Dr. Rich Currie: Peruvian blog from St. Clotilde, Amazon

January 21, 2011

Greetings from Santa Clotilde, Peru!

This is the end of week three in Santa Clotilde.  I have secured access to a laptop, found internet , work has settled into a routine, and I am no longer constantly distracted by a Macaw named Leo.  In short, I am ready to sit down and write.

For past readers of the Ethiopia and Central African Republic non-blog travel-blogs, I should begin by saying that this is not a Medecins Sans Frontieres project.  It is a missionary hospital, and I am working here for only a month, deep in the Amazon basin of northeastern Peru.   The story of how I ended up in Santa Clotilde is difficult to summarize, and involves a number of unusual opportunities and random connections that I pondered for considerable time last week as I sat on an earthen floor in the darkness, chewing on semi-rotten armadillo.  For now, suffice it to say that my path here was paved by a number of very inspirational people, and I hope to introduce you to them as time goes on.

Near the top of that list is Padre Jack, my sole gringo counterpart out here on the Rio Napo.  Jack is an American missionary who has been living and working on the Rio Napo since the mid 1980´s, having established the hospital here in Santa Clotilde with a partner, Father Moe from Canada (now in Lima).  Jack is 50% catholic priest, 50% doctor, and 100% Green Bay Packers fan.  Easily one of the most remarkable and inspirational people I have ever had the pleasure of meeting.

I will pause here to acknowledge that yes, you are correct, Peru is a Spanish speaking country.  Some of you might remember – either first hand or through the blog – of my misadventures speaking French in Central Africa.  There are, as we speak, at least 12 nurses in that part of the world who now believe that the clinical sign of “strawberry tongue” is more properly known as “mango mouth”, thanks to my translation limitations and an inappropriate tendency towards expansive hand gesturing.  But for all of you nay-sayers out there who scorn my ability to learn Spanish in 6 weeks or less, to you I say:   good point.  You should have brought this to my attention earlier.

Now here I am, working in a small rural hospital in the Amazon basin, about 6 hours by speedboat upriver from the city of Iquitos – the world´s most populous city that can only be accessed by plane or by boat.  And I am surrounded by people who speak Spanish fluently, and only one other English speaker (Padre Jack), and I am wearing out my Spanish-English dictionary as fast as my thumbs can flip pages.

It was in this context one morning last week that I found myself taking part in a lengthy conversation in Spanish at the hospital nursing station, of which I understood nothing, and at the end of which Padre Jack turned to me and said, “well how does that sound?  Would that be fun, leaving tomorrow for a couple of days upriver on a vaccination campaign?”  Having long ago firmly established that I lack a healthy sense of self-preservation, my reaction was, of course, “yes”.   By which I specifically meant, “maybe, and we need to talk about this later”.

We turned our attention back to the hospital and, as is custom here, worked continuously through to 3pm at which point all thoughts turn to lunch and an afternoon siesta.  Throughout the day it had not escaped my attention that people were busy in the background packing boxes and loading a boat but, leaving as I was the next day, I figured there would be plenty of time to ask Jack more questions in the evening.  I didn´t think too much of the random people asking me, with increasing frequency, if I had a bag for the trip.  “Si,” I would say, thinking of the small carry-on backpack in my room that had yet to be packed.   I didn´t fully appreciate the significance of the question until I was being asked it three times in a row by the same exasperated nurse while simultaneously, out the corner of my eye, I observed a surprised Padre Jack having an animated conversation with the boat driver.   It included such Spanish phrases as “now!?!” and “not tomorrow?!” and “yes, yes, sure he´s still going”.

Here´s the deal:  you are going on a boat trip up an isolated river in the Peruvian Amazon to visit small jungle villages and provide medical consultations on a vaccination campaign, for an unknown number of days.  You have twenty minutes to pack, and no time for questions.  Go.  Spanish-English dictionary?  Check.   Clinical tropical medicine book?  Check.  Stethoscope?  Check.  Headlamp?  Check.  Towel, change of underwear, fresh socks, second shirt, extra pair of scrub pants, flip-flops, first-aid kit, knife, bar of soap?  Check, check, check.  Suntan lotion, bug spray, comb, shampoo?  Nope… not quite enough room for those.  Toilet paper?  You´re darn right.  Toothbrush?  Just barely.

As I hurried from my quarters at one end of the hospital towards the entrance, people started throwing things to me at random – here comes a flimsy and soiled roll of foam for sleeping, two clean sheets from the laundry, and now a mosquito net.  Catch, catch, catch, run.  As I´m boarding the boat I lean out and shout to Padre Jack waving from the shore:  “how long will I be away??”.  “Hard to say…” he shrugs amicably, “maybe four days… might see you Saturday.”  A random girl is holding a monkey on the shore and I am instantly distracted.  Push off, engine starts, and we´re heading upriver.

Boat to Vaccination Clinics

At this point I turn and look around the boat to take stock of the fellow characters sharing the narrative in this pending Shakespearean tragedy.  The boat itself is about 20 feet long and 3 feet wide, with a small outboard motor, a canopy roof, and plastic flaps that roll down to cover the sides in the rain.  Sitting at the wheel is Victor Hugo:  a short, stocky, animated fellow with a booming voice and a quick laugh.

I met Victor Hugo on my first morning in Santa Clotilde when, having previously heard that I like to jog, he nearly knocked my door off its hinges at 5am to drag me out for a run.  If this were a Mexican television comedy, he would be the one wearing the bumblebee suit.  Sitting behind Victor Hugo is no-nensense Nelly, technical nurse extraordinaire.  She first started working at the Santa Clotilde hospital over 20 years ago when, as legend goes, she hired herself.  She has no formal nursing training, but did spend a lot of time at the hospital in its earliest years caring for a son who is type 1 diabetic.  At some point she decided that she had seen enough and informed Jack and Moe that they were going to teach her to be a nurse, and that she was going to be good at it.  They did, and she was right.  I feel better seeing her back there.   If she could raise an insulin dependent diabetic in the middle of the jungle, presumably she can keep a needy English speaking Canadian alive for 3 or 4 days.

Or 5 days, as the case may be.  But we´ll come to that later.

Victor Hugo and His Monkey

First stop:  where´s the beef?!  Victor Hugo is already thinking ahead to dinner. Thirty minutes upriver he pulls over to the side and ties up the boat.  Hard to see above the high muddy bank but I sense that there is a clearing in the jungle above us and Victor Hugo leaps up and into it.  Nelly asks if I like beef.  “Si,” I respond politely, my limited Spanish prohibiting me from completing the sentence with:  “in particular I have a fondness for prime rib”.  Ten minutes later Victor Hugo jumps back into the boat holding a bloody slab of meat in one hand, and a heart in the other.  Yes, a heart.  A buffalo heart apparently.  It´s fresh enough that it´s still very bloody and, lacking any form of packaging or container he tosses it directly onto the floor of the boat before rinsing his hands in the river.  I poke it to see if it is still beating.  It is not.  Off we go.

Vaccination Home Visit

One hour and one tropical rainstorm later, we arrive at our final destination for the day:  San Raphael.  This village is home to a small outpost of the Santa Clotilde hospital, and is staffed by a registered nurse from a school in Lima.  As part of their training every nurse and doctor in Peru is farmed out to an isolated community for a year of mandatory service.   David is a little more than halfway through his year of servitude, and he is delighted to see us.  He comes from a city near the coast, he talks fast Spanish, and he couldn´t care less that I don´t understand most of what he has to say.  To a city-born nurse who has been isolated in the jungle for over 6 months, a mute foreign doctor is the perfect captive.  We had worked our way through most of his childhood and into his teen years by the time that somebody finally served the beef.

At night Victor Hugo led us to his father´s home (San Raphael is his home town), and we threw down our packs and foam and strung up our nets.  In the process of unpacking I found a small side pocket with a long forgotten bottle of water purifier, which brightened my chances of survival considerably.  His father´s house even had a toilet, of sorts:  a porcelain bowl, without a seat or a tank, and located in the open without a door or curtain.  You flushed it by carrying a bucket of water over and pouring it directly into the bowl, which then appeared to drain directly into a gulch in his yard.  It worked.  I would remember it fondly in the days to come.

The following morning, with David now part of the crew, we set sail on our vaccination campaign.  The plan for the trip was widely discussed and loudly debated, but in Spanish of course, so I can´t pretend that I ever had the foggiest clue where we were or what came next.  When everyone got out of the boat, I got out of the boat.  When people grabbed their packs, I grabbed my pack.  I slept where I was told to sleep and ate what I was told to eat.  I played with the monkeys I was allowed to play with, and didn´t touch the dogs that they told me not to touch.  They looked after me well.

Bush Clinic

Basically we rode the river, stopping to vaccinate wherever we could.  At times the jungle would be cleared away for a large, orderly village of 40 or 50 huts, complete with a school and wells and areas cleared for buffalo to graze.  Sometimes people would gather in one central area for their vaccinations, and sometimes we would walk from door to door.  In other parts of the river we would come across a single hut, or – my preferred technique – at times we simply chased down unsuspecting fishermen in their dug-out canoes with shouts of “Hey!  Over here!”, raised needle waving maniacally in one hand.

In the larger centers, wherever people gathered, I would offer up medical consults. At times I would get no requests at all, just wary looks.  At other times the lure of free drugs would prove so popular that I would still be frantically throwing out prescriptions as the rest of the team pulled me back onto the boat.  Victor Hugo had packed our medicine chest to his own unique and apparently random tastes, and it wasn´t exactly the MSF kit that I have grown to love.  There was a need for improvisation, but we made do.  Always at the end of every little scrum there was one person from the back who would approach as I was preparing to leave and say, quietly, “time for one more?”.  Cue the 16 year old with a sore liver, fever for 2 weeks, and eyes the color of a lemon.  Or over here, the baby who fell into a fire, 8 days ago.  In these cases I would offer up what medicines we could, write letters of reference on the back of scrap paper, and instruct them to catch the very next public boat to Santa Clotilde.  I was assured that public boats are frequent, and that the cost was affordable, and I expected to find them all safe and sound in Santa Clotilde upon my return.   Not one of them went.

When the sun started to set we would stop wherever we happened to be, and invite ourselves to sleep in a random villager´s home.  All of these houses were of similar construction – wooden floors raised on stilts, mostly open walls, and a thatched roof overhead.  They were surprisingly breezy and comfortable, and in the cooking area (usually a separate platform connected to the main house by a precarious plank) the family would busy themselves cooking up whatever food we happened to bring with us.  This was Victor Hugo´s department and – social butterfly that he is – he was remarkably well connected and adept at finding things to eat.  Sometimes he would bargain for a chicken, other times he would negotiate fresh fish from the fishermen we were vaccinating, and sometimes he appeared (to my culturally uninformed eyes) to simply walk up to strangers and say:  “Hi, we would like your bananas”.  Once or twice he disappeared for a couple of hours with his gun, but whatever he dragged back always looked like it had died at least a month ago, so I doubt that he did any actual hunting.  The ass-half of an armadillo was a particular treat – shell cracked cleanly through with a machete and the animal carried dangling in the air by the claw of one protruding foot.  Sometimes the patients gave food as well – a home visit would end with an offer of corn, or a medical consult would conclude with the gift of an uncooked egg.

If the food at times was sketchy, sleeping was equally hit or miss.   Amongst the advantages of a house built on stilts I would include the relative paucity of crawlies on the floor, the spectacular views, and the crisp breeze one gets off the river at night.  One relative disadvantage is that the area under the house serves as the family barn.  Dogs wait anxiously for scraps of armadillo to slip through the cracks of the floorboards, and pigs muck around noisily contenting themselves in the shade.  On at least one occasion I put the finishing touches on my mosquito net only to lie down contentedly and then see, through the crack in the floorboards, a flock of poultry roosted on a beam a foot beneath my head.   Out came the flashlight:  that´s a chicken, that´s a chicken, that´s a… curses!… rooster.  Roosters and I have very different ideas about what constitutes “sunrise”, my own personal definition requiring at least some – even just a hint – of light in the sky.  I also don´t take kindly to the rooster habit of keeping up appearances;  that is to say, making all sorts of look-at-me-aren´t-I-up-and-at-it-early, such-a-busy-fellow noises, all the while perched in the same place just a foot below my head and secretly doing nothing at all.  Using my headlamp and peering through the crack I saw at least one rooster crowing with his eyes still shut.  So very unnecessary.

Throw in the lack of toilets or latrines, the recurring rainstorms, the ridiculous quantity of bug bites, the limitations of even the most hardy of water purifying drops, and all in all it was a best of times, worst of times experience.  I count myself lucky to have had the opportunity to travel a portion of the Rio Napo – a truly remarkable part of the world, filled with friendly and inspiring people.  Nevertheless, by day four I was ready to hit the eject button.

In my defence I should add here that when day four came around I was under the impression that we would be out on the river for at least three more days.  In my limited Spanish I heard talk of a Monday return.  It seemed impossible to predict – some villages would gather smartly in a central area and we would finish everyone in under two hours, while in other places we would labour from house to house and spend 30 or 40 minutes with each individual family, waiting patiently for random siblings to be called back from the fields or the fishing boats.  I had no concept of the local geography or how much further we had to go.  And thus, tired and confused, dirty and itchy, we arrive at the low point of the journey.

On this particular afternoon the sun was shining fiercely – a blessing from the point of view of the hastily scrubbed laundry drying on the grass, but it was mercilessly hot and relentlessly humid.  We were in the village of Corpal Urco, having arrived at 2pm to find that no one was in their homes:  we would have to sleep the night and wait until morning to vaccinate.  I was hot, bothered, itchy, starting to burn in the sun, and bored.  We had found a little spring to wash up in but still, with the humidity and the mud it was impossible to get clean.  Victor Hugo had found a friendly family to serve as host, but unlike the previous homes this hut had enclosed walls, nowhere to sit, and little to no breeze inside.  The town was laid out around a little hill and, with nothing else to do, I hiked up to the top to stare at the river. David sat down beside me, wordless for the first time in days.   An hour of contemplative stubble-itching passed in this fashion, watching driftwood float downriver in the turbulent current.

That´s when it hit me:  DOWNriver?!?   The driftwood is floating in the same direction that we have been traveling.   Put another way:  we, like the driftwood, have been traveling downriver.  Is it possible that all this time, ever since pushing off from the muddy shores of San Raphael, that we have been traveling towards Santa Clotilde, and not away?!?

“David,” I said, snapping out of my stupor abruptly, “which way is Santa Clotilde?”

“There,” he replied, pointing in the direction of an emergency radio antenna downriver.  An emergency radio antenna very much like the one in Santa Clotilde, that I was now noticing for the very first time.

I started to get excited.  “Do you mean in the direction of that tower, or at the tower?” I asked.

“Yes,” he said patiently, “I mean there.  At the tower.  That tower is the tower of Santa Clotilde.”

Gobsmacked.  Could it be that we had struck camp for the night in plain view of home?!?  Was this entire misadventure the Peruvian equivalent of 12 year olds pitching a tent in their own backyard???

“But, what, where, who, how…” I stammered, “how long would it take to get to Santa Clotilde from here?”

David stopped a passing local and asked.  The old man sized up our boat in a glance, thought for a moment, and said:  “20 minutes”.

A lone tear rolled down my cheek.

“Then I could swim there?”  I turned to David, perhaps a little too hopefully.  “Could I??”

“No doctor.  Piranhas.”

“Mucho piranhas?”

“Bastante piranhas.”

A second tear.

At this point Victor Hugo joined us and confirmed that he would be dropping me off in Santa Clotilde the following afternoon, after we finished our work in Copal Urco. Nelly sang out that food was ready.  A refreshing breeze blew through.  A bright blue tropical butterfly landed on my sandal.  The laundry was dry.  Birds chirped. Rainbows appeared on the horizon.  I was back in my happy place.

After lunch or dinner (I was never sure what to call it, we ate only one meal after breakfast), Victor Hugo was belatedly struck by the notion that he had chosen the wrong house for us to sleep.  Perhaps it was the 8 children running around inside the cramped hut, or the horde of pigs snorting in the swamp below us, or the near furless dog itching itself on the front stoop, or the sweat rolling down David´s face as he sat perfectly still panting, or the site of me trying – unsuccessfully – to lie down in any direction without banging my head on a wall.  Whatever it was that inspired him, Victor Hugo suddenly leapt to his feet and declared that he would find us another house.  A house with a breeze!  On the top of the hill!  I jumped up too and volunteered to go with him, curious to glean some cultural insight into the Peruvian phenomenon of arranging random home-stays.

Apparently the process goes something like this:

Victor Hugo (reaching the top of the hill and approaching the very first house):  “hey kid, is your mom home?”

Child (gesturing into the dark house behind him):  “Si.”

Victor Hugo (peering in the open window and shouting):  “Hey, senora, can we sleep in your house tonight?”

Random voice from somewhere in the back of the house:  “Si.”

Never failing to underestimate my Spanish, Victor Hugo then turns to me – in case I didn´t understand the preceding interaction – and confirms for me with hand gestures that this is where we will be sleeping.  I get it.

This turns out to be no ordinary hut, as the satellite dish parked out front would attest.  It houses the village telephone.  Fixed to a makeshift wooden dividing wall that separates the hut in two, with a thick cable running straight down from the grass roof above, this telephone booth looks about as inconspicuous as that of Dr. Who.  The whole set-up was so ridiculous that I couldn´t wait for someone from the village to come in and use it.   After the sun had set and we had strung up our mosquito nets haphazardly about the room, I got my wish.  The phone started to ring.

A little bit of context here:  night falls quickly and completely in this part of the world.  It was pitch black inside the hut.  The homeowners were sleeping in a separate part of the hut behind the partition, and making no sign of movement.  So Victor Hugo gets up, carefully navigates the dizzying maze of string and wires suspending our mosquito nets in the dark, and sleepily answers the phone.

“Buenas noches??”

Someone in the village is receiving a call from a daughter in Canada.  Victor Hugo gently sets down the phone, tiptoes to the door… and then hollers into the darkness of the night:



At this point I come down a bad case of the giggles, which only incites Victor Hugo to try harder.  He bellows louder, and longer, and repeatedly… practically winding himself… and all to no effect.  No response from the perfect darkness.

Victor Hugo tiptoes back to the phone, picks up the receiver and asks, “in what part of the village does Senor Siguentes live?”  I assume, incorrectly, that he is going to wander through the village to track down Mr. Siguentes in person.   But this is not exactly what Victor Hugo has in mind.

He walks back to the door.   With great fanfare, he spins 100 degrees to face, presumably, the part of the village where Mr. Siguentes is purported to live.  He cups his hands to his mouth, and hollers:


I´ll be damned if he didn´t get a response right away.

Unfortunately Senor Siguentes looked to be about 80 years old, with arthritis to boot, and by the time he finally hobbled crooked-backed and wonky-kneed into the hut whoever it was on the other end had either lost interest or maxed out their phone bill.  Undaunted, Senor Siguentes cleared himself a spot on the floor amongst us and settled down in the darkness to wait.

I´m not sure how long he might have sat there, as my next memory is waking up in the middle of the night to the sound of a fast approaching tropical storm.  These night storms – with their impossibly heavy bursts of rain, wicked gusts of air, and incredible thunder that rattles your very chest – are my favourite part of sleeping in the jungle.  I stretched out on my ratty foam pad in dreamy comfort, secure in the knowledge that I was safe and sound inside the hut.  Safe and sound except, curiously, that my leg felt wet.  Very wet.  I did, on some level of consciousness, register that water was pouring through the top of my mosquito net but my initial response was simply to slide my foam 6 inches to the side, away from the stream of water hitting my leg, and go back to sleep.  Funny… now my whole head feels like it´s sitting in a puddle of water.

Suddenly I see the shadow of Victor Hugo leaping to his feet.  David bellows in surprise.  Nelly cries out in Spanish.  Not too far away a lightning bolt strikes and, in one brief nano-second of illumination, I register that the roof is leaking. EVERYWHERE AT ONCE.

What happened next plays out in a series of bursts of lightening.  There is no soundtrack to this comic-tragedy as the pounding rain and heavy thunder drowns out all the screams of anguish.  Flash:  Victor Hugo, in his boxer shorts, running in circles and doing – if I saw correctly – jazz hands (cue the bumblebee costume).  Flash:  David, unwisely, rolls himself into his foam and becomes a human armadillo. Flash:  Nelly, brightest of the bunch, makes a head first dive for the dry spot under the phone booth.  Flash:  Victor Hugo is either tearing down our mosquito nets intentionally to keep them from getting wet, or, and I favour the latter, is caught in the strings and is raging about the room like a shark trapped in a fishing net.

Suddenly, a candle.   Help has arrived.  The matron of the house emerges calmly from the side of the house that HAS a working roof.  She is holding in her hands – wait for it – two tiny tin pots.  The Titanic is going down and she has arrived on scene with a half-liter bailing bucket.

I won´t continue aside to say that the next hour or so was not my favourite part of the trip.  Standing against a wall in the darkness at 3am and waiting out a storm is not my idea of eco-tourism done properly.  Eventually however the rain abated, Victor Hugo was untangled and, through the blessing of uneven flooring, the water rolled out of the house as quickly as it had come in.  By the time David cautiously poked his head out of his foam roll again, we were able to throw our soggy beds back down to sleep.

The next day, Santa Clotilde:  land of dry beds, proper roofs, well-cooked meals and, of course, my curious friend Leo the Macaw.  I´ve only been here for three weeks total, but it already feels like home.

Tomorrow a team is embarking on a 15 day trip upriver to the villages surrounding the town of Buena Vista.  FIFTEEN days.  Victor Hugo is sidelined with a serious case of Dengue Fever.  Nelly has managed to keep a low enough profile to avoid getting enlisted.  David is due back in San Raphael.  I was asked but, unfortunately, can´t go.  “Darn it,” I say, trying to sound convincing, “if only I wasn´t flying back to Canada in 11 days…”.

January 29, 2011

Bienvenidos otro vez a Santa Clotilde Centro de Salud.

I only have two days left in Santa Clotilde, and I thought I would send one last letter before I leave.  Padre Jack zipped off to run some errands in Lima last week while I stayed here to guard the proverbial fort, leaving me as the sole remaining English speaker this side of the Rio Napo.  Put another way:  I´ve just completed a 216-hour game of charades.  To everyone´s relief Jack returned Tuesday afternoon, enthusiastic and energetic as ever, and positively triumphant after the glory of this past weekend´s action in the NFL playoffs.  Yesterday morning in the daily staff meeting he managed to combine his two greatest passions – priesthood and football – with a five minute parable in which God paints his house green and gold. I´m not sure that the Peruvians understood all of the nuances but the overall message was clear:  God is a Green Bay Packers fan.

Although I didn´t relish the idea of Jack´s departure when it was first proposed, in hindsight it turned out to be a great opportunity.  Jack´s absence allowed me to play a more central role in the hospital than I otherwise would have, and with increased responsibility came the advantage of more direct interaction with my amazing Peruvian counterparts.  You´ve already met the likes of Victor Hugo and Nelly in a previous email; now I have the opportunity to introduce you to the rest.

I´ll begin with Dr. Alex, who graduated from Peru´s prestigious Cayetana Heredia medical school in Lima.   He applied to work in Santa Clotilde with a cover letter that read:  “At Cayetana Heredia we learned medicine on the poor in order to practice on the rich.  It is time to do the opposite”.  That caught Jack´s attention.  Three years later Dr. Alex is still quietly hard at work in Santa Clotilde, now happily married to a Lima-born nurse (Janina) who gamely left the big city to come here and join him in the jungle.  Beside them stands Dr. Fernando, another graduate of Lima, who has been in Santa Clotilde for nine months.  Just this week Fernando was accepted into the Oblates (priesthood) and, sadly for Santa Clotilde, in February he is being shipped to Bolivia for a year of elite jedi-level theological training.  Rounding out the medical team is the newly arrived and newly graduated Dr. Angelica – Lima born, Cuban trained, latin dancer extraordinaire.

Between the four of us we share coverage of a 20 bed inpatient department, a busy outpatient center, and a maternity program.  Santa Clotilde serves as the referral center for all of the isolated nursing outposts up and down the Rio Napo, and accepts and treats all comers.  The needs are great, the resources limited, but surprisingly the quality of medicine is never compromised.   I am impressed by the diligence and caring of the nursing staff, the attention that each patient receives, and the refusal to ever deny treatment regardless of circumstance.  Morning rounds here play out like those of the Intensive Care Units of large hospitals back home, each bedside stop accompanied by a detailed nursing report, animated debate, careful clinical planning, and plenty of teaching for the half dozen or so nursing students who are placed here by the schools in Iquitos and circle around Padre Jack like small planets in orbit.

It is here, on morning rounds, that my Spanish really gets to shine.  By convention each bedside discussion begins with a clinical introduction by the physician on-call the night before.  This is when I proudly step forward, chart in hand, and address the dubious crowd as follows:

“Pregnant lady… arrive at 4am… push push push… push more… much pushing… makes this (pointing to baby)… healthy… then push more… 20 minutes… placenta come… I find tear… tear small… fix good…  everyone happy… I go to sleep… I breastfeed well… no, mistake, HE baby breastfeed well… today vaccinate”.


“My friend Nixon… 8 years old… snake bites foot last night… sick and bleedy… medicine and fluids… now okay and eat breakfast… delicious”.

Those are the easy ones.  The more complicated patients – undifferentiated fever, kidney failure, odd rashes and unusual diagnoses – those take considerably more effort.  Sometimes the necessary hand gestures become so overwhelming that I have to set the chart aside to liberate my freedom of expression, re-enacting the mosquito bite that gave the patient dengue and then trying, and failing, to explain all the minutia of the clinical progression with pantomime.  In the end I collapse exhausted, frustrated, and sputtering in an exasperated explosion of English, French and Spanish, the appalled crowd keeping a wide berth from my flailing arms.  At this point Janina the lead nurse intervenes, bends over to pick up the chart, and carries on professionally as if nothing unusual has happened.  I recover in time to successfully mime the acquisition of syphilis for the patient in bed 6.

On the days when I am not post-call I am considerably more dignified.  On those occasions I stand confidently at the foot of the bed – head and shoulders taller than all of my surprisingly short Peruvian counterparts – and listen to the clinical history intently, almost as if I understand Spanish.  When the mood feels right, I quietly nod my head.  Sometimes Alex engages the group in lengthy bedside clinical lectures, which to my non-Spanish ears sound identical to the voice of the teacher in Charlie Brown.   Suddenly he will stun me by turning in genuine interest and asking, “and is this your experience in Canada as well?”  Fortunately I know enough about Alex to predict that he is usually right, and so I concur.  Always concur.  On those rare occasions when concurring has clearly proved to be an inappropriate response (what drug did you use for this when you worked in Africa?  “Yes!!”) then Fernando will step forward and gamely attempt a translation into English.  Unfortunately, unbeknownst to Fernando, to the best of my knowledge he does not speak any English.

Fernando and Jack

After rounds we scatter in different directions.  Angelica is happiest when doing obstetrics and quickly perches herself in the maternity consult office.  I prefer to sift through the wild and wacky unwashed masses in our unfiltered, un-triaged outpatient department.  One of Alex or Fernando will join me there or stamp out fires and fix up the inpatients, and the other runs off to the local high school where they each volunteer a couple of days a week to teach math or science. Jack doggedly tries to see patients wherever he can, but given his vast experience and kindly demeanor he has become everybody´s problem solver and can´t seem to take a step in any direction without being interrupted with a question or a crisis in progress.

Chaos in the Topico

In the middle of all this is the central “topico” (resuscitation and procedures room), where we all meet up at the right time, in the right numbers, whenever things get scary or interesting.  I consider it the heart of the hospital, and it´s the place that I like the best.  The shelves are overflowing with jars of fluids, stacks of dressing materials, ancient half-used medicines, and antiquated cast-away equipment from all parts near and far, and the end result is a hodge-podge of a procedure room that looks like it was designed by Dr. Seuss.  In the middle of the all this chaos is a lone hospital bed, above which someone has installed a surgical light from the 1920´s.  It harnesses all the power of a modern day nuclear power plant and converts it efficiently into a flickering light as bright as a candle.

On a shelf off to the side, heroically competing for space amongst all this clutter and yet somehow, magically, always visible from any part of the room, is the principle reason why I am here:  a framed photo of a smiling Dr. Kerry Telford.  Kerry was a mentor to me when I completed part of my international health residency at a refugee clinic in Vancouver, and she used to volunteer in Santa Clotilde on a regular basis.  In late 2009 Kerry and her baby daughter were killed in an airplane accident. For all of us who were inspired and touched by Kerry – and it is a tremendous tribute to her that we are so very many – continuing this work in Santa Clotilde has become a small part of her enormous legacy.  Everywhere that I go in the village, mentioning Kerry´s name is an instant ticket to shared memories and friendship.  To display her peaceful photo so modestly, in such a chaotic part of the hospital, seems to me the perfect tribute.

Through the window of the topico one looks out on the central courtyard, a small grassy space that is crisscrossed by staff and patient and tropical bird alike several hundred times a day.  It is here that one can sit and take measure of the inner workings of the hospital.  There is always activity out in the courtyard, and when appreciating the tidy landscaping, scrubbed walls, and general hustle and bustle, one could easily be fooled to think that Santa Clotilde employs a team of a hundred unionized maintenance workers.  In fact, as best as I can tell, the cleaning and laundry team consists of just one person, Yolanda, and all of the maintenance needs are met by the hardy duo of Orlando and the unfortunately named Nacho.  He makes me hungry.  The rest of the maintenance work here—indeed the bulk of it – is done by an ever-changing team of relentless volunteers.  Padre Jack had mentioned once that “for those who cannot afford the care, there are always little ways to contribute,” but I didn´t appreciate exactly what that meant until I carried my morning cup of hot milk to the courtyard one day and had a closer look around.  That man bent over cutting the grass with a machete… doesn´t he look like the father of the baby with meningitis?  And the lady scrubbing the walls – that has to be the mother of the boy who vomited up five live worms.   Won´t forget that face anytime soon.  Outside the kitchen washing up the breakfast trays – could that be the older brother of the boy with the nasty burn?  And the girl with the broken arm who is sweeping the corridor, isn´t that the… wait a second.  That´s the girl with the broken arm!  What is she doing sweeping the corridor!!

The hospital is perched on a bit of a hill and, if not for the tangle of trees and huts that block the panorama, it would otherwise afford a pretty nice view of the town and river.  The town itself is surprisingly well developed, or at least more so than I would have expected based on my previous experiences working in Africa.  The streets – never wider than 4-6 feet, for there are no cars here – are neatly built of concrete with gutters on either side for the copious rainfall.  The main streets have lights, at least between the hours of 6pm and 11pm, and here and there tangles of power lines penetrate grass roofs to light up a stereo or a television.  There is even a city sewage system, albeit completely non-functional, and two standard water towers, which are always empty.  The surest sign of progress is the presence here and there of random public garbage cans – something I have never seen before in travels through the developing world.  Presumably these garbage cans are dumped directly into the river when full, but their mere presence adds a soft touch of hospitality to the town.  Add in a central park, a thriving downtown with 6 or 8 general stores, and an unusual fascination with building impromptu outdoor volleyball courts, and Santa Clotilde is a genuinely pleasant place to go for a stroll.

Sometimes I go for these strolls just to stretch my legs, but most times I am driven to abandon the hospital in my perpetual quest for food.  The ladies in the hospital kitchen are always kind enough to give me bread and a hot beverage when they see me lurking in the doorway in the mornings, and lunch, which is taken around 3 pm, is something of a feast.  Nevertheless this is the full extent of food on offer and those long hours between 4pm and bedtime can sometimes leave me feeling a little wanting.  It is for this reason that the randomness of the afternoon strolls can prove so useful.  If, for example, I think that I might cook an egg for dinner, then rest assured that the egg store will most certainly be out of eggs, but in my randomness I might chance upon the girl who sells fried banana strips from a basket she carries on her head, and these will serve just as well.  If on the other hand I happen to crave fried banana strips, then I guarantee that the banana girl will never be found, but possibly, in my search for an egg, I will walk past a house with a papaya for sale in the front yard.  Failing that, in my walks along the riverfront there is an old man who has taken a liking to me and regularly greets me with offers of food, which I gladly accept for the low price of providing him company and watching him whittle wood. He will ask, “would you like an orange?”, and indeed I would, so I sit down beside him.  He will then shout to his hard-of-hearing wife who trots dutifully out to the yard holding bananas.  Or maybe bread, or a coconut… pretty much anything except for what he has specifically called for.  There are no restaurants in Santa Clotilde – at least not in the easily recognizable and predictable sense of the word – and so if all these avenues fail than my last and only trick, which I am not necessarily proud of, is to head to the charity boarding school and eat with the orphans.

Boarding School

In truth they are not, technically speaking, orphans.  But I do eat their food.  They are simply children whose parents live far, far away.  For one month every year Padre Edgar – one of Padre Jack´s Peruvian counterparts – runs a charitable boarding school for children who come (for free) from the remote and isolated surrounding villages.  In their one month of intensive schooling the children learn standard school fare, mingle with children from towns and places that they might otherwise never get to see, and are taught about their native Qeechwa culture, environmentalism, and citizenship.  As a raucously full boarding school – with kids stacked like lumbar sometimes 4 or 5 high in impossibly cramped bunkbeds – it is half school and half summer camp, with group activities and organized chaos scheduled for every minute of every day.  It´s a very interesting place to hang out when I need to get away from the hospital and indeed, when I first heard about it, it seemed like as good a place as any to offload the Frisbee that I brought with me from Canada.  Within five minutes of tentatively poking my head through the door for the very first time, Padre Edgar whisked me downstairs to the classroom / dining mess and put me in line for an omelette with the rest of the kids.  Like a stray animal who stumbles across food left out on the porch one night, I would return time and time again.

Padre Edgar and Leo

As the month draws to a finish the school will close for the year this coming Monday, and last night I was invited to attend the end-of-school assembly.  The idea was simple enough:  the kids, divided into groups of 4 or 5, were each assigned one of a set of “valors” (core values) and they were to artistically present – in whatever ridiculous fashion struck them – how they would incorporate this value into their community upon return to their villages.  A “valor” might be something like “solidarity”, or “respect”, or one of 10 other options whose Spanish equivalent was meaningless to me.  The point here is that it offered a very high probability of not only an omelette, but maybe even candy too, and I quickly accepted.

Aside from language and the physical surrounding, this particular school performance was not unlike any other assembly of 8 to 12 year olds that I have ever seen.  That is to say:  at two and a half hours long, the assembly was about 2 hours and 25 minutes longer than it needed to be.  What kept it interesting however was that I was invited to join the judge´s panel as a last minute addition, somewhat like a B-list celebrity judge on a low budget version of Peru´s Got Talent.  And by “invited” I mean “ordered”.  Lest I be inclined to mistake the gravity of the task ahead of me, one of my co-panelists, Dr. Fernando, quickly called an impromptu pre-assembly judge´s conference to discuss how the groups should be graded.  I volunteered that maybe we could just watch the assembly and then chat for 30 seconds to pick the winning group, but that of course was voted down as shamefully unprofessional.  Instead a 30 point grading scale was carefully devised and debated, including 10 points each for “creatividad”, which I generally understood, “presentacion”, which I felt like I could guess at, and “applicacion”, which baffled me completely and left me constantly dropping my pencil so that I could bend over and cheat from my neighbour´s scorecard.  It certainly didn´t help that I don´t speak Spanish, or Qeechwa, or have a refined palette for the artistic nuances of native Peruvian dancing.  In the end I created my own 30 point score based on “generousity”, which was directly weighted to the quantity of booze each group donated to the judge´s panel.  The local homebrew in Santa Clotilda is a fermented yucca product called maceta.   It happened to feature prominently as a prop in most satirical reproductions of life in the home villages and, since apparently no one had second thoughts about allowing 8 year olds to use the real thing in their presentations, there was plenty leftover at the end of each skit to be offered as sacrifice to the thirsty looking judges.  Three skits and three drinks later I found myself laughing hysterically at amateur shadow puppets, and weeping with passion over the majestic beauty of crayon drawings of forest animals.  At the end of the assembly I wanted to stand up and slur “you´re all winners to me!!”, but Fernando, consummate professional that he is, kept the panel focused and on track.  We reverted back to the points system for our final decision.

Me and Julio Down by the Schoolyard

When I am not working in the hospital, or begging for food, or stealing from orphans, there is one other activity which has kept me busy:  soccer.  Yes, tick South America off the list, I have now played football on four continents and counting.  In Vietnam soccer was played in the sand, with barefoot ninjas bedazzling me with tiny feet and fancy footwork.  In Ethiopia it was a game of heat and endurance, with no role for boundaries and wide open plains where kicking the ball laterally could lead at any moment to an impromptu marathon.  Central Africa, land of conflict, was defined by formal rules and official referees, and of course made most memorable for the always ridiculous substitute-player sideline shoe-transfer.  What would be the defining characteristic of football in Peru?

If I had to choose but three words to describe the Peruvian approach to football, I think I would use:  “complicated financial transactions”.

It wasn´t until week three that Julio, the hospital pharmacist, finally invited me to play in a community football match and – naïve rookie that I am – I foolishly left my wallet at home.  This led to an especially awkward moment at the beginning of the match when I suddenly realized that not only were players being assigned to different sides, but money was being centrally collected.  Perhaps sensing my confusion – or spotting my empty pockets – Fernando stepped forward, paid an unspecified amount, gestured in my direction, said something in very fast Spanish and bam – before I could ask any questions – the game had begun.

I should backtrack here to point out that the game was being played at a nearby schoolyard, on an outdoor basketball court.  Yes, a concrete basketball court.  I did at one point ask why we weren´t playing on any of a number of grassy soccer fields scattered around town and I was told, quite simply, “snakes”.  That seemed like a reasonable explanation.  Nevertheless, when you cram 12 adult men and a soccer ball onto a concrete basketball court, what you end up with is something that is not altogether soccer-like in appearance.  The ball spends a lot of time in the air, and there is an awful lot of good natured but necessarily violent hand to hand combat, and the end result is several mild concussions from repeated headers and a variety of black eyes from flying elbows.  It´s also a wicked amount of fun.

The game was timed to two fast and furious twenty-minute halves, at the end of which was an equally fast and furious transaction of cash.  We lost 5 to 3 and – disappointed equally by both the outcome and the brevity – I was on my way to try and settle with Fernando when it became clear to me that we were gearing up to play another game.  Cue the complicated and boisterous financial transactions yet again, and this time I took advantage of the delay to race home and grab some cash.  Returning with money in hand, I went to Julio and hesitantly held out an open palm of coins, hoping that he could settle whatever debt might be outstanding.  He routed through the stash thoughtfully, picked out two five-Sole pieces, engaged himself in the serious business of yet more complicated financial transactions with players on the other team, and then returned and gave me… a 10-Sole bill.


No time for questions however as once again the game was underway.   There were heads to collide with and elbows to contend with and, once again, after two fast and furious 20 minute halves we came out on the losing side, 5 to 3.  Yet more complicated financial transactions were taking place all around me while I lingered in confusion, waiting to see if someone would approach to ask for money.   Nobody did.   Then – who cares that the sun was starting to set – it became clear that we were gearing up to play yet again.  Repeat the madness.

This time, having established by careful observation that the going rate appeared to be five Soles, I put a single five-Sole coin in my hand, walked up to Julio with clarity and purpose, and offered the single coin on an outstretched hand.  Surely this could not be misinterpreted.  Julio collected it quickly, engaged in some rather laborious haggling with nearby players and then, after 5 to 10 minutes, returned and handed me… two one-Sole coins.


Start the match.  This time we won 4 to 3 and, albeit thoroughly exhausted, I was keen to hang around and see what this would mean for my three-Sole investment. After a number of yet more complicated financial attractions Julio finally approached me, pointed to Victor Hugo´s younger brother Watson, and said:  “you give him 14 Soles”.


So let´s recap.  Losing, and not paying in the first place, apparently costs nothing. Scoring two goals and getting a black eye in a winning effort nets -5 + 2 – 14 or a total of -17 Soles, which, most interesting of all, I have to pay to Watson.  WATSON IS MY TEAMMATE.


I didn´t have enough cash left in my pocket so a group of us straggled back to the hospital – Watson eagerly in tow – where I routed my piggy bank and came out with the 14 Soles required.  I gave this to Watson, who turned and engaged in a complicated financial transaction with Fernando, who turned and engaged in a complicated financial transaction with Julio, who turned and handed me… a 20-Sole bill.


Funny game this Peruvian soccer.   I can´t complain about the outcome however, black eye notwithstanding.

Now there are just two days left before I depart for Iquitos.  On Sunday I will be on call for one final time, breaking my streak of 3 consecutive Sundays in church.

Pause here to allow someone to throw a bucket of cold water on my mother.

Yes, in Peru I have turned into something of a church-goer, enamoured as I am with the spectacle of Latin American social gatherings.  Just a few of the unique perks of Peruvian mass that prove attractive to a lapsed catholic such as myself include the offering of wine for EVERYONE with communion, served in the always popular party style of chips-and-dip, and the latin American habit of mixing a little Simon and Garfunkle in with the church music.  Don´t believe me?  Search You Tube for “Padre Nuestro – Sound of Silence” for but one example of the Garfunkalization of the holy word.

Additionally, and most importantly, church is where I am most likely to encounter my good friend Leo, the world´s craziest Maccaw.  Leo is owned by Padres Jack, Edgar and Roberto, or perhaps vice versa, and as a free roaming Maccaw he has little sense of respect for formality or etiquette.  Halfway through mass last week Leo suddenly swooped into the church, searching for Roberto or Edgar and probably hoping for a peanut.  As the giant blue and yellow bird flew over the congregation zeroing in on the target destination of Padre Roberto´s shoulder, both priests frantically gave the international hand signal for “not now, not now you crazy bird”, confusing Leo and prompting  him to change the flight plan just as he was reaching the altar.  Now resorting to Plan B, Leo decided instead to land on a candle – which unfortunately was lit – and after knocking it over and threatening to burn the church down – all for lack of a peanut – he screamed loudly, dive bombed the crowd, and then swooped majestically to an impromptu perch above the main door of the church.  There he sat with his back to us, nonchalantly scratching his wing and perhaps looking for scorch marks, and trying for all the world to preserve what little dignity he had left.  THIS is what I call entertainment.  If I could get seconds on the chip and dip I would probably stay for an extra hour.

So that´s all from Santa Clotilde.  The going away party is tomorrow afternoon and then, unless I can weasel my way out of it, a night at the local disco to practice my latin American dancing.  Monday Iquitos, Tuesday Lima.  Wednesday its an overnight flight  to Canada and Thursday:  Toronto.  Finally Friday, if all goes well, I´ll back in Salmon Arm.

Dr. Richard Currie is a family physician practicing in Salmon Arm, BC.  To read more from Dr. Currie, check out his previous blog series on his MSF work in the Central African Republic.

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