After a one-hour motor boat ride to Mazan and then a two-hour slow canoe boat ride to Llachapa we pulled up at an idyllic green hill on the side of the Napo River. Eager children approached us to help carry all of our supplies up to the school where we were staying. One little boy was only 3 years old and carried 2 large sacks of bread up the hill. As we passed by two rows of little wooden houses on stilts with people peeping out, it hit me just how rural this community was. Our whole team was excited and moved by how welcoming and invested Llachapa was in our visit.

We quickly sprang into action getting everything ready for the arrival of the Community Health Workers (CHWs) and the first day of the training.  Our new partner, Teresa Benedez, from the Peruvian Ministry of Health (MINSA) helped us register the CHWs as they trickled in. I was excited to meet all of them and see what they knew and how they practiced in their community. After a year of being on the Education Committee and preparing a curriculum for these trainings, I couldn’t wait to find out what they had retained from past trainings and what new things we would teach them.  After seeing that many of them needed help with taking a pulse and a respiratory rate we immediately began reviewing those skills in small groups and facilitating the more advanced ones to teach their colleagues.

Now it was time for dinner. We brought a ton of food, so much that I couldn’t even carry the 300 eggs that we brought. I had eaten in the jungle before. I knew to expect bones in my food and strange Amazonian fish. However, I couldn’t stomach the fact that I had a cabeza (fish head) staring up at me with its pearly eyes while Lida sitting next to me had the other half of this creature including the tail. I looked around me and saw everyone else happily eating so I offered my cabeza, a delicacy, to one of the other CHWs who appreciatively ate it.

The next morning we taught the CHWs about nutrition. Each small group had topics such as malnutrition, diet and growth charts. After each group had learned their topic, they presented it to the entire group of students. My group made a meticulous example of a growth chart and then taught everyone how to read one. Jaime, one of the older promoters in my group, explained that if a child’s growth crosses 2 or more growth lines then that child is in danger.  Afterward, he explained to me that he was so thankful to know that someone (CU Peru) trusted him enough to teach him and his colleagues how to read a growth chart since he was never entrusted with that capability before and never had felt empowered to even ask to see a child’s chart in his community.

On our third day of the training we taught about malaria. This topic was well received by the CHWs especially during a time of increasing cases. They were engaged and asked questions about the lifecycle of the mosquito. They even asked if malaria could be transmitted by drinking water that contains mosquito eggs (it can’t, in case you’re wondering). During this lesson was one of the many times when our new partnership with Sociemap, a medical student group in Iquitos, came into play. Guillermo a 3^rd year medical student accompanied us and taught the mosquito life cycle and facilitated a discussion among the CHWs on different points at which prevention could be implemented. This new partnership has widened our circle of influence and provided a cultural and regional link between CU Peru and the CHWs.

Things got competitive when we started a game of jeopardy about malaria. The students would run up to us to buzz in on the imaginary “bell,” which was slapping our hand. They were so into the game and almost always knew the right answer, even down to the tiniest details.

At the end of a long day of learning about malaria we started a game of Volleyball with the CHWs and some children from the community. Soon it began to sprinkle, rain, pour and then thunderstorm. We all kept playing despite being drenched, screaming and laughing and jumping in giant puddles. This was when I finally felt a strong connection with everyone involved: the CHWs, the community, the children; everyone was ready and willing to stick things out and work as a team even though it was pouring buckets on all of our heads.

The final day I was filled with excitement to test what we had taught our students. When Rolando, one of my most attentive students, stepped up to take the post test, I felt excited and nervous for his performance. He answered the test questions with such confidence and so quickly that I was taken aback and had to check to make sure that I had heard him correctly. At the end of the test, I looked back and he had gotten nearly every question right! I felt so proud of Rolando when I handed him his certificate and said “Felicitaciones” (congratulations). As I got into our “peke peke” (boat) and waved goodbye to the people of Llachapa, I felt a pang of sadness to leave the community and all of the CHWs. As I waved bye to them, I was fully confident that they were to return to their community with the knowledge and capability to change the lives of their fellow villagers.

Sarah Allexan,
2nd Year Medical Student

There are some people that are destined to follow in their family’s footsteps; whether it’s growing up in a family business or always wishing to be the next doctor in line. My family has always been simple in careers and my pursuit of helping people in the health profession was going to be the first of my family…. or so I thought (a little more about that later).  The past couple of weeks have been eventful, overwhelming, surprising but in the best way possible for the organization and the future of Comunidades Unidas Peru.  This past week Mathilde, Michael, Igor and I have been working diligently on forming yet another great connection with DIRESA, Direccion Regional de Salud Loreto (http://www.diresaloreto.gob.pe/portal/index.php/quienes-somos), a government organization committed to primary prevention of health. We have also formed a bond with an amazing student organization called Sociemap, comprised of local medical students from the Iquitos medical school. It only takes a little hope and some good people along your path to land where we are now. We jumped right in on our newest assignments of Malaria prevention, diagnostic, and treatment trainings for the “agente comunitario de salud” (the new name for CHWs down here!).  We also decided that this year we would start handing over some responsibility to other advanced CHWs that have shown success in their trainings and in their communities. As much as I just wanted to sit in the air conditioned room of Nativa Apartaments (CU Peru’s home away from home) where I could lay on a soft bed, drink a cup of hot coffee, actually take a bath, and maybe do a little Facebook stalking, I knew that it was back to the jungle for me. The crew saddled up our backpacks and once again took the fast boat to Mazan, grabbed some street food in the market (we haven’t learned, but my G.I tract is still going strong), sweated like no other, and then were off to our first advanced CHW trainings of the year. These trainings were designed to see how proficient in an area some of the advanced CHWs were and give them guidelines on how to teach there colleagues different themes including vital signs, how to use the Donde No Hay Doctor (Where There is No Doctor) book, and respiratory illnesses.

After four hours on a less than fast boat ride, we finally made it to our first destination: San Juan de Floresta where were greeted by 142 steps to the village. We trekked our way up slowly while the members of the community seemed to run up with 50 kilo sacks of rice on their shoulders. It really makes you think sometimes how capable some people can be to support their communities and families. We finally made it up to the small village and made our way through the curious stares of children up to the CHW’s house. Although surprised to see us, he greeted us with open arms and was excited to hear the news that he was chosen as an advanced CHW to help us conduct trainings. One thing you learn about these communities is that small things go a long way for these people and they find anyway to make us feel like family. They opened their community to us for the night, made us a meal, and allowed us to set up our hammocks in their community center. Simplistic, yet so satisfying and exactly what we had hoped for.  For the next day and a half we went over the curriculum with Julio and Gilver including how to teach during the trainings and what to expect in the next couple of weeks. You could tell that they were just as excited as we are to know that little by little, the sustainability of the project becomes a reality. We also learned that hammocks with bug nets do not always protect you from mosquitoes no matter how covered you think you are. Michael and Igor woke up to a friendly surprise of hundreds of mosquito bites sprawled across their backsides. Mathilde and I must not be so sweet…. And I have nothing to complain about in that regard.

After we left our first village, we were excited to continue on; and we were not disappointed. We went to what many people would call Urco Mirano, or what I would call a backpacker’s paradise. We cruised through luscious green forests in a smaller subset of the Napo River and were greeted with an open clean water lake. We all gazed around us as if we had found a lost city. There was clean water below, blue skies above, and the village ahead looked like the best we have seen so far. Bridges stretching a mile long that connected the village and green grass spread throughout. We knew that we were in for a treat. Per usual, we were greeted with curious children wondering who the funny looking people were coming to their village. Big brown eyes staring and examining each and every one of us trying to understand; yet they are innocent stares and I always greet them back with smiles and “Buenas dias” (good morning).  We traveled just a small ways and found one of the village’s CHWs doing what they do best; talking with their community members. Again we came with a surprise but per usual hands were open, hugs, kisses, and handshakes were online casino exchanged and both CHWs of the village were off finding us a place to hang our hammocks and a place to share dinner.

Our 2^nd advanced training started late afternoon, and although we were pretty tired from our travel, we still had enough energy to be blown away by the experience and aptitude of this particular CHW, Elmer. Not only was he knowledgeable about the topics we chose, but also his energy and ideas to help his community were exactly why I joined CU Peru in the first place. He really is a true example of a CHW; someone who is well-known, passionate, cares about his family and community, and is willing to work hard to change how people view their health. We couldn’t ask for a better person to help us with the trainings and hopefully continue them in the future.  We also collaborated on ideas to motivate his community on the importance of building and maintaining latrines for hygiene and sanitation and will hopefully have a project for our lengthier community visit in the coming weeks. Although my first training of any type was difficult and trying, people like Elmer helped increase my passion for working with communities to build a healthier and happier future. He exemplifies what CU Peru’s mission, which is to strengthen communities’ health through sustainable practice and trainings of well-motivated people such as CHWs.

I could go on and on but then I would never reach my point. As I reflect upon our week’s adventure into another part of the Amazon, I always think how this came about. How did I get put into a position where I would be in the middle of nowhere helping people learn about how to increase their community’s health?  I never expected that I too would be walking in similar footsteps of my family. I skyped with my father upon my return and again told him of all my adventures. To my surprise, my father knew exactly what I was talking about and began talking about how his father was also a CHW for his small village in Mexico. My grandfather was known as “El doctor” to everyone along their village, and everyone would come to him for almost anything and everything; machete wounds, gun shots, colds, etc. My father told me that it would take almost 7 hours by horse to get to the local health post when you needed medication or help. Could this be true? Could my grandfather really be the exact person that I was helping in Urco Mirano and San Juan de Floresta? Was he one of the men that many people in the community looked up to and came to with their health concerns?  I never met my grandfather, but I know that if I did he would be just as amazing as the other CHWs that we visited and he would continue to strengthen my passion for health and commitment to helping people live healthy lives. I am glad that I have the opportunity to follow in my family’s footsteps in one of the most unexpected ways possible and I am excited to see where these next few weeks lead.

Ashlee Cerda,2nd Year MPH Student

As a first year pharmacy student who has previously done medical related work in impoverished areas of Latin America I thought I had a good handle of how I would be spending my time in Peru. I am surprised to find that it is quite different than I had expected.

“Wear something nice tomorrow” said Igor, a fourth year med student and current president of CUPeru, before clicking off the light and climbing into the crisp clean sheets at our hotel in Iquitos. “Tomorrow is our meeting with Dr. Ferruci (the director of the ministry of health for the Loreto region), it’s an important meeting.” Igor had been networking like crazy the past week, setting up meeting after meeting, working his way up to get his foot in the door with the Director. I knew how important this meeting was.  We woke up early to discuss what we wanted to accomplish. Our goal was to articulate who we are and explain how we educate community health workers in the rural regions of the Loreto province of Peru. We would do this hoping he would take note of our great work and eventually trust us to operate freely and maybe even one day collaborate to help train community health workers.

After coffee, Igor, one of our mentors Dr. Richard Anstett, and I crammed into the back of a motorcar and headed to the regional governmental office. I knew right when I walked in that I had underdressed. Official looking men and women hustled and bustled exchanging signatures and handshakes. High heels clacked on the hard stone floor, echoing off the walls and then abruptly stopped in front of us. A well-dressed woman with impeccably placed hair greeted us with flawlessly enunciated Spanish. I looked at my blue cloth shoes, and back up at the dapper Peruvian business woman, then at Igor (equally well dressed), then back down at my raggedy shoes.

The last thing I expected to be feeling in Peru was underdressed. I packed for survival mode: high top boots for protection from the snakes, rain poncho for torrential rainforest soakings, Swiss army knife for emergencies. I left my sleek leather dress shoes at home, polished for when I return. My dress shirts freshly pressed, still hang in my closet. “Surely, I won’t need these amenities?” I asked myself as I packed. “No, CUPeru is about teaching rural health workers in the far corners of the Amazon, they will just be dead weight in my pack.”  This CU Peru rookie couldn’t have been more wrong.

After some time we were taken to a room with a table that seemed to be up on a stage. The thick black tablecloth had a very official looking emblem embroidered into it. Dr. Ferruci entered and everyone stood up. I clumsily scooted back my heavy wooden chair and stood as straight as I could to shake his hand. Most of the Peruvians I had shaken hands with had a limp hand shake, but Dr. Ferruci’s was strong and direct. We sat down again. Igor began the meeting explaining who CUPeru is. He reached into his brown leather laptop case and pulled out several manila folders that contained the schedule for the trainings and handed them to all parties present.  He explained how we are graduate students of various medical fields who volunteer our time throughout the year fundraising and preparing the CU Peru curriculum. He talked about our newly formed partnership with a Peruvian group of medical students in Iquitos called Sociemap and how we are planning to collaborate during our upcoming trainings. He showed them our recently made mini-documentary that explains who we are and our unique teaching methods. Dr. Ferruci listened attentively, every so often pulling out one of his countless mobile phones and skillfully texting responses without taking his eyes off of Igor’s presentation.  It was clear that he was enjoying what Igor had to say, he wore a very sincere smile. He seemed especially impressed by the small group teaching model and how interactive the trainings are. Everyone from both parties appeared pleased with how things were going.

Igor concluded and Dr. Ferruci said a few words about how impressed he was. Then he paused. The silence lingered in the air for a long time. Igor and I exchanged glances. Had we both been wrong? Was the Director of Health less impressed with CUPeru then we had presumed?  He began to talk, his tone notably quieter and more serious. “There is an outbreak of malaria” he said gravely, looking downward, breaking eye contact for the first time. “We are afraid it will get worse if we don’t take action in the villages.”

“What is going on?” I thought to myself. This was not the response I expected after explaining our organization. The meeting had taken a turn and I had no idea where it was going.

Dr. Ferruci paused and drew his gaze from the table back to Igor, looking him face to face. His thick eyebrow were furrowed in seriousness “We would like to form a partnership with CU Peru for the training, to help teach community health workers to prevent, diagnose, and begin treatment for Malaria.”

My mind was blown. What he was asking of CU Peru was shocking to me in so many ways.  I had always been under the impression that the role of the community health worker was only prevention and triage, almost never treatment, especially of a disease as serious as Malaria. Secondly, we had left such an impression on him that he wanted to partner with us. We had tried in the past to form partnerships with the ministry of health and had difficulty even getting them to recognize who we were.

Since I joined CU Peru I have had ambitions of being in a leadership position, but at that moment I did not envy our President. He had a very difficult decision to make. An important man, in a high ranking governmental position was asking for his help to complete a critical and difficult task. Normally we have a year to plan our curriculum. We were just a few steps away from solidifying our training dates and he was asking us to add on two more days. It could potentially be a logistical nightmare.

I looked at Dr. Anstett. We were both on the edge of our seats to hear what Igor was going to say. “Sería un honor (it would be an honor)” Igor replied. Dr. Ferruci smiled as the tension in the room subsided and then filled with excitement. I think that both Dr. Anstett and I knew at that moment that Igor had made the right choice. We came to this place with the hopes of helping train community health workers to save lives. We arranged this meeting with ambitions of taking the first steps in a partnership with the regional ministry of health. In that moment, we had a chance for both dreams to come to fruition.

The days since have been a whirlwind of curriculum planning and we’ve had several more meetings that I still felt underdressed for, but I’m starting to get used to it. We took a 4 hour boat ride from the main city to meet the mayor in Llachapa (one of the locations for our trainings) to sign a logistics contract. As we were going over the paperwork he told us that his son and sister were recently diagnosed with Malaria.  It was disheartening to hear, but at the same time it put in perspective why we are working so hard.

-Michael Carpenter, Second Year Pharmacy Student