Greetings from Santa Clotilde, Peru!

This is the end of week three in Santa Clotilde.  I have secured access to a laptop, found internet , work has settled into a routine, and I am no longer constantly distracted by a Macaw named Leo.  In short, I am ready to sit down and write.
For past readers of the Ethiopia and Central African Republic non-blog travel-blogs, I should begin by saying that this is not a Medecins Sans Frontieres project.  It is a missionary hospital, and I am working here for only a month, deep in the Amazon basin of northeastern Peru.   The story of how I ended up in Santa Clotilde is difficult to summarize, and involves a number of unusual opportunities and random connections that I pondered for considerable time last week as I sat on an earthen floor in the darkness, chewing on semi-rotten armadillo.  For now, suffice it to say that my path here was paved by a number of very inspirational people, and I hope to introduce you to them as time goes on.
Near the top of that list is Padre Jack, my sole gringo counterpart out here on the Rio Napo.  Jack is an American missionary who has been living and working on the Rio Napo since the mid 1980´s, having established the hospital here in Santa Clotilde with a partner, Father Moe from Canada (now in Lima).  Jack is 50% catholic priest, 50% doctor, and 100% Green Bay Packers fan.  Easily one of the most remarkable and inspirational people I have ever had the pleasure of meeting.
I will pause here to acknowledge that yes, you are correct, Peru is a Spanish speaking country.  Some of you might remember – either first hand or through the blog – of my misadventures speaking French in Central Africa.  There are, as we speak, at least 12 nurses in that part of the world who now believe that the clinical sign of “strawberry tongue” is more properly known as “mango mouth”, thanks to my translation limitations and an inappropriate tendency towards expansive hand gesturing.  But for all of you nay-sayers out there who scorn my ability to learn Spanish in 6 weeks or less, to you I say:   good point.  You should have brought this to my attention earlier. 
Now here I am, working in a small rural hospital in the Amazon basin, about 6 hours by speedboat upriver from the city of Iquitos – the world´s most populous city that can only be accessed by plane or by boat.  And I am surrounded by people who speak Spanish fluently, and only one other English speaker (Padre Jack), and I am wearing out my Spanish-English dictionary as fast as my thumbs can flip pages.
It was in this context one morning last week that I found myself taking part in a lengthy conversation in Spanish at the hospital nursing station, of which I understood nothing, and at the end of which Padre Jack turned to me and said, “well how does that sound?  Would that be fun, leaving tomorrow for a couple of days upriver on a vaccination campaign?”  Having long ago firmly established that I lack a healthy sense of self-preservation, my reaction was, of course, “yes”.   By which I specifically meant, “maybe, and we need to talk about this later”.
We turned our attention back to the hospital and, as is custom here, worked continuously through to 3pm at which point all thoughts turn to lunch and an afternoon siesta.  Throughout the day it had not escaped my attention that people were busy in the background packing boxes and loading a boat but, leaving as I was the next day, I figured there would be plenty of time to ask Jack more questions in the evening.  I didn´t think too much of the random people asking me, with increasing frequency, if I had a bag for the trip.  “Si,” I would say, thinking of the small carry-on backpack in my room that had yet to be packed.   I didn´t fully appreciate the significance of the question until I was being asked it three times in a row by the same exasperated nurse while simultaneously, out the corner of my eye, I observed a surprised Padre Jack having an animated conversation with the boat driver.   It included such Spanish phrases as “now!?!” and “not tomorrow?!” and “yes, yes, sure he´s still going”.
Here´s the deal:  you are going on a boat trip up an isolated river in the Peruvian Amazon to visit small jungle villages and provide medical consultations on a vaccination campaign, for an unknown number of days.  You have twenty minutes to pack, and no time for questions.  Go.  Spanish-English dictionary?  Check.   Clinical tropical medicine book?  Check.  Stethoscope?  Check.  Headlamp?  Check.  Towel, change of underwear, fresh socks, second shirt, extra pair of scrub pants, flip-flops, first-aid kit, knife, bar of soap?  Check, check, check.  Suntan lotion, bug spray, comb, shampoo?  Nope… not quite enough room for those.  Toilet paper?  You´re darn right.  Toothbrush?  Just barely.
As I hurried from my quarters at one end of the hospital towards the entrance, people started throwing things to me at random – here comes a flimsy and soiled roll of foam for sleeping, two clean sheets from the laundry, and now a mosquito net.  Catch, catch, catch, run.  As I´m boarding the boat I lean out and shout to Padre Jack waving from the shore:  “how long will I be away??”.  “Hard to say...” he shrugs amicably, “maybe four days... might see you Saturday.”  A random girl is holding a monkey on the shore and I am instantly distracted.  Push off, engine starts, and we´re heading upriver.
At this point I turn and look around the boat to take stock of the fellow characters sharing the narrative in this pending Shakespearean tragedy.  The boat itself is about 20 feet long and 3 feet wide, with a small outboard motor, a canopy roof, and plastic flaps that roll down to cover the sides in the rain.  Sitting at the wheel is Victor Hugo:  a short, stocky, animated fellow with a booming voice and a quick laugh.  I met Victor Hugo on my first morning in Santa Clotilde when, having previously heard that I like to jog, he nearly knocked my door off its hinges at 5am to drag me out for a run.  If this were a Mexican television comedy, he would be the one wearing the bumblebee suit.  Sitting behind Victor Hugo is no-nensense Nelly, technical nurse extraordinaire.  She first started working at the Santa Clotilde hospital over 20 years ago when, as legend goes, she hired herself.  She has no formal nursing training, but did spend a lot of time at the hospital in its earliest years caring for a son who is type 1 diabetic.  At some point she decided that she had seen enough and informed Jack and Moe that they were going to teach her to be a nurse, and that she was going to be good at it.  They did, and she was right.  I feel better seeing her back there.   If she could raise an insulin dependent diabetic in the middle of the jungle, presumably she can keep a needy English speaking Canadian alive for 3 or 4 days.
Or 5 days, as the case may be.  But we´ll come to that later.
First stop:  where´s the beef?!  Victor Hugo is already thinking ahead to dinner.  Thirty minutes upriver he pulls over to the side and ties up the boat.  Hard to see above the high muddy bank but I sense that there is a clearing in the jungle above us and Victor Hugo leaps up and into it.  Nelly asks if I like beef.  “Si,” I respond politely, my limited Spanish prohibiting me from completing the sentence with:  “in particular I have a fondness for prime rib”.  Ten minutes later Victor Hugo jumps back into the boat holding a bloody slab of meat in one hand, and a heart in the other.  Yes, a heart.  A buffalo heart apparently.  It´s fresh enough that it´s still very bloody and, lacking any form of packaging or container he tosses it directly onto the floor of the boat before rinsing his hands in the river.  I poke it to see if it is still beating.  It is not.  Off we go.
One hour and one tropical rainstorm later, we arrive at our final destination for the day:  San Raphael.  This village is home to a small outpost of the Santa Clotilde hospital, and is staffed by a registered nurse from a school in Lima.  As part of their training every nurse and doctor in Peru is farmed out to an isolated community for a year of mandatory service.   David is a little more than halfway through his year of servitude, and he is delighted to see us.  He comes from a city near the coast, he talks fast Spanish, and he couldn´t care less that I don´t understand most of what he has to say.  To a city-born nurse who has been isolated in the jungle for over 6 months, a mute foreign doctor is the perfect captive.  We had worked our way through most of his childhood and into his teen years by the time that somebody finally served the beef.
At night Victor Hugo led us to his father´s home (San Raphael is his home town), and we threw down our packs and foam and strung up our nets.  In the process of unpacking I found a small side pocket with a long forgotten bottle of water purifier, which brightened my chances of survival considerably.  His father´s house even had a toilet, of sorts:  a porcelain bowl, without a seat or a tank, and located in the open without a door or curtain.  You flushed it by carrying a bucket of water over and pouring it directly into the bowl, which then appeared to drain directly into a gulch in his yard.  It worked.  I would remember it fondly in the days to come.
The following morning, with David now part of the crew, we set sail on our vaccination campaign.  The plan for the trip was widely discussed and loudly debated, but in Spanish of course, so I can´t pretend that I ever had the foggiest clue where we were or what came next.  When everyone got out of the boat, I got out of the boat.  When people grabbed their packs, I grabbed my pack.  I slept where I was told to sleep and ate what I was told to eat.  I played with the monkeys I was allowed to play with, and didn´t touch the dogs that they told me not to touch.  They looked after me well.
Basically we rode the river, stopping to vaccinate wherever we could.  At times the jungle would be cleared away for a large, orderly village of 40 or 50 huts, complete with a school and wells and areas cleared for buffalo to graze.  Sometimes people would gather in one central area for their vaccinations, and sometimes we would walk from door to door.  In other parts of the river we would come across a single hut, or – my preferred technique – at times we simply chased down unsuspecting fishermen in their dug-out canoes with shouts of “Hey!  Over here!”, raised needle waving maniacally in one hand. 
In the larger centers, wherever people gathered, I would offer up medical consults.  At times I would get no requests at all, just wary looks.  At other times the lure of free drugs would prove so popular that I would still be frantically throwing out prescriptions as the rest of the team pulled me back onto the boat.  Victor Hugo had packed our medicine chest to his own unique and apparently random tastes, and it wasn´t exactly the MSF kit that I have grown to love.  There was a need for improvisation, but we made do.  Always at the end of every little scrum there was one person from the back who would approach as I was preparing to leave and say, quietly, “time for one more?”.  Cue the 16 year old with a sore liver, fever for 2 weeks, and eyes the color of a lemon.  Or over here, the baby who fell into a fire, 8 days ago.  In these cases I would offer up what medicines we could, write letters of reference on the back of scrap paper, and instruct them to catch the very next public boat to Santa Clotilde.  I was assured that public boats are frequent, and that the cost was affordable, and I expected to find them all safe and sound in Santa Clotilde upon my return.   Not one of them went.
When the sun started to set we would stop wherever we happened to be, and invite ourselves to sleep in a random villager´s home.  All of these houses were of similar construction – wooden floors raised on stilts, mostly open walls, and a thatched roof overhead.  They were surprisingly breezy and comfortable, and in the cooking area (usually a separate platform connected to the main house by a precarious plank) the family would busy themselves cooking up whatever food we happened to bring with us.  This was Victor Hugo´s department and – social butterfly that he is – he was remarkably well connected and adept at finding things to eat.  Sometimes he would bargain for a chicken, other times he would negotiate fresh fish from the fishermen we were vaccinating, and sometimes he appeared (to my culturally uninformed eyes) to simply walk up to strangers and say:  “Hi, we would like your bananas”.   Once or twice he disappeared for a couple of hours with his gun, but whatever he dragged back always looked like it had died at least a month ago, so I doubt that he did any actual hunting.  The ass-half of an armadillo was a particular treat – shell cracked cleanly through with a machete and the animal carried dangling in the air by the claw of one protruding foot.  Sometimes the patients gave food as well – a home visit would end with an offer of corn, or a medical consult would conclude with the gift of an uncooked egg.
If the food at times was sketchy, sleeping was equally hit or miss.   Amongst the advantages of a house built on stilts I would include the relative paucity of crawlies on the floor, the spectacular views, and the crisp breeze one gets off the river at night.  One relative disadvantage is that the area under the house serves as the family barn.  Dogs wait anxiously for scraps of armadillo to slip through the cracks of the floorboards, and pigs muck around noisily contenting themselves in the shade.  On at least one occasion I put the finishing touches on my mosquito net only to lie down contentedly and then see, through the crack in the floorboards, a flock of poultry roosted on a beam a foot beneath my head.   Out came the flashlight:  that´s a chicken, that´s a chicken, that´s a... curses!... rooster.  Roosters and I have very different ideas about what constitutes “sunrise”, my own personal definition requiring at least some – even just a hint – of light in the sky.  I also don´t take kindly to the rooster habit of keeping up appearances;  that is to say, making all sorts of look-at-me-aren´t-I-up-and-at-it-early, such-a-busy-fellow noises, all the while perched in the same place just a foot below my head and secretly doing nothing at all.  Using my headlamp and peering through the crack I saw at least one rooster crowing with his eyes still shut.  So very unnecessary.
Throw in the lack of toilets or latrines, the recurring rainstorms, the ridiculous quantity of bug bites, the limitations of even the most hardy of water purifying drops, and all in all it was a best of times, worst of times experience.  I count myself lucky to have had the opportunity to travel a portion of the Rio Napo – a truly remarkable part of the world, filled with friendly and inspiring people.  Nevertheless, by day four I was ready to hit the eject button.
In my defence I should add here that when day four came around I was under the impression that we would be out on the river for at least three more days.  In my limited Spanish I heard talk of a Monday return.  It seemed impossible to predict – some villages would gather smartly in a central area and we would finish everyone in under two hours, while in other places we would labour from house to house and spend 30 or 40 minutes with each individual family, waiting patiently for random siblings to be called back from the fields or the fishing boats.  I had no concept of the local geography or how much further we had to go.  And thus, tired and confused, dirty and itchy, we arrive at the low point of the journey.
On this particular afternoon the sun was shining fiercely – a blessing from the point of view of the hastily scrubbed laundry drying on the grass, but it was mercilessly hot and relentlessly humid.  We were in the village of Corpal Urco, having arrived at 2pm to find that no one was in their homes:  we would have to sleep the night and wait until morning to vaccinate.  I was hot, bothered, itchy, starting to burn in the sun, and bored.  We had found a little spring to wash up in but still, with the humidity and the mud it was impossible to get clean.  Victor Hugo had found a friendly family to serve as host, but unlike the previous homes this hut had enclosed walls, nowhere to sit, and little to no breeze inside.  The town was laid out around a little hill and, with nothing else to do, I hiked up to the top to stare at the river.  David sat down beside me, wordless for the first time in days.   An hour of contemplative stubble-itching passed in this fashion, watching driftwood float downriver in the turbulent current. 
That´s when it hit me:  DOWNriver?!?   The driftwood is floating in the same direction that we have been traveling.   Put another way:  we, like the driftwood, have been traveling downriver.  Is it possible that all this time, ever since pushing off from the muddy shores of San Raphael, that we have been traveling towards Santa Clotilde, and not away?!?
“David,” I said, snapping out of my stupor abruptly, “which way is Santa Clotilde?”
“There,” he replied, pointing in the direction of an emergency radio antenna downriver.  An emergency radio antenna very much like the one in Santa Clotilde, that I was now noticing for the very first time.
I started to get excited.  “Do you mean in the direction of that tower, or at the tower?” I asked.
“Yes,” he said patiently, “I mean there.  At the tower.  That tower is the tower of Santa Clotilde.”
Gobsmacked.  Could it be that we had struck camp for the night in plain view of home?!?  Was this entire misadventure the Peruvian equivalent of 12 year olds pitching a tent in their own backyard???
“But, what, where, who, how…” I stammered, “how long would it take to get to Santa Clotilde from here?”
David stopped a passing local and asked.  The old man sized up our boat in a glance, thought for a moment, and said:  “20 minutes”.
A lone tear rolled down my cheek.
“Then I could swim there?”  I turned to David, perhaps a little too hopefully.  “Could I??”
“No doctor.  Piranhas.”
“Mucho piranhas?”
“Bastante piranhas.”
A second tear.
At this point Victor Hugo joined us and confirmed that he would be dropping me off in Santa Clotilde the following afternoon, after we finished our work in Copal Urco.  Nelly sang out that food was ready.  A refreshing breeze blew through.  A bright blue tropical butterfly landed on my sandal.  The laundry was dry.  Birds chirped.  Rainbows appeared on the horizon.  I was back in my happy place.
After lunch or dinner (I was never sure what to call it, we ate only one meal after breakfast), Victor Hugo was belatedly struck by the notion that he had chosen the wrong house for us to sleep.  Perhaps it was the 8 children running around inside the cramped hut, or the horde of pigs snorting in the swamp below us, or the near furless dog itching itself on the front stoop, or the sweat rolling down David´s face as he sat perfectly still panting, or the site of me trying – unsuccessfully – to lie down in any direction without banging my head on a wall.  Whatever it was that inspired him, Victor Hugo suddenly leapt to his feet and declared that he would find us another house.  A house with a breeze!  On the top of the hill!  I jumped up too and volunteered to go with him, curious to glean some cultural insight into the Peruvian phenomenon of arranging random home-stays.
Apparently the process goes something like this:
Victor Hugo (reaching the top of the hill and approaching the very first house):  “hey kid, is your mom home?”
Child (gesturing into the dark house behind him):  “Si.”
Victor Hugo (peering in the open window and shouting):  “Hey, senora, can we sleep in your house tonight?”
Random voice from somewhere in the back of the house:  “Si.”
Never failing to underestimate my Spanish, Victor Hugo then turns to me – in case I didn´t understand the preceding interaction – and confirms for me with hand gestures that this is where we will be sleeping.  I get it.
This turns out to be no ordinary hut, as the satellite dish parked out front would attest.  It houses the village telephone.  Fixed to a makeshift wooden dividing wall that separates the hut in two, with a thick cable running straight down from the grass roof above, this telephone booth looks about as inconspicuous as that of Dr. Who.  The whole set-up was so ridiculous that I couldn´t wait for someone from the village to come in and use it.   After the sun had set and we had strung up our mosquito nets haphazardly about the room, I got my wish.  The phone started to ring.
A little bit of context here:  night falls quickly and completely in this part of the world.  It was pitch black inside the hut.  The homeowners were sleeping in a separate part of the hut behind the partition, and making no sign of movement.  So Victor Hugo gets up, carefully navigates the dizzying maze of string and wires suspending our mosquito nets in the dark, and sleepily answers the phone.
“Buenas noches??”
Someone in the village is receiving a call from a daughter in Canada.  Victor Hugo gently sets down the phone, tiptoes to the door... and then hollers into the darkness of the night:
“Manuel Raphael Siguentes!  TELEFONOOOOOOOOOOOOOOOOOOOOOOO!!!”    
At this point I come down a bad case of the giggles, which only incites Victor Hugo to try harder.  He bellows louder, and longer, and repeatedly... practically winding himself... and all to no effect.  No response from the perfect darkness. 
Victor Hugo tiptoes back to the phone, picks up the receiver and asks, “in what part of the village does Senor Siguentes live?”  I assume, incorrectly, that he is going to wander through the village to track down Mr. Siguentes in person.   But this is not exactly what Victor Hugo has in mind.
He walks back to the door.   With great fanfare, he spins 100 degrees to face, presumably, the part of the village where Mr. Siguentes is purported to live.  He cups his hands to his mouth, and hollers:
I´ll be damned if he didn´t get a response right away.
Unfortunately Senor Siguentes looked to be about 80 years old, with arthritis to boot, and by the time he finally hobbled crooked-backed and wonky-kneed into the hut whoever it was on the other end had either lost interest or maxed out their phone bill.  Undaunted, Senor Siguentes cleared himself a spot on the floor amongst us and settled down in the darkness to wait.
I´m not sure how long he might have sat there, as my next memory is waking up in the middle of the night to the sound of a fast approaching tropical storm.  These night storms – with their impossibly heavy bursts of rain, wicked gusts of air, and incredible thunder that rattles your very chest – are my favourite part of sleeping in the jungle.  I stretched out on my ratty foam pad in dreamy comfort, secure in the knowledge that I was safe and sound inside the hut.  Safe and sound except, curiously, that my leg felt wet.  Very wet.  I did, on some level of consciousness, register that water was pouring through the top of my mosquito net but my initial response was simply to slide my foam 6 inches to the side, away from the stream of water hitting my leg, and go back to sleep.  Funny... now my whole head feels like it´s sitting in a puddle of water.
Suddenly I see the shadow of Victor Hugo leaping to his feet.  David bellows in surprise.  Nelly cries out in Spanish.  Not too far away a lightning bolt strikes and, in one brief nano-second of illumination, I register that the roof is leaking.  EVERYWHERE AT ONCE.
What happened next plays out in a series of bursts of lightening.  There is no soundtrack to this comic-tragedy as the pounding rain and heavy thunder drowns out all the screams of anguish.  Flash:  Victor Hugo, in his boxer shorts, running in circles and doing – if I saw correctly – jazz hands (cue the bumblebee costume).   Flash:  David, unwisely, rolls himself into his foam and becomes a human armadillo.  Flash:  Nelly, brightest of the bunch, makes a head first dive for the dry spot under the phone booth.  Flash:  Victor Hugo is either tearing down our mosquito nets intentionally to keep them from getting wet, or, and I favour the latter, is caught in the strings and is raging about the room like a shark trapped in a fishing net.
Suddenly, a candle.   Help has arrived.  The matron of the house emerges calmly from the side of the house that HAS a working roof.  She is holding in her hands – wait for it – two tiny tin pots.  The Titanic is going down and she has arrived on scene with a half-liter bailing bucket.
I won´t continue aside to say that the next hour or so was not my favourite part of the trip.  Standing against a wall in the darkness at 3am and waiting out a storm is not my idea of eco-tourism done properly.  Eventually however the rain abated, Victor Hugo was untangled and, through the blessing of uneven flooring, the water rolled out of the house as quickly as it had come in.  By the time David cautiously poked his head out of his foam roll again, we were able to throw our soggy beds back down to sleep.
The next day, Santa Clotilde:  land of dry beds, proper roofs, well-cooked meals and, of course, my curious friend Leo the Macaw.  I´ve only been here for three weeks total, but it already feels like home.
Tomorrow a team is embarking on a 15 day trip upriver to the villages surrounding the town of Buena Vista.  FIFTEEN days.  Victor Hugo is sidelined with a serious case of Dengue Fever.  Nelly has managed to keep a low enough profile to avoid getting enlisted.  David is due back in San Raphael.  I was asked but, unfortunately, can´t go.  “Darn it,” I say, trying to sound convincing, “if only I wasn´t flying back to Canada in 11 days…”.
Sorry, as always, for the length of the email.  I should try to write less and more frequently!  Hopefully I´ll get a chance to write once more before I leave, with some more practical adventures from the hustle and bustle of the Santa Clotilde hospital.  Looking forward to seeing everyone in a couple of weeks!!