The Amazon Medical Project

April 2011

Dear Clinic family, friends, supporters, pets, and onlookers - Once again an entire year has flown by (how is it that this seems to happen faster every year?), and it is now past time to be sending you the clinic's Annual Report. We have grown. I keep saying "boy, we've been busy" in practically every clinic letter, but it is true. We saw more patients in 2010 than in any previous year, and the first few months of 2011 have kept us all very much on our toes. This makes me feel that all the effort and money and time that went into building the new clinic were justified, and that my time in Peru continues to be worthwhile. However, it also means that our expenses have been growing steadily, and this is not a good time for that to be happening. So, let me tell you about it...

In Peru in 2010, we spent a grand total of $110,717.96. Of this, almost $22,000 went to buy medicines, supplies, and laboratory reagents, double what we spent in this category two years ago. Part of this is because the prices of everything keep rising, part is because the value of the dollar fell (this is actually a contributing factor in everything, so we'll come back to that), part is that we now use more expensive medicines than we used to (we have a few patients with special needs, and more and more with illnesses like diabetes and high blood pressure, who need ongoing care), and part is that we can now purchase certain lab tests like pregnancy tests and urinalysis and clinic supplies like exam gloves, that we could not get in Peru in the clinic's early years. We also received free of charge from the Peruvian government somewhere around $18,000 worth of vaccines, $7,000 worth of birth control pills and Depo Provera, and around $500 worth of antivenin (for snake bites) and malaria medicines. Without these supplies, our medicine costs would have been much higher.

Our largest outlay, as always, was for wages and benefits for our clinic workers. We continue to have a full-time Peruvian physician on staff, and in July, Wilbert left, which meant an assortment of severance benefits for him. He was replaced by his sister Yasmina, who had worked with us a few years ago when she was just out of medical school. We also count Juvencio and Edemita, both of whom I trained long ago, on our clinical staff, as well as a Peruvian nurse, and three night watchmen cum handymen, gardeners, repairmen, etc. Wages and benefits, both those mandated by the government and the ones we offer on our own such as occasional help with medical expenses, came to a grand total of $63,897.25. This is by far the largest single category of expenditure for the clinic/Amazon Medical Project; but these people are the heart and soul of the clinic. Without them, we might as well just put a box of medicines on the riverbank and let people help themselves.

We spent a little under $700 from our Special Patients Fund, which we use to pay for care not available at the clinic. This year there were no major expenses, mostly transport for several critically ill patients whom we took to Iquitos, such as the man I wrote about with tetanus; plus a few odds and ends.

Then we went through about $21,000 on Clinic Operations, which is pretty much everything that does not fit into Medicines, Salaries, Bank Fees, or Special Patients. It includes what we pay to our accountant in Iquitos, what we pay to the government in taxes (yes, you have to pay taxes in Peru even if you are a non-profit organization), legal fees (it was time to renew our biannual Licensia de Funcionamiento, the permit granted by the regional health authorities to continue operating as a clinic), and solar system costs. Having built the clinic in 2009, there were no major construction expenses, but we did do some finishing up - nearly $5,000 for paint, brushes, and labor to finish painting the inside and outside of the clinic, which now gleams. And we built a shelter for patients and their families when they are waiting outside the clinic (the men often prefer not to come into the waiting room inside, for fear they will be grabbed and vaccinated, or suffer some other horrible fate). We bought laundry detergent and toilet paper and coffee and candy for the kids on Vaccine Days; we repaired and added a few pieces of equipment, replaced aged sheets and curtains (we were still using some of the sheets that had been donated by a Duluth hotel when they replaced their linens, and which were brought by the Rotarians when they built the original clinic in 1993), paid for bottled gas for the kitchen stove and the one where we sterilize instruments, and made all the other small purchases necessary to keep the place running on a day to day basis.

Bank fees amounted to around $1,800, and about $1,200 went for petty cash expenses. About half of the petty cash could perhaps be counted along with bank fees, since this was money lost when we made transfers from Wisconsin to the checking account in Iquitos from which we pay salaries, and the bank exchanged the U.S. dollars for nuevos soles at a rate not very favorable to us, i.e., less than what we would have gotten if I had exchanged the money on the street. The remaining petty cash outlays were mostly for transport for me when I am running errands in Iquitos. (When I am in Iquitos, I stay in my room at Pam's house and do not receive a per diem allowance, so we do not have those costs.) And there is always the possibility that there are a few missed expenses - if something does not get written down, it is lost, as virtually all transactions except employee salaries are paid in cash, with written receipts, not electronic ones.

And that is what we spent in Peru. However, we also spend money in the U.S., where I am the major expense. Since the AMP board generously doubled my salary at the end of 2009, I now receive $20,000 a year in wages, and they again put about that amount toward my retirement. There are also Social Security taxes to be paid, and health care and airplane tickets, bringing the total cost for me to a little over $56,000. Kim Stokes, who takes care of all our administrative chores in the U.S., including depositing and acknowledging all your donations, sending out these clinic letters, transferring monies to Peru for me to spend there, doing our taxes, maintaining our web site, answering queries from various people interested in helping, etc., earned $27,500, with no benefits. We spent a little over $1,000 on medical supplies and instrument repairs which were not available in Peru, about $1,500 to maintain our web site, roughly $3,100 on printing (not counting almost $700 of donated printing services), $1,673.81 on postage and shipping, almost $1,500 on bank fees in Wisconsin, and smaller amounts on telephone, legal, office supplies, and so forth, bringing the total spent in the U.S. to almost $95,000. It thus cost a little over $200,000 to keep the clinic up and running in 2010.