Dear Clinic Gang
I apologize for the tardiness of this year's annual report, but I have been so involved in tracking the flooding that it has just gotten put off.
In the U.S., also as always, I am the most expensive item on the list. My salary came to a little over $41,000 ($20,000 in wages, and the rest put into the 401k that was established for me a few years ago), Social Security took $3,151.63, and health insurance cost a little over $7,500. Then, we paid Kim $30,000 for her invaluable services (and she receives no benefits). We spent another $15,000 or so on an assortment of topics including printing ($3,034.65, plus a little over $1,000 worth of printing that was donated), postage ($2,075.21), my plane tickets to and from Peru ($3,235 for two trips, and that is economy class!), bank fees, web site and telephone costs, legal fees, workers compensation insurance, and $1,500 for the highly useful class I attended in Lima on Ultrasound in Tropical Medicine. And we bought our wonderful new ultrasound machine, and a few other supplies and medicines in the U.S., for a little over $3,000, bringing the total amount spent in the U.S. to roughly $100,000.
In Peru, we spent $123,209.78, divided among Medicines and supplies, Salaries and benefits for our Peruvian workers, the Special Patients Fund, Clinic Operations, Clinic Repair and Maintenance, and bank fees (a little over $2,000). Details follow.
We purchased $23,494.85 worth of medicines and laboratory supplies (urinalysis tests, pregnancy tests, microscope slides, test strips for the glucometer, etc.). It comes to a little over $8.00 per patient for medicines and supplies, which seems like a lot to me until I look at what medicines cost in the U.S. (We also received over $20,000 worth of medicines from the Peruvian government, mostly vaccines and birth control, plus a few vials of snake anti-venin and medicines to treat malaria.)
Our largest expense category is for our wonderful clinic staff. I always note that, without them, we would have no clinic - unless one wanted to just put out boxes of medicine and let patients help themselves. Our clinic employees include one full-time Peruvian physician, three nurses (and for a few months in 2011, a student nurse), and three maintenance men/handymen/watchmen. Salaries for all these people for the entire year came to a grand total of just under $48,000. This money is given out in monthly salaries, plus an extra salary each July and December. Then there are various benefits which include a retirement fund for each person, a severance pay account, a government-run health plan, meals for those who live in Iquitos and sleep in the clinic while working, and medical costs covered by the clinic when the government plan just isn't up to it. Oh, and we now have life insurance on each of the employees, so if any of them dies or is disabled, heaven forfend, their families will receive a lump sum. These assorted benefits cost an additional $17,629.14.
The Special Patients Fund is what we use to pay for medical care which the clinic itself is not equipped to provide. In 2011, we spent a little under $200 in order to have Pap smears done for 24 women. Another $1,300 was divided up among a number of patients. Among these expenditures were nutritional supplements for a two year old girl with a colostomy, who needs surgery to close it, but who is too malnourished to withstand the operation; transport for several women with obstetric difficulties; assistance with laboratory studies and sonographic examinations for a dozen or so patients with a variety of problems; transport for the man who was critically ill with dengue hemorrhagic fever and a perforated intestine; and help for Juvencio and Edemita's mother, who suffered a complication after undergoing cataract surgery (the lens which was implanted into her eye came loose and was poking out of her eyeball, irritating her eyelid and the eye itself for months, until we finally got someone to remove it - the lens, not her eye.) Clinic Operations is a large category, which covers pretty much everything except medicines, salaries and bank fees. This year, I started a separate sub-category for Repairs and Maintenance, since these costs account for a substantial chunk of the non-medical costs of keeping the clinic going. Operations came this year to just under $21,000, and Repairs and Maintenance took another $8,500.
Clinic operations includes the cost of our accountant in Iquitos who keeps up the books in the manner prescribed by the Peruvian government ($1,666.59); Customs duties ($549, for our new ultrasound machine); legal fees ($141.11); Peruvian income tax ($1,979.28, a rather arbitrary amount related to how much we spent, rather than the income we receive from patients, which averaged about $1.42 per patient visit); and sales tax ($85.42, representing 2% of our patient receipts). Also under this heading are disposal of used needles by the regional health authorities (they charge a pittance, and I don't have to take this stuff out to the rainforest and bury it), coffee, tea, sugar, toilet paper, laundry detergent and bleach and Pinesol, food for the clinic cat, propane for the kitchen stove and the one used to sterilize instruments, ink for the printer and printing costs for various forms, postage, and telephone (partly for long-distance communication when I am in the U.S., but also for communication between Iquitos and the clinic, now that cell phones function at least sporadically along the river). We purchased a gasoline-powered pump to pull water from the stream and send it up to our main water tank, got a new printer when the old one expired, and fixed a few pieces of medical (compressor for the dental drill, replacement pieces for the stethoscopes) and non-medical equipment (chainsaw, hand saws, and repairs to my dugout canoe).
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