“It's Not an Emergency": A Tale of One Patient, Two Organizations, Two Cities, and Two Countries
Have you ever had “one of those days”? The kind that never seems to head where you expected? The kind where “Dead End” and “Detour” signs are everywhere? So began my March trip to Iquitos. I was there to plan and organize for two August missions. Little did I expect to spend my first ten days rolling a heavy stone up a very steep mountain.
My project, Selva in Action, has been working out of Iquitos for the past seven years and has formed a partnership with Amazon Promise (AP), a U.S. NGO that has worked in and around Iquitos for over 20 years. We share information, staff, challenges, and help each other when possible.
About a week before I arrived in Iquitos, a man knocked on the door of Amazon Promise (AP). Ricardo, not his real name, presented with a large, black and yellow ulcerated tumor on his left thigh about 7” in diameter and 1.5” high. He required a cane to walk and his condition was clearly an emergency. The AP staff prepared to seek treatment for Ricardo.
Then came the roadblocks: Ricardo had neither a DNI (Peruvian ID Card) nor SIS (the Peruvian Health Insurance). By perseverance, Rosa, the Administrative Coordinator for both AP and Selva in Action, and Adriana, AP’s Administrative Assistant, were able to get Ricardo’s ID card in a week! Most people wait over a year for their ID card. Then Ricardo had to be registered at a Health Post to receive his SIS documents. With DNI and SIS in hand, Ricardo was taken for a biopsy to the only oncologist in Iquitos who sees SIS patients. Since there was nobody in Iquitos to read the slide, it was taken to the States by an AP volunteer.
Then I showed up and became responsible for the local oversight of Ricardo’s case, since the AP director had returned to the States. With ID and Insurance in hand, we went to the Government hospital emergency room and were told that his case wasn’t an emergency, because, according to SIS, if the person is ambulatory, it’s not considered an emergency. NOT AN EMERGENCY? We went to the other Government hospital emergency room. Fortunately, we had connections there, and Ricardo was given a bed and some IV fluid. They tried to remove his biopsy stitches, but his tumor started draining and they offered to amputate his leg as a solution. Because there was nothing they could do to help him and, “It’s not an emergency”, they insisted that we remove the patient.
We determined that the best solution would be to get Ricardo to the National Cancer Institute (INEN) in Lima. Sounds easy, right? Not so. The process required registering with the medical post for an oncology referral; having the oncologist refer him to INEN; having INEN accept him as a patient; applying to SIS to cover the airfare; and finding someone to accompany him and advocate for his needs.
We used every contact we had in Iquitos, and after a lot of “Sorry, can’t help you” or “This will take a month to process”, the boulder kept getting heavier. All I could think of was that Ricardo was dying a little each day and that we had to get this problem resolved, so I did the only thing I could think of – I sent a desperate plea for help to PAMS’ doctors in the U.S. It was like calling in the heavy artillery – the big guns…and they came through like knights in shining armor with bugles blaring! They never said, “He’s not a PAMS patient.” They said, “How can we help?”
With the persistent intervention of Drs. Manuel Valdivieso and Carlos Alvarado, the assistance of PPP Administrator, Genoveva Moreno, the invaluable support of Amazon Promise’s contacts in Lima, and well-placed phone calls from the office of the Director of Social Services in Iquitos, we managed to send the patient to INEN to receive treatment. Two months after the start of chemotherapy, the tumor has decreased in size and is no longer painful. Ricardo has united with family members in Lima and will continue his chemotherapy as an outpatient. While his treatment plan may require two years and a possible surgical procedure, he now has a chance for a better quality of life.
I am grateful for our partnership with Amazon Promise and honored and humbled to be a part of the PAMS family. Mil gracias!
Anita Soluna, M.S.
Project Director | Selva in Action (SIA)