Getting to Santa Clotilde

Given that, in life, the journey often offers more than the destination itself, combined with the fact that Santa Clotilde is in such a remote part of the world, I thought it would be interesting to describe exactly how one gets to this remote pueblo on the Napo River.

The most direct and hassle-free route to the Napo River lies through Lima, the capital of Perú. (It is possible to get into this part of the Amazon through Colombia, as I did on this trip, and I suppose one could find the upper reaches of the Napo in Ecuador and travel downstream from there, but these routes are only really feasible as part of large trips when visiting other places.) From Lima, we take a two-hour flight up and over the towering Andes hugging Perú’s coast and drop down into the jungle enclave of Iquitos. No roads connect Iquitos with the rest of Perú. Coming in on the airplane we can see why: dense jungle as far as you can see, ribbons of river criss-crossing the green in no particular pattern. Situated at the confluence of the main channel of the Amazon River and Nanay River, a major tributary, Iquitos is more than three-thousand kilometres from the river’s mouth in the Atlantic Ocean and yet sits only 150 metres above sea level. That should give you some sense as to the vastness and density of the Amazon rainforest.

Iquitos itself is a fun, frontier sort of town. Weaving in and out of dense traffic on the moto-taxi ride from the airport I am nostalgic for other traveling adventures. That and the tropical humidity and I could just as easily be somewhere in Southeast Asia. In Iquitos the people traveling to and from the Centro de Salud in Santa Clotilde typically stay at a property run by the Franciscan mission in town. A lot of the humanitarian work done in this part of the world was pioneered (and is still being continued) by missionaries and this place serves as a base camp of sorts for people heading further into the jungle. For our purposes it is quiet, cheap, and reasonably close to the port from where the next leg of our journey begins.

After a 5:30am wake-up call, the first challenge is the Mercado de Productores, one of Iquitos’ bustling early-morning markets. With our big packs we navigate the rickety, wooden steps, slick with the morning rain, down past the lines of fish laid straight out on the dock for sale and along the wobbly planks to where the lineup of boats awaits. Our movements are guided by the guttural cries of the fishermen hawking their goods, while the stench if garbage and fish makes us forget our growing hunger. Sounds and smells dominate the senses here.

Getting from Iquitos to Santa Clotilde requires two separate boats. While Iquitos sits directly on the Amazon itself, Santa Clotilde is actually on the Napo River, a main tributary that sweeps down from the north before joining the Amazon about two-hours boat ride downstream from Iquitos. Because the rivers run parallel for a while before eventually joining, it is actually much faster to take a boat about an hour out of Iquitos and cross over the narrowest point of land to the Napo before heading up river from there.

On the dock in Iquitos we find one of the rapido boats heading for our crossover point. This is not the sort of place that keeps an orderly schedule. A boat doesn’t leave until it is full. We climb in, handing our luggage to the deck hands to be strapped to the roof, and wait while the owner is out on the dock trying to convince potential passengers that his boat is better than the one next to it. Luckily for us this is a well-traveled route and soon we are crammed in next to several families and headed out onto the Amazon. I should take a second to describe the boats. Metal-hulled and 20-25 feet long, with a large outboard engine hanging off the back. It is this engine (both the speed and the bone jarring din it creates) that separates these boats from the more traditional method of river travel in these parts, the peke-peke (essentially a flattened canoe with a weed-whacker hanging off the back), hence the name rapido.

Less than an hour later we land in a little village named Indiana. There is little time for leg stretching though as there is a legion of moto-taxi drivers waiting who will do everything short of lifting you out of the boat to get you to choose their ride. Within minutes we are whisked away onto a narrow jungle road. With a mixture of rolling green hills and dense vines on either side, this crossing is the first close-up view of the beautiful countryside in this part of the world. It is only a glimpse though and soon we find ourselves on the dock in a small town called Mazan, having finally arrived on the Napo River. There is enough time here to meander through the covered market and to indulge our growling stomachs in a long-awaited breakfast. Sitting at one of the open tables in the market I am served a hearty bowl of caldo de gallina – essentially chicken noodle soup with chunks of carrot, onion, celery, and platano – out of a huge, steaming vat overtop of the fire directly in front of me.

Refreshed and fed, we head back to the dock and climb in the boat for the final leg of our journey, a five-hour jaunt up the Napo River from Mazan to Santa Clotilde. Luckily for us, this boat is a step up from the previous one. The seats are padded, and look slightly more permanent, and there is a beverage service – one of the driver’s sons climbing over the rows of seats passing around a big bottle of Inca Cola. When the loud thrum of the engine throttles up I wonder if I will be able to handle this environment for five hours. But after fifteen minutes the din becomes soothing and the scenery of the passing jungle shore lulls most of the boat into a peaceful sleep. There isn’t much along the open river. Most of the villages have been built back from the river along the infinite number of intertwined quebradas and lagoons that snake across the whole rainforest. Occasionally we stop in some of these pueblos to drop people off. When we do there a crowd awaits us, pestering the driver for one of his small supply of newspapers. There isn’t so much as a mail service along the river, but the people do like to keep abreast of what is going on in the rest of the world. Slowly we eke our way up the river, dozing off and on, taking photos of the jungle, and reading some tropical medicine. Eventually, just after I have had about enough, the spire of a radio tower protruding from the green landscape comes into view ahead of us around a bend in the river. Sensing my curiosity, a man across from me points and says, “Santa”. More huts and cleared land start appearing along the left-hand shoreline. Ten-minutes later we pull up to cement dock along the shore. A crowd of people awaits to meet returning loved ones. Our baggage is hauled off the roof intact. We are easily directed the short distance up the main path to the Centro de Salud and with the thump of our bags dropping on the wooden deck of our new home our journey has finally come to an end. Three planes, three moto-taxis, and two boats later, we have arrived in Santa Clotilde!

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Tres Fronteras

The jungle is most definitely as hot as when I last left it. It is not a dry heat, like in Santa Marta where I woke up this morning, that can singe your skin and turn your body hair golden but is easily mitigated by the ocean breeze. No, this is a heat that with the first breath after stepping off the airplane is able to penetrate to your very core, seeding inside of you, its offspring covering your skin with the brine of a slow, unrelenting sweat. Suffocating is really the best word to describe it. Still, what a remarkable place.

I am writing now from Leticia, Colombia, capital of the Amazonas region. Look at a map and you will see that Leticia occupies the southernmost point of the country, the tip of Colombia’s finger as it stretches out to grasp the snake that is the Amazon River. Legend has it that a member of a Spanish exploring party fell in love with an Amerindian woman named Leticia during his travels and named a new settlement on the vast Amazon after her. In the 19th and early 20th century the area flipped back and forth between Colombia and Perú as part of several armed conflicts before finally being awarded to Colombia as its toehold in the Amazon by the League of Nations in the 1930s. Today Leticia is an important Amazonian port (I know that sounds strange when it is nearly three thousand kilometres from the river’s mouth in the Atlantic Ocean) and sits at the tri-border between Colombia, Perú, and the giant Brazil to the east. Tabatinga, Brazil’s sister city, and Leticia are for all intents and purposes one city, with a traffic stanchion and a couple of pilons marking the border. You only really know you’re in Brazil when all this store front signs switch to Portugese.

For me, Leticia is serving as a gateway into the jungle and the last Colombian stop of my two week tour here. And what an adventure it has been! Starting off with a few days in Bogota, I was quickly re-introduced to the life of a hostel-jumping backpacker. Free breakfast, unreliable WiFi, and a bunch of Australians. After a wild night with a couple of Dutch guys at the magical kingdom of the Andres Carne de Res bar in Bogota and a searing new sunburn from the walk up Montserrate (when hiking at more than 8000ft of elevation it is probably a good idea to take a hat!) I was off to the Caribbean coast.

The city of Cartagena was in North American news in 2012 for the indiscretions of a few US Secret Service agents, but in reality it is noteworthy for being Colombia’s most important remnant from its history as a Spanish colony with an extremely well-preserved colonial center and a bustling tourist industry. It was extremely easy to settle into the Caribbean life there. I went to Spanish class in the morning and took a siesta most days after lunch. In between I strolled the narrow streets of the colonial center and walked the old fortress wall surrounding it. The cool of the evenings though was when the fun really began. Luckily for me, a German friend I had met in Bogota was in Cartagena at the same time and had a friend living there at who was able to connect us into the local scene. Along with a compadre from class, a Swiss guy named Marco, the three of us took salsa lessons in the early evening before meeting other new friends for dinner and drinks in a restaurant on one of the plazas. Later we would head out to another bar or one of the many discos to further hone our newfound (and incredibly poor) dancing skills. Not a bad way to spend a week.

After five days of this, sadly, it was time to move on. The next stop was Barranquilla, about two hours northeast along the coast from Cartagena. Not a common stop on the gringo trail (and for good reason, it’s a dumpy city), but my two weeks in Colombia happened to straddle the only four days each year when Barranquilla breaks free of its gritty, industrial nature. Said to be the world’s second largest Carnaval (after Rio), the Barranquilla Carnaval features four days of street partying with reckless abandon. Nobody works, nothing is open, and everyone is out in the streets. My new German friend Jens and I managed to get a last minute hotel deal and went for the first two days. Not knowing anyone in town or really anything about it, at first we found it difficult to know where to go and what to do. The first day we stumbled upon a street parade several kilometres long with hundreds of people lining the route. Everybody buys chalk to and foam canisters to throw and spray at each other. As gringos we were certainly fair game and pretty soon I received a face-full of foam from a grinning bystander. Roaming the crowd, we struck up a conversation with a group of local teenagers who were more than happy to show us around and explain how it all worked. With their information, the next day Jens and I made it to the main parade, cheering from the grandstand with locals and other gringos alike as the various groups marched by in their colourful costumes.

Exhausted from Carnaval and dried out from the sun, I headed further along the coast to a city called Santa Marta. My trusty Lonely Planet led me to La Brisa Loca, which, at least for me, is exactly what a backpacker’s hostel should be. Reasonably clean and cheap dorm rooms, a big rooftop view with hammocks for lounging, a bar with cold drinks and foosball, and plenty of other travellers looking for a good time. Jens was still with me at this point and we managed to grabtwo other guys for a trip into Tayrona, a national park that stretches east along the coast from Santa Marta. We were an interesting group to say the least. A Canadian doctor, a German philosophy student, an English hostel owner currently living in Budapest, and an American just out of the Marine Corps, none of whom knew each other at all, spent two days hiking through the jungle and down the beach, discussing everything from European politics (Russia had just seized the Crimea the day before) to World Cup soccer hopefuls to philosophy. The beach was as spectacular as any I have ever seen, with warm, turquoise Caribbean water, soft, fine white sand, and only the waves to bother you. It was a perfect way to get off the grid.

From Tayrona, all I had left was a few days before heading to the Amazon. I decided to head back to Santa Marta for a few days of relaxation at La Brisa Loca. The city itself has some good beaches nearby and a bunch of great restaurants. I was able to get my fill of the expat culture (and preload my stomach) before what I know will be a challenging month.

Pretty soon it was Saturday morning and time to head to the airport. After a hop to Bogota and a few-hour layover I was back on a plane to the jungle. Sitting next to the window I watched as we ascended into the clouds and the ground disappeared beneath us. Heading south from Bogota it doesn’t take long for Colombia to drop from its lofty Andean heights to the dense rainforest of a low river basin. Even through the clouds obscuring my view I could sense the vast expanse of nothingness unraveling beneath us. As the sun dwindled away on the horizon to my right we descended through the fog. In stark contrast to the Caribbean coast where I started my day, a place of soft, dull colours fitting with the tranquil haze through which life is lived there, the curves of the Amazon jump out of the rainforest tapestry surrounding it. Both are beautiful, but the Amazon is more spectacular, particularly at sunset, when the sun’s fading light reflects off the clouds to produce the entire spectrum of orange in a panorama fading into darkness. The stillness is only disturbed by the flash of a thunderhead in the distant, endless sky. This will be my home for the next month. Bienvenidos a la selva!

T-minus 6 weeks and counting…

Flights are booked…elective paperwork is in…vaccinations are up to date…this is really happening, I’m going back to Santa Clotilde.

With only six weeks to go until my second stint in Santa Clotilde begins, the preparations are starting to ramp up. When I started the ball rolling on this elective last summer I told myself I would have time to be more prepared than I was last year. There would be months to study and practice Spanish, read up on tropical medicine topics, and re-connect electronically with the friends I made down there. In reality though, the time disappears. Rotations in ICU (Intensive Care Unit), CTU (Clinical Teaching Unit, internal medicine’s admitting service – typically not a favourite rotation amongst residents), General Surgery, and Emergency really don’t provide a lot of free time and so here we are with less than two months to go. Time to make the best of it! And, to compound things, I am taking vacation for the two weeks prior to the start of my time in SC and am planning to spend them in Colombia before heading to Peru. Spanish, salsa, and scuba diving off Caribbean beaches sounds like a perfect way to spend a couple of weeks before a month in the jungle, but it certainly adds to the logistics.

To keep myself accountable over these next few weeks I thought I would post about what I am doing to prepare. The way I see it, the two most important things I can do to get myself ready are: 1) become as comfortable as possible conversing in Spanish and 2) review the common tropical medicine topics that I am likely to see while I am down in Santa Clotilde.

1. Spanish

Enjoying a month in the Peruvian Amazon begins and ends with one’s ability to communicate in Spanish. To learn this language was one of the biggest reasons I pursued my elective in Santa Clotilde last year and, while I certainly made progress, it remains a significant goal. After using a number of resources for my preparation last year including Rosetta Stone, a few classes at a language school here in Vancouver, and some random textbooks, to prepare this time around I’ve stumbled onto Babbel. It is a computer-based language learning program akin to Rosetta Stone with a primarily visual and auditory interface. Unlike Rosetta Stone, Babbel is based online so it is easy to log-in and review some vocabulary or start a new lesson if I have a free fifteen minutes at work. Also unlike Rosetta Stone, it is reasonable for the wallet: a 3-month subscription to the site cost me ~$10 a month. I’ve been plugging away for the last month and a half and my plan is to do an hour of Spanish daily for the next two weeks, and then ramp up to two hours daily just before leaving for Colombia (that’s probably a little ambitious).

http://www.babbel.com/?locale=en

Speaking of Colombia…I’ve decided to use one of my two weeks there to take a Spanish course. I did this last year in Mexico City a couple of months before going to Peru and I found it was a great way to spend time in a new city/place. This time around Cartagena, on Colombia’s Caribbean coast, is the destination. I’m hopeful that two weeks of immersion in Spanish will get me more comfortable for when I head into the jungle.

2. Tropical Medicine

Dengue fever, malaria, tuberculosis, strongyloidiasis and envenomation are some of the weird and wonderful problems that we are only aware of in theory here in Canada, but are very much a part of reality in the Amazon. Hopefully over the next few days I will be able to compile a comprehensive list of topics that I will review before my rotation begins. I have a copy of the Oxford Clinical Handbook of Tropical Medicine which I found a very useful resource last year and will use to review this time around. Luckily the Centro de Salud in Santa Clotilde has a copy of Hunter’s Tropical Medicine and Emerging Infectious Diseases, one of the foremost texts on the subject, donated by a previous visitor.

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Stay tuned over the next few weeks as the departure date approaches as there will be more updates about tropical medicine topics. As well, please feel free to keep me accountable by posting in the comment section. Adios!