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Saturday, February 26, 2011

Cidade das Mangueiras

Wrapped in disguise, Belem's streets are lined with enormous trees, low hanging branches, with bright green foliage and heavy red and yellow mangoes!  In addition to meaning Mango Tree, mangueira is also the name of a famous Samba School in Rio de Janeiro (conveniently the one I danced for two years ago!).  Just my luck, mangoes being my favorite food, it was the first sign this place was made for me!  And with Carnival fast approaching I thought what a bit of Brazilian knowledge to share with the world!


Mangueiras (Mango trees)

Samba School Mangueira

Belem is the capital of mango fruit in all of Brazil.  Originally from Japan, mangoes can now be found on the streets, cars, and heads of the people of Belem.  Make sure to always be looking up, you never know when it could be your last.

This place is a land full of wonder.  Today, it is a metropolitan city that is home to over 2 million people.  Sitting near the mouth of the amazon, Belem traditionally has some of the most exotic and delicious cuisine in all of Brazil.  Walking through the streets you discover Amazonian Brazil.  The mixture of indigenous people and Portuguese influence, makes Belem like no other city in the world.  But with this beauty comes great challenges.

The view of Belem from Marcia's Friend's House.

The Amazon Forrest takes up 62.1% of all land in Brazil with most of that Forrest covering the States of Para (were Belem is found) and Amazonas.  The river is the life line for the millions of people that live here.  It is the source of all things, work, food, and water.  In essence it is life.  You can imagine the constraints this region has on providing healthcare, clean water, and education.

Yesterday, I visited the Instituto Evandro Chagas.  The people from Belem call it The Olympus.  A 200+ bed hospital dedicated solely to cases of Infectious Disease.  IEG has a pediatric floor, a 10 bed ICU, an entire ward for AIDS patients and a whole designated hallway for TB cases just to name a few departments.  This tarnished and decrepit building houses some of the most interesting cases in ID, in the world.  I saw disease I never knew existed.

In addition to several AIDS, Malaria, and TB patients, I saw cases of Chagas Disease, Leishmaniasis, Leprosy, Dengue, and even a COBRA BITE!  Most conditions being transmitted by mosquito bites, flea bites, and actually poorly prepared Acai (Acai being native in this region, it is the most popular consumed food here.  A large source of income and claim to fame for the state of Para as well).

Chagas Disease can present as swelling in the effect area, headache, fatigue and fever.  It eventually leads to enlarged liver and spleen and if it is not treated will lead to death.

Leishmaniasis presents as lesions and as it hides in your macrophages it is protected from your antibodies many times developing into a chronic condition.  It can be fatal for immunocompromised patients. Hence the challenges of Transplantation in the Amazon.

Beyond the interesting cases of infectious disease you couldn't help but notice the desperation and despair of the people.  The people there were poor, very poor.  Most patients live deep within the Amazon Forrest and suffered great lengths before arriving at Instituto Evandro Chega.  One case, a 5 year old boy had an unrelieved headache for over a YEAR.  His family went to the health clinics several times but where always sent home.  It wasn't until the boy started to go blind that they made the diagnosis.  Now, permanently blind, his family had to return to work 6 hours away while he continued his 6th week recovering in the pediatric ward.  

This poor boy's story was not alone.  Each patient we met had a similar experience, 3 months of symptoms, 6 months, 9 months, before they found proper care.  Besides the geographical challenges of the amazon, the posto de saude (healthcare clinics) struggle to find adequate providers.  Most patients I talked with lived anywhere from 3 hours by car to several days by boat away.  Because of the distance, and the needed length of days for IV therapy must patients stayed within these crumbling walls anywhere from 2 weeks to 6 months.  With no resources for home care or optimal clinics in the indigenous regions, patients sit alone finishing treatments waiting to return home.  

With so many hurdles for improving the health care system one wonders where you find hope?  It isn't enough to provide "free" healthcare if one can't access it or finds it suboptimal for sustainability with life.  

Before I left, I met with a friend who has spent most of his medical life abroad in undeserved areas such as Nicaragua, and I asked him, "Do you ever see progress?  Can you maintain hope when it seems so dismal?"  and he replied, that of course you do, you just have to measure progress in a different way. 

For me, the hope lies in the people.  Listening to Marcia and Mauricio's passion for helping others is profoundly moving.  In the face of diversity, overcoming problems such as geographical hurdles, infectious disease, education, and cultural stubbornness, these two have battled through.  Their Liver Transplant Program for the Northern Region of Brazil will be a legendary accomplishment.  Pioneering transplant through the Amazon Forrest.  From their friend Fabio, who constructing a hospital out of a boat, travels along the Amazon River providing primary care, to the hard working heroes of Belem that every day work to make it better.  

Furthermore, having dinner tonight with Marcia's cousin, a public defense attorney for the indigenous people of the Amazon, you can't help but feel a sense of renewal and purpose as he passionately explains the absolute neccesity of stopping the building of a dam in the Xingu River to directly save the lives of over 20,000 people, effecting 5 different tribes, and one huge city.  It is our commitments now that shape our future.  Our choices to look at total despair and inject hope.  If nothing more, being surrounded by such purposeful people has sparked emotions and drives in me to do more, seek more, and accomplish little goals for big changes.

Sometimes you need to ask yourself, what in this world seems impossible to change, and then prove the world wrong.

Our Team of Doctors for the Liver Transplant Program

Our Team of Doctors for the Liver Transplant Program

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