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Late may 2015

Dear Clinic Friends, Family, Well-wishers and Supporters --

Oh my, not only are we into yet another year, we are nearly half-way through it. This means it is time to account for ourselves for the year just past (well, more or less just).
Let's start with our patients. In 2014 we tended to 2,893 of them, most (2,772) for some sort of medical or dental care, a few (121) who simply purchased over-the-counter items such as toothbrushes or worm medicine, which we buy in Iquitos and sell at cost. Among our patients, we provided Family Planning for 285 people, mostly women but also a few men who use condoms. We had a good malaria year, only 42 cases in all; and saw 195 people with a variety of skin problems ranging from ringworm (common) to abscesses to hives to psoriasis. We even saw one woman with an unusual patch of dry, scaling, slightly reddened lesions on her abdomen, who turned out to have syphilis (not uncommon in Iquitos, where her husband had been indulging himself on occasion). We treated 197 people for diarrheal illnesses, which happily is a bit down from previous years (272 in 2012, 238 in 2013 -- hopefully, this means that the water quality programs being promoted in many villages are having an effect), and saw 32 people with pneumonia.
Juvencio performed dental extractions, sometimes on multiple teeth, for 37 persons, and filled or repaired teeth for a dozen or so more, in addition to his work with Dr. Jeannette Grauer and with Nurse Diana Bowie on their trips to villages along the Napo River, where they provide care to hundreds of dental patients.
Trauma cases this year included the usual falls, lacerations (sometimes as a result of some of those falls, sometimes from axes or machetes used in daily chores from firewood cutting to food preparation, sometimes from collisions during soccer games), burns from spilled pots of food, and contusions from assorted unintended contacts with unexpected objects or persons. There was a man who suffered lung problems after sucking on a tube in order to transfer gasoline from one container to another (the usual practice here, and I have seen people smoking while doing this). There were several puncture wounds from nails and from plant spines, and at least one from a jagged bone from one of the many varieties of catfish which live in the river. Dr. Gregorio succeeded in removing one such spine which had been residing in a man's foot for a week and a half. Several foreign bodies made their way into eyes, and were removed. Probably the most serious injury of the year occurred when a tree toppled over on a man, resulting in blood in his urine for months, due to internal injuries which we were never entirely able to figure out (nor did the hospital in Iquitos do any better, though I believe he did improve with time). One man in his early 70's got up at two a.m. to check on his fishing nets, slipped and fell, and when he did so, a piece of his floor broke, and he fell through to the ground, cracking a couple of ribs.

We made it through the entire year without a single poisonous snakebite. This is a first, and should be a rejoiceable event, though it does make me wonder whether we are becoming too civilized.
We vaccinated 463 people, against tuberculosis, diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, influenza, and yellow fever; and provided Well Child Care for 105 children. Additionally, we treated 505 kids under the umbrella of our "Diarrheal and Respiratory Illnesses" program, in which we offer very low cost care for multiple illnesses affecting children.
Then there are always a number of patients who do not fit into any category, and some of these are our most interesting ones. Among them were several women with mastitis (breast infection), including one who is now 41 years of age and nursing her 3 month old baby. There was a 51 year old woman who was obviously psychotic and hallucinating, with delusions for the previous few months and no history of psychiatric illness (she was well beyond our capabilities, and I told her daughter to take her to a psychiatrist). One of our neighbors and a long-time clinic client, now 64 years old, came in with terrible belly pains a couple of days after celebrating his birthday with an exuberant quantity of sugar cane rum; he noted that he has had similar symptoms the last three times he drank heavily, and we encouraged him indulge more moderately. There was a 64 year old woman who had supraventricular tachycardia (a fast heart rate) at a rate of 180, which we were able to document on our lovely little handheld one-channel cardiac monitor (this occurred when she was seriously dehydrated and resolved once she received intravenous fluids). There was a 13 year old girl who presented with severe low back and hip pain, which Dr. Gregorio diagnosed as psoas myositis, inflammation of the psoas muscle, which lives deep inside the lower back. There was a man who came in with two days of bleeding following dental extraction, and who had a history of similar episodes following minor trauma all his life; he most likely has Von Willebrand's disease, which probably will not need treatment. I removed a basal cell cancer from a woman's face (and the diagnosis was confirmed by the Meriter Laboratory in Madison, WI, at no cost to us or our patient), but could not help another woman. She first came in a year and a half ago with what looked at the time like early cervical cancer. She put off going for treatment, and when she did, and the doctors wanted to perform hysterectomy, she was too frightened to have the surgery. Now, she is dying of advanced cervical cancer. An 18 year old was luckier. He was playing a vigorous game of soccer in full sun and arrived with heat prostration and dehydration, but with fluids and a little time, he recovered.
And a nurse transporting a patient from a government clinic downriver stopped on her way to Iquitos, to ask us to put in an intravenous line on her patient. She has the same nominal training as our nurses, but apparently, where she works, one must be an RN (Registered Nurse) to start an IV line, whereas Edemita, Juvencio, Carmen, and now Elmer, are all perfectly capable not only of putting in IV's but also of cleaning and suturing wounds, diagnosing and treating common illnesses, and performing a host of other services.
Our fame occasionally brings in a few patients who are from farther afield than the majority of our clients. Such was the 46 year old man who lives outside of Iquitos and was referred by a family member. He arrived with cirrhosis of the liver and portal hypertension and ascites, i.e., fluid backed up in his abdomen due to the fact that his liver has turned into a rock and cannot filter the blood as it should do. We removed some of the fluid for him, but the only real cure for him would be a liver transplant.


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