A Medical Student's Perspective
by Eva Clark
Peru is seductive. Whether because of its wonderful people, its troubling development problems, its natural wonders, or some other un-pin-pointable aspect, people who travel there once usually can't suppress the desire to return. As an MD/PhD student, I don't have a whole lot of time. However, you make time for what you love, and after having the opportunity to accompany a friend on a medical mission in the Amazon region of Peru, I was hooked and thirsty for more. While finishing my second year of medical school, I began to look for another excuse to return to Iquitos. I happened on the Amazon Promise website, and after discovering that their summer medical student internship fell within the only time period I had available, I immediately applied and began to look for ways to raise money. On paper, the internship seemed like it was made for me: free medical clinics, the jungle, learning new skills, meeting other crazy people, and IQUITOS...I couldn't wait. I was also excited about working with Amazon Promise when I learned about the HIV-prevention program they were implementing for our trip. I had worked in several labs that study HIV in the past, as well as an HIV clinic in Zambia (where the prevalence of HIV is up to 25%), thus I was very interested in helping to prevent a sub-Saharan Africa-like scenario in a country that HIV had attacked relatively recently.
For the next
several months I saved as much money as I could, but when I received an
email about the Woffington Scholarship I jumped at the opportunity. I
became the recipient of that extremely kind donor's generosity. The
Woffington Scholarship gave me the opportunity to hone my clinical skills
while experiencing first-hand the challenges of providing health care in a
third world setting. In July
2006, I was off to Peru. The trip was absolutely amazing. I met some
of the most kind, interesting, and, well, crazy people who I have ever
encountered, and these acquaintances quickly turned into friendships that
remain strong today. I learned more than I could have imagined
possible about the challenges and rewards of providing health care in a
developing country, from the Peruvian and Western medical professionals
that made up our team, and particularly from our patients in Iquitos and
its surrounding jungle villages. I was especially excited to work
with Elena Deem, as she tested and educated the members of each community
about the dangers of HIV/AIDS.
There are two patients I saw who were the most memorable for me. The first was a young boy with extremely bad psoriasis. His mother brought him to our free clinic in Belén, the most impoverished district of Iquitos. He was very small and skinny for his age, and his entire body was covered in white scaly skin lesions, most of which had been scraped or broken down into bloody sores. I was horrified when I saw him, not because of the way he looked, but because he had clearly gone for so long without medical care. It was decided that the best course of action would be to put him on steroid/anti-inflammatory drugs and to show the mother exactly how to wash him with a special kind of soap. I was chosen to demonstrate the latter, and in order to obtain some semblance of privacy, the three of us were escorted to a nearby police station/wood mill, which boasted a "bathroom" in the back. This little room turned out to be a very narrow area covered in wet wood shavings and reeking of decaying waste. With a plastic tub and a bar of soap, I hastily set to work in order to make the job as quick and painless as possible. However, despite the heat of the day the water was chilly, and in an effort to demonstrate proper bathing technique to his mother, we had to expose the boy's shivering little body to most of the room, including the off-duty police officers who had gathered around to watch. It broke my heart to have to scrub all of his sores. Eventually we got him rinsed and dried with soft towels. We gave his mother soap and medicine. I had her repeat all of the treatment instructions back to us. Although she seemed to understand, we can only hope that the boy is able to recover living in an environment where clean water is difficult to obtain and good soap and medicine are scarce.
The second patient who has stuck very clearly in my mind was a little old lady who came to us while I was working beside Dr. Victor in a jungle village. She had a large growth on her nose that had denuded her right nostril. Thinking it was an advanced basal cell carcinoma, we gathered around her to examine her since that kind of thing is rarely seen in the US anymore. Once we began taking her history, however, we found that her chief symptoms were coughing, bloody sputum, night sweats, and weight loss...even to a lowly medical student, those symptoms screamed "tuberculosis"! Upon further questioning we discovered that she had been diagnosed with TB several months before, but she was unable to finish the treatment course because the clinic where she received observed therapy was far away and expensive to travel to. We immediately requested that all of the members of her household be brought to us, which turned out to be several children and a very skinny young man (her son). Sure enough, all of them were symptomatic, and her son additionally had some other interesting symptoms. Not only was he very thin, but he had a wide-spread fungal infection covering his back as well as other "opportunistic" infections that led us to believe that he could have HIV/AIDS. By this point several team members had joined Victor and me. We eventually gave masks to the entire family and then arranged for them to stay for free in the nearby village where DOTS TB therapy was available until they had completed the entire drug regimen. As for the son, Elena, our resident HIV/AIDS educator, took him aside and conducted a comprehensive evaluation and gave him some hard advice about his situation. There is a free drug treatment program at the Regional Hospital in Iquitos, but it can support only a few patients at a time and so the criteria for being in the program is very stringent. By the time I left Peru, the son had been convinced to travel to Iquitos to stay in a home for HIV/AIDS patients until he could get into the treatment program.
We also saved the life of a very ill dog that had been abandoned in the jungle for many months. I'm excited to say that 'Lola' will soon be in the US with my family.
These amazing stories are just some of
the many that have stemmed from the kind hearts and practices of the
members and volunteers of Amazon Promise. My life has been touched
by the opportunity to work with them. The internship solidified
my desire to focus my career on international health, and it ingrained in
me principles that are important to uphold while doing such work. I
am currently mid-way through my graduate work and when I finish, I plan to
do a residency in internal medicine and then a fellowship in infectious
disease. I feel that this path will give me the tools that will be
most useful as I am drawn even closer to a life that follows in the foot
steps of Amazon Promise by helping to bring sustainable healthcare to
those who need it most.
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