When the little girl, who lived in a village on a tributary of the Amazon River in Peru, was bitten on the leg by a poisonous snake, she developed a serious condition called a “compartment syndrome.” It took her frightened parents a couple of days to get her to a rudimentary government jungle hospital where doctors found that the pressure on the child’s blood vessels had caused the muscle tissue to die. To save her life they amputated her leg above the knee.
Alejandra Before ProsthesisA decade and a half later, the girl, now grown and the mother of an infant, learned through jungle missionaries, that an American orthopedic surgeon was visiting a riverfront hospital of a nearby region, in an Amazon frontier city called Pucallpa. With her infant in a sling over her back, and supporting her walking with the help of a pole, she trekked over muddy rainforest trails and floated by dugout canoe for an 18 hour journey to get to the hospital.
Here she met Peter Cole, Chief of Orthopaedic Surgery at Regions Hospital, Saint Paul, Minnesota. Cole made a plaster cast mold of the stump of her leg, took it with him on his return to the U.S., and left it with the Tillges Certified Orthotic & Prosthetic Company in Maplewood, Minnesota. When Cole returned to Pucallpa six months later, he had with him a new leg for the young woman. “The first time anyone had seen her smile, ” said Cole, “was when she was taking her first steps with the prosthetic. Everyone was clapping and crying.”
Peter Cole’s journey from Saint Paul to the jungle village of Pucallpa on the Ucayali River, a major tributary of the Amazon, began, in one respect, as a boy of 10. He moved with his parents to Caracas, Venezuela, where his father and grandfather were involved in the oil business, and lived there for almost four years where he learned Spanish. “It was a very impressionable time of my life, ” he says. Furthermore, though Cole did his undergraduate work at Emory University in Atlanta, he went to medical school at the University of Miami in South Florida. “Half of our staff and patients were Latin, ” he remembers. “I had a lot of close Cuban friends. I’ve always had an affinity for the Latin culture.”
BIG smile after prothesis.A meeting with Craig and Heather Gahagen, while Cole was in medical school, was providential. Gahagen was an aviation missionary, operating an aviation program that had been founded by his father in the 1960s and which connected missionary settlements in the Amazon basin. His base was about 40 miles west of the Brazilian border. Cole remembers Gahagen challenging him and his wife Nancy. “When med school is done, you won’t have any excuses, ” he told them, “You have to come down and visit us.” The day after his graduation from medical school, in 1991, Peter and Nancy Cole flew to Peru. During the three weeks they spent in the village of Pucallpa the two Christian couples dreamed about “how we could marry our two professions. And that is when it started, ” Cole said.
It began with the Coles making semi-annual trips to the jungle village. “We believed that if we waited until the ‘right time’, until our kids were ready, we would never have gone, ” Cole said. Their youngest son, Channing, was six months old on his first trip. In Pucallpa, Cole walked into the rundown government hospital, introduced himself, and said that he just wanted to check out what sort of facility they had. To his delight he was welcomed with “complete open arms. They latched onto me, ” he said. “They wanted to take me on rounds, scrub for surgery, and show them how to do things. To this day I have never even shown them proof that I am a doctor.”
By 2004 Cole had established sufficiently strong relationships with the hospital, local government officials, and the outlying missionary settlements that he and Nancy decided to buy some land and establish a permanent base. They purchased 25 acres and, in 2005, built a guest house that would sleep 15. They affectionately called it “Jungle Bunks.” The guest lodge is built on pilings fifteen feet above ground, because, in the rainy season, the Amazon rises 32 feet. A 50 meter long board walk leads up to the door to traverse the water during the monsoons.
Dr. Peter Cole with Leyla and BettyIn the initial years, beginning in 2004, the project was completely financed by the Coles. Over the past seven years, as the scale of the project has grown, they have added to their payroll a mission director and secretary, as well as a full time Peruvian surgeon. Cole explained that, with the growing number of trips, the fiscal health of the mission depends on weaning the organization off their majority support. The mission currently runs on about $120, 000 a year.
The Mission Director, Lisa K. Schroder, was hired in 2006. Cole describes Schroder as being “a talented and fearless worker” who lives in Rochester, Indiana, and travels to the Twin Cities once a month to meet with Cole “She is a wife and mother of two boys, who left a high-powered career as an engineer for Zimmer Inc. and committed to an out-of-home job helping the fledgling project, ” he said. In addition to her background in orthopedic engineering, Schroder has an MBA from Purdue.
Twice a year, Cole and Schroder take from 12 to 20 team members to Pucallpa for a week-long marathon visit. Word goes out months in advance when a medical trip is taking place. On the day the medical team arrives at the jungle city, patients begin lining up at 4:00 in the morning at the hospital. If the visit is for a week, the team will see about 100 people on Monday, and identify the 25 they will operate on the rest of the week.Cole is proud of the fact that all of the surgery is performed at the local hospital. As he explained, “We are not just building a hospital and running it with our own people, or going down with our team and taking over a hospital. Rather, we work with the hospital personnel, rub elbows, teach, and demonstrate how we treat patients by our actions.
They are so grateful for what we do, that they open up clinic space, staff operating rooms with their anesthetists, their OR nurses, their floor nurses. Even the Chief Hospital Director welcomes us with a ceremonial greeting. This approach really helps us to disseminate information, to spread a culture of care in a place where life is very cheap, ” he said.
Team Member Sarah Molitor with Patient YanndoCole’s team members counter the racist attitudes that exist in Peru toward the indigenous people. “The Amazon Indians are not seen in the same regard as people of Spanish descent, ” he said. “Just the fact that we would talk to these patients, look them in the eye, hold their hands, is unusual for them, and I believe makes a difference.”
Cole notes that an orthopedic team at work is not like a primary care situation. “There is a lot of complicated technology involved in orthopedics. We use more tools, implants, and instrumentation than any other specialty, ” he said. Because these are not available at the government hospital, every member of his team takes with them from the States, a trunk of implants and instruments that are stockpiled for use with patients.
About 60% of Cole’s patients are individuals who have deformed bones. He says that bones that did not heal properly are all over the Amazon because there are no orthopedic surgeons there. “If you are hurt there you do not get treated.” He emphasizes that this is not “slam-bam surgery.” A single surgery can take up to five hours. But the results transform lives. “Take a young girl with a thigh bone that has not healed, ” he said. “She lives on crutches, will never get married, will be an outcast in her village, and will be completely marginalized in this culture. Some infants with deformities, such as clubfoot, are even killed by their Indian parents because they are believed to be possessed, ” he said.
Cole says he could write a text book in pathology with what he sees in a week at Pucallpa. “If you have a tumor in the U.S. it will manifest so early and be treated so early, that you never see what it is like when it is taking over an entire leg and is growing through the skin, ” he says. “Not so at the far reaches of the Amazon!”
The mission has recently added another dimension to his work in Peru. As he explains, “In my U.S. life I am an investigative researcher who promotes and publishes functional outcomes in orthopedic surgery, in a genre of research termed, evidence-based medicine. I felt that it was disingenuous of me to be a champion of outcomes in orthopedic surgery, which emphasizes close follow-up of patients, and then go down to the Amazon and never know what happened to my patients.”
As a result, a couple of years ago, the organization hired the Peruvian general surgeon Rosa Escudero, M.D., to work full time following up on the patients. “She goes into the villages, into the Indian tribes, even the barrios, to get follow up. That is gold to me! As a physician I am just not comfortable rendering a treatment and not knowing what happens.” Cole said that Escudero also runs the mission at the local organizational level, particularly as it relates to gearing up for trips and patient care.
Cole explains that his Peruvian colleagues at the government hospital have a hard time understanding his desire to follow up on his patients. (Cole confesses that, in this case, he may be imposing his American culture on the local medical system.) They wonder why the Americans want to set up a clinic to see all of the patients he had operated on in the past—who they believe are doing just fine. “They do not understand that I want to know the good as well as the bad outcomes. It helps us prognosticate for other patients. It helps us see what we could do even better, ” he says.
So what drives Cole? Part of the appeal is that he finds orthopedics to be a wonderful field. Orthopedists, he says, “are all guilty of wanting to fix things. I like to take something broken and fix it, and see the result the next day, ” he said. “It is not like managing diabetes or hypertension. It is a very ‘immediate gratification’ kind of field.”
“What is often left unspoken”, Cole explains, “is that his work in Pucallpa is a Christian ministry”. He is quick to add that it is not a Bible distribution network and certainly not a proselytizing ministry. “We are there to demonstrate our love for God by loving others through our work.” The ministry is named, Scalpel At The Cross. “The scalpel represents the surgeon’s profession. I lay that at the foot of the cross to be used by God however He wants. I put my talents there. I am an instrument of His, ” he said. Cole invites people to visit the website at www.scalpelatthecross.org.
