The Amazon Medical Project

Diarrheal afflictions accounted for only 162 cases this year, down from over 200 in each of the previous years. I believe this reflects rising conscientiousness in boiling or adding chlorine to the river water prior to drinking it. There are also a couple of towns along the river where community water tanks, complete with chlorination, have been set up by visiting foreigners, and these are a good project, I think. We have not seen cholera for several years, nor have there been any outbreaks recently of typhoid, so maybe we are making progress.

We performed 39 dental extractions in 2007, and Juvencio received additional training from visiting U.S. dentists, in the art of filling dental cavities. He is still in the training stages, so we are not offering this service on an official basis, but he has filled several cavities for friends and family members, which has been great. He also accompanied a visiting dentist on a trip in June to visit several communities, where dental hygiene teaching and toothbrushes were provided to several hundred school children; and on his own initiative, made a similar foray into a couple of local villages in September.

The downer for the year was the clinic's vaccine refrigerator, which in April, after years of faithful service, gave up the ghost. The vaccine refrigerator is a whole nother story, which has already been told in part and will be recounted in more detail later; but the bottom line is that we were able to vaccinate only 138 people last year, down by almost two thirds from the over 300 for whom we provided this (free) service in 2006. The good news, however, is that the fridge is once again running, and in 2008, we are gonna do better.

Finally, the clinic has two programs aimed at children, one for treatment of the all-too-common diarrheal and respiratory illnesses which ail them, and one for preventive health care. In the Diarrhea/Pneumonia program, we provide complete care for any child with any diarrheal or respiratory illness, whether minor (such as a common cold) or major (such as a life-threatening pneumonia or diarrhea with dehydration) for S/ 2.0 (around $0.65 US), which is a very reasonable cost even for Peru. Of course, we would (and do) take care of these children anyway, whether or not their parents can pay, but offering the low price service tends, I think, to encourage parents to bring their children in BEFORE they are gravely ill. Over 300 children were brought for this service in 2007.

Then, the Well Child Care program offers, gratis, a full exam (with the side benefit of weight and height data for children of our area), dental fluoride treatment, worm medicine, a toothbrush, and (as long as the tourists have brought them) multivitamin supplements for a month. Parents love the free medicines, and the 190 children who received them got a little boost in their struggle with borderline malnutrition, as well as encouragement to their parents to bring them in for vaccines, and to boil or chlorinate drinking water.

The remainder of the clinic's patients came for a variety of other illnesses, and as always, many patients receive more than one diagnosis. We cannot save everyone, but we do try, and of course many illnesses are minor or self-limited. And our Special Patients fund enables us to offer care to patients whose needs are beyond our scope, such as the young girl with juvenile rheumatoid arthritis, for whose specialty care we are paying, and for whom we are providing the necessary medicines to enable her to walk.

On to the financial side of things

I divide clinic expenses in Peru into several categories: Medicines and medical supplies, Clinic operations, Salaries and benefits, the Special Patients fund, and Bank fees. U.S. expenses are likewise divided into Clinic expenses, Medical supplies purchased in the U.S., my salary and benefits, and U.S. Operating expenses. Before we start in on that, however, I need to make a note regarding money in general.

I keep our records at the clinic in nuevos soles, the Peruvian currency, but I translate all these expenditures into U.S. dollars, which is of course also the currency used for our U.S. costs, and the currency in which we receive most of our income. The exchange rate is the rate at which I can purchase soles, using U.S. dollars. In the beginning of 2007, the exchange rate was about 3.20 soles to the dollar, dropping not long after to around 3.13 and remaining there until about September. In September, as the housing crisis hit the U.S. markets, the value of the dollar plunged, down to 2.70 in October. By the end of the year, it was about 2.95, but it has continued to slide, down now to around 2.60.