Mazan

To get to Mazan, the town where the road from Iquitos ends, you first make your way through the chaotic Puerto de Productores--a dock where the local vendors for fruits and meats begin their morning around 5am--the boats come in filled with plaintains or other fruits, fish or chickens, and up and down the rickety wooden staircase you see a file of men marching with burlap sacks filled with goods weighing likely around 70-80 pounds--or people with up to 6 chickens in each hand, held by the legs and upside down (this apparently calms them), or did you know you could get a hog to move by dragging it by its tail (not something I would encourage, but its amazing how an animal that heavy can be led around by just its tail). The dock itself is a piecemeal affair, with platforms leading to boats connected to each other with a single plank of wood that creaks and moans under the pressure of one passenger (but many almost too eager male hands ready to steady you should you wobble).

Mazan is a big town by Loreto standards--about 400 households, concrete sidewalks that double as roads as well, where people go zipping by on their motorcycles, and electricity most of the day. I stayed the night in the town hostel--I was expecting to spend the night swatting at mosquitos, but the hostel was thankfully made of concrete walls with mosquito wiring on the windows. I went out for the evening for dinner with one of the NGO workers--several of the houses in the city center set up tables and grilles outside their homes where you just pull up a chair and the senora serves you freshly grilled fish, sauasage, chicken with rice and grilled plaintain (the senora looked like she was going to cry when I said I was vegetarian, and could I please have some eggs and rice. In that moment, I believe I was the most pitied creature on earth). I returned to the hostel looking forward to a restful, bug-free sleep.

I realized as I entered the room how different everything looked by night, when the room was lit up by the eerie glow of the neon bulb overhead--there were strange smudges on the walls--it almost looked like large blood marks had been painted on all 4 walls, and I realized by looking at the various corpses of dragonflies, roaches, and beetles on the floor that they had met their untimely end at the hands of previous residents of the room, with their remains crushed on the wall like a gruesome cemetery. The bathroom door had a large hole in it, like someone had gone to it with an axe, and someone had started to smudge out the letters E-V-I on the door (the L perhaps left unfinished by whatever was living in the bathroom finishing off the resident).

We headed off in the morning 30km downriver for the the last bit of mapping left for the project was the expanse of rainforest along the river Mazan. This expanse of mapping was far easier than some of our previous trips--almost all of the houses used water from the river, so it was almost a straight hike back, with the boat transporting us along patches that were impassable by foot--in the end we covered 20km by foot and I won my war against biting insects. Only 4 new chigger bites (the buggers founds their way through my shirt and bit me on my back).

I spent the rest of the week working with the malaria surveillance team for their ongoing project--a team of 6 nurses visits 60 households per week. If a member in the family has either a fever, or has been traveling in "la zona" where there are epidemic malaria levels, the nurse draws a blood sample from the individual, and prepares both a microscope slide and a PCR sample, which are taken back to Iquitos for processing.

I think one of the things I realized about malaria which I took for granted before is that malaria is truly a devastating disease, but it wreaks the most havoc on communities that don't have access to either medical care or medicine. Because the symptoms of malaria are pretty general, albeit more severe (diarrhea, dizziness, fever, vomiting), you cannot definitively diagnose malaria unless someone takes a look at your blood under a microscope to see the parasites, or if you are so far advanced in your malaria that there are enough parasites to be read by one of the rapid-tests. In communities where these services are not available, the persons health worsens and worsens and by the time they realize that they likely have malaria, it could be too late to get the attention they needed from the beginning.

And in areas such as the Amazon, where you now find falciparum which can be fatal if left untreated since it spreads to the brain (vivax is more abundant but is several debilitating rather than fatal) During my three days with the surveillance team, I saw several patients that been diagnosed with malaria--one was a woman who believed she was pregnant. The nurse gave her chloroquine pills and instructed her to go to the hospital first thing on Monday morning to find out for sure whether she was in fact pregnant, with the hope that the parasite was not chloroquine-resistant--the other drugs available to combat malaria are potentially damaging to a developing fetus, and I'm not sure what can be done if the parasite does not respond to cholorquine treatment...

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