On February 22, with Edemita on vacation and Edgardo away on his days off (and Juvencio tied up half the morning filling three cavities on one boy), we had 32 patients. Elmer was fairly flying, all morning long, when we fielded the first 18 of the day. These were many and varied, and included a grown woman with asthma, a child with chickenpox (not one of the vaccines given in Peru, which reserves its resources for immunizations against more lethal illnesses), three patients for dental fillings, a fifteen year old for her first prenatal check, and one of our neighbors for debridement of what I initially thought was an abscess, but he explained that he had a gusano, a botfly, and had killed it with tobacco residue, without removing it.
This led to a nasty, indurated lesion with a hole in the center and icky-looking yellow dead tissue. We cleaned it out and filled it with a honey mixture, and it seems to be improving. (A couple of days later, Edgardo was able to pull out the defunct larva, and the man healed more rapidly after that.)
The final patient of the day was a woman from Sta. Isabel who had been in an accident in Mazan earlier in the day and was brought in on a stretcher because she "couldn't walk." I was at first dismayed that they had brought her to the clinic -- if she was paralyzed, she would need to go to Iquitos, and it would have made a great deal more sense to take her to the clinic at Mazan or Indiana, both of which are much closer to the city than we are. Juvencio however teased out the actual story, which was that while in Mazan, she had been on the street and had been knocked down by a motokar, which had stopped briefly, then dashed off. She had apparently gone to the Mazan medical post and gotten a shot there, presumably for pain, then made it home to Sta. Isabel, a short distance upriver from the clinic, and was walking when she arrived, though slowly and painfully.
Dr. Gregorio ascertained that she did not seem to have an enlarged or painful spleen or liver, and could indeed move her lower extremities, so this was really a case of her being very sore following a relatively minor accident. We gave her a pain shot in clinic, plus another round of injectables to take home for use in the night (there is always someone around who can give an injection), and sent her home, walking slowly but on her own.
The 25th brought us eighteen more patients, including several children with fungal skin infections, one of our neighbors for her first prenatal visit (she is 29, and this will be her fourth child -- I suggested tubal ligation at the time of delivery, though that would mean she would have to go to Iquitos, and all her other deliveries have been at home, so it is not likely she will head for the city this time), and her husband who wanted a shot for his aches and pains. Look, I told him, these are not going to go away with a single injection of anything, and you are not really in distress now. I am going to give you pills that you can take when you actually have the pains. He was not happy. He really wanted a shot.
There was a rotund 25 year old woman whose periods have become very irregular, almost non-existent, unless we give her hormones. Gregorio had suggested she get an ultrasound, and this shows polycystic ovaries. She wants another child (she has only one), and I told her she will need to consult with a specialist, though I warned her that the medicines for this condition are only marginally effective. I encouraged her to lose weight, which is far more likely to help, but this is a tough thing to do.
And there was a two month old infant whose mother said he had welts on his neck. Actually, he just has a heat rash, which is not surprising since it has been warmer than usual since the beginning of the year, and he has no neck to speak of. His head, like those of most babies his age, pretty much rests on his shoulders, so his neck is all squished up and never gets a chance to dry out or feel fresh air. I told his mom to try to keep him clean and dry, and gave her some zinc oxide cream for him.
February also saw the toppling of a favorite tree. This was a large oje, or Ficus insipidus, located not far past my house on Yanamono Stream. Ficus insipidus trees grow quite large, and this was an immense specimen. However, as the water has retreated, its roots have been exposed … and ooh boy, are they exposed. Half the tree has no soil beneath its roots. It has all washed away, and some day when there is a good rain, or a swift stream, or the tree just feels like it, it was going to tilt and fall, right across the stream and very possibly directly onto Elizario and Nimia's house.