janeiro 2012

Paiki pulls in his line for the last time. He’s already landed three catfish and five piranhas, but that’s not the most he’s ever caught. “The fish don’t bite as much in the rainy season,” he says, “but it gets easier to catch them again when the river subsides.” Paiki is very familiar with the laws of the rainforest. He has lived in the Amazon jungle his whole life and has been hunting wild boar, tortoises, and fish since he was a child.

Paiki starts up the outboard motor of his small boat and begins to maneuver slowly and skillfully through the treetops rising out of the water. When the dry season begins in a few weeks, the water level of the Rio Fresco will sink by up to ten meters and the tree trunks will become visible again. At the moment they are still concealed beneath the masses of yellow-brown water that are racing through the Brazilian state of Pará.

Paiki, who is 31, had a dentist appointment this morning in his village, Kikretum, which is rather remote even by Amazonian standards. Kikretum has 500 inhabitants and is located in the center of the territory occupied by the Kayapo tribe. Here there is nothing but rain forest as far as the eye can see. The nearest big city, Marabá, is two hours away by plane, and it’s six hours by boat to the smaller city of São Felix do Xingú.

In any case, Paiki thought it was more important to fish today since he has four children to feed. His wife gave birth a week ago to a boy – something that makes Paiki particularly proud. Perhaps the little one will grow up to become a Kayapo warrior. The associated rituals won’t be easy, though. For example, the boy will have to tear off part of a wasp nest, and the angry insects will sting him over and over again in this test of courage. That’s simply the way it is here.

An assistant nurse from Brazil’s Secretaria Especial de Saúde Indígena (SESAI) health department was present when Paiki’s youngest son was born. Nevertheless, doctors and dentists generally make only fleeting one-day visits to extremely remote Indio villages like Paiki’s. “The shaman, an indigenous healer, treats us when we get sick,” says Paiki as he ducks to avoid a thick hanging branch on the way to Kikretum. The shaman takes care of things like snake bites and “illnesses of the spirit,” which is how the Kayapo describe psychological disorders. He realizes quickly whether an ailment has to do with the water spirit and whether his patients should be given herbs or perhaps be ordered to avoid certain foods. Still, the shaman isn’t much help with tuberculosis, hernias or malaria. These days, many Kayapo are demanding better provision of what they call “the white man’s medicine.” In 2009, angry Indios even occupied a building owned by the precursor of SESAI in order to lend weight to their demands.

A Territory the Size of Austria. SESAI’s rain forest doctors regularly visit Kikretum in a single-engine airplane. This aircraft is necessary because the 7,000 Kayapo are spread across a territory the size of Austria. The physicians are unable to treat many cases on site. In such situations, they send their Indio patients to hospitals in cities such as São Felix do Xingú, Marabá, or even Belém, which has a population in the millions and is located near the faraway Atlantic coast. “One of my sons had pneumonia once,” Paiki recalls. “It took six weeks to treat him in Belém. We stayed with him the whole time and slept on plastic chairs in the hospital. It would be a lot easier if we could get more medical treatment right here in our villages.”

Paiki’s wish is now coming true. More than a dozen doctors arrived recently, something that had never been seen before in Kayapo territory. Physicians and nurses from the Expedicionários de Saúde (EDS) non-governmental organization, which is financed solely through donations, have transformed the village school in Kikretum into a small hospital for a ten-day stay. They have built tents and cranked up diesel generators, and have brought with them air conditioners, surgical instruments, and even ultrasound units from Siemens. The dreaded dentists have also come as part of the group. The Indios claim that their encounters with these medical professionals more often than not cause them to lose a tooth rather than get one saved — so they are rather reluctant patients.

Paiki’s boat is getting closer to his village, and he can already see that there’s a lot going on at the shore. A ferry has just arrived from Gorotiri, another Kayapo settlement. The vessel has brought patients — and therefore work — for the eye doctors, the pediatrician, the surgeon, the gynecologist, and the other physicians, who together will conduct around 1,700 examinations and treatments (including more than 70 operations) during their stay. Paiki ties up his boat and strolls through the crowd. He has run a narrow pliable branch through the gills of his freshly caught fish and knotted the ends. The fish hang on the stick like a string of pearls — the long fat catfish and the piranhas with their deadly sharp teeth. They’ll soon be swimming in a soup. Many of the new arrivals from Gorotiri have brought companions with them. Some have bows and arrows. They plan to hunt for their food during their stay in Kikretum. A cage holding an impatient parrot with fluttering wings seems lost in the crowd; a young Kayapo girl picks ants out of her rat’s fur.

The fact that a boat full of patients has landed here is a minor success when you consider that rumors had spread in Gorotiri that the doctors pull out the eyes of patients and replace them with horse eyes. The village elders had to convince the sick people that they would be helped in Kikretum before they would agree to go. The seasoned Kayapo warrior Akiaboro set a good example. Akiaboro, who considers himself a political leader of the Kayapo, stands up straight as he moves through the crowd, with yellow-green parrot feathers adorning his head. “There are some illnesses that the white man can treat better than the shamans,” he says. “I myself came to Kikretum to get a checkup.” Akiaboro also wants to see the dentist because there’s something wrong with one of his root canals. “I haven’t slept for days because of the pain,” he confides.v 

Paiki’s visit to the dentist is still far off. It’s now afternoon and there’s a big line in front of the village school. A Kayapo girl is playing soccer with a balloon; her skin is covered with ornamental painting, and colorful chains hang from her wrists and ankles. Before the patients are sent to the right treatment station at the school, their names are entered into a computer. The nurses stick labels of various colors onto the skin of the Indios to indicate to other personnel where they need to go. “Blue stands for the eye doctor, pink for the gynecologist, yellow for the pediatrician, and green means the operating tent,” says Claudio Braga, who runs the computers.

Wireless Network in a Forest. Kikretum’s instant hospital has an IT system that would be the envy of many facilities. “Our 11 laptops are linked in a wireless network; and all of the patient files are digital and are accessible in the treatment and operating tents as well,” Braga says proudly. “Virtually no other Brazilian hospital has such a high IT standard — but we’ve got it here in the rain forest.”

Examination equipment and surgical instruments are cleaned in a sterilization room behind Braga’s desk, which holds the computers and the printer. Two young members of the Kayapo tribe are now covering the roof of a platform with fresh palm leaves. This helps many of the older patients, some of whom can hardly see any more. The powerful rays of the sun cause the lenses of the natives’ eyes to blur sooner here than elsewhere. It’s not surprising that cataracts are a big problem here.

“The illnesses we diagnose have a lot to do with environmental conditions and the Indio lifestyle,” says Fabio Atui, a surgeon with a private practice in São Paulo who also works at one of the megacity’s best hospitals. Even though Atui has a family, he always takes unpaid vacation time to join the EDS expeditions, which have been carried out since 2003. He considers it important to bring first-class medical services to the remote regions of the Amazon. “People in the tropical rain forest often suffer from infectious diseases, fungi, and scabies,” he explains. “They move around a lot, walk for miles, and carry heavy loads, which is why hernias are common, whereas heart problems are rare.”

When he’s in the jungle, he works in the operating tent. Those who wish to enter must first put on a pair of blue overalls and a surgical mask in a closed-off anteroom. Atui also wears white latex gloves. He now has a hernia patient under the knife. Several surgical instruments are now in the incision; a monitor displays the patient’s vital functions. An air conditioner continually pumps cool air into the tent, but outside it’s hot and humid — typical Amazon weather.

“We only do certain kinds of operations in the rain forest,” Atui says. “The diagnoses have to be quick and unequivocal, and the operations may not require any complicated preparations or post-surgical treatments. After all, we’re only here for ten days.” The diagnoses in particular are a major challenge, because EDS doesn’t provide any X-ray machines, as they are too big and heavy to transport. Still, Atui can rely on a handy ultrasound unit that Siemens provides at no cost.

He and his fellow physicians, as well as nurses and other assistants, voluntarily forgo the comforts of civilization and privacy when they carry out their mission. For example, the latrines and showers are in a wooden shed next to the kitchen, and instead of eating at a nice restaurant in the city, staff members ladle out a mixture of rice, beans, and meat for themselves from a large pot. On the first evening, expedition director Ricardo Affonso Ferreira tells the young doctors who are participating in the project for the first time, “It’s a privilege to be here. We want to show the Indios our respect. We don’t expect any thanks — we’re not 21st-century missionaries.”

Atui sees things the same way. He’s convinced that the only way to prevent further deforestation is to make sure the Indios continue to inhabit the rain forest and view it as their home. He believes it’s wrong to send them to a city for a few weeks for medical treatment. Many Indios are already exposed to the promise of luxury and good times in urban areas through TV stations that broadcast the Carnival in Rio live to the huts of Kikretum. They also watch the music videos of American pop stars, not to mention the daily Brazilian soap operas that also display images of material prosperity.

Older members of the Kayapo can well remember all the things money can buy. Back in the 1980s, gold was discovered in Kayapo territory, attracting all kinds of fortune hunters. The gold diggers who swarmed into the region had to pay the Indios a fee for what they extracted, and the Kayapo actually ended up buying airplanes with the money. However, the gold supply was depleted after a few years, and the quick cash the Kayapo had made also quickly disappeared. By this time, prostitution and drug dealing had established themselves on the outskirts of the reservation: “Civilization” had found its way into the rain forest.

High Infant Mortality. Paiki has two televisions in his hut, where he now arrives with his catch. Garbage is lying around, and the family’s few possessions are stored in plastic bags that hang on the walls. Paiki shares his hut with another family. Everyone sleeps on the floor, in tents, or in hammocks. Paiki’s wife is lying in one of the hammocks and nursing the new baby. Young Indios in particular suffer from the effects of poor hygiene and the humid climate of the Amazon. Respiratory diseases are common among children, and doctors say the child mortality rate is nearly ten times higher here than in São Paulo.

“Many women don’t like to be examined,” says Iria Novaes, a gynecologist from Campinas. “For most of the women I see, it’s the first gynecological examination they’ve ever had in their life.” Novaes is supported in her work by one of two ultrasound units that Siemens supplied to EDS to supplement the company’s financial assistance to the expeditions. One evening, just before she retires to her tent for the night, Novaes talks about the people she has treated earlier in the day. One patient was a 27-year-old woman who Novaes was very concerned about because she suspected the woman had cancer. Novaes took a tissue sample and sent it to the university hospital in Campinas for analysis. Meanwhile, her own examination with the ultrasound unit revealed at least one piece of good news: No apparent signs of metastases, indicating that there was still hope and time for treatment and recovery.v 

Communication between doctors and patients across cultural barriers is no easy thing. Although the expedition includes interpreters, and some Kayapo — like Paiki — who speak enough Portuguese to get by, language is still a problem. In addition, many gestures that are important in doctor-patient communication are not understood. The Amazon region isn’t the only place where physicians face such problems. The situation of the indigenous people in Brazil is extreme in many respects, but there are in fact billions of people in rural areas around the world who have only limited access to medical care and treatment (see Pictures of the Future, Spring 2011, Tracking Illnesses in Inida).

Their situation can be improved at an affordable cost if two conditions can be met, as they are in the EDS expeditions: The physicians must be dedicated, and they must be provided with modern and affordable technology to assist them. Instead of exporting its devices, Siemens is now manufacturing more and more medical equipment directly in emerging markets in order to ensure that state-of-the-art medical technology can be provided at reasonable prices.

Celso Takashi Nakano, an eye doctor, also thinks it’s wrong to have to work with secondclass or discarded equipment just because he’s in a rain forest. Nakano collected a large number of donations, which is why he is now able to utilize the most modern equipment on the market when he accompanies the expedition. He operates mostly on cataracts, one after the other — as often as 20 times a day. “We have the most difficult cases in the world here,” he says.

It’s a huge challenge, even for Nakano, who is considered the best man for the most complicated cases at the university hospital in São Paulo. “The Kayapos’ pupils barely dilate, which is probably due to their diet,” he says. This makes his work very difficult, because he has to insert his surgical instrument into the narrow pupils. It’s 9:30 a.m. — time for Nakano’s first patient. He uses an ultrasound device to shatter the man’s blurred and hardened lens and then inserts a new lens with a tiny pair of tweezers. His patients wake up from their anesthesia in a hammock in the village school a little while after their operation, a thick bandage wrapped around the eye that has been operated on.

One of the first patients, whose bandage has since been removed, pays a visit to the doctors during lunch. The sunglasses he’s now wearing make him look like an aging rock star. “Check out how clearly I can see now!” he cries out in Portuguese as he takes off his glasses. Prior to his operation, he had only 15 percent of his sight, but soon — after his eye is completely healed — it could return to more than 80 percent. The doctors call out to him a friendly “Meikumré!” — a Kayapo phrase that translates more or less into “All right!” Toward the end of their stay, some members of the expedition team actually start wearing the tribe’s traditional painted decorations.

The closer the end of the expedition approaches, the longer the line gets in front of the dentists’ tent. Word has spread that the dentists who have come this time save more teeth than they pull, so those who have yet to see a dentist — or were afraid to before — now want to get their turn. A sign in front of the tent says “kekét meitere” — “nice smile.” As Pedro Affonso Ferreira from Campinas points out, the dentists here have to do their best work because “we don’t have enough special lamps. I have to use a headlamp even though its light causes some materials to harden too quickly. That means I have to work faster.”

Hours of Rain. The sky has darkened again outside, as it so often does in the afternoon. Leaves begin to rustle in the trees, and raindrops that will soon turn into a downpour start falling. Kikretum will then be transformed into a swamp. Small makeshift wooden bridges — like those on the Piazza San Marco in Venice when the canals flood — allow the last patients to get to their accommodation and to the village school. One last boat comes in from A’Ukre, and a larger one arrives from Gorotiri. On board are, among others, nine patients with symptoms of malaria. Just two years ago there were hardly any cases of malaria in this part of Kayapo territory, but this infectious disease is now on the rise. Preventive measures are the only thing that can help here; the EDS doctors know that high-tech medicine and equipment are powerless against this deadly illness.

In just a few days, the expedition team will take down the tents and take off from the jungle runway in their single-engine plane, which will fly them to the nearest major airport in Marabá. They will then travel on to the big cities in southern Brazil where most of them live and work. They won’t return to Kikretum for some time, though, because each EDS expedition is sent out to a new destination. After all, there are plenty of people throughout the vast Amazon region who are in need of medical attention and treatment.

Paiki walks back to the dock and watches as a young Kayapo boy flings rocks out into the Rio Fresco with his slingshot. “They didn’t even drill,” Paiki yells out happily. It seems that he has finally made it to the dentist. He smiles and reveals teeth that have been repaired with a lot of shiny metal during the past few years. “We’ll be sad when the doctors leave,” he says. Can Paiki imagine that he himself might leave the rain forest some day? That will never happen, he says. He belongs here.

And although it might be easy to sell the jewelry his wife makes in a big city, life there would be too complicated; he always gets lost, he tells us. The boy on the river bank has now begun to dance. In between shots with his slingshot, he sings the chorus of a song in English that he recently saw performed on television: “Baby, baby, baby, oh! Baby, baby, baby, oh!”

Andreas Kleinschmidt