The course is finally over and we are graduating a class of 18 with certificates from the Universidad Mayor de San Simon. Though the final flurry of grading and testing was stressful, the sight of the students proudly claiming their certificates and the enthusiasm of our partners in the emergency flight service was well worth the long hours. After several weeks of 12 to 14 hour days putting together the course, I am pleased to have a little more time to dedicate to the other elements of the project.
The other pieces of the puzzle are falling into place as well, as we make plans for another course in August, and finalize many parts of the documentation system and maps. Meeting with a local cartographer who works with SAR Bolivia opens new doors for collaborations in the future. After several weeks of work with the pilots, we have finished a flight planning system that incorporates all of their flight strip data into Google Earth and allow changes to sync between the various pilots and myself. They are really pleased with the system, and excited to learn more about ArcGIS, a demo version of which is installed in the computer in the hangar that was purchased with Live It funds. I have also finished mapping government data on health centers and population centers, which in combination with the Mano a Mano landing strips is allowing the pilots to find the most rapid and efficient way to reach their patients. As the data from the service is collected using the new flight record system, I will continue to help produce maps that allow for retrospective analysis of the service and epidemiology of the region, hopefully continuing my work with Mano a Mano and A Tu Lado into the future.
Finally, I also had the opportunity to ride along on a flight to see one of the communities in the Amazon region. San Lorenzo is one of the largest towns the flight service visits regularly, since it actually has a government health center with a doctor, making it a primary referral point. Patients from surrounding communities often come in with critical health issues which are recognized by the medical staff, and a branch of a Cochabamba Catholic sisterhood works with Mano a Mano to fund flights and find free health care for the patients who are almost universally uninsured and impoverished. On the hour long flight I am sharing the back of the tiny plane with a woman whose toddler just had a tumor on his cervical spine removed, a missionary who is paying for the flight, and several large sacks of onions. The town is 5 hours by road from the nearest city during the dry season, but after the rainy season is takes approximately 4 days on horseback to reach the next nearest town. We touchdown on a muddy grass runway, skidding for a few seconds in the tropical heat.
I had hoped to talk with members of the community who might be interested in attending a first responder course in the future. However as things worked out I fell into conversation with one of the Catholic sisters who has worked with the community for 8 years. They have started an alternative healing center (including traditional Amazon healing practices from the region). After a brief conversation about her work, I shared A Tu Lado’s vision for the Emergency Medical System in the region. As well as having paramedics on the flight service, we hope to create a network of local responders, a type of community health worker trained in basic emergency medicine who would act as the first link in the chain of survival. As well as providing basic health care, these community members would be the designated link with Mano a Mano Aviation, checking on the state of the runway, reporting on weather, and identifying emergencies and developing health issues. Although we had originally planned to teach the first responder course at the same time as the paramedic course, the resources were not available to realize this vision this summer. A silver lining in the delaying of the course is that I was able to go and actually see some of the situation on the ground and speak with local health workers, deepening our knowledge of the reason and allowing us to plan a more pertinent first responder course in the future.
From speaking to the nurses at the clinic, it became apparent that some local efforts were already underway that A Tu Lado and Mano a Mano might be able to collaborate with. Nurses have been training community health workers, albeit in a sporadic fashion, for the past several years, although efforts have died off in the last year. The health workers were enthusiastic about the idea of equipping community members in the remote villages with health knowledge and resources in order to provide grassroots medical care where currently no organized system exists. They also proposed various innovative ideas of how to manage logistical elements of the course, and indicated their strong interest in receiving further training themselves, as well as collaborating in any classes for community members. Informal conversations with a few community members at the runway indicated that there is a high level of interest in emergency medicine, which is perceived as a real need in an area where trauma from animals and machinery, as well as medical and obstetric emergencies are common occurrences. With hordes of new ideas and potential collaborations swimming inside my head, I climb back into the plane headed for Cochabamba. Reflecting on our new knowledge with the pilots and my team members, it looks like there is a lot of work left to be done in the area, but a lot of potential as well. My time here in Bolivia is almost done however, so I will be dedicating my last few days primarily to wrapping up the loose ends of this project and making plans for the future.