Amazon Clinic: Healthcare in the Village (life and death)

Andres, the day after hitting a tree limb in the jungle

Andres was playing, running along the side of a jungle pond.  He slipped and a broken tree limb raked up the side of his face, splitting open his cheek and above his eye.  I heard him crying as he was helped, by his many young cousins, back to his house.  I knew it was more serious than the usual falling or upset child event, as even the adults were rushing to see what had happened.  Something about the tone of the crying that alerts them.

Before I could go down to look, Andre's cousin, Stephanie, came running into my house and said Andre's uncle asked if I had some surgical stitches and if I could stitch up his face.  While I did have the stitches for emergencies, I have never applied them to someone.  I did not want my first try to be on a boy's face.

And, after looking more closely at him, he did need stitches.  The wound had split cleanly, and was bleeding freely.  However, due to the tension in his chubby cheeks, the would would not close.  I knew that leaving it open to infection was not a wise choice.  I applied iodine to the wound and advised them to go to a town 30 minutes downriver, by slow boat, where he could receive medical help.

One and a half hours later Andres and his father returned.  The clinic was closed and no one could apply the stitches.  At this time they were starting to become desperate.  He borrowed the suture kit and tried another close village where, it was said, one of the villagers knew how to apply the stitches.  At this time it was nightfall, so a trip to Leticia would be very dangerous on the river.

Three hours after sunset they returned.  Andres was all stitched up.  His picture is from the day after the incident.

This is one example of the healthcare in the village.  The project volunteers have a well-stocked medical kit, which can handle almost anything short of surgery.  Villagers regularly ask for aspirin, antibiotics, or other things.  Mostly I give them advice, bandages, and Tylenol, but never aspirin.  Giving an aspirin to a person who has Dengue fever can complicate the illness.  And Dengue fever is common among the villagers.

One of the most frequent and worst request I receive is for anti-diarrhea pills for babies.  This usually comes after the second of third day of diarrhea.  I do not give the pills, as stopping the diarrhea and keeping the parasitic infection in the baby can be as harmful as the dehydration.  I explain about giving the baby only purified water and food that is not contaminated.  I also have powdered re-hydration mixes that they may try.  My best advice is for them to take the baby to the hospital in Leticia if he or she does not improve.  However, they will only do this at the last moment when it seems eminent that the baby will die.  The trip to Leticia is very expensive for them.

During my last three months of  living in La Libertad three people have died.  One person committed suicide after a fight with his wife.  This incident also involved alcohol.  He left behind his wife and five children.  This was two days before Christmas. The second death involved a 70 year old man.  He had untreated stomach cancer.

The third death was the strangest of the three.  A 30 year old man came down with a weakness on one side of his body.  He continued to loose strength, and weight, over a period of five month.  He received treatment in Bogota, where they found and removed a parasite from his brain.  His health continued to decline, and the doctors could not find the reason.  He was our neighbor, living next to the project's guesthouse.  He died at 1:10 at night, during the middle of a huge thunder and rain storm.  The man left behind a wife and two small children.  One of the children is Andres, the boy mentioned in this story.

A new project boat

We have a new boat!  Our boat was hand-made in Peru, of wood.  It is about 21 feet long and has high sides.  While it is slightly tipsy when getting in and out, it is very stable and rides high when loaded and under power.  We modified it by placing side benches and a roof.  The roof keeps off the worst of the rain and sun.  It is painted in oil-based paint to preserve the wood.  A light-weight, rot-resistant wood was used for its construction.  We hope to get at least three years of use from the boat.

The boat will be used for volunteers, tourism, and to transport villagers when needed.  It seats six people, including the pilot, and a reasonable amount of gear.  It is powered by a 13hp motor (owned by our village supporter Gustavo).  While this is still considered a "slow" boat, when loaded lightly in can make the trip to Leticia in under 2 hours.

Our new boat at the Leticia docks

 Below is our old boat.  The worst problem it faced was severe structural rot.  It also rode low in the water, was not covered, and made with a heavier, less rot-resistant wood.

The old boat now belongs to the village kids

Christmas dinner photos!

Now that I am in Bogota I can upload some pictures.

After boiling and cooling, the chicken is shredded

On December 25 of 2014 the Amazon Pueblo project hosted a dinner for the Children of La Libertad.  The meal was a traditional Colombia favorite, arroz con pollo (chicken and rice).  We also served chicken soup and soda.  I bought the supplies in Leticia the day before, then boated them back to La Libertad with Gustavo.  Five village women helped to prepare the dinner.  We had a good turnout, with over 100 kids attending.  We had enough extra food for the parents as well.

Betty is cooking the chicken soup

The kitchen is a popular place to wait for the meal

Chicken broth soup

The main meal, arroz con pollo

A long line, but everyone waited patiently

Enjoying the meal

I have returned! Visit us in the guesthouse!

After a long time without a blog post I have returned once again.  Much has happened with the project, which I hope to be able to pòst in the coming two weeks.

I am currently in Bogota, so the internet connection is fast enough for use.  During this trip I am going to start the process of officially registering the project as an NGO in Colombia, get more information from the Minstery of the Interior of Colombia on how to register the village as an offical legal entity, and fix a problem with my resident Colombian visa.

I have also moved the office of the project to Leticia, where I will live and teach English while managing the project.  The English teaching will, I hope, provide for my living expenses.  But more on this in a future post.

And now, THE GUESTHOUSE!  I have registered the guesthouse with AirBnB, an internet business that helps people to rent their homes.  I have used their service very sucessfully in Maine, USA, and I hope to also have good luck with it in the village.  When we have spare beds, tourist may rent out the bed in hostel-fashion, or the whole house when available.  Below is a link to our listing.  Check it out and come for a visit!

https://www.airbnb.com.co/rooms/5270758?guests=2&s=_s5V 

A Great Experience in La Libertad

Hi Everyone,

My name is Jeff Sires and I am engineer-in-training from Conway, New Hampshire. I just returned from an incredible trip to the community of La Libertad, where I met with Ben and some of the villagers the Amazon Pueblo Project has been working with. The purpose of my trip was to become acquainted with the community, its people, and to investigate a defunct water filtration system similar to one I worked on for my senior project in civil engineering at the University of New Hampshire. My only regret is that I had just three days to spend in La Libertad.

After completing a project in Peru for Engineers Without Borders, I took a short flight from Lima to the amazon region and Iquitos, Peru. There, I waited one day for the fast boat (barco rapido) that would take me down the Amazon River to the area known as Tres Fronteras -- where Peru, Colombia, and Brazil all come together. The 12 hour boat ride took me through the heart of the Peruvian Amazon to Santa Rosa. After arriving in the late afternoon, I took a short water taxi across the river to the city of Leticia, Colombia where I stayed the night before taking a morning boat to La Libertad.

The barco rapido, which took me from Iquitos, Peru to Santa Rosa, Peru.

The view from Santa Rosa, Peru, looking across the Amazon to Leticia, Colombia.

A view of the village, taken as I was standing next to the guest house facing in the direction of the Amazon River,

Upon arrival to the village, I was met by Ben on the newly finished balsa, or dock, along with a strong rainstorm that made us happy to have shelter for an hour or so. As the rain subsided, Ben and I discussed recently completed projects, future possibilities, and eventually made our way to the guest house where I was impressed to find remarkably comfortable accommodations for such a remote location. I was happy to have my own bunk fitted with bug netting, along with use of kitchen and bathroom behind the house -- both with functioning water systems.

My bed in the guest house.

As the first afternoon went by, I was introduced to some of the neighbors, including Gustavo. Despite relatively basic living conditions and a strong motivation for their improvement, the villagers were very friendly and generally happy. I felt welcomed by everyone, especially Gustavo and his family who live in the house adjacent to the project guest house.

Tired from travel, I fell asleep around 8 PM and woke up early the next morning. I took some time to walk around the site of the water filtration system installed by an NGO several years prior. According to locals, the system had not been functioning for about seven years. It had been designed to use slow sand filtration as means to remove particles and contaminants from the local water source. Many of the components are still in place, but some have been removed and used for other purposes in town. In looking at the system, and with my knowledge of how slow sand filters operate, it appears that the system could be rehabilitated fairly easily. The challenge, though certainly possible, would be to ensure its sustainability through education of local caretakers and the village in general.

Water tanks on a concrete platform, previously used as part of the water filtration system.

For the rest of my time in La Libertad, I helped Ben to work on walkways surrounding the guesthouse, asked as many questions as I could, and practiced my Spanish with Gustavo's son, Hector. In meeting some of the locals, it is clear that there is great motivation for improvement and a wealth of knowledge and commitment to the Amazon Pueblo Project.

Overall, I was very impressed with the work that has been done in the community so far, and excited by the idea of returning to do more myself. Over the next couple of months I hope to apply for funding through grants and other sources to help repair the town's water filter, as well as to send students from the University of New Hampshire (from academic departments such as Engineering, Sustainable Agriculture, Nutrition, Anthropology, etc.) to the village for other potential projects. I will be sure to post updates as these things develop!

I want to thank Ben, the Amazon Pueblo Project, and the community of La Libertad for giving me the opportunity to visit and work with the village. I hope to return soon!

A picture taken from Gustavo's boat on the return trip to Leticia.

Boats arriving at one of the docks in Leticia.

Visit and Stay in the Amazon!

Our guesthouse is finished.  Come and visit us in the Amazon!

The current rate of exchange is $2,400 pesos per US dollar (February, 2015).

Rot in our structures, facilities improvements, and general update.

Eye
I am currently in Leticia. Last week I met with an ophthalmologist from Bogota. She travels to Leticia once a month to treat everyone in the area. The jungle city has very few specialists (and no ophthalmologists). My eye infection is viral, not bacterial. I probably caught it in Bogota, as she said that there is currently an epidemic of viral conjunctivitis in Bogota. My eye has improved greatly, but will not be completely better until one or two more weeks have past.

Getting better

Lights
There is now electricity available in the village! This is provided by a company that has contracted with the Colombian government. They have power from a generator from 3 pm to 9 pm. People use freezers as refrigerators, which works to keep things somewhat cool throughout the day. I am trying to connect power in our structures, but it is a bit difficult. There is about a mile between the generator and the guesthouse. The wiring in the village basically consist of cut and spliced together extension cords running from house to house. At many junctions they did not even use electrical tape, instead wrapping the exposed wires in bits of plastic bag.

The good things with electricity are that we are able to have light during the night, operate and charge small electrical devices, and to one day have a refrigerator. A negative side is that the villagers spend more time watching TVs, sometimes listening to music that is loud enough to hear clearly 500 feet away, and spending less time talking, playing, working, or doing homework.

Our first light bulb!  Hanging to the side of this is Mark's blowgun.

Additionally, watching many TV shows and movies seems to be having an effect on the culture of the villagers. I have been told that as families watch shows were children are disrespectful to parents, the children are less well-behaved. Likewise, the soap operas that feature drama and yelling between spouses has led to more drama and yelling between the husbands and wives of La Libertad. I will not even try to theorize what the influence of consumerism, affluence, sex and violence seen on-screen are having. If there are any sociologists or anthropologists reading this blog (or if our readers know of any), I think this would make an incredibly interesting study.

Connected to the grid and our solar power system.  It may look messy, but it is electrically stable and works well!

Infrastructure
The rot problems were worse than I initially thought. There was more rot in the kitchen, with about 1/3 of the walls and some of the floors needing to be replaced. All of the structures have insects called gorgojos eating the wood, and carpenter ants in some places. I believe the gorgojos are powderpost beetles. The new roof and paint should keep much of the rot from returning. From internet research we believe that the paint will kill the gorgojos (if they are powderpost beetles). With more adequate roofs and paint the external walls should not become as rain-soaked, which will help to reduce rot.

The kitchen wall under the sink.  This rot was unnecessary and was due to a faultily-installed sink angle.

The kitchen floor next to the stove.  This is carpenter ant damage.

We must also reinforce the dock and paint it with a mixture of tar and gasoline as a wood preservative. This is on the list of projects for December. Hopefully we will have volunteers in the village to lend a hand!

Additionally, we are installing a new toilet and giving the old one to Gustavo. We are helping him to build a new bathroom for his family and tourism business. He is using the project’s toilet a lot and not cleaning it often (6 kids and 3 adults are using it).

The 9 feet deep toilet pit.  I have covered it three times and other people keep uncovering it.  Why they keep uncovering it, I don't understand.  Three days ago a four year old girl fell in.  She started crying, but was unhurt.  Luckily they grow the kids tough around here!

Quest for wood
The amount of wood needed to complete the rebuilding exceeded our original wood supply. We went on an expedition to find a tree that would supply the needed boards. The tree had to be of sufficient size, type, and straightness to meet the requirements of the building project. Different species of trees are harvested for different reasons: posts that will be set into the ground; floors; walls; ceilings; handcrafts; or boats.

Oskar, our chainsaw man.  He is a good worker, a founding member of the Christian church in La Libertad, and does not drink.  It is good to have a sober lumberjack with a chainsaw.

Last Wednesday morning we struck off to the forest to find a tree. Oscar, our lumberjack, selected the tree, cut it, and used his chainsaw to mill the trunk into usable lumber. In this case he selected a tree called a mata matar. This tree has white wood when cut, but it turns red after 4 days. It is a very heavy wood, but has excellent strength, rot and insect resistance.

A small group of boys followed us out to the jungle to watch the tree being cut.

As long as the insects or things don't bite, anything is open to being picked up and played with.

While waiting and on the walk back from the site we found various jungle fruits like ubo (round, light orange-colored, sour, and tasting a bit like passion fruit), nejillas (sweet, floral taste, with little flesh) and uvas (a grape-like sweet fruit with a large, single pit).

This fruit looked like grapes, but were most definitively not.  They had a tough outer skin and a single, large seed.  The flavor, however, was slightly like grapes.  Very strange.

This boy is at the top of a thirty foot high tree picking jungle grapes.

Umberto with some ripe jungle grapes.  This is one of my favorite pictures.

Redirection of funds
Due to the rot and needed expansion of our facilities, the maintenance and improvement budget has doubled. It is very important that we make the improvements needed to preserve the buildings. We must protect our investment in the structures. While initially this is expensive, the savings over the long-term will be significant. A palm roof cost 1/3 of the price of a metal laminate roof, but must be replaced yearly, leaks, and is a haven for insects and rodents. A metal roof covers and protects the buildings more adequately, is more hygienic, and will last for more than 10 years before needing replacement.


We have redirected $1,000 from the pier project to cover the maintenance to the buildings. We had originally budgeted $2000 for the pier and dock improvements, and $1000 for building maintenance. However, I believe we have a good chance of using part of the $1,000 from the project as the village's contribution to build a much better pier with concrete.


Quick update on everything:

• My sister Crystal and her friend Kaitlyn volunteered for a week in the village. They painted a mural of the world on the school and painted much of the guesthouse. It was great having them help out in the village. Thanks Crystal and Kaitlyn!

Painting the guesthouse.  This make the room not only more cheery, but will also help to prevent insect damage.

This is a 10 foot wide mural painted on the side of the school.  It was organized by Crystal and Kaitlyn and painted by the village kids.

• We installed a new roof on the guesthouse.

Our old, leaky, rat and cockroach infested roof.  Good bye old roof!

Hello nice shiny new roof!

• We replaced rotted wood in the kitchen.

Kitchen repair.  In the end we needed to replace 3/4 of the walls and half of the floors. 

Helpers for kitchen wall painting.  The kids are currently on their "summer" break from school.  They have two months free.

• I had two village meetings at which we discussed the formal incorporation of the village. This may bring an additional $15,000 dollars into the village annually. I may take a trip to Bogota in the coming weeks to help move the process along.

• We have three (and possibly five) volunteers interested in visiting the village during the next two months.

I came across this moth on the walk back from one of my meetings.

What is on the “to do” list for December and January?

• Connect the kitchen and bathroom to the village power grid
• Finish the roof for the kitchen
• Paint surfaces

Gustavo's dog, Pelacho

• Put in a zinc laminated counter top in the kitchen
• Finish tiling the shower floor
• Reinforce the dock
• Weatherize the dock
• Fix the project’s bathroom
• Build Gustavo’s bathroom
• Continued maintenance to Gustavo’s motor

Gustavo's motor for his boat.  The motor needs constant maintenance in order to operate reliably.  It is not fun to break down on the river.

• Gutter the kitchen and collect the runoff water in a 1,000 liter tank
• Go to Bogota to explore option for incorporating the village
• Start planning the projects for which we will apply for government grants

FUTBOL!

That’s it for now!

Eye infection in the Amazon and project update

Things are going well, but it is –at times- uncomfortable for living conditions. We have not had significant rain for the past two weeks, so all of the rainwater for drinking is almost gone. Even the project’s 2,000 liter tank is running on fumes. Other families also use our tank when they really need drinking water. I have heard that some villagers are resorting to drinking river water. Not a wise thing to do considering the high concentration of parasites that call the water, and the people who drink it, their homes.

Almost empty water tank

The project’s structures are also taking a beating. We have structural rot in the kitchen and bathroom due to water splashes from roof water run-off. Inside the kitchen the walls are rotting around the sink, as the countertop is improperly angled. The screens on the guest house are rotting and broken, which helped to add more itchy bug bites to the hundreds that I already have.

Rot due to rain splatter.  After board replacement, an enlarged roof will help the problem.

Sanitation is also an issue. The thatched roof is home to many (I am reluctant to guess or investigate the actual number) defecating cockroaches. Large jungle rats hunt and eat the cockroaches. Then the rats poop out the digested roaches. And where does all this defecation go? It goes to everything below the roof, which includes me. Little bits of the thatch also decompose and fall. I believe all of these factors helped to contribute to my bothersome eye infection (more on this later).

The ceiling.  A home to cockroaches and nocturnal jungle rats!

But that is enough complaining about maintenance and sanitary conditions. What are we doing to address the issues? Next week we are going to put a rat-free metal roof on the guest house, the bathroom, AND the kitchen (due to a drop in the price of metal roofing, we are able to replace all roofs). We will deep-clean the buildings, put in new resistant aluminum wire screens, start to repair the rot, paint everything, and maybe even put a comfortable toilet into the bathroom! These things should help with a lot of the sanitation problems.

Screen rot

Other project news:

• The entire village is motivated to go forward with the project (a major task by itself).
• The dock that we started building last March looks really good and is ready for “phase two”. Depending on funding this may include building a small store and seating on part of the dock.
  

  

  The current walkway

• The village chief and I had very productive meetings about projects with the state and national government this week in Leticia. Basically the village needs to supply at least 10% of each project’s costs, all of the labor (or pay for specialized labor), and to complete each project in phases with the rounds of funding corresponding to each project phase. To apply for each project we must submit all plans, costs, timelines, and who and how many people will benefit.  Projects:
• A much more expensive and well-build pier system than originally planned

  

  People looking at the site of our pier and walkway.

• Drilling a deep well
• Rebuilding and upgrading the village water filtration system
• Further dock developments
• Developing a village recycling system
• Improvements in agricultural production
• Traditional fishing development and improved technique
• Beekeeping
• The beginning stages for aquaculture
• The beginning stages for cacao production
• Rice production

•  I believe the time is rapidly approaching for the village to begin talking about the problem of open defecation. We need toilets for all. However, this can be a complicated and messy situation. How “green” do we want to go? I believe that composting human waste is the answer.
• This week I learned, to my surprise, that the village has not yet incorporated. It is not an officially recognized Colombian village. What this means I have yet to discover. It seems that being a legalized village would only be in the peoples’ best interest. However, the old chief told me that there is some resistance to doing this. I believe that the resistance comes from not knowing the proper way to become legalized. The paperwork and steps needed seem overwhelming. But paperwork is one of the things at which I excel. The village WILL become official.
• The Peruvian government is hosting a trading convention in Leticia this Thursday, November 20. We expect the village cooperative to enter into our first international business contract! We hope to sell agricultural products, fish, and handcrafts. I will give an update about this in next week’s blog post.
• On Friday the 21st my sister Crystal and her friend are coming to visit the project.  This is their first trip to Colombia.  Our father and other sister, Rose, visited Bogota in 2005.
• I am happy with our progress during my first two weeks in the Amazon.

And more news:

Appointment cost $12.  Wait time without a scheduled appointment was 15 minutes.

Anyone for drugs?  Read about whatever problem you have, go in and buy drugs.  Be you own doctor!

• EYE INFECTION. Last week I noticed a bit of blurriness and irritation in my right eye. I did not examine my eye, as there are very few mirrors in the village. When I got around to shaving I noticed it was very red and swollen. You might say pink, as in pink eye, which it was. I have had conjunctivitis three times before, but this was the worst case I have ever had. I believe it came from a combination of the stress of moving around a lot in Colombia, the pressures of the project, the extreme heat and humidity, the lack of sanitary conditions in the village, and the constant stream of rat-dropping falling into the house from our thatched roof every night. Luckily, the next morning I had a trip planned to Leticia. In Leticia people with money may buy any drug normally available only by prescription in the United States. The exceptions to this are narcotic class drugs like heavy pain-killers or amphetamines. I picked up some antibiotic eye drops and started dropping away. The next day I looked up what I was taking on the internet and found that it contained steroids, which I did not want to take due to their side effects. To make a long story short, I ended up trying three different drops and to a visit to an optometrist. I am now taking Cipro-based drops. I paid $9 for the eye drops and $12 for the doctor’s office visit. (I also found a good anti-allergy mast cell stabilizer drops for $5 per bottle). While I do have traveler insurance with World Nomad Travelers (highly recommended) I did not file a claim. This bout of conjunctivitis has been exceptionally difficult to control, but I believe I now have the upper hand.

  

  Pink Eye

• There is a new coffee shop in town. It is called Punto Café (Coffee Spot). It is run by a very nice young woman named Adriana. She speaks English and Spanish.  She opened the shop, located on one of the main streets of Leticia, four months ago. She serves espresso, cappuccino, lattes, regular coffee, juices, and an assortment of pastries baked on location. Adriana also has a love of Turkish food –serving the only Kibbes in town. Why the interest in this little restaurant? Before the arrival of Adriana I could not buy a good cup of coffee in Leticia. I had the plan, if we ever had an Amazon Pueblo office in Leticia, to invest in an expensive machine and serve good coffee. If I spent the time looking through the city for a descent cup of coffee, I’m sure other have as well. Adriana said she is interested in forming a partnership with the project. I will set up an English Facebook page for her, and she will have the project’s brochures in her shop.

  

  Punto Cafe!

  

  Adriana

  

• I am planning a visit to San Francisco (Amazonas) to get a detailed view of their cacao production operations. They are located about one hour upriver from La Libertad by speedboat. The president of the operations, Arcesio Rendon, is from inland Colombia, but has been living in Leticia for over 10 years. They have 10,000 trees in production. However, they have many problems with the fermentation process needed to make a good chocolate. Currently their chocolate is bitter and tasteless. Gustavo (from La Libertad) described it as tasting like bitter dirty water with sugar added. Arcesio recently received a government grant to improve their production. I am curious to see how things are going and to make suggestions regarding quality improvements.

  

  Arcesio.  If this business venture does not work out, his plan B is to move back in with his mom.

My next post should be on Friday, as I wait for Crystal to arrive. Hopefully I will be able to include pictures of our newly-installed roof!

Village Green