Health and Needs Survey: Pictures, Patients, and Parasites!

Health Survey in La Libertad

During the last week in January, 2016, we were grateful to have two volunteers work with us in the village.  Fernanda was from Brazil and Rebecca was from the USA.  They both helped us to collect health, occupation, and needs data.

A pan for toasting yucca to make farina

Fernanda is a fourth-year med student.  Rebecca is a business consultant.  They arrived in Leticia on the same day.  While in Leticia they stayed in the local hostels Alas Excusiones and Residencia Marina, both located less than a five minute walk from the project's office/apartment.

Wagner with the mixing spoon.  Richard in the background with his kids.

We went to each house in the village and spoke with the people.  We asked questions about their illnesses and overall health concerns.  Almost everyone in the village was receptive to speaking with us.  Some people talked much more readily, others answered with only yes/no.

Wagner, the man in the pictures with a white and red striped shirt, is the health promoter for the village.  He has had advanced first aid classes, communicable disease classes, training for snake bites and insect stings, and practice stitching up wounds.  He is responsible for seeing that the people of the village follow healthy practices.

Carmen with her father and little brother

We noticed that the people were not always able to easily express their health conditions to us.  For example, when asked if they had parasites about half the families replied that they did not.  Upon further questioning we asked if they had frequent stomach pain, diarrhea, vomiting, or other gastrointestinal issues, to which they responded, "yes", that they had at least one, and in some case all of these symptoms.  All of these symptoms are frequently caused by parasites.  One house, when asked if they had diarrhea exclaimed, "When do we NOT have diarrhea!".

So how accurate is the self-reporting that we recorded?  It is good that we have collected this information.  It would also be good (for the next volunteers possibly?) to compare the data we collected with the health data that the government's Secretary of Health has, or with their health provider insurance agency.

The villagers do have free, state provided health care.  However, they frequently do not have the money or ability to do into the city (a three hour boat ride) to receive the care.  Even if they do go, they must sometimes wait up to two days before they are seen.  Frequently the treatment given may be sub-standard (one ibuprofen table, one antibiotic tablet, then told to go home).  Given these shortcoming in the medical system, the villagers may wait until their health is so bad that they are dying -before seeking medical care!  During the past four years at least two people in the community have died en-route to the hospital in Leticia.

Carmen with her cousins

Rebecca and Fernanda collected the data over three days, working part-time.  Fernanda then typed the data into a small report, which is found at the end of this post.

Some interesting points are:

• over half of all houses wanted glasses, dental care, or both
• all houses had, we believe, water-borne illnesses
• 50% of the population is under 15 years of age
• 1.5% of the population is over 65 years of age
• 3% of the population has tuberculosis
• an unknown number of villagers have AIDS and/or other sexually transmitted diseases
• malaria and dengue are frequent and ongoing diseases in the village

Making the fermented drink chicha de chantadura

While some parts of this report may paint a dismal picture of the health conditions in the village, while collecting the data we were able to get a glimpse into the daily life of the villagers.  This showed us the closeness of the families, less-hurried pace of their life, and their connections to nature.

While Fernanda collected health data, Rebecca asked about the villagers' work aspirations.  Planting, harvesting, and processing yucca (cassava) was one of the most common business desires.  Fishing, increased tourism, and planting other crops was also common.  When the idea of growing and processing cacao was brought up, 96% of the houses wanted to go into the chocolate business.

  Basically, everyone wanted to do everything for employment!

Learning jungle skills!

Fernanda and Rebecca also had time to speak with the villagers informally and try their hand at weaving the palm leaves to make a thatched roof.

We are also very thankful to Fernanda and Rebecca for helping the most ill of La Libertad to access health services in Leticia.  After collecting the health data they organized and led a trip to Leticia, spoke with the insurance providers and the clinics in order to help the people receive the services that they desperately needed.

Here is the full health report...

This health data is self-reported. and therefore subject to error.  But this info may be used to give some idea of the villager's health, may be compared to government-collected data, and may help in the design of future health studies in La Libertad.  In other words -a great start and more research is needed!

COLLECTION OF DATA - LA LIBERTAD, January 24 - 26, 2016

"Children" and "girls" are always people <15 years

"Women" and "men" are always people> 15 years

The house numbers described here might not correspond exactly to the village map.

HOUSE 48

- 8 persons: 3 girls, 3 children, 1 woman, 1 man

- Diseases in the past year: flu, parasitic worm infection

- Water: Rain untreated

- Bathroom: no

- Win: glasses

HOUSE 47

- 8 persons: 3 boys, 3 girls, 1 female, 1 male

- Diseases in the past year: parasitic worm infection

• 3 days ago 1 child has a fever (39.1 C), diarrhea, vomiting - no medication; parents are boiling water

- Water: Rain untreated

- Bathroom: no

- Win: glasses

* Many people have eye complaints. From what I have observed many "pterygium" (medical heat in Portuguese; do not know the word in Spanish)

HOUSE 46

- 8 persons: 3 boys, 2 girls, 2 women, 1 man

- Diseases in the past year: parasitic worm infection, flu

- Water: Rain untreated

- Bathroom: yes

- Win: glasses, dentist (have dental infections)

HOUSE 45

- 7 persons: 3 boys, 2 girls, 1 female, 1 male

- Diseases in the past year: diarrhea, parasitic worm infection, flu

- Water: Rain untreated

- Bathroom: no

- Forward: -

HOUSE 44

- 10 people: 2 boys, 2 girls, 4 women, 4 men

- Diseases in the past year:

• currently one woman has inflammatory signals in the left eye; 1 child has "bumps" (medical heat in Portuguese é s, not the word é s ENGLISH) on her forehead; 1 women also "Pterygium" (medical heat in Portuguese é s, not the word é s ENGLISH) in both eyes

- Water: Rain untreated

- Bathroom: no

- Win: glasses

HOUSE 43

- 6: 1 child, 3 girls, 1 female, 1 male

- Diseases in the past year: diarrhea

• now the child is 9 months with diarrhea two weeks ago; It is visibly dehydrated. She was  given re-hydration fluid (1 liter of boiled water + 4 tablespoons sugar + 1 teaspoon of salt), but he needs a doctor

- Water: Rain untreated

- Bathroom: no

- Forward / problems: children have bumps on forehead

HOUSE 42

- 8 people 5 children, 1 girl, 1 female, 1 male

- Diseases in the past year: diarrhea, parasitic worm infection, flu

- Water: Rain untreated

- Bathroom: no

- Wanted: dentist

HOUSE 41

- 11 people: 4 children, 2 girls, 3 women, 2 men

- Diseases in the past year: parasitic worm infection;

• currently one child has colic pains diffuse type at the abdomen

- Water: Rain untreated

- Bathroom: no

- Win: glasses

HOUSE 40

- 8 persons: 2 boys, 2 girls, 2 women, 2 men

- Diseases in the past year: -

- Water: Rain boiled or chlorinated

- Bathroom: no

- Win: glasses

* Stories: 6 cases of tuberculosis in the community; frequent sexually transmitted diseases, particularly gonorrhea; there are also cases of dengue and malaria

HOUSE 39

- 10 people: 4 boys, 3 girls, 2 women, 1 man

- Diseases in the past year:

• currently 1 female of 58 years has undiagnosed illness - progressive muscle weakness that box when the prevents walking

- Water: Rain untreated

- Bathroom: no

- Forward: -

HOUSE 38

- 8 persons: 2 children, 4 girls, 1 female, 1 male

- Diseases in the past year: flu

- Water: boiled rainwater

- Bathroom: no

- Forward: -

* To talk to teachers, they complained of problems with your vision; also claim that doctors give away the same drugs for all patients, as amoxicillin, acetaminophen and ibuprofen. I also say that major problems in san school: lack of toilets (without 2 bathrooms for 80 children), lack of books and food.

HOUSE 16

- not present

HOUSE 15

- 6: 1 child, 3 girls, 1 female, 1 male

- Diseases in the past year: diarrhea, parasitic worm infection, flu

- Water: Rain untreated

- Bathroom: no

- Forward / problems would like to have more doctors and medicines; also they told that one of her daughters have eye problems

HOUSE 14

- 5 persons: 2 boys, 2 girls, 1 man

- Diseases in the past year: -

• man complains of pains in the shoulder blade; Five years ago it was performed surgery to repair fractures in his right shoulder blade and ribs

- Water: boiled rainwater

- Bathroom: no

- Forward: -

HOUSE 13

- 6: 3 children, 1 girl, 1 female, 1 male

- Diseases in the past year: -

- Water: Rain untreated

- Bathroom: no

- Forward: -

Casa 12

- 5 persons: 3 girls, 1 female, 1 male

- Diseases in the past year:

• currently one baby has diarrhea, vomiting and other

- Water: Rain untreated

- Bathroom: no

- Forward: -

house 11

- 8 persons: 3 boys, 2 girls, 2 women, 1 man

- Diseases in the past year:

• now a baby has the flu

- Water: Rain untreated

- Bathroom: yes

- Forward / complaints: lack of medical attendance

CASA 10

- 6: 1 child, 2 women, 3 men

- Diseases in the past year: diarrhea, flu

• a man is quasi-blind; 15 years ago it was made cataract surgery

- Water: Rain untreated

- Bathroom: no

- Forward: -

House 9

- 11 people: 2 children, 4 girls, 2 women, 3 men

- Diseases in the past year: parasitic worm infection

• 1 week ago a baby presents coughs; he also has "pimples" on his forehead

- Water: Rain untreated

- Bathroom: no

- Forward: -

House 8

- Nobody home

House 7

- 4 people: 1 woman, 3 men

- Diseases in the past year:

• the woman complains of always being "dizzy" and also says not see well

- Water: Rain untreated

- Bathroom: no

- Forward: -

HOUSE 27

- 8 persons: 2 boys, 2 girls, 2 women, 2 men

- Diseases in the past year:

• a woman complains of pain in lower abdomen three weeks ago; menstruation is with more color black; 7 years was performed surgery "tubal ligation" (medical heat in Portuguese é s, not the word é s ENGLISH)

- Water: boiled rainwater

- Bathroom: no

- Forward: -

HOUSE 26

- 5 persons: 3 children, 1 woman, 1 man

- Diseases in the past year: flu, diarrhea

- Water: boiled rainwater

- Bathroom: no

- Forward: -

HOUSE 25

- 7 persons: 3 children, 1 girl, 1 female, 2 males

- Diseases in the past year:

• 3 days ago the woman has a fever, headache, body aches and weakness hair; on the last night she had 2 episodes of vomiting

- Water: Rain untreated

- Bathroom: no

- Forward: -

HOUSE 18

- 8 persons: 4 children, 2 girls, 1 female, 1 male

- Diseases in the past year: diarrhea, flu

- Water: boiled rainwater

- Bathroom: no

- Wanted: dentist

HOUSE 19

- 2 persons: 1 female, 1 male

- Diseases in the past year: flu

• the woman is blind 1 year; It was also treated tuberculosis two years ago

- Water: boiled rainwater

- Bathroom: no

- Forward: -

HOUSE 2

- 12 people: 3 boys, 3 girls, 3 women, 3 men

- Diseases in the past year: flu

- Water: Rain untreated

- Bathroom: yes

- Forward / problems: "irritation" of the skin

HOUSE 30

- 5 persons: 2 children, 1 woman, 2 men

- Diseases in the past year: diarrhea

- Water: boiled rain

- Bathroom: no

- Forward / problems: glasses

HOUSE 31

- Nobody home

HOUSE 32

- Nobody home

Total c bag with residents	30
Total people (so far) Total persons <15 ng os Total persons> 15 ng os Total persons> 65 ng os	190 106 84 3
Diseases (home) flu 12 Diarrhea 11 INFECTION or n parasitic worm 8

Instructions for Buying a Speed Boat ticket from Leticia to La Libertad

(This is a guide for volunteers who need to travel to La Libertad.  Rebecca, a current volunteer, and I made it today.  This explains some of the steps that must be followed to get a boat!)

Instructions for Buying a Speed Boat ticket from Leticia to La Libertad

To get to La Libertad you must take a speed boat (barco rapido) up the river.  A speed boat (1 hour ride) to the village cost about $18,000COP one way.  The speed boat departure times may be at 8am, 10am, and 1:30pm (the times change).  You must purchase the tickets well before departure time, at least 1 hour before as they sometimes sell out quickly.  You must also arrive at the boat dock at least 30 minutes before departure time.

Ticket Offices

Perhaps the easiest way to find the “barco rapido” is to go to the Port of Leticia and ask where the barco rapido may be found.  Almost any resident or police person will know where to find it.

Go all the way down Calle 8 to the port.  When you cannot go any further, take a left and go all the way down to the almost the end of this road.  Then enter the building complex to the left of the street.  This will put you in the general location of the ticket offices.  During the dry season the ticket office is found in this building complex.  The complex is on the river side of the Parque Orellana (by the RED arrow on the map). 

Three different companies share the “barco rapido” transportation business on this section of the Amazon.  The companies are named Lineas Amazonas, Transporte Amazonicas, and Tres Fronteras (last name may be incorrect).  All three businesses are located in the same area of the building, all have clear signs.  Passengers must ask at any one of the businesses who is running the boat for the day that travel is wanted.  A name and passport or document number is required at the time of booking.  A ticket may be purchased a day in advance for an extra fee of 10,000 pesos.

Alternative Office Location

One-half hour before the scheduled boat departure the office moves from the building to the raft from which the boat departs.  This raft is found floating in the river at the port of Leticia.  Its general location is indicated by the YELLOW arrow on the map.

During the rainy season the offices are flooded.  At this time the offices also move to the raft from which the boats operate.  However, not all of the businesses are represented at the raft, only the business which is operating the service for that day.

 

The office building has a roof made of palm leaves

WARNING -the location, times, and prices of the speed boat agency may change.  You must be proactive to secure transportation.  Please be patient and careful.

Our first government grant (and the problems that go with it)!

The Dock/Pier Grant

We have received our first government grant from the Colombian department (state-level government) of Amazonas.   Amazonas is one of 32 Colombian departments.  The grant is being used to repair and improve the village's raft and to build a small cement pier with six steps.  While this may not seem like much, it is a start!

The dock is currently in great need of repair

The Grant

We first applied for the grant (only in the name of the village of La Libertad) in April of 2015.  The application then seemed to be lost in the system.

I resubmitted the paperwork in May, but this time in the name of our newly-registered Colombian Fundacion Amazon Pueblo.  This was much more effective.  Within two weeks I had a meeting with the office of International Relations, who have been very friendly and helpful with the grant.

Unfortunately due to paperwork, my five month return to the USA to earn money, and government elections, we received the supplies eight months later, on December 26.  By this time the dock had suffered significant structural rot and damage.

Properly constructed and painted walls help to provide much strength and to protect the dock's structure.  When the repairs and improvements are finished we hope to have a dock that, with minimal adequate ongoing maintenance, will last for at least the next three years before needing major reconstruction.

Loading the project's boat in Leticia

Transport

Problems Finding a Third Boat

In all we had a little under four metric tons of materials to transport upriver.  To do this we needed three boats.  Unfortunately we could only find two boats; one belonging to the project and the other belonging to the community of La Libertad.  Other people said that we could borrow their boat, but on a different day.

We were also faced with problems of finding other people to pilot the boat.  One woman, who refused to help when asked, said "Who wants to work for free?"  I briefly went into the explanation that this was to support the community, it was volunteer work, and that we would pay for the gasoline, oil, and for lunch for the volunteers.  I continued to explain that all the other volunteers who previously built the raft also worked for free.  She responded with silence.

Two days after our first trip we returned to Leticia with the community's boat for another load of materials.

Trip Number 2
During the second trip we carried mostly gravel, which is unavailable around the village of La Libertad.  The gravel is needed to make the concrete for the steps and a small pier/platform.  Currently the steps up the hill are cut from mud and clay, with wooden boards set at some locations.  These are difficult to use when the weather is dry.  After rain the steps are almost impossible to use without falling.

 

We are pulling out of the port of Leticia in route to La Libertad

Hector did not have his rain coat, but he did have a plastic bag!

The trip from Leticia to La Libertad normally takes a little over two hours in the project's boat.  However, the village's boat is larger, heavier, and has a 9 hp motor compared to the project's 13 hp motor.  Both boats were heavily loaded.  Because of this the trip upriver took a little over four hours.

The best time to travel on the river is during overcast days.  It is also enjoyable on a sunny day, but the heat can become exhausting, helps to cause dehydration, and sunburn is common.  We usually try to leave the village slightly before sunup.  And when traveling upriver from Leticia it is best to leave before noon. 

During the afternoon there is a greater chance of rain and thunder storms.

Many floating branches and trees make river travel hazardous

We entered the rainy season two month ago.  Since then the river has risen about 12 feet.  After major rain the branches and trees that have fallen by the river side are swept downstream.  Sometimes we had to avoid a 75 foot tree that is slowly making its way to the Atlantic.  If we hit one of the larger obstructions we risk breaking the propeller, or even worse, capsizing the boat.  When a boat capsizes the boat motor is frequently lost on the bottom of the slit-laden waters.

A former cocaine lab 10 kilometers downriver from La Libertad

Site-Seeing on the River 

While traveling on the river many interesting sites are passed.  Huge hotel resorts, new and old rafts, speed boats, and large oil tankers and barges or small one-person dugout canoes may be viewed.  One of my favorite landmarks is the ruins of a cocaine processing laboratory.  Some members of the village worked there when the drug trade was at its strongest, about 20 years ago.  Since then the Colombian side of the river has maintained greater lawfulness and has greatly reduce the presence of the illegal drug industry.

 

Paddling away!

We picked up travelers upriver.  They helped to pilot the boat.

20 gallons of gasoline.

Workers and watchers

The Arrival

We arrived at the village of La Libertad a little after 4:30 pm.  We were greeted by the representatives of the governor's office of International Relations.  They had arrived earlier on the speed boat with additional supplies and food for a cookout to celebrate the start of the raft and steps construction.  After briefly talking with the representatives, their speed boat arrived and they returned to Leticia.

At the top of the river back a small crowd of children and men were onlooking.  The children quickly arrived and volunteered to help carry supplies to the project's storage house.  The men continued to look on.

Our First Major Problem in the Village

We are now in the phase of the raft and pier building were the village must do their part for the project.  It is Amazon Pueblo's responsibility to help the village chief and member to apply for and manage the grant and project.  It is the government's responsibility to supply the promised materials, and it is the villager's responsibility to supply the labor needed to use the materials to complete the project.

Rumors

There have been rumors in the village that the chief and the Amazon Pueblo project are stealing money from the government and splitting it.  It has been gossiped that we are receiving a large amount of money to complete the dock, pier, and stairs.  These rumors are being spread by people who are not helping with the work of the project.  If I may be so bold to say, they are actually working against the goals of the project.

I have addressed these rumors in the past, but they continue to be spoken.  I am now going to address the people who are spreading the rumors personally and bring them the copies of the grant request, along with the receipts from the government, and the project's accounting records of 2015 and the beginning of 2016.  As these people are accusing me of corruption (a crime) without proof, they are in violation of the Colombian slander laws.

These same types of problems relating to government grants, corruption, and mismanagement of funds has plagued previous leaders of the village.  This is one of the reasons the village has no water system, bathroom or sanitation system, and almost no improved walkways other than dirt path that turn to thick, stinking mud with the rain and hot, humid climate.

Solution

However, the difference between the chiefs of the past and the Amazon Pueblo project is that we have the accounting records and receipts to give proof that we are not embezzling the funds.  The current and past chiefs have not had adequate accounting systems to be able to dispel the rumors.

One of the changes that we hope to implement is to teach the chief and the leaders of the village to follow good accounting practice.  They must be able to keep accurate records, implement financial controls to reduce the temptation of embezzlement, and to be able to answer to the charges of stealing money with proof that is indisputable.

We also plan to help the village to determine when and how to report possible instances of theft, corruption, and other crimes, as well as how to avoid the charges of slander.  We basically need to help the village to develop civility, civil society, and social justice.

The Concrete Steps

These steps are being built in the port of Leticia.  Our plans are very similar, but with much fewer steps.

Example

The picture of the steps above is an example of what we want to build on the riverbank of La Libertad.  The wood is used as forms to pour the concrete.  After the concrete has had time to dry and cure (at least 28 days), the wood is removed.

The Work

These steps are going to take a lot of work, some of which may be difficult to complete, considering very few people in the village have experience with concrete.

1. Find and bring 2 cubic meters of sand to the pier area
2. Find and cut the wood to build the forms
3. Build the forms
4. Prepare and set the rebar
5. Mix and pour the cement
6. Remove the molds

Unloading the building materials at sunset.  Luckily we arrived before dark.

What We Have Learned from Our First Colombian Grant

1. Plan for the grant to take many months to be realized.
2. Determine exactly who, in a written document, will be doing the village's contribution of manual labor.  If no one is identified as village volunteer workers, the grant will not go forward.
3. Have a better plan for communication with the office of the Colombian government.  Write out the expectations for both sides, the government's and Amazon Pueblo's, clearly in an official document.  Goals and strategies should be established.
4. Have a meeting with all involved sides to work out the logistics of the grant at least two weeks before receiving money or materials.
5. Have a clear system of signed receipts for goods or money received.
6. Establish an evaluation program for the grant.  The evaluation should directly relate to the goals and strategies agreed upon previously.