In 2005, the Keck School of Medicine incorporated a career advisement component directly into the curriculum, i.e., the Pathways Advisory Program. The Pathways Advisory Program is intended to help guide students in the initial stages of making decisions that may influence or facilitate their ultimate choice of an area of specialty. In Year 1, students select from one of three pathway choices: 1) Academic Medicine for students with interests in research, 2) Clinical Specialist for students who have a specific specialty in mind, e.g., psychiatry, pediatrics, etc., or 3) Community Health for students with interests in practicing medicine in communities that are historically underserved.
As a result of these changes our medical students have increased opportunities to involve themselves in a diverse selection of projects, especially during the summer following completion of Year 1 coursework. This past summer three of our students opted to take advantage of a unique opportunity to accompany a physician, Ed Helmer M.D., to the remote village of Brillo Nuevo within the Amazon Jungle of Peru. This article recounts their experiences and reflections.
Reflections of Ed Helmer, M.D.
Many years ago, my life was profoundly altered. I was given the opportunity to live with and provide health care to a small, indigenous Indian community, Brillo Nuevo, deep in the Peruvian Amazon jungle.
The event was singularly unexpected. I traveled with a friend, a Peruvian artist who lived and painted in the village, my goal being merely to “hike the Amazon.” When we got there, he introduced me to the tribe as a “doctor” who had come to help them (I am a neuroradiologist by trade, and the actual practice of clinical “hands-on” medicine was something that I hadn’t done for decades). That didn’t seem to matter to the tribe. I was literally “thrown into the fire” and started seeing patients. After the initial intimidation I felt with not knowing what the heck I was doing, I realized that I loved the whole experience. After two weeks in the village, I came back to Los Angeles determined to return to the jungle. I brushed up on my medical skills, and began a new life! I returned to the village the following year, and stayed for 3 months.
The experience was life-altering. At first, it was purely and simply the adventure that stimulated me – living and surviving on my own in a remote and primitive locale, as well as the daily medical challenges. Later, however, I came to realize and experience the sheer joy of being able to humbly provide service to others. Since that time I have come to realize that providing service to others is the greatest blessing in my life. I continued returning to Brillo Nuevo for 10 years, and stopped in 1987.
In 2004, I was approaching retirement, and I wondered how I would want to spend my time. I planned a return trip to Brillo Nuevo, although I had serious doubts that anyone in the village would remember me after so many years. To my delight, when I got to the village they did remember me and the response was so filled with emotion that it was hard for me to control myself as I walked through the village.
First, an elderly woman (the mother of the chief of the tribe) who is now over 100 years old, recognized me and threw her arms around me, calling me “grandson,” and then the sister of the chief (who I had helped during a difficult labor and delivery in 1979) threw her arms around me, began to cry out of happiness, and wouldn’t let me go for several minutes. I was overwhelmed, and struggling to maintain control.
The villagers asked me if I could come back to the village as before, and continue what I had begun several years ago. They said, “If you return, we will build you a house.” I knew immediately that I would return. The chance to re-experience what I had done before was too compelling to pass up. But I wanted something more now. I knew what the experience of offering service to the community was going to be like. I wanted others to be able to experience it as well, as part of their medical training.
That is where Dr. Schechter, a close friend, at the U.S.C. Keck School of Medicine stepped in. As part of the development of the Pathways Advisory Programs, he asked me to give a “jungle talk” to the 1st year medical students. I didn’t know what to expect, but, immediately upon finishing my talk, 25 students asked if they could go with me. I finally narrowed it down to 3 students. My hope was that these students would be able to experience what I had experienced in the past – not just the adventure, but also the joy of offering service to a small, remote and isolated community.
My hopes were not only met, but were exceeded! The students were fantastic! They adapted to this new and alien environment quite well, and seemed to feel right “at home” in the village. Each of them shared in the daily medical experiences with me, and each of them was intimately involved in the diagnostic and therapeutic problems that confronted us daily. We became, within a few days, a very good medical team, each of the students bringing his or her background, experience and training to bear on the events of the day. Each night we reviewed the day’s medical problems, and, toward the end of the trip, we started evaluating what we had learned from the entire experience.
I couldn’t have asked for a more rewarding experience. I believe the students came away with feelings of awe and reverence towards the practice of medicine at a very fundamental level that I think can only be obtained in a setting such as we found ourselves.
Reflections of Allyson Hoppe
“Does anyone have a compass?”
I heard these words and began to realize what I had gotten myself into before we had even reached the village.
We were sitting in a small powerboat in the middle of the Amazon River in a blinding rain trying to find our way to a small town off a tributary. We couldn’t even see a few feet in front of us. Luckily, just as I left my clean air-conditioned apartment in Los Angeles, I had grabbed a 1-inch diameter compass. The first crisis was averted, but the entire trip was filled with these moments of “Oh, no!!! What are we going to do?” but, somehow, they all worked out and became the most incredible 5 weeks of my life.
After learning that I had been selected for the trip, I attended numerous planning meetings with Dr. Helmer, and before I knew it, Year 1 of medical school was behind me.
Our first few days were mostly filled with settling in, our house had not been completed as we had been told, so there was constant construction. I learned through experience that it is nearly impossible to listen to a heart when there is hammering in the background. Luckily, heart disease is not a prevalent problem for the people of Brillo Nuevo. Nonetheless, we set up shop, cooked a few meals, and finally opened our clinic. We began by assisting Dr. Helmer and we wrote the notes on the forms we had designed. I was scared and felt insignificant and unprepared.
Having only finished the first year of medical school, I had experience with taking a detailed history and completing a few parts of a complete Physical Exam. I felt very unsure of my skills and wasn’t sure I would be an asset at all to Dr. Helmer who had seen so much potential in me during the interview. Then I had a breakthrough. An older woman by the name of Amalia came in complaining of back pain. We interviewed and did a brief physical and determined the cause was muscle strain from working in her farm all day, every day. The decided treatment was a BenGay-type muscle cream. I was trying to explain to her how to use it in Spanish but I couldn’t find the right words, so I gave up and began to rub the cream on her myself. As I rubbed, I could feel her relax in my hands and I could feel my confidence grow. I realized that I didn’t have to know everything to care for these people, they didn’t care if I had my MD, they just knew that I was there to help them and they trusted that. That day was a turning point for me, not only my experience but professionally and personally.
In our clinic we saw a constant barrage of coughs, fevers, aches, pains, suspected parasite infestation, rashes, etc. We were fortunate to be allowed to witness a live birth on one of our last days. It was nothing like home. The mother squatted while her mother helped to hold her up. A third female was positioned to catch the baby. It was a boy and they asked us to help name him. I was so touched to be involved in that decision. It was clear to me in that instant that we’d really impacted the village in a positive way, and here was our chance to leave our mark behind.
As a stipulation of our provided funding from USC, a research project was a necessary venture. We conducted a general health survey of the entire village. We interviewed someone in every house and found out who lived there, names, ages, where they got water, where the latrine was, etc. We drew up a map of each building and learned a lot about public health in an underserved population. The compilation of the interviews will give us more specific numbers and details. We took the name and a picture of all our interviewees. We brought each house a gift of clothing and toothbrushes (400) so that when we left there was no one in Brillo Nuevo without a toothbrush! They were so grateful for these small gifts and opened up their homes and shared their experiences with us.
Overall, my time in Brillo Nuevo was an incredible time filled with joy, fear and self-doubt, but mostly unique experiences that I will always hold dear to my heart. I hope that at some point in the future I will be able to return and see my friends again.
Reflections of Mike Hemak
When you tell people you’ll be leaving the country for the Amazonian jungle of Peru to live amongst a tribe of indigenous Bora Indians in a village accessible only by boat, you get interesting reactions. After fielding many questions concerning the lack of electricity and showers, rats, disease, snakes, and my mental health, I have come to realize how unique and important the individual is who embraces such tasks. I remember my family asking why I must go on such an exotic, risky trip and not go somewhere safer, closer to home, or more civilized. To me, the answer is simple: In the context of health care and disease, those people who are the least accessible (for whatever reason) are at greatest risk of being forgotten and, therefore, are in greatest need of assistance.
In Brillo Nuevo we saw roughly 15 patients per day, with complaints ranging from puncture wounds to eye infections to malaria to beechos (the Bora word for parasites). Cases came from a surprisingly wide array of medical specialties including dermatology, pediatrics, infectious disease, orthopedics, family medicine, and OB/GYN. In addition to the difficulty of the Spanish language barrier and the unbearable heat and humidity, our work was complicated by both the simplicity of our examination equipment as well as our inadequate range of medical treatments. However, it seemed only fitting in this environment to be honing the more primitive fundamentals of the medical profession – palpation, observation, auscultation – rather than relying on cultures, x-rays, and blood chemistry panels.
My most lasting memory will be a young man named Javier. He came to us complaining of cough, slight fever, and difficulty breathing. Less than 24 hours later, we found him lying in a hammock, wrapped in a blanket yet shivering on a sweltering day, incoherent and glassy-eyed, with a temperature of 105.6ºF. Tragically, Javier held the unlucky distinction of having the first case of Plasmodium falciparum malaria in Brillo Nuevo – a variation of malaria the village was unprepared to handle. Beyond the potentially devastating epidemiological consequences of this development for Brillo Nuevo, Javier seemed hours away from certain death, but with prompt Mefloquine treatment, he recovered fully within days.
Although international health care often brings you down to eye-level with the inequalities of society, the suffering of the underserved, and the daily burdens of poverty, it also possesses the ability to inspire you with unparalleled hope and joy. My interaction with Javier, however, represents the very first time I can say with certainty that I helped save another person’s life, and the power of that simple statement extends far beyond inspiring me professionally as a future physician still coming to grips with the influence of his profession, but strikes to the heart of my convictions in international medicine. For me, Javier will always represent a palpable, indisputable example of the difference to be made through international humanitarian health care, and it is my memory of him that gives me the hope and conviction to return to the lands of rats, disease, and snakes again soon.
Reflections of Megan Klenow
When I first heard about Dr. Helmer going to the Peruvian Amazon the concept seemed highly admirable but also somewhat unreal. The part of the jungle he spoke of visiting was very remote and beyond my frame of reference. After the five-day journey of simply getting to the village, the first thing that struck me was the collection of people who greeted our boat. I had never met them before but I was met with many warm smiles and helping hands with my luggage up the steep, muddy slope to our Brillo Nuevo home. The excitement among the Indians upon our arrival was palpable, merely walking into the small village-four white people with mixed ability to communicate in Spanish-and we weren’t questioned or doubted by the community who had been on this plot of land in the Amazon for ages. We were only welcomed. As we settled into our house with its roof of woven leaves and opened up our clinic, patients came pouring in to see us. We turned no one away and helped our patients the best we could with the medicines we had been able to bring with us.
After visiting the teachers of the schoolhouse one afternoon and talking to them about the children of the village, I came to think about the choices I had been given in my life. I’ve basically grown up with very little eliminated from the list of my life’s possibilities, if I was willing to work hard for it, and I’ve always assumed that I deserved these choices. Learning about the Bora Indians, I came to understand that I had absolutely nothing to do with the fact that I was born into a family in California rather than in the remote Peruvian Amazon. I doubt that I could find as much satisfaction living in an Indian tribe as I do in studying medicine, but this understanding gave me a sense of responsibility, i.e., responsibility to use what I have been fortunate enough to learn (medicine) and to help others have many choices as well, i.e., the choice to thrive and lead a healthy, productive life.
The Peru experience allowed me to see what I have been learning in medical school on a very fundamental level. It allowed me to see that what I am learning in medical school is a tool whose most important purpose is to help other people. This may seem simplistic, or even obvious, to anyone who knows that medical school is where people go to start the process of becoming a doctor, but before Peru this wasn’t obvious to me. I’d inadvertently lost sight of why it was I’d come to medical school in the first place. The people of Brillo Nuevo brought this back into focus for me; I wasn’t here to compete for the highest test score or beat my classmates out at memorizing the most minute details of obscure illnesses-no, my intention is to shoot much higher than that, and on a much more global scale.
Reflections of Joel Schechter, Ph.D.
The original goal of promoting and supporting the Brillo Nuevo experience was because it provided an exciting and relevant clinical training experience for our medical students within our Pathways Advisory Programs. Indeed, my “debriefing” meetings with Dr. Helmer and the three students confirmed how successful the trip was for them with respect to those goals. But, it quickly became evident to me that a much richer goal had also been achieved. The students had a unique opportunity to experience very basic global healthcare issues by providing fundamental medical services on a person-to-person basis. The greatest benefit achieved by this experience appears to be the inspirational lessons learned by each of the students, i.e., each student is hoping to return to Brillo Nuevo with Dr. Helmer during Year 4 of medical school when their clinical training will be much more advanced. Nonetheless, even having completed only Year 1 of medical school these students met every challenge, learned how to work effectively as a medical team, all under the mentorship of Dr. Helmer. For Dr. Helmer himself, the experience in Brillo Nuevo accompanied by medical students clearly reinvigorated his appreciation of his role as a physician caring for others on a person to person basis – worlds apart from his career as a neuroradiologist – and his appreciation for sharing his enthusiasm for medicine as a mentor to these future physicians.