Yesterday, Rocky stopped by my house in response to my call for his help in “cultivating” – our version of mowing the lawn, which involves chopping all vegetation off at ground level with a machete. This sounds severe, but in the rainforest, one does not want to be offering cover to termites or other pests. “Snake in the grass” is not just a figure of speech. It was too wet from the previous night’s rain for him to do much that day, but he agreed to come and cultivate as soon as things dry out. After we had agreed on this, he casually pointed out that there was a cascavel, a poisonous snake, curled up on the lowest of my front steps. He said he almost trod on it, but it shook its tail and warned him in time. Cascavels do not actually have rattles, but they are in the rattlesnake family, and shake their back ends when disturbed just as if they really did have rattles. They are quite a bit smaller than the fer de lance, but most people around here consider them more deadly. He waited for me to instruct him to dispatch it.
Instead, I hopped from one foot to the other, dithered and dallied, and got teary-eyed. I just hate to kill a living creature – and a pretty neat one, at that – when it is not bothering me. This is probably the very same cascavel that was curled on my back walkway last weekend, although there are enough snakes in the vicinity of my house that it could have been the cousin or spouse of that one. The implication remains, however, that sooner or later I might accidentally encounter him, and that would not be good. I still had a very difficult time ordering his destruction, even though I knew that Rocky, although patient, thought I was nuts, and if Edemita hears about this she will shake her head and roll her eyes. Ever since her youngest daughter was bitten a number of years ago, Edemita cuts no slack whatsoever for snakes. Any who dare to cross her path do not live to tell the tale.
I finally compromised by offering to allow Rocky to kill it, should it be around when he comes to cultivate. He has seen me trying to protect snakes before; he smiled gently, agreed, and left.
Doctora Yasmina one day removed an inch-long piece of rubber from a woman’s foot. This woman had stepped on a nail a couple of months ago and had come in at that time, then returned later with an abscess in her foot. She continued to have pain, so she came back a third time, and Yasmina found the plug of rubber, presumably from the sole of her flip-flop, pushed into her foot by the nail and now emerging on the far side. Hopefully, she is now cured for good.
And let’s not forget the baby with pneumonia and mild diarrhea whose parents walked from their village on the Napo River, a three to four hour hike through the rainforest carrying the sick child, with their slightly older daughter tagging along. I wanted them to stay until the following day to check up on the little guy in the morning, but they said they had no relatives in this area and planned to make the return journey that day. He did not seem sick enough to insist that he be hospitalized, so I gave him antibiotics in clinic (one of the coveted SHOTS), and more to take home to be given orally, and urged them to return, if at all possible, within a couple of days for follow-up. Since they have not yet come back, I am hoping that he got better, rendering a return journey unnecessary. Either that, or he didn’t get better and they lost hope. I’m thinking he got better.
Another interesting if rather sad patient was the 36 year old woman who came in for itchy lumps on her arms and chest. She had not recently changed laundry soaps (the options here are limited, anyway), had not eaten any new foods or taken any medicines, and could not think of anything else that might have provoked this outbreak. I gave her antihistamines and explained that we often cannot pinpoint the cause of such reactions.
However, in the course of my usual background questions, I found that she has had ten pregnancies, out of which she has seven living children. She had one miscarriage, lost one infant to pneumonia, and had a two year old die of epilepsy. Her youngest child is about a year and a half old, and to my relief, she is taking birth control pills. However, her last menses was over a month ago, and with the pills, she should be as regular as clockwork. I asked Nurse Carmen to run a pregnancy test, and yup, she is again pregnant. The poor woman clearly had not expected this to happen, and though she was stoic, she was not at all elated. In fact, she looked pretty beaten down.
This was however a perfect opportunity to use our new ultrasound machine, and it performed like magic, clearly showing the tiny yolk sac in the woman’s enlarging uterus, and even demonstrating rapid pulsation where the minuscule fetal heart was beating away. I still have to learn to use the machine more competently, then we will be able to get a fairly decent idea of gestational age (on physical exam, I would say she was eight toten weeks along, but it would be good to have a more definite idea). But even now, in my extremely amateur hands, it is proving useful in obstetric cases, and I expect that with more practice, we will find it helpful in other patients as well – and hopefully, most of them will be happier with the information it provides.
The river level normally starts the year fairly high, often drops a bit in February (don’t ask me why), then comes up briskly starting some time in March, peaking in mid-May, then drops rapidly thru June and July and August, reaching its nadir in September or so, then starting to rise again in October. This all has to do not with our local rains -- which can raise the water level temporarily but which rapidly run off on their way to the Atlantic Ocean – but with what is happening in the Andes. When the glaciers melt and the rains fall in the mountains, those waters gather themselves and come rushing down toward us, causing our part of the Amazon to rise. Once the glaciers freeze up again and the rains turn to snow, less water runs off, and our river drops. The pattern is pretty consistent, year to year, although there are of course variations in how high and how low the river gets.
This year, the water started rising early. By late February it was clear that it was going to be over the banks a month ahead of the usual time. The questions are whether the peak will be correspondingly early (we all have our fingers crossed that it will be so), and whether we will set a new record for maximum river level.
Copyright © 2008 Amazon Medical Project