Feature by Jacqueline Prause
Submitted by SAP
In the quiet darkness of the Amazon night, a broad boat deftly navigates a tributary of the Madeira River, making its way towards a tiny village of wooden houses and thatched shelters nestled on the shoreline. But the boat’s approach does not take the village by surprise. As it nears the riverbank, the cheers of children excitedly herald its arrival: “The doctors are here! The doctors are here!”
And so begins a new day of service for Ana Khouri, manager for Partner Delivery Management of SAP SuccessFactors solutions. Khouri was a member of the 2023 expedition of Doutores das Águas (Doctors of the Waters), a non-governmental organization (NGO) in Brazil that provides medical and dental care, alongside essential socioenvironmental education, to the isolated communities of the Amazon River Basin. “We had such a welcome,” Khouri says, reflecting on her experiences in the villages the expedition visited along the Acari and Canumã rivers from July 31 to August 12. “We arrived there at night. The boat had not yet docked and everything was dark, and then all these kids were already at the edge waiting for the boat. They were screaming and cheering. It made me kind of emotional.”
Healthcare for Isolated Communities
For these communities, the annual visit of Doutores das Águas, now in its twelfth year, is often the only occasion people are able to see a doctor. Their villages are so remote that they would otherwise need to travel many days by boat just to reach the nearest health center. Many have been looking forward to the NGO’s visit. Beforehand, families receive a password to access the services onboard the boat, which include health checks, vaccinations, vital medicines, dental care, and new dentures.
Doutores das Águas sends one expedition per year into the Amazon, divided into two successive stages with each taking either a northern or southern route. Khouri’s expedition traveled south, navigating the Acari and Canumã rivers for 12 days to deliver services to six villages. The boat, 21 meters long and seven meters wide, has sleeping berths for 32 team members plus 12 crew members. It travels at an average speed of 15 kilometer per hour, powered by a 300 HP propulsion engine and has capacity to carry 13,000 liters of fuel, enough to last an entire month. Two generators are also onboard. Built specially for Doutores das Águas, it is equipped with modern medical equipment, including an ultrasound machine, four dental chairs and a dental lab, and a portable wash basin for lessons on teeth brushing. It carries enough stockpiles of vaccines and medicines to support communities for one year, until the boat’s next visit.
In 2023, the expedition provided services to 36 communities in 23 days to deliver 2,081 medical treatments or vaccines and perform 1,890 dental treatments and 62 micro-surgeries. And the onboard dental lab produced 265 dental prostheses or dentures, giving many people their smiles back.
Hidden Skill Set Reveals Passion for Healthcare
In the Amazon, even winters are intense, as daily temperatures reach 37 degrees Celsius with high humidity and frequent rain. The shrill buzz of mosquitos is ever present. Creatures of the rainforest move about invisibly, eager for a free pantleg or untucked shirt to crawl into.
For Khouri, who joined SAP in 1999, life on the hospital boat is a long distance from her workspace at SAP Brazil in Rio de Janeiro, where she ensures that partners have the enablement tools and support that they need to deliver successfully to customers. Her energetic, affable interpersonal skills and tenacity for problem-solving – the same qualities that help her succeed in her work at SAP – enable her to thrive in dynamic environments.
But there is another side to Khouri that few colleagues know about. She has a background in nutrition with a master’s degree from Michigan State University. This hidden skill set, which is an integral part of Khouri’s whole self, qualified her to join the expedition as a socioenvironmental and nutritional health expert. “I always liked the healthcare field,” she says. “So, to be there and to be able to provide this benefit to these people and to be part of the team, that’s my motivation. We are giving the people healthcare.”
Learning by Doing for Health and Hygiene
In the early morning, villagers gather to listen to the doctor, dentist, and the socioenvironmental and nutrition team, who discuss the importance of nutrition and hygiene for long-term health. Afterwards, the adults go to the line to be called in for treatment. “We stay with the kids and teenagers. We play games about food, nutrition, garbage disposal, and recycling,” Khouri says. This year, 750 children received instruction in socioenvironmental and nutritional activities.
One game is a competition to see which team can collect the most garbage in a big bag. “The kids are all running, and we run after them, in this intensive heat,” Khouri says. A prize is awarded for the most garbage collected. There are lots of batteries and plastic drink bottles. “This is one exercise we do to tell them they shouldn’t just throw things on the ground because it’s going to be washed away to the river.”
Twice a day, the children receive instruction on how to brush their teeth. They each receive a dental examination aboard the hospital boat. “We teach them with games and music how to brush their teeth,” Khouri says. “In the boat, we bring a huge sink with eight places so we can have eight kids at once and we give them a small toothbrush and toothpaste.”
Children who have no cavities at their annual dental checkup receive a badge. In communities where the boat has visited previously, the number of children with no cavities is increasing – evidence of the NGO’s impact on healthcare in the region. “We have lots of little kids, 5 years old or 6 to 7. They have the badge ‘Zero Cavities,’” Khouri says. “We also teach them how to wash their hands and to always wash their hands before they eat.”
“The kids somehow get attached to you,” Khouri says. “They don’t know you, but then at the end of the day, sometimes you sit quietly somewhere to have a break and they come and hug you. They stay with you. This is something that touched me.”
Tapping Natural Resources to Satisfy Global Markets
People in the communities along the river live simply from the land and the water. They sometimes sell the fruits, cashew nuts, and mandioca (basis of tapioca) that they cultivate. Many have begun to earn money by selling copaiba oil, used in traditional medicines. The oil is extracted using traditional, sustainable methods to tap tree resin. The oil is popular in high-end cosmetics and pharmaceuticals, including sunscreen, because of its anti-inflammatory properties. “Some of the communities extract the oil,” Khouri says. “Unfortunately, they sell it very cheap to the middleman, who sells it to cosmetics companies for a lot of money.”
The NGOs that work in the region, including Doutores das Águas, are encouraging the communities to create a cooperative so they can sell copaiba oil directly and receive more money, because the oil “is really cheap and it is very ‘in’ at the moment,” Khouri explains.
One Boat Is Not Enough
Khouri wants to participate in the next expedition of Doutores das Águas, scheduled for April 2024. Also, the communities change over time, as she notes, “Some of the communities disappear. They are so small that they migrate.” One community has become more developed since becoming connected to the region’s main road, making healthcare more accessible to community members.
“What I expect for the future of these communities is that they get more access to healthcare, improve hygiene, and take care of the river by adopting the garbage collection practice that we teach them,” says Khouri. “I would like people to know that this issue exists and that the need in the Amazon is huge. One boat is not enough.”
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Top photo courtesy of Ana Khouri
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