AMAZON ADVENTURE

By Pam Cairns
Contact the author via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

In July 2004 the Vine Trust's first UK Medical team left from Edinburgh to work on the Amazon Hope, a 24 metre, ex-Royal Navy vessel They were headed for the river Amazon in Peru. The team of eight health professionals was the first of many regular teams to leave the comforts and sophistication of the NHS to take their skills to help some of the world's poor. In 2005 there were six teams; this year thirteen teams, more than a team a month.

These medical teams have been taking Primary Health Care to the villagers on the banks of the River Amazon and its tributaries, most of whom have very limited access to health care due to geography and poverty.

January 2005 saw the opening of a new Health Centre in the shanty town of Puerto Belen, Iquitos, thanks to funding from Llyods TSB Foundation for Scotland. The Health Centre is part of the Medical Project employing a full time doctor, a dentist and nursing staff. This facility will allow the poorest families better access to health care.

The Vine Trust charity was established in 1985 in Bo'ness West Lothian initially to help the starving in Africa; as the charity has grown it has increasingly work in partnership with Scripture Union, Peru caring for the street boys who are abandoned by their families through poverty. These children, some as young as five, survive by stealing or prostitution. In 2001 the Amazon Hope vessel sailed the Atlantic from Glasgow, all the way up the Amazon River to Iquitos. She was fitted with a GP surgery and dental surgery, to begin work on the rivers. The Vine Trust acquired the Amazon Hope 2 in 2003; this vessel, a sister ship of the Amazon Hope, has been refurbished and not only fitted with a pharmacy, GP and dental surgeries but also a small operating surgery. This will allow surgical procedures under local anaesthetic, such as cataract and hernia. In the autumn of 2005 the Amazon Hope 2 completed a UK round trip, raising awareness of the Medical Project and encouraging health professionals to sign up for our two week trips, using part of their annual leave to help the poor in Amazonia.

The Project can only reach out to some of the regions of Amazonia as this area is so vast, but the aim is to serve three large river areas, visiting three monthly to establish a meaningful health service to the villages. Quarterly visits will not only allow the identification and management of chronic problems such as asthma and diabetes but also identify secondary needs such as cataract and hernia problems. At the moment villagers, blind because of cataract or troubled by a hernia, have to pay for surgical treatment but they are too poor, so remain blind or in pain. Such patient, where possible will benefit from the operating facilities on the Amazon Hope 2; for example eye surgery and other minor operations.

A Health Worker will be recruited in each village, and trained in Iquitos by theTrust and by so doing ensure that when the Amazon Hope is not in the area there will continue to be a health presence in the community. Regular visits will allow the delivery of comprehensive medical and dental health education. Already this work has begun with dental education of prime importance both in the Belen Clinic and also on the river trips.

Many of the communities visited do not have clean water or sanitation, the villagers coming down to the river to drink or carry water back to their homes. Dirty water of course, is responsible for much ill health through waterborne infections such as dysentery and parasites. The Project plans to install clean water and sanitation facilities in as many of the villages as possible. Already work has begun on the technical and funding issues both in the UK and in Peru, to enable this to happen. An exciting development has been the recent appointment of a water engineer to the staff in Iquitos.

The Project works closely with the Peruvian Ministry of Health. The Ministry provide malaria and immunisation teams for each trip. Recently a midwife has also been seconded for the trips. Working together in this way allows the more inaccessible communities to benefit from better uptake of immunisations, better ante-natal care and better malaria control. Both infant mortality and maternal mortality are high in Peru so increasing the herd immunity and improving ante-natal care in the communities served by the Project will help reduce these rates considerably.

Visits to the local district hospitals in Iquitos have highlighted a great need for modern equipment, particularly in intensive care. Over the last six months the Vine Trust has been collecting ex- NHS equipment, which has been discarded in the continual upgrading programme that occurs in NHS hospitals. This equipment is checked by our volunteer technicians and stored in our factory unit ready for shipment to Iquitos this year.

Medical teams are usually of eight to ten health professionals. A minimum of two doctors, one or two dentists, a pharmacist, nurses and dental nurses. As most of the work is Primary Care, the doctors in the team are usually GPs, GP registrars, A/E doctors, paediatricians or general physicians. On board the Amazon Hope there is a Peruvian doctor and nursing staff.

There are very few investigations available on board or in the medical centre although small laboratories will be established this year, so teams have to rely on their clinical skills. The villagers all speak Spanish so unless a fluent Spanish speaker, a team member will learn very quickly the importance of communication in their own clinical practice! Fortunately there are always translators on board.

Most team members comment that the whole experience of working on the Amazon Hope positively impacts on their professional development and also at a personal level. It easy to read about poverty and see it on the television, but it is a totally different matter to be working with the poor and seeing the consequences of such poverty.

The Vine Trust aims to encourage UK health professionals to use part of their annual leave and for a short time use their skills to help the poor of this Amazonian region. The trips are for two weeks although it is easy and relatively inexpensive to extend the trip for a few more days to take a trip to Macchu Picchu or other parts of Peru.

The Project has opportunities for volunteer doctors to spend three months working both in Belen and on the Amazon Hope. This year two GPs are undertaking this work which will bring huge benefits to the Project.

If you would like to know more about the Amazon Hope Medical Project, log on to the web site is www.vinetrust.org.

To apply to join a team email health@vine trust.org or contact Dr Pam Cairns 01592 265885

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.