Dear Clinic Gang --
As I say at this time each year, good grief, another one has gotten away from me. It is therefore time again to let you know what the Clinica Yanamono has been doing, so here we go.
We saw a total of 3,376 patients in 2015, more than in any of the clinic's previous years. We have gotten close to 3,000 patients before, but never quite passed that mark. This year, there were 86 people who simply made a purchase -- toothpaste, feminine hygiene supplies, or other over-the-counter items -- and 3,290 who received medical service. There were five months of the year in which we had over 300 patients. These were February, June, July, August and November. We can never predict our patient load. Each day is a new one, and brings whoever decides to come in; patients cannot phone ahead for an appointment. The early part of the year is usually a busy time, and June, July and August are generally our busiest months. But September through December are typically much quieter, so I do not know what brought this influx of patients to us in November, a normally calmer time. I think however that it probably has to do with the quality of our Peruvian staff, and I thank them for all their hard work.
Among our patients, 89% had been to the clinic at some time in the past, while 11% were new to us. I think this is because we have been around long enough that we are known to most of those who live in this area (though new people do move in, and sometimes we see a long-term area resident who simply has never come in before). Women comprised 56% of our patients, men the remaining 44%, which is not surprising -- women are more likely to admit they are sick, and are more likely to bring in their children and perhaps seek some care for themselves while they are here. Children numbered only 38% of our patient population, but bear in mind that while the age of majority in Peru is 18 years of age, we consider those 15 years and older to be adults, since a fair number of those adolescents are parents themselves. The elderly -- those 70 and older -- were only 2.7% of our clients, and many of these were repeat visitors, coming for follow-up of their high blood pressure or diabetes.
We have several programs for which we receive supplies from the Peruvian government. These include the vaccine program, family planning, and diagnosis and treatment of malaria. This year, we immunized 587 persons, including small children (who usually objected, sometimes fiercely) against tuberculosis (BCG vaccine), polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, hemophilus influenza, and measles, mumps and rubella. We also protected a goodly number of adults from the horrible death inflicted by tetanus, and when the government has a few vials of influenza vaccine, we give that, too. Unlike in developed countries, children are not vaccinated against chicken pox or hepatitis A, and the HPV vaccine which it is hoped will prevent many cases of cervical cancer is just beginning to make its way into Peru. They now have it in Lima, and in the last year or two have begun to provide it to schoolgirls in Iquitos, but it has yet to arrive for our patients.
We had 365 visits for birth control, mostly but not exclusively from women (there are a few men who come for condoms). Also under the aegis of this program, we try to get Papanicolau smears every three years from the women. They are not always eager to have this test, but I try to convince them that it is life-saving, as cervical cancer is very common here, and we see several women each year who have advanced and inoperable cancer, which I would very much like to avoid.
Also in the preventive medicine category is our Control de Crecimiento, or Well Child Care, program, which provided worm medicines, toothbrushes, dental fluoride treatment, and (when we have them) vitamins to 174 children of the area, with the hope of helping them to remain healthy. We also require that they present their vaccine cards in order to receive these free pills, so we have an opportunity to bring their vaccines up to date, and often we can get their mothers enrolled in family planning (if the day is not otherwise too busy to do so).
There were 77 cases of malaria this year, a relatively high tally. This is partly because the annual flood was so high and so lingering … we were underwater for five full months instead of the customary two, and when the river did recede, it did so very, very slowly, leaving muddy banks which collected imprints in the muck, which then filled with water, which was warmed by the sun, making perfect mosquito hatcheries. There was also one village downriver that seemed to be an epicenter. Somehow malaria got a foothold there, and there were so many cases of malaria from that one village that even the government got concerned and tried (or so they said) to do some spraying there.
We also saw plenty of people with diarrhea -- the exhortations to boil, chlorinate or filter water before drinking it are slowly filtering into people's consciousness, I think, but there are still many who are too accustomed to drinking straight from the river, or too poor and uneducated to grasp the fact that the water is not as clean as it once was -- and pneumonia and other breathing problems, and skin infections. The tropics are a haven for dermatologic diseases, and we see a great variety of fungal skin infections, from ringworm to athlete's foot to diaper rash to vaginal candidiasis. Then there are scabies, and warts, and chigger bites, impetigo, infected pustules, and herpes zoster ("shingles"), and chicken pox, since the vaccine for this common childhood illness is not available here. And there are one or two patients whom we follow for psoriasis. These folks of course have a chronic condition, and the medicines available for treatment here are rather limited. We do what we can.
Then there were 73 cases of trauma, mostly but not all minor. The first of the year was a year and a half old boy who is being passed from one family member to another since his mother is not capable of caring for him, who managed to scald himself in the face and chest with hot milk. Happily, the burns were not too bad and he recovered well. There were the usual complement of people stepping on nails and being poked by sticks, sometimes in the eye. There was in fact one man who came in with a gigantic splinter a good eighth of an inch in diameter and an inch in length which had embedded itself in his eyelid five days earlier. Ouch. We took it out. There were several machete cuts, including one right across a boy's nose (he slipped and fell while carrying his machete), and one man whose chain saw got away from him and barely nicked his chest and neck. I told him he had been incredibly lucky.
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