Those more adventurous among us ventured further away from civilization as we know it to conduct a promoter training in the community of Llachapa (jah-chah-pah). Our five intrepid explorers included myself, a fourth year medical student; Shelby, a third year pharmacy student (both of us have been to the area before); Igor and Alia, two soon-to-be second year medical students; and Beth, a soon-to-be second year PA student.
For those not familiar with the area, this is a small community of approximately 300 people, almost all of whom are either famers, fishermen or both, like many of the others on that part of the river. We selected Llachapa for our second training for a number of reasons. It is somewhat centrally located along the Napo River. Perhaps most importantly, it is probably one of the cleanest and most forward thinking of all of the communities in the area. The people there are extremely well organized, and as a result have benefited from the interventions of a number of NGOs working in the area. They have communal fishing ponds and fruit farms to raise money to build better community buildings, and they actually have a treated water plant, something few communities in the area can claim. One of the hopes in having a training in a community which has done so well for itself is that it can serve as an example for the people visiting from surrounding communities.
Llachapa also has a secondary school, complete with dormitories, which we were assured we would be able to use to house all of the promoters. (In the rural communities out here, few communities actually have more than a one room school house for primary school, and students lucky enough to be able to attend a secondary school do so two weeks on and two weeks off so they are able to participate in their families’ agricultural activities — more on that later.) Shelby remarked more than once that this high school was so nice it reminded her of the San Diego High school. It had its own power generators, running water and five enormous gazebos where the majority of the learning took place, all surrounded by dormitories sufficient to house nearly 100 students in a large cement and metal complex.
We woke up very early on the morning of July 7th and caught one of the first rápidos of the day (a boat made of metal with a big, >25HP, engine) out to the sleepy town of Mazan. Igor had arranged a motorista for us well in advance to take us via peque peque (a large canoe with what can only be described as an oversized weed-wacker as an engine) the 3 hours downriver to Llachapa. While our intrepid motorista was to pick us up precisely at 9 a.m., those of us who had spent a little time in Peru knew this probably meant about 10. We waited under the increasingly blistering Amazon sun on the concrete docks until about 11:30, when we decided that our motorista was probably (definitely) not coming. We had hoped the promoters would be ready to meet us in the community by 2 p.m. and, because we had some serious setting up to do, we were sort of in a hurry. We finally settled on a motorista who we felt was charging the smallest ‘gringo tax’ and we were off with a 9 horse power engine traveling down the mighty Napo with the jungle passing us by on either side at nearly 10 miles per hour. We got into Llachapa around 1:45, with a good many members of the community waiting to greet us and take our bags to one of the one room schoolhouses in the community and from there to the cement building with a tin roof (but large enough window to allow the slightest of humid breezes to pass through).
Imagine our surprise upon arrival to discover that school was to begin the same day as our trainings, and that there would be no beds for the promoters (or for us). Despite a month of thorough preparations by a highly competent group of medical students and our faculty mentor, Dr. Anstett, and the assurances (on numerous occasions) of multiple people, we found ourselves scrambling for housing for a large group of promoters and American students.
Fortunately, all the gringos brought our REI mosquito net hammocks and were able to string them up in the gazebos of the secondary school. The promoters, unfortunately, had been expecting a place to sleep, and the majority of them had nowhere to sleep but the concrete floor of the primary school. We had also purchased enough food for all the attendees for the entire duration of the training, which was stored at a nearby tourist lodge and was scheduled to be dropped in Llachapa before we got there.
The food had not arrived either.
But we powered through that afternoon, and after the training, Igor and I hurried as fast as the peque would take us to the tourist lodge with the food before the sun set. Fortunately, it was all there, boxed up and ready to go.
We had originally planned on one promoter from each of about 29 communities, and we ended up with 23 promoters from about 20 communities. Unfortunately, some of the promoters from farther downriver were unable to make the journey upriver, or unaware that they were invited to our trainings.
The first day of the trainings was for introductions. I recognized some of the promoters from my stay in the area two years ago, and some of them even remembered me. We all, however, had a lot of names to learn. We also handed out stethoscopes, watches, thermometers and blood pressure cuffs. The promoters were not used to receiving supplies like this from other trainings, as they were clearly surprised to be handed all of this diagnostic equipment.
Our curriculum differs from that of other trainings promoters have been exposed to in that it foregoes the large group lectures in a sweaty classroom in favor of small groups of 5-6 promoters led by one of us as the instructor. They loved learning about how to take vital signs, and many of them began to understand the importance of simple things like taking a pulse and a temperature. We also let them experiment with their new stethoscopes, which was quite the sight to behold. The way their eyes widened with delight when they were able to hear their neighbor’s heartbeat was something each of us really enjoyed watching.
-Jason Murphy, MS4
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