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La Doctora

La Doctora: An American Doctor in the Amazon

Linnea Smith
Copyright Date: 1999
Edition: NED - New edition
Pages: 256
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  • Book Info
    La Doctora
    Book Description:

    Taken straight from the pages of Dr. Smith’s journal, La Doctora offers readers a rare glimpse into the suspense and drama of practicing medicine in a culture far removed from the sophisticated supplies and supports of 20th-century medicine.

    eISBN: 978-0-8166-9540-9
    Subjects: Language & Literature

Table of Contents

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  1. Front Matter
    (pp. i-vii)
  2. Table of Contents
    (pp. viii-ix)
  3. CHAPTER ONE “My Wife Can’t Have Her Baby!”
    (pp. 1-14)

    “My wife can’t have her baby. You must come!”

    The young man standing at the stream’s edge had simple fear in his eyes and a desperate plea in his voice. It was early in the morning and the clinic was not yet officially open, but babies trying to be born do not always respect clinic hours. The mere fact that he and the elderly midwife accompanying him had paddled their dugout canoe from the far side of the island to the small stream where my rudimentary clinic was located indicated that there was a problem.

    And this one would turn...

  4. Leap into the Unknown

    • CHAPTER TWO My Last Vacation
      (pp. 16-33)

      In some ways, it isn’t at all surprising that I wound up where I did, yet if I had been asked ten years earlier―or one year, or even one week, before my first trip here―I would hardly have predicted that I would soon be deciding to spend years in the Peruvian Amazon.

      In 1990 I was a forty-year-old graduate of the University of Wisconsin Medical School with specialty training in internal medicine.

      After completing my residency in internal medicine, I joined a small group practice in a town among the rolling hills of west-central Wisconsin. For three years I had...

    • CHAPTER THREE Setting Up Shop
      (pp. 34-46)

      There was no certainty that setting up a medical practice in Peru would work out. In fact, from the perspective of any typical U.S. middle-class standard, it was highly unlikely that I would achieve anything more than getting bitten by a few mosquitos (if not worse). And, from a financial point of view, moving from a Wisconsin medical practice to the middle of the jungle was unquestionably economic suicide—at the least. One of my partners at the clinic at home shook his head and said frankly, “You’re crazy, Linnea.”

      I didn’t leave my native land lightly. Even more worrying...

    • CHAPTER FOUR Jungle Medicine
      (pp. 47-58)

      As colorful as the story would be, no feather-bedecked shaman ever came to dance in front of me in an effort to chase away the blonde demon. The truth is that people appeared to be so desperate for medical help that they had been seeking medicines from Pam, who is a science teacher by training. They had been bringing their sick babies to her and requesting remedies for diarrhea, for skin problems, for wounds, and for a wide variety of other ailments. There were no requests to see my medical credentials (not at first, and never from the people themselves,...

    • CHAPTER FIVE Indiana
      (pp. 59-70)

      All this time, I was practicing medicine essentially without a license. Officially my medical degree from the University of Wisconsin and my Wisconsin license carried no more weight here than a Peruvian medical degree and membership in the Peruvian Medical College would have carried in the U.S. It therefore seemed prudent that I ingratiate myself with the medical system of the region.

      To this end I began to schedule some time at the clinic in Indiana. Indiana, halfway between my clinic at Yanamono and the city of Iquitos, is about twenty-five miles away, or an hour and a half by...

  5. Life on the Amazon

    • CHAPTER SIX Life Along the Stream
      (pp. 72-85)

      Stepping off the plane in Iquitos, you can have no doubt that you have arrived in the tropics. Warm, heavy, unmistakably tropical air engulfs you, thickening as you descend the ramp steps. If it’s night when you land, there may be a moon wavering in the hazy sky. If it’s daytime, the sun will be beating down and the heat will be billowing off the tarmac.

      You almost inevitably arrive by stepping out of a plane. You can’t come by rail; there are no tracks through the thousands of miles of surrounding forest. Nor can you come by car or...

    • CHAPTER SEVEN Life Outside the Clinic
      (pp. 86-100)

      The first few years I lived here, whenever I felt down, tired, discouraged, isolated, lonely, or just plain ready for a change, I would sneak off and ramble down the lodge’s trails that wander through gorgeous scenery. The Bushmaster Trail goes out from the back of the lodge and heads off into the stretch of jungle between the Amazon and the Napo Rivers. Ten minutes into the Bushmaster, one is out of earshot of anything whatsoever that is man-made. Not even the rumble of the largest and loudest of the river barges penetrates this part of the forest. Local folks...

    • CHAPTER EIGHT Red Tape
      (pp. 101-109)

      Some people who visit Peru are struck by the same impulse that felled me and want, somehow, to help. “What medicines, what supplies, can we send you?” they inquire. “You can’t send anything,” I reply. “You can only bring things when you return. Your friends who follow in your footsteps, impressed by your adventures here, can bring things when they come. But you cannot send things.”

      They want to know why. Will nothing arrive through the postal system? Well, that is part of it. Although recent improvements have been made, not everything that enters the labyrinthine passages of the Peruvian...

    • CHAPTER NINE Fiesta
      (pp. 110-116)

      When people ask me what I miss most from my native country, I say, “My friends, my family, and my bike,” the latter a 600 cc Kawasaki on which I have spent many pleasant and relaxing hours. To make up for the loss of my bike, I attend as many fiestas as I can, and dance. (Dancing is an activity—much like riding the bike— that I maintain is a reasonable substitute for sex, at least if you need a substitute. It would be nice to have the bike, sex, and rock ’n’ roll, but then, life is never perfect.)...

  6. Jungle Doctor

    • CHAPTER TEN Culture Clash
      (pp. 118-130)

      One of my favorite illustrations of the unpredictability of cultural differences comes from a story told by a Peruvian ecological worker. She and her associates were from Lima, but had been working with the people native to the high Peruvian jungle. This was more or less analogous, in U.S. terms, to a group of well-meaning and well-heeled Manhattanites setting out to help in Appalachia. The ecologists, at any rate, found that these particular people suffered from a diet severely deficient in protein.

      The ecologists worked out a solution of which they felt they were justifiably proud: a method of raising...

    • CHAPTER ELEVEN Necrotizing Fasciitis
      (pp. 131-137)

      I can say, without need for false modesty, that I am the best physician for miles around. Of course, I could say equally truthfully that I am the worst, but I don’t because it doesn’t have quite the same ring to it. The main reason that I am the best, the worst, an7d the average is that I am the only. The nearest other doctor is at Indiana, and I have already touched upon the limitations of the care available there, not to mention the fact that transport to thepostais not always available or affordable. My patients are...

    • [Illustrations]
      (pp. None)
    • CHAPTER TWELVE Tropical Diseases
      (pp. 138-145)

      I am often asked about the prevalence of esoteric, exotic, or downright weird diseases here, and also about my own health.

      As for exotic diseases, there are a few, of course. I very rarely had to treat piranha bites or freshwater stingray injuries when I was in Wisconsin (although neither of those problems is exactly run–of–the–mill here, either). There have been a few cases of cholera, which can be a bad disease, though fortunately a short–lived one (“short–lived” referring to the illness itself, not to the patient, at least not usually). And after years of...

    • CHAPTER THIRTEEN More Learning
      (pp. 146-154)

      In order to maintain my medical license in Wisconsin, I must engage in what is called continuing medical education, or CME. This is available to physicians through a variety of avenues—conferences, mailorder study courses, computer programs, and others. Although it would not be necessary to keep my Wisconsin medical license active, I feel a little more secure by doing so; thus I subscribe to a number of journals and once every few years even make it to a conference.

      The legal requirements, however, are not the only reason to try to maintain currency. There is always the sense that...

  7. Clinic Expansion

    • CHAPTER FOURTEEN Rotary Rescue
      (pp. 156-163)

      After my first year and a half, the “clinic” was fairly well established and I was caring for about a hundred patients a month. At this point, the clinic contents still were limited to a few basic instruments, a bed doing duty as an exam table, and medicines stashed mostly in cardboard boxes, all located in one room with a kerosene lamp, a pitcher of water, and a thatched roof. I take a perverse enjoyment in “making do,” but a real exam room, a second room for seriously ill patients, and more room for record keeping would have been most...

    • CHAPTER FIFTEEN Juvencio
      (pp. 164-170)

      When people ask me how I discovered Juvencio, I am at a loss. How could I have known that he would turn out to be the invaluable resource that he has become? I can’t answer that question very clearly, other than to credit my intuition and be thankful for my good fortune.

      I did know him slightly before he came to work for me. His three small children were regular customers at the clinic—extremely regular. They all seemed to suffer from one diarrheal illness after another, until I finally convinced him and his wife to boil their drinking water....

    • CHAPTER SIXTEEN Building the Clinic
      (pp. 171-182)

      After Joe and Jon returned to Duluth, several months of ever–moreintense correspondence followed, involving questions and answers and research on my end and the same on theirs. For starters, if the rest of their Rotary colleagues agreed to this project, a site would have to be found, and permission obtained to use it. Although I tried not to get my hopes up, in case the project was rejected by the larger group, it was next to impossible for me to keep that resolve.

      So, I waited. We exchanged more faxes. I waited some more. Finally one afternoon I was...

  8. More Jungle Medicine

      (pp. 184-190)

      Because the rain forest has no motor vehicles except for boats, and very little industrial machinery, our cases of trauma are few. Machete cuts are relatively frequent and occasionally serious; axes fall into the same category; people occasionally find a way to fall from the roof or from treetops. We also saw a five–year–old girl who was helping her family feed sugarcane into the press, which is like a wringer washer. She must have held on a little too long, because the machine pulled her hand cleanly off.

      But generally trauma in the jungle is unusual, much to...

    • CHAPTER EIGHTEEN Childbirth
      (pp. 191-200)

      I’ve seen enough newborn babies to agree that some of them can be pretty cute. However, I’ve never felt particularly drawn to obstetrics.

      Here, my distaste for obstetrics in general and jungle obstetrics in particular has increased for two key reasons:

      1. If the delivery is normal, a woman doesn’t really need the help of a doctor. After all, throughout history women have delivered babies without medical care. However, if the delivery is not normal, the complications can very quickly become lifethreatening. I have neither the training nor the equipment and facilities to deal with such emergencies.

      2. Babies really...

    • CHAPTER NINETEEN Snakebites
      (pp. 201-207)

      My very first patient in the Amazon, way back when I was still a tourist, was a snakebite victim. Around here people walk barefoot most of the time, work in the cane fields, and bathe in the river. Since snakes of various types, many of them poisonous, thrive in this part of the world, close encounters between two-footed and no-footed denizens are inevitable. The meetings are more frequent when the water rises and the available dry land shrinks, forcing us all, snakes and people, into ever smaller spaces. Most bites are attributable to various species ofBothrops, of which the...

    • CHAPTER TWENTY Failures and Reflections
      (pp. 208-214)

      All of life involves a certain element of luck. You can be an honest, virtuous, industrious, careful person and still get hit by a drunken driver, or maybe worse, your husband or wife can be the victim. If it’s not a drunken driver, then maybe it’s a falling piano, or leukemia, or a problem child. But in the field of medicine, patients depend on more than their own luck. In the field of medicine, luck spills over from the doctor to the patient. Even the best surgeons encounter horrible cases in which anatomical irregularities or technical malfunctions or elementary errors,...

  9. The End of the Beginning

    • CHAPTER TWENTY-ONE Coming of Age
      (pp. 216-227)

      It took seven long years, but finally, after much striving, I am a real doctor—a real Peruvian doctor, that is. Here’s how the miracle happened.

      Coming as I do from the U.S. of A., where the legal climate is strict, it worried me from the very beginning that I had no actual license to practice medicine in Peru. I figured that my Wisconsin license would carry me for a while, since the state of legal affairs is more fluid here than in the U.S. Besides, I was practicing in an area where I was unlikely to come under official...

    • CHAPTER TWENTY-TWO What Am I Doing Here?
      (pp. 228-235)

      Eight years ago I left a comfortable group practice in rural Wisconsin and moved to a piece of Peruvian rainforest 2,300 miles up the Amazon River in order to develop an undersupplied, underfunded clinic. I am still here. Why?

      When people ask me why I choose to live here, I think what they are really wondering is why a U.S.-trained physician, subject in the U.S. to unadulterated adulation and incalculable gross income, would leave all that in order to live sacrificially with minimal income and bury herself in this remote jungle without an evening newspaper, let alone the ten o’clock...

  10. Glossary of Spanish Terms
    (pp. 236-238)
  11. Back Matter
    (pp. 239-239)