Doctor's Review: Medicine on the Move

November 22, 2017
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Remote Area Volunteers to Guyana

They appeared seemingly out of nowhere, off a jungle side trail none of us had noticed. Six small children in bright uniforms, the youngest only three, walking silently in single file. It was 7am and they were setting off on a one-hour uphill hike to school.

Other times, we stumbled on hidden waterfalls, a pair of blue macaws flying by, and starry, starry nights. Small wonders like these were a regular feature during our two-week visit in February to the mountainous Pakaraima region of Guyana, near the Brazilian border. We were a group of 12 who had signed on with Remote Area Medical Volunteers (RAMV) Canada to provide medical services to secluded Amerindian villages.

Our enthusiastic team leader was Dr Gary Samson, a retired Cape Breton dentist and veteran of seven previous RAMV expeditions in both Guyana and Nepal. Along with Gary there were two other dentists, two GPs, an optometrist, an orthoptist, a pharmacist and four support personnel. Baggage allowance was pushed to the limit; 20 hockey bags and backpacks were stuffed with medical and camping supplies and a whole lot of trail mix.

From the capital of Georgetown we flew to Paramakatoi (known as PK), where we pitched our tents outside the guesthouse and set up for two full-day clinics. As a central regional village, PK was well staffed with both a nurse-midwife -- nurse Saigo, a village fixture for over 30 years -- and a Medex, usually a community health worker with one-and-a-half years of training.

I was keen to start seeing patients, but Joanne Perry, an Ottawa GP who had been to Guyana on three previous trips, warned me not to expect too much excitement. During our brief stay we would miss the more common dramatic illnesses such as malaria, complicated deliveries and trauma.

The Amerindians who make up the vast majority of the population in the Pakaraima region are quite healthy and often struggle to come up with a reason to see the "medical doctors." It seemed the social aspect was a big draw -- most of the village turned up for the occasion. We spent time with the Medex and nurse, consulting on more complex cases and emphasizing the importance of mosquito netting and regular deworming, especially in children.

A few house calls gave me a glimpse of the local lifestyle, best described as very simple: mud and thatch houses, dirt floors, woven hammocks and a low bench or table as the only furniture. An elderly man who had fallen and injured his abdomen was in urinary retention and required catheterization. My relief was as great as his when the red-tinged urine started pouring out into a bucket (no leg bags available).


Remote Access
Arrangements had been made to hire 18 porters, known as "droughers," to carry our equipment and supplies for the next 10 days. These men were mostly local farmers, incredibly fit, shod only in flip-flops and carrying few, if any, belongings. To break us in gently, Gary had planned our first leg as an easy two-hour hike downhill through jungle forest to Bamboo Creek.

That route would not have been so easy when done in the opposite direction, at night and transporting a woman with post-partum hemorrhage, as had happened a few months earlier. She was airlifted from PK to Georgetown and survived.

On our early morning hike all was quiet, majestic trees towered in the canopy overhead and Tarzan-quality vines could be seen everywhere. Thankfully, there were few insects or other nasty creatures about, though Thomas, the head drougher, carried a rifle in case we met up with the jaguar, whose tracks he occasionally pointed out.

Bamboo Creek was the smallest settlement we would visit, so we allowed only a half-day clinic there. Afterwards, our trip followed a set pattern: rise at 5AM, pack up and eat breakfast while still dark, get ready to head out by 6:30, hike five- to six-hours to the next village, set up tents in a church, school or sometimes the clinic building itself, and run a full-day clinic the next day.

Tuseneng, our next stop, was a lovely village set in a river bend where the forest thinned out into savannah. We were met there by a Jesuit student priest who hiked with us for the next few days to Kato, site of those wonderful hidden waterfalls and then, finally, to Kurukubaru, where we held our last clinic.


Down And Dirty Diagnosis
The medical problems varied little. Arthritis, vague abdominal pains, fungal skin infections and occasionally "bush yaws" (cutaneous leishmaniasis): a nasty looking but generally benign and self-limiting ailment. We saw snakebites in various stages: healed scars, slow-healing ulcers, secondary infections and one fresh bite in a young man with early sepsis.

Worm medicine was doled out generously as were ibuprofen and multivitamins. Many medications were provided by Health Partners International of Canada, a charitable organization that supplies medical supplies at minimal cost.

More complex were the cases requiring referral: hernias, massive splenomegaly and complicated pregnancies. These patients can be sent to Georgetown once all the lengthy paperwork is done, but many opt to walk over the border to Brazil, a one- to two-day journey, where the socialist government of Lula da Silva treats Amerindians without charge.

The dental and eye teams were usually much busier than we were, as this care is rarely available locally. Unfortunately, dental caries are rampant and the dentists, with no capability to do fillings, were forced to extract the most symptomatic, abscessed teeth.

In the future, this could change, as lightweight, battery-operated drills become available. Most villagers, big and small, were eager to get their eyes checked. Dr Victor Spear, a Toronto optometrist on the team, noted the remarkable absence of cataracts in the older villagers, which he attributed to their traditional diet of cassava and antioxidant-rich fruit.


Work In Progress
Does handing out a few pills and creams make any difference? Joanne's perspective of repeated visits over a seven-year span allows her to note many small but significant improvements. "When I first came, if I asked about contraception, all I got was a blank look. Now many women come in to ask for family planning pills, which unfortunately are only sporadically available to them.

Many villages have new clinic buildings, the supply of medications is better, immunizations are now routine and the Guyanese government has just instituted a lunchtime feeding program for children in schools.

None of this is directly due to RAMV, of course. But the fact that this small group of outsiders is constantly returning to these underserviced areas makes it harder for the government to ignore its Amerindian population and their pressing needs.

We flew back to Georgetown with a quick stop at the spectacularly beautiful Kaieteur Falls, site of the "Trudeau Lodge." Apparently our former PM had a close relationship with the Guyanese prime minister of the day. A guesthouse was built especially for Trudeau to use on his honeymoon with Margaret, or for a tryst with Barbra Streisand, depending on which guide tells the story.

The capital, low-rise and rather charmless, squats on the banks of the mud-coloured Demerara River. We were met and escorted around by Ann and Paul Geer, a Guyanese couple who lived some years in Canada and who provided invaluable logistic support to the team. A final dinner at a Brazilian restaurant, complete with wickedly strong caipirinha rum drinks, allowed the carnivores among us to make up for the steady starch diet of the previous two weeks.

Such close living quarters, hard work and long hiking isn't everyone's idea of a relaxing holiday. But for those who join a RAMV field trip, the rewards are many and long lasting. Well over half will return for another expedition. Small wonder…

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