We had our first baby delivery of 2015 when I was running errands in Iquitos. A young woman from the neighboring Yagua village came to the clinic in mid-morning, in labor, and Gregorio reported that when he checked her cervix (the opening of the uterus), it was already dilated to five centimeters, which is half-way to being sufficiently open for the infant to pass through. By 4:00 in the afternoon, she gave birth to a girl, who joins a slightly older brother. It was a good delivery -- the baby arrived, the placenta followed, and all was normal -- which is nice since Gregorio seems to be even more uneasy with obstetrics than I am.
If they were all like that, I wouldn't mind obstetrics.
Then, a few days later on a busy morning, Gregorio informed me that there was a woman who might be in labor. As fond as I am not of obstetrics, his feelings toward this topic make me look like a born midwife. He offered to take care of all the other patients, if I would take care of this lady. Sure, of course.
She is 35, and has seven living children plus a couple of miscarriages by her first common-law husband. However, she is now onto another man, and evidently he wants a child of "his own." She reported having gone to all her prenatal check-ups in Francisco de Orellana, but we knew nothing of her history, and she forgot to bring along her prenatal visit card, or her vaccine card. She had been in labor since about midnight, so I figured I'd better do a quick exam, or we might be in for a surprise. She said her water had not broken, but sometimes women midjudge this.
A hasty vaginal exam revealed a fully dilated cervix and a small head well into the vagina, and yes, she had correctly judged that the birth sac was intact. I was still asking about how many children and so forth, but Edemita was smarter than me, and began gathering materials for a delivery. Then the woman gave a mighty heave, and I did not even have time to put on gloves before there was a whoosh of amnionic fluid drenching the front of my skirt, my feet, and the floor around me, and a very slippery baby landing in my bare hands. Once his head was out, he hardly waited to emerge with his plump shoulders, then the rest of him dashed after. To my great relief, I managed to keep the poor little guy from sliding off onto the floor, but it was a close thing. Newborns are slipperier than fish.
He was an unhealthy blue, was limp, and did not make much of a respiratory effort for what seemed like hours, though it was probably actually two or three minutes. I blew first my own breath, then oxygen, into his mouth and nose, gently slapped his chest, and he conceded a faint cry, then a few respiratory efforts, then eventually came around.
The placenta followed about 15 minutes later, then Edemita instructed me to go and wash my skirt, an order with which I happily complied. (I keep an extra skirt at the clinic, for rainy weather and moments such as these, so was able to put the original one to soak while I donned the spare.)
The third baby of the year came at 11:00 p.m. that same week. This mother was in her early twenties, with one child at home. Edemita says her water broke just as she walked in the door, and the baby slid out onto the floor along with the wash of amnionic fluid. At least the mom was sitting down by then, so the newborn did not go flying.
All in all, that made three deliveries in one week, good grief. I most definitely hope this fulfills our quota for the year.
We had plenty of other patients, too. There were machete cuts, burns, and a couple of surgical procedures -- Gregorio removed a bulky hemangioma (a golf-ball sized benign tumor) from the back of one man's neck, and a cyst from another's scalp. There was a 38 year old woman who came in pregnant for the eighth time, whom we found to have a blood sugar level of 501. There was a 38 year old man who was reported to be gravely ill, who had come back from Lima just to be seen at our clinic, and whose sister wanted the clinic to take him immediately and urgently to Iquitos -- wait, why did he not get treatment in Lima? And how is he traveling, if he is seriously ill? It turned out he is actually from the Yagua village, had been working in Lima, and once I examined him it was obvious that he was not gravely ill at all. His only problem was constipation.
Meanwhile, the annual flood was looming large. By the morning of February first, there was water beneath the boards along the path between my house and the Lodge. By nightfall, it was oozing between the cracks of the boards. Within two or three days, it was flooded as deep as my ankles, and the stream was moving -- slowly, but steadily -- into the forest, not out toward the main river as it does for most of the year. We had begun our transformation from the small tributary streams of Yanamono and Yanacaño, into the mighty Amazon. How high will the water get this year, I wondered, and when will it recede?
A week later, I was able to reach the lodge (where I take all my meals, not to mention morning coffee) only by my dugout canoe. The water had become too deep for me to walk, even with the aid of a walking stick for balance. According to the Peruvian Navy, we had just about reached the all-time high water level for that date. We remained tied with the record high levels for the next week or two, as the river rose slowly but inexorably. The radio and television were filled with announcements of horrendous flooding in San Martin, upriver from us, and all our fingers were crossed.
My house is built on stilts about five feet high, to keep the floor (hopefully, at least) above the annual floods. There is a stairway going down from the front door, which meets a short walkway made of three long planks laid parallel to one another and stretching away from the house. The end of this walkway T's into a plank boardwalk which runs from the Lodge to the path beyond my house. By Valentine's Day, all these boards were floating.
Normally, there is a lull in the river's rise, somewhere in late January or February. I don't have any idea why this happens, but it usually does. This year, I was beginning to think it would not come. Then, in late February, the river ceased to come up and stood still for a day or two, then slowly fell. It dropped a foot or so, then stood still for a few days.
By March 11, it had begun to rise once more, and this time will probably not desist until it reaches the flood's peak. But the Navy now prognosticates that we will not reach 2012's disastrous high water mark, which is a relief, if they are indeed on the mark.
Copyright © 2008 Amazon Medical Project