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A river runs through it: a GP’s work in Peru

1 September 2009

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Practice Manager
Burton Croft Surgery, Yorkshire

Dawn has worked in healthcare for more than 15 years. During that time, she gained an Open University business qualification, giving her the learning to underpin her knowledge and move into management. Before moving into primary care, Dawn worked for a private hospital group, managing many successful projects including new builds and IT implementations. Dawn is also a freelance writer and is currently writing an A–Z reference book for effective managers. She recently completed volunteer training with the Prince’s Trust to mentor young people embarking on new business ventures

When we are feeling under the weather, our first port of call is usually to the doctors’ surgery for our GP’s opinion of our symptoms. But what if you lived in such a remote place you had no access to healthcare? How would you survive, especially in a third-world country?

Dr Jasmine Salih gave up her fulltime position as a GP working as part of the team at Burton Croft Surgery, a well-established practice in Headingley, Leeds, West Yorkshire, and took on locum work.

“I enjoy the locum work because of the greater diversity, as all practices are run in different ways,” she said. “However, I can’t always follow a patient’s care through to the end, which can be frustrating.”

Jasmine’s role as a locum GP has allowed her the flexibility to travel and volunteer for charity work. After travelling on holiday, she enrolled to help underprivileged people in Peru gain medical help and support through Scottish-based charity The Vine Trust (see Resource).

I spoke to Jasmine about her career as a GP and her experiences in Peru, which involved sailing up the Amazon on the aptly named Amazon Hope, providing aid and medical care to outlying villages along the river.

I asked Jasmine what made her want to be a GP. She replied: “There wasn’t anything specific but I had always imagined myself being a GP from a very early age. I always found visiting my own doctor fascinating, and this stuck with me.” During her training she worked in A&E, obstetrics and gynaecology. She then took a year out and travelled to Australia.

She said: “The variation makes it interesting. When you connect with a patient and see their care through to a positive conclusion, it really gives you a feeling of wellbeing. It is good to see that you are really making a difference.”

New experiences
Since she qualified in 2001, Jasmine has seen many changes in legislation – the changes to GP contracts being one aspect. The human rights act being implemented had a massive impact on mental health issues, end-of-life issues, ethical aspects, etc. Undertaking charity work with the Vine Trust has opened Jasmine’s eyes to many new experiences. Each member of the clinical team funds his or her own travel to Peru. The volunteers sleep on the boats and are allocated an interpreter to help them communicate with the local people.

The boats play a key part in providing primary healthcare services to thousands of people living in villages along the Amazon River and its tributaries. Being inaccessible by road, many of the remote communities in the Amazon have little or no access to healthcare provision. The boats moor up alongside makeshift jetties and wait for the masses to converge on them. Jasmine explained that the boats moor up in the morning, and the patients gather and are registered on the upper deck.

All the medical care takes place down below, where there are consulting rooms. “It can become quite crowded down below when everyone is working at full stretch,” Jasmine said. “When the ophthalmic teams are onboard there is a makeshift operating theatre set up below decks.”

Illnesses and infection
A mix of ailments is seen during the travels up and down the river: acute illnesses; sexually transmitted infections; skin infections; ear infections; diarrhoeal illness, and many cases of anaemia due to bad diet.

Some villagers, however, just come along for a look; they don’t really have anything wrong with them, but they think they need multivitamins. These are only given out if it is felt necessary (anaemia being treated with iron tablets). Each person is dewormed as a matter of course!

Jasmine saw a number of unusual complaints not usually seen in practice in West Yorkshire. These included tropical malaria, a machete wound and leishmaniasis – an infection transmitted by a fly, causing a skin manifestation. This can be treated quite positively with antibiotics. The Ministry of Health provides free antibiotics, but any patients who need these have to travel up river to the Amazonian city of Iquitos.

Tuberculosis is treated for free at the local health posts, which are scattered around the area but don’t have much in the way of drugs and dressings. Advanced cancers are prevalent in the young and old. There is no real treatment for these and so they will advance.

Jasmine told me of one young girl who had a facial cancer that was eating away at her face due to lack of treatment. “These things are difficult to comprehend as everyone wants to tackle the problem, but it is impossible due to the minimal care that is available. We saw a lot of pregnancy in young girls, sometimes girls as young as 14 came onboard for help and advice. There is often a midwife travelling with the crew for this very reason.”

Heated work
Jasmine has travelled out to Peru twice; the first time was purely for a holiday. The second time, she worked from a clinic in Belen and then sailed with the medical crew for five days; the standard trip most people undertake lasts nine days.

During her second trip, Jasmine also sailed for 18 days, travelling with the regular medical team for the standard trip and then with the ophthalmic team for the second leg. Their makeshift theatre was set up below deck, and they brought their own light and microscope onboard to be able to work effectively. There is little respite from the heat of the Amazon rainforest, as there is no air conditioning in the consulting areas.

I asked Jasmine why she went to this particular part of the world. “A friend had signed up for the trip and it gave me the incentive to do the same. They are looking for doctors or medical people with general skills rather than specialists, and I felt that I could offer that.”

Hope and charity
Had she found her trips interesting? “Very,” she said. “Going to work in another country, which is underprivileged, is quite a challenge. Working alongside locals gave me a much clearer understanding of how local people think and prioritise things. If I had been a tourist in the country I would never have had this insight.

“It was medically very interesting as I got to see malaria and saw stingray wounds and snake bites. Fortunately, I had my copy of Australian Guidelines for the Management of Snakebites, issued by The Vine Trust as part of their guidance notes!”

Did she feel vulnerable? “Not really. The charity ensures you are well protected. However, Scripture Union Peru, who work in partnership with The Vine Trust, were alarmed when I told them I went into Iquitos town for the day on my own. I felt safe; the locals were lovely and very friendly. They were fascinated by my fair skin and blonde hair.”

Do you think you made a difference in Peru? “Probably not; no one person can. It is a team effort. When you weigh up all the facts, those with acute illnesses get treated. Primary care is provided, as regularly as is possible, with secondary care needs such as cataract and hernia operations being provided when the teams are available. The boats serve three main areas with quarterly visits, which are not enough, but do make a difference.

“The people involved in the charities are dedicated and are trying to promote self-reliance rather than the need for foreign input.”

As one Amazon Hope volunteer is quoted on their website as saying: “Compared with other craft on these rivers, the arrival of the Amazon Hope is like the arrival of the Starship Enterprise!”

I am sure all the locals have a feeling of hope when they see the boats arriving with their volunteers, as they not only bring medical help but also religion, with the help of an onboard preacher.

Many of the communities visited do not have clean water or sanitation. The villagers go down to the river to drink or carry water back to their homes. The charities are now working to improve water supplies to the communities that the boats service through their clean-water project.

Jasmine summed up her travels by saying: “Working in such basic conditions with very limited access to investigations and medication, and even less ability to follow up chronic disease, reminded me just how important general practice is. Revisiting the core values of general practice, and attending to the individual needs of patients presenting in surgery, has become increasingly difficult in a target-led NHS.”


The Vine Trust