Beyond the Road’s End: A Medical Brigade in Bolivia
- Kaitlyn Johnke- Board Member Alliance For Good Health, MPH
- Jan 23
- 20 min read
An Invitation Into the Unknown
"Do you want to come with me on a medical brigade to the TIPNIS in Bolivia? I think you’ll like it. We’re going to remote communities with no access to healthcare—it’ll be an adventure. We’ll take a small plane to get there, sleep on the ground, and there will be lots of bugs. No cellphone service."
That was the proposal my friend Dr. Elizabeth Pastor made to me. Having just completed my Master’s in Public Health and Latin American Studies—with no job or other commitments—I was intrigued. And so, I agreed.
In October 2024, I traveled to Bolivia to support the public health projects of Alliance for Good Health (A4GH), a nonprofit founded by my friend Dr. Pastor. In the month I spent in Bolivia with Dr. Pastor, I saw firsthand how critical the efforts of A4GH are for the communities we visited. In communities with no access to healthcare, even basic medical and dental care can make a life-changing difference. If you’re inspired by this work, I hope you’ll consider supporting these efforts—every donation helps provide essential care, from dental treatments to vaccinations. More details on how to help at the end of this post.
Why Public Health, Why Here
I first met Dr. Pastor in 2019 when we were both interns in the Ecuadorian Amazon. After years of running her own medical practice in the U.S., Dr. Pastor shifted her focus to public health to make a deeper, long-lasting impact. She was the one who introduced me to public health, sparking a passion that eventually led me to pursue my master’s degree.
For me, public health is the perfect intersection of my passion for serving people and my curiosity about different cultures, societal structures, and ways of life. True public health work means collaborating with communities to create sustainable change, whether through infrastructure, policy, education, or behavior change.
Dr. Pastor founded A4GH to implement these principles in Bolivia, where she spent the formative years of her childhood and young adult life and still maintains connections. She wanted to use her public health expertise to support Indigenous communities in improving health outcomes while respecting and working within their cultural realities.
During the time I was in Bolivia, we worked on a variety of different projects and also did some tourism.
Reaching the TIPNIS Is the Work
The highlight, though, was a 10-day medical brigade to the TIPNIS (pronounced Teep-nees). The acronym TIPNIS stands for the Indigenous Territory and National Park of the Isiboro and Sécure Rivers (Territorio Indígena Parque Nacional Isiboro Sécure). The Moxeño, Chimané, and Yurakaré Indigenous groups live within this protected territory, which remains isolated from the rest of Bolivia due to the absence of connecting roads. The TIPNIS spans both the departments of Beni and Cochabamba, and the primary access routes are by motorized canoes or small planes typically operated by NGOs. The communities live with limited modern conveniences and resources - bathing and washing clothes in the river, drinking untreated water from the river, basic hole-in-the-ground latrines (sometimes open defecation), and little to no cellphone service.
A Road That Changed Everything
The extreme poverty in the area is primarily due to the lack of roads. In 2010, a highway was proposed to connect Villa Tunari in Cochabamba with San Ignacio de Moxos in Beni, passing through the TIPNIS (see image below). The proposition of this project caused significant pushback from environmental and indigenous organizations. In response to widespread protests, this project was postponed indefinitely in 2011. However, the medical staff we worked with expressed frustration about the lack of roads, as it left Indigenous communities without reliable access to healthcare, clean drinking water, childhood vaccinations, and sanitation infrastructure. Expanding these services remains difficult due to the challenges of transporting construction materials into these communities by boat or plane.
Preparing to Leave, Again and Again
For this trip, Dr. Pastor's main public health project was a dental hygiene initiative. She chose this focus after her previous visit to the TIPNIS, where she observed widespread cavities and dental issues. With tooth extractions having been the primary solution for locals with these issues, many Indigenous adults were left with few teeth in adulthood. This led to the creation of A4GH’s campaign Una linda sonrisa te da buena salud (‘A beautiful smile gives you good health’). Before I arrived in Bolivia, Dr. Pastor had already designed and organized the campaign, securing connections, resources, and partnerships with local health departments and NGOs to make it possible.
The medical brigade to the TIPNIS was scheduled to begin mid-October, towards the end of my time in Bolivia. In the time before, between other activities, we gathered supplies - water-filtering bottles, bug nets to put over hats to protect our faces, tall rubber boots to walk through the river water, and flea collars for our boots to deter biting insects. While the focus of the work that I did with Dr. Pastor was the dental hygiene project, the medical brigade, funded by A4GH, also included a medical team, a dentist, vaccinations, medicines, and medical equipment - resources that rarely reach these communities. Without this funding through A4GH, the local health department previously struggled to make any trips at all out to the TIPNIS.
Grounded by Smoke
From the start, our departure on the brigade was uncertain. A month before I arrived, an earlier attempt to launch the brigade was thwarted by intense smoke from wildfires, making it impossible for the small plane to land. This phenomenon occurs annually but was prolonged this year due to a delayed rainy season. Still, Dr. Pastor remained determined- the brigade would happen one way or another.
Smoke in Beni, Bolivia
While we were in Las Pampas for the weekend at an ecolodge with limited cell service, we received word that a small plane from the NGO Mano a Mano might be available on Tuesday to take us to the TIPNIS—just two days away.
San Ignacio: Final Preparations
We arrived in the town of San Ignacio de Moxos (also known simply as San Ignacio) on Monday, the base for the medical team who we would be traveling with. San Ignacio is the capital of the Moxos province and the closest large town to the TIPNIS. There, we stayed with Ivo, a friend of Dr. Pastor’s and a volunteer for A4GH. Our first stop was the health center, where we met Gabriel, the local health professional coordinating the brigade. Collecting the medications we would bring with us proved to be a time-consuming process, as each item had to be logged and organized before we could take it with us.
Dr. Pastor (left), Berta ( middle) Director of the of Municipal Health Gabriel (left) Coordinator Brigades for the Moxos Health Health for the province of Moxos, Kaitlyn (right). Berta (middle) and Dr. Pastor (right)
Next, we visited the local market to buy food—vegetables, fruit, rice, and pasta—being mindful to purchase only small amounts of perishable items for the first few days. Meanwhile, the sky looked quite ominously smoky.
In preparation to leave on the brigade the next day, I had to tell my family and friends that I would be unreachable for at least ten days—possibly longer, depending on how the return journey unfolded. I was nervous. I anxiously thought about how, if anything happened to us while we were out there, no one would know anything was wrong for days. Dr. Pastor reminded me that I was traveling with nurses and doctors, and tons of medications. It would be fine, she assured me. We slept very little that night as we stayed up very late doing final packing and washing clothes.
At dawn, we loaded heavy boxes of food, medication, and camping supplies into the back of Ivo’s truck and drove to the health post for final preparations. But just as we were pulling up to the health post to load more medications, we received disappointing news—the plane couldn’t leave. The sky was still too smoky for a safe flight. Frustration set in. Every delay shortened our already limited time in the TIPNIS and pushed the end of the brigade uncomfortably close to my scheduled return flight to the U.S.
At the same time, exhaustion weighed on us. The past few days had been a blur of travel, packing, and organizing. I was still recovering from a bad stomach bug, so once we accepted the change of plans, the unexpected downtime felt like a small relief.
Back at Ivo’s house, Dr. Pastor called Gabriel. The new plan- try again on Thursday, two days from now. That gave us a bit of time to rest, but looking up at the hazy sky, I wasn’t hopeful it would improve. The uncertainty gnawed at me. Over the next two days, we wandered around town, ate well, and continued preparing for the brigade, even studying a bit of Chimane, the native language of many communities in the TIPNIS. Still, our eyes kept drifting toward the sky, gauging the thickness of the smoke. On the eve of our second departure attempt, the forecast predicted rain. We clung to that hope, singing Que llueva, que llueva... and willing the rain to come.
With the sky smoky, Dr. Pastor had already floated the idea of arriving by boat, but Gabriel dismissed it, due to the extra time it would take to arrive. Still, she insisted—we had to get there. The donations had been collected, the supplies were ready, and too many people were counting on us. Abandoning the mission wasn’t an option.
That night, a few raindrops began to fall. We fell asleep listening to the pitter-patter on the roof, hoping it would be enough to clear the smoke by morning. I wanted to believe, but uncertainty lingered. When we awoke at sunrise, Dr. Pastor stepped outside to check the sky. “It looks better, I think,” she said.
But when I looked, I still saw haze. Maybe it had improved, but not enough to feel confident. Moments later, a call from Gabriel confirmed our fears—the plane wasn’t leaving.
The new plan - we would travel by boat, leaving the next morning.
Once again, we launched into a flurry of preparations. One major additional task was securing gasoline - which was in short supply - for the motored canoe we would take up the river. While running errands, we spotted a gas truck—a rare sight. A line had already formed, with people placing their gas jugs neatly along the roadside. We joined the queue, waiting as the sun dipped lower in the sky. Eventually, we succeeded in getting the gas we needed for the brigade by explaining our situation to the workers.
By River, Not by Plane
At around 3 a.m. the next morning, Gabriel pulled up in a pickup truck, ready to load our things into the back. In order to get to the river’s edge where our boat was waiting, we had to travel by truck for four hours. As I looked at the pile of supplies, I couldn’t imagine how everything was going to fit—especially since we still had more people and gear to pick up.
But somehow, our driver worked his magic—packing, stacking, and tying everything together before securing a blue tarp over the heap. I worried that something would come loose and fly off along the way.
The next four hours in the truck were uncomfortable, to say the least. It felt like a miracle that we had managed to squeeze into the vehicle—and we were only beginning the journey.
As we drove, the first light of dawn crept over the horizon. After what felt like an eternity, we finally arrived at the river’s edge.
“Is that our boat?” I asked, eyeing the long wooden canoe with growing concern. It was already half-filled with water. It had an incredibly basic structure, and it was hard to imagine how it would carry all of us and our things for several days up the river.
We sat down for a simple breakfast of hard-boiled eggs and cheese while beginning the process of loading the boat. That’s when we noticed another problem- the propeller for the boat motor wasn’t the right one.
As we waited for someone to retrieve a replacement from the nearby town, one of the men who would be navigating the boat began slicing meat, preparing it to dry into charque (a common Bolivia food of dried, salted meat) for the journey ahead.
Then, we were off. The first hour felt like a safari, with caimans, capybaras, and alligators appearing alongside herons, egrets, and other birds on the river banks. Around each bend, new creatures emerged, adding to the thrill of the journey. At one point, we spotted a massive caiman, its unblinking eyes fixed on us from just a few feet away, nearly level with the boat’s edge. A shiver ran through me as it suddenly disappeared beneath the water. We sped forward, leaving only the memory of its immense size and a lingering sense of vulnerability and awe for this unfamiliar environment.
That first day, we traveled through diverse landscapes and stopped for lunch on a riverbank.
As we traveled by boat, we sat atop our supplies, fully exposed to the relentless sun. We all wore long-sleeved shirts and hats, though by the end of the trip, the exposed bits of our noses and cheeks were marked by sunburns and deep tans. Water slowly but steadily seeped into the bottom of the boat, and we took turns using an old gas jug to scoop it out. I sat next to Gabriel, who mentioned that while rare, boats occasionally tipped over—something he had experienced firsthand. Just in case, I kept my cell phone sealed in a plastic bag. With the dry season nearing its end, the water was at its lowest point of the year.
As the sun started to get low on the horizon, we stopped at a river bank and set up camp. Our dinner was tuna salad sandwiches, made with the light from our headlamps in an attempt to avoid the torrent of bugs that came with the sunset.
Once we ate, it was time to bathe. I looked to Soledad, a local volunteer on the trip, for guidance. I put on my bathing suit, and we used a pot to pour water from the river onto our bodies. I was nervous about caimans, but they told me that caimanes weren’t often seen at this part of the river. The water was warm and sandy. When we were done “freshening up”, we ran back to our tents to avoid the bugs.
As I settled down to sleep, my first night sleeping on the thin sleeping pad in the tent, my body was damp and slightly sandy from bathing, my hair still wet, and the night felt hot and humid. I wasn’t sure if bathing in the river had done much to clean me or cool me down.
A storm was brewing overhead; we could hear lightning in the distance. With the storm, the discomfort of the tent, the sounds of bugs and frogs and the river outside, and recalling all the animals we had seen throughout the day, I felt vulnerable and a little nervous to fall asleep.
Later that night, the winds picked up as a storm brewed overhead, the winds thrashing the tent walls. I dreamed that the river was rising up to the level of our tents, and we would soon be swept away by the current. Eventually, the rain came down heavyly, and my back got wet from touching the wall of the tent. I moved towards the middle of my tent and tried to sleep. I heard the men on our trip rushing to cover the medical supplies we had with us from the rain. In the morning, the air was chilly, and the river was slightly higher. We packed up our wet tents and headed back onto the boat to go farther upstream.
When Prevention Has Never Been an Option
We arrived at the first community in the TIPNIS, La Curva, in the early afternoon. This village sat outside the usual route taken by the brigades and was often bypassed, as the medical team typically landed further ahead by plane. It was one of the most rustic sites we visited. As soon as we arrived, we began setting up the clinic and introducing ourselves. The community was quiet and reserved, and finding someone who could translate from Spanish to Chimane proved to be a challenge.
Elizabeth gave a presentation about dental hygiene and general information about teeth, explaining that poor dental health can lead to other complications in the body, in addition to difficulty eating and chewing. When she finished, we moved on to giving all the kids and adults a toothbrush and teaching them how to brush their teeth. For some, this would be their first toothbrush. We poured water onto their toothbrushes, gave them toothpaste, and instructed them how to brush their teeth, often holding their hand to guide it, “arriba abajo, arriba abajo,” up and down, up and down, inside their mouth.
The state of most of their mouths was alarming. Most teeth, if they had them, were rotting out, black cavities taking over their teeth, or their teeth had already been pulled and were gone, leaving gaping holes in their mouths. The adolescent teeth were the most alarming to me, given that what we were looking at were their adult teeth, without any hope for new teeth coming in like the younger children could have. Many children, as we helped them brush their teeth, had severe gum problems that resulted in their gums bleeding from severe gingivitis. When they spat out the toothpaste, it was mixed with pink and red from blood.
We also did an exercise in which the kids would chew a pill that would turn the plaque on their teeth bright pink. Then they were given the opportunity to brush their teeth again and see with a mirror where they were brushing their teeth well and which parts still needed improvement.
For the very young children, we handed out small pieces of cloth to the mothers so that they could wipe out their babies’ gums and teeth. We explained to the mothers how even breast milk can deteriorate babies’ dental health, even before they have teeth. We showed the moms how to gently but thoroughly rub the cloth along the gums and emerging baby teeth and instructed them to do it twice a day and to wash the cloth frequently.
While Elizabeth, Soledad, and I worked on the dental hygiene project, the rest of the brigade focused on their own tasks, which I had the chance to observe and assist with once we finished—such as triaging community members, administering vaccinations to children, and giving out deworming medication. At this site, we didn’t have a generator to power the equipment for filling cavities, so our dentist worked on extracting teeth that were too damaged to save.
Throughout these activities, I quickly picked up a few words in Chimane. Soledad and I helped distribute deworming medication, instructing patients to “kunyim,” meaning “swallow”. To call people up for treatment, they were grouped by ailment, using the word “arere” for “pain,” followed by the affected body part. I also learned that “hem” means “good” and “haa” means “like this.”
Once we finished with all the dental hygiene and medical activities, Elizabeth liked to play music to get the kids to loosen up and have fun to make the experience more enjoyable. This community was so shy but one little girl, only a few years old, loved dancing! I held her hands and we danced and danced.
The next morning, we packed up our tents and got back on the boat, heading out towards Oromomo, the community where the plane usually landed. Oromomo also had a health post, and resident health professionals who would later accompany us further up the river. Moreover, the community had the generator we would use to power the dental equipment for filling cavities.
Staying Longer Because We Had To
Staying in this community was slightly more developed than our last few nights along the river. We used a pit latrine instead of the bushes. The families of the other medical professionals that lived there took care of us by preparing meals for us, and in exchange, we also made a few dishes for them.
The men went out fishing at night, and twice they caught a muturo, an enormous type of fish found in the Amazon. We chopped up the fish into small pieces and ate it fried.
We spent our time in Oromomo visiting each of the 10 classes at the school one by one and repeating the same dental hygiene activities with each group—from the youngest students, around five years old, to the oldest high schoolers. Here, communication was easier, as most students could understand or speak Spanish. The school setting also worked in our favor, providing a captive audience for our lessons. Nearly all the students needed dental care, with most requiring fillings for more than five cavities each. Because of this, we decided to extend our stay from the planned two days to four, allowing the dentist enough time to properly treat each student while also ensuring we reached every class. While this community was more developed and had its own health post and medical professionals, the students still did not have access to basic dental supplies like toothbrushes and toothpaste.
Beyond providing care, part of our mission was advocacy and sustainability—helping communities push for what their government should already be providing, such as regular dental care and access to basic hygiene supplies. Elizabeth had discovered that the communities in the TIPNIS were technically entitled to government-provided toothbrushes and toothpaste, but corruption and bureaucracy had prevented them from receiving these supplies.
In another community before we had arrived at the TIPNIS, Elizabeth wanted to help the children have their regular dental cleanings that they are also entitled to by supporting them with transportation to the health post for the cleaning. This would have ensured some continued efforts for preventative dental care. However, the dentist was unwilling to provide preventative care - he only wanted to pull their teeth (even if they were already wiggly and going to come out!). Elizabeth suspected that this was because he wouldn’t get recognition or compensation for cleaning teeth the same way he would by pulling teeth. This made it hard to reinforce to the kids and families that regular cleanings were, in fact, possible and a positive experience.
Back in the TIPNIS, Elizabeth led dance sessions with the students in the afternoons to make the dentist and doctor visits a more enjoyable experience. They loved it. We recorded videos of the dances, and the kids were thrilled to watch themselves afterward. One moment that stuck with me was when a child asked if dancing would earn them a tube of toothpaste—it wasn’t part of the deal, but of course, we would have given it to them regardless.
Pushing Forward
When our four days in Oromomo came to an end and we began packing up, we had to switch to a larger boat to accommodate the extra three medical professionals and additional equipment we were bringing with us. As we waved goodbye to Oromomo community members on the bank, we quickly realized we had a problem - we were too heavy for the shallow river.
To make matters worse, as we were walking upstream, we stopped to refill the engine with gas, and the lid to the gas valve of the motor fell off into the river and quickly got pulled away by the current. We used a plastic bag to cover it. Later, as we were walking ahead of the boat, there was a very long delay in the boat catching up to us. It turned out that while they were restarting the boat, it caught fire, causing minor burns to our boat driver. Luckily he jumped into the water fast enough, and no one and nothing was severely hurt or damaged. We weren’t able to make it as far as we had hoped that day, and we had to camp out on the bank of the river.
The next morning, we headed out to the community Ushve. We were slightly concerned about getting me back in time for my flight to the USA. Elizabeth had mentioned I could have stayed in Oromomo, but I insisted I wanted to stay with the group to finish the brigade - even if it meant that our approximate departure left me with no spare days in case anything did not go according to plan. Our slow pace made me worried I wouldn’t be able to catch my flight back to the USA.
Eventually, we came upon Aguas Negras, a small community that featured a tourist lodge for tourists who would come to fish the region. There were no tourists there at the time, so we were allowed to go up the steep hill where the camp was perched and enjoy the views of the river. They also refilled our water jugs (which we had finished) and gave us a large bag of cookies to eat. Our boat guides spoke with the people from the community and arranged for us to switch into multiple smaller canoes, so that we could finally move up the river at a faster pace.
It was afternoon when we reached Ushve, our third community. We set up our tents in elevated school buildings. This community was very eager to receive care and information from us. They all sat on the ground to listen to Elizabeth give her talk. Then we split up into groups and I worked with the mothers with small babies on cleaning their newborns’ teeth and gums with a cloth.
When Even the Generator Isn’t Enough
It was later on that we discovered, after setting up the dental equipment, that the generator we brought with us from Oromomo did not have the correct amount of power for the dental equipment for filling cavities. The only dental service we could provide for this community was pulling teeth that were too far gone. During our one full day in Ushve, it rained and made the ground extremely muddy. We began to struggle with water, and our amount of food was dwindling, though the community generously gave us citrus fruit and a live chicken.
We performed activities with the kids where they would draw a toothbrush and toothpaste and a smile or teeth. The idea was that this could be something they could put up at home to remind themselves to brush their teeth.
By this point, I was getting used to the camp life. In the evenings, we would go to the river to bathe, a true “million star” bathing experience. We washed our clothes in the river and hung them up around camp. My body was aching less from sleeping with only a thin pad for cushioning - I think I was getting used to it. The outhouse experiences were varied - the worst ones had wasps and flies and spiders and broken doors that provided questionable privacy.
The morning of our second day in Ushve, the rain had stopped and we headed out to our final community - Asunta. We repeated the same process again with the dental hygiene class, handing out toothbrushes and toothpaste, but what was really on my mind was our plane ride out, which would be the following morning. We were able to get a generator in this community to continue filling more cavities. Gabriel confirmed the plane ride for the morning by going over to another tourist lodge to use their wifi not far away from Asunta.
On our last day, we continued working, but I also took time to soak in the beauty of the landscapes and communities I had spent the past nine days in.
I would miss the nights on the riverbank, surrounded by the sounds of the forest—the birds, the frogs, the insects, all creating a symphony of nature. I also felt a deep appreciation for the dedication of Elizabeth, Gabriel, and the rest of the team—how much effort it took to bring care to these remote villages. Experiencing it firsthand not only showed me just how necessary and impactful these brigades are but also how incredibly challenging public health work can be, given the limited infrastructure and environmental barriers.
Why We Have to Return
On our final morning, we woke early and made our way to the runway. An older woman with a hernia came with us, hoping to travel for treatment. Meanwhile, the rest of the team was already making plans to return and continue improving children's oral health. We waited, anxiously scanning the sky. Several times, the hum of a bee or fly tricked us into thinking a plane was approaching. A half-hour passed beyond the pilot’s expected arrival, and a sinking feeling settled in my stomach. If I missed this flight, I’d miss my connection to the U.S. and have to rebook everything. With no cell service except at a distant tourist resort, we had no way of confirming whether the plane was even coming. More minutes passed. Then, finally—finally—the plane appeared, and I made it back to San Ignacio and onward to the U.S. just in time.
While it all worked out in the end, this experience gave me a deeper understanding of the struggle to provide healthcare in remote areas—not just the technical difficulties and logistical challenges, but the language barriers, cultural complexities, risks to personal health and safety, and the general discomfort that medical staff take on in order to reach these communities. We faced bugs, questionable drinking water conditions, latrines, sleeping on the ground, and uncertain transportation and communication.
Sustainable, effective public health projects can’t be accomplished in just one visit. Long-term presence and support are essential for lasting change. There wasn’t enough time to fill every child’s cavities. We need to return— to reinforce these health practices until they become routine, and to continue working toward solutions, like ensuring access to clean water and regular oral health care and prevention.
Help Us Return to the TIPNIS
The communities of the TIPNIS welcomed us with trust, resilience, and hope—despite having little access to even the most basic healthcare. What you’ve read here is only a glimpse of what sustained public health work can achieve—and how much more remains to be done.
At Alliance for Good Health, we believe lasting change requires returning again and again: reinforcing prevention, completing treatment, and supporting communities until good health becomes the norm—not the exception.
You can be part of that effort.
💙 Donate to help fund future medical and dental brigades
🪥 Support access to toothbrushes, toothpaste, vaccines, and essential medicines
✈️ Make it possible for healthcare teams to reach the most remote communities
For our next medical brigade, we are working toward a $5,000 fundraising goal to cover essential costs, including transportation ($300), food for the team ($200), and at least one dentist for the week ($100), along with dental supplies for cavity fillings and cleanings and toothbrushes and toothpaste for hundreds of families.
A gift of $50 can help provide dental care and preventive education for up to five children. Every contribution—no matter the size—directly supports care in places where help rarely reaches.
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