The Field Work Begins - Comunidad Las Mercedes del Apere

It’s 8am on October 31, 2022 and I’m bouncing along in a Nissan 4-wheel drive SUV driven by Dr. Melgar. Dr. Melgar is the director of the San Ignacio Health Network and he’s leading our team on our first excursion to the community Las Mercedes del Apere. The time has come to start the field work in the first of the three communities where we are strengthening the vaccine cold chain.

Joining me and Dr. Melgar were Lidia (a local nurse in charge of the vaccination program for the Moxos Province), a nurse assistant, and Dr. Cruz (the local epidemiologist). We left San Ignacio de Moxos in the morning and headed toward “Las Mercedes del Apere”. It was my first visit to the area! Las Mercedes del Apere is a community located about 25 miles north of San Ignacio de Moxos at the banks of the river Apere. Due to the tortuous road conditions, it took an hour and a half to reach the health post.

During our journey, I saw two boys and a girl walking alongside the dusty, pot-hole ridden road. I’d guessed the boys were about 6 and 10-years old, and the girl couldn’t have been older than 11. The boys had long green pants, no shirts or shoes, and had very short haircuts. The girl was wearing a short, blue skirt, white sleeveless top, and pink flip-flops, and she had her long black hair pulled up in a ponytail.

They were herding cows along the dirt road, and the girl had a stick in her right hand. They smiled and waved at us as we drove by. I wondered how long they had been walking and where they were heading - to Las Mercedes like us? It was so hot (95-degrees F!) and we were surrounded by the jungle on all sides. We continued to drive on the windy, dirt road full of potholes - some as deep as a foot - towards our destination. Even though Dr. Melgar was an expert at swerving around the worst of the potholes, the car ride was very bumpy. Finally, I heard Dr. Melgar exclaimed the words I’d been waiting for…”We have arrived!”

I looked around the community of Las Mercedes, noticing first an open field- their soccer field - surrounded by homes made of “Chuchío”(a type of weed that has a stem which grows 14 to 16-feet high and leaves that are 6.5 feet wide, spreading like a fan; they grow on the banks of the rivers in the Amazon) with roofs made of the leaves from the palm tree Motacu (Babassu palm, native to the Amazon).

Some of the homes were made of wood planks, and they had Motacu or calamine-leaf roofs. In contrast, the health post was made of brick with a clay-tile roof. The health post serves about 330 people in the local community and at least another 300 in the surrounding communities which do not have their own health post. The health post is staffed by a male nurse who has been there for at least 15 years and a young male doctor who has been there 3 years. It has no electricity, but the community has been connected to the electric grid. They do have drinking water that comes from a 115 feet deep well, pumped to a tank. From there, it is piped to 2 sinks in a communal space and a communal latrine. There is evidence of previous work and support from the NGO Samaritan's Purse which provided them with the two sinks, a water tank, and latrines at the local school.

The local doctor and nurse were so excited once I started to describe A4GH’s plan to expand and strengthen the vaccine cold chain in their community. They started expressing how this will improve the vaccination rates. They mentioned how there are so many people who live in the surrounding areas and come to the health post just for vaccine administration. Given their current lack of resources and refrigeration at the health post, the health post often doesn’t have available vaccines, and they have to turn away patients, telling them to return at a later date. Unfortunately, many do not return due to multiple factors - work commitments (especially for subsistence farmers), lack of transportation, or simply forgetting. Listening to the experiences of the local medical professionals and taking stock of their health post (the exam rooms, pharmacy, and supplies) was truly an eye-opening experience. It made me reflect on how privileged we are in the U.S. to have state-of-the-art health facilities, even in some of our poorest regions. It’s hard to compare the two realities; but I couldn’t help but feel gratitude for the health care systems I’ve had access to and motivation to see this project through for the community.

My first day in Las Mercedes, I found myself just taking it all in. Such a beautiful, scenic, and quiet community nestled in the Bolivian Amazon. Most of the people were working in their small farms. Many are subsistence farmers and trade products among themselves. They grow yuca, plantains, bananas, sugar cane, maize (corn), and beans. To feed themselves and their families, they also fish, raise chickens, and hunt wild game. They do not have opportunities to trade with other communities as they do not have the means to transport their goods. The children attend the local school which provides first-grade through twelfth education, in multi-level classrooms. At first glance, life in Las Mercedes is so different from life in Cincinnati, Ohio. Taking a closer look, though, I could see some similarities - kids playing sports after school, moms waking up to cook breakfast for their families, men gathering to talk about the weather or the day’s news. The patterns of humans just being humans, no matter where we are in the world.

Keep an eye out for my next blog as I make my way to the other two communities part of the vaccine cold chain project!