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Amazon Medical Project Inc


For those of you who have asked, are asking, or will some day want to ask -- what am I doing here, anyway? -- here’s an approximate idea.

I am a Wisconsin girl born and bred, with a few years' time out in Kentucky and Tennessee. I went to Medical School at the University of Wisconsin - Madison, graduating in 1984. I completed additional training in Internal Medicine, also in Madison, and am board-certified in that specialty. Then, I went into a small group practice a few miles up the road in Prairie du Sac.

In February 1990, I came to Peru for the first time, for what I thought was just a vacation. There was to be one week at Explorama Lodge, then one week to see Cuzco and Machu Picchu. At the end of the first week, however, I didn’t want to leave the jungle.

Even after seeing Machu Picchu and getting back home to Wisconsin, I still didn’t want to leave the jungle. So, after some faxing and phoning and letter-writing and much patient assistance from Pam in the Explorama office, I came back to Peru, to the Explorama Yanamono Lodge, in June 1990, armed with my stethoscope, my oto-ophthalmoscope, a small microscope, a bottle of prenatal vitamins, a few doses of antibiotics, and a three-month leave of absence from my Wisconsin practice.

Linnea J. Smith, M.D.Photo Credit: Amber Wobbekind

I spoke no Spanish, and I knew there was no running water, electricity, nursing help, pharmacy, x-ray, respiratory therapy, med flight, etc., etc. Explorama was kind enough to give me a discount rate on my lodging and to throw in the use of a room in one of their thatch-roofed houses for me to use as clinic space.

At the end of those first few months, it was even harder to return to my former life in Wisconsin (which incidentally I had always loved; if I was seeking an escape, I had certainly not been aware of that). Explorama has arranged for my local transportation and my international communications and been my family in Peru, ever since. I take care of their tourists when the need arises, but my main reason for being here is to help the local people, who have little other recourse for medical care. This is a goal of which Explorama has been consistently supportive.

Doctor WorkingPhoto Credit: Kelly Riddle

For anyone unfamiliar with the area, let me explain that the Lodge is 80 kilometers (50 miles) downriver from Iquitos. That’s one and a half hours in the speedy aluminum boats that Explorama now uses, although when I first came here, we traveled in more picturesque but slower thatch-roofed boats that made the downriver trip in two and a half hours, but took four hours to return upstream. That’s still better than what is available to the local people, which are “river taxis,” boats which chug along slowly (at least as long as they don’t break down or run out of gas, both fairly common occurrences) and stop for anyone who wants to get on or off, and take from six to eight hours to reach Iquitos. 

Or one can paddle one’s dugout canoe, the local equivalent of the family car, for sixteen to eighteen hours. Needless to say, there is no ambulance service in the rainforest (and no helicopter evacuations).

The nearest other doctors in this area are in a Peruvian government-run clinic, halfway between here and Iquitos. When I first arrived, that small medical center had neither doctor nor a nurse, and even now they do not always have the medicines the doctor wants to prescribe. For fancy stuff like x-rays or most lab studies, one must go to Iquitos.

Seeing as the competition was minimal, my practice grew. By the time I was back in Wisconsin for a visit in late 1991, I was seeing about 100 patients a month, almost all of them poor, acutely ill, and with no other available source of medical care. On that visit home, I was interviewed by Jean Feraca on her Wisconsin Public Radio program. Following the broadcast, a man called the radio station and identified himself as Jon Helstrom, an architect and a member of Rotary Club, from Duluth, Minnesota. He was intrigued by what I was doing. Now that I know him better, I realize that he was itching to organize a project, and I had the incredibly good fortune of becoming the lucky beneficiary. After Jon made a preliminary visit here, he convinced his Rotary District to send a crew down to Peru to build a 30 by a 60-foot clinic, complete with well and solar panels, on the bank of the river, about 15 minutes walk from the Lodge. While they were at it, they also built me a two-room thatch-roof house on the Lodge grounds so that I finally had my place to stay.

The Rotary Club members who came here to build the new clinic were so taken with the people and the place that they returned several more times to amplify and improve the clinic. However, by mid-2008, it was clear that the Amazon River was eating the land on which the clinic sat, at a pace that threatened to drop the clinic into the river within a very few years.

On Helstrom was therefore consulted and again came up not only with a floor plan for a new clinic (situated on Yanamono Stream rather than on the erosion-prone main river) but also the funding and people with which to build it.

The new clinic, which opened in March 2009, has the exam rooms, lab, office space, pharmacy, dental room, and patient overnight room of the original clinic; but it also boasts a comfortable living space for the doctor and nurses from Iquitos, a kitchen, and better quarters for the local clinic staff who often spend their nights there, as well as far more storage space than in the original clinic, and a much improved and expanded office (to accommodate the large number of patient files that have accumulated over all these years, and the documentation to go with them).

Way back in 1992, I began training Juvencio Nuñez Pano, a local man than 22 years old, with a wife, three children, and a sixth-grade education. He proved to be an incredibly bright student and quickly became my right-hand man, capable of examining a patient, recognizing all the diseases we commonly see and prescribing and administering treatment. He continues to work as a nurse, lab technician, dentist, and all-around engineer, and fix-it man.

HoatzinPhoto Credit: Bob Pelham

The clinic staff also includes his sister Edemita, who began working in May 1995, doing laundry and secretarial chores, and soon made herself indispensable. I trained her in medical procedures, but like Juvencio, she also subsequently earned a college-level nursing degree from the Universidad Nacional de la Amazonia Peruana in Iquitos. She greets and triages our patients, looks up their histories, takes their vital signs, performs her exam (and can in my absence treat many of the commoner ailments), and practically grabbed the family planning program from my hands ... a grandmother since she was 31, she understands the need. And when I am in Wisconsin, she manages the clinic’s purchasing and administrative chores. As the clinic has grown, we have added the first one, and then a second additional Peruvian nurse.

Our current two are brothers who grew up far out on the Napo River; both are incredibly bright, unflaggingly enthusiastic, and a great help in the clinic. Then, there are three watchmen-handymen-gardeners, who keep the clinic from falling apart in the humid tropical climate and call me when an emergency comes in at night. Also, we have had a few graduates of the nursing school in Indiana (the one between here and Iquitos, not the one between Ohio and Illinois) doing the practical work required in their programs and occasional volunteer physicians from abroad. And now that I am spending more time in the U.S., we have a rotating cast of Peruvian physicians. No one trained in the city wants to stay long in the rainforest, but we do try to keep a physician on hand, especially when I am not personally here.

We now see 200 to 250 patients a month, for everything from family planning (a program offered by the Peruvian government, in which we enthusiastically participate), to the treatment of intestinal parasites and various infectious diseases, to vaccines, to occasional trauma, such as the boy whom a medium-large caiman once attempted to have for dinner. We receive support from the Peruvian government in the form of medicines (family planning supplies, malaria medicines, and vaccines). We do not receive any funding from the government, but the Ministry of Health officials in Iquitos have always been very supportive in a moral sense, since they cannot persuade Peruvian physicians to go to, and stay in, rural areas where there are no support facilities, no medicines, no physician back-up or time off, no place for their wives to shop, no television, and no money to be made.

Close-up PicturePhoto Credit: Dan Fruechte

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