Imagine a pregnant woman in a small farming town in the middle of the U.S. Her county has no hospital that delivers babies, so prenatal visits mean driving hours each way. When labor comes, those same hours can mean the difference between a safe delivery and a dangerous one. For millions of expectant mothers in rural America, the health risks that come with that distance are simply a fact of life.

This picture will feel familiar to any clinician who has practiced outside a metropolitan area. What is less obvious is how closely it mirrors the experiences of villages thousands of miles away, such as the ones scattered in the southeastern corner of Peru’s Amazon basin.

In July, Brandi Ledbetter, MD, a California-based family medicine physician, traveled to isolated regions of the Amazon and up the Andes mountain range to provide care to remote villages along the Madre de Dios River. Her team included a pediatrician, two nurses, an EMT, a pharmacist, an optical specialist, multiple translators, and several other support staff. Together, they provided prenatal care and other basic urgent care services to members of these communities, where the distance from any hospital or clinic leaves residents with little access to care of their own.

A River Region Cut Off From Care

The Madre de Dios region is one of the most isolated places in Peru when it comes to healthcare access. It lies in the country’s least densely populated department and is spread thin across a landscape where roads barely reach. Winding through dense rainforest, the river itself is the primary highway for many of the region’s isolated communities.

Dr. Ledbetter observed these conditions firsthand. In a report she shared after her trip, she noted, “Each village we visited was home to a different indigenous Peruvian tribe. We camped overnight at clinic sites and then continued down the river to the next village. Villages have little contact with healthcare, if any.”

Broader research on the Peruvian Amazon echoes her experience, demonstrating that structural barriers significantly impact healthcare access for river communities. In a study conducted among remote river communities in Peru, fewer than half of pregnant women received prenatal care at a local health post. A large share also gave birth at home, in part because a single public boat that would take them to a delivering hospital might traverse the river only once a day. That arrangement works if everything goes according to plan, but the real challenge is in reaching a hospital when complications arise.

As a result of this limited access to hospital care for pregnant women, “There was a large need for prenatal care and education around pregnancy [and] delivery,” per Dr. Ledbetter.

“News of our ability to provide prenatal vitamins, butterfly ultrasound, blood pressure measurement, and urine analysis quickly spread. I soon had so many prenatal patients,” she added.

To meet the influx, Dr. Ledbetter’s team adopted a patient approach called CenteringPregnancy, an established model of group prenatal care used across hospitals and clinics in the U.S. that studies have linked to outcomes comparable to traditional care. Rather than offer a series of individual appointments, the model brings together expectant mothers with similar due dates for a single, longer session. The session is split between individual clinical checks, where each mother receives blood pressure and other measurements, and group time, where mothers ask clinicians pregnancy-related questions and learn alongside one another. On a riverbank, this structure allows a clinician to reach far more patients than back-to-back appointments ever would.

Meeting the Need on the Riverbank

With the support of CERT International, a nonprofit that runs free medical and dental clinics in underserved communities, Dr. Ledbetter and the team saw 566 prenatal and urgent care patients and provided 1,514 prescriptions.

In addition to direct care, the team also focused on health education. When the nearest clinician is so often a day’s boat ride away, it becomes essential to teach patients how to prevent and recognize problems on their own. “A large personal goal [was] to provide as much health education as possible, from simple hand hygiene measures to more complex discussions of pregnancy, blood pressure, vaccines and wound care,” Dr. Ledbetter shared. “Patients were so eager to learn all they could.”

The trip’s hardest moments showed the true consequences of limited access to care. With no ambulance and no nearby hospital, the team’s boat had to become an ICU at times. “We did have two patients requiring evacuation: an acute tib/fib fracture and sepsis with altered mental status,” Dr. Ledbetter said. “These emergent cases were [...] loaded onto our boat and taken five hours to the closest health care facility.” Getting those patients to safety was a feat in itself, but the team’s care didn’t stop there. By partnering with support staff based in Puerto Maldonado, the capital city of the Madre de Dios region, and Cusco, the nearest major city where specialized hospital care is available, they ensured that patients remained connected to continued care even when they moved on.

The Same Distance, Closer to Home

The obstacles Dr. Ledbetter and her team faced along the Madre de Dios River mirror broader systemic challenges documented across Peru’s rural health system. Health centers in the Amazonian regions are too few in number and rural areas have half the density of health professionals that urban areas do.

As clinicians working in rural parts of the U.S. know well, these access issues are not isolated to Peru. Rural Americans live an average of 10.5 miles from the nearest hospital, about twice as far as people living in urban areas.

The Peruvian mother who could not easily reach a health post for prenatal care and the American patient whose county has no nearby hospital may be separated by continents, but they are united by the same challenge.

Dr. Ledbetter’s reflection reminds us what access to healthcare means, wherever a person happens to live. “The shouts of excitement at our boat pulling up to their village will not soon leave my memory,” she shared. It is the sound of care arriving somewhere it rarely reaches, and it means the same thing anywhere distance keeps people from a clinician.

A travel grant from the Doximity Foundation covered airfare for Dr. Ledbetter’s work. The Foundation offers travel grants to physicians and APPs who are making a global health impact.