Laura Gilchrist / Medical Officer / Christchurch, New Zealand
In May 2014, UK doctor Laura Gilchrist, alongside four others and a medical student embarked on her first jungle medicine adventure: two weeks aboard the Amazon Hope. Here are her five lessons from an incredible voyage.
One bored Tuesday in 2010, at the end of a frantic junior doctor shift, I found myself in Edinburgh University lecture theatre at a ‘Wilderness Medicine’ talk. Internally questioning whether there really was more to medicine than drug charts and discharge summaries, the speaker talked with such vigour that all my fears were at once put aside. As the slideshow of snake bites and parasites unfolded, I was captivated by the idea of practicing tropical medicine, with a boat as my clinic and the Amazon as my wallpaper.
1) Yo no hablo español
Down in the deepest bowels of the boat, floating amidst the Amazon jungle and in a room the size of a broom cupboard, I call in my next patient. In walk a family of five. With my interpreter Ronald and I, we are now a total of seven. I have never felt so grateful towards the inventor of air-conditioning.
‘Cual es su problema?’ I enquire, perhaps overconfidently. I have been rehearsing Spanish for over a year, and want to test how far I can get. I am met with blank stares. I repeat the question, adopting a slightly Hispanic accent, musing that my accent was my downfall.
Ronald laughs, but the patients – a brightly-beaded Mother with an infant in her lap, and three other children, continue to stare vacantly. I wonder if I am missing the joke.
‘This is a Quechuan family,’ he chuckles, ‘They don’t understand Spanish.’
‘This is a Quechuan family,’ he chuckles, ‘They don’t understand Spanish.’ These patients belong to a minority Amazonian tribal group. Eagerly, I urge him to start translating for me, but it turns out he does not speak Quechuan either. As I overhear the buzz of the brimming waiting room, I am aware I must work fast. With the use of no language, at all.
This is certainly a test for my stethoscope and examination skills. With this cultural group, I am also informed that women are hesitant to have pelvic examinations or to provide urine samples without their husbands present. I have flashbacks to communication skills classes at University; there was definitely not a session for when translation is impossible and certain examinations are forbidden. Aside from accosting a member of boat crew who could speak the language, universal sign language is the only option.
2) The Amazon doubles as a toilet and a drinking source for many
I reconvene with the other medical volunteers on the top deck at break time, keen to hear how their first morning’s consultations have gone.
Luckily my language issues have not been encountered by anyone else; the vast majority of patients speak Spanish. For them, the morning has brought diarrhoeal illness, headaches, sore throats and coughs. Not a far cry from a morning surgery back home.
Unlike the UK however, Giardia is often the culprit here: a microscopic tailed parasite which plagues the intestines, ensuring the host cannot venture far from the toilet. It becomes clear that this is a part of life for many Amazonians, as their only water supply for drinking, cooking and washing is the Amazon itself. We can only offer the temporary solution of antibiotics for the whole family – the large scale infrastructure required for a longterm solution being too much for our small boat.
We also give mebendazole, which treats worm infestations, to every child under three. Although I later meet a lady who presents with parasites visibly crawling from her mouth, most parasitic infections are subtle, causing long term physical, nutritional and cognitive impairment.[1]
3) A three-month wait to see a doctor brings perspective to three hours in A&E
The floating clinics are the only chance many of these people in remote locations have to seek medical care for three months at a time. Understandably, they are very popular. In the first day alone, amongst ourselves, the Peruvian medical team, the dental staff and midwife, we turnover around 250 patients. The medical boat travels to different villages along the Amazon, saving the patients a long canoe or boat ride to Iquitos, the nearest large town. Each beautiful sunrise aboard the Amazon Hope brings a new village and a new set of patients and medical problems – from the common to the unusual or even downright bizarre.
For the British team and I, this is an exciting ten day excursion where we get an opportunity to practice travel medicine, live aboard the Amazon, and help the local community. For the Peruvian team, this is their working life. We are in absolute awe of the devotion and passion the Peruvian team display, trip after trip.
4) A floating hospital by day may be a salsa club by night
Although the days are long, and all hands are on deck by 7am, each incredible meal is enjoyed together, and there are plenty of inventive activities. Afternoon clinic finishes around 5pm, giving ample time to explore the new village and keep up fitness in one go. The competitive spirit of the kitchen staff is enough to spur anyone to run around an Amazonian village in subtropical temperatures.
‘I am very fat,’ Israel calls, practicing his English ‘I am going to beat you. You, Laura are very slow.’ I hate to tell him ‘fast’ and ‘fat’ have very different meanings.
By night, an array of entertainment is put on for us by the Peruvian team. The medical director of the boat, it seems, doubles as a salsa instructor. The deck, (a clinic area by day) re-emerges as a dance hall. So follows our first (hilarious) South American salsa experience.
5) When your boat breaks down, help out the local doctor then search for pink dolphins
Just as our clinics begin to run smoothly (like a well-oiled ship, you might say), our ship’s engine stops running altogether! Day seven of ten, we find ourselves stationary at the only village with a medical centre. Self sufficient with its healthcare, the boat rarely stops here long.
Stranded for an indefinite time period, and awaiting an engineer from the mainland, we decide to take a tour. The clinic harbours several forlorn consultation rooms and an observation unit. Hundreds of clinical notes are stacked erratically behind reception.
Naturally, we assume that the enormous population served by this practice would be reflected by a sizeable medical team. Yet we are introduced to the district’s only doctor, on-call for six months straight.
Swift calculation by our medical director equates to… impromptu boat-based clinics, of course. Word spreads quickly, and we suddenly have a queue of villagers a kilometre long.
The busiest day of all unfolds, bringing with it the first, and only, malaria diagnosis of the trip.
As a reward for our work, (and because the boat is still lacking lustre,) we are surprised with a spontaneous fishing trip. Although the fishing itself is unfruitful, we are regaled the urban legend of ‘Bufeo Colorado,’ a pink dolphin who shape-shifts into an attractive fisherman to seek ‘land-based’ females to impregnate. Although among the most endangered and rare species of dolphin, we are sufficiently captivated to convince ourselves that we have spotted one of the elusive creatures.
Homeward bound
Under the dusky wash of the setting sun, the Amazon Hope chugs slowly back towards Iquitos. The clinics are completed and the people of Amazonia have replenished stocks of analgesia, antibiotics, and antiparasitics. They are up to date with eye checks, dental checks and obstetric care. The well-timed emergency cases have been treated. Those less well timed are a troubling thought. Villagers must wait patiently until the boat’s return in three months time.
While thoughts of wrestling snake and scorpion bites provoked anxiety before the trip, language barriers and sheer patient volume were the major challenges. Jungle medicine may have mirrored medicine in the developed world more than anticipated, yet the backdrop of the largest rainforest on Earth, incredible wildlife and exquisite sunsets coloured the most unique clinical setting imaginable.
Joining the Amazon Hope
Amazon Hope accepts /
- GPs within the NHS or in Out of Hours care
- Dentists in practice in the UK
- Nurses or nurse practitioners in primary care or A&E
- Doctors working in A&E, or paediatrics
- Ophthalmologists, Optometrists and Opticians
- Medical elective students
You can expect to manage /
- Tropical diseases, including malaria, Giardia, amoebic dysentery
- Basic Obstetric care
- Minor injuries and minor surgery
- Paediatrics
- Tooth fillings/extractions
- Diabetes/asthma/blood pressure management
Time of year / The best time of year to plan your trip is UK summertime. Although humid all year round, the rainy season is January to June, so prepare for a wetter trip if you go at this time!
Religious affiliation / Amazon Hope is a Christian-based organisation. This does not mean you have to be a practicing Christian to take part. There is a morning prayer meeting but this is optional.
Language / It is not essential to speak Spanish for the trip, as your clinics will be always be supported with an interpreter. However, knowing a few basic phrases goes a long way with the locals.
For further information, and trip dates for 2015, visit the Vine Trust.
[1] Halliez, M and Buret, AG, (2013). Extra-intestinal and long term consequences of giardia duodenalis infections. World Journal of Gastroenterology, 19 (47) 2013 Dec 21.
