On the boat to Iquitos

I'm sitting on the back our our hospital speed boat, heading to Iquitos, with the bright sun reflecting off of the calm water to my left. To my right, the sky is somewhat overcast and Treycy is sitting in her mom's lap, smiling with a cast on her arm. Grodier, an amazing young carpenter and father of three, is laying on a stretcher in the front of the boat. He can't walk and we suspect that he fractured his back after falling down carrying a door. Our new pharmacist Luis Alberto is at my side. Since his arrival, patients have not wanted for any medicines. He does a good job.

Charlie is home with dad, and for the first time I'm traveling without him. Knowing that we should return by tomorrow afternoon to Santa Clotilde makes this a gentle transition. I have no worries... I came home from my first "real" call two days ago (in other words I was in the hospital the whole evening, overnight, and then all morning rounding on our 25 patients and tending to patients who arrived with malaria, vomiting, and dehydration). Brian was in the shower. Charlie was fed, bathed, clothed, and watching Rio2. The laundry was done, the house was clean, veggies washed, powdered milk made, and he had food waiting for me. So as you could imagine, I'm loving this boat ride... it's the first 

time in over a year I've had to myself. 

What a miracle it is really, to be here in Peru.
Charlie is 16 months and I've been considering weaning him from nursing. The local wisdom that I consistently hear while talking to other mothers here is "put toothpaste on and then he wont want to nurse anymore." After weeks of contemplation, I tried it. It worked like magic! After one taste of toothpaste, he wanted nothing to do with me. I offered him a bottle which he happily accepted. Multiple times throughout the day he would re-address the issue, pulling my shirt down and digging for a drink. Every time, he saw the flaking toothpaste and the smell of mint, looked at me and cringed his nose, and walked away. After 15 hours, I actually gave up. He was half asleep at 10pm, fussing and crying, and I was tired and overfull, so I gave in. I thought maybe a bit of a slower transition over a couple weeks would work better for me.

Work has been busy and fulfilling. I feel so happy to be able to meet the needs of local

families. Last night we gave Treycy ketamine to reduce her fracture and cast her arm. We played lullabies and talked about rainbows and butterflies and she smiled. This morning I walked over, knocked on her cast, and asked her "when did you put this on?" and she giggled, shrugged her shoulders, and replied "I dont know." The beauty of ketamine is that kids don't hurt and remember nothing. We also have 3 kids in the hospital with glomerulonephritis and high blood pressure, three patients with HIV- two of whom are incredibly sick, a bunch of people with pneumonia and possibly TB, a few kids with severe malnutrition, fevers, and big livers. One 14 year old boy had surgery for spina bifida as a baby and although he can walk, he has ulcers on his butt and foot because he lost some of his sense of feeling and forgets to shift his weight. He's healing well. We had a woman who was 22 weeks pregnant with a severe infection in her belly who ended up delivering a very premature baby. Another woman was on her way to our hospital from 4 hours upriver and ended up delivering TWINS en route, in her canoe. The mom and full-term healthy twin girls arrived healthy and breastfeeding and went home two days later. 

In Iquitos, after bringing the patients to the hospital and ensuring they get the X-rays and care they need, I'll be shopping to re-stock our pantry and buy a few fresh items for thanksgiving dinner. Although Santa Clotilde is a small town, we find almost everything we need there. For the things we cant buy in Santa Clotilde, we go to Iquitos. For the things we cant find in Iquitos, like good ground coffee, hershey bars, and peanut M&Ms to fulfill Brian's addiction, we phone a friend and the monthly volunteers are often able to find room in their bag for us. We're so grateful for all the support from back home that allows us to serve here!

Felicidades Vanessa, Bill y Baby Mia Valentina!

Vanessa is one of our superstar nurses. Having surpassed a couple of pre-term labor scares, and enjoying a fun filled baby shower last night at Lili's house (below), she arrived to Centro de Salud Santa Clotilde this morning in labor pain! As you can see above, she's ready for this baby to come!

                

                    Can mom or dad feed a baby faster?

Padre Jack, making balloon animals!! What can't he do!

One last ultrasound for Vanessa! Baby looks good!

After saying an "Our Father", as is custom here, doctors Yesica and Toni perform a Cesarean Section, to find, as suspected....

A perfectly healthy, gordita baby girl Mia Valentina!! 

God Bless Vanessa and Bill and Baby Mia!

X-Ray

We've recently have two young mothers admitted with active tuberculosis. One lives here in town, and active TB was detected two days after she gave birth to her 5th child. Another woman from upriver came in to clinic with her 4 month old (her 4th child) and was diagnosed with active tuberculosis. All 9 children are PPD positive and need chest X-rays, as do the husbands and other family members. We need to know if these kids have active tuberculosis (which in children is sometimes asymptomatic), and the only way to know is based on chest X-rays. If we give them prophylaxis against tuberculosis and they have active tuberculosis, the bacteria will become resistant and transform the infection into a very hard to treat dilemma.

Do you know the diagnosis?

We do not have an X-ray machine here at Centro de Salud Santa Clotilde (CSSC). This is #1 on our needs list at the current time. We serve over 30,000 people along 250 miles of river. Our top three most common diagnosis here at CSSC are 1) infectious disease/parasites/abdominal pain, 2) respiratory infections like pneumonia, and 3) musculoskeletal complaints like fractures and trauma... most of which "require" an x-ray. It costs $100 per patient to go to Iquitos (on the fast public boat) for an Xray, most of which we end up covering because most of our population are subsistence farmers and don't have that amount of money.

Some families choose the "wait and see" approach to fractures in their children due to fear of the cost, and children end up with permanent disabilities. Without X-ray, we treat complex pneumonias including tuberculosis and attempt to put bone fractures back into place. We had a premature baby born with respiratory distress and after 10 days of no improvement she went to Iquitos and with a simple X-ray was diagnosed with a diaphragmatic hernia (intestines herniated into her lungs). Stranger things happen... we recently had a woman who swallowed a fish bone, but on evaluation we saw nothing in her throat. She admitted that it was no longer in her throat. On her second day here in the hospital, she was alert and talking, and we felt the fish bone starting to poke through the skin of her neck, and hours later she died. Maybe the X-ray would have detected the fish bone earlier and saved here life.

We have a long list of people who need X-rays, and we have rampant tuberculosis in the area, and we have a 35 bed hospital, and we have a fantastic radiologist at U of Michigan who reads all our X-rays (done in IQT)  for us, and we recently had a volunteer pulmonologist Dr. Wayne Farmer who gave two amazing talks on reading X-rays and tuberculosis, and we are living in the 21st Century. So why don't we have an X-ray machine? I ask myself this question almost daily. We are actually just $150,000 away from a portable digital X-ray machine, and have high hopes that the local government here will come thorough with funding next year, in collaboration with the local rotary club and maybe other generous donors. This will allow us to bring the X-ray machine to our 100 communities and formalize a tuberculosis program.

Cutaneous flour migrans

This is a bag of flour that we use to make pizza, pancakes, roux, tortillas, etc. 

"Cutaneous flour migrans"

 Most of the bugs come out with sifting, and we could use a little extra protein anyway!

Young couple, new parents

Congratulations to this young couple! Their beautiful baby boy was born quickly, with Brian present in case resuscitation was needed for the presence of meconium. Otherwise the midwife does the delivery with the nurse present for the resuscitation, and we're only called for complications. A great majority of patients here on the river deliver at home, but despite this, our midwives keep busy!