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Annual Report (Continued)

Continued from the previous page.

We saw two other diabetic patients with “diabetic foot,” a multi-bacterial infection which often affects people with long-standing diabetes. Diabetes messes up the nerves, so pain sensation is diminished, and patients may sustain injuries which they simply do not feel. These go on to become infected, and by the time the patient notices that something is wrong, the infection is deep-seated and may even involve bone. Furthermore, diabetes also damages blood vessels, so blood is not delivered very well to the extremities, and since the blood supply is poor, it is difficult to get antibiotics into the involved areas. These infections often result in amputations. Amazingly, both of these patients healed without surgery, even the woman whose great toe was purple-black, with obvious involvement of the bone. I was frankly impressed. (We told her she had to go to Iquitos, where the surgeons would have amputated the toe, at least. She did not like this idea and flatly refused, so we gave her oral antibiotics, and by gum, she healed.)

Frog

If someone could guarantee that all babies would be born safely, quickly, and without complications, I wouldn’t mind delivering them; but life-threatening emergencies can crop up suddenly, and there is not always a way to get such patients out to a higher level of care. We therefore provide prenatal care, but I always exhort obstetric patients to get themselves to the city well before their expected date of delivery. Nonetheless, a few women each year decide to give birth at home, then find that things are not going quite as they expected and come to the clinic. This year, there were four of them, and happily, all resulted in normal outcomes, i.e., healthy babies and mothers who survived. Edgardo and Edemita delivered one of the infants when I was in Wisconsin and Dr. Roldan was in Iquitos.

There was one male patient who worried me, but not Dr. Roldan. This 57 year old man had an itchy lesion in his rectum that he claimed had been present only a few days, but when we took a look, there was a horrible ulcerated swelling in his anus. I was sure it was a cancerous lesion, but Dr. Roldan said nah, this is rectal prolapse, gave him medicine for intestinal parasites, and had him return in a week – by which time, the lesion had resolved completely.

A sixteen year old boy was brought by his mother with a 4.5 x 7 cm. mass in his underarm, along with an ultrasound report from Iquitos that described a mixed-texture, very vascular lesion. This means it is probably cancerous, which does not bode well for this boy. There is a cancer center in Lima, but it is unlikely that the family will go there, so he will most likely not survive. And a 48 year old woman came with a very ugly-appearing 4 cm. lesion on her jaw which went all the way through to the inside of her mouth. She had already had a biopsy done in Iquitos which showed cancer, but we took another one which confirmed the diagnosis. Furthermore, the tumor is into the bone, which means that any treatment would require removal of a large chunk of her jawbone – which in turn means she will probably refuse treatment, and will die of this terrible tumor. Another woman, 34, with poorly controlled diabetes, was luckier. She brought an x-ray demonstrating a large cyst in her lungs, but this is probably echinococcus, a parasitic infestation which is treatable. She will need surgery to remove the thing, but should do well if she gets the operation.

Kids with Monkey There were several older men with urinary retention, whose bladders we drained by catheterization (though these fellows need long-term follow-up with a urologist, which can be difficult to achieve, especially when the patients live not in the city but out here along the river); and a 14 year old girl with a bad bellyache after having stuffed herself with palm fruits; and several small children who had stuffed corn, beads, small pieces of sponge, etc., up their noses or into their ears (or in one case, both locations); and a four year old who probably had whooping cough. At least, he came in several times with persistent cough, finally culminating in a prolonged, loud, indrawn whoop. He got better when we gave him treatment for whooping cough, which tends to support the diagnosis. Oh, and a small boy caught his penis in the zipper of his pants. Dr. Roldan succeeded in extricating him, but apparently the poor fellow was pretty bruised on that sensitive part of his anatomy.

We cannot help everyone, and we cannot save everyone, but we do what we can, and I continue to think that we do a fair amount of good for a fair number of people.

And as always, the funds to do this come primarily from those of you reading this missive. We do not charge for any of the programs such as birth control or vaccines, for which we receive the supplies from the government, but I think it is a great mistake to simply give everything away, so we make nominal charges to our patients for other services (please note, no one is ever turned away because they can’t pay). These charges netted roughly $2.00 per patient visit, just under $6,000 in 2017. All other funding comes from donations.

So we thank you all for your support, and will do our best to provide an interesting 2018 for your future reading.

Children Playing Futbol