Additionally, there were costs for replacement towels, sheets, and exam table covers; my flights to and from Lima when I am coming from and going to the U.S.; the costs of my stay in Lima for the ultrasound course (kept to a minimum by a friend who kindly let me stay in her apartment); transport around Iquitos for clinic employees when running clinic errands; and other minor expenses like the costs of hot chocolate and sweet bread for the annual children's Christmas party.
As you know from my earlier letters, transport of critically ill patients is always a challenge, and we received a used (very used) boat as a donation in mid-year. The costs of fixing it up ran to around $2,800, and a new 40 hp motor for it cost $4,000. Both the repair costs and the motor were paid for by generous donors who gave specifically for this purpose, and these costs were also included in the Operations category. (Now we are in the process of trying to get the boat registered, a chore which has so far taken over six months... you are supposed to register new boats in Peru, not re-cycled used ones, and the bureaucratic hurdles are steep. But we will get this vehicle up and running in 2012. I am pretty sure we will, anyway. But that's another story, for another letter.) And that about finishes Clinic Operations.
Clinic Repair and Maintenance comes next. Our new clinic is a beautifully designed, highly functional building; but it is larger than the original clinic, it is away from the main river, necessitating some arrangements for access during low-water season, it is now three years old, and it is in the rainforest. Upkeep is inevitable.
This year, Clinic Repair and Maintenance included several projects which totaled $8,563.52. When the river was high, we found we needed to construct a floating boat dock. Later in the year, when the water was very low and patients had to walk in from the main river bank, a quarter of a mile away, we built a stairway up from the river, and a latrine near the river's edge. When an engineer was sent by the regional health authorities as part of the process of renewing our license to operate, he felt that we should build a septic field for the laundry water, rather than let it flow into the stream; so we did. Then the steps leading up to the clinic entrances rotted out (disappointing, after only two years, but what can we do, when they are under water for weeks each year?) and were replaced. Tubing was purchased, so that we can pull water from the stream and pump it into our main water tank. And we constructed a cement stand for the two rain tanks which had been placed on a wooden floor which had rotted out (we knew when we built the clinic that this arrangement would not last long, but at the time we had neither the money nor the time to do better). Finally, we spent around $1,100 on paint and thinner, about $600 on sundry small maintenance costs such as nylon line for the weedwhacker, silicone, wire staples, duct tape, etc., and about $550 on labor to perform such chores as cleaning up outside after the annual flood, washing and painting the interior clinic walls, and other projects which were more than the clinic huatchimanes could accomplish in their daylight work hours.
And in the last category of clinic expenses, we disposed of about $1,000 in Petty Cash, which largely covers the costs of my getting around in Iquitos when I go to the city to collect vaccines, make purchases, go to the bank, etc. There is also some loss when we make transfers from the U.S. in dollars, and put them into our nuevos soles bank account; and probably a few items that I just forgot to write down... except for salaries, virtually all purchases are made with cash. If I neglect to make a note of something, it is lost.
Thus, for a grand total of slightly under $80 per person, we provided medical care for close to 3,000 patients. It scares and worries me each year as I see the costs going up, and they will continue to go up, especially as the dollar is not strong - it keeps losing value, making all our purchases significantly more costly than they were a few years ago. Then again, as with the medicines, I think of what medical care costs in the U.S., and figure we're not doing so badly.
For all this money, which all of you helped to provide, we got Family Planning to 314 women, and vaccinated 691 persons, against diphtheria, pertussis, hepatitis B, hemophilus influenza B, measles, yellow fever, pneumonia (babies get this vaccine now), diarrhea (also for babies), and especially, tetanus, which claims far more lives in Peru than it does in the developed world.
We took care of 53 trauma patients, whose injuries ranged from minor to not so minor. We saw the usual quotient of machete cuts, puncture wounds, burns, and falls. There was also the poor woman who managed to knock herself in the head with a branch, sustaining a laceration to her forehead, then fell down into a nest of biting ants; a 16 year old boy whose father is a medicine man, who came with a chemical burn after applying a plant remedy to his face; a five year old who cut his foot on a homemade grater (you bend a thin sheet of flat metal into a curve, then punch lots of nail holes through it, grating your food, or in this case, your foot, on the punched-through edges); a 23 year old with a broken nose after an altercation; and a man whose dog had accidentally bitten him, and the wound became infected. Probably our most serious trauma case of the year was a heartbreakingly brave 6 year old who pulled a pot of soup over on herself, sustaining second degree burns over most of her chest and arms, and much of her back as well. And for interesting cases, we had a 43 year old man who fell from the steps leading up to his house, at a time when he was somewhat intoxicated; a 16 year old with a fishhook in her hand; a 10 year old who had stepped on a catfish and embedded one of its barbed spines in his foot; and finally, a broken leg sustained by one of the clinic employees, when his boat was rammed by another (the ramming boat was driven by a girl too young to have much experience in water-passing etiquette). And there was one man who sustained a shotgun injury to his foot, in a hunting accident wherein his stepfather shot him in the mistaken belief that he was an animal rustling in the underbrush. Hunter safety courses would be helpful, but they do not exist here.
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