Every year on the annual Gesundheit!/Bola Roja clown trip to Iquitos, Peru, I spend a couple days doing some psychiatric consultation at a medical clinic run by Amazon Promise. This amazing nonprofit organization gets medical volunteers (doctors, nurses, dentists, medical students to treat the Amazon’s indigenous people. They helicopter into the deepest jungle where they are still greeted by blow-gun armed warriors, they also run clinics in Belen, the poorest area in the city.

This year’s clinic was conducted in a single-story, brick, elementary school building that’s elevated on 20 foot concrete pillars. It is the only building in the community of San Francisco that won’t wash away during the annual flooding. In the large central corridor a registration table, waiting area, three examining tables, a pharmacy, laboratory, a dental area at one end, and me seeing patients at the the other end. The clinic took place while school was in session, clowns were painting murals on the walls, and Patch Adams MD, perhaps the world’s most recognized humanitarian clown, was teaching kids the Bunny Hop in the waiting area. The noise level was intense, the privacy non-existent,

Patients were referred to me if the screening clinician thought they might benefit from a visit, and wrote my name down in the place on the intake sheet marked for referrals to the Shaman. I sit in a small circle talking to them through my incomparable translator Rosa. We have been together for a couple of years, and she has the remarkable heartfelt talent to translate my words into a story that means something to her people. There was no privacy, kids were moving past us whenever the bell signaled classroom changes. The noise level so loud that we had to sit almost face-to-face, but people had no difficulty getting into their stories with as much intensity as in my private office.

The first time I came here I was so overwhelmed by the insoluble problems that accompany poverty and powerlessness that I wondered what service I provided at all. But it turned out that the simple act of spending 20 to 30 minutes listening to people was therapeutic, and the brief, directive treatment I provided gave Rosa tools for when I wasn’t there.

I saw the now expectable array of the battered, abused, and desperate. A woman in her late 30s who was raped and impregnated as a 12-year-old and relives that trauma every time she has sex. I told her to speak to women who had been similarly traumatized and found a way to move beyond their suffering. Rosa made an appointment for her to meet with a group at a shelter for sexually abused women.

I saw a mother and her 10-year-old son (the boy disappeared moments after we met to mingle with the crowd). Mother told me the boy was inattentive, hyperactive, and always getting into trouble. I wrote out strategies for limit setting and how to reward good behaviors.

Lots of depressed mothers whose greatest fear was not being able to feed their children every night, whom I commended on their resilience and ability to persevere. My last patient Lupe, an 80-year-old woman who when I asked her what the problem was that brought her to see me, she laughed and said she didn’t have a problem. The nurse asked her if she’d like to talk to somebody about how she was feeling, and Lupe said sure, I always liked to talk to people. She proceeded to tell me she came from humble means, but she was happy with what she had. She’d been married to a good man for many years, raised four children, had 12 grandchildren most lived close by. We live together, we cry together, we celebrate and laugh together, life is good to me. I had tears in my eyes when I hugged her goodbye, and thanked her for reminding me what it meant to be healthy.

Stay connected in loving, supportive communities that inspire the spirit. Gesundheit! Good health lives in Belen.