The Amazon Medical Project

The final budget category is Salaries and Benefits. As noted above, I am paid from Wisconsin, but our clinic employees all receive salaries, vacations or vacation pay, deposits made into retirement accounts and severance pay accounts, and then there are taxes to be paid to the government on all this. Salaries is always our largest category of expenses, which makes sense, since without the people who work in it, the clinic would be nothing but a free-standing pharmacy. But salaries are complicated, so brace yourself.

In 2008, we wound up paying salaries to Dr. Yuri, then his sister Yasmina, then Dr. Wilbert, and paid severance pay benefits to both Yuri and Yasmina when they left. That, on top of the fact that we actually had a Peruvian doctor on staff for all twelve months, brought our physician costs to over $16,000, nearly double what we paid in 2007, despite the fact that no raises were given to the physician(s). Dr. Wilbert remains with us, and like Yuri and Yasmina is a wonderful doctor. However, he is a little older than his siblings, and more experienced, and I have just given him a small raise, in a bid to convince him that he really, really likes working in the clinic, and therefore wants to stay. We'll see if it works. Then there was Carmen, who joined us last March as a nurse, after we had given a trial of work to a young local man who proved to be very nice, but not much of a nurse. Wages for him, severance pay for Clara who left at the start of the year, and ten months of work for Carmen, came to about $3,200.

And of course there are our local employees who have been with us forever - at least, until now. Juvencio left the clinic last year to strike out on his own, so his wages were minimal. Edemita has now taken over most of the administrative work when I am not around (and a good deal of it even when I am on hand), and earned a total of about $5,200 in 2008. Each of the three "huatchimanes," who do guard duty at night and during lunch hour, and who take care of clinic grounds and maintenance, took home roughly $3,500 apiece. Then there were taxes and benefits - a severance pay account for each employee, to which contributions are made twice yearly; payment for the government-run health plan (which hardly anyone uses since it is very patient-unfriendly, but we have no choice - the payments are mandated); a retirement fund for each employee; and health care costs paid by the clinic, which was mostly the $1,100 it cost for Edemita's hysterectomy (in a private clinic, not the government one).

These expenses, plus the salaries, plus $4,350 paid for employee meals, brought our total Salaries and Benefits expenditures to $50,342.06. As always, almost all the money to cover these expenses came from those of you who are reading this letter, and we thank you most gratefully. Our patients paid a grand total of $2,560.60, an average of roughly $0.91 per person, which obviously comes nowhere near to what we need to keep the clinic going. Every one of them, even though they do not know who you are, is relieved to have access to medical care through the clinic, and appreciates what you have done to keep us up and running. Next year's report will be somewhat different, because as you already know, the Clinica Yanamono that took care of all those patients no longer exists, at least not in any functional form.

The new, improved William "Bill" Harrison Memorial Yanamono Clinic opened on March 16, to an overflow crowd, and we have been busy ever since. The Rotary Clubs of Duluth, Minnesota, and Thunder Bay, Ontario, and their compatriots at the district level, very generously provided the funding to construct the clinic; and the Rotarians themselves again came down to build it. But as with any building project, there will be other expenses that we did not have before. We have already purchased a new vaccine refrigerator to replace the failing old one (that was such a long story, it was going to be a clinic letter, but I think it has been bumped from the list because there are too many other things to talk about), and several new filing cabinets so we no longer have to pinch our fingers trying to stuff patient charts into the completely packed old cabinets. We will need to replace curtains and most of the clinic mattresses, and since the new clinic is about a quarter mile inland from the edge of the river, we are going to have to do something about improving the muddy path leading in from the river, so that when the stream gets too low for boats to get to the clinic, people can make their way overland. And we should have a shelter at the river's edge so that people who are waiting for river taxis to take them back to their homes can sit out of the sun and/or rain. And those are just the projects I know of, at the moment. I imagine others will surface.

So, once again many, many thanks for keeping us afloat. Next letter, I promise to go back to the last stages of clinic construction, although as mentioned already, I can tell you that we are up and running, on schedule, and the new clinic is fantastic. Excitedly, Linnea