I held my filthy hands out over the railings, the dirt smeared with fragrant purple hand soap. The nurse, Cristiana, poured precious clean water from a bottle taken from the maternity/birthing room over my hands, and the dirt flowed away. I thanked her and returned to the waiting room, where a cranky but beautiful red hen hunkered on her chosen throne of the lone wheelchair. She lays eggs there, and if you try to move her, she will peck your hand until you bleed and squawk loudly enough to scare the many kids in the room with their mothers. She sits regally, like the Queen of the May, and woe to any patient who actually arrives needing the one and only wheelchair that belongs to the clinic. The hen may end up sitting on the patient’s lap.

Earlier that morning, Dolly Beaver, head of Angels of the Amazon, a not for profit organization dedicated to economic, social and health issues that concern river communities along the Tahuayo River, had walked alongside me as we climbed the steep riverbank towards Esperanza Village. It was close to ten am and the clouds were already threatening rain.

Men working in the shade called out to Dolly, also the wife of Dr. Paul Beaver, who established the Tahuayo Lodge, the area’s largest employer. We made our slow way to the clinic which was at the far end of a long soccer field.

The original building, which sits next to the newer clinic buildings, is still in use, but not for seeing patients, Dolly explains. It is a compact concrete building with barely enough room to cram a few people under the limited shade or to protect them from frequent downpours. The rooms have been turned into a lab, with a shiny new $7000 microscope, purchased through an AoA fundraiser. This tiny lab now provides critically important, swift test results which can sometimes mean life or death for an ill patient.

The clinic itself is part of a cluster of small buildings that surrounds the village’s cell tower. In its heart are two dark blue raincatcher tubs. While there are sinks in the bathroom and toilets, the clinic, as my dirty hands caused me to discover, has no running water.

Yet babies are regularly born here in the maternity room, the largest suite of small rooms down the concrete path. There, donated scrubs are crammed into the donated shelving, and an ancient birthing table dominates the middle of the room. A single small bottle of water (the source of my clean hands) stands with sterilizers and other key supplies for the birth process and new baby when it arrives. But no running water. Remarkably it all works- for a steady flow of daily clients with kids and complaints that range from the sniffles to serious illnesses and deep machete cuts that have to be referred to Iquitos.

The waiting room was overflowing with mothers and babies, along with one father taking up most of the chairs and benches. The floor was covered with kids. They crawled, leap frogged, cried, giggled, hugged Dolly, hugged me, ran outside, ran inside, slept in their mother’s laps, nursed, chased chickens and generally used the clinic as an impromptu kindergarten.

As Dolly took me on a tour of the clinic, its emergency room, a treatment room, the locked and stocked pharmacia with its shelves full of American supplements and government-supplied drugs, I watched the tableau out front. I realized that the clinic wasn’t just a clinic. As the nurses slowly served their clientele, the women were taking their time and enjoying each other’s company and their broods. This was a women’s center, much like what I had once seen in New Zealand but on a much smaller scale. Here these women had the perfect excuse to get away from their husbands, the confines of their homes, be with each other, gossip, complain, laugh and relax. Their husbands knew where they were. It was a safe place.

Two permanent nurses, Christiana and Perla, have housing right on the ground. Jorge, another nurse, was in Iquitos today. This tiny, water-starved facility serves 13 communities legally, and informally at least four more, stretching its resources to the limit. It can house up to six overnight patients. The rooms had no fans or air conditioning. As the communities grew and the word got out that it was a better place to come due to the support of Angels of the Amazon and Dolly’s hard work, more would be coming.

Dolly walked me outside where school kids played a raucous game of soccer, kicking a ball into a netless goal. An ancient yellow dog wandered by, slowly waving his tail at us. Above, clouds began to gather for rain.

She pointed at the barbed wire fence that formed a boundary around the clinic’s grassy block.

“I want to fence this in with concrete,” Dolly explains. “Eventually get a roof up over our heads. Protect the wood from the harsh elements. We need to drop a well if it’s possible and we can get funding. Bring in fresh water, but that’s very expensive. So much needs to be done here.”

Adriana del Aguilar, the tall, lanky student whose home we had visited the previous day, came skipping around the corner. She gave me a big hug and headed into the clinic to sit with her mother and baby brother. Dolly said that this was why Adriana was at home cooking for the father right now.

I walked back inside with Dolly, who began addressing the group in Spanish. I bent over to touch the hen, which immediately pecked my hands. I just as quickly began to gently stroke its head and feathers with great care. After three attempts to attack me, she quieted down and settled in under my touch. She was quite content to be stroked as long as you didn’t interrupt her egg laying process. Dolly was holding court as this went on and the women were rapt. They always paid close attention when she spoke, as she is held in high regard. Part of this is because she has built her medical knowledge by following the doctors and nurses around, and she has learned how to recognize symptoms. For nearly twenty years, Dolly has been taking a deep personal interest in nearly every aspect of the welfare of the villagers of this part of the Amazon, most especially the women, for she understands that to educate and empower the women is to truly transform the community from the ground up.

After a few moments I went out to find the old blonde dog, which was panting in the heat. He ducked his head under my hand, expecting to be struck, but in a few moments was moving in for more attention, then kissing my chin. That’s how my hands got so dirty- and how the reality of the lack of running water was pressed home.

After Dolly finished lecturing the group we reconnected at the clinic door. I had caught bits and pieces. When we were back in the boat and headed to the Lodge in the gentle rain, she explained. “The conversation began when they asked me why I only had one child.”

“One of the older mothers there just had another baby thirteen years after her last. It nearly killed her. She says ‘every baby is a gift from God.’ I took that opportunity to talk to them about what happens to an older woman’s body when you have kids by talking about myself, why I don’t have more kids at 45. This woman argued that she didn’t know if her tubes were tied and then it hadn’t occur to her to go find out. It’s a simple procedure with the obgyn. I said to her you might not find out for another eight years and by then you might be pregnant again, and it could kill you. That also hadn’t occurred to her. She had said her hips had given her terrible trouble, and I turned that around to explain to her how dangerous it was.

“I don’t get opportunities like this to talk to groups of women about this kind of thing very often but when I do I have to take it. This kind of thing just doesn’t get discussed enough. People just don’t know. Also there was a man there with his wife- he needed to hear this as well.”
This kind of sensitivity to the need for educating the men along with the women has earned Dolly a high level of respect among the husbands as well as the women of the village. They appreciate that they are included in discussions, and she wants them to understand economic and health issues that affect the family. She knows that if this young father realizes that if his wife could be lost in childbirth by having his children in middle age, he might think twice about making this request. She simply presents the information, it’ s up to the young father to take it to heart.

Part of the issue of the women’s health stems from the limited diets the women eat, now being challenged by an influx of sugary products being sold at the local village stores. Diabetes is on the rise. Vegetables are very rare here, items like green beans, corn, carrots, beets and other basics are coastal products that have to be flown in and are far too expensive for river folk. River fish, rice, eggs and chicken are the staples, and increasingly people are drinking the ubiquitous sweet sodas and drinks ranging from powdered sugar drinks to Coke and Inka Cola. All this impacts diet, and bone health suffers. Milk and yogurt are largely unfamiliar, and have to be consumed the day they are bought as most homes don’t have refrigerators. Families can’t afford to purchase pill supplements so unless they are provided by the government or Angels of the Amazon, people don’t receive some of these basic nutrients.
A great deal of this can be dealt with through education, although long standing habits are hard to break. New habits being formed through building affection for sweets, Coke and other poor diet choices need to be dealt with directly as they undermine already hunger-endangered families.
Because Dolly is so respected, when she answers direct questions about her own body and life choices, the women listen, and her stories are discussed later among the villagers. Long standing cultural change is slow. However, it happens, as women see the advantages in their own health and the lives of their family members. Dolly and the many supporters of Angels of the Amazon are dedicated to developing other leaders in the village to carry on this critical work for the future.
Angels of the Amazon and its “Energizer Bunny” of a leader Dolly Beaver represent bright lights in this part of the forest. Through their dedicated work to provide safe and sanitary health care for the many river communities, education and thoughtful discourse on life choices, they hope to continue to improve family welfare, life quality and longevity for the Amazonian people on the Tahuayo.

And the hen in the wheelchair.