Dentist Joenita Araujo, looks over paperwork while aboard the Igaraçu June 2015. Doctors and dentists were on a visit to various tribal communities up and down parts of the Amazon River and its tributaries. The Igaraçu is a two-story floating clinic outfitted with medical staff, dental rooms and ex­am rooms and a pharmacy. It serves 44 communities of the Wood River above the Madeirinha, Autaz-Açu and Autaz Mirin rivers. The 80-foot transom bow takes a month-long break in between trips to resupply and perform maintenance. (Ken Cedeno)

Ken Cedeno is an independent photographer based in Washington, D.C. His essay recalls his personal experience documenting the Igaraçu. 

More than 100 colorful hammocks fill the two decks of the passenger boat Santana Graca at the start of my 19-hour trip from Manaus, Brazil, often called the “Gateway to the Amazon.” I sit among boxes of food, pans, clothing, a car and half-nude mannequins tied to the boat’s railings. People sleep, text and chat. A few women breast-feed their babies. It’s 7 a.m.

I’m heading to Borba, a small town 90 miles south of Manaus to join the crew of the Igaraçu, a two-story, 80-foot floating medical clinic that serves the indigenous poor of the Amazon.

The Igaraçu is part of a project of the Brazilian government’s “basic river health unit” system, which provides primary care to the country’s indigenous tribes. These tribes, who live in very remote areas of the Amazon, have a tough time getting to the larger communities of Borba or Manaus for medical care. So, the Igaraçu comes to them: Ten times a year, the crew travels up and down the many sub-tributaries of the Amazon, serving over 40 communities and 2,500 patients.

The Igaraçu makes its way to the next village while doctors and nurses visit homes in the indigenous communities on the Amazon River in June 2015. The doctors will catch up with the Igaraçu on a small power boat. The Igaraçu is the first government-subsidized boat for Brazil. (Ken Cedeno)

Passengers sit among their colorful hammocks during the 19-hour overnight boat ride on the Santana Graca on their way to Borba, 93 miles south of Manaus, Brazil, on May 30, 2015. (Ken Cedeno)

Among the supplies on the passenger boat Santa Graca, are naked mannequins on their way to Borba. (Ken Cedeno)

About 10 days after arriving in Borba, on a 100-degree day with extreme humidity, the staff of the Igaraçu and I set off. Our journey takes us along a tiny stretch of the 4,195-mile long Amazon and its 1,100 tributaries.

As the Igaraçu approaches each community, patients slowly emerge from their wood huts. Women balance their kids in one hand and a colorful umbrella to block the hot sun in the other. Many wear nylon shorts, T-shirts and the ever-popular Havaianas flip-flops. Some patients arrive in boats loaded with a dozen other passengers. They walk up the boat’s dark timber plank and gather for consultations in the small “waiting room” near the bow.

With the hum of the Igaraçu’s hard-working air conditioners in the background, the staff reach into metal filing cabinets filled with colored folders. Each is labeled with the name of a community — Divino Espirito Santo, Curaça, Esperança, Sao Raimundo. Staff members check patients’ blood pressure and weight before they send them off to a doctor or dentist in the other rooms. Common ailments include dermatitis, diarrhea, colds, rashes, bad teeth and what’s called “delusional parasitosis” (the mistaken belief that one is being infested by parasites). Staff are also prepared to handle the occasional emergency, such as a birth or a machete wound.

Physician Luiz Pessoa balances himself as he navigates to a patient’s house in an indigenous community on the Rio Madeira June 2015. (Ken Cedeno)

Pessoa examines a young patient as his mother looks on while aboard the Igaracu June 2015. (Ken Cedeno)

A patient waits on her hammock for doctors and nurses from the Igaraçu as they visit homes in the indigenous communities in June 2015. (Ken Cedeno)

A few times I accompany a team of doctors inland. We motor out in a smaller boat and trek up slippery hillsides to visit elderly or infirm patients, treating ailments such as leprosy or cancer.

And along the way, I’m reminded daily of the Amazon’s jaw-dropping biodiversity: During our 10-day journey, we spot gray and pink dolphins, vultures, parakeets, alligators, bats and piracatinga fish (a flesh-eating fish like the piranha) — and, of course, those pesky mosquitoes.

In such a remote area of the world, the simplicity and ingenuity of the Igaraçu is what most impresses me, along with its kind and generous staff. The proverb “Necessity is the mother of invention” comes to mind many times on my journey as I watch villagers climbing the plank of the Igaraçu.

Patients arrive in small boats to be seen by the doctors and dentists aboard the Igaraçu. (Ken Cedeno)

Patients wait for consultation aboard the Igaraçu. (Ken Cedeno)

Children of the Divino Espiroto Santo Community play soccer on the Rio Madeirinha, a tributary of the Amazon River. (Ken Cedeno)

Aricele Silva Carvalho, age 24, has suffered from a large tumor for the past two years. She is seen by physician Luiz Pessoa in the Divino Espiroto Santo Community in June 2015. (Ken Cedeno)

The Igaraçu is lit up by its own lights and the moon, as it sits on the edge of the Negro River. (Ken Cedeno)

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