Not sure anyone really enjoys early-morning flights, especially when they allow for only four hours of sleep.  Today we flew to Iquitos , the capital of Peru’s northernmost region (Loreto), which incorporates their equatorial forests.  We are meeting administration at Hospital Regional De Loreto \”Felipe Santiago Arriola Iglesias\”, a few doctors within their staff, and an official with the Ministry of Health of Peru (MINSA) to outline our initiative and goals.

Our purpose in meeting was to persuade the hospital administration and staff to participate in a correlative study, similar to those conducted in our prior mission in Uganda.  In Uganda, we completed a “Concordance Study” and an “Outcome Study.”  The concordance study is a comparative assessment of VSI sweeps against conventional ultrasound evaluations.  In this study, we would need both “normal” and “abnormal” patient surveys to validate the VSI protocols and process.  For the outcomes study, we would need to access post-procedure patient data to evaluate VSI’s efficacy.

At the airport, we received an impromptu cardiac stress-test when baggage check-in flagged some of our luggage as over-weight.  Despite our frantic efforts to reapportion the suitcases, mixing out clothing, the ultrasound system, the UPS (backup power supply), gallons of gel, video capture devices, MIT boxes, various cables, and personal items, we still ended up with one over-weight bag.  Airport staff redirected us to the opposite end of the terminal to pay an added fee, lacking the commerce equipment to take payment right there.  Our flight was nearing departure as we stood in line to make payment, but mercifully a kind-hearted supervisor, perceiving our distress, waived the fee so that we could get going.  We made our flight with five minutes to spare.

Rushing back through, I noted a sign: “Comienza Aquí”, which seemed perfect as an obvious metaphor for the journey on which we were embarking.

With the moments we had to spare, we grabbed a sandwich at the little store in front of our gate – and boarded the plane to Iquitos.
When we landed, we disembarked onto the tarmac. I felt like reciting the line from the Wizard of OZ – “I’ve a feeling we’re not in Kansas anymore.”

There was great excitement and relief when we saw our side-tracked, over-weight bag on the luggage carousel, as we had left it marooned, across the airport from our departure gate.  We were not sure that bag would make it!

From the airport, we took a car over to the hotel to drop off our luggage.  (You can see a picture of the front door and also the view from my room) in the associated pics.)  It was, not surprisingly, very warm and humid.  The roads are congested with what are called moto-taxis, which are basically motorcycles with the back wheel removed and instead attached to the axle of a two-wheel cart behind.  They make a fair amount of noise and the drivers seem fearless as they dart in and out of traffic.  From the hotel, we took our trip to Hospital Regional De Loreto in a moto-taxi (an experience everyone should have at least
once).

Upon our arrival, we were welcomed by Gabriella, the Santa Clotilde hospital’s administrator, and Dr. Norberto, from its hospital staff.  As I referenced in my Introductory blog, our journey would tomorrow continue by 8+ hour boat ride to Santa Clotilde, and then another 8-hour boat-trip up the Rio Napo to the rural village of Angoteros.  This was our first meeting with Gabriella in a non-Zoom conference setting.  You will hear a lot more about Gabriella in the upcoming blogs.  She is an effective and dynamic powerhouse with an obvious ability to make things happen.

We later met Alex, the Hospital Regional De Loreto’s administrator.  Once we began our presentation, it became very clear that Alex was excited about what he was hearing.  His enthusiasm was encouraging and uplifting.  Charlie, the MINSA official arrived a short time later.  He also very quickly grasped the benefits our program could offer.

Our discussion expanded to an explanation of the logistical challenges specific to Iquitos and the region of Loreto.  Iquitos is bounded on three sides by the Amazon and two tributaries, the Rio Nanay and the Rio Itaya .  Consequently, Iquitos is functionally more like an island than a connected land mass.  Transportation to and from Iquitos is by air or by river transport.  In the Loreto region, many places have access only by river or by foot.  So, when someone becomes ill in the remote areas of the region, it is extremely challenging to get them to Iquitos or Santa Clotilde where they can be treated.

Transportation of the sickest patients is done by water taxis, or in extreme cases, by sea planes that can take off and land on the rivers.  Because of the expense, potential patients will often wait until their condition is so grave that they cannot be treated successfully or cured.

Another efficiency concern surrounds when patients are flown in for a condition that causes pain but is not life threatening (like a cyst).  The possibility of reducing these unnecessary flights seemed to excite Charlie, because if they could reduce unneeded transportation costs, these funds could be used elsewhere.

In the picture below, my left hand is pointing at Iquitos.  My right hand shows how far up the Rio Napo we need to travel to Santa Clotilde.  Brian’s left hand is pointing at the village of Angoteros.  You can see how close we will be to the border of Ecuador.  It sure looks like a long trip.  You are probably asking – “Why are we smiling?”

As we left, Alex suggested that we could meet with some of the Hospital Regional De Loreto’s doctors after returning from our training sessions in Angoteros and Santa Clotilde.  We had accomplished our first goal and were very pleased.  Success on the first of many phases.  By the way, did I mention that the room was air conditioned? – it felt like heaven.

We took another moto -taxi back to the hotel.  Each of us had work to take care of so we spent the next few hours on our laptops – aided by the fact that we had internet access.  We walked to dinner around 7:30 pm, after which we saw the hotspots of Iquitos.  Along the Rio Itaya, there are many restaurants, dance clubs, bars, and ice cream shops.  Throngs of people were out in the very humid air, enjoying the start to the weekend.  Young people were dressed up and obviously involved in their courting rituals.  The place was very alive.

We headed back to the hotel, knowing that we had an early morning to get to the boats to travel nearly eight hours to Santa Clotilde.

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)

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.