In August, I participated in a medical mission to Peru. The previous 2 blog posts detailed first impressions and the first half of the trip. This post will entail the local excursion on our free day as well as the remaining 2 days in clinic.
Lake Sandoval
We had a free day! Of the original 40 volunteers only 6 of us remained. We all managed to get on the same excursion. We bonded quickly which is typical with this type of shared experience. In addition to myself, the remaining volunteers included the other 2 nurse practitioners, a pre-med college student, a mother (also named Amy), and her daughter, a high school student paramedic.
Our travel agent arranged for a car to pick us up at the hotel and bring us to downtown Puerto Maldonado. There, our English-speaking guide led us to a covered motorized boat. We traveled via the Madre de Dios River- a vital waterway flowing through southeastern Peru and into Bolivia. Originating in the Andes, the river winds through lush rainforests and supports a diverse range of wildlife, including caymans, capybaras, giant river otters, and many species of fish and birds.
We arrived at the Tambopata National Reserve, where we walked about a mile through the beautiful forest. Our guide pointed out the wildlife and local vegetation. There were monkeys everywhere! There were also many different kinds of birds and butterflies in every color.
At the edge of the forest, we got into a small boat that held about 10 people. Our guide took us through a narrow waterway that led to Lake Sandoval. He did most of the paddling, but we tourists also had paddles to help. The lake was gorgeous. We saw caymans and turtles. We paddled around the lake’s edge where there were too many monkeys to count. They were swinging on vines and having a great time. We had encountered warm weather during the trip but this day was especially hot! There was no shade on the lake, so we were roasting. After an hour, our guide brought us to a picnic area. We were happy to get out of the heat for a few minutes. Our delicious lunch was chicken and rice wrapped in a banana leaf.
At the picnic spot, there was a bathroom, kind of like an outhouse. It was on the land of a local and we had to pay a small amount to use the facilities. I was happy to have a place to go but the toilets didn’t flush and there wasn’t water for hand washing. This trip really allowed me to appreciate the value of reliable plumbing.
After lunch, our guide took us to the other half of the lake. At this point, we were really hot. No one was complaining but we were tired. Then we found a bunch of otter. They had just captured some fish and were enthusiastically having lunch. They were swimming and playing. Despite the heat we all had a great time.
After our tour, we met the new volunteers who had just arrived. There were only 3: another Amy (now there were 3 of us!), who was a paramedic as well as a dentist and his daughter. That day happened to be her 16th birthday, and she was not thrilled to be spending it in the rainforest.
Most of us went to dinner with the new volunteers. Our local host took us to a steakhouse. They were grilling the meat right out front. I had beef kabob with sausage. It came with rice and yucca. I also tried a local beer.
Clinic Day 3
On this day we went to a church in Puerto Maldonado. It was only 10 minutes away. That was so much nicer than the 1-2 hour drives we had taken previously. I was nervous about clinic. For the first 2 days, we cared for almost 200 people a day with an entire team. Now only 3 providers remained. We no longer had a person to run the pharmacy, so we had to dispense our own medications. We also had to collect all urine samples and blood sugars as required.
At first, it took us a while to see our patients. We had to get used to doing everything for ourselves. I saw an older man who had cut himself earlier that day while slicing Yucca. I cleaned out the wound and rewrapped it. I also gave him some antibiotics since it was a dirty wound. In the beginning, he kept talking and talking, not pausing to allow my interpreter to tell me what he was saying. I finally interrupted him and explained in my limited Spanish that I needed my interpreter and to please slow down. In addition to his cut finger, he had a variety of minor complaints. I gave him a few remedies. Then his wife came over. He was worried about her because she was crying a lot. It turned out her grandchild had just died. I asked if she had anyone to talk to or if she went to church. She said she just wanted to be left alone. Then her husband told me he was afraid to leave her unattended because she was becoming confused. I asked our team leader to connect her with community resources. I felt bad that there was nothing I could do for her. I still feel like I could have done better.
I saw many families. There was an 11-year-old girl with Down Syndrome. She had heart surgery as a baby but had never followed up with the cardiologist. The father was able to describe a previous heart murmur and was wondering if she still had it. Her exam and heart sounds were normal which was a good sign. I still encouraged him to have a follow-up with the cardiologist. She also had significant vitiligo which is a lack of pigmentation, caused by an autoimmune disorder. She had seen a specialist who recommended laser treatment, but the family couldn’t afford it. I gave them some cream but it probably wasn’t strong enough to help.
Many people showed up for care including several Haitian refugees. I had not realized that Peru was a key destination for refugees due to its relatively open immigration policies within South America. By 11 AM, our leader closed registration, because he knew it would take the rest of the day to see all the clients. The patients were different from those we had seen previously. We were now in the city and many people had already seen medical providers in Puerto Maldonado or Cusco. They had lab results, x-rays and even endoscopy results. Some wanted our opinions. Others requested specific drugs. One woman asked for Percocet. I explained that we did not have Percocet, but I would be happy to give her some Tylenol. Many times the medications needed were available at the local pharmacy, but the residents couldn’t afford them. We were able to supply a 2-week supply of some things.
Clinic day 3 was extra special because it was my birthday! I wasn’t going to tell anyone but I’m a Leo! I love birthday attention. The clinic day went like any normal day. That night during our debrief, our team leader got us cake. We also celebrated the young girl whose birthday was the day before. She didn’t like the attention but I did! Several of the group came out for a drink to celebrate. I tried a local drink made with Pisco, a Peruvian liquor with a tequila-like taste. This drink was mixed with fruit juice and was delicious.
Clinic Day 4
The last day of our mission was unique. Our clinic site was similar to a nursing home. The residents had some access to medical care but mostly just needed attention. I didn’t feel a lot of pressure. I just did my best to listen and give everyone a mini-exam. Unfortunately, most people had chronic conditions. I couldn’t help them. However, one man was younger than the rest. He was the caretaker for the facility. He said his shoulder was causing him pain and interfering with his ability to do the gardening. I had just learned to do a shoulder injection. I felt I could do it but wanted the more experienced practitioner to watch me. She talked me through the injection and the man experienced immediate relief of his pain.
After clinic, we returned to our hotel to inventory and repack supplies. Doing inventory is one of my least favorite things. It takes forever and is extremely tedious. However, it was important for the next group to have appropriate supplies. Overall, I feel glad to have participated in this mission. While I couldn’t treat many conditions, I was able to give extra attention to people in need. It helped to realign my goals and changed my perspective. I feel I will be better able to care for clients in my own clinic.
The next day, most of us went our separate ways. I was meeting my family in Cusco. The other nurse practitioners were also going to Cusco and we ended up on one of the same tours. Stay tuned for part 4 of the series which will talk about our adventures in Cusco.