Letter from Peru: Amazon Promise Spring 2024 Update

by Patty Webster and colleagues
Ms. Webster is Founder and President of Amazon Promise

I’m happy to report our May medical outreach team has just returned from the field providing medical, dental care and other health services to 350 people living in remote communities of the Pacaya Samiria National Reserve.

This was an especially important trip because we haven’t been able to return to this area since our last medical intervention in 2019 before the pandemic. These villages are smaller and take longer to reach than other places we work in, but whether it’s a community of 3, 30 or 300 people, our teams will do what’s necessary to reach those in need to provide the highest quality of care possible wherever they are.

Clinic at the river’s edge, community of Bagazan, May 2024. Drs. Nolia Chavez and Claudette Soto provide dental care while laboratory technologist, Nolberto Tangoa sees patients.

Everyone was so welcoming and happy to see us. We’re thankful to be working in these communities once again.

Amazon Promise Associate Medical Director, Eva Clark, MD, PhD, first volunteered with us as a medical student over 14 years ago. She’s now an Infectious Disease specialist in Houston, Texas and has years of experience working in Peru. Eva was part of our recent team and has written a great article about her return as a volunteer (see below). It was awesome to have her back as a volunteer after 14 years!

Dr. Theresa Sepulveda, along with interpreter Jose Luis Valles, provide care to a family in the community of Bagazan. May 2024.

We’ve been partnering with several professional chapters of Engineers Without Borders USA since 2011, and together we’ve implemented potable water systems in 19 communities. The twentieth system should go in later this year.

Scott Gregory is the Program Engineer for Engineers Without Borders USA. Last August Scott traveled with a team lead by AP Special Projects Manager, Jose Luis Valles, to survey and assess all of the previously built potable water systems. He’s written a thoughtful synopsis on our partnership and the lasting positive changes seen in the remote communities served over the years (see below).

Patty Webster (right) and a family at a clinic.

We’ll be back in the field beginning July 13th, working in communities of the lower Ucayali River.

Providing quality medical care, health education and clean water to vulnerable populations living in remote Amazonian jungle communities and underserved urban neighborhoods has been our primary focus for over 31 years.

Your support has been essential. We can’t do it without you!

— Patty

Engineering Report

by Scott Gregory
Program Engineer/International Community Program, Engineers Without Borders USA (EWB-USA)

Scott Gregory (right) with Jose Luis Valles, Special Projects Manager for Amazon Promise.

Through the years our partnership with Amazon Promise has proven to be highly impactful towards delivering EWB-USA’s mission of improving basic infrastructure access to underserved communities. The complementary focus areas of our organizations, provision of essential health services and construction of sustainable infrastructure solutions, are naturally aligned and together have contributed to bringing lasting change to remote communities in the Upper Amazon Region of Peru.

From initial community vetting and assessment through construction and monitoring of completed projects, the Amazon Promise team continues to exceed expectations in the coordination and delivery of over twenty active and completed projects through eleven years of partnership. Through decades of experience, the contextual knowledge and trust that Amazon Promise has built with communities is key to the success of our collective impact and shared vision on supporting sustainable community driven initiatives.

Thank you for your continued support and we look forward to deepening our connection and impact for years to come!

My Return to Amazon Promise: Medical Clinics in the Pacaya Samiria National Reserve

by Eva Clark, MD, PhD
Assistant Professor of Pediatric Tropical Medicine and Infectious Diseases at Baylor College of Medicine

Dr. Eva Clark

In May of 2024 I had the opportunity to accompany the Amazon Promise team on a medical trip to villages in the Pacaya Samiria National Reserve. Though I serve as the organization’s Associate Medical Director and regularly visit Iquitos to work on a research project, training and work had prevented me from volunteering since 2010. My Infectious Disease fellow, Theresa Sepulveda, also volunteered on the team.

The Journey Begins

Despite this long hiatus, after planting my clean rubber boots on the floorboards of the long wooden boat that would transport our team to remote communities of the Reserve, I felt the last 14 years fall away. The Amazon Promise team greeted me as if we had returned from our last trip together only yesterday. It seemed as if no one had aged a day!

During our three-hour boat ride that left from the port town of Nauta headed to the reserve, Patty and I passed the time regaling our excited new team members with nostalgic stories of encounters with pink dolphin pods, tarantulas, mosquito bite prevention techniques, and clinic day logistics. Before we knew it, we had arrived at our temporary home in the village of Buenos Aires.

After being greeted by our host, Justo (and a tarantula), we settled into our shared rooms and began to prepare for the next-day’s clinic. As Infectious Disease physicians, Theresa and I were particularly interested in understanding what types and formulations of antibiotics that the Amazon Promise pharmacy contained. We quickly realized that we would not be able to rely on our typical go-to dosing apps. Thus, we developed a backup plan using our available resources. This was our first major realization of how much we’ve come to depend on the easy accessibility of the internet for our daily clinical work.

First Stop: Buenos Aires

Our first clinic day would be in our home village, Buenos Aires—thus our patients were only a short walk away.

A group of men from the village helped us set up clinic in the local community hut, a raised wooden platform with a thatched roof. The dental clinic and laboratory were set up in the primary school building next door.  Amazon Promise staff Segundo and Alter had already registered a handful of patients by the time our four individual medical stations were ready, and Ricky was busy setting up the pharmacy and topical stations. 

Peruvian physician Magaly Padilla efficiently started with the first group of patients, while the rest of us took a little longer to get on our feet. However, once we were oriented to the common patient complaints (including symptoms related to uncontrolled hypertension, diabetes, and chronic intestinal parasite infections), patient chart and routing system (e.g., laboratory, back to clinic, then pharmacy, and dental if needed), and had identified a private room for patient exams, we developed a wonderful consult system that supported each of our weak areas with each of our areas of expertise.

Dr. Magaly’s knowledge of general medicine—and particularly the local universal healthcare (“Seguro Integral de Salud”) benefits and structure—was invaluable to our ability to assist patients as a team. Many patients specifically had orthopedic complaints, for which volunteer Physician Assistant, Tori Franklin, ensured they secured proper exams, diagnoses, and therapies. Theresa and I, as Infectious Disease doctors, were super-enthused to find a number of patients with infections in our wheelhouse, from fungal conditions like eumycetoma (i.e., Madura foot) and tinea corporis (ringworm) to bacterial diseases like ecthyma and impetigo.

The Importance of a Laboratory Technician

While all the field services that Amazon Promise has developed over the years are incredible, on this trip—my first as a fully-fledged Infectious Diseases doctor—the field laboratory was particularly inspiring. Amazon Promise always travels with laboratory technologist Nolberto Tangoa.

I have known him for many years, not just through Amazon Promise, but in his capacity as the head of the laboratory of the San Juan Health Center. He is an excellent laboratory technologist with decades of experience, ranging from microscopy to molecular techniques. Using a light microscope and common stains (e.g., Giemsa), we can do thick and thin blood smears (i.e., to evaluate for malaria), touch preps (i.e., to evaluate for leishmania), wet mounts (i.e., to evaluate for trichomoniasis and bacterial vaginosis), and KOH stains (to evaluate for various fungal diseases).

Nolberto also has rapid tests for Dengue and HIV, and the materials to run point-of-care hemograms, glucose, cholesterol/triglycerides, pregnancy tests, and urinalysis. We utilized his skills to the maximum to rule in and out a variety of infections, allowing us to treat our patients with proper directed or empiric antimicrobial therapy. I can’t emphasize enough how extraordinary it is to work remotely with these kinds of laboratory and pharmacy resources.

Remembering a Snake Bite

Towards the end of the clinic day, we met Jose da Silva and his wife, who brought us their newborn for a well-child check. All ten of their children, ranging in age from 11 days to 18 years, were born at home without medical assistance. Mother and baby were doing great.

Dr. Eva Clark examining Jose’s leg, 12 years post snake bite, May 2024.

Jose entertained us with the story of his first encounter with Amazon Promise, about 12 years ago, after being bitten on the lower leg by a “jergon” (the local name for a fer-de-lance (Bothrops atrox), a venomous pit viper species found in Central and South America). After he was carried from the riverbank to the village where the team had set up clinic, he was administered anti-venom and pain medications and cared for throughout the night. He was immediately transported to Iquitos at the break of dawn.

After a four-hour boat ride to the port town of Nauta, an ambulance then drove him two hours to the city where he was admitted to the Iquitos Hospital.  He remained interned there for two weeks and ended up needing a fasciotomy surgical procedure where the leg was cut open to relieve severe swelling and allow for normal circulation. Amazon Promise staff supported him during the months it took him to recover. He subsequently returned to Buenos Aires and resumed his daily activities, with full use of his leg.

Each night after returning to our base camp the team met up for dinner and debriefed on the day’s activities.

Second Stop: 20 de Enero

The next morning, we traveled about 20 minutes by boat to the larger village of 20 de Enero (yes, that is the village’s name). While generally the healthcare problems of people living in this village were like those we had encountered in Buenos Aires, we found a relatively large number of villagers with cataracts and pterygiums, a benign growth of the conjunctivae also known as “surfer’s eye.”

Elsa Maria is one of several people in need of cataract or pterygium surgery.

The professions of most people living in this area revolve around harvesting an estrogen-packed palm fruit called aguaje and transporting it to Nauta. Thus, many are exposed to significant UV light and other environmental irritants such as dust, wind, sand, and smoke, which can all contribute to pterygium development. Additionally, there may be a genetic predisposition to pterygium, which was brought home to us when we encountered a family of four adults, all with advanced pterygium.

While the best “treatment” for pterygium is to prevent it via use of protective eyewear, once it has developed, most ophthalmologists only recommend surgical removal if the pterygium has grown to encompass more than 50% of the cornea. This was the case in most afflicted villagers who approached us in 20 de Enero, so, in addition to directing them to obtain a referral to an ophthalmologist via the Nauta Health Center, Amazon Promise is working with an Iquitos-based ophthalmologist to plan a group intervention.

The End of the Journey

Before I knew it, the time for tearful farewells had come, and I found myself hauling my muddy boots out of the boat and into a motor-taxi waiting to take me to the Nauta taxi station.

While this brief glimpse into the kaleidoscope of experiences typical of an Amazon Promise trip barely begins to describe the “tip of the iceberg,” as it were, of healthcare needs in this remote part of the world, my hope is that it serves to illustrate the impact that an experienced medical organization can have on the health of a village. While the Peruvian healthcare system works to improve the resources and access to medical care it can offer its people, sustainable medical, dental, optometry, and other healthcare services provided by Amazon Promise are invaluable to supporting the health of the local people.

Returning to the boat.

Little Things That Make a Huge Difference!

Mercedes, 85, and her husband Jose, 88, (left photo) walked to where we were holding clinic using splintery wobbly bamboo branches. When we fit them with sturdy adjustable canes, they both threw the branches to the ground and walked off steady and confident.

Same for Juana (right).

They truly make a difference.

More Images from the May Outreach Trip

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