Three days in the Amazon

Day #1 – I'm writing now from within the ghostly protection of my mosquito net, by the light of a candle. It is dusk. We're in the Amazon. Monkey roars, bird twitters, frog chirps; the occasional shriek of a macaw. There is something so other-worldly about being in the rainforest – even on merely a tourist expedition – a certain untamed wildness about these places that commands respect and caution.

A long story to get here, briefly to catch you up, my parents came on Friday, I showed them around Cusco, and we went to chabad. Expect for Hanna who wasnt feeling well. By the time we got back on Friday night, there was vomit on the coverlet and Hanna was burning up. Shabbos day we went to chabad, walked around, came home and rested and stayed in debating what to do about Hanna. She was still vomiting large quantities of fluids and couldnt keep anything down. We were all slated to go to Manu, the wildest part of the Amazon that is reachable in a few days, but with Hanna sick as she was, we werent going anywhere. Instead we put off the trip one day and waited her out. In the meantime we horseback rode in the Andean hills, over the cloudline, through golden grasses, eucalyptus groves, ancient Incan ruins, and mysterious tunnels and caves. A lovely day, but when we came home, the TV wasnt on, Hanna wasnt complaining about there being no food in the house, she was still pretty sick. What to do. After a lengthy debate, I sent Mom and Dad to Manu – someone should see it, and I felt resourceful and familiar enough with the area to entertain us for a few days while they were gone. So 5am Monday they left. I spent the day organizing our own trip to Puerto Maldonado, the more accessible (fly in fly out) part of the Amazon. That I did it was a feat of luck and persistence in itself, but by this morning when we were supposed to leave, Hanna was still not feeling well. Then the tough call, is she just in post-illness fatigue, or is she really still sick in which case this was serious and we couldnt go. I was ready to resign myself, but in a surprise move Hanna wanted to try – the idea of warm humid weather and getting out of her hotel room was enticing – so we went.

The flight itself was amazing. In only 35minutes we flew over the colossal Ausangate range (which if youve been following the blog, you know all about), and witnessed an impossible terrain change. Until the Ausangate range, it is dry dry arid foothills for miles and miles. After the range, it is instantaneously lush and tropical. The classic mountains-block-the-rain-from-passing weather phenomenon, but to the extreme, with the Amazon on one side and high altitude deserts on the other.

We deplaned onto the airfield, hit with a wall of heat and humidity. It is only 80 degrees here right now (winter) but the powerful sun and 100% humidity make an instant sweat. It was really interesting, a very true and not so touristy rainforest experience. See, people actually live here. A rainforest community. And so it is not pristine or beautiful at first. It is thatch-roof shacks, rickshaws, barefoot kids, and stray dogs. It is chickens running in the streets and papaya plantations. Everything looks about ready to fall down, and certainly not water-tight which makes me wonder about the rainy season here. Once we passes a car in the river. I thought the guy had been trying to drive it through and gotten stuck, but the I realized he had just stopped the car there to give it a bit of a wash. There is so much dust here; the condensation on my waterbottle ran brown. We drove along a dusty dirt road for an hour.As we rattled along, little brown monkeys dived off the side of the road to escape the bus, the rainforest looked disorganized, scarred in places, with vines growing up and down and every which way, such that youre not sure which direction the forest is growing. Weeds, vines, groves of fine feathery bamboo punctuated with giant flat ovals of banana leaves. There are trees here that look like Dr Suess came up with them; thin white perfect branches with no leaves at all, just tipped with bright red poofs at the ends.

After an hour on the dirt road, a boat was next. This is the accessible part of the Amazon, I remind you. Stepping on the boat, you go through a snow-globe of tropical butterflies. Attracted to the banks of the river by salt deposits, literally hundreds or thousands of butterflies create a cloud of flickering florescent colors and patterns. Theyre like pests here – people waving the butterflies off their faces, wincing as their covered in them – which is funny because had we seen any single one of them in the park at home, we would run for the camera. My favorites were little white ones with intricate black spirals on the outside of their wings, like dizzy zebras, and then when open, a luminescent tropical blue band set against black tips.

The boat ride was relaxing, an hour and a half up river, stopping to see a herd of caybata, he large rodent in the world, munching happily on the banks. They look like a cross between a hippo and a guinea pig. It was interesting they paid no attention to our boat, but when one of the tikitiki motorized canoes passed, they bolted. They know who hunts them and who leaves them alone. We saw big white birds with blue faces and lots of egrets, logs of sleeping long-nose turtles and one big caiman (crocodile family). Local gone miners on sluicing rafts waved as we went by. But the boat transporting Amazonian wood did not – the guide pointed it out to me, and said it was illegal, but with poor law enforcement, nobody cared – such is life here. Poaching anacondas for their good-luck heads, crocodiles for their delicacy meat and skin, turtle eggs for soup, nevermind the PBS drives to protect the endangered animals, the reality is here, with now law enforcement people do what they want.

We got to the lodge by 4pm, drank our very welcome starfruit juice. And I promptly took a cold shower (running water here from the river, but clearly no warm water). Hanna is doing really well. Sleeping when she can on the airplane, bus, boat, and now in the room. She is feeling pretty good and recuperating, and actually has a pretty good attitude about the whole trip, "thats a huge guinea pig. These mosquito net canopies are kind of cool." We're going out caiman-watching tonight, and we'll see what tomorrow has in store.

Day #2 – Last night we cruised up and down the river in the boat, listened to the night sounds of the jungle and saw lots of tiny caimans. This morning, 4:55am wake-up call for the hike. Breakfast was 5:30 and we were on the trail by six. This was really the Amazon, how do I know? Because it was uncomfortable. Alive and uncomfortable. First, Ive never seen such diversity of mosquito. Usually they all look the same, you know? But here there were big ones, small one, black ones, white ones, striped ones, and medium-sized polka-dotted ones, to names a few. And they were everywhere. We were like the pied pipers of mosquitos, bringing along a bouncing joyful trail of them as we walked. I could see the rainforest only through a cloud. They hovered, alighted, and sucked when possible. However, I had a wicked good protection strategy: 1. Cover up with clothes that cant be bitten through (no cotton or thin materials). I wore a gortex jacket with the collar flipped up to protect my upper body and back of my neck, and nylon rain pants that traveled into knee-high rubber boots. 2. Hat with a brim. Ive noticed that mosquitos always hover around the top of my head and face, so wearing a hat with a brim has them hovering around that instead, off my face. 3. DEET. Sure its carcinogenic, but so is barbequed food , and you dont see me saying no to a BBQed burger, do you. All over my clothes and hat and jacket, apply liberally (but not yet to skin). Key places to get are edges – hat brim, jacket collar, sleeve cuffs, waistband if exposed. 4. Baby oil for the skin. Good old Johnson&Johnson baby oil over neck and face and hands if you think they might peek out. All this for the excellent result of trudging 6 hours through the rainforest without a bite.

We didnt see much wildlife except the constantly spectacular tropical butterflies and their spiky neon predecessor catepillars, but the flora and fauna was incredible. By 9 we had reached a jungle lake, were they served juice and crackers (just want to note, a juicebox! What a joke! As if that was going to be enough fluids. They had told us to bring water but some people didnt). There was a platform over the water, and we could peer through the cracks to see little pirahnas feeding on the sardines underneath. We took out canoes and watched the birdlife on the water, rainforest chickens with blue faces and 4ft wingspans, colorful tanagers and circling vultures.

The truth is, just walking though the jungle is like being in a fairyland; with the calls of the birds, and the smell of hot earth and living greens. The floor is periodically littered with impossibly purple or red or pink flowers. They nearly glow, and with every step hundreds of iridescent butterflies take flight, as if they were the flower pedals come alive. Giant glowing powder-blue, and tiny transparent outlined wings which allow you to see the jungle through them, they look more like fairies than insects. Then there is the steam that rises from the earth creating a mist around the fauna. When a beam of sunlight penetrates the canopy, you can see the rising droplets and the falling nectar. Its like being on another planet. Every few steps we would walk by a tree or a plant which gave birth to a branch of modern medicine. The salicylic acid tree (aspirin), the quinine tree (anti-malaria), and when the guide offered me a medicinal stick to chew (but not swallow), I took it happily asking what is this for? In a few seconds my tongue started tingling, went numb, and the numbness spread throughout my mouth rapidly; anesthesia, she laughed.

Then it was time to head back. We took a different trail home and it was tough going. First, my mosquito strategy started backfiring as the temperature climbed. Black gortex-nylon-rubber is not the best choices for keeping cool, and drops of sweat ran down my back, but Id rather be hot than open my jacket to the hungry mob waiting just outside. I ran out of water. Of course, because I had brought only 1.5L (Im sure Avi is so annoyed), and I drew out the last drops over the final hours. Then, there was the mud. So much mud. It was, in some place, feet deep and made of heavy clay and as the day heated up, it steamed furiously as we slogged through it. As if alive as well, it grabbed my boots and determinedly clung to them as I tried to pull them back onto my foot. It was tough going, hot and mosquitoy and fighting the jungle that tried to hard to suck us in and eat us. The best feeling ever was when we saw the man-made steps out of the jungle to the lodge, and got a tall cold glass of passionfruit juice.

Hanna slept through all of this: The night activity and all through the morning hike (good thing, Im not sure she wouldve enjoyed), got up briefly to pick at lunch and went back to sleep within 5 minutes. So she hasnt seen much, but shes here, and shes not complaining, so its a start. Tonight, night hike (not sure about that after todays), and then tomorrow, home. This has been great but a little lonely with no one to share it with, and quite so authentic that Im ready for a break from the hot humidity and the cold water – how nice to think of cool mountain air and a warm shower.

Now its siesta time, the heat of the afternoon, though some of the staff are out playing soccer. There are moneys in the trees overhead and a macaw on our window sill. Otherwise, the steady hum of the cicadas indicates the heat, and I am just going to sit for the next few hours and watch the jungle baste.


Day #3 – So Hanna couldnt handle the night hike, so I arranged to redo the caiman watching she had missed the night before. But she didnt have energy for even that. So she went to bed, and I went again on the tour. It was really fun – I hadnt realized how much I enjoyed it the first night. The air on the boat in cool and wet with no bugs at all. The stars are brilliant and both Jupiter and Mars are visible in the sky, along with the famous Southern cross. The night calls are incredible, and there is a 10 minute meditation where they turn off the motor and you just drift along the river silently listening to the voice of the night. The caiman spotting itself is cute. Someone stands in the front of the skiff with a bright flashlight (hooked up to a handheld generator for power) and scans the shores for the two red caiman eyes to flash back. Then we sort of sneak up on them, as much as 10 people in a motorized craft can sneak, and inevitably they look at us for two minutes and then scuttle into the water. They are surprisingly fast when they decide its time to go.

I went to bed at 8pm as always here, to the perfect sound of the million cricket choir, and was awoken this morning at the standard jungle wake-up time of 5am, to nearby throaty roars in the jungle. After Costa Rica, I know enough to not think these are jaguars, but rather, huge Howler Monkeys, which to me is about as scary. By seven we were back on the boat, speeding home towards Infierno port and then the bus and then the plane. As far as Im concerned, the water is the only place to be in the jungle. As the sun rose, it gave color to the black forest changing it back into its iridescent green. The clouds began to dissipate and the furious blue charged out. I could have stayed on that boat forever, skimming the flat water between walls of Amazon.

Back in Puerto Maldonado was the reality of being a person trying to live in the jungle. The chickens and the poverty and the little motorscooters and the lazy shacks; an ugly city of the edge of such pristine beauty. It is interesting, the people here are somehow different from the Peruvians I have met so far. There seems much less joy here. First, everyone who worked at the lodge seemed sort of beaten down, doing it for work and not for pleasure, which while the reality most places, was not my impression of Peru in general. Like the taxi driver who took us up to the ruins in Cusco; he stopped off to show us his favorite spot with the best view of the city. That could have been another fare he was missing, but he enjoyed talking to people and showing them his city; things like this have been my experience here. In Puerto Maldonado, people seemed to have problems, they work 7 days a week, all year, including Christmas, and though they get one month vacation, the tourism business is just too much, and theyre burnt out. This is what they said to me. It reminded me of medicine, and I thought how everyone needs a break, no matter where they are or what theyre working in, people are only made to work so hard before they start missing the things that make life fun and meaningful. Another example is our guide who was 24 and had a 7 year old son. She had tried going to school in Puerto Maldonado, but the classes were poorly taught and the teachers always on strike, plus she needed money, so back to work she went. She is a woman of the jungle, and left only for 1 years before she couldnt stand being away from it anymore. This is how it is, the jungle is in their blood, and yet in a way, a dead-end. She dreams of studying environmental law, but previously there was no law school in the jungle. A new one opened so maybe she'll try it, seem how it is, a possible new path.

Today is a fast day and a travel day, since there is not much I can do besides sit in a boat-bus-plane-van-train which without exaggeration is the plan for today. Tomorrow, we'll be positioned for a different cloud forest and a different tempo; Machu Picchu.

Ancient deep tissue wisdom

My parents are here! And the hotel offers very cheap massages on the day of arrival. So at 3pm we all filed downstairs into the high-end spa for our massages. We were given the option of Relaxing or Deep Tissue. I should have known by the fact that Deep Tissue was in a whole separate classification -- set in opposition to Relaxing -- that this was not going to be fun. I have a vague idea that it would be painful, but clearly not enough to stop me from trying it.

The problem with deep tissue massages, for me, is that without a lot of meat or fat on me, the only thing deep to my tissue is bone. Wincing the whole first thirty minutes, I kept thinking, I cant survive this. Certainly not without crying out. It was a bone-crushing rub. The masseuse actually got up on the table so that she could throw her whole weight behind her elbow which was being pressed again and again over my scapular ridge. I wasnt a believer then; mumbling mentally about this being a pseudoscience. I thought my back and body might go easier than my neck and shoulders, the muscles being bigger there, but turned out that my muscles were just pinged against my ribs like a xylophone. And there was no love in it either. This wasnt a Bethany massage. It was borderline angry, just shy of sadism (not so shy actually, but I want you to keep thinking that Im a pretty normal person).

Then around minute 40, a transition happened. I started to enjoy it. I cant tell if my body had just warmed up, or if the masseuse was getting tired and so pressing less hard, but whatever it was, I started to really relax into it. By the last 10 minutes I was actually smiling instead of gritting my teeth, and when I got up, I was a new woman. A lot like the stretchy mother in The Incredibles, and very happy. Crazy but true, in one hour, I went from skeptical to sold on the ancient wisdom of deep tissue massage.

Ahhhh

Luxury. Im staying in a hotel. With wifi, television with English channels, movies, a bathtub, and hot matte de coca in the lobby. Its inexplicably rainy and cold here in Cusco, and Im planning on taking the day off from here on out. A hot bath, matte de coca in bed, with a movie and internet. What a great day.

La Ultima Dia

What an AMAZING last day. Wow. Storybook. Cant go into it all right now, will have more time tomorrow afternoon. Basically, the morning we drove way up into the mountains and blitzed out 125 patients in 3 hours. It was insane. But I had the time to sit and talk privately with a woman who lived with the stress of her father being an alcoholic. Not violent, but she was so worried about him and didnt understand his disease. That was probably the most effective thing I've done in Peru. Then at 1pm we headed to Lamay, the clinic was packed by Jackie, and we ran out for a 2pm meeting with the Mayor.

It was some meeting; it was a diplomatic banquet.

In the top of the municipal building, they had decorated the party room with streamers and balloons and flowers. Everyone was there -- the elders of the community, the clinic workers, municipal workers, and of course the Mayor and his wife. They served us vegetable soup (still dumbfounded why anyone would opt not to eat meat), and beautiful fresh fruit, and we sat and talked and enjoyed. There was Bach on in the background. Everyone felt like they were going to be asked to waltz. Then Guido got up to talk. He spoke about all the back and forth in the year before, and how excited everyone was when we got here. But more than that, he said how impressed he was by the compassion and attention and sensitivity that each doctor and student displayed towards the poor people that we treated. And of course how excited he was to have a partnership that will continue on into the future to effectively improve the health of the people of Lamay. Then he presented us all with two large plaques, written on leather and pinned to a framed background. They are of course hilariously Latin American and so wonderful. Then each of us got a "certificate" which we assumed was a piece of paper, but here apparently means a hand-painted wooden plate personalized for each person. Incredible. We all hugged and laughed and some more people gave speeches and I even cried a little. We gave small gifts to Guido and Lucia (who always made us lunch), and formally gave the microscope to the clinic... with a red ribbon and all, like in a perfect dream. So much friendship and good will. I cant wait to come back next year. They all stood in the street and waved to us until the bus was out of sight.

The Ultimate Penultimate

Strike days are always the best because we spend time with people in the community, and thats the most important work. For example today in the market we met up with Yanett, she invited us to her house. We ate cake and drank papaya juice in her kitchen and spoke with her parents about healthcare in Peru. She brought various herbal remedies from her extensive medicinal garden, and they promised to teach me each and every yerba when I come back.

But tonight was the best night. For me, the best night in Peru. Nothing in particular happened, but it was the culmination of all our efforts here in a feeling of family and good will and excitement over improving the future.

First we had our regular Tuesday night meeting, with presentations of patients (from epilepsy to GERD), with some extra reflection. The reflection ran along the lines of, what did we give these people, what did we accomplish, etc. And we came to a very important insight. Yanett's family was saying to us what we so often hear in the US: The last generation of doctors just dispensed pills, we need someone to listen to our problems, to care, and to tell us we'll be OK. Raphael Bendezu, the Peruvian doctor here, also offered a similar insight, saying that listening to these people and reassuring them or directing them within the medical system is the most important part of the medicine we do here, and indeed medicine in general. The very fact that people like us -- who seem impossibly wealthy, educated, and glamorous -- spend time holding hands, kissing cheeks, bandaging wounds, teaching and explaining, and treating the poor country people with the respect they deserve, is a new experience for them. And can do as much for their state of mind as temporary fixes like albendazole or tylenol. As Raphael said, much of what we see here is a product of poverty, which is a bigger problem than just us (worth tackling, mind you, but slow to change), but a caring and knowledgeable ear can do wonders. Especially when coupled with meds, supplies, and community action to improve the system. A special moment was when we reflected, maybe we did more to help than we thought.

During this meeting, Senor Guido (the mayor) showed up to seek us out, and refused to interrupt the meeting, waiting instead for us to finish. It was amazing, but he was like a changed man tonight. In the past, very reserved, austere, tonight he was all smiles and kisses. Kisses! He knew our names and our plans and was thrilled about the ideas of a mobile clinic and a womens shelter. More than thrilled. He was like a giddy schoolboy making faces and jokes. Jokes! I kept looking around like, is this really happening? He met with everyone and then stayed for dinner where the table talked regular social talk, trying (unsuccessfully) to explain American Football. It was an exciting energy, that we did great work, the mayor and community were our friends, more than that, like family, and we were planning for a future together -- a future dedicated to improving people's lives slowly but surely.

Dinner was the next phenomenon. We bought a huge cake to surprise the staff, and when dinner was over, everyone gathered and ting-ed our glasses and Anna stood up and said thank you so much, we feel like family here. Then Alida hustled the staff to sit down and we all served THEM cake and they laughed and ate and asked for our emails, and there was such a special warmth all around. Even Edwin had a piece of cake (one wont hurt). It was the perfect end. Guido and Edwin, the staff, some random stranger who became our friends after we fed them cake. Everyone was working together, using their power and lucky positions in life to help people less fortunate. Of one mind, and one heart. Sound cheesy, but thats how it felt in the room full of friends.

If nothing else, we built wonderful relationships with incredible people. Relationships to last a lifetime. This really was something to be proud of.

Strike!

This is Alida, Gita, and I at Hearts Cafe, an NGO we're making connections with in Ollantaytambo

Yep. It had to be that our penultimate day was quite Peruvian in that we cant leave the town. STRIKE!
This happens about once a week or once every other week. The strikes here are tranquilo, calm, with people parading, megaphones, and road blocks made of huge boulders that people roll into the road. No violence. Unless you try to cross the lines, then they slash your tired, throw stones, and maybe beat you up. But if you just walk over and dont provoke them by crossing union lines, tranquilo. So despite big plans to do a huge outreach program in Matinga, we are taking a forced administrative day in Urubamba. Its Ok. We need it. And tomorrow will just be crazy busy with all the stuff we couldnt do today!

Los Peruanos

Do you know, I love working in Peru. I really do. And there is one major reason for that; the Peruvian people. Unlike the stereotype some people have of South American countries -- siestas, fiestas, corrupt governments, manana-manana attitude -- Peru is quiet the opposite I have found. The Peruanos have huge hearts. They are dedicated to their people, and work often back-breakingly hard to support their families, friends, communities. They give charity at every level. They go out of their way to help a stranger as they would a friend. They laugh a lot, enjoy their chicha beers, are connected to their culture; know the old dances, language, philosophies. Values of community, physical work, connection with Mother Earth (pachamama), spirituality, centeredness, are so prominant, that people put aside more superficial values of money, fame, and success without thinking twice. The children are happy and playful, even with runny noses. Taught to work hard, the kids here are loved deeply, nursed and carried against moms safe back for years, but expected to be independent and to pitch in. One man explained to us the Ancient Incan morality as the famous phrase: Dont be lazy, Dont lie, and Dont steal. Its really these values that we see in the modern people.

So why is this coming up now? Besides every single day receiving an education from the Peruvians in generosity, selflessness, priorities (family, friends, community), today bore a special example.

We have been talking a lot amongst ourselves about the needs of the community here that we can work on in the future. A mobile clinic is a pretty straightforward goal which would be helpful. A more long-term one would be to establish a shelter for women and children subject to domestic violence. As I have mentioned in a past blog, we see many women bad situations (though my guess is that the numbers are comparable to the US; others here believe it is more pronounced because of cultural acceptance. Research question!). We saw this as a need, but it is most important what the community sees as a problem. Clearly we can only help out a community effort since a) were not so big and powerful b) were only down here one month a year and c) most importantly this needs to be a grassroots effort owned by the community (just aided by us) as this is the only way it will be embraced and sustainable. So today we had a meeting with Dr Sotomayor who works at the Lamay clinic day to day and spoke with her about our idea for a womens and childrens shelter but made it clear that we only are suggesting this as a possible course and her feedback would determine our course of action. She got really excited (for the first time as far as I have seen), and said she has been thinking about this need but never had any money or specific external push that could get it going. And she rounded us up and took us in the ambulance to the site that she has been plotting to use for this purpose. It is the old clinic. Abandoned for three years, in cobwebs and peeling paint and broken windows, we all looked at it and saw a brightly painted safe and healthy shelter building. She even showed us (though we couldnt get in because the bars on the front were rusted together), where the guard would sit, how the fence would run, she had this all thought through and just needed a little help to get it going.

This is how the Peruvians are. Forward-thinking, hard-working, and community oriented. When we think of an idea, they had thought of it already last year, but they just dont have the resources to do it. It is so rewarding working with them because they have all the elements and drive to better their own lives, they just need a little money and attention and energy to do it. And those are the only three things that we can really bring with us, so its a perfect partnership.