Today was our first day of training in rural Angoteros. We spent the morning getting everything in place, with the biggest logistical challenge being the need for electricity to conduct our presentation. Power only runs between 6 pm and 10 pm. At 10 pm the lights go out no matter what you are doing. When I say the lights go out – I truly mean it is pitch black. Luckily the little USB charger fan I brought serves as a back up charger for a phone and as a flashlight.
I got out of bed at 5:30am at the insistence of the local roosters. Whoever said roosters start crowing at sunrise has not met these roosters. The first “cock-a-doodle-doo” I heard was around 3am. Thereafter, a constant rooster symphony let us know they were there and wanted the world to know it. After a few hours of work using my computer on battery power, it was now breakfast time. Before we left, we received an extremely pleasant surprise. Dommi, the Polish missionary we met yesterday, had sent over a bag containing bath towels for each of us. This was most welcome, as showering the day before had felt awkward, drying off with no towel. Funny what we take for granted.
There are no restaurants here in Angoteros, and only a few tiny stores called “tienditas” (translation: “little shop”). I have included a picture from inside one so you can see what shopping is like and what purchase options exist. The people in this village of less than 800 people live primarily off what they grow and what they can hunt or fish.
As we walked over for breakfast, a small movement in a tree caught my eye. See if you can find what caused it in this next picture.
In case you did not spot it – here is a zoomed picture. A little girl was standing up in the tree. I am not sure if she was up there to get a glimpse of the strangers in town, or simply as a fun activity.
We made arrangements to pay a local resident to cook for us each day. She is the wife of one of the clinic workers we are training. His name is Geordano. They have three adorable children – the littlest of whom stole my heart. She was afraid of me at first, but after seeing me in her house for a while, and a game of peekaboo, she started coming around.
Here is a picture of the family’s pet turtle. It had a string attached to it…I guess in case the kids want to take it for a walk…? Also notice a baby chick which seem to feel right at home wobbling into the house. I found the contrast of the baby chick with the Barbie-style doll amazing – two worlds colliding. As you can see, life is very different in the rural Amazon from what we are accustomed.
For breakfast we had a fried egg and some platinos (plantains). As I mentioned in my last blog, Jens is also a visitor here since he works at the hospital in Santa Clotilde but is here training on Volume Scanning Imaging (VSI). He seems to have a very fun-loving personality. Unfortunately, I do not understand as much of his Spanish as I would like. I am finding that there are some people that are easier for me to understand than others. This may be a function of individual dialects as well as unique pronunciations. As you can see in the picture, Jens is always smiling.
For lunch we had some roasted chicken (cooked over an open fire) and some rice with a piece of Yuca (pronounced YOO-ka). It tasted very much like a potato – but more flavorful. I am now seeing that the cooking hearth seems to be a mostly standard home accessory…an open fire pit built into the kitchen floor. They have sand or dirt below the firepit as protection against igniting the wooden floors. It seems that there is really nothing that prevents the side boards from catching other than where they place the wood to be burned within the pit. They place iron grating above the fire when cooking or keeping foods warm.
On our way back to the maternity house we met Dommi. After hugs and kisses…a kiss on one cheek: the Peruvian/Spanish way…a kiss on both cheeks: the Italian way…and three kisses (one side, the other side, and then back again): the Polish way. Dommi commented that the Polish way “is clearly best as you get three kisses.” We thanked her profusely for the towels to which she quipped – “I have the only five-star hotel around”, laughing at her own self-deprecating humor. Dommi was there to announce the award of fifteen scholarships by the Diocese for local students to study in Iquitos. The plan is that the educated students would come back afterward and work in Angoteros. This education opportunity is very significant, as most families cannot afford to send their kids to schooling more advanced than our equivalent of middle school, and also because most families want to keep their kids with them to help work the land. I believe this scholarship plan is also a means of changing the culture so that people start to value education more by seeing how it can improve the lives of individuals and the community.
We were amazed when we arrived in the house to see a large-screen television with 7 or 8 kids around it. Apparently, neighborhood children join their friends to watch television during the 4-hour period of grid electricity. They were watching Star Trek: The Next Generation, which originally broadcast in the 1990s. The show was in English but there were Spanish subtitles.
A little more about our training today. By late afternoon, we finally got down to the VSI training. We were able to get a portable generator to use, with only a few issues, the first being that we only had about twenty minutes worth of gasoline. Eventually that issue was resolved – how exactly remains a mystery. The next challenge was how to connect electricity to the maternity house. The “portable” generator was very heavy and the staff decided to move it the shortest distance possible, which put it outside Leslie’s room. Geordano stripped the wires with a 2-foot-long machete. Yes, you read that correctly – the local clinic staff is very resourceful and find ways to make things work. Geordano twisted the wires and stuck the plus and minus leads into the prongs of a wall-socket. The lights came on but for some reason there was no electricity to the plugs in our training room. Eventually we found that one of the breakers was tripped and we were good to go.
We taped a bed-sheet to the wall to act as a screen. We brought in a small projector, and along with a few chairs and my bed to sit on, plus my laptop, we had an instant classroom. My talk was on basic ultrasound physics, followed by the theory of VSI, and the differences between VSI and traditional ultrasound. There were 8 people in attendance – including the three local clinicians who will be performing the protocols and the one person from Santa Clotilde (Jens) who will do the same down there. The others included a young doctor, Franciet (spelling may be way wrong here) who is at the end of her program for which she has to perform one year of medical practice in a remote location. In two months’ time, she will leave and a new doctor will start his or her rotation here. She really wanted to attend the lectures and training – and we of course are thrilled to include as many people as possible. We actually used the panoramic picture (included below) as a prop to explain how speed matters when performing a VSI sweep.
Brian gave a quick lecture on the history of MIMAs and showed some examples of VSI scans. At that point we were ready to demo the first protocol which is for right upper quadrant. This protocol allows for diagnosing issues with the gall bladder, pancreas, liver, and bile ducts. It consists of six sweeps with the patient in various positions to acquire the optimal images. Tomorrow, the trainees will begin practicing the protocol themselves. After that, we will begin the OB protocol.
We were pleased with today’s outcome – but really wish we’d had a fan to help keep the inside temperature down. We tried buying one in Mazán, the town in which the boat stopped two days ago, but there was only one fan to be had – and it was so large that we did not think we would be able to carry it. We were rethinking that decision now.
Closing out, as power goes off in 31 minutes, one thing is for sure, Angoteros locals are a lot tougher than we are. But I am thankful for the cool showers, for the treatment we have had, and the special accommodations that they have provided…which goes way beyond what most people have here.
I am including a picture of my room when the power goes out- enjoy! 😉
Below are hyperlinks to the prior blogs on Bringing VSI Imaging to the Amazon of Peru:
BRINGING VSI IMAGING to the AMAZON of PERU (Intro/Chapter 1)
BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 2)
BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 3)
BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 4)
BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 5)
BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 6)
Frank Miele, MSEE , President of Pegasus Lectures, Inc. Frank graduated cum laude from Dartmouth College with a triple major in physics, mathematics, and engineering. While at Dartmouth, he was a Proctor Scholar and received citations for academic excellence in comparative literature, atomic physics and quantum mechanics, and real analysis. Frank was a research and design engineer and project leader, designing ultrasound equipment and electronics for more than ten years at Hewlett Packard Company. As a designer of ultrasound, he has lectured across the country to sonographers, physicians, engineers and students on myriad topics.
