The Amazon Medical Project

January, 2006

One night, Juvencio became a patient. He has long known that he develops an itchy rash if he takes ibuprofen, but he has been able to take naprosyn without problem ... sort of. It turns out that lately, if he takes naprosyn, he has developed a mild but itchy rash.

When he turned 30, he vowed he would quit playing futbol, since every time he plays he seems to end up with a sore knee or ankle. But it was a vow he could not keep. For one thing, there is little else to do here in the late afternoon; for another, it’s great exercise; and best of all, he is one of the best players around and is highly admired and sought after in this role. Now that he is 35, he continues to play, but he also continues to come moaning the next day, with his various aches and injuries.

A few days ago, he again had a sore knee post-game. He therefore took a tablet of naprosyn, along with diphenhydramine (Benadryl) to prevent the rash. Unfortunately, the Benadryl was not enough ... within minutes of taking the medications, his entire face swelled like a balloon, he broke out in hives everywhere on his body, and his skin was swelling and itching all over. Panicked, he raced all the way to the clinic (not actually the best course of action, but this time, it worked), where Alberto treated him and his symptoms resolved. Fortunately for him, he had no difficulties with his throat closing, or with wheezing in his lungs.

But I suggested that he avoid all NSAID’s in the future, a course to which I think he will adhere.

There was one mother-to-be who had turned 13 in December, and her baby is due in February. She came with the baby’s father, her marido (common-law husband), who is 25. That should be good – at least he is sticking with her. However, Edemita tells me that he drinks a lot, and that when her parents argued with him, he ran off, and she ran with him, eloping at midnight by dugout canoe.

When I examined her, all seemed fine, except for the fact that she is too young to be having a baby, is tiny, and the baby’s head seemed on the large side. I am very concerned that the infant may not be able to make it through her child’s pelvis, and urged strongly that she go to Iquitos as soon as possible, enroll in the Seguro Materno program (one sol, about $0.30, for all care involved with labor and delivery, including Cesarean section if necessary), and stay there until she has the baby. I repeated this advice several times, and had Edemita repeat it as well. Nonetheless, I doubt that they will do anything about it. They are too poor to be able to afford passage to the city, and food while they are there. If I give them money, the man will probably drink it away; and they don’t understand the dangers and want to have the baby at home.

I now live in terror that sometime within the next few weeks, this child is going to show up at the clinic in the middle of the night, with an obstructed labor.

Then, just for fun, I became a patient myself. I usually reassure people that I have been here for many years and find the place perfectly healthy, and usually, this is true. But one day when it was hot and I was sweating freely, I very abruptly became aware that a spot below my left knee was itching madly, and when I looked, there was an ugly mass of tiny, intensively pruritic (itchy) blisters. What on earth was this? It looked as though my skin had been irradiated and was bubbling up.

Over the next day or two, the blisters subsided, but they were replaced by a reddened, raised, indurated, irregular oval ring measuring almost two inches across. It looked like a gigantic ringworm, which is a superficial fungal infection of the skin, but I had never seen a ringworm that began with blisters, had never heard of one that itched so intensely (and continued to itch relentlessly), and had never encountered one that developed so rapidly. I was searching through my textbooks, looking for possible diagnoses, and dreading that this was the opening salvo of some terrible, probably fatal, lymphoma of the skin.

However, when Juvencio looked at it, he said, oh yeah, that's just a ringworm, and it comes from animals. Sure enough, when I began to slather it with our anti-fungal cream, it slowly improved. Several days later, a smaller, non-itchy, obvious and typical ringworm cropped up on my abdomen, then a few days after that there was one over my ribs, and finally one more turned up under my arm. I was getting worried that my immune system was badly impaired, when Mike Miller, the clinic's student volunteer for February, suddenly developed a half dozen identical lesions simultaneously.

At this point, I began to look very suspiciously at the very sweet, very affectionate, but very scuzzy kitten who has been hanging around the lodge kitchen and who was losing fur on one of his shoulders.

Now, we are all using the anti-fungal cream (the cat, too), and we are all healing.