The Amazon Medical Project

Mid - January, 2011

I got back downriver on the day of New Year’s Eve, so I expected a sleepless night due to festivities in the Yagua village. But it turned out to be the quietest N Y Eve ever, owing to the death of one of the Yagua elders. He expired on the last day of the decade, and the last day of the year in which Peter Jenson died, too. No one knows his exact age, probably including himself, but he was one of the oldest folks in the village, probably around 70. It is sobering to think that he would have been a young man – just like Peter was – when Peter came here nearly fifty years ago and started Explorama. Palacio was of the generation that hunted with blow guns, partied with masato, and knew how to make and wear clothing of chambira palm fiber. His wife survives, along with several others of the same generation, but they, and the way of life they represent, are fast disappearing.
Anyway, that night the village held the velorio, or wake. This is a tropical climate, and there is no such thing as embalming fluid, so bodies are not kept around for long. When someone dies, the custom is to hold the velorio that night, and family and friends all come and sit with the departed until the morning, when burial takes place. The entire village respected the velorio, so all New Year’s festivities were postponed, and the night was quiet except for the occasional thump of a traditional drum being played softly. Oh, and around 11:00, there was the abrupt sound of a chainsaw. What the …???? I wondered, and then realized: someone was carving out the boards which would be used for the man’s coffin. Sure enough, a little while later came the bang of a hammer.

Late February 2011

At 1:30 a.m., there came a knock at my door (well, actually several knocks; I am a sound sleeper). I shrugged myself awake, and ascertained that it was Carmen, the clinic nurse, accompanied by Ari, one of the clinic watchmen. They informed me that Dra. Yasmina wanted to send a patient to the Posta Medica, the government medical outpost twenty five miles upriver at the town of Indiana. Evidently, an entire family from Huanana, on the Napo River, had come in around nine p.m.with what looked like dengue fever.
Among this family, the nine year old son looked to have garden variety dengue, consisting of high fever, severe headache behind the eyes, sometimes a skin rash, and the characteristic pain in the bones which gives dengue the nickname “bonebreak fever.” Dengue is uncomfortable, like “the flu,” but also like the flu, for the most part is not dangerous. There is, however, a variant called hemorrhagic dengue fever (DHF), which is characterized by the usual dengue symptoms, plus bleeding disorders and inflammation of the blood vessels, which leads to leakage of serum, the watery part of blood, from the vessels. If the leakage is severe enough, people can die from loss of circulating blood volume or other complications; and there was an outbreak of DHF in Iquitos beginning in December. The news reports, as usual, tended to make it sound more serious than it was. Still, with a dozen or so deaths, mostly in young people, everyone was on the lookout for DHF.
Both of the children would need close follow-up, but they did not appear to be terribly ill at the moment. But their father, 34 years of age, did look seriously ill. He had a fever, a blood pressure of 120/80, a blood count of 54% (high, suggesting concentration of the blood due to loss of part of the fluid portion of the blood volume through leaky vessels), vomiting with traces of blood, abdominal pain, an enlarged liver, and blood in his urine. Dra. Yasmina had been treating him for four hours with medicines for fever, antibiotics, and IV fluids. However, by one in the morning, his blood pressure dropped to 100/80 and he began developing petechiae, which he had not shown on arrival. At this point, Yasmina sent Ari and Carmen to fetch me.
One does not lightly take a boat onto the river in the middle of the night. There are no street lamps, and there are floating hazards of sundry descriptions, making travel risky. However, the night was clear and quiet, and the moon was still over half full, shedding fairly bright light.

And I had to agree that he looked truly ill. He had now developed shifting dullness, that is, fluid in his belly sloshed around, so that when he moved from his back to his side the fluid moved with him. Fluid in the abdomen, or in the lungs, is one of the indications of severe dengue hemorrhagic fever – and he was also breathing rapidly and also had some crepitations in his lungs.

We loaded the man onto the clinic stretcher and took him down to the boat. The moonlight illuminated the water, and there was little other traffic on the river, though we did pass one brightly lit large boat with hammocks swinging on its decks, cradling its sleeping passengers. However, Altimiro did have to keep a close eye out for floating debris. Our only illumination was a flashlight wielded by Arnaldo, who peered into the darkness, trying to anticipate any obstacles that might shear off the motor’s propeller or cause other significant damage. After a little more than an hour, we arrived at the posta.
I went to the main door and knocked, then knocked again, then went to a window where I could see a dim light and hear a crying baby. Through the screened window, I asked the women in the room to call the nurse on duty, and pretty soon the front door opened. I explained our mission to the nurse, and she showed me where we could put the patient (on a wooden bench), and went to call the doctor on duty. By now the man’s blood pressure was down to 80/50, which qualifies as shock. I was glad to turn him over to the doctor there, who was very gracious about accepting him, then Amber and I collected our stretcher from under the patient, and left.
A week or two later when I was in the city to run the usual clinic errands, I stopped at the Regional Hospital to check on our patient. As it turned out, he had good reason for his abdominal pain, and the fluid in his belly … he had perforated his intestine. There was reportedly no sign of appendicitis, but the wall of his small intestine had apparently become so edematous that it had burst. The man was doing well, though he still looked ill to me. The surgeons had removed the damaged segment of his intestine and formed an iliostomy, or opening for the small intestine on the abdominal wall. He would have to live with his wastes flowing out through his abdominal wall and into a plastic bag for a few weeks, but then it should be possible to close the ileostomy and he would be able to return to a normal life.