Mission impossible

How one little hospital in the jungles of Peru defeated even the legendary Dr. McClure

Stephen Handelman October 18 1976

Mission impossible

How one little hospital in the jungles of Peru defeated even the legendary Dr. McClure

Stephen Handelman October 18 1976

Mission impossible

How one little hospital in the jungles of Peru defeated even the legendary Dr. McClure

Stephen Handelman

Dr. Robert McClure, indefatigable and brisk at 75 years of age, set off one year ago for the leafy forgotten villages of northeastern Peru. The lifelong missionary surgeon and former moderator of the United Church of Canada had cared for lepers in India, headhunters in Borneo, the wounded on the Burma Road and the Gaza Strip. Now he was heading for Pucallpa, 450 miles northeast of Lima, a town of shanties and houseboats on the edge of the great squawking Amazonian jungle, to revitalize the Hospital Amazónico. He left amid fanfare befitting the country’s most celebrated missionary and carried with him the promises of funds from private and government sources. But five months later he was back in Canada. He had done what for him was the “unthinkable.” For the first time in 50 years of missionary work he had quit, and with him went most of the volunteer nursing team. What went wrong?

At the height of the rainy season in the long November and December nights, while the jungle rain poured down with a throaty roar and turned the few roads into rivers of mud, McClure, palid eyes darting energetically behind rimless glasses, and his young team of nurses from Canada, Belgium and Sweden mapped out a new river medical service to bring health to the mosquito infested villages along the two great rivers that form the Amazon—the Maranon and Ucayali. They would travel for days by “peque-peque,” a rickety motor launch, bringing 3,000 to 4,000 precious vaccines at a time to once inaccessible Indians. Upon his arrival in Pucallpa, McClure had been immediately touched by the helplessness of the Indians. They still sharpen their teeth like carpenter saws but keep radios and sewing machines under their hammocks. Aloof, “gentlemen of the jungle,” they die in droves from a foreign flu imported by a road-building gang. Brothers marry sisters to save the village and then watch as their children die from big heads and little legs, and from a simple thing like whooping cough.

McClure didn’t mind the ringworm he picked up, or the scabies and fungus, or the proliferating abscesses, the relentless diet of fish and fruit, or the prickly ever present veil of mosquitoes. But he had not known that in taking on the job he was walking into a “nest of serpents,” as the local Roman Catholic bishop put it. The hospital, started in 1960 through the efforts of foreign doctors and governments and controlled by a foundation in Lima, was enmeshed in debilitating red tape, was heavily in debt and overstaffed. Incompetence and quietly muttered hints of corruption flowered like jungle foliage. Money from Canada for the joint Swedish-Canadian river project came in dribs or not at all. “I had no control,” explains McClure. “I would spend three days on the river with the mosquitoes so bad that I left blood all over my pillow when I woke up and then 1 would come back to the hospital to another hassle about expenses.” in the end he felt he had no choice but to leave, causing, in his own words, “a dynamite explosion in Canada.” Embarrassing questions are still being asked. Why were the fund-raising drives carried out by the Amazonian Hospital Foundation of Canada so unsuccessful? Why did the foundation hold up funds allotted to the program by the Canadian International Development Agency (CIDA) when McClure continued to beg, plead and finally demand that he get financial help while his teams ran out of vaccines and the hospital lost its credit at the local stores? Red tape, more than any other factor, seems to have been the culprit. McClure found himself caught between the Canadian foundation, which wanted a clean accounting of the money spent, and the Lima foundation, which continually demurred. “The red tape is such an integral part of the system that it’s like fighting a war,” says McClure. “I’ve done a lot of frontline work and it’s no comfort that the people backing you up will be absolutely correct in auditing reports but won’t get you money.”

For the townspeople of Pucallpa, McClure’s departure was not that surprising. They have watched a series of missionary luminaries come to shed light in the jungle only to find themselves overshadowed by it, arriving energetic and zealous as McClure did and later leaving, as he did, angry and frustrated. The episode was only one of a number of crises that have plagued the hospital. But somehow another luminary always comes along, backed by another foreign country, while the Indians wait silently for the sounds of the “peque-peque.”

Down the street from Monsignor Gustav Provost’s office, the jukebox in White Patricia’s bar offers a surprisingly wide selection. An old Spanish melody called Virgins Of The Sun gets equal treatment next to Sexy Sexy Sexy by James Brown. The outside world has the frontier-style port of Pucallpa firmly in its grip. A former goldmining town turned lumber capital. Pucallpa is the heart of the 10,000-squaremile jungle parish that Provost, a 69-yearold Quebecker, came to administer in 1957. A surge of colonists from the coast has already pushed its population to nearly 100,000, and the shanties and houseboats on the Ucayali River are jammed. The main street is still unpaved, street lighting is several years away. Indian women in bright red and yellow tunics swarm in from the settlements every day selling trinkets, cloth and necklaces to tourists in the restaurants. “The Indians are losing so much,” says Provost disapprovingly. “It took me 20 years to realize that. It’s impossible to avoid, I suppose. Once an anthropologist said to me, ‘Don’t touch these people.’ They will be touched whether we do anything or not, I thought. Then he said, ‘At least you won’t be responsible for their extinction.’ ”

A naturalized Peruvian, Provost rose to eminence as leader of a group of 23 Canadian priests who make up the first stable ecclesiastical presence in the region since the Franciscan missionaries of the 17th century. He has watched as a series of brilliant doctors arrived with stethoscopes and mosquito nets to offer themselves to that jungle. The first was the founder of the present hospital (then called Hospital Amazónico Albert Schweitzer), a strange German doctor of obscure origins named Theodore Binder.

Binder convinced a German foundation to support his budding hospital in the jungle. He charmed governments and private groups into massive injections of cash. Foundations to channel funds sprang up in Sweden, Canada, the United States, Switzerland, France and England. But, unfortunately, Binder could never make his peace with chamber-of-commerce-oriented Pucallpa. He would sometimes tell patients to avoid a particular town doctor, whom he labeled a “killer.” He pointed out to his patients which products sold in local stores were “poison.” The whispers of opposition soon turned into a storm. Then one Sunday night in 1972 he disappeared. According to informed reports, he took one million German marks with him.

“Sure, there were rumors of graft and corruption all the time he was here,” says Provost. “I don’t know. There was always quite a bit of money around and Binder went to Europe several times a year, but he did have rich friends. No one could prove anything. Poor Binder. So huge, so fine a man, then suddenly, such a brute.”

After Binder’s departure the Lima office was reorganized. New controls over the money were put in place, but Binder’s original dream had already been so distorted that the hospital’s medical facilities were being used by the town’s middle class, who arrived at the door in taxis. Then came a new star from overseas, Dr. James Dalrymple, a brilliant English surgeon. A short time after he took over as director the news of Doctor Jim’s accomplishments spread throughout the jungle. Local wisdom held he was the type of man who would perform a kidney transplant in the morning, have lunch, and then work for another eight hours. But Dalrymple the surgeon apparently believed in Dalrymple the legend. The affection the town held for him and his own unflagging work spurred him to expand the hospital from 60 beds to more than 120 beds. His dream was a regional hospital.

Worried administrators in Lima saw a conflict coming with government plans and with their own stretched budget. They tried to persuade Dalrymple to devote more time to the river service, but he resisted. “A surgeon needs patients,” explains Provost. “What would he do with an empty hospital?” The conflict could only end one way. The proud English surgeon was fired. Outraged townspeople reacted quickly, invading the hospital. For two weeks the occupation dragged on. When the dust had settled, the Peruvian government sent a director from the ministry of health. The caravan of medical luminaries from around the world lurched on.

McClure was the next to take up the torch, and he had a precise mandate:“My job was to manage a full-scale retreat.” The hospital had been cut down from 120 to 30 beds and now he had to drastically reduce its staff, almost an impossibility in Peru where a special ministerial order is required to get anyone discharged. But his main task was to build up the river health system: five nurses, three motor boats, four social workers and one doctor. Often the money needed to finance their trips and buy their drugs had been spent by the debtridden hospital. Two signatures were required on every cheque and the hospital administrator who shared responsibility with McClure often refused to sign for the health teams’ vital supplies. In December the hospital was still trying to meet its October payroll, and Canadian money was being held up. In 1974, the project had been promised $99,500 from CIDA and as much as the Canadian foundation could

raise. Eventually most of the CIDA money made its way down through the Canadian foundation but very little of the private money materialized because of disastrous fund-raising drives. “I could not get the statement of expenses from the Peru foundation in the form that the Canadian foundation wanted it,” says McClure. “I’m not a chartered accountant.” To buy supplies he borrowed money from budgets meant for other programs. When he needed a portable refrigerator to carry medicine (the teams usually worked out of beer parlors along the river) he paid for it out of his old-age pension. When he finally decided to quit, officials in Lima accused him of

negativism and hinted to others that he was getting too old. But McClure retorts: “When I decide a thing won’t work, that’s it. At 75 years of age you can’t wait around for things to change.”

Elizabeth Hunger, a temporary hospital administrator, was highly critical. “You couldn’t believe the atmosphere when I came. Dr. McClure had gathered all his staff around him. He wanted his own kingdom, he wanted the river service to be completely separate. He’s a capable man, but he could not adapt. He was used to hospitals in Borneo with 800 or 1,000 beds. This wasn’t like that at all. He was always shouting. What he disliked most was the corruption. Well, I disliked it, too. Last year, we had four Peruvian directors. Each one was a worse crook than the other. But that’s the way life is in this country. You have to get used to it. At 75 years, you’re not flexible any more.”

McClure’s departure did spur reform and, ironically, the river health program is now flourishing thanks to the arrival in July of yet another new director, a Limabased Swedish industrialist named Hans Langenskjold, and a $ 1.5-million grant from the Swedish government. Money seems always to have been at the root of the hospital’s problems. Since 1970 Sweden and Canada have provided the bulk of the hospital’s more than one million dollars in operating expenses. After the Binder crisis in 1972, the French foundation withdrew. So did the Swiss and the English. The United States left in 1973, but the Swiss came back. Holland helped in 19J2 and 1973 and returned in 1975, as did the United States. England provided a grant in 1973 and then medical material in 1975. “You understand it has not been easy,” says Augusto Dämmert Leon, the earnest president of the Lima foundation. “When we had our crisis in 1972, we knew it was going to be a challenge. But without challenges, what can you do?” Dämmert, a former diplomat and ex-mayor of one of Lima’s wealthiest suburbs, is typical of the high calibre of the hospital’s five-man board. “In a developing country, you have to expect problems,” he says. “You can’t always have things the way you’re used to in North America. Our fundamental obligation is to the Indians who need our help. If it weren’t for them, we wouldn’t be there.”

Pierre and Michelle l’Heureux have been traveling alone in the jungle for days. On their rickety “peque-peque,” they have

been gliding in and out of muddy channels clogged with underbush, stopping at three or four huts on the bank that make a village, providing the inhabitants with some sort of medical diagnosis for the first time in their lives. They were returning to their hometown of Quebec City after two years of study and travel around the world when they met McClure in the jungle. Only recently graduated in medicine at the University of Ottawa, the 26-year-old L’Heureux was captivated by McClure’s vision. The couple’s command of Spanish was limited to 10 correspondence course lessons and their knowledge of tropical medicine was confined to the contents of

Manson’s Tropical Diseases, but they quickly became an asset to the river team.

“It’s really a matter of basic medicine,” says L’Heureux as he conducts a clinic in the little village of Tumbes. There are no Indians here, only poor woodcutters of Spanish stock who claim descent from jungle pioneers 50 years ago. “In a Spanish village, you don’t see as much malnutrition as in the Indian villages. But this child, for instance, has worms. We’ll give him something to treat them, but in six months the worms will be back. As long as they continue to walk barefoot in the mud and don’t boil their water, what can you do?”

Pierre and Michelle have decided they can’t do very much more. This is their last trip on the river. “We’d like to stay, but would it do any good?” muses Michelle, 25, a graduate nurse who acts as her husband’s scrub nurse. “There was a doctor leaving when we came and we promised McClure we would take the doctor’s place for at least three months. But if we were to stay another year... I don’t know. We love it, but it’s just too disorganized.”

The young volunteer nurses, sent here by organizations in their home countries, say McClure’s departure made them question their own commitment. The little health post of Paoyan, 18 hours downriver from Pucallpa, is alive with the solidarity of the besieged. Suzanne Palme, a 20-yearold Swedish high-school student, sits by the kitchen table under the photograph of Albert Schweitzer and cuts strips of Gouda cheese for dinner. Although she’s the only member of the team who is not a trained nurse, a previous volunteer position in a student group promoting cultural ties between Sweden and India whetted her appetite for international good works. “We were all in this together,” she says. “After Dr. McClure left, I promised Pierre I would stay if he stayed. But he’s leaving, so I have to go.” So will Katrina Vermoes, 26, and Hilda Adreauns, 25, both Belgian nurses. So will Agneta Asp, 30, a Swedish nurse trained in tropical medicine whose nine-month stretch has been the longest of any of them. Two other nurses have already left. The ambitious reorganization outlined by foundation officials does not seem to ease the team’s anxiety. “They’re just building castles in the air,” says Suzanne Palme.

The only member of the river service who isn’t part of the frantic exit is 28-yearold Michel van der Heyden, a tall, sandybearded doctor from Belgium. He was also the last to arrive (just as McClure was leaving). McClure, he says without a trace of irony, had promised to stay on a little longer to help him adjust. Now van der Heyden has taken McClure’s place as director of the river service. In fact, until a group of new nurses and doctors arrive from overseas, he is the river service. Van der Heyden is realistic. “The politics of health,” he says, “are the same anywhere. It’s hard to figure out where to best put your money. I really don’t think it’s as bad as they say it is. Then again, I haven’t been here long enough.”

In a highrise apartment in Toronto, Dr. Robert McClure, his heart checked and approved by his doctor, makes plans to take up another post overseas—this time in the Caribbean Island of St. Vincent. But his mind still wanders to the jungle. He says he hopes that the river health program will work. “I’m still terribly interested in it,” he says pulling out a sheaf of letters from doctors and nurses in Peru. “I have no bitterness.” Only disappointment at having been forced for once in his life to quit.'ÿ»