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Volunteering as a doctor in remotest Peru

Dr Jasmine Salih put her clinical skills to use in a completely different setting when she volunteered for a novel and lifesaving healthcare project in Peru

Dr Jasmine Salih put her clinical skills to use in a completely different setting when she volunteered for a novel and lifesaving healthcare project in Peru

The city of Iquitos in Peru is so remote it cannot be accessed by road. Earlier this year I spent two months working for the Amazon Hope Medical Project, which is based there.

It all started during a study group meeting about eight months before my eventual departure when my friend and colleague announced her up and coming 'adventure' working as a doctor on a boat that provided medical care to the remote Amazonian villages in Peru. The seed was planted! The project is run by an organisation called The Vine Trust, in partnership with Scripture Union Peru. I duly visited their website at www.vinetrust.org and was reassured to find an obviously well-run project with back-up for UK healthcare workers from a doctor, nurses and a midwife provided by the Peruvian Ministry of Health. And they were looking for people with general medical skills making my background in general practice perfect.

Preparing for snakes and malaria

The boat trips are organised so that teams from the UK spend two weeks with the project, meaning that time off work is not usually a problem. However, because I am a locum GP I was able to take a longer period of time off and this meant I could also work in the clinic, situated in the shanty town area of Iquitos, and do some research on how to develop the project in future.

Once my signature was on the dotted line the Vine Trust sent me some very informative guidance notes. These included information on the conditions I could expect to encounter, the drug formulary for the project, information on malaria prophylaxis and recommended vaccinations as well as, more worryingly, the Australian Guidelines for Management of Snakebite. And so off I set armed with the Oxford Handbook of Tropical Medicine, my stethoscope and a pass in elementary level Spanish (although as translators are provided it is not necessary to speak any Spanish.) Peruvian doctors normally wear a 'uniform' so I was advised that theatre blues were the most practical clothes to work in as well as identifying you as being medical. I was also advised that it is often the disposable items such as dressings, urine dipsticks, tongue depressors and gloves that run short.

Rickshaws, canoes and boats

After a warm welcome by the Peruvian team I was set to work with my translator, Vladimir. I started off in the clinic, which operated from 8am-3pm Monday to Friday and on Saturday mornings. Patients were registered and had their weight, blood pressure and temperature checked by the nursing team before being seen by the doctor.

There were heavy rains during my first week and the area around the clinic flooded, so my journey to work consisted of a ride in a motorised rickshaw and then a ride in a homemade canoe.I was also able to go out with the boat on two occasions, the first for five days and the second for 18 days. We slept on the boat in air-conditioned cabins and there was a cook on board to feed us. The usual working day consisted of seeing patients at one village in the morning and then moving to another village for the afternoon.The medical consulting area was downstairs on the boat, which meant that with up to five doctors working at a time, things could get very cramped. Just as well there was often time to play football or volleyball with the villagers after work (as long as you didn't mind losing!).

The Peruvian patients

As in UK general practice, patients presented with a range of conditions, most commonly headache and dizziness, diarrhoeal illnesses, respiratory tract infections, UTIs, skin infections, gynaecological problems, STIs and malnutrition. Some of the less usual things were congenital abnormalities and developmental problems in children, leishmaniasis, malaria, a sting ray wound and – those Australian Guidelines came in useful – a snake bite.

Highs and lows

I did encounter some frustrating situations. The formulary was quite limited, especially towards the end of the boat journey when drugs tended to run out completely. On some days in clinic, especially when it was raining, we saw very few patients.

There were some patients, for instance those with cancer or with congenital abnormalities, whom we were unable to help and who are not entitled to free care by the Peruvian healthcare system. However, these were far outweighed by the positive aspects. Rewards came in the form of huge smiles from the children and sometimes gifts of fruit from the villagers. Working with the Peruvian team, who were incredibly dedicated, was an inspiration.

Working on the boat made me realise that I can adapt my medical skills to working in a different environment and I had a real sense that they were being put to good use. Working in a much more basic medical environment with only limited access to investigations, medication and less ability to follow up chronic disease has reminded me how important it is to get back to the core values of general practice and attending to the individual needs of the patient in front of you in an increasingly target-led NHS.Sometimes it's the simple things that make all the difference.

All in all, I found the whole experience hugely rewarding, both in a personal and medical sense, and hope to be able to contribute more to the project in the future.

Dr Jasmine Salih is a locum GP in Leeds

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