and communications, reports, grants, fundraising and outreach to potential strategic partners. If you have an interest, expertise and some time that you’d like to commit, please contact Kristina Server at [email protected]. Copyright © 2011 Amazon Promise. All Rights Reserved. 26 AMAZON PROMISE DONORS Amazon Promise extends its gratitude for the continued support from the following individuals and organizations: Above and Beyond Anonymous Donor of multi-vitamins Dan Bishop Thomas Bloch Dorothy and David Bonnett Sarah Deem Mark Dingley and Margarite D'Amelio Gregory Dopulos MD Barbara Erny, MD Ed Ferrero Jennifer Fraser Bob Fulton, D.D.S. Sue Hinshons Richard Horstman Robert Hyzy, MD Irina Karnaugh Joe and Beth Mares Dorene McCourt Dr. Charles and Lynn Morrison Anoop Nambiar, MD Timothy Nostrant, MD Pfizer Foundation Matching Gift Fund Queen's University Belfast Students Working Overseas Trust (SWOT) Robert James Frascino AIDS Foundation Roberto Paliza Joseph and Loretta Ramirez Richard Rohrer, MD and Jill Stein, MD Jeffrey Schneider Shrine Grade School Class of 1980 Justin Smith Jack W. Swanberg Rod and Betty Wade Chun Lin and Hungchieh Wei Stephen Winter, MD and Eva Chan Our 2011 Volunteers January Emily Q. Smith Amy Fung, D.D.S. Shiu Kiang , D.D.S. Enrique Linan, MD February Matthew Schlough Patrick Forrest Lauren Yagiela Jane Lee Alice Chi Julie Heringhausen Melissa Lygizos Megan Elaine Wilson, MD Catherine Ann Saenz Bonham, MD Brian K. Jordan, MD Bob Hyzy, MD Vida Skandalakis, MD Doreen McCourt Millie Samaniego, MD Elena Deem, PhD July/August Beth Lineham Francis Brown Ben McCartney Parvinder Shergill Natasha Liou Aekta Davda Bhavana Murthy Jennifer Park Mark Bundy Caitlyn Tennyson Eric Moenter Carmen Tocca, RN September Nathaniel Lee Richard O’Byrne Monica Rabanal, NP Sapna Radia, D.D.S. Charles Morrison, MD Lynn Morrison Richard Roher, MD October Phil Miller, MD Andrea Vitello, MD David Coffey, MD Lindsay Larson, MD Bill Larson Evangeline Rodriguez, PA Julie Strohsahl, PA Amelia Siani, PA Copyright © 2011 Amazon Promise. All Rights Reserved. 27 Our Valuable Contributors Maralyn F. Abbott Terry Allen, MD Steve & Gloria Andruszkewicz Rafid Antone Patrick & Sonya Apodaca Dave & Mary Arce Tara Arness, MD Paul Baranoski Marianne Barber Kara Bardram Marc & Mary Jo Barie Richard & Yvonne Bates Don Bevington & Marisa Baragli Shiraz Bharmal Marek Nesvadba Bouchard Laurin Brenner Sam Burd Marianne Butler Emma Byrne Jeanne P. Carroll David Chang Changingthepresent.org Jenyen Chen Kon Chen Robert & Sharon Chinook, MD Jinhoon Choe David Christianson & Yuko Mera Paul Kessinger & Molly Cole Howard Conlon Dorothy Connelly Kathleen Cotter Richard Cromer James Cronk Ms. Maureen Curley & Ms. Diane Barsam Catherine Cyr Brett D'Amelio Frank D'Amelio Gerardo D'Amelio Julyne Derrick Christiane Diehnel Deanne Dingley Brian Erler Jackie Erler Larry Eyink & Susan Schulman Alexandra Fairchild, MD N. Elizabeth & John Fath Mazetta Ford-Medina Lee Frankel-Goldwater Cleotilde Gabagat Salimata Gassama Stella Gentile Bob German Jewel B. Gibson Paul Glac Mr. & Mrs. Edward Glac Martha Glynn Priscilla Gminski GreaterGood.Org Victoria Green Kay Greenwald Hyacinth Grey Donald Grossman & Elaine Hirsch S. Michael Hahm Richard Henrikson Hesperian Foundation Joseph F. Hodapp Colleen Hogan Mary Lynn Holley Molly Horstman, MD Jillian & Aaron Huberty Minghung Kao & Lihui Hung Sunghwan & Insook Hur ING Financial Services Mary Anne Janke Judith Jensen Michelle Keightley Shelley Kemperman Patricia Posada Klapper Mark Kleinle Lauren Kondi Margaret Koob Levi Koral Susan & Edmund Kwan Harry & Jennifer Kwan Kathleen Lacci Ingrid Lacoste Leah Larsen Lindsay Larson Brenda Lazarus, Ph.D Jaejoon Lee Walter Levi & Olive Haugen Larry Lipton Jessica Long, MD Andrew & Florence Lozyniak Barbara Lynch Drs. Dan & Lindsay MacDougall Shari Mackie Shannon Mahoney Jeff Markowitz Phil Markowitz Mark & Haleigh Maurice Barbara McCarthy Irene McCutchen Dorothy McGrath Sheri McNary Yuko Mera John Metsker Philip Miller Robert Miller Melissa Mocek Tom Morris Alan Murray Network for Good Lawrence Nobs Jean & Alfred Oneto John Paik David Petersen & Teresa Rennick Irena Pietrowska Marion Prescott Patricia Protheroe Ms. Mary Prunty Bonnie Raitt Lynn Ramirez & Steve Nelson Caroline & Victor Ramirez Carole & Joseph Ramirez Susan Reens Phyllis Rice Rick Richard Dale & Barbara Rothe Barbara Sahagan James & Heather Scates Thomas & Tania Schlatter Mark & Gail Schlenker Henry Showell Art Silver Greg Simmons Danielle Slack Copyright © 2011 Amazon Promise. All Rights Reserved. 28 Kevin Smith Cem Soykan, MD & Rhonda Gill Scott Stevens Lynn & Cecilia Stiles Jean Strong Fred Swanson Gina Testaverde Arthur Thomas Sydney Thompson John Tintinalli Judith E. Tintinalli, MD Marie-Louise Tomas Laurie Bemi & Gary Towsley Barry Trachtenberg, MD United Way of the Greater Triangle Nishi Valli Gail Walden Nicholas Ward Leslie Warshaw Carl Watson Peter & Margaret Webster Robert Weiss Beverly Wenz Nancy White Eric Wynn HyoungDock Yoo Edward Yu Adrienne Zazzi, MD These contributions represent gifts and in-kind contributions from Sept 1, 2010 – Nov 30, 2011. Please contact [email protected] with any corrections to this list. Copyright © 2011 Amazon Promise. All Rights Reserved. 29 Amazon Promise: US Board of Directors Patty Webster, President Dr. Robert Hyzy, Medical Director Abigail Scherrer, Vice-President Jacqueline Carroll, Treasurer Kristina Server, Strategic Development Dorene McCourt, Corporate Relations Melonie Rockwell Amazon Promise: US Team John Tintinalli, Adviser to the Board of Directors Dr. Robert Fulton, Director of Dentistry Elena Deem, PhD, Director Educational Programs Amazon Promise: Peruvian Team Patty Webster, Medical Team Leader Jose Luis Valles, Interpreter Rosa Aranzabal, Administrative Coordinator and Interpreter Gina Tello Bardales, Promotor of Health Training and Community Education Dr. Miguel Pinedo, Staff Physician Neil Chavez, Staff Dentist Segundo Coloma Cahuaza, Logistics Alter Coloma, Logistics Luisa Bardales, Cook Extraordinaire Blanca Medianero Burga, Legal Council Editor & Layout: John Tintinalli, Progenitor LLC (http://Progenitorllc.com) Amazon Promise PO Box 1304 Newburyport, MA 01950 USA 1-800-775-5704 [email protected] www.amazonpromise.org Amazon Promise is a U.S. non-profit organization, exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. Under state law, which will vary from state to state, and federal law, which may change annually, a large portion if not all of your expedition fee is tax deductible in the United States. Likewise, monetary and material donations made in the U.S. are tax deductible. Copyright © 2011 Amazon Promise. All Rights Reserved. 30