The Amazon Medical Project

What does this mean for the Amazon Medical Project? Well, it means that everything is getting more expensive. A lot more expensive. Our largest cost in Peru is employee salaries and benefits, which amount to roughly S/9,300 monthly (except in July and December, when that figure doubles). At an exchange rate of 3.20, S/9,300 comes to $2,906.25; at an exchange of 2.90, that same amount of Peruvian currency comes to $3,206.90, an increase of $300 a month. At the current rate of exchange, the cost is $3,576.92. And the dollar continues to slide.

This means that all our costs rose last year, even when our Peruvian costs were stable. This year, the problem will be worse, and it will be compounded by the irony that even though the dollar is dropping in value, which ought to improve the sol's buying power, that is not happening. On the contrary, prices of daily essentials like food and gasoline are rising at a frightening pace in Peru. The economics of all this is beyond the scope of this letter, but the bottom line is that the bottom line is changing.

That said, let's start with clinic expenses in Peru. We spent nearly $7,000 on medicines this year, up about $1,500 from 2006. Part of the reason for this is that more and more medicines are available for purchase on the open market in Iquitos, which is nice, and part is that we have more patients using more expensive medicines. We have always used mostly very basic and relatively inexpensive medicines such as worm medicine, old-fashioned antibiotics, and analgesics like acetaminophen and ibuprofen.

We are, however, seeing more patients whose needs are different. The young girl with rheumatoid arthritis, for instance, was prescribed medicines which are far more costly than the basics, and we have more older folks being diagnosed with diabetes, and some patients whose asthma requires the use of expensive inhalers and immune modulators. And we have now gotten hold of some tests for Helicobacter pylori, a bacteria which lives in the stomach and is associated with gastric ulcers, and also, eventually, with stomach cancer. H. pylori is very common in Peru, which probably explains why stomach cancer is very common in Peru. With the tests, we can now identify people suffering from this infection, and we can treat them. But the treatment is lengthy and the medicines are costly.

So, for a variety of reasons, our medicines costs are rising, and I imagine will continue to do so (plus, of course, the dropping-dollar factor).

Clinic operations, those costs which are neither medicines/supplies, nor labor costs, have remained steady compared to last year, although almost double the costs in 2005. In 2007, we spent about $11,600 on this category. This money can be further broken down into routine expenses such as clinic supplies (toilet paper, coffee, paper to wrap instruments for sterilization, etc.), office supplies (the notebooks on which we write our notes, the pens with which to write, stamps and seals and ink, etc.), copying expenses (we have a raft of registers and reports, both for our own use and those required by the Peruvian government in return for the vaccines and medicines which they provide), postage, minor maintenance, and so forth, all of which comes to a little under $5,000 and is pretty much stable, year to year.

Then there are our Peruvian accountant ($1,200), Peruvian sales and income taxes for the clinic receipts (yes, we pay around $1,100 in taxes, even though we are legally a non-profit organization and our expenses vastly outnumber our Peruvian receipts), occasional minor legal fees, etc., and all these also remain pretty steady.

The clinic, however, was built in 1993 and is aging, and we are also growing a bit, with the introduction of a doctor from Iquitos and often, a nurse assistant from the city as well. This year we spent almost $2,500 to build a septic system to replace our trusty but filled-up latrine, about $1,600 to dig a new well and purchase a submersible pump to replace the A.Y. MacDonald pump that gave up the ghost after only 15 years of reliable service, and a couple hundred dollars on the solar system. In 2008, the projects will be different, but there will be more projects.

I have already mentioned the Special Patients Fund. Expenses there were $1,550 in 2007, up considerably from the $275 spent in 2006 and the $137 of 2005. This is because, as I reported in the February letter about the young man with the gunshot wound, we now have an agreement with the Clinica Ana Stahl in Iquitos to take care of certain patients whose needs are beyond our capacity. This has been a boon to a few, carefully selected patients, whose individual needs are far beyond those of the average clinic patient – and I try to make sure that these are folks who can actually be helped by these relatively expensive measures. In addition to the gunshot wound and the girl with rheumatoid arthritis, there was a small child with an abdominal mass (that turned out to be constipation), and several other people for whom we provided the means to obtain diagnostic studies that would otherwise have been out of their reach. I anticipate that we will continue to utilize these monies for similar cases.