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There have been some requests for this article on Bolivia's Rio Beni Health Project, since it saw print in an issue of the Santa Ynez Valley Journal that wasn't archived online. Not about Mongolia, but if you're interested in this blog, it's likely you're interested in hopeful development efforts in third-world countries, so take a look. It's one of those things that gives me hope in the possibilities for our planet.


Where Thoreau and Livingstone Meet:
Lou Netzer and the Rio Beni Health Project

After spending decades as the last doctor in California's Santa Ynez Valley willing to make house calls, after starting a home for Alzheimer patients, an elementary school, and a café on the side, Louis Netzer retired and set off not on an ocean cruiser, not on a tour of the world's greatest golf courses, but on a journey to the far corners of world.  He didn't get any farther than the village of Rurrenebaque on the banks of the Rio Beni, a remote tributary to the Bolivian Amazon.  On his annual two-month visits to the Valley in the following years Lou spoke often of his first moments on that smooth river, of the surrounding jungle, of the faces of the warm-hearted local people whose ailments he knew how to cure, of the moments he realized he would be staying until he did cure them.  In subsequent years, at talks he gave all over Santa Barbara County raising money for the Rio Beni Health Project, Lou said that he didn't have hope, because hope implies expectation.  He just had faith.  Lou's faith was the power behind his conception of the Project, which began in 1997 with "basically a boat and a motor."  Lou's faith is what drove him to reach tens of thousands of the poorest people in South America's poorest country, often their first experience receiving regular medical care, before succumbing to cancer himself in October of 2002.

Lou learned of his illness early enough to ensure that the Rio Beni Health Project would continue without him.  In 1999 he teamed up with his close friend, Christopher Brady, who had just returned from four years working in Africa but had six years of working in South America under his belt. The seven-person team that today keeps the project alive and expanding is a colorful crew of personalities bound together by the legacy of the man they loved and a commitment to the health outreach project that began as his dream.  The Rio Beni Health Project, or El Proyecto de Salud de Rio Beni, exists today as a rapidly growing endeavor managed by a newly established non-profit organization Netzer-Brady International. It is supported in part by Direct Relief International, officially recognized by the Bolivian government, and it reaches rural indigenous communities with unprecedented treatment and long-term education over hundreds of square miles of jungle wilderness.

Rurrenebaque, Beni Region, Bolivia, August.  A hen pecks at the tiny river of cane juice left on the trapiche. Near the small building that serves as Project headquarters and home-clinic, a boy walks to school in the required white shirt and navy trousers carrying a guitar, kicking up white dust from the road.  Another boy passes holding the hand of his little sister, a green bird fluttering in his hair.  A curvy woman with red lipstick rides "side-saddle" on one of the motorbikes serving as a taxi, driven by a young man who'll take her to any point in "Rurre" for one or two Bolivianos.  By 10am the sun is fiercely bright, the air heavy, the heat palpable. 
Outside the Project clinic the deck is full of prospective patients of all ages sitting in the shade and waiting to be called in.  One of the many leafy green plants growing up around the deck throws patterns of shadow on the threshold to the front room of the clinic, which is small and dark and crowded with fans circulating warm air.  Lola Guálica, a cheerful, round-faced nurse who has been working with the Project for seven years, calls clients up one by one and takes down their basic information. 

In the same room at another desk, Modesto Cuevas, a slim and soft-spoken sociologist and community organizer, uses that information and a personal interview to gently screen prospective patients.  "We need to make sure they belong to the town's neediest financial stratum," he explains.  "If a woman is married to a policeman, for instance, I direct her to one of the neighboring clinics.  There are other health clinics around here.  This one is for those who truly can't pay." 

A screening process like the one carried out by Modesto is unnecessary in most of the communities the Project visits.  For half the working week the Project functions as a "floating" health clinic: project team members and big red bags of medical supplies packed into a narrow little boat, zooming up or down the placid river through chilly morning mists and back through brutal afternoon sun, reaching the poorest communities of the region by boat because there is simply no other way to reach them.

Only one of the current team members has been with the Project since its inception.  Antonio Mendía, project pharmacist, auxiliary nurse, boat pilot, and general handyman, is tall, handsome, and popular among the ladies in town.  He met Lou Netzer in 1997 when he was eighteen.  Lou was trying and failing to operate his own new boat on the river.  "He was just this crazy little doctor, and you know doctors, they can't do practical things," Antonio laughs.  Antonio soon became Lou's right-hand man, and not just because he knew how not to crash a motorboat.  Antonio grew up in Rurre and knew all the people and the locations of poorer communities up-and down-river.  He was the logistics behind the dream.  "It was hard," he says, grinning.  "We were only two."

The simple screened-in, thatched-roof, one-room cottages in which the "happy, crazy doctor" stayed and housed his guests have now run down, battered by the heavy rains, heat, and influx of foliage that make the jungle a force to be reckoned with for its residents.  The Project team is talking about ways the huts could be used; one idea is to house Project guests, volunteers and hopefully someday more doctors there.  Another is to accommodate tourists--since the Project's inception Rurre has grown significantly due to the popularity of the spot with Israeli youths traveling through after completing their two-year army requirement.  An Israeli put Rurrenebaque on the map by nearly dying in the jungle nearby and writing a book about it.  Now Rurre sports multiple hostels, restaurants, internet cafes, and even a jungle-themed bar that serves such cosmopolitan drinks as the Flaming Lamborghini.  It's a far cry from the tiny village Lou first discovered nearly a decade ago with one working fax machine in the mayor's house, but neighboring communities and a large portion of Rurre's own population are still staggeringly poor.

Lou knew to live outside of town, away from Rurrenebaque's gossip network.  He was un loco, pero un loco feliz who saw all sorts of animals from the screens of his hut—even a panther once—and sometimes from within that hut: his efforts to convince a visiting snake to leave, since Lou never did get over his fear of snakes, went like a slapstick comedy. "The clouds go low in the mornings," Antonio says, gesturing to the mirror-like Rio Beni.  "Twice Lou crashed into the opposite bank.  He came to the clinic sopping wet from head to toe, but grinning.  Everything was an adventure for him."  During one of his visits to California, Lou was interviewed by a group of middle school students and reported, "20% of all the fresh water in the world goes through the mouth of the Amazon every day. The rains are heavy, and they last so long! As a matter of fact, I just spoke to my friend Antonio this morning, and my clinic is under water right now."

The forest Lou mentioned having to beat back with a machete every day is taking over his old compound, crawling over bamboo structures with limbs of brightest green.  This is where Lou did "the Thoreau thing," as he put it more than once, reading and writing and collapsing into his hammock after a long day treating patients.  The afternoon is warm and quiet, full of fragrance and emerald colors.  Antonio sits quietly in the wall-less structure that used to be Lou's kitchen.  "Lou loved cooking," he says after a pause.  "He loved having people by and talking and cooking.  But he also loved his solitary time."  Solito is the word Antonio uses, which is an affectionate diminutive term.  It does not mean only "by himself."  It means, roughly, "by his little self."  In the end, Antonio's relationship with Lou resembled that of a parent and son more than anything else, and Lou's wish to visit Rurrenebaque one more time after falling ill had its basis in his wish to say goodbye to Antonio as much as in his love for the Project.  Antonio looks around the compound.  "Sometimes I come here by myself, just to think," he says.

Travel days start early for the Project team.  At the weekly staff meeting, the team agrees on a 7:30am meeting time at the clinic.  As this is Bolivian time, at around 8:15 everyone is there, layered with waterproof jackets, baseball caps, and sunglasses.  Here alongside Antonio and Jose is Dr. Frida Rada, Modesto's
wife, the Project doctor who lives permanently in Rurrenebaque. (The Project regularly changes directorial hands in Bolivia; it has hosted a regular stream of long-term health professional work alongside the Bolivian team – usually an American or Cuban doctor will come with kids and spouse in tow for a two-year contract. Through the years over 20 pre-med and medical students and residents from around the world have worked short-term with the team, not to mention visits from anthropologists, photographers and writers.) Christopher Brady took over US-based direction of the Project under the auspices of Direct Relief International, an international aid organization, and another California-based NGO called Concern America, but in March 2008 he and Lou’s daughter Uldine, a physician, established their own non-profit -- Netzer-Brady International --to carry the work forward.

It is Christopher and his brother Jim, another prominent resident and educator, who came up with and lead the Project's most successful yearly fundraiser to date: Ride/Walk For a Reason, a bike and hike trip whose participants, mostly families from Santa Barbara County, spend the preceding year raising money for the Project and then either ride bikes in July from La Paz to Rurre, a grueling 300 miles., or do a 4-day jungle trek with local guides visiting Project communities. Ride families rope in an essential $100,000 for the project annually.  Participants learn about local ecology, strengthen the ties Lou created between Santa Barbara and Rurrenebaque, and observe the Project team at work on a day not unlike this one. 

Even an August day starts out with some mist on the river.  Antonio sits in the Project vehicle, a big jeep that takes the team and all the heavy red equipment and medicine bags from the clinic to the waterfront.  A stop is made at a market with walls painted aquamarine, and Lola runs in to order a dish of rice, meat, and fried egg for each member of the group.  The street is already packed with people.  Outside the market stands a family of several barefoot children and a mother whose face is wizened with premature wrinkles and missing a few teeth.  They pass a baby anteater between them, waiting for the furry creature to attract a potential buyer. Frida puts a hand to her mouth and coos at the creature from afar.  "I'd want to buy it, because it won't survive with those children.  They just don't know how to treat it properly.  Where would we put it?" she asks Modesto.  "We already have a monkey!"

Frida is concerned again at the water's edge while Antonio readies the motor of the boat, watching a man is yanking a cow with a rope tied around its neck onto a neighboring barge.  "I just can't stand it when animals are mistreated," she says.  Neither can she stand mistreatment of humans, something she makes clear two hours later after an exhilarating ride through the chilly mists to the community of San Miguel.  Once the equipment is offloaded and schlepped up the slippery riverbank by Project members and eager locals, and the clinic is set up in whichever communal space is available--which in the case of San Miguel is a fairly new open-air space whose construction was made possible by a recent influx of tourism--Frida begins to receive patients.  When a young mother slaps a baby who will not stop crying, Frida says firmly to her, "We do not use violence with children.  We don't hit children." She lifts her hands up at her husband, who looks up quietly from his post across the room.  "It bothers me," she says. It's the same thing she said when the children outside the market picked up the baby anteater by its hind legs.

Modesto and Frida (whose official Project duty is "health education and training coordination" though she's also a doctor) developed and lead the program of project promotores.  A promotor is nominated by each community the Project works with to act as a liason between the Project and their community and provide emergency medical treatment.  The promotor, who is usually between 15 and 30 years old, then makes a promise in front of their whole community to stay in that community for life.  Promotores receive university-level courses in medical training in a four-year program created, managed, and administered primarily by Frida and Modesto. Whenever the Project boat slides up onto the edge of the Rio Beni, the solitary figure waiting at the top of the tall banks is almost invariably the project promotor, who has known the date of the Project's visit for months and alerted the whole community to the fact. 

In August one of the rare meetings takes place in Rurrenebaque to which all promoteres come from their respective corners of the region.  Some take days to get there.  The promotores meet in a large room in a public building and sleep on cots in another.  Frida stands at a blackboard in front of the room, scribbling medical terms and asking questions about symptoms of an allergic reaction.  There must be about fifty young students male and female, with round-faced, Andean features, looking shyly up at her.  They answer each of Frida's questions correctly.  She turns to them.   "I love you guys!" she cries.  They smile.

On a mission to procure cane juice during lunch break in San Miguel, Modesto reflects on the promoter program as he disappears between tall, rustling stalks of sugarcane until only his voice remains.  "This is why the long-term mission of the project is to educate.  This knowledge should be in the hands of the people.  The social aspect of the project is the most important," he says, reemerging after using his pocketknife to harvest a few choice stalks. 

Promotores also stay in the Rurrenebaque and neighboring San Miguel hospitals to observe and talk with doctors, nurses, and patients.  Elian, the promotor for San Miguel, has a tattoo on the skin between his index finger and thumb.  It says "Jessi Te Amo" with stars. In response to the presumption that the name pertains to a romantic interest, Elian shakes his head.  "Jessi left us," he says.  "She was only two.  She was my little niece, most loved by me.  Very intelligent.  Already walking and talking.  She got sick, and it was so rapid, only three days, and then she was gone.  There was no time."

Indeed when one observes the broad smiles exchanged between Project members and promotores before the big red bags have even made their way up the steep hill, the embraces on the sunny banks of a breathtaking river, it is easy to forget that the lives of whole communities rest in their hands.  Bolivia, a country whose population of 8.8 million roughly equals that of New York City, supposedly guarantees health care to its citizens, but Bolivia is one of the poorest countries in South America; its residents are 60% indigenous, and being born indigenous, especially in that part of the world, still essentially guarantees a life lived below the poverty line.  Project doctors spend most of their time diagnosing malaria and various dysentaries.  Some of this is combated by basic education about sanitary methods—washing one's hands after bathroom use, bathing and washing in clean water--and some would be easily cured by inexpensive medicine that had not yet found its way to the communities of the Beni Region by the time Lou arrived on its banks.  This is Bolivia, where infant and maternal mortality rates are among the highest in Latin America, literacy rates are miniscule, and the phrase "government official" is synonymous with "thief" in the minds of both formally educated and uneducated Bolivian citizens.

All Project teams members are quick to point out that there would be no need for the Rio Beni Health Project if the Bolivian government were doing its job.  As the past years of protests, civil strife, economic frailty, and the 2005 Presidential musical-chairs game makes clear, Bolivia is still sadly distant from a time of stability and prosperity.  In December 2005, socialist and indigenous party leader Evo Morales won the presidency in a fair and democratic election. One of Morales' biggest pledges was to orient economic recovery towards safe and legal use of the country's coca crops, a major source of income for the Bolivian poor.  Coca is the crop from which cocaine is derived, and the eradication of coca fields has been a primary focus of the infamous War on Drugs conducted by the American government.

In lieu of efficient and consistent government guidance, the Project has multiple agreements with the local hospitals, not just to train promotores but to refer patients to facilities for ultrasounds and other surgical or emergency needs.  The municipal government agreed to pay the way of medical supplies otherwise donated for free from La Paz to Rurrenebaque and to donate 600 litres of boat fuel to the Project, but the Bolivian government has long been notoriously corrupt and that boat fuel remains undelivered.

In the meantime, efforts like the Rio Beni Health Project are the most successful methods of bridging the gap between the Bolivian poor and the resources they lack.  In Tamarín, one of the region's poorest communities, a bent old lady with hardly any teeth waits with a grandchild on her lap outside a run-down shack, the only open public building.  Inside, business as usual: Lola takes down patients' names and ailments, visiting doctors treat the patients, and Antonio retrieves the medications they prescribe.  Outside, the sun spins large red leaves of an immense almond tree near a boarded-up church.  Modesto stands with a group of adoring children, talking with them and playing games.  A starving kitten is scooped up by one of the children, then thrown to the grass.  The children, standing in the shade, sport the large bellies and skinny legs betraying the presence of malnutrition and parasites.  Modesto walks the path with them to the one-room schoolhouse, where he'll give a talk on the importance of brushing teeth and then hand out toothpaste samples and chalky chewable pills that eradicate parasites. 

When Lou got sick he wrote an open letter to members of the Santa Barbara community along with a card asking for donations to the Project.  After raising two children in his first marriage, he fell in love anew late in his life with Chantal, the French mother of his son-in-law.  He wrote in the letter of watching her walk along the beach while he sat bundled from the wind.  "I renew my pact with God," he wrote.  At his memorial service Dr. Reuben Weininger said that Lou's medical practice was a practice of applied love.  In and out of consciousness in his final hours, he wrote the words "for love" on a scrap of paper.  In Rurrenebaque, the mountains of jungle look like sleeping boars in the fading daylight as another boat purrs by and the tuckered-out Project members head home to rest.  V's of birds fly quick and low over the surface of the Rio Beni as the sunset spreads purple into the sky.  It is unquestionably for love that Louis Netzer began this health project, and it is unquestionably for love that the motley crew that is the Project team sticks together and moves forward with it--both for love of the good works and public service therein and for love of the sprightly, crazy fellow who knew the secret to making dreams come true.

Christopher Brady writes, "The Rio Beni Project continues to expand geographically and in the services it provides to the indigenous people of the Rio Beni region, including a quickly expanding potable water program. Recently the Bolivian Ministry of Health officially acknowledged the Project, and the team has applied for and been granted its official status as a Bolivian charitable health organization named La Fundación Salud Rio Beni--Louis Netzer (The Rio Beni Health Foundation). For more info, write me at CGBrady@igc.org or visit the new website at netzerbrady.org."