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August, 2013

 Once again, it is time for the Clinica Yanamono/Amazon Medical Project Annual Report.  Oh my, where to start?
    Well, let's start with what we spent.  The grand total for the year of 2012 came to roughly $225,000, and as usual, was divided between expenses in Peru, and those in the US.  In the U.S., we paid Kim $30,000 to receive, deposit and acknowledge donations; figure out our taxes; organize board meetings; respond to e-mails and inquiries; arrange for transfers of funds to Peru for me to spend there; act as liason between me and anyone wanting to get in touch with me; and generally take care of all our administrative needs.  My salary was again $20,000, and we again put about that much into a 401k for me; then there was a little over $3,000 in taxes, and $8,100 for health insurance for me, unemployment compensation, and ERISA (whatever that is).  The remaining $23,000 spent in the US went for office supplies, bank fees, postage, printing, telephone, and airline tickets to me get back and forth from Peru. 
Ok, that part was pretty simple.  The actual clinic expenses are a tad more complicated. 

    In Peru, the total spent was $121,619.56, slightly under last year's costs, mostly due to a $9,000 decrease in what we spent on medicines and supplies, which this year came to just under $15,000. 
We spent $4,364.33 through our Special Patients Fund, which provides care which the clinic cannot supply.  Some years, this is mostly the Papanicolau smears that we send for as many women as we can; but this year we had one patient who accounted for about $3,500.   This was the man about whom I wrote earlier, who stabbed himself in the stomach and neck.  Considering that he perforated his stomach, underwent surgery, and spent several nights in the Intensive Care Unit, the costs were modest compared to what it all would have cost in the US, though very expensive for Peru.  There was also a young woman who came in with "childbed fever," an infected uterus after she gave birth at home.  When she did not improve with antibiotics, we helped her to get to Iquitos, where she was found to have appendicitis.  The government's Seguro Social program provides health care gratis to those who live along the river – but only for items available in the regional hospital's pharmacy.  If they don't have it, whatever it is, then the family must provide it, or do without.  This young woman needed about $55 worth of medicines and supplies which were not available from the hospital pharmacy - including anesthesia for her surgery and sutures with which to close her surgical incisions -- and we provided those funds.  We also transported several patients who needed care beyond what we could offer. 

    Banks took a toll of almost $3,000, for account maintenance (they make U.S. banks look very, very generous, and charge us extra if we write too many checks on the checking account), charges involved with transferring money from the U.S. to pay our bills in Peru, and money lost when we make those transfers to the account in nuevos soles.  This happens because the exchange rate that the bank uses when we send dollars and they deposit it as soles is significantly less than what we could get if we changed the money on the street corner.   The only way around that would be to transfer $10,000 to Peru, go out onto the street to exchange it, then go back to the bank and make the deposit.  Not a great idea.  It looks like we lost about $700 through this route, the transfers themselves cost around $700, and the rest was for regular bank maintenance fees and the transaction tax that the government levels on any bank transaction over a certain amount.  
    That covers the simple categories.  Salaries, Clinic Operations, and Repair and Maintenance of our wonderful new building (it is already four -- FOUR!!!! -- years old, but it still seems new to me) are all more complex. 
    Salaries (including benefits and taxes) for our Peruvian employees came to $72,551.91, obviously by far our greatest cost, and a fair reflection of how vital these personnel are.  Without them, the clinic would just be a box with medicines in it. 
    Doctora Yasmina left us in mid-year, and Doctor Pablo came on board in late October, so we were without a Peruvian doctor for four months.  Between them, they took home a total of a little under $15,000 in salary... not bad for a medical doctor who lives on site and is available 24 hours a day for most days of the month.  Our nursing staff includes Edemita, Juvencio, Carmen and Luciano, and of course Juvencio and Edemita have far more seniority than the other two; and we had another nurse for the first six months of the year.  Salaries for them ranged from a high of $8,232.99 for Edemita, who assumes the responsibilities of clinic administration when I am in the US, down to $2,260.87 for Luciano, who began the year as a student on a stipend rather than a regular salary.  Total cost for the nursing staff's take-home pay was $26,724.14.  Then there were the three "huatchimanes," our night watchmen, maintenance men, gardeners, and all-around do-it guys, who collected $13,306.08, divided equally among the three of them. 
    A note here: we gave all the clinic employees a small raise in 2012, since they had received no raises for several years, and we began paying overtime to the nurses when they take care of patients in the night or after hours.  Most rural clinics in Peru do not do that... when I asked whether the doctor at the government health center in Indiana gets paid extra when he gets called out in the middle of the night, I met with a puzzled look:  that is just part of the job.  But I remember how I nearly burned out after being on call for years, and I do not want that to happen with our nursing staff.
    The take-home pay is only part of the Salaries and Benefits equation, however.  Under Peruvian law, we must pay monthly for each employee's share of the government health program, one month's salary each year for each employee into a severance pay account, and 13% of each person's gross salary into a retirement fund, all of which added up to almost $16,000.  We also provide meals for those who come from Iquitos to work in the clinic, at a cost of about $1,800 this year; and we pay for some health care costs for our employees because the government system is, shall we say, less than ideal. 


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