The Amazon Medical Project

In addition, we bought some HIV test kits this year, and some Helicobacter Pylori test kits. Neither of these is readily available in Iquitos, and I debated on them since they are costly - around $10 each. However, H. Pylori is a bacteria which lives in people's stomachs and is associated not only with ulcers but also with stomach cancer, and stomach cancer is very common in Peru. So, I figured we would try to test at least a few of the people whose symptoms are most suggestive of H. Pylori, and maybe we can lessen their chances of developing stomach cancer in future. We also helped the Amazon Dental Project, run by Dr. Jeannette Grauer, a dentist originally from Uruguay who now lives in the U.S. Dr. Grauer spent $18,522, all of which was raised by donors who gave specifically for this project. She used the money to enable her to once again visit communities along the Amazon and Napo Rivers, pulling teeth, filling cavities, and teaching thousands of schoolchildren dental hygiene and giving them toothbrushes with which to practice it. In Peru, the clinic spent $76,924.23.

I divide our expenses there into four categories: Medicines and medical supplies; Clinic Operations; Salaries and Benefits; and the Special Patients Fund. There are also expenses for Bank fees (over $1,500 in 2008) and Petty Cash, which covers my motokar costs while running clinic errands in Iquitos, and miscellaneous small and/or misplaced expenses - since virtually every transaction is paid in cash, forgetting to write something down means that expense goes unrecorded. Petty Cash was roughly $500 this year. We spent somewhat over $10,000 on medicines and medical supplies this past year in Iquitos, plus the medicines and supplies purchased in the U.S. As noted above, there are still items which are hard to find in Peru, but the availability of medicines has improved tremendously since I first starting working in the rainforest. In fact, part of the reason that I spend more each year on medicines and supplies in Peru is that we can now purchase costly items such as asthma inhalers in Iquitos. And, we are taking care of more people with chronic illnesses who need ongoing treatment, such as the young girl with rheumatoid arthritis.

The Special Patients Fund is money which we use to help people obtain treatment or lab studies or x-rays that we cannot supply through the clinic. The amount spent in this category varies widely from one year to the next. This year we spent less than $500 in all. This paid for transport to Iquitos for two young women who were in premature labor, and for one very ill patient (the woman I wrote about who subsequently died of "blackwater fever"); bought glasses for a four-year-old child; and helped with the costs of hospitalization for the mother of one of our clinic employees, when she suffered a stroke. We spent around $13,850 on Clinic Operations in 2008. This category covers pretty much everything that is not directly medical, bank, nor salaries, and includes such sundries as clinic supplies (laundry detergent, bleach, coffee and sugar to sweeten it, food for the two clinic cats), office supplies, gasoline for the weed whacker and the generator (used to power the dental drill compressor and to run power tools), clinic repair and maintenance, equipment repair and maintenance, copying costs (we print up an awful lot of registers and forms, and will be doing even more since the government has stopped printing a lot of them itself), and per diems for clinic employees when they run errands in the city. (I do not receive a per diem when I go to Iquitos, but feel that it is reasonable to give clinic employees money to feed themselves while on clinic errands.) There is of course a Miscellaneous category, and this year it was mainly occupied with the parts and pieces of a plastic skeleton, about three feet tall, which was offered in installments by a local paper. The first few pieces were substantial in size, and inexpensive. Then, once we had gotten hooked, the pieces got smaller, and more numerous, and more expensive. But it is a pretty cool skeleton, with removable teeth and heart, lungs, stomach, kidneys, even some of the large blood vessels all in their respective places, and it makes a good teaching tool.

Also under Clinic Operations are the fees we pay to our Iquitos accountant to keep us out of trouble with the Peruvian equivalent of the IRS, occasional legal matters (mostly to do with licensing of the clinic), my dues to the Colegio Medico del Peru, plane tickets to get me to Lima and back when I am going to the US (international tickets are covered at the US end), and Peruvian sales and income taxes. In addition, we spent a little over $1,000 on our solar system this year, mostly to replace some aging batteries. Then there were two "projects:" we built a cement platform to support the clinic's rain tank, since the wooden one kept getting eaten away by the termites and the rain; and we built a kitchen area for the clinic employees who live at the clinic. When we first built in 1993, the clinic staff was me, Juvencio and Esperanza, and we all went home at night unless there was an emergency. However, we now have our doctor from Iquitos (and often his or her spouse/partner), and Carmen, our nurse. These folks cannot go back to their Iquitos homes at night. Instead, they live at the clinic for two or three weeks, then return to the city for their days off. Thus, it became necessary to provide a place for them to cook. The water tank stand cost just under $600, the kitchen ran around $2,300. Of course, had I been able to foresee my decision to re-build the clinic, we would have continued to work with the facilities we had. But both these projects occurred in the first half of the year, and I did not plan on re-building, until the bank caved in, in Juy...