The Amazon Medical Project

In August, we went out on a series of similar expeditions, this time to villages near the clinic, which Juvencio and Edemita had suggested as needy of services, and which I had scouted out ahead of time. Having learned from the first round of touring (and being unaccompanied this time by dentists), we organized our services a little differently. On these visits, we attempted to filter out those who truly were ill from those who simply wanted free pills. We offered reading glasses to everyone over the age of 40, had another line of people who needed only to collect their worm medicine and vitamins, and put the physician who had accompanied our group into a corner where she could tend to those with physical illnesses, while I took the job of screening interviewer. In four days, visiting four different villages, we provided medical consultations for a total of about 75 people, reading glasses for almost 150, and worm medicine and vitamins for over 550 persons. The following week, Juvencio went out with another visiting dentist and performed 15 dental fillings and over 100 applications of dental sealant, as well as teaching proper dental hygiene and handing out toothbrushes to about 1,685 schoolchildren in eight river communities. He then joined a nurse who has been visiting communities along the Napo River for several years now, and helped her to provide reading glasses for another 80 people and toothbrushes for another 400, all in villages which are remote from the city.

All this means that we, along with these various groups, reached hundreds of people who otherwise would not have received the services provided (some of them would probably have come to the clinic, but many live too far away for this, and most would not have made the journey just for worm medicines and vitamins). The removal of badly decayed teeth is a tremendous service, and the provision of toothbrushes and teaching how to properly use them may help lessen the need for extractions in the future. The worm medicine and vitamins are needed by everyone, and hopefully will contribute at least temporarily to improved nutrition and thereby to better overall health. And several of the patients who were actually ill may in fact have benefitted significantly from our interventions.

Which is all to the good.
On the other hand, I have some reservations.

For one thing, we saw a number of patients for whom we could do little. One woman who wanted treatment for vaginal bleeding turned out to have advanced cervical cancer, for which she had apparently refused surgery, and who will slowly bleed to death. Of course, probably no one can help her; but it was heartbreaking to talk with young mothers with many children in the villages upriver, asking them if they used birth control, only to have them reply that the centers where birth control was available were too far away for them to reach, and often out of supplies if they did manage to get there. (Fortunately, for the women near our clinic, this is not a problem.) Another woman for whom we arranged free tubal ligation in Iquitos (she recently had a bizarre placental malformation called a hydatidiform mole, had liver disease a few years ago, and already has four living children) never showed up for the procedure.

And a fairly large amount of resources were expended, considering the costs of traveling to South America for all the volunteers from the U.S., in order to provide treatment that could have been distributed by local workers at a fraction of the cost. Then, there is the simple arithmetic of the fact that at any given time, in any given place, most of the people will be healthy. Going out to look for sick people is fairly low yield, which means that these village visits will mostly be to tend to people who are not actually sick. I had to question my own role, lining people up to receive worm medicine. Any minimally trained person could have done that job, and perhaps my time would have been better used manning our own clinic, where a higher percentage of those who present themselves are in fact in need of medical care when they arrive. Surgical projects, such as repair for cleft lips and palates and burn scars, offer a higher yield in terms of reaching people who truly have serious problems and cannot afford to fix them on their own, because the surgical candidates can be lined up ahead of time and brought together at the time and place that the surgeons and dentists are available. Dental extractions and fillings can also be done, as Juvencio and the dentists demonstrated, on many people in most Amazon villages. But in order to provide care for sick people, who become sick at various times and in various places, and who often cannot wait until a scheduled group arrives, what one needs is a clinic in a fixed place, where those who need help can come at any time.

Like the Clinica Yanamono, of course.