3 September
Barcarena

From the swaying desk of Dr. Sam Allen
The medical team always gets mentioned in the KM3 reports, and we decided to write more in detail on what we have been doing in South America. First, let me introduce ourselves. We are Dr Michelle Phillips, Jenny Campbell (army nurse extraordinaire) and myself Dr Sam Allen, better known as Dr Sam. Michelle is an anaesthetist in Bristol, Jenny is from the Queen Alexandra Royal Army Nursing Corps, and I am a Specialist Registrar in Infection and Tropical Disease working at University College and Royal Free Hospitals, London. During the first three stages of the expedition we were joined by Dr Jo Brown a GP from Bath. We also have a dental surgeon on board, Graham Catchpole, popularly known as 'Fangs' - but more on him in another report.

Most of our work has been conducted in the poorer settlements along the rivers where Portuguese is commonly spoken. As we are not conversant in the language, a former Brazilian body builder, Geraldo Rainaldo de Lima, has been as our liaison officer and translator seconded to us by the Presbyterian Church in Manaus. He has been invaluable in helping us communicate with the villagers.

L-R Michelle Phillips, Sam Allen, Graham Catchpole, Jenny Campbell, Geraldo Rainaldo de Lima

Finding our patients
Usually when we stop at a village we enquire whether the inhabitants require any medical or dental aid. Most places we visit do not have a doctor or a nurse, so invariably we are never short of patients. We have with us a good supply of drugs, dressings and a basic diagnostic kit.

Although the people in the interior of Brazil are poor, we have found that they are well nourished. The rivers are full of fish and the jungle provides a rich variety of fruits as well as meat, mostly monkey, capybara, snake, chicken and pigs. However, the villagers find that they are generally not able to afford medical or dental treatment and so our help is gratefully received.

Medical problems on the rivers
The cases we have seen are wide and varied, but they are generally similar to problems that a GP in the UK would come across. For example, we performed frequent antenatal checks on women and examined new born babies. Skin infections are common mostly dermaphyte fungal infections, but we have also treated bacterial and viral lesions. Intestinal worms are also widespread, but this is easily treated with just one tablet.

As we are journeying through the tropics it is inevitable that we would encounter diseases associated with this region. Leprosy and polio used to be prevalent, but fortunately these are now rare. Malaria and Dengue Fever, which are transmitted by mosquitoes, are still big killers in this area. Tuberculosis is a major health problem here, as it is in the rest of the world. AIDS is reportedly on the increase although we didn't see any full-blown cases.
Leishmaniasis is common in these parts of the jungle and along the riverbank. This disease is transmitted by sand flies and can cause chronic ulceration of the skin, destruction of facial cartilage and enlargement of organs. We have all been savaged by sand flies and we hope that none of us catch this disease. No repellent is effective against these annoying insects - they just dance in Deet and bite through our clothes.

Treating the Team
The expedition members have all remained healthy, with an occasional bout of diarrhoea, but no serious outbreaks.
We have not had to treat anyone for rabies or malaria, and despite the preponderance of poisonous snakes no one from the expedition has been bitten. We have, however seen several locals with new and old snakebites. One man had half of his lower leg missing, secondary to snakebite. Another child was left with a paralysed arm after a scorpion sting.

Most of the team's injuries have been minor ones - several of which were sustained during our regular football matches!! Others were obtained during more serious pursuits - whilst working in the jungle or on the boat.
During the period of high drama at the Ribeirao rapids twelve of the fifteen crewmembers were catapulted from the decks of KM3 into the white-water. Many sustained scrapes, bruises and crush injuries - but we were all very lucky that no one was more seriously injured.

As we come to the end of our expedition we look back on the work we have done over the last four months, and hope that we have had some impact on the lives of the people whose villages we have visited.