Download 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
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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
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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