Continued from the previous page.
A few years back, I wrote about some of the changes that have occurred in the area served by the clinic. The clinic itself has changed, too.
When it all began, back in June of 1990, I was the sole worker. I had visited Explorama Lodge in February as a tourist, and by the end of the week, could hardly tear myself away. Even once I returned home to Wisconsin, I kept feeling that I just had to be in Peru. Finally, after consulting with Pam in Explorama’s office, I requested a three-month leave of absence from my practice in Wisconsin, and bought plane tickets to Iquitos. After spending the night in the city, I headed downriver to the Lodge I had visited only a few months earlier as a tourist, wondering what my new role would be.
The first day, I set down my small bag of instruments and supplies, a few medical books, and the microscope I had brought with me (microscopes are very heavy, but in 1990 your suitcases could weigh up to 75 pounds; although in those days wheeled suitcases had not yet been invented, and I have many memories of racing through the Miami airport, dragging huge duffel bags along the floor). Then I stepped back, and took a photo. My small collection of implements and supplies did not look like much with which to be starting a clinic, sitting there in the large open sala of the guides’ house. I thought of what I had left behind in Wisconsin – a clinic which was a real building, tight against Wisconsin’s winters, with electricity, running water, in-house x-ray and lab, staff, and a hospital a few steps away – and wondered whether I might in fact have made a big mistake. One of my partners had commented frankly, “You’re crazy, Linnea,” and I wondered whether perhaps he had a point.
The “clinic” was actually just a single room in the house where the guides slept when they were at the Lodge with tourists. The night before, it had been the bedroom for one of the guides, who was ousted and sent elsewhere. The house was built up on stilts, to keep the floor above the annual flood waters, and had a thatched roof. There was a kerosene lantern for light, a bed with a simple stuffed mattress, one bookcase, one chair, and a small table made of a not-quite-rectangular piece of plywood nailed to four legs (bats liked to roost on the underside of it, sometimes startling me and/or my patients when they flew out). Cesar built me a small cupboard with shelves and compartments to store medicines, once I obtained some. Water came from the outdoor showers used by the tourists, and I carried it to the clinic in a pitcher. And, as I did not speak Spanish, Pam or the guides would translate for me. Sometimes the guides, all male, were reluctant to tackle what might be called lady problems, and sometimes they interjected their own opinions into the responses offered by my patients. They also taught me about the local culture … when I instructed a patient to take a medicine three times a day, “once with each meal,” the guide who was translating rather scornfully informed me that “these people don’t eat three times a day,” which was a reminder that I was in a whole new world.
I had brought a few basic medicines with me, but needed to stock up on more, so I went to Iquitos, and Pam and I embarked on a search for a wholesale pharmacy. We were directed to a couple of retail pharmacies, but neither had much in stock. (Despite its population size, Iquitos is plunked in the middle of the rainforest, with no roads or railroads coming in. Everything that reaches the city does so either by airplane or by boat, and obtaining supplies is often difficult. Things have improved markedly since 1990, but it is still common to find that an item is out of stock and won’t be available until the next shipment arrives from Lima, whenever that may be.) Finally, we stumbled onto a small drug warehouse, and I collected a couple hundred dollars’ worth of antibiotics, medicine for intestinal worms (such a common problem that before long, I concluded that no matter what people came in for, I should be giving them worm medicine), antiseptics, and so forth. When the proprietor wrote up the sales slip, he asked where all this stuff was going. Pam replied on my behalf that we were taking it to the people who lived near the Yanamono Stream, and he inscribed “Clinica Yanamono” on the receipt. Thus the fledgling clinic was christened.
My initial three month leave of absence ran its course, I extended it for another month or so, then returned to my partners and told them I planned to take the next year off and return to Peru. That leave, too, got extended, and for the next couple of years, I worked out of that small room, sweeping the floor each morning, cleaning the accumulated debris which inevitably falls from a thatch roof, and occasionally battling termites. If there was a quiet spell without patients, I would walk in the rainforest, and learned my way around the major trails in the vicinity of the Lodge.
Then, on a trip back to Wisconsin, I was interviewed on public radio. Following the program, there were several people who called the station to make comments. One urged me to plant a cure-all tree from India in the jungle. Another identified himself as Jon Helstrom, an architect from Duluth, Minnesota, who told me that his Rotary Club might be interested in helping me. I shrugged – knock yourself out, was basically my reply – but to my surprise, he followed up, calling me again before I returned to Peru. He then convinced his Rotary Club to send him and Joe Leek, a semi-retired ear-nose-throat physician, to Peru to meet me and see what I was doing. Was I for real?
They arrived at the Iquitos airport in May of 1992, bounding out of the Customs area and greeting me enthusiastically. They spent a week at Explorama Lodge, Joe observing me and my patients, while Jon looked at locations and local building styles. At the end of their trip, they told me that they thought they could convince their Rotary Club to build me a small building of my own. When I asked what the timeline might be, they responded that it would probably take a year or so, which put a dent in my eager anticipation – my patient load had gradually increased, and there were days when there were ten or more patients. However, they agreed to provide funding for me to hire a local assistant for a year, which would be a help.
Now the question was: who to hire?
I knew Juvencio Nuñez because he worked at Explorama as a boat driver, and because his three young children were frequent clinic patients. The family lived not far from the Lodge, and along with assorted minor injuries and illnesses, were prone to bouts of diarrhea, until I was able to convince Juvencio and Olga to boil their drinking water. He also had come once, as I was leaving for a trip to the US (in those days, each time I left, people figured I would probably not return), to thank me for the services I was providing, which impressed me favorably. I had to make a leap of faith, but in talking with him, he seemed quite bright, so I asked if he would like to come to work for me. I appreciated the fact that he asked for the chance to explain the situation to Peter Jenson, Explorama’s founder, rather than simply quitting his job with Explorama. Peter was happy to hear that I would be getting some help, so Juvencio came on board. I taught him how to take blood pressure and temperature, and how to evaluate and treat the illnesses we saw most commonly, and he showed amazing aptitude, quickly absorbing everything I told him, and learning to suture a wound by practicing on dead fish. In short order he proved his worth, and continues to work with the clinic now, 25 years later.
When the Rotarians returned in early 1993, they constructed the first “real” clinic, on land donated by the Guerra family, at the edge of the Amazon River. They built a wooden structure with a metal roof, 30 by 60 feet in size, and they installed a flush toilet, sinks, and a solar electrical system, and paid to have a well dug. I quickly realized that we would need more help, and hired Juvencio’s sister, training her as I had trained him. We also needed someone to be at the clinic at night, to notify me if any emergencies came in, and to take care of grounds and building maintenance, so three local men were hired to cover these tasks.
This of course entailed costs beyond what I had incurred when working by myself out of the room at Explorama Lodge. Initially, I had simply bought medicines out of my own pocket. I charged patients a miniscule fee, ostensibly to help cover the costs of the medicines they were receiving, but this income was (and still is) very minimal. Tourists, however, occasionally slipped me a little money, and if someone wanted to send a check once they got home, the Lutheran church across the street from my former hospital in Wisconsin very kindly allowed people to make donations to them on behalf of the clinic. These donations were, and still are, the primary funding source for the clinic. (We eventually became a 501-c-3 non-profit, enabling us to receive contributions directly, but this did not happen until 1997, so the church’s willingness to help in those early years was a great boon.)
Our patient load gradually grew, until we reached 200 to 250 patients monthly. It took a long time to find someone who was a good fit for the clinic, but we did finally expand our nursing staff. And, when after a decade of working full-time in Peru, I decided that I needed to return to work at least part-time in Wisconsin, we added a Peruvian physician, as well. I now spend quite a bit of time as an administrator, though I am always eager to see any patient who is a long-time habitue of the clinic, or any interesting cases. And of course, I am still the doctor when our Peruvian physician goes to Iquitos for his days off each month. And everyone for miles around knows where I live.
I used to sit sometimes on the back steps of the clinic and marvel at how this entire hive of activity, with an actual building, exam tables, medicines, laboratory equipment (well, not much of that, but more than just the microscope with which I began) had grown out of that small bundle which I set on the table, that first day when I set up shop.
Now, we’re even bigger and hopefully better. The land on which the original clinic was built was gradually eroded by the river, until it became clear that the building itself was not going to last; and the same Rotarians returned and built us a brand new clinic in 2009. This one includes the waiting area, exam rooms, offices, pharmacy, lab, and kitchen that were all part of the original clinic, but there are now two offices instead of one (given the amount of paperwork I now do, it is immensely helpful to have my own office, and space for the medical charts of the over 60,000 patients we have seen over the last 27 years), and a much larger kitchen area, as well as living quarters for the clinic staff who live upriver in Indiana or in Iquitos, who cannot go home at night. We have a vaccine refrigerator, a laptop computer and printer, and a kitchen refrigerator for the clinic employees who live at the clinic. None of these were part of the clinic in 1993. We have a hematocrit centrifuge to measure whether a patient is anemic, and a glucometer to check blood sugar level, and an oxygen tank and nebulizer. None of these were around in 1993, either.
So, we have evolved. From a one-woman operation which served a couple hundred patients a year, we have become a clinic which attends between 2,500 and 3,000 patients annually. Both Juvencio and Edemita, whom I trained originally, now have accredited nursing degrees from the National University in Iquitos, and our newer nurses are also officially trained. It is hard to believe that the “new” clinic is now nearly nine years old, but it is.