The Amazon Medical Project

            The problems which brought people to the clinic were varied. We provided family planning to 360 women, vaccines to 535 people (considerably up from 2008 and 2007, thanks to our new vaccine refrigerator), and Well Child Care to 181 children. These programs are our efforts at preventive medicine … along with my constant exhortations to boil the river before drinking it.

            We saw a variety of cases of trauma. These included the young boy of whom I wrote who suffered a posterior hip dislocation when a banana tree toppled on him, an assortment of lacerations due to machetes and axes, including a couple of fingertip amputations which we repaired; punctures of sundry appendages by such items as branches and caña brava, the tall wild sugar plant with a stiff stem; burns due to mishaps with kerosene lamps, cooking fires and/or small children pulling soup pots onto themselves; sprains and a few broken bones due to collisions while playing soccer; and a few cases of relatively mild trauma to eyes. There was one man with a gunshot wound from a hunting accident, and a fifteen year old who tried (unsuccessfully, thank goodness) to hang himself. Oh, and there was a man who managed to fall and give himself a black eye and a forehead laceration, who could not quite recall the details of the accident due to his inebriated state at the time of injury. There were also a number of people who came to see us not for their wounds, but for the infections which had developed in them.
            Speaking of infections, infectious diseases make up a very large group of illnesses due to bacteria (abscesses, pneumonia, dental infections, pelvic inflammatory disease, venereal diseases, cellulitis, urinary tract infections and kidney infections, tuberculosis, among others), viruses (colds, bronchitis, chicken pox, herpes, AIDS, warts, etc.), parasites (malaria, and waterborne agents such as giardia and amoeba that cause diarrhea), and fungi (lots of ringworm, athlete's foot, and jock itch, along with occasional cases of more serious infections involving the lungs or other organs). Many of the people who come in with bacterial infections are seriously ill, due to pneumonia or pelvic inflammatory disease or large abscesses or those nasty infected wounds or tuberculosis or its complications; and most of them, we can help. The viral illnesses have no real treatment, although there are vaccines against some of them. (We have vaccines for measles and mumps and polio, not yet for chicken pox or the HPV virus that causes cervical cancer. These are available in developed countries but Peru cannot afford them.) We are seeing a few cases of AIDS now and again, and I expect we will see more; in fact, a young man in the Yagua village died of this affliction a year or two ago. On the parasite front, it was not much of a year for malaria, perhaps due to aggressive spraying of mosquitoes in and around Iquitos (most of our cases occur in people who were visiting relatives in the city in areas with a high concentration of malaria); but diarrhea from all causes continues to be a significant problem. We lack the laboratory facilities to diagnose specific causes of diarrhea, but based on the clinical scenarios, I think giardia is fairly common. As for fungal infections, we can usually treat those affecting the skin; the fungi that cause systemic illness are more difficult, but fortunately are pretty rare.
            Skin diseases are popular in our warm and humid climate, accounting this year for 148 patients. These ranged from scabies (very common in small children) to varicela (chicken pox) to impetigo to ringworm and athlete's foot, to furuncles and scalp lesions and heat rash.
            We only had three poisonous snakebites in 2009, continuing the downward trend that I think is due to increased population density. In my first years here, there were 12 to 15 bites a year, now we down to less than half that. We also had one young man bitten by a capybara whom he was tending, a terror-stricken two year old who ran afoul of a scorpion (their stings are not fatal, but are quite painful), and a man who was perforated by the hard, tough, sharp spine of one of the many catfish who inhabit the river. (Fortunately, the fish makes good eating, so the human victim had the last laugh.)
            We committed 31 dental extractions, and now that Juvencio is back with the clinic, he is starting to do a few fillings as well. I have hopes that he will be able to continue receiving ongoing training, so we can save some more of the teeth that are in trouble, but are not yet beyond hope.
            And there were a number of patients who did not fit into any program or category. Some of these, like the starving infant who weighed only 1.7 kg. (3.74 pounds) at two weeks of age, or the young woman with hemorrhage following childbirth, we can help. Others, such as the 47 year old man who had terrible swelling of his left arm probably due to blockage by tumor in his lymph nodes, are beyond us -- well, he may have been beyond help by anyone, although his refusal to go to the city for more evaluation made it impossible to know that for sure.
            For all of them, though, we are very glad to be operational, and very, very glad to have our wonderful new facility to work in. And we are deeply grateful to all of you for making it possible -- Linnea