Most folks like to joke that one day they’ll abandon the trappings of the modern world and move into a hut in the middle of nowhere, doing good works and living off the land. For most of us, that fantasy-fueled cocktail party banter never comes to fruition.
Twenty years ago, Dr. Linnea Smith (at right) made it happen when she left a comfortable job with a small medical group in rural Wisconsin to set up a remote jungle clinic on the banks of the Amazon river, three hours downriver from Iquitos, Peru.
I started encountering Dr. Smith, or La Doctora, as she is called by the riberenos, the river people, during her meals. She takes them at the Explorama eco-tourism lodge where I was staying on the Hear the World foundation’s Global Explorers trip. Explorama’s food was always fresh and tasty, but what kept Dr. Smith coming back was the kitchen. Her house (below, left), a 5-minute walk through muddy marsh and a quick canoe trip during the river’s high season, from the lodge has two rooms; the front room, or sala, where Linnea keeps a desk and stores her canoe paddles and a bedroom with enough room for her bed and space for her clothes. No kitchen.
“Until last year I didn’t have indoor plumbing and I resisted it for a long time. I liked walking to my latrine. I saw interesting things out there. It’s the only place I ever saw an invertebrate eat a vertebrate,” La Doctora explains in a voice that is deep like a young Kathleen Turner’s. But after two decades without the creature comforts of a flushing toilet and continuous shower, she relented to having pipes installed, as much a concession to turning 60 as she was willing to make.
In 1990, Dr. Linnea Smith was working as an internist in Wisconsin. She graduated medical school six years earlier, having started the process at age 30 (“I believe everyone should take some time off before they grow up,” she says). When she finally became a doctor after years of being an impoverished student, Smith realized she had the money to travel the world. That brought her to Peru.
But her Peru isn’t the tourist friendly Peru of Macchu Picchu and Inca trails. While tourists do frequent the banks of the Amazon at the eco-lodges that have sprung up over the past forty years, the area north of Iquitos remains terribly remote. Iquitos itself is only reachable by boat or plane and the city of half a million people on the largest river in the world remains relatively isolated.
During that first visit, La Doctora spent a week at the Explorama Lodge, which is a 3-hour motor boat ride, or 6-hour canoe ride from Iquitos up the muddy brown expanse of the Amazon. She spent a week walking through the jungle admiring the blue morpho butterflies, poison dart frogs and tamarin monkeys, catching piranhas from a canoe, swimming in the Amazon’s tributaries under the stars and nursing a schoolgirl crush on the region that was about to turn into much, much more.
“I tell people it’s like falling in love. When you fall in love you can like a person and have a lot in common and they treat you nice, but none of that really covers it. That could all be there and you could just be good friends. In addition to all those good things you have to have magic and chemistry and this place did that,” Smith recalls. “I fell in love and I had to be here.”
She returned briefly to the States but after some negotiating with Explorama and some housekeeping at home, she was right back in the jungle, operating a clinic for the indigenous people out of the lodge.
There is a definite need for her services. She can say without hesitation that she is the best doctor for a hundred miles because she is the only doctor for 100 miles, but it wasn’t just the need that kept her on the banks of the river. It was the sense of community and being welcomed into the homes of the river people.
“I left a Quinceanera the other night and was chastised for going home so early, it was 3 a.m.,” Smith laughs.
Her first clinic was a spare room in the lodge with little more than a bench, a bed a microscope, kerosene lamp and a jug she filled with water but as word of mouth spread about an American doctor in the area, her practice rapidly grew. The nearest clinic to the lodge and the surrounding Yagua Indian villages is 35 miles downriver at the small settlement of Indiana. That medical facility has only a couple of physician’s assistants (who no physician to assist) and an occasional visiting nurse. The nearest fully equipped medical facility isn’t for hundreds of square miles.
La Doctora treats wounds, snake bites, stingray stings, dengue fever, malaria and a multitude of stomach ailments caused by villagers drinking agua cruda, or water straight from the Amazon River. She has been successful in convincing many of them to boil it before consuming it, but it has been an uphill battle. She has delivered countless babies and more than a few young women running along the banks of the Amazon are named Linnea.
She is on call practically 24-7, which is what happens when you’re the only doctor for miles and your patients can canoe right to your house.
“Every night when I go to bed, I put out the clothes I will wear when my patients call on me in the middle of the night. If I hear a boat coming in the stream, I know they’re coming for me,” La Doctora says.
The Yanamono clinic, named for the narrow island that divides the Amazon into two forks and where many of Smith’s patients hail from, quickly outgrew it’s quarters at Explororama Lodge and through the help of the Duluth, Minn. Rotary Club was able to build a larger facility (below, right) and subsequently an even larger one just last year. This latest clinic is even equipped with a pharmacy (above, left) and a refrigerator to house La Doctora’s vaccines — an amenity so modern in this part of the world without a power grid that the doctor jumps up and down like a school girl when she looks at it.
Smith accepts medication from the Peruvian government but not money, a strategy employed so that she doesn’t end up in their pocket.
“I don’t want to be told what to do. If a Catholic government comes, in I don’t want to be told that I can’t provide birth control,” La Doctora says. Although it is hard to imagine anyone telling this formidable blonde-haired blue-eyed gringa who walks faster than any Peruvian runs, what to do in any circumstance.
Family planning education is one of her biggest goals, in order to try to stop the endless cycle of teenagers having their first baby at fifteen, their first grandchild at 30 and having ten pregnancies in between.
“I ask women with eight kids if they want a ninth and they always shake their head no and I tell them, you have to take these pills and keep your legs crossed until you see me next month,” she laughs.
Since arriving on the river, Smith has saved countless lives, seeing upwards of 200-300 patients a month, who she charges an average of 10-15 soles, or $3 USD.
“I have to charge something or people will take the services for granted,” she explains.
Some patients she can’t save, like one woman whose breast cancer (not a common occurrence in the Amazon) had progressed to a point where parts of her breast were rotting off her body and her right arm was blue and swollen. All Smith could do was give her medication to ease the pain and help her die in peace.
She realizes she is filling a gaping hole in the Peruvian medical system in a place where not even doctors who are from the area will stay and practice, but when visiting tourists praise her as a saint and tell her how noble her work is, she snorts like a sailor.
“My life here isn’t a sacrifice. Every day is challenging and exciting and I have the good fortune to have a portable profession.”
Things have hummed along nicely on the banks of the river for over a decade and La Doctora planned to spend the rest of her days on the Amazon, but at age 55, life intervened and Smith fell in love again, this time with a man back in the United States … Jerry.
“I fell hard for Jerry. He was just hot, the kind of hot you don’t think you’ll encounter when you’re my age. I wanted to be with him.” But La Doctora wanted to be in Peru too.
“When you’re young and you fall in love, you build a life together. When you’re middle-aged, you both have lives of your own to live.”
Committed to two great loves, La Doctora makes compromises. She spends two months in the spring and four months in the fall back in Wisconsin with Jerry and the rest of the year with her Amazon practice. And that’s how it will stay.
“Barring catastrophe, I am hoping to die in my tracks. Saying goodbye to all this is something I can’t imagine doing voluntarily and is something I will do only if I am forced to.”
If you would like to donate to La Doctora, please visit the Amazon Medical Project website. In addition to funding, the Yanamono clinic is also in need of a portable ultra-sound machine.
Photos by Jo Piazza.