I (Rick) just returned from a trip to the high jungle town of Quillabamba with Dr. Bill Allen, his adopted son Vladi, and one of his clinic's nurses, Jasmine. The village is only 75 miles northwest of Cusco, but it took 6 hours of driving over snow-capped mountains and then down to the edge of the Amazon jungle along the Urabamba river. Bill has been approached by senior health officials in the Cusco region and Partners in Health to help them with the growing number of patients with TB and some with multi-drug resistant TB (MDR-TB). This increase in TB and MDR-TB cases is very worrying to public health officials because it is a respiratory disease. You can catch it simply by breathing the exhaled breath of someone who has the disease next to you in the market, on a bus, in your home, etc.
The very fact that the disease is even in the Quillabamba region is something of a mystery (and scary), because TB and MDR-TB exist primarily in densely populated urban areas like Lima and prisons. The two patients we met with who are receiving treatment and are recovering from MDR-TB have probably not been beyond Cusco or even Quillabamba (pictured below).
Therefore, Bill wants to figure out how these individuals got MDR-TB and whom else might have been exposed. He also wants to find ways to more reliably diagnose patients with TB and increase the likelihood that patients will receive proper and thorough treatment. It is excruciatingly hard. Appropriate treatment for TB consists of directly observed therapy (drugs taken orally) for six months, otherwise known as DOTS. MDR-TB treatment requires injections for 6 months and then 1.5 years of follow-up drug therapy. Currently, it cannot be delivered in places like Quillabamba. Patients are supposed to come to cities like Cusco and Lima to receive treatment, but that is almost impossible and extremely impractical for people with TB, because they tend to be poor and reliant on daily labor for their existence. Traveling to Cusco, much less Lima, for 6 months for treatment takes them away from their crops, families and/or daily work on which they depend. Bill's hope is to bring state-of-the-art diagnosis and treatment to them in their remote communities in order to help them survive and to halt the spread of the disease.
The clinicians with whom we met in Quillabamba were especially appreciative of Bill's efforts to collaborate and partner with them. They said that in the past some NGOs would come to the village to provide some type of medical care, but they would do so in isolation from the existing hospital and public health services. Consequently, their lack of coordination and communication led them to seeing far fewer patients, accomplishing little and eventually leaving town altogether. Bill's ambitions are to work closely with the local medical providers and complement the great work they are already doing and the extensive knowledge they have of the area. Why reinvent the wheel?
This trip allowed me to see my first ever patients with tropical, infectious diseases like TB and malaria. As one would expect, it is very different from reading books and articles or watching documentaries about them. It is much more emotional and personal to interact with a fellow human being who is suffering from a disease like Yellow Fever (for which I am very grateful to have been vaccinated). It is especially sad and painful when they are children.
On a lighter note, Jen and I have been enjoying our soccer games at El Arca Orphanage even more recently since we got all the kids red and white soccer jerseys. It is much easier to known who is on your team and whom to pass the ball to when everyone is wearing the same colors!p.s. - Tim kicked his way to a yellow belt in Taekwondo, so watch out evil-doers! His reward was to be able to march in a parade in the Plaza de Armas in the center of Cusco with the board he kicked in two (video of dangerous kicking below).
