U.S. Navy Docs Complete Mission to Bring Healthcare to Amazon

By Vivian Mason

A team of five U.S. Navy doctors, including faculty and alumni of the Uniformed Services University (USU), participated in a month-long mission to administer healthcare to the riverine people in the Brazilian Amazon. The Navy doctors were there to learn, expand the spectrum of medical services offered, and identify opportunities for future partnering.

The mission was particularly meaningful for the team’s leader, Navy Lt. Cmdr. (Dr.) Nehkonti Adams, an assistant professor in the Department of Preventive Medicine and Biostatistics and director of the Military Tropical Medicine program in USU’s School of Medicine.

Lt. Cmdr. Nehkonti Adams works with 2nd Lt. Raissa Vieira Sanchez, a Brazilian medical officer, to diagnose a small boy from a remote village along the Amazon River in Brazil. (Image credit: U.S. Navy photo by Mass Communication Specialist 2nd Class Andrew Brame)

“I come from a developing country,” said Adams, who grew up in Liberia. “Missions like these are fantastic because I have observed the effects and consequences of limited access to care.”

The five-member Navy physician group also included Lt. Cmdr. (Dr.) Patricia Hogan, a critical care and pulmonary medicine fellow; Lt. Cmdr. (Dr.) Robert Lennon, assistant professor of Family Medicine, USU, and 2009 School of Medicine alumnus; Lt. Cmdr. Thomas K. Barlow, assistant professor of Dermatology, USU; and Lt. (Dr.) Gregory J. Condos, an assistant professor of Medicine at USU, all 2013 School of Medicine alumnus.

“Establishing a recurrent mission on the Amazon provides an activity that bolsters readiness of U.S. Navy medical providers,” according to Navy Capt. (Dr.) William T. Scouten, the mission’s medical planner and surgeon with the U.S. Naval Forces Southern Command/U.S. Fourth Fleet. “It enables healthcare professionals to understand the unique challenges of practicing medicine in the riverine setting, as well as improving communication and patient evacuation, and planning for riverine missions.”

Lt. Cmdr. Nehkonti Adams speaks with Guarde-Marinha Douglas Galvao Monteiro, a Brazilian medical officer, while visiting a remote village along the Amazon River in Brazil. (Image credit: U.S. Navy photo by Mass Communication Specialist 2nd Class Andrew Brame)

The riverine population is a cultural and ethnic mix of Portuguese people and various indigenous groups who live along the river banks and make their livelihood from the Amazon. To begin their collaborative mission along the winding network of waterways of the Amazon, the five Navy doctors, along with three of their Brazilian Navy counterparts, boarded the Brazilian Navy hospital ship NAsH Soares de Meirelles to begin work. There, the U.S. team observed the Brazilian doctors and medical officers as they tended to the riverine patients.

After three days, the U.S. team became comfortable with handling cases on their own with the help of a translator, and primarily performed basic and follow-up care. The team saw patients with hypertension, diabetes, tropical diseases, skin rashes, infections, malnutrition, dental disease, fungal infections, headaches, and other medical issues. They also assisted with providing health education.

“It was interesting to watch the Brazilian doctors manage cases and interact with the patients because they have learned how to provide culturally sensitive and appropriate care with limited resources,” Lt. Cmdr. Adams recalls. “For example, there were only two exam rooms, two dental procedure rooms, a room for basic x-rays, and a small lab with one microscope. Their focus is more on obtaining accurate patient history and utilizing a thorough physical exam to assist in making the diagnosis. The Brazilian doctors take more of a practical approach and provide a great amount of patient education.”

Lt. Cmdr. Nehkonti Adams (near left) and Lt. Gregory Condos (far left) work with 2nd Lt. Raissa Vieira Sanchez (middle), a Brazilian medical officer, to diagnose an elderly woman on her houseboat near a remote village along the Amazon River in Brazil. (Image credit: U.S. Navy photo by Mass Communication Specialist 2nd Class Andrew Brame)

“I was most struck by the incredible skill, flexibility, and wisdom of our Brazilian counterparts, despite being so early in their careers. These are the attributes that are drilled into us from the first day we arrive at USU -- the ability to adapt and lead as physician officers right out of the gate,” said Condos.

The team was welcomed at every stop by the riverine people, for whom these floating clinics are the primary source of medical care. However, care wasn’t always administered aboard the NAsH Soares de Meirelles. On one occasion, the doctors went ashore and established a clinic in a schoolhouse and visited patients in their homes. They also went aboard a native houseboat to diagnose a sick, elderly woman. One family traveling by boat hailed the ship down so that they could obtain care for their teenage son who had sustained a gunshot injury to his hand.

Local villagers board the NAsH Soares de Meirelles near a remote village along the Amazon River in Brazil. (Image credit: U.S. Navy photo by Mass Communication Specialist 2nd Class Andrew Brame)

Scouten hopes that the riverine medicine mission will offer future opportunities for partnering that are beneficial to Brazil and the United States. “I also envision a collaborative curriculum for medical education that prepares both Brazilian and U.S. mission participants. This curriculum would be a ‘living document,’ the content of which would reflect expected pathology and standard management,” he said.

“Missions like these highlight the incredible opportunities uniquely available to military physicians. The ease with which we were able to practice under austere conditions is a tribute to the unique military medical curriculum at USU, which emphasizes the doctor-patient relationship as the cornerstone of medicine over laboratory and imaging studies,” said Lennon.