Wednesday, February 20, 2013

Parasite Research Project


Three years ago I went to the Amazon Rainforest with a medical aid team, providing immediate relief for physical needs of the people, but saw a much larger problem: short term solutions aren’t sustainable fixes for largely long term problems.  Anti-parasitic medications are given out to children with bellies swollen full of worms, but I knew in a few short months of drinking river water after the medication ran out, the parasite infestation would be back.



What really needs to happen is sustainable healthcare development that liberates the Amazonian people from dependence on outside support and breaks the cycles of disease.  In this case, instead of giving anti-parasitics as a short term solution, it is essential to teach the concept of germs, contagion transmission, and the importance of boiling or filtering water.

Because of this burden on my heart, the next year I co-led a trip with a nursing friend of mine focusing on teaching.  We created a curriculum that incorporated easy to understand material, props, microscopes, and hands on examples.  Doing it this way made it more fun for children and also not too complex for adults, most of which don’t even have an elementary school education.  We did teach a couple complex things such as how to make soap using palm branches and animal fat, and disease transmission. 

For those of you that are interested in making soap, I will briefly describe the steps.  This type of soap is essentially lye soap, or sodium hydroxide laced soap.  Sodium hydroxide is a strong chemical base which is why washing the hands with it kills bacteria (all bacteria, even the good).  By burning palm branches (the most accessible source of ashes in the area) and running water through the ashes, a lye solution is made.  When the lye solution is mixed with melted and filtered animal fat, it creates a soap.  Depending on the type of fat uses, the soap is either liquid or harder.  Chicken fat produces a liquid soap, pork and cow fat create a harder soap.  The process is a little more complex than described, but it is a very easy and accessible source of soap for better hygiene. 

This was difficult because their baseline understanding was very minimal, but we are hopeful that we made a long-term difference.  Changing one’s perceptions and beliefs are difficult and take a long time to implement.  It is going to require more than a single teaching session.  It is going to require a long term educational process that should originate on a governmental level.

I have been interested in parasites because of the children that I kept seeing coming into the clinics, unable to live normally because of the parasite side effects.  All I want is for those children to be happy and healthy.  Nothing pains me more than seeing them hurt, sick, or dealing with something that they shouldn’t have to.  Of course increasing sanitation and hygiene that is usually associated with industrialization directly affects that, but in a rural area of a developing nation, survival is really the only thing on their minds.

I am returning to Peru with a medical volunteer team this summer and decided that would be an ideal time to incorporate a parasite research project.  Because I have seen parasites as an issue, I wanted to investigate further by determining the extent of the problem numerically and statistically.  In order to do this I am taking a two pronged approach.  The fist approach involves a medication inventory of anti-parasitic medications prior to the trip and afterward, in order to determine how much was given out to the patients.  The second approach is to utilize a demographic, medical history, treatment and risk factor assessment survey during the triage station of the clinics.  This will allow me to get a better understanding of the depth of the issue, as well as allow for the possible future development of more focused, sustainable interventions.

In the future I would love to incorporate medical aid with medical teaching in order to improve sanitation and personal hygiene habits.  Hopefully, the results that I obtain from this year’s research project will encourage more focused intervention techniques.

Tuesday, February 12, 2013

Jungle Fears - Animals


Feeling defenseless in the jungle against invading critters, riding the waves of fear in the Peruvian Amazon. 

Insects & Arachnids:
When the sun goes down, headlamps are the only thing safely getting you from point A to point B in a jungle village.  Whether you are going from the kitchen to the sleeping quarters or from your hammock to the bathroom.  Nothing prepares you for the possible critters that you will encounter, some of which are not just dangerous, but deadly.  Because most of the villages have cement sidewalks, those are the safest thing to follow, but because they retain the heat, at night critters are attracted to them. 

On one occasion, quickly unzipping my army hammock (which has the mosquito netting on top) a couple of friends and I slipped on our shoes and headed toward the bathroom.  Already fearful that every noise was an animal about to kill us, we stumbled upon nothing more than a tarantula the size of my head! 

Yes a tarantula, a black tarantula which are very dangerous due to their potent venom.

The friends I was with were girls, so the inevitable scream came next.  It was like they were in a horror film.  Of course the rest of the guys came out then, thinking someone was dying, but finding out everyone was safe,  we just started taking pictures of it.
  
Tarantula’s are scary, but they are almost as scared of you as you are of them, so don’t think that they are going to attack you when you least expect it.  They are more interested in large insects, birds, and small mammals than in humans. 

There are other tropical spiders that you should be worried about.  The rule of thumb is the smaller and the more colorful they are, the more poisonous they are.  Don’t go putting your hands in places that you cant see, especially in places like thached roofing of houses and boats, that is where they like to hide particularly in the day time.

Other insects to worry about are catepillars, mosquitoes, flies, ticks, beetles, ants, and fleas.  Of course you will see tons of insects because 90% of the Amazonian jungle animals are insects.  A single square mile of rainforest is often home to more than 50,000 insect species.  Caterpillars shouldn’t be touched because many of them can  bite and sting, and those with pointy spikes on their backs may inject poison.  Many of the bright-colored beetles are full of poison and by native tribes are often ground up and used to tip arrows and spears.  The ground is ruled by ants like fire ants and army ants which can sting or bite through the skin.  Army ants are common in tropical environments and are aggressive and predatory insects which capture insects, spiders, and small vertebrates, and differ from other ants because they build living nests with their bodies called bivouacs in trees and burrows.  The air is ruled by mosquitoes and flies which are common disease vectors.  Mosquitoes especially the Aedes egypti mosquito are known to transmit malaria, dengue fever, and yellow fever.  Some flies such as sand flies transmit Leishmaniasis, Oroya fever, and Pappataci fever.  Some of the most common insects are:

Rhino beetle, Leaf-cutter ant, Metallic gold riondinidae, Paper wasps, Orange-striped paracaidas, Black butterfly, Deep red millipede, Copper grasshopper, Green mantid, Black beetle, Brachydiplax dragonfly, Giant tiger centipede, Leaf bugs, Pill millipede ball, Comet moth, Long horned grasshoppers, Giraffe necked weevil, Iguaze butterfly, Praying mantis, Dung beetle, Brown cicada, Huntsman spiders, Brown cicada, Heliconius sara butterfly, Honey bee, Red spider, Ceiba borer beetle, Stick insects, Owl butterfly, Fire ants, Black-winged heliconius, Stag beetles, Army ants, Orange-striped paracaidas, Fire beast caterpillar, Tropical termite, Crooked jaw termite, Bumble bees, Hornet, Scoliidae wasps, Common wasps, Shield bug, Giant tiger centipede, Paper wasps, Comet moths

As you can see by the sheer numbers of jungle insects, it is vitally important to use bug spray – especially that which is high in DEET. 
  
Reptiles and Amphibians:
Tropical rainforests are home to a huge diversity of reptiles (snakes, lizards, turtles, tortoises, and crocodiles) and amphibians (frogs, toads, salamanders, newts, and worm-like caecilians).  There are more than 1,000 species of frogs in the Amazon Basin often found in trees rather than in bodies of water.  Of course reptiles and amphibians are possible vectors of disease, dendrobatids are of the greatest concern.
  
Dendrobatids are the most notorious of the rainforest amphibians which are tiny, but brilliantly colored poison dart frogs.  These striking but slow-moving frogs secrete powerful toxins from glands on their backs and use their color to advertise their toxic composition to potential predators.  You should not touch them.  Tribes in the jungle dip blowgun darts in the poison as the poison is full of powerful cardiotoxic and neurotoxic steroidal alkaloids.  A lethal dose is the equivalent to two grains of ordinary table salt.  It is one of the deadliest toxins, 15 times more potent than curare, and ten times more potent than tetrodotoxin from the puffer fish. 

Made famous around the world by the film of the same name, the anaconda snake is also known as the water boa.  The snake lives in water and swamps surrounding the Amazon and is nocturnal.  Be careful though, boas are the largest type of snake there is and anaconda are the largest type of boa there is! Anacondas are very common to be seen, and they are very scary because they are so big, they often eat animals that roam around jungle villages.

Dogs, Cats & Bats:
In Peru, wild dogs can be found almost everywhere.  They are a direct cause of zoonotic transmission of many diseases from Cryptosporidosis to helminth infections.  You really shouldn’t pet them and especially shouldn’t feed them because then they wont leave you alone.  Dogs, cats, and bats are also huge sources of rabies in the jungle.  One thing to be weary of is that bats love to hide in the toilets so its best to make some noise before going in, especially when the bathroom is outside.  There are 950 different species of bats in the Amazon, so you"d best like them!  The jungle is home to Amazonian vampire bats which are the only true vampire bat in the world.
  
Wild cats like the Ocelot and Jaguars are also sources of disease.  Intestinal diseases commonly infect cats and when they urinate in rivers where water is collected for bathing and drinking, cysts and ova are often transmitted to humans.  Of course this is one of the more rare problems.  If not a source of disease, wild cats are nocternal and territorial animals to be feared.  Ocelots are ‘dwarf leopards’ that hunt a variety of small mammals.  The free range chickens in villages are often a possible food source for them.  The Amazon Basin contains the largest population of jaguars worldwide.  The jaguar is the King of the Amazonian food chain - and when you bear in mind some of its competition, that"s some claim to fame!  You"re best chances of seeing a jaguar are if you are in a forest area, near a stream, close to nightfall - but be very careful as this is also the time the jaguar is looking for prey.
  
River-borne Animals:
Phirranas, freshwater stingrays, leeches, manatee, caiman, bull shark, aripima, arowana, candiru, and electric eel.

Movies such as James Bond made in the 1970s and 1980s have made the piranha a worldwide phenomenon.  But, did you know that there are 20 different species of the piranha in the Amazon and nearly all of them are vegetarian?  In fact, the only species of piranha that can strip flesh of an animal in double quick time are the red-bellied piranha.

Although not largely a threat to humans, the manatee is also known as the water ox - and is the Amazon"s largest marine mammal.  A fully grown adult manatee will weigh over a thousand pounds and measure over nine feet long!  Now considered an endangered species, the manatee"s closest living relative is the elephant.

Caiman are related to alligators and crocadiles and inhabit the Amazon.    Bull sharks have been seen all the way in waters surrounding Iquitos and are threats to humans.  Aripima or Paiche are one of the largest fresh water fish in the world, reportedly with a maximum length of 3 metres (9.8 ft) and weight up to 200 kilograms (440 lb), which can topple boats causing a threat to human life.  Arowana are also fish that are large predators similar to the paiche. 

Candiru are a number of general parasitic, fresh water catfish in the family Trichomycteridae; all are native to the Amazon River.  The strongly electric electric eel (Electrophorus electricus) and more than 100 species of weakly electric fishes Gymnotiformes also inhabit the Amazon Basin.  River stingrays have a venomous caudal sting, and are one of the most feared freshwater fishes in the Neotropical region, sometimes more feared than piranhas and electric eels.  However, they are not dangerous unless stepped on or otherwise threatened.

The Amazon is also home to the larges leeches in the world.  The giant Amazonian leech can grow up to 17.72 inches (450 millimeters) long and 3.93 inches (100 millimeters) wide.  There are also leeches called ‘T Rex’ which have a habit of invading an orifice and feeding on mucous membranes.  Described in a paper published April 14 in PLoS ONE, the first specimen was found by doctors in 1997 in the nose of a 6-year-old boy in San Martin, Peru. He had complained of headaches.  Another specimen was taken that year from a 16-month-old boy in Ayacucho, Peru. A decade later, a third T. rex was taken from the nose of a 9-year-old Peruvian girl who felt a “sliding” sensation in her nose. All had bathed frequently in Amazonian streams.



Thursday, February 7, 2013

Needs of the Jungle People


The jungle people live very modestly according to their traditional, indigenous roots.  They live in houses constructed of wood with grass or dried palm roofs.  They don’t have much, so they stick to farming, fishing, and logging.  Because they mostly abide by traditional beliefs, healthcare behaviors are very difficult to change and newly implement in the region.


The general infrastructure is practically non-existent, however, each village has a ‘chief’ or mayor that is in charge which provides some sense of communal direction.  The rural villages aren’t usually large enough to have roads or bridges or anything, but many do have cement walkways which were funded by the Peruvian government as part of an initiative to develop the jungle.  When you get to larger jungle cities like Nauta or Iquitos there are paved roads, dirt roads, wood and metal bridges, cars and mototaxis, and Iquitos even has an airport which was previously used by the Peruvian military.  Only in really large jungle villages there is likely to be a single building with plumbing of some sort, but generally, they don’t have running water or sewage and just use river water and a latrine.  In Iquitos and Nauta there is plumbing, but the standards are very low in comparison to American plumbing standards.  The same goes for electricity.  In the rural jungle, the government has funded the strategic placement of lights and generators, but because of funds, the villages are only able to use the electric on a very minimal basis (ie: at night for an hour or so).  Iquitos and Nauta have electricity and even have energy generating electric plants powered mostly by burning wood from the surrounding rainforest. 


The medical infrastructure in the jungle is virtually non-existent except for a select few international, non-profit organizations.  In a region of a poor country where disease, parasites, malnutrition, rampant tooth decay, and premature death are normalcy, medical care is a true necessity.  Children are who suffer the most and many are left alone to survive on the streets or in the jungle with no parent or family unit to provide care.  Many countries have healthcare workers that man health posts, but in the Peruvian jungle, such government-run health posts are run much like their rural school systems; there is a physical building, but the people are rarely there, medical supplies are largely not stocked, and people’s limited healthcare knowledge prevents a belief in medicine and encourages their beliefs in “curses.”  Larger cities like Iquitos are the only places in the jungle that have actual hospitals and reliable doctors with stocked medications and vaccinations.  However, from the experience of a past team member, the hospital in Iquitos doesn't even have running water which is a major public health concern.




The ultimate goal for the region is really to shift their focus from living traditionally to living sustainably so they can ultimately provide for themselves and meet their own needs.  This is where the church comes in.  Planting the seeds of spiritual growth is a foundational part of church focus.  Healing, teaching, feeding, and loving the people of Peru are the fertilizers for the seeds of spiritual growth.  All of the help given may make a difference for a lifetime and may impact thousands on a humanitarian level, but the power of God makes a difference that will reach into eternity.


Saturday, February 2, 2013

Jungle Necessities & Packing


When going into the jungle it is best to pack as light as possible because you will have to carry all of your stuff around with you.  Invest in a good hiking backpack like a North Face hiking backpack or a cheaper Jansport hiking pack.  You will probably also need a duffel especially if traveling for medical missions because you will need to take meds along, so a cheap one is good because it will get dirty, also make sure it has wheels and good handles/straps for carrying.  In order to pack your clothes and other items most efficiently I would recommend that you check out Ebags packing cubes for both your backpack and your duffel or luggage.  Also make sure to use brightly colored tape or special bag tags so you can always keep track of your bags and they are easy to find on the luggage carousel.

Depending on what side of the Andes you will be on throughout your trip will change what kind of clothes you will pack.  To the West of the Andes is the coast where Lima is.  The climate is usually not as warm and muggy as the jungle so you will need to pack a little heavier clothing.  In the jungle, North-East of the Andes it is usually more tropical weather, so you would need to take shorts and moisture-wicking clothing.  

Specific things to pack should include:

In Your Backpack
-Flashlight/ Headlamp
-Travel Pillow & Blanket
-Bug Spray (under 3oz.) [put in plastic bag to avoid spillage]
-Hand Sanitizer
-2 Sets of Clothes
-Camera
-Fanny Pack (Embarrassing, but easy to keep things organized and accessible in the jungle)
-Important Paperwork (Tickets, passport, driver’s license, copy of insurance card, shot record)
-All Medications (Doxycycline, Typhoid, Tylenol...)
-Anything Expensive (I don’t recommend you bring anything expensive: ipod...)
-Empty Water Bottle (Nalgene)
-Food
o   Trail Mix
o   Granola Bars
o   Fruit Snacks
o   Crackers
o   Gum
o   Hard Candy

Things to Pack (either in backpack or checked bag)
-Hand Sanitizer
-Toilet Paper (seriously important)
-Head lamp 
-3 pairs of scrubs
-Ear plugs
-Chap-stick (with sunscreen)
-Travelers Pillow & Blanket 
-Lightweight Jacket (for wind and to prevent mosquitoes)
-Sweatpants and sweatshirt (you will want this)
-Hat
-Pen
-Water bottle 
-Fanny Pack 
-Baby wipes
-3 bug sprays with 99% deet
-Ziploc baggies
-Heavy Socks
-Swimming Shoes (not flip flops)
-Flip Flops                                                  
-Camera 
-Extra Batteries
-Extra Memory Card
-Debit card 
-Tennis shoes
-Passport and Documentation 
-Confirmation for Flight 
-Quart Ziploc Bags
-Trash Bags (3)
-Brush
-Shampoo
-Towel (2-3)
-Wash Cloth
-Poncho 
-Kleenex
-Toothbrush (2)
-Toothpaste
-Sunscreen
-Plastic spoon(s)
-Basketball shorts
-Face Wipes (believe it or not, they are awesome!)
-Bible 
-Journal 
-Hair bands, stretchy headbands
-T-shirts (6)
-Swimsuit (1-2)
-Jeans (2)
-Deodorant
-Medications 
-Cash 
-Snacks  (Bring enough to share)
    o   Peanut Butter
    o   Apple Sauce
    o   Breakfast Bars
    o   Trail Mix
-Tylenol PM (to sleep)
-Benadryl (for itching due to the mosquitoes)
-Shoes to wear in the jungle and city


The reason to take several pairs of things is because things don't dry in the jungle, they always stay damp and often start to mold - especially toothbrushes and swimsuits.  It's better to swim in a swimsuit or shorts and a T-shirt, because small fishes often nibble on your nipples and other protruding parts.  Piranhas, electric eels, electric rays, candiru catfishes, stingrays, river sharks, anacondas, caimans, and other South American freshwater horrors are not a real danger (contrary to what every local will tell you).  You'll hear stories about candirus invading people's urinary tracts at every campfire, but there have been only three documented cases in all of South America, all with people swimming without swimsuits.


The first week is difficult to adapt to in a jungle environment because of the heat and humidity, so try to spend the hottest hours in the shade, try to wear as little clothing as possible (men- stick with boxers under clothes, and women- either wear loose underwear or none at all because it will be constantly wet and the rubbing during a hike is horrible), exercise helps your body adjust, dehydration is always dangerous so keep hydrated, and don't wear hiking boots.  Sandals get really dirty, but they are so much cooler, also don't forget that feet need sunscreen and bug spray too!  The sandals to get are Chacos, they are light, dry fast, and are comfortable.

The overall best tip for the tropics is: Wear your sunscreen during the day and make sure to wear bug spray- 100% DEET is the best, but it can block your pores and make you very hot, so be smart, but don't go overboard. Wearing bug spray from head to toe prevents chigo fleas, botflies, sandflies, and mosquitoes.





Preparing For Jungle Travel


Questions to Consider:
When preparing to travel to the jungle, there is a lot that you need to consider.  Before even starting the simple task of packing, there are important questions to think about.  Where are you going?  This is a critical question because you should try to pack customary clothing in order to respect the people, plus helps you to think about the type of clothing to pack depending on what side of the Andes you will be on throughout your trip.  What is the weather going to be like?  Whether it is the rainy season or the dry season, will change what you wear, how you pack, what your transportation will be, where you can go, the extent of hiking you will be doing, etcetera.  How much money are you planning to spend?  This will allow you to better choose the places you will be able to go to, the transportation you will take, the  hotels in which you will stay, and the types of restaurants that you will go to.  How much Spanish do you know?  The amount of Spanish you know is critical because that is the language that you will need to communicate with.  If you don't know much Spanish and will not have a translator with you, it is best to stay in larger cities due to safety, so if you are planning on going to the jungle, make sure to research possible translators to accompany you.


Books & Maps:
It is always important to know where you are going and to be prepared mentally, physically, and spiritually for what you are going to be doing there.  If it is primarily hiking and sightseeing, getting a couple travel books and reading up on the area would be a good place to start.  Fodors TravelIntelligence is a good website to start for guidebooks and planning your trip, and National Geographic’s ‘Peru Adventure Map’ is also a great source.  Specifically if you are going to another country for medical missions, good books are: ‘Where There is No Doctor’ by David Werner, Jane Maxwell, and Carol Thuman, ‘Jesus MD’ by Dr. David Stevens, ‘GrayMatter’ by Dr. David Levy, and ‘Let the Nations be Glad’ by John Piper.  ‘Where There is No Doctor’ is a fantastic book which is a Third World medical manual that brings together modern concepts of public health with personal health care in an easy to read and understandable book for the third World villager.  ‘Jesus MD’ is actually the book I read in preparation for my last trip, and I loved it; it is an inspiring book that describes Jesus as the ultimate doctor giving first hand examples from Dr. Stevens’ life as a doctor in Tenwek Hospital in Kenya.  ‘Gray Matter’ is not really internationally medically related, but it is a blend of medical drama and spiritual insight that focuses on the importance of prayer in the medical environment.  Lastly ‘Let the Nations be Glad’ is a perfect book for missions; I don’t particularly love John Piper, but this book explains how missions is not the ultimate goal of the church, worship is, worship fuels the goal of missions.


Travel Tips:
When you are traveling via airplane on the way to Peru and home, make sure to wear slip on shoes and have your passport and tickets easily available in order to make it easier to rush through security.  For better comfort flying, get a seat in an exit row, bring a neck pillow (and small blanket), and pack some snacks on your carry on- make sure to follow the rules with liquid volumes or they will just confiscate it and throw it out.  

Especially in the larger jungle areas, you don’t want to be an obvious traveler because that makes you subject to possible mugging and pick pocketing (that also goes for cities as well).  Many times it is almost impossible for travelers to not stick out, so just make sure to be extra careful, and don’t carry all your important documentation and money on you at once.  It is important to keep everything spread out in multiple places so you will never be left helpless.