The Amazon Medical Project

Every year around this time (once the inventories are done, the numbers for the year are crunched, and the patients are taken care of for the moment), I try to pull together a summary of what the clinic has done for the year more or less just past. This time around, it is a daunting task, since 2009 saw the construction of a whole new clinic, which meant a lot more was going on than usual.
            So, let's start with the new clinic. Since you are probably tired of hearing me rave about it, we can get it out of the way right off the bat.
            When I first started working in Peru, my clinic space was a single room in the thatched-roof house where Explorama's guides slept. My lighting was a kerosene lantern, and water came in a pitcher which I filled in the tourist showers. In 1993, when the Duluth Rotarians came down to build a REAL clinic, they constructed a 30 by 60 foot structure with solar panels for light, a well for water, rooms for exams and procedures, a pharmacy, a simple lab, an overnight room for patients, laundry, kitchen, bathroom, and a couple of additional rooms for staff overnight and/or other uses. The cost was roughly $35,000 in materials, plus the work of a whole gang of volunteers mostly from Duluth, Minnesota and Thunder Bay, Ontario. Over the years, we gradually expanded the clinic, adding a string of four rooms in back for additional staff, a flush toilet to replace the latrine originally built for patient use, an enlarged kitchen, and a hammock house which served both to house patients' families and also, in recent years, as housing for Edemita and her husband Ari, who became de facto clinic caretakers, in addition to their regular jobs with the clinic.
            The new clinic measures roughly 31 by 110 feet, close to twice the size of the original clinic, though not a lot more than the total floor space we had if you count the various additions. The cost this time around was roughly twice that of the original clinic, almost $75,000 in all, and most of the money was raised (again) by the Duluth Rotarians, though we did add a few items that were not included in the original plans (such as the wonderful cement sidewalk and laundry area, and expansion of the solar system) which raised the anticipated costs and were covered by other donations. I went into a lot more detail on the construction back when we finished it, so will settle for this brief overview here.

All told, we had roughly $250,000 in cash expenditures, not counting all the donated supplies, services, and in-kind donations (over $15,000 worth of vaccines, family planning supplies and other medicines from the Peruvian government, just for starters). As just noted, around $75,000 was needed to build the new clinic. The remainder is divided, as in previous years, into monies used in Peru, and those spent in the U.S., to support the operations of the clinic through the Amazon Medical Project. Usual and customary clinic expenses in Peru include Salaries and Benefits for those who work in the clinic; Medicines and Supplies; our Special Patients Fund; and Clinic Operations, which is everything that does not fall into the first three groups.
The largest category is Salaries and Benefits, where this year we spent almost $52,000, slightly up from 2008. It would be tough to hire a physician in the U.S. for that sum, but we actually got our full-time Peruvian physician (Dr. Wilbert, all this past year and continuing at least for the moment), two full-time nurse practitioners, what amounts to a part-time physician's assistant, and three full-time watchmen-handymen-gardeners-all-round guys. Also included are payroll taxes and assorted mandated government programs, which together come to roughly 20% of the total received by the employees as take-home pay. I anticipate that the category of costs will increase somewhat in 2010, because I am going to try to offer Dr. Wilbert an incentive to remain longer with the clinic, and because Juvencio, who had left for about a year, came back on staff and this year will probably be around for the entire twelve months.

Medicines and Supplies went up to $15,000, a fifty per cent increase over what we spent in 2008, partly due to the poor exchange rate (we don't get as many soles for our dollars as we used to), partly due to simply buying more medicines for more patients, and partly due to some of our patients needing relatively expensive medications that were never available in the past. Oh, and the fact that prices of pretty much everything have been rising steadily in Peru (just like everywhere else, I guess).