Saturday, August 29, 2015

Healthcare in the Village: Piranha attack, insect bites, teeth, parasites, and tragic loss

This is the second post this year about the healthcare in the village.  For the first part, please click here.

Today's blog post is about some of the things that I experienced over the past few months since my first healthcare report.  However, I will not mention Dengue Fever, Malaria, Tuberculosis, STDs, heart disease, cancer, alcoholism, or drug addiction; all of which are experienced by the villagers.  I will save these issues for another day.

While reading this report, please do not think that the villagers' lives are filled with constant misery.  The children do not know that they live in poverty, because they have no knowledge of the things we take for granted, such as a shower or a toilet in your home.  The adults have, more or less, accepted the things that they do and do not have.  They long for comfort (as do we all) but are content to live in the jungle and happy to be with their families.  I see more laughter and smiles in the village than I have ever seen when shopping in a store or eating at a restaurant in my comparatively wealthy home country.

Additionally, these reports are among the worst of what I have personally seen during my last eight months of time in the village.  Most families experienced nothing worse that lice over that time.  And the people that have followed the project's advice for cleanliness in the house, good bathroom and hand washing habits, and treatment of infections have a noticed improvement in their health.  Gustavo's family, our neighbor, is an excellent example of this.

Piranha Bite

Patricia and her two sons with our medical supplies
It was a hot afternoon.  Two of the village children burst into the kitchen while I was painting the wall a vibrant green.  They said that Patricia had been bitten by a piranha and was bleeding badly from her hand.  I ran up to the guesthouse and grabbed our medical supplies, then walked quickly to her neighboring house.

She had been cleaning the fish her husband had just caught.  One was a large black piranha.  It was not yet dead.  When she started to gut it, the piranha spun around and sank its teeth into her hand.  Patricia, thinking quickly, placed her hand against the side of the boat, while her husband quickly wielded a small club and hit the fish on the head. I learned to NEVER pull on a piranha that has attached itself to the skin.  The result would cause the flesh to be sheared off and removed with the fish.

The bite
After getting the fish off her hand the wound bled profusely.  However, this was better than only a little bleeding, as the generous blood flow helped to clean the wound.

When the bleeding stopped I cleaned the wound further with an iodine solution and dressed it.  I also gave her some antibiotics to take.  I checked back with her on the following days.  Her hand was healing well.

Infected Bug Bites (sometimes with worms as an added bonus)

The two mystery bites after the first round of draining
I woke up one morning and found that two of my bug bites, of which I had at least 20, were a bit more swollen usual.  I watched them grow until they were of an alarming size.  I showed them to my neighbors, who said that they may have worms inside, slowly eating my flesh and growing.  I have seen this happening to my friend's two pet dogs, so I knew they must be treated.

Pelacho and Cani the dogs

The dogs had small flies bite them and lay eggs beneath their skin.  The eggs hatched into worms and started to feed on blood and tissue beneath the skin.  As the worms grew they became more noticeable.  If carefully watched the worms could be seen to move slowly underneath the dogs' skin.  A small breathing hole was found in the skin around each worm.  The usual method of treatment is to place gasoline over the hole.  When the worm comes up to breath, it may be grabbed with the fingers.  The worm fights being pulled out, but usually may be removed.  If left in the body the worm will turn into a small fly, then emerge to start the cycle again.

Edison treating the bite with nicotine (an insecticide) from a tobacco cigarette
An alternative is to smoke some tobacco and use the nicotine-containing resin from the cigarette to cover breathing hole.  Nicotine is an insecticide.  This slows down the worm when it comes to the breathing hole, making it much easier to pull out.

Searching for the worm
I opted for the nicotine treatment instead of the gasoline.  After keeping the nicotine on the insect's breathing hole for 10 minutes, my neighbor pierced the swollen bite to try and remove a worm, but none were found.  It was a simple infected bite.  I started a course of antibiotics.  My hand healed well, with only two slight skin discolorations over the bites to indicate anything had ever happened.

I am very happy to be parasite-free

Dental Care
In June, 2015 a dentist from Canada came to the village to do dental exams and judge the needs of the villagers.  About 80% of the villagers had cavities.  Some of the people, both old and young, had extensive dental disease.  Out of the 100 people viewed, at least 10 were evaluated as requiring dental extractions -and in many cases multiple ones.  These dental problems may have come from a combination of sugary and starch foods coupled with poor, or no, flossing and brushing.  We discussed the importance of good oral hygiene and how it can influence health.

Over three-quarters of all villagers have rotted teeth
About 10 people in the village suffer with eye disorders.  Many of these go untreated.  An uncounted number of people over 50 years old need reading glasses.

Gustavo, pictured below, has frequent eye pain.  This is especially bothersome for him when he needs to navigate on the river.  At times, his eyes become bloodshot, dry, and his vision blurry.  He is not sure how long he can keep working if the condition worsens.

Gustavo suffers with eye pain, especially during river travel

This woman has, I believe, a cataract.  If this is correct, then it may be easily treated.  If any eye care professionals are interested in helping, they are greatly needed.

A cataract???
Mystery Infection
The three year old boy pictured below was brought to us during the dental exams.  His upper leg was swollen, tender in the center of the swelling, slightly red, and painful.  It looked like an infection to our dentist, our photographer, and me.  This condition had lasted two weeks.  He had trouble walking and needed to be carried up the hill to our meeting place.  His father said that he was brought to the clinic in the city of Leticia (50 km away) one week earlier, and had only been given a pill, then send away.  It had cost his parents a day of work and two more days of pay to bring him to the clinic.  They wanted to know if we could help.  We offered to help take him back to the clinic and insist that he be given proper care.  We even offered to pay the parent's transportation costs to leave the following morning.

The next morning came and we were ready to take the boy and one of his parents to the clinic.  They did not arrive at the dock at 8 am, as agreed.  There had been a party in the family's neighborhood the night before.  His parents had stayed up very late.  After going to his house and waking the father, he said that his son's leg had improved, and that he no longer needed to go.  I and the two volunteers with me felt very frustrated.  We left La Libertad that day, and then I returned to the United States.  I will investigate what happened to the boy when I go back to La Libertad in six weeks.

Boy with a swollen leg
Intestinal Parasites
No discussion of healthcare in the Amazon would be complete without a discussion of intestinal parasites.  While I have not tested the entire village, I believe 100% of the people have multiple intestinal parasites.  Upon returning home to Maine two years ago I tested positive for five different types.  These included cryptosporidium, blastocystis hominis, giardia, and other two others I cannot remember.  I now have the most sanitary kitchen and the most purified drinking water in the village.

Girl with a swollen (roundworms) belly
The majority of the young children have swollen stomachs due to intestinal parasites.  These parasites include the ones I mentioned before, but they also have Ascaris lumbricoides, the giant roundworm.  This is the most common worm infection in humans in the world.  The worms are between 7 and 15 inches in length.  A female can produce up to 200,000 eggs per day.  The eggs are passed out of the body with the feces. After excretion the eggs may live in the soil for up to two years under the correct conditions.  When the eggs are stepped on, they may attach to the skin and then passed to the hands, and afterwards to the mouth.  They may also spread by contaminated water.  Out of the 26 houses in the village, only two have toilets.  All the other houses practice open defecation; usually within 10 yards of their homes.

With time the people of the village adapt to their parasitic infections.  Only the very young, very old, or the sick are really bothered by them.  It takes years to build up a tolerance.

Orley the boy with Cani the dog (and both with roundworms)
The boy above was given anti-parasite drugs by a state-sponsored healthcare work who gave the medications on a visit through the village.  They visit every two to three months.  Two hours after taking the medications the boy started vomiting worms.  The medication is not always popular with the children.

Our med kit
Tragic Death
I arrived in the village during the mid-afternoon.  We had traveled upriver in the boat belonging to the project, a small but river-worthy, seven meter covered craft.  The trip had been uneventful, but the wind and waves were a bit on the high side.

The Viejo Bravo

While walking down the path to the guesthouse I saw a small crowd of people gathered in front of our neighbor's house.  I greeted Wagner, one of the supports of the project.  He told me that our neighbor's 9 year old son, Fermil, had been lost in the river earlier in the day.

The boy almost always accompanied his father on trips to help and to provide companionship.  Fermil's father had been transporting food and handcrafts from the Colombian side of the river to the Peruvian side.  His boat was small, had low sides, and was overloaded.  They had no life preservers.  The waves broke over the side of the boat, it flooded and capsized.  The undertow currents caught the boy and pulled him under.  His father was unable to find him.

Fermil was one of the nicest kids in the village.  He always came to the shore to help us carry supplies from the boat to our cabin.  He played well with the other children, helped his mother around the house, and was always friendly and willing to talk or lend a hand.  He also came to every English lesson offered by our volunteer Sarah, who said he was one of her best students.  He will be missed.

This story relates to healthcare in the area of preventable death.  With proper forethought, with care during life's activities, tragedies such as this one may be avoided.

Sarah with Fermil and his sisters.  He was one of our best English students.

The Future
We try to help.  We are currently making contacts with other organizations in the Amazon, raising funds, organizing volunteers, and developing our program to provide effective services.

Some of our goals for 2015:
  • raise $6,000 by September 30
  • drill a well and build one bathroom for every two houses
  • start raising funds for a safe boat and motor for project/village use with life preservers
  • make advances in sustainable business, healthcare, and education.  
Our website has more details.

After reading this post my aunt commented, "Why would any person want to volunteer in the village after reading this?".   Visiting the village is not for everyone.  We have had 14 volunteers spend a combined time of 15 months in La Libertad.  The biggest complaint is the bug bites, from which only I have had an infection.  We have had one other volunteer contract intestinal parasites after visiting Colombia.  However she spent one month traveling in other parts of the country (in parts also known for parasites), and only three days in the village.

We have learned over the past three years of time in La Libertad the best ways to store food, disinfect surfaces, treat skin infections, wash clothing, avoid insect bites, and to stay healthy.  We hope to pass along this knowledge to the members of the community for their benefit.

Would you like to help? Please visit How to Help

Thank you to Beki Henderson, Crystal Angulo, and Sarah Blackman whose photos helped to make this post possible. 

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