After too many months in both the States and Lima, I’ve finally made it back to Yantaló. Back to the wonderful weather, the breathtaking landscapes and all the smiling faces that I fell in love with the first time. It is certainly nice to be here. …And this time I’m here to stay.

I made it just in time to get to work. Upon my arrival, the rainy season was drawing to a close and we were preparing for our first cement pour at the clinic site. The cistern forms had been completed and we were ready to go. The weather cooperated and, despite a couple minor malfunctions with a cement truck, we finished in one day, without much difficulty. (Not surprising, considering the incredible work ethic of the Yantalinos.)

I also had the pleasure of meeting some great volunteers. Brett (aka “Fernando”) and Sarah (”Sarita”), two medical professionals from Edmonton, Alberta, Canada, spent most of their time at the school. They were joined by Caitlyn (”Catalina”) from Seattle, Washington. They taught first-aid to the teachers, as well as sex education to the students. They were understandably a little hesitant when the Director asked them to step in for the assigned sex ed professor, but the outcome was terrific. They used curriculum from the Scottish model (which Sarah was taught) entitled “Love, Sex & Respect”. From what I witnessed, the instruction was better than what we got in my high school – and we were rated the best school district in California. They had a great time, and the students learned a lot of valuable information. Great job guys!

Percy, Fernando, Veronica, Sarita y Catalina

It wasn’t all work and no play, though. The volunteers had a chance to visit Tingana, the nearby nature reserve, as well as Sauce – a beautiful lake near Tarapoto. We also had a great day hiking up El Morro, where stunning views of Yantaló, Moyo and the entire Alto Mayo region can be seen.

As for myself, I’m spending most of the time clearing my new land and preparing for both the construction of the first duplex/bungalow, as well as planting bananas and cacao. With an estimated 3000 plants of each, I have lots of work ahead of me. I couldn’t be happier though. Rain or shine, I’ll take working the land here over another SoCal commute any day.

Gotta get back to work. Hope to see you here soon.

- Travis

Once developed, the Yantalo Lab will not only serve Yantalo, but will also serve as a referral lab for other regional hospitals and clinics in the Moyobamba area (100,000+ people) in providing time-sensitive and sophisticated laboratory testing. In addition to basic hematology and chemistry tests, and simple traditional microbiology, our Lab will be equipped and staffed to perform Hemoglobin A-1-C’s, liver and thyroid function tests, viral hepatitis serologies, and PCR tests for HIV, MTB, HPV, Dengue virus, influenza, and perhaps Yellow fever. Our histology lab will be able to process and stain biopsy specimens performed by local or visiting physicians and transmit high-resolution scanned images of slides via the internet to Milwaukee and Lima for pathological diagnosis by virtual microscopy. Our Molecular lab inMilwaukee (and in time the lab in Yantalo) will be able to screen for inherited diseases, such as cystic fibrosis, and help improve drug treatment and prevent adverse side effects with pharmacogenetic testing.

By establishing the Yantalo laboratory and providing regional training and assistance in quality management, quality clinical diagnostics will not only come to Yantalo and transform the lives of the people living there on the fridges of medical care, but will also spread to other hospital laboratories in northern coastal, central and eastern Peru. This laboratory will also support the laboratory testing, blood product, and general supply needs of visiting international teams of surgical and medical teams that periodically rotate through the region, elevating their capacity to provide care to more complex patients.

My apologies for the delayed note; today is my first moment to regroup after the travels and clinical call upon return.

First, my best wishes to you, Mary and your family as you face her illness together.  I know it is very difficult, but I also know that support of family and friends in these situations is important.  All of us here are friends who offer our unqualified support and our prayers.

With regard to Yantalo and Peru, let me say simply, thank you.  Though not as much as you, I have traveled and lived many places…the trip to Yantalo was unique, memorable and positive in ways that surprised me.  What you are doing rekindled some of my 1960’s idealism.  It was one of the most rewarding trips I’ve undertaken; the medical aspects, Yantalo school, our companions, the jungle, everything about it. Your kindness and hospitality were extraordinary.  I am indebted to you for all of your efforts on our behalf.

We’ll talk the week of October 12 regarding next steps.  I have given this some thought.  If we are to organize a Jan/Feb 2010 meeting related to minimally invasive surgery we will have to move quickly.  We are planning a lecture here on campus later this month to provide our colleagues some insight.  We’ll talk.

Again, gracias and best wishes.

Keith T. Oldham, MD
Professor and Chief
Division of Pediatric Surgery
Medical College of Wisconsin
Marie Z. Uihlein Chair and Surgeon-in-Chief
Children’s Hospital of Wisconsin

The RN technicians Veronica and Nancy in Yantalo, kept the record of patients we saw and what treatment was recommended and what treatment was delivered.  We were very busy and with the assistance of Nancy, Kaci [my daughter] and Veronica, I was able to accomplish much more than last year.  In 5 working days, we saw 270 students at the school that included and exam, fluoride varnish application and a toothbrush dispensed.  There were only a couple of students that just received an exam and toothbrush because we ran out of fluoride.  We extracted about 140 teeth.

Unfortunately, there was one extraction case on a girl approximately 21 years of age where I could only remove one tooth and half of another.  She required surgical removal of the remaining portion with an air powered drill, suction, better lighting and x-rays.  I referred her to Moyobamba for extraction of the remaining tooth.

I left all of the remaining dental supplies with Wuillman, the local coordinator for the Foundation. I gave a soccer ball to the school and I left numerous small toys with children that my office usually dispenses.

I think the most important goal for Yantalo’s dental health should be prevention through education and a fluoride program.  I was truly saddened by the amount of dental caries present in children under age 14.  It exceeds that of the United States by my observation five-fold.  I discussed the harm caused by Inca-Cola and Coca-Cola with some of the community members and they were surprised to hear theses beverages could be causing dental problems.  I left an excellent series of Spanish dental health education short videos with Percy, the bilingual teacher at the school.  I am willing to talk more about how a dental health education program can be implemented in Yantalo.  Living with pain and infection until teeth must be extracted should not be acceptable.

Kaci and I were invited to attend some type of pinning ceremony for new leaders of the student classes.  We even filled in for two students who didn’t have parents present.  The students then sang me Happy Birthday and I was presented with a gift and a birthday cake from the school.  Our trip into the jungle was enlightening. We saw monkeys, birds and even caught fish with our guides using a stick, some hook and line and some berries.  The owner of Puerto Mirador even gave me a bottle of Pisco   I cannot thank everyone in Yantalo and Moyobamba enough for making our trip memorable and enjoyable.  Please pass that along and know that my heart is with the people of Yantalo.  I will do my best to continue support efforts there in the future.

I want to thank you so much for your part in the arrangement of my birthday dinner and the time Kaci and I spent with Dr Carlos Samame and his daughter Monica in Lima.  It made our trip even more special.

On a last note:

My dental supply company in Rochester NY, has donated two pieces of slightly used small equipment.  One is a curing light that hardens sealants and white fillings and the other is a triturator which mixes capsules filled with things like silver amalgam fillings, cements and white fillings for kids.  Let me know how you would like proceed with that.

Hola mis amigos.

February was a very busy month here in Yantalo.  There’s been a lot of activity lately, and we’ve still got a number of projects going on at the moment.    Because this area of Peru has the highest infant mortality rate in the country, the Foundation, in conjunction with Not Another Minute, conducted an extensive interview of all the recently pregnant women here.   Thanks to a group of student nurses and caring Yantalinas, 239 women were questioned regarding their child-bearing experiences and resulting health issues.  Great job Gerly!  Thank you and your helpers for the hard work.

At the moment, we are fortunate to have Anjali Hulbanni, a graduate from the University of Michigan, and emergency medicine specialist, who is spending a month here working in the local clinic, as well as the hospital in Moyobamba.   She’s travelled extensively and volunteered around the world, giving her a sound perspective of how health care really exists (or doesn’t) for most of the world.   And from the stories I’ve heard so far, she’s seeing a lot of new things here in the jungle, from machete wounds to a plethora of GI issues.  She will also be helping out the school nurse next week, when the students return.

Regarding the future clinic, we recently purchased and received a large portion of the building materials needed to begin construction.  Wuilman travelled to Chiclayo, where the supplies could be purchased for much cheaper, and arranged for their delivery.    Because the rebar is 9 meters in length, we had to knock down the rear walls of his mother’s house, just so we could have a dry place store it for now.   It is certainly exciting to see the Foundation’s plans turning into reality.  I just wish I had more time here now that the rain is subsiding and things are finally getting under way.
Additionally, we’ve nearly completed renovating the girls’ bathroom at the secondary school.   Originally, we’d hoped to complete both bathrooms, but because of the extensive work needed in the first (including replacing all the water and drain pipes, building a new wash basin and completely stripping the existing cement from the walls with hammer and chisel – which took me about 2 weeks), the boys will have to wait until the next vacation.   Presently we are placing the tiles on the walls.  Tomorrow we should begin covering the new floor.   Despite the pastel green paint, which is standard for the schools here, it definitely looks a lot better than before, and more importantly, will be much more sanitary.   Since I won’t be here much longer, I’m glad I could help with at least one project from start to finish.   … I just wish my hands would stop hurting.  It was better last week when they were just numb all the time.
Monday March 9th is the first day of school, so the teachers are back, attending meetings and preparing for classes.  The school is also constructing a new laboratory which should be finished soon.   Most of my building experience is with wood, so it was very interesting to watch the crew create the new structure from cement, using only form wood and braces from the jungle and rudimentary tools.  Given what they have, it’s quite impressive.    However, I’m a little unclear on what they are actually going to teach in the new lab, being that science curriculum is virtually non-existent here.

As for me, I certainly appreciate the more visceral work lately.   However, the English classes are getting better (and easier to teach) each day.   I mentioned before, I wish I had more time in Yantalo.   It’s been a wonderful experience helping out the Foundation — either with my handful of colored markers and portable dry-erase board, or a bit of elbow grease.   I am truly sad to be leaving, but there’s always next time.  …And that will not be too far down the road.  I know I’ll be back soon.

Take care.  Ciao.