Even the four new ‘more accessible’ communities I’m working in have become inaccessible as well, because the TransChaco highway (the only paved road that passes through the Chaco) has also flooded.  Many of the dirt roads in the Chaco are impassable and many communities are isolated from help.  Food and water have to be delivered by air to the affected areas and there is no electricity.

Yesterday (April 14th), Ultima Hora reported that the government’s priorities are evacuating people from severely affected areas and providing medical attention.  It seems that a lot of people have been exposed to snake bites because of the flooding and Ultima Hora reports that three people with emergency medical conditions have died due to isolation from medical care.

ABC has a page dedicated to flooding in the Chaco where you can follow events as they unfold:

http://www.abc.com.py/especiales/chaco-bajo-agua/

What does this mean for my project?  It is unlikely I am going to get access to any of my study communities for the next while.  Even if I do get access, some of my research participants have likely been displaced by the flooding and may not be so quick to return.  So I need to re-think my timeline again.  And I may have to go back to the U.S. and try to return to the Chaco in the summer.

The camping trip is a welcoming event for new undergraduate students in biology at the Universidad Nacional de Asunción.  It’s a chance for the new students and some of the older students to get to know each other.  We went on hikes, played games, and sang songs around the campfire.  And there was a series of talks about biology methods.  I gave a talk about some of the methods we use in primatology to study behavioural ecology (I have BSc’s in primatology and biology).

Giving my talk on behavioural ecology methods.

I spent most of the weekend swimming in a natural pool below waterfalls:

Natural pool with waterfalls. The students are practicing fish capturing techniques.

And I went on a couple of hikes to see a bigger set of waterfalls:

Waterfalls.

… and the re-construction of La Rosada, one of the oldest iron mills in the Americas, which was destroyed during the War of the Triple Alliance (Brazil, Argentina & Uruguay vs. Paraguay, from 1864-1870):

La Rosada iron mill re-construction

La Rosada iron mill re-construction

This is the first time I’ve really experienced the eastern side of Paraguay!  The plentiful water, heavy tree cover, and lack of dust were heavenly after extensive time in the Chaco.  I may need to reconsider the way I choose my fieldsites…

• The current situation with the spread of multi-drug resistant (MDR) TB is alarming.  The best prevention for tuberculosis is finding and successfully treating patients.  We urgently need to improve case finding, diagnosis, and treatment.  How can you help?  Put pressure on your government to restore funding to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
• This year’s StopTB campaign is “Stop TB in my lifetime”.  And they have an interactive website where you can make your own posters with a message, etc.  (Considering that Mycobacterium tuberculosis can persist as a latent (dormant) infection for decades, I’m skeptical about whether this is a realistic timeframe.  But we could certainly drastically reduce TB cases in my lifetime.)
• MSF (Doctors Without Borders) produced some wonderful infographics about the effects of TB, treating TB, and the history of TB.
• Take a look at MSF’s TB & Me blogs, which are written by patients suffering from MDR-TB.
• And I posted some information about TB last year which is still worth a look.

Most of their time is spent checking the growth and development of young children (including handing out powdered milk to malnourished kids), giving vaccinations, and doing pre-natal care for pregnant women.  Now that the doctor has joined the USF they started offering family planning (which is something I have been immensely curious about, but have had a hard time asking about in the communities before now).  They also do walk-in consultations.  The facilities they have available to them vary by community, so they carry everything they need in the back of the truck and set up as best they can in whatever shade is available.

A couple of weeks ago I went to the regional meeting for the U.S.F.s in the Central Chaco.  I spend a lot of time hanging out with the U.S.F. where I’m doing my study, and I try to coordinate my activities with theirs and help out where I can, so they invited me to attend the meeting with them and see what the other U.S.F.s were up to.

Preparing USF presentation

The photo above shows the core team of my local U.S.F..  On the left is Nurse A., in the middle is Dr. C., and on the right is Sister C., who is also a nurse.  Each of the 6 communities where they work has at least one health promoter and some of them also have a local health post.  The U.S.F. makes a round of the communities once a month and during the rest of the month they are based out of a central health post.  They also travel to other communities when there is a medical emergency.

At the meeting, each of the U.S.F. teams presented some background information about the communities where they worked (number of communities, where they are located on a map, ethnic composition, census data), some metrics for their major activities in the communities (total number of consultations, vaccination rates, number of births attended, number of tuberculosis cases, etc.), and talked about some of the major obstacles they faced in their work.

USF presentation

One of the groups, U.S.F. #2 based out of Tte. Irala Fernandez, made an awesome video that shows what it’s like to be on the front lines of global health.  Nurse Luis kindly gave me a copy to post to the blog (I added some rough closed captioning in English):

The U.S.F.s in the Chaco are trying to provide primary healthcare in very difficult conditions.  The communities are located over large distances, which become impassable in bad weather.  The U.S.F. I work with is actually the first to receive a dedicated vehicle to transport them to their communities and fetch emergency patients. Previously they would have to get rides to communities with the local police or an occasional government truck that passed through.  They have limited resources to provide care and create makeshift consultation offices under trees, in the back of a truck, or in a schoolroom.  The Chaco is very ethnically diverse and there can be problems with cross-cultural communication and local politics.  When they are not on duty (although I often see U.S.F. members attending patients outside of ‘office hours’) they live in isolated places with few creature comforts.

No wonder that the U.S.F.s have been slow to fill positions in the Chaco.  Especially positions for doctors.  Many of the doctors who decide to work for a U.S.F. in the Chaco, including Dr. C, did their medical training in Cuba, where there is a strong emphasis on health and social justice and medical professionals are strongly encouraged to work with underprivileged groups.

Despite the challenges they face, the U.S.F. team members are dedicated to their work and really fight to provide the best care they can under adverse conditions.  Did you catch the positive tone of the video?  They are amazing people.