The penumbra of disease
The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases.
Edward Jenner, 1798
Loreto, six provinces that total a quarter of a million square kilometres of rainforest surrounding the city of Iquitos, accounts for about half of the lowland rainforest area of eastern Peru. Wilma Casanova de Caspia and her husband, Martín Caspía, are now in charge of epidemiology in the region. The two of them were kept very busy indeed during the plague year of 1991, for there were 27,000 cases of cholera in this region of about 600,000 people, with an official death toll of 426. The number of cases dropped to 6000 in 1992, and to 5500 in 1993. By July 1994, when I talked to her, there had only been 730 new cases, and no deaths. Cholera had been faced down, but hardly conquered.
Until the disaster of 1991, there had been no attempt to collect epidemiological information on this huge area. Now Wilma sends a weekly report to Lima on data collected from travelling doctors and nurses, who communicate with her through a network of radio stations. While there were, until 1994, only about fifteen medical professionals working in this vast area, the government recently doubled the salaries of health workers in the field from 400 to 800 dollars a month. As a result there are now about fifty doctors and nurses who report their activities to Wilma.