PSU Magazine Winter 2001

inundates the forest for four to seven months of the year, creating a unique habitat of swamp forest, called igapo. The combination of dense rain forest and seasonal flooding results in a pro– foundly inaccessible landscape with a unique public health challenge. The native population of the Ama– zon Basin suffers from a variety of health problems, including diarrhea and respiratory infections as well as parasite infections such as malaria and amoebas. In addition to these infec– tious diseases, inhabitants also suffer from eye problems. Pterygium, cataract, and glaucoma are disea es of the eye that, if untreated, lead to blindness. Pterygium affects the conjunctiva of the eye resulting in an abnormal membrane growth that eventually will cover the pupil. It is possible to restore the eyesight in patients with ptery– gium by surgical removal of the mem– brane. Cataracts account for 80 percent of blindness in this population and can also be reversed through surgi– cal replacement of the affected lens with a synthetic intraocular lens. In contrast, blindness from glaucoma can– not be reversed. D r. Jose-Ricardo Rehder, chairman of ophthalmology at the faculty of medicine at ABC University in Sao Paulo, has spearheaded a program that provides ophthalmologic services to remote areas in Brazil. Together with Dr. Halmelio Sobral, director of medical services for the fire brigade in Brasilia, they created "Amazon Vision 2000." To extend the reach of the program, Rehder joined forces with the Brasil– ian Navy, which designed and built two ships for the sole purpose of pro– viding health services to inaccessible populations in the Amazon. A draft of only 10 feet allows the ships to navi– gate in shallow waters. Equipped with an operating room, dentist office, x-ray machine, pharmacy, gynecology clinic, examination rooms, and a landing pad for a helicopter, the floating clinic was an ideal resource for Rehder. E or our mission, we signed on a crew of 40 sailors, five ophtha– mologists, four general practice physicians, one psychiatrist, two den– tists, one pharmacist, and one epidemi– ologist (me). We made for a truly multidisciplinary team. Our goal was to assess the health needs of this popula– tion, provide health care, and surgi– cally restore eyesight among the blind. The Carlos Chagas was equipped with state-of-the-art ophthalmologic equipment that would allow cataract and pterygium surgery on an outpatient basis. To minimize surgical steps and maximize rapid recovery, the surgeons used a recently developed dehydrated acrylic lens (the Acqua lens by Mediphacos, Brazil). It can be inserted into the eye through a minimal inci– sion and after 20 minutes swells three times its volume to serve as a new cornea for the patient. The lens will respond to postoperative laser treat– ment, when indicated. Although such surgical interven– tion provides tremendous improve– ments in quality of life, the native population was initially suspicious. During Rehder's first trip, an Indian tribe refused to be treated by white doctors. They based their reluctance on the colonial legacy of maltreat– ment. Rehder was able to convince the blind wife of the tribal chief that the operation was safe. She underwent the surgery and regained her vision– and could see her grandchildren for the first time. This earlier experience paved the way for our month-long trip from Manaus to Belem. We focused on small villages and cities that lacked health care for their residents. My job was to monitor the health status of the population served on our voyage. I developed a questionnaire to be filled out by the physicians that would allow us to calculate the prevalence of dis– eases in this population. Such a cross– sectional survey is usually conducted to determine health needs of the study population with the goal of being able to respond with the most appropriate health services. In our case, anything we found would be useful, since little health information exists regarding the Locals often came by boat to be treated at the medical ship. WINTER 2001 PSU MAGAZINE 13