Tarps, string, and duct tape.

That’s really all we need to set up our daily clinic consult rooms. We arrive early in our partner communities – lugging bins and suitcases full of medications, medical supplies, tables, chairs, drinking water, generators, tarps, string, and lots of duct tape. Sometimes we arrive by bus. Sometimes we arrive by motorized canoe, nine people plus gear per small wooden dugout canoe.

We scramble up the river bank – making a human chain to pass the heavier supplies. When we reach the treatment area, we assess the space and plan the triage area, the pharmacy, and the 4 consult rooms for the physicians. We’ve used outdoor basketball courts, school houses and community centers. We string up tarps to separate an open space into 4 consult rooms. Duct tape holds the entire project together. The other day, my consult room was up a set of rainforest decayed plank stairs to the top of the schoolhouse. I moved my desk to the other side of the room to avoid the sunlight streaming in through the partially open ceiling until the school headmaster quickly moved it back, showing me that the wood floor couldn’t support the desk in its new position. I hadn’t thought of that, I guess.

Clinic days run shockingly smoothly. We usually have the assistance of a local dentist, psychologist, physical therapist, and even a hairdresser for free back-to-school haircuts for the kids. Patients are extremely stoic – barely complaining though their bodies are stiff and sore from the endless work in the fields.

I treated an 11 year old girl with a machete injury from cutting cacao pods from the tree. It will be a while before I can eat a chocolate bar without seeing her mangled finger in my mind. Infected bug bites are the norm, including rarities like sandfly induced leishmaniasis (the Amazon is a dermatologist’s heaven) and a great assortment of worms and parasites. We hardly see any chronic diseases like diabetes, hypertension, hypercholesteremia, or heart disease. Our patients are healthy and strong, but suffer from gastritis, orthopedic injuries and the effects of poverty. I’m constantly learning new things from Karen, the most compassionate family doctor I know, and from Andrew who is doing amazing work in women’s health. Local doctor Natalia works alongside us in the medical brigades, then follows up with house calls over the next few months.

The local alcoholic beverage is chicha, a fermented drink traditionally made from the masticated juices of the yucca tuber, chewed only by the women of the communities. The saliva ferments the beverage, which is then mixed with water and used as a meal replacement. Children start young drinking chicha, and it is the source of community wide heartburn.

Mimi and Lena rotate through the support positions. They’ve worked the fluoride station, distributing toothbrushes and toothpaste and demonstrating good brushing technique. I bet I won’t have to remind them to brush their teeth when we get home! They’ve worked in the pharmacy, distributing deworming medicine to all the children in the villages who get treated with albendazole twice yearly. They’ve worked as translators with the doctors, and are getting proficient at counseling in Spanish about the importance of boiled drinking water and general hygiene. They jump in and lug supplies through muddy paths, and haven’t once complained about the food, even when it’s pretty strange. That’s all I’ll say about the food.