The Rotary Club members who came here to build the new clinic were so taken with the people and the place that they returned several more times. First, they came back and built a "hammock house," a small shelter for patients' families; and taught me and my assistant to do tubal ligations, excise the pterygiae that commonly obstruct people's vision here, and to pull teeth. Another bunch showed up to build us a whole lot of shelving and desk space, yet another group came in early 1995 to construct a four-room building for student housing and to make a few refinements in the plumbing system (a shower!!!), and in 2000, a small crew of Rotarians came to dig several wells, one for the clinic and two for local villages.

Before beginning clinic construction, while the Rotarians were getting to know me, and moved by my piteous pleas of overwork, they agreed to fund an assistant for one year. Thus, in October of 1992, I began training Juvencio Nunez Pano, a local man then 22 years old, with a wife, three children, and a sixth-grade education. He has proved to be an incredibly bright student, and now serves as my right-hand man. He is capable of examining a patient, recognizing all the diseases we commonly see, and prescribing and administering treatment. The illnesses with which he is familiar include conjunctivitis ("pinkeye"), middle and external ear infections, the common cold, sinusitis, asthma, pharyngitis, tonsillitis, bronchitis, pneumonia, parasitosis, the various types of diarrhea common to this area, skin infections both bacterial and fungal, poisonous snakebites, and a little bit of gynecology and rheumatology. He is able to incise and drain an abscess, put in stitches, start an IV line and give intravenous fluids, pull teeth, and counsel patients on birth control and hygiene. He knows sterile technique (we do very little surgery, but have done a few Cesarean sections, on which he assists me), does the few lab tests we perform, including reading the slides to diagnose malaria, keeps records on all the patients he sees, cleans instruments and does other clinic maintenance, and kicks a mean soccer ball.

The clinic staff now also includes his sister Edemita, who began working in May, 1995, doing laundry and secretarial chores, and quickly made herself indispensable. She meets and brings in all the patients, looks up their histories, takes their vital signs, does her own exam (and can in my absence treat many of the commoner ailments), and practically grabbed the family planning program from my hands ... a grandmother since she was 31, she understands the need. Finally, there are three watchmen/handymen/gardeners, who keep the clinic from falling apart in the humid tropical climate and call me when an emergency comes in at night. In addition, we have had a few graduates of the nursing school in Indiana (the one between here and Iquitos, not the one between Ohio and Illinois) doing the practical work required in their programs, and occasional volunteer physicians from abroad. And now that I am spending more time in the U.S., we have a rotating cast of Peruvian physicians, nurses, and assistants. No one trained in the city wants to stay long in the rainforest, but we do try to keep a physician on hand, even when I am not personally here.

We now see 150 to 250 patients a month, for everything from family planning (a program offered by the Peruvian government, in which we enthusiastically participate), to treatment of intestinal parasites and various infectious diseases, to vaccines, to occasional trauma, such as the boy whom a medium-large caiman once attempted to have for dinner. We receive little material support from the government (family planning supplies, malaria medicines, and vaccines, when available), but the Ministry of Health officials in Iquitos have always been very supportive in a moral sense, since they cannot persuade Peruvian physicians to go to, and stay in, rural areas where there are no support facilities, no medicines, no physician back-up or time off, no place for their wives to shop, no television, and no money to be made.

The support that enables the clinic to continue functioning has come from a surprisingly broad range of contributors. Explorama, as mentioned, not only feeds me (a sizable contribution in itself) and lets me live on their property, ride in their boats, and use their telephone and p.o. box and now even e-mail (in the city, of course, not out where I live), but also provides the social support that keeps me in some kind of touch with my former world. Explorama's tourists have been another huge source of support ... the main source, actually. Their many donations of money and medicines, their courier service (many people bring items donated in the States, which otherwise would have no route of transport), and the occasional contribution from their ranks of someone like Paul Gakle, all help. Indirectly, the tourists are another fount of funding, since Grand Circle Tours/Overseas Adventure Travel, a tour company which brings many people to the Amazon, has been giving us a generous yearly grant for our Well Child Care program. The Rotarians of several cities raised over $35,000 for the materials for the original clinic, not to mention their additional projects to build the hammock house and the student housing and to dig the wells. Other Rotary groups have given generous grants, notably the Madison, Wisconsin Rotary Club; a club in Pennsylvania paid for the digging of a deeper well; and another group of Rotarians from Mount Horeb, Wisconsin, purchased the generator we use to run our dental drill. In addition, various Rotarians have made individual contributions, such as the couple who brought Juvencio and his wife to the U.S. to visit in 1995 and again in 2000. An Optimist Club in Colorado provided the funds to purchase the vaccine refrigerator. Then there is the above-mentioned Paul Gakle, a retired engineer who visited Explorama before the current clinic was even built, and became so interested that he took a course in writing grant proposals, using the clinic as his subject; as a result of which he has obtained a series of grants from The International Foundation. Finally, on grounds that I don't want to foster dependence, the patients themselves are asked for a small contribution to their own care. (Their payments average less than $1.00 per person, a fraction of what it costs to treat them and maintain the clinic; and treatment is never withheld for inability to pay.)

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