Conventional Medicine inan Unconventional Setting

An Interview with Linnea J. Smith, M.D.

Anne Hendren Coulter, Ph.D.

Anne Hendren Coulter: Let's startwith something you said in your book(La Doctora [see sidebar]). There youmentioned that you had to revise yoursense of "clean and sterile" and yourneeds for excellent lighting and abun-dant medical supplies. What other majordifferences are there between medicalpractice in Peru and medical practice inthe United States?Linnea J. Smith: The major differ-

ences between practice in the ruralAmazonian area of Peru and practice inthe United States have to do with theavailability of materials, medicines,

supplies, diagnostic facilities, transport,telephones and other means of commu-

nication, insurance (there is no suchthing here), and expectations. The peo-ple who live around here expect less inabsolute terms than their U.S. counter-parts (knowing perfectly well that if a

child needs heart surgery to survive,then that child is going to die), but [therural people] do have a hunger for"remedies" of all sorts.

AHC: In your book, you noted thatAmerican medicine may have "goneoverboard with treatment." Would youexpand upon this notion? What are theparticular areas in which this is the case?How might we restructure the system torectify this?

LJS: This is a question that is cause fora book-length debate. But, basically,what happens is that, with more andmore high technology, we are gettingsmaller and smaller increments ofimprovement for more and more

money, e.g., $100,000 worth of vaccinesaves many lives whereas a few hun-dred thousands of dollars' worth ofheart transplant saves one. Also, we are

using more and more resources on peo-ple who are more and more ill, whichhas the same result of ever-more-costlycare for ever-smaller improvements inquality of life. How can we rectify this? Isuppose [this could be caused] by eithera major economic catastrophe so that themoney to do the "high-tech" stuff is no

longer available or else by a majorchange in our national attitude, so thatwe accept tighter limits on what is

Linnea J. Smith, M.D., in the Amazon basin.Photo credit: Ian J. Cohn of Diversity: Archi-tecture and Design.

expected. I don't anticipate either ofthose things happening soon.

AHC: As we are an alternativemedicine journal, we often report on theworks of the "curanderos" and "brujos."In some parts of your book, you havesuggested that local healers, like these,are not always helpful to patients. Couldyou elaborate on this?

LJS: I do not have objective data bywhich to judge the results of the tradi-

195

EDITOR'S NOTE: Linnea }. Smith,M.D., a specialist in internal medicine,left her native Wisconsin in 1990 as a

tourist for Explorama Lodge, near laui-tos, Peru, and was called upon to helpnatives and other travelers. She becameenamored of the place and returned to"doctor" the local people with Westernmedicine. Starting with a small medicalpractice and her own ingenuity, she hasbuilt a clinic and trained several assis-tants. She now serves as "La Doctora" to

people who are living on a slice of theAmazon River. She recently discussed,with our managing editor (via e-mail),her adventures in Peru and their rele-vance to "traditional" and conventionalmedicine, both of which she has experi-enced firsthand.

196 ALTERNATIVE & COMPLEMENTARY THERAPIES—AUGUST 1999

How much is a reasonablecost to spend on a human life?

Above; approximately two thirds of the people seen at the Yanamono clinic are adults. Photocredit: Jon Helstrom, Dan and Judy Peterson, Amazon Medical Project, Karl Nollenberger, andMoonshadow Photography. Reprinted from Smith, L. La Doctora: The Journal of an AmericanDoctor Practicing Medicine on the Amazon, Duluth, MN: Pfeifer-Hamilton Publishers, (8001-247-6789, © 1999 (permission granted).

The Work ofDr. Linnea Smith

Amazon Medical Project5372 Mahocker RoadMazonmanie, Wl 53560Fax: (608) 795-2646e-mail: amp@amazonmedical.orgWeb site: http://www.amazon.medical.orgThe Amazon medical project is a tax-exempt, not-for-profit organization that supports

Dr. Smith's work with the people in the Amazon river basin. Anyone who is interested inlearning more about the organization, its goals, and its work, or who is interested incontributing to its support, may contact the organization via mail, fax, or e-mail.

Dr. Smith's work is described in:La Doctora: The journal of an American Doctor Practicing Medicine on the Amazon

By Linnea Smith, M.D.Duluth, MN: Pfeifer-Hamilton Publishers, 1999

The Work ofDr. Linnea Smith

Amazon Medical Project5372 Mahocker RoadMazonmanie, Wl 53560Fax: (608) 795-2646e-mail: amp@amazonmedical.orgWeb site: http://www.amazon.medical.orgThe Amazon medical project is a tax-exempt, not-for-profit organization that supports

Dr. Smith's work with the people in the Amazon river basin. Anyone who is interested inlearning more about the organization, its goals, and its work, or who is interested incontributing to its support, may contact the organization via mail, fax, or e-mail.

Dr. Smith's work is described in:La Doctora: The Journal of an American Doctor Practicing Medicine on the Amazon

By Linnea Smith, M.D.Duluth, MN: Pfeifer-Hamilton Publishers, 1999

tional healers, shamans, herbalists, etc.,so I really can't answer this questionfairly. It is difficult from a simple, sub-jective point of view to judge local heal-ers as they vary greatly in their abilities.When one sees a physician in the

United States, although there is certain-ly variability among doctors, one knowsthat the person with that license has

passed nationally standardized testsand met certain widely acceptedrequirements. There is no standardiza-tion, on the other hand, for traditionalhealers. This means that some are excel-lent, others are less so.

AHC: Have you learned anythingfrom the traditional healers?

LJS: Several of the traditional healersare actually quite helpful. They have a

number of "remedies" and practicesthat are proving to be appropriate forsome ailments. For example, gingerappears to be useful in treating nausea.

Other remedies that seem to be provingto be helpful include products from therosy periwinkle for childhood leukemia(in use for more than 30 years now),Aloe vera for burns, a mixture based on

caiman fat for asthma, several of thetraditional birth-control methods (ouroral contraceptives were developedbased on these), and probably some ofthe topical healing agents.Also aside from objective measures, the

traditional healers provide comfort in a

way that is hardly expected anymorefrom modern medicine.

AHC: Would you recommend any ofthe traditional healers' practices to yourU.S. colleagues?LJS: More "laying on of hands"

would probably be a good idea. On theother hand, although patients some-

times complain about doctors being toorushed and not paying attention to theircomplaints, they also sometimes com-

plain if the doctors don't order enoughtests. Few people are really willing to

accept the diagnosis the "modern" doc-tor offers, if the diagnosis is reachedsimply by listening to and examiningthe patient. It is felt that X-rays andblood studies must be obtained in orderto validate the doctor's findings. Peoplewill go to all sorts of healers for all sortsof rituals, but if a physician in the Unit-ed States were to blow smoke at a

patient and break into a chant, thepatient would probably flee the office.Again, this is a matter of cultural expec-tations, and I think that, to some extent,these expectations are changing. Alter-

ALTERNATIVE & COMPLEMENTARY THERAPIES—AUGUST 1999 197

If a physician in the United States were

to blow smoke at a patient and break into a

chant, the patient would probably flee the office.

Top left, the clinic's examination room, and, top center, the clinic's laboratory. Bottom left, the pharmacy. Medicines and supplies are left bytourists, donated from the United States, or bought in Iquitos, Peru. Bottom center, Dr. Smith in an examining room in the clinic. Top and centerright, Dr. Smith's Yanamono clinic on the Amazon River. Bottom right, a waiting room in the clinic. All photos in this group: Ian J. Cohn of Diversi-ty: Architecture and Design.

198 ALTERNATIVE & COMPLEMENTARY THERAPIES—AUGUST 1999

The biggest need in the UnitedStates is a change in national attitude.

Dr. Smith still occasionally makes house calls. Photo credit: Jon Helstrom, Dan and Judy Peter-son, Amazon Medical Project, Karl Nollenberger, and Moonshadow Photography. Reprintedfrom Smith, L. La Doctora: The Journal of an American Doctor Practicing Medicine on the Ama-zon, Duluth, MN: Pfeifer-Hamilton Publishers, (8001-247-6789, © 1999 (permission granted).

native medicine journals, like yours, arean example in point: People who readthem are attempting to make the inte-gration between what might be calledscientific medicine and intuitionalmedicine.

AHC: It seems that you function quitewell without most "high-tech" equip-ment. Given the insurance quandary inthe United States, which tools wouldyou suggest that we could live safelywithout?

LJS: "Safely" is a relative term. If wedid away with, say, CT [computedtomography] scans, we would save mil-lions of dollars in health care costs, anda few more people would die. So, thequestion is: "How much is a reasonablecost to spend on a human life? Then,

the next question is: "Exactly what dothese tests and treatments cost?" Andthat is often difficult to answer,because, for example, we still don'tknow exactly how many women's livesare lengthened by the use of mammog-raphy and what the total costs for theselives are ("costs" include not only themonetary expense but also the sideeffects—biopsies for women who turnout to have lesions of no significance,the worry suffered by these women as

they wait for their results, and othersimilar, hard-to-measure items.) Thus,in order to answer this question, therecipients of health care must firstdecide how they want to define safety,that is, what level of risk they are will-ing to accept. At present, in the UnitedStates, virtually no risk is considered to

be acceptable. As long as that remainsthe case, the costs of medical care willbe high.AHC: Are there other aspects of your

practice/experience in this nonallopathiccountry that would shed light on howthe North Americans could set up a more

efficient integrative medicine process?LJS: I'm afraid that, as I mentioned

earlier, the biggest need, if the UnitedStates wants to have a more efficient and"integrative" system, is a change innational attitude. One has to be willingto say: "O.K., I'll take Aunt Jane into myhome and take care of her instead ofputting her in a nursing home"; or"O.K., I don't need a CT for myheadache and, if I turn out to be the one

in 10 million people who turns out tohave a tumor, then I'll accept that"; or"O.K., even though it is me or my hus-band, or my father, a heart transplant isway too costly to be worth doing."It also wouldn't hurt if we simply set-

tled for a little less treatment of every-thing—not every headache requires an

aspirin, not every day when we feeltired means we need St. John's wort, notevery lapse of memory is heralding theonset of Alzheimer's [disease]. Learningto be a little more content with what wealready have would be a big step. D

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