Annual Report (Continued)
Continued from the previous page.
We had several obstetric emergency patients, including a couple of women who were miscarrying, and an 18 year old woman who came in labor when she was only about 24 weeks pregnant, and lost the baby. There was also a 45 year old woman who had allowed her birth control to lapse, and became pregnant. She had not come for any prenatal visits, but when she fell and began bleeding, she came to the clinic, where she delivered a fetus too young to survive. And there was a 15 year old who was 8 ½ months pregnant, whose baby had probably died before she went into labor – the young mother-to-be did not have a fever, but did have a foul-smelling vaginal discharge, had very little in the way of uterine contractions, and was noted to be rather somnolent, which is unusual for a woman in labor. The clinic staff took her in our wonderful new clinic boat to Indiana, but along the way, she delivered, and the child was born dead. This is sad for the baby, but probably better for the young woman.
There was also an outbreak of cases of belly pain in September, some of them emergencies, some who came during regular clinic hours. There is a high school in the Yagua village, and many students come from villages far downriver, boarding in the village while they attend classes. These cases of colic started turning up not long after some of these students brought barbasco from their home village, and dropped it into the river. Barbasco is a local vine which is poisonous to fish, and is therefore used as an easy way to catch them. Just mash a few lengths of the vine, drop it into the water, and wait for the fish to die and float to the top. But the river was low when they did this, and coincidentally, the small local water treatment plant also happened to be out of chlorine at the time. The result was a series of people with intestinal pains. No one died, and after a while, the epidemic waned.
We transported eight patients who needed a higher level of care. Our first of the year occurred in March, for a 15 year old girl with appendicitis, who underwent surgery in the city and did well. Then in May, when I was in the US and our Peruvian doctor was in Iquitos, a very ill four month old baby was brought in with fever, cough, respiratory difficulty, dehydration – and a cleft palate, which was undoubtedly at the root of his other problems. We took him to Indiana to the government medical center, but he is caught in the Catch-22 that affects infants like this. He is too underweight to have surgery to repair his palate, but he won’t be able to gain weight until that repair is performed. Until then, every drop of milk he gets from his mom goes up his nose, and sometimes down into his lungs, but very little of it actually reaches his tummy. It is a difficult problem to solve.
In late August, a 27 year old woman came in from a community far out on the river. She had been diagnosed with tuberculosis, as had at least one of her children, but for reasons that were very muddy, they had not gotten any treatment. We took the whole family to Indiana, where they hopefully received the medicines they so badly needed. There was another seriously ill infant, this one from the local Yagua village, only 14 days old, with a bad case of pneumonia and sepsis (blood stream infection). She wound up spending two weeks in the Intensive Care Unit in Iquitos, but eventually returned home, and as of a few days ago was doing just fine. Yet another infant, 8 months old, came in with chickenpox and sepsis; she was eventually sent on to Lima, and we heard she underwent some sort of surgery there, but we do not know if she survived.
And then there are patients who fall into no particular category. We saw several older people in 2017, mostly women, who came in with cough and shortness of breath. In developed countries, COPD, chronic obstructive pulmonary disease, mostly affects folks who have been long-term smokers. In places like this, the victims are primarily women – they have spent half of every day, for their entire adult lives, cooking over an open (and smoky) fire, in a semi-enclosed space. Even though they may never have smoked a cigarette, they have nonetheless been exposed to plenty of smoke, and as they age, they begin to suffer the consequences.
One of our diabetic patients presented with diarrhea, and we gave her a sulfa antibiotic. That probably was not the best choice, because she is also taking a sulfa-based drug for her diabetes. A few days later she came back, disoriented and feeling generally very weird, and was found to have a blood sugar of only 42 – almost certainly due to the drugs, both of which can cause blood sugar to drop, especially when two drugs are combined. (This is called an iatrogenic complication, meaning us doctors did it to you.) We switched her to a different antibiotic, and she recovered. And we made ourselves a note: no sulfa antibiotics in patients taking sulfonylureas for their diabetes.