At night, it's inky black on the upper reaches of the Amazon. There is not a light to be seen after the generator is shut down. The only sounds are the bugs buzzing in the air and the mysterious animals in the jungle—and the night noises of humans sleeping on a boat rocking in the river.
The scene is aboard the The Nenita, a hospital boat based out of Iquitos, Peru. It's operated by Project Amazonas, an NGO in Peru that's working to deliver health care to small communities located deep in the Amazon, far away from traditional medical facilities.
The boat is staffed by people like Dr. Olivier Drouin. Drouin has been into the Amazon with Project Amazonas twice. He’s both a traveler and a volunteer. It's an aspect of travel often referred to as "voluntravel" or even more commonly as "voluntourism," and to people like Drouin, traveling to just get some great photos and have a nice story about your trip isn't enough. For Drouin, it's about knowing that the expense and visit actually made a difference in the world.
It was the summer of 2005 when Drouin first stepped off the plane in Iquitos and hopped a boat heading toward a Project Amazonas research station where he was volunteering on an ecology project. Drouin wasn’t a doctor yet. He was in his mid-20s, had just completed a biochemistry degree and was looking for inspiration and a way to give back. He'd already become the kind of person who gives back in the community. Even for someone who had grown up in rural Quebec before moving to Montreal, Drouin admitted he was in for a shock, not only by the quiet nights of the jungle, but by cultural differences. The Peruvian people he was helping, he said, had similar aspirations and dreams as his own, but their life’s focus and pursuit of those dreams was far different.
"I saw different priorities and expectations. People here (in developed countries), they worry about what will happen in 40 years when they reach 75 and will have to go into a retirement house. The people I met in the Amazon worry instead about more of what is going on today; tomorrow is a constant source of uncertainty for them, but it also brings a calm to the people there. There is a serenity in how they are focused on today's needs."
On that trip, working at a jungle ecology station, he made trips to some of the small villages with an ecology director to discuss agriculture with the locals. While there, he watched the program's medical director interact with the people in the villages. "Just seeing how he really cared for people was really inspiring; it convinced me to move toward medicine."
Six year later, Drouin returned to the Amazon as a doctor who had just completed medical school. It was a visit that sneaked him away from the pressures back home of starting his residency. This time, instead of working in an ecology station, he was aboard the hospital boat.
From Iquitos to the Jungle
The Project Amazonas hospital boat The Nenita is based in Iquitos, a large city dropped in a bend of the Amazon at the confluence with the Rio Itaya and the Rio Nanay. It's the kind of city that has an international airport with service to Miami. It has the discotheques where throbbing music pounds well into the night. There are the roadside food vendors, the established restaurants where you can still get the thick cuts of the local endangered fish, paiche.
For travelers and city dwellers, there is the central market, widely regarded as safe and relaxed. It's where you can buy granadilla fruit still on the vine. "It's like a passion fruit, but much better," says Jonathan Shanin, a Project Amazonas volunteer from South Carolina who is also executive director of non-profit support organization AidJoy. Then there's the Belen market ("You will either love it or hate it," he says) and then there is Lower Belen, a floating hovel of shanties built upon pilings. Shanin calls it the largest slum in the Amazon. It floods on a regular basis (every year, generally speaking), and there is no sewage system in place, leading to dire health consequences.
It's from this modern city that the hospital boat departs. The 74-foot boat is made of local hardwoods and features a barge-like flat bottom. It moves up the river, docking briefly at some of the local villages to give local people news that the boat will be returning to provide health care in the coming week. The boat winds its way up tributaries that are the headwaters of the Amazon. Running the boat is a crew of six Peruvians, many of whom have been with the boat for more than a decade. Their cargo is people—a mix of local ministry of health officials and non-local medical volunteers—and the medical supplies that those people need. As it floats back down the river, it then stops at the local villages to provide medical care.
The volunteers pay to participate in the trip. Their fees cover basic trip costs like the diesel fuel, the crew, the medicines and the food. There's a little left over from the fee that helps Project Amazonas grow, but it's money that is just as likely to be dropped into savings for the inevitable time that comes to replace the boat's diesel engine.
This is by no means a luxury trip. Some earn bunks. Some, like Drouin, sleep on deck at night under mosquito nets. The days are often difficult—not only because of the heat, but also because of the sometimes dramatic medical issues that are faced in the villages—but at night the team members sit together, laugh, tell jokes and eat communally on the top floor of the boat. It's not all needles and medicines; volunteers like Shanin tell of playing soccer in the villages, swimming for pleasure in the Amazon, or simply sitting down with villagers to exchange stories about their different lives.
"You talk about the same things we all experience. I tell them about my life, how I like to go canoeing like they do, or that I am dating a girl, that I go to work, that I like to visit my friends." Shanin's life in the mid-size city of Greenville, S.C., is a far cry from a thatched-roof village in the Amazon. The scenery and situation may be different (some of these villages are occupied by tribes which practiced cannibalism not too many generations before), but he says it's finding those common bonds that creates the smiles between the volunteers and the communities they are assisting.
By day, they deal in what they call "real medicine." It's medical care without the benefit of the high-end technology that might be found in a standard North American hospital. When the boat is moving up and down the river, there aren't days to wait on complicated tests before follow-up visits. It's often about understanding the symptoms and basing care around what can be learned from those conditions. The limited services that the hospital boat provides is a challenge, but the volunteers do what they can. The medical care may be limited by Western standards, but in terms of jungle standards, it’s cutting-edge medicine.
Vicious Cycle of Health and Poverty
"What I realized is how much distance matters in those communities, and not always in a positive way," explains Drouin. "We saw people who needed medical care, and if they had been in town, they would have had much different medical care than in those rural communities."
He tells the story of a woman they heard about from one of the villages. She was feeling ill and ventured out on her own for care. Because of the remoteness of her jungle home, it took her three weeks just to go to Iquitos where she arranged a CT scan of her abdomen. The scan wasn't good news. Her illness was being caused by a tumor in her abdomen, but she was sent home because she could not afford to stay in the city to receive treatment.
"It struck me how the place you live and where you are born influences your health at such an acute level," Drouin muses.
That problem that Drouin references is linked back to the Lower Belen slums, to the shanties and the raw sewage and yearly flooding. Shanin explains the vicious cycle that links lack of medical care in remote villages directly to the poverty and conditions of Lower Belen.
"When a child from a rural village needs medical care, the entire village will pool their financial resources to send the child and their parent to the regional hospital in Iquitos. The parent stays at the hospital while their child heals. By the time the child recovers there are no financial resources left to travel back to their village; the child and parent move to the only place they can afford, lower Belen."
It's the traveling volunteers working with the local medical authorities that can help break the cycle. Getting the boat to those villages and getting medical education into the community means fewer desperate trips downriver to Iquitos, and Project Amazonas is trying to take it a step further, building a permanent medical facility deeper in the jungle at Mazán that will eliminate the three-week trips that doctors like Drouin tell of. In addition, there are plans for a newer, larger boat with more medical capabilities. The Project Amazonas team members also look at cyclical problems not just through their MD glasses. The organization tries to address the challenges from a variety of angles, focusing on not only health care, but on conservation, ecology and education.
In the six years between his trips into Amazonian Peru with Project Amazonas, Drouin says he has seen change, noting more communities have access to health care and are more educated about health. The experience, he said, was rewarding. “I could have done the regular travel experience, something like seven cities in seven days, just going around and taking photos.” But the tribes he reached weren't meeting him to put on a tourist dance for tips, they were there meeting face-to-face and leaving as friends. It was a trip about authenticity and giving back.
Voluntourism isn't for everyone. Some people would be better off making a donation and going instead on a relaxing trip to the beach. But for those persons who feel called to be active participants in their giving, Drouin offers his simple tips for selecting a voluntourism opportunity that he has learned from trips to the Amazon, Africa and other developing countries.
First, he says, is that travelers must look at the mission and the vision of the organization. "It's a part of their website that people often overlook, but it tells you about the spirit of the people running the organization." (While you're starting to investigate the organization, do widespread searches about the organization's reputation. Sadly, there have been legitimate stories of voluntourism destinations that were thinly veiled shams built to prey upon the good hearts and thick wallets of volunteers.)
Next in importance for Drouin is that the organization needs to help from within. He says he looks for organizations that work with people from the local community, that are staffed and led by locals, so that it's not simply a case of foreign travelers visiting for a couple weeks, doing some good, but then the situation immediately reverting back to the prior condition when they leave because there is no existing local structure.
Third, before he commits his time, he says he likes to talk with the people who have been in the organization and in the field for a number of years. "I think that the best organizations are those that are making long-term commitments."
PHOTO GALLERY: Project Amazonas
Dr. Olivier Drouin (Montreal, Canada) teaches children the fine art of bubble-blowing after clinic winds down. ©Michael Bergen
Nightfall on the Ampiyacu River with the moon and Jupiter in in close proximity. ©Jonah Markowitz on behalf of AidJoy
A medical team member leaps from the Nenita riverboat into the cool waters of the Yaguasyacu River. ©Jonah Markowitz on behalf of AidJoy
Dr. Olivier Drouin (Canada) and Dr. Pablo Ruiz Beteta (Peru) interview patients, assisted by Yagua Indian elder Manuel Ramirez (in white shirt). ©Michael Bergen
A Bora Indian boy stands in the entrance of a traditional Amazon home known as a maloka. ©Jonah Markowitz on behalf of AidJoy
Pablo Ruiz Beteta (Peru) removes an encysted wood splinter from the shoulder of a patient, assisted by Leeds (United Kingdom) medical student Lucy Guile. ©Michael Bergen