In August, I participated in a medical mission to Peru. In the previous blog post, I talked about preparation and first impressions. This post will detail the first half of the medical mission.
The mission seemed to be split into 2 components. Many of our volunteers did a “mini-mission” and worked in clinic for 2 days before heading home. Of the initial 40 volunteers, only 6 of us remained for the entire week. Three more volunteers joined us for the second half of the mission. For this reason, each segment had a very different feel.
Orientation
On the day of arrival in Puerto Maldonado, all 40 volunteers gathered for introductions. We shared our backgrounds and levels of experience both medically and with mission work. There were many young people: students and children of the adult volunteers. Many of the volunteers brought supplies and donations. We unpacked and organized everything by category. There were medications, wound care supplies, reading glasses, and personal protective equipment (gloves and masks). We repacked everything and organized the bags for the next day.
We then had dinner of Peruvian pizza. Peruvian pizza is a unique fusion of traditional Italian pizza with Peru’s diverse and vibrant culinary influences. It maintains the classic elements of a pizza—such as a thin crust, cheese, and tomato sauce— and also incorporates local ingredients. For example, I tried a pizza with a mango topping.
We had a local host named Juan Carlos. He was from Cusco but was familiar with Puerto Maldonado and our clinical sites. He served as a liaison arranging transportation, safety and meals for the volunteers. He explained local customs and recommended activities and places to eat.
Our hotel had few amenities, but it was clean and safe. Even though the hotel had air conditioning, the rooms could get a little warm. Fortunately, there was a fan over the bed, which kept the nights comfortable. Not everyone had hot water with their showers. After hot clinic days, I tended to shower in the evenings and didn’t mind the cooler water.
Clinic Days
Each day, we had breakfast at the hotel. The staff consistently served eggs with sausage that kind of looked like hot dogs. We had plantains, papaya and bread. There was coffee which was many times lukewarm and in limited quantity. Americans have a distinctive coffee culture compared to their South American counterparts. In the U.S., coffee is often consumed in large amounts and we’re used to having it in abundance. Since I usually really enjoy my morning coffee, I made a note to consider bringing a small coffee pot next time.
After breakfast, we grabbed the supplies and loaded them into vans. An advantage to having such a large group of young people is that they usually carried all the stuff. Each day, we went to a different clinical site. The environment as well as the patient population varied with each day. We had access to toilet facilities but were advised to always bring toilet paper and hand sanitizer. You also can’t flush toilet paper in most parts of Peru. It goes into a trashcan nearby.
Day 1
On the first day of clinic, we drove about 2 hours to La Pampa, Peru, located near the Interoceanic Highway connecting Peru to Brazil. La Pampa has become notorious for illegal gold mining which has caused severe environmental damage. The area is also known for human trafficking and labor exploitation. Despite governmental efforts to combat illegal mining, La Pampa remains emblematic of the ongoing struggle between economic opportunity and environmental conservation in the Amazon.
The night before our trip, our host gave us the history of the region and told us it was a “bad place.” He warned that we shouldn’t leave the compound unattended. With that said, I felt quite safe during my time in La Pampa. We set up a clinic inside a church and many residents came to seek care. Six providers: 3 physicians and 3 nurse practitioners conducted medical exams. We examined farmers and other manual laborers as well as the women and children of the community.
There was a registration desk staffed by volunteers. The clients checked in and were triaged by a nurse or paramedic. The clients were given a slip of paper with their chief complaint and vital signs. We used that paper to chart our findings and interventions. After our exams, most clients went to see one of the 2 dentists who performed many dental extractions.
Our interpreters were local volunteers and pre-med college students majoring in Spanish. A significant challenge was that the interpreters didn’t know much medical Spanish. I studied Spanish in preparation for the trip and could communicate basic needs, but I should have studied more medical terms.
For the first couple of hours, I felt unsure of myself and my abilities. I had spent the last 9 years running an aesthetics and wellness clinic and felt out of practice treating real medical problems. I reminded myself of my past experiences including working at the health department. Soon I was able to relate these clients’ concerns with my arsenal of knowledge. I settled in and was able to treat people with more confidence.
I saw a variety of clients from infants to 80-year-olds. Some clients had chronic conditions and were hoping for the opinions of American doctors. Some people came to us hoping we had access to diagnostics and specific medications. We were only allowed to give a 2-week supply of any given medication. Further, we couldn’t start treatments for any chronic conditions since we wouldn’t be there to evaluate the effects of our interventions. Anyone who needed a higher level of care had to be referred to the local medical providers.
Other providers have confirmed that it’s normal to feel frustrated when you can’t properly work up a diagnosis. You’re treating based on a limited history and gut instincts. We were told that the local medical community was strained, and many times patients felt they did not receive proper care. We were assured that the people just wanted to be heard and to have our attention.
The first client I saw had foot pain for 20 years. When I examined her, I discovered severe lymphatic swelling of her right foot. It was the worst case I had ever seen. I was unable to treat this condition, so, patient #1 was a referral. The second client was an 80-year-old man who was a farmer. He had severe pain in his shoulder and could barely lift it. I suspected he had a rotator cuff tear which again I couldn’t treat. One of my colleagues suggested a steroid joint injection. “We can do that here?” I asked. She performed the injection while I assisted. Later that day, a woman had chronic shoulder pain which would also benefit from an injection. I asked one of the physician volunteers to teach me to do it. If this was going to be a thing here, I wanted to learn to treat my own patients. He talked me through it, and it wasn’t that difficult.
A female client came with a urinary complaint. Her urine test was negative for infection. Many times, women experience urinary symptoms but actually have a vaginal infection. We didn’t have diagnostic capability for this, and I couldn’t even do a pelvic exam. However, I prescribed antibiotics that would treat the most likely cause of a vaginal infection.
Later, I saw some children. Many of the parents had concerns about anemia and intestinal parasites. Everyone was prophylactically treated with Albendazole for worms. While we couldn’t check for anemia, we had a small supply of multivitamins. Mostly, they just needed reassurance that the children were ok.
By the end of the day, we had treated 172 people. The day was long. It was hot but not intolerable. Many of the clients had waited all day to be seen. Historically, the first day of a mission can be chaotic but overall, the day went well. Everyone worked hard and had a great attitude. I was amazed by the number of young people who remained positive while working in uncomfortable conditions.
Back at the hotel, we gathered to debrief. Everyone was asked to give a highlight of the day and a shout-out to another volunteer. Since there were 40 people, it took a few minutes for everyone to speak. My highlight: I learned a new skill: a shoulder injection! I hadn’t treated many orthopedic issues during my career, so it was neat to learn something new. My shoutout was to a nurse practitioner named Kathy. She oversaw the pharmacy which was a long table with medications lined up. I was impressed by how she remained organized and composed.
One of the volunteers said that his highlight was the look of relief on a mother’s face when I examined her baby and reassured her that the baby was healthy and thriving. This lifted my spirits as I had been feeling unsure of myself.
Day 2
On the second day, we drove an hour and a half to Alegria. Located in southeastern Peru, Alegria is part of the Madre de Dios region. This region, named after the Madre de Dios River, is renowned for its vast rainforests and serves as a gateway to the Amazon Basin. It is home to several protected areas, including the Tambopata National Reserve and Manu National Park. Historically, Madre de Dios was sparsely populated, with Indigenous communities. However, during the rubber boom of the late 19th and early 20th centuries, the region experienced an influx of settlers. In recent decades, Madre de Dios has faced challenges due to illegal gold mining, deforestation, and human encroachment. Despite these challenges, the region remains a critical center for conservation efforts, scientific research, and ecotourism.
On this day we served 127 people. The clients were given time slots to show up, which made things less chaotic. The prior day, we could see more than 100 people waiting in line. This made us feel under pressure to examine clients quickly. By bringing in the clients gradually, we were productive but not under as much stress. Also, on day 2, we were used to the procedures and skill sets of the volunteers.
The clients that day seemed more affluent. Many of them had cell phones. The children often wore t-shirts with Disney characters. One girl was using a smartphone. Someone asked where we were from and we answered, “The United States.” In a perfect valley girl American accent, the girl said “OMG, the United States.”
I examined an 81-year-old woman with high blood pressure. She had been prescribed medication but stopped taking it because she felt fine. This is a common behavior among clients in the United States as well. I explained the dangers of untreated high blood pressure, specifically that she could have a heart attack or stroke. I asked if she was able to get her prescription filled and she said she would. Another lady had severe swelling in her knee. It was difficult to get the exact history but many years prior she had experienced an “accident.” It looked like she had surgical scars. Then she recently had another accident. The bone was almost protruding, but it was difficult to tell how long she had been that way. She needed to go to the hospital and see a surgeon. Our team leader assured us that even though we couldn’t treat some things, we were helping people make the local connections needed to receive proper care.
On the way back from clinic, we were pulled over by the police. They wanted to see everyone’s passports and took pictures to send to their supervisor. This made some of our volunteers very nervous, but our host assured us that this was normal procedure. These checks are standard practices aimed at maintaining security and preventing illegal activities. Police interactions are usually straightforward, though travelers need to produce proper identification. We had been advised to carry our passports with us in case of emergency. In the past, mission volunteers have had to leave the country emergently and only those with their passports could go.
To prepare for clinic, I downloaded a copy of the Sanford Guide which is a reference for antibiotic doses for various infectious diseases. Also, I printed off treatment guidelines for common complaints with appropriate medication dosages. I kept a binder at my station in case we did not have internet service.
We returned to our hotel and had another debrief. Many of the volunteers were leaving the next day. After dinner, we wished everyone safe travels. There were 6 of us remaining. The next day was slotted for “training.” It ended up being a free day. One of the volunteers had planned an excursion. The rest of us managed to get tickets as well. Stay tuned for part 3 of this series which will expand upon the beauty of Puerto Maldonado as well as the remaining 2 days of clinical service.