She says that people who go into medicine are generally altruistic, one way or another.

"It's not for the money, it can't be. Even if it is initially, that idea would get beaten out of them in residency."

Whether this is true for all doctors or not, it certainly is for this one.

Seema Kaur is a resident doctor at the George Washington University Medical Center, Washington D.C., but her altruistic desires recently landed her in the Amazon - for four weeks.

"I love my work and my patients here, but I feel people get better despite us not because of us. There is something about going and doing something for people who really need you. It's like you or nothing."

After researching various programs on the internet, Seema found the kind of program she was looking for: one that was only a month long, that her residency program would give credit for, that was not tied to missionary work, and that had a working infrastructure to support the doctors.

This September, internal medicine resident Seema Kaur traveled 36 hours to work as a physician in a medical clinic run by Fundacao Esperanca, located one thousand miles up the Amazon River in a town called Santarem. Santarem is the third largest city in the Brazilian Amazon and sits on the Tapajos and Amazon Rivers.

The people of Santarem are poor and cannot afford medical care. Fundacao Esperanca, Portuguese for "Hope Foundation," is a non-profit clinic supported by local and international donations and nominal fees. This is where Seema and another resident doctor from George Washington University worked for three weeks. She then headed even further into the Amazon for another week - alone.

Urban medicine…

The clinic grounds were beautiful with flowering trees, exotic birds, and monkeys. It was sparsely equipped for dentistry and surgery when volunteers were available. The doctors were given a few medical texts, a basic laboratory, and a limited pharmacy.

The clinic provided a lot of preventive health for the locals. Most of the medical problems arose from intestinal parasites caused by unclean drinking water. So once a month, the doctors would go to the nearby villages and talk about a preventive measure such as how to boil water - basic stuff.

The people live off the land and water. They eat fish, crocodiles, wild boar, and a lot of fruit. It is not completely nutritious and they have a lot of malnutrition problems. As another preventive measure, they showed them how to cook a healthy meal. They got all the mothers together, ones with young children, and taught them how to make a nutritious soup. They cooked it together and ate it together.

All that said and done, Seema saw a lot of 90 year-olds. "So you figure if you can live to 90 with dirty water, limited food, and no medical care, it may not be all bad."

But it is not all good either.

The program ran a Diabetes Clinic twice a week. One of Seema's patients was a seven year-old boy who had Juvenile Diabetes. He came to the clinic often, and they became friends. Although Seema practices internal medicine and did not do pediatrics, she had to do it now because there was no one else to help this kid. His sugars were totally out of control. He used to be home alone in the afternoon so he would just eat anything he wanted. He did not have any regular insulin and he had no way to check his blood sugars. The boy was tested only when he came to the clinic. Normally, brittle diabetics and kids who are diabetic check their blood sugars three times a day and adjust their insulin accordingly.

"I increased his insulin a little bit, but what do you do? I was terrified. He could go into a coma and die of low blood sugar. And he was just a kid."

Poverty also takes a toll.

"A lot of the patients can either pay to come see you, pay for the lab tests, or pay for the medicines - not all three. So usually they just go to the pharmacist and tell them the symptoms and hope they get the right medicine."

And sometimes there just isn't much that can be done. There was a lady who would come into the city from the village for Diabetes treatment. She really needed insulin but she couldn't afford it.

"The first inclination is to just pay for whatever they need, but that is not the solution. And even if I bought the insulin she could not use it because she did not have refrigeration in her village. It's not just one problem, they are compounded. So I put her on tablets and crossed my fingers," says Seema.

"Life is very different there. But the people are somehow surviving. The human body is pretty resilient."

The people…

The expectations of society there are different. "There, people are much more philosophical about death - accepting of it. They understand that dying is a part of life. Here in America, if a person dies the family feels cheated even if it is of old age. It is not always someone's fault, and sometimes, unfortunately, it comes early. In some ways we have swung too far the other way - it is never acceptable."

"It was also nice to see people so unselfconscious. The women are comfortable with their bodies, whatever shape or size. They wore very little clothing because it was hot, but nobody stared. It was the hottest time of the year. The lowest temperature ever recorded was 76° Fahrenheit. Everyone had showers twice a day and sometimes after lunch too. There was no air-conditioning. "It was hotter that India in July."

R & R...

After three weeks at the clinic, Seema had a break for some rest and relaxation…well…she went on a jungle tour with the other resident doctor and his family. She had two guides, one carried a revolver and the other carried a machine gun for protection against animals, mostly leopards. Going through the jungle meant clearing the way with a machete.

From a travel magazine, she had ordered some supplies that the army uses to repel mosquitoes. She sprayed repellent on her clothes and used 30% DEET on her skin. "It makes you wonder what all this chemical is doing to you, but you have to have it on. There are all kinds of dangerous diseases one can catch from mosquitoes, especially since there is no medical access or treatment."

The Amazon waters are filled with piranhas and alligators. The group went fishing for piranhas, which have amazing teeth. And when the guide needed to cut the fishing line, he would use a live piranha to slice through it!

They made piranha soup, which Seema thought was pretty good.

Further inside the Amazon…

For the last week of her stay, Seema signed up to volunteer at an isolated village further down the Amazon River. A cook, an interpreter, two nurses, a pharmacist, a lab technician and an AIDS education specialist went on the 20-hour boat trip to the Quilombo Projects - a protected community with no outside contact. She was the only doctor on the trip.

"It was like going back in time several hundred years." The people live in huts spread out along the Amazon River. The kids go to school in their own little canoes. The only structure in the village was the school, which they converted into a makeshift clinic. They set up an examination room, an office that had a little table and a fan, and a pharmacy-dispensary with medicines they brought with them in Tupperware containers.

Seema really was on her own there. It was her opinion or no opinion - "I better come up with an opinion."

On one occasion she went out of the examining room to pray, "Vaheguruji cir thay hath rakhna…I don't know what I'm doing…"

"There was no other doctor there and I had to stick a needle into a man's chest - no X-Ray, no surgery, no stat, no follow-up, no support for another month when the next doctor comes."

And then she did it.

She heard some pretty sad stories too. A little girl who came to see her was diagnosed with Gonorrhea. One does not get that from just walking around. The girl was staying with her neighbor because her mother was having a baby at the hospital. As it turned out, the neighbor had a young boy who apparently sexually abused the girl. And even sadder, the mother was coming back from the hospital with her baby and her three year-old son when the canoe tipped over. It was dark. She could not see her three year-old son and was forced to swim to shore with the baby. They never found the boy.

"Things happen here to kids just like back home, just in a different way," says Seema.

"But even with all the sad stories and social problems, what struck me most was that the people were so content. They had little or no possessions. They had two pairs of clothes, one to wear and one to wash. When someone caught a crocodile or fish, they shared it with the whole village. It's that concept of not getting attached to maya that the Gurus taught us." They were living it.

Seema and her staff saw two-hundred and nine patients in three days. "I never worked so hard in my life."

But in the end, she had some moments of tranquility in the middle of the Amazon.

"It was beautiful. I would do my paath in my hammock with views of nothing but water and jungle."

Coming home…

"When I was people watching on the shuttle between JFK and LaGuardia I saw that people are so unhappy, you can see it on their face, it just shows. We have so much here and we take so much for granted."

"I got back to the hospital and things were as I left it, everyone complaining. But I was so happy to be back and to have had this amazing experience, just happy with life in general and this new perspective. One of my resolutions is not to complain about my residency. Whatever the problem is, we'll get through it. I have learned to make the best out of nothing."

And the seva will continue…

Now back in her residency, Seema Kaur is working on establishing an alliance between the George Washington University residency program and Fundacao Esperanca. She wants to establish a program at the hospital to make it easier for the residents and the faculty to have the opportunity to volunteer in the Amazon. This will be a learning experience for her on how to organize volunteer medical assistance programs. And perhaps, in the future, expand into other areas around the world.

Like Punjab.

Report by Anju Kaur.