Sept. 11, 2002
Iquitos, Peru is a not so small city in a remote portion of the Amazon jungle. It is located in the widest portion of South America just below the Equator, more than 2,000 miles from the Atlantic Ocean and less than 600 miles from the Pacific.
Accessible only by air or a 10-day boat ride up the Amazon River, Iquitos finds itself isolated and alien to the rest of the world. It is poor, crowded with nearly 500,000 people each trying to figure a way to survive in a world that doesn't know that they exist. Iquitos is certainly a Third World city in a Third World country that is desperately trying to emerge as a stable Latin American democracy.
I first visited Iquitos in 1988. Arriving in the complete darkness of a moonless Amazon night, I felt I had entered an abyss. Never had I been anywhere so disconnected from the rest of the world.
Medical teams have been coming to Iquitos for 16 years and those from Loudoun County since 1992. Through those years, hundreds of hernias have been fixed, dozens of gall bladders removed and more than several cleft lips mended. Women who had female problems were treated as women by a gynecologist and children with burns were skin grafted by plastic surgeons.
SEVERAL LOUDOUN COUNTY physicians diagnosed and treated heart disease, infections, hypertension, malnutrition and rashes. Nurses taught their Peruvian counterparts modern surgical techniques and introduce technology to their operating rooms.
These annual visits would come to be expected, a way of measuring time like the spring equinox or the start of the monsoons. Every year hundreds of would-be patients squeezed into the clinic hoping to be chosen by the gringos, chosen to get an operation or a medication that their health care system could not provide. Some traveled more than a week to get to Iquitos. Half would be turned away. There would not be enough time or sufficient supplies to treat them, or they were just too sick, perhaps, with death upon the horizon. There are times when all one can offer is just a few shared moments of time.
Last May, 12 Loudoun County nurses, physicians and surgeons traveled to Iquitos. In seven working days, they examined over 100 patients, performed 58 operations and treated a dozen or more people who were ill but only needed medical therapies. Several were cured of their infections because of the antibiotics we brought. Many others were able to be mended and brought back to health because of the anesthetics and instruments our doctors and nurses carried every mile of the journey.
Yet, it was not a simple process. First World medicine does not translate easily into a Third World setting. America's best technology had to be left behind. Diagnoses needed to be made the old-fashioned way by using the senses to see, hear and feel symptoms. Language, always a problem, was not a barrier to care. The Peruvians spoke Spanish and pidgin English. The Americans responded in pidgin English. Instructions were given in pantomime.
THERE IS no such thing as elective care in Iquitos. Everyone we saw was impaired by their malady and in need of therapies that were long overdue. Most had pain with no way to treat it. They would tolerate it stoically, perhaps forever, or until the American doctors arrived. Maybe someday the Peruvian health care system will be able to care for these impoverished peoples but for now the resources and funds aren't there. Until then, Iquitos will take help from wherever they can get it.
When I first arrived at the Hospidal Iquitos, I saw physicians emotionally struggling, trying practice good medicine with ancient supplies. Wounds were sewed with coarse cotton thread using needles better designed more for canvas than for skin. This thick suture was pulled through the wound and tied, often without the
benefit of an anesthetic. Surgical tools were Spartan and anesthesia equipment almost nonexistent. None were sized for children as a sick child wasn't expected to live.
There were but a few surgeons in Iquitos and none who were cavalier enough to operate on a child using only local anesthesia. Most were content to let nature take its course.
I operated in such conditions, sweating off the jungle heat that often
exceeded 100 degrees with 80 percent humidity. There was no air-conditioning other than a tropical breeze passing through the open terraces that separated one ward from another. I worked in my scrub suit without a gown but wearing a cap, mask and gloves that kept perspiration off of my patient. I worked under lights that kept burning out and there was no money to replace them.
WHEN IT became too dark to see I would bite on a pen light or tape a flashlight to the earpiece of my glasses and keep on working. My colleagues were equally as inventive figuring out ways to stop bleeding or mend bones with tools invented on the spur of the moment. Despite formidable obstacles, the teams that worked the Hospidal Iquitos during those years never lost a patient. All were present and accounted for, recuperating and regaining their health by the time medicos returned to the United States.
There is the specter of adventure yet the feeling of bewilderment when I find myself in a jungle where I could walk in any direction for a 1,000 miles and still be in the same forest looking at lagoons and a canopy that seem endless. This is a strange and beautiful place essentially untouched by humanity where animals look at people quizzically because they have never seen a human.
I sit in the center of this panorama and wonder what am I doing here? What am I trying to accomplish? I take people from the jungle and try to make them better but then I send them back to the jungle where nature will take it course and survival will go to the fittest. I am sure I do some good for every person I treat and that every patient will return to his home better than he left it.
We still return to Iquitos, doing the same things that we have done for the last 14 years, providing the poor with specialized care that their health care system cannot provide. Maybe it will someday, but for now we have no shortage of patients. We will not eradicate poverty or push Peru out of the Third World, nor will we challenge, let alone conquer, the jungle. But, we will allow a single individual, who by the accident of his birth is forgotten in time, who with our intervention can sneak into the present and find adventures all his own.
Dr. J. Richard Casuccio, a plastic and cosmetic surgeon practicing in
Sterling, is the founder and president of Doctors Overseas Lending
a Helping Hand.