We now have a new blog. 


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http://santaclotildemission.blogspot.com/


Los Angeles

     Hello everyone!!!!  We have not blogged in a long while, and although we have been away from Peru for almost 3 months now it has been for good reason. Antoinette and I are in a 4 month formation program in Los Angeles, CA with Mission Doctors Association (missiondoctors.org). As we have mentioned previously this group, since 1959, has been supporting doctors on mission throughout the world including Zimbabwe, Uganda, Papa New Guinea, Thailand, and Kenya. We currently have doctors in Guatemala, Cameroon and Peru (when we head back to Santa Clotilde). Our formation program is very interesting and we are in class from Monday through Friday learning helpful skills to aid our work outside the U.S and away from the culture and way of life we are so accustomed to here at home. Our curriculum consists of several topics such as mission theology, communication, Myers-Briggs, cultural awareness, emotional health, moral theology, surviving overseas, health overseas, and enneagram to name a few. Although we were already in Peru for one year, we recognize the importance of these classes and how it will help us to communicate, avoid burn-out and not make common mistakes when working abroad. I think we are more aware of ourselves and will be able to live and work a more balanced life when back at Centro de Salud Santa Clotilde.
      Speaking of Santa Clotilde, the work carries on!  I would like to thank Fr Jack, Dr Juan and Dr Julio along with all the midwives, dentist and staff for continuing the good work while we are gone, as well as the volunteers and students from Mission Doctors, Loyola, UBC and U of Minnesota.  Some exciting news comes back to us from Peru such as: a visit from the national Ministra of Health who sat  down and had a conversation about our reality. Progress is being made on our x-ray machine slowly but surely, and another doctor from El Salvador, Cuban trained is also working on the river. Our logistics coordinator Javier and Padre Moe are working diligently to restore in working fashion the barcasa, our barge that will be able to make trips up and down the river, even all the way to Iquitos for vaccines, supplies, patient transport, and our Amazon experience for visitors.
     We are in training until the end of May and then back to Chicago for a while, then back down to the selva which I think about daily. Keep us and all on the Napo river in your prayers!

Brian
April 21, 2013

Italo




Italo was a 5 yr old with difficulty breathing and swollen lymph nodes in neck. I've never seen such an impressive X-ray. He had Leukemia or Lymphoma. Pray for Italo and his family.

The fragility of life

     We have our trip planned home to start our formation for 4 months with Mission Doctors Association in Los Angeles, but the last week in Santa Clotilde kept us more than busy with an in your face view of reality here in Peruvian Amazon. The week was non-stop as several emergencies came in to our Centro de Salud. The first was a child from Cabo Pantoja, the community on the border between Ecuador and Peru, six hours up river in speed boat from our hospital. Italo, a very smart and pleasant 5 year old boy came in with several months of fevers and night sweats with swollen lymph nodes on exam. His likely diagnosis was a lymphoma. We performed a lymph node biospy and sent the sample to Lima for pathology. He was stable during the day but at night due to the compression of the swollen glands in his neck had some difficulty breathing but his oxygen saturations remained within normal range.
    On Wed morning began a 3 day series of difficult stories that I am now reflecting on exactly everything that happened. We recieved a call from our nurse tecnico stationed in a small community 4 hours up river in Rumi Tuni, he had a pregnant lady come in with difficult labor in her 10th pregnancy, she had labor pains for 2 days but came in because of an acute worsening of pain the night before, he felt the baby's head and a tense abdmonen, we knew the patient would need a c-section. So immediately Toni and our midwife left Santa Cloilde in our emergency boat, a delivery kit, and our USB adaptable echo and laptop. They arrived to find a woman in distress with a stillbirth and hemorrhaging, on the echo Toni saw an unusual thing, bubbles inside the abdominal cavity. They started a second IV and pushed fluids and pain meds and started on the way back to Santa Clotilde. Toni called me just prior to departure and we started to prepare the OR for an emergency c section and found donors for blood that was awaiting in the fridge for their arrival. When they arrived we went directly into the OR after she received 6 liters of fluid on the trip down, we started her blood transfusion, antibiotics and a 7th liter, awaited her labs to ensure she did not have signs of severe infection and bleeding issues (DIC in medical speak) and proceeded with spinal anaesthesia and the c section. As Dr. Juan Jon and Toni entered the abdomen they found the bag bulging into the abdominal cavity, a uterine rupture with bleeding, the baby was a stillbirth as expected. The mother tolerated the procedure well and after a difficult repair a tubal ligation was performed to prevent a high risk of death for mom if there were to be another pregnancy. A baby lost but a mother of a large family saved.
     Shortly after Toni left a health post in the town of Tacsha Curaray, that is 2 hours down river from us, came in their emergency boat bringing a gentleman with a right femur fracture. This man was on his farm with his cattle when a rope tied to one of his cattle was on the ground looped loosely by his foot, the cattle startled and stampeded and the rope pulled the man's leg and he was dragged for a short distance. His leg is stable as is his blood count, he will need to go to Iquitos for an operation when we have the means, a doctor free and our emergency boat ready
     That same night, Wednesday, night Dr. Juan was on call and it was busy, 6 admissions, including two very sick children. Juan had a 18 month old child come in with severe dehydration. He started fluids and she started to respond, but still very sick. At 5am another child entered with seizures that were controlled with diazepam and lumbar puncture performed to rule out meningitis. Meanwhile Toni continued her travels as she left a day early on Thursday morning to Iquitos with Italo whose airway compression from his lymphoma worsened and was more critical. After rounds the child with dehydration continued to worsen developed a fever and then started also having seizures. As we tried to look for papilledema we noted cataracts and with mom's history of weight loss (40% of her weight, supposedly) we were unsure if this was a congenital malformation, brain tumor or metabolic disorder leading to the illness. Shotly after we were able to stop the seizure the child went into arrest and despite CPR, ambu bag for air with oxygen and atropine and epinephrine this child died. Our other child from 5am with seizures was getting better. We also had another elderly gentleman with likely lyphoma also head to Iquitos for a consult with the oncologist and a bone marrow biopsy, we also did his lymph node biospy earlier in the week.
     We thought all was settled, I was preparing for my trip to Iquitos to meet Toni for our flight to Lima. I was bringing down 3 more patients to the regional hospital, one as an emergency as he had an open fracture of his arm and two others who had their outpatient appointments, one for vertebral tuberculosis and the other for basal cell carcinoma on the face.
     I was finishing up paperwork and packing when I recieved a phone call at 1am from our nurse Elita in Iquitos saying she was just notified from the hospital that Italo, the child who went with Toni had died in the hospital.  Toni arrived with the patient in the ER and he was stable, attended to by medical interns. Toni was helping them by presenting the story and making recomendations. However there is NO DOCTOR in the emergency room at this regional referral hospital for a city with a population of 180,000 people. The pediatricina did not show up for several hours, meanwhile Toni stayed with the patient this whole time. The chest x-ray of Italo was heart breaking he had a very large chest tumor (mediastinal mass), when he cried his compression was worse and his oxygen dropped. He went to CT accompanied by Toni, no other doctors, nurses nor pediatricians, but he could not lie flat on his back due to his oxygen and shortness of breath. The radiologist was upset he could not lie flat and just told her to "get him out of here" She went back to the room with him and advised the nurse not to agitate him as his oxygen drops and that he needs to be seated not lie flat. He as watching sesame street on her laptop, coloring when she left him. He was dead an hour and a half later. We know he had a very bad, aggressive disease and we are not sure if he would have lived, but he certainly should not have died in a hospital supposedly with the resources of a surgeon to do a tracheostomy an ICU and ventilators.  We are glad to be coming home for a break to mentally recharge before we head back to continue to fight in Peru.

Brian
20 Jan 2012

Toni's brithday

     Just after Christmas on Dec 28th is Toni's birthday. To celebrate I wanted to throw a party and following tradition provide a nice meal for our guests. Since Antoinette is allergic to poultry; the food staple of chicken was out. I decided to buy a pig to serve. However, here in the jungle buying a pig is not as simple as going to the grocery store and buying a ham, or pork chops or ribs. One of our co-worker's mother raises pigs about 45 minutes up river. The morning of the 28th he left and picked up a pig, i thought a 30-40kg pig would suffice, he came back with a 62kg pig, and although it cost more than I was expecting to spend it was very cheap in comparison to the same amount of meat back home. He came back in the early afternoon with the hog tied and hanging froms it legs on a post.  We carried it outside of the kitchen and then proceeded to prep the pig. It was the first animal i have ever killed (other than a bird with our BB gun a long time ago...even then i think it was my brother that pulled the trigger- we both felt very guilty afterward for killing a living animal). They first boiled a huge pot of water then showed me where to stab the heart, after a few loud wails from the pig he took his last breath. (warning some more graphic pictures below) I felt as if i was re-enacting images that were evoked while reading "The Lord of the Flies" in high school. Then the other guys teaching me the ways of butchering and preparing a pig did the rest. They poured the boiled water on the pig and scraped off all the hair leaving only the skin, then they opened up the underside from neck to rear and took out the viscera. Then we sectioned the pig and cut away the fat. That night we prepared a rub and let it sit overnight in various fridges as it was a large amount of meat; the next day the whole pig was cooked for the party on Sat night.
     It was a much different feeling eating this food, as i think about the whole process, i did not feel guilty as I did with the small bird killed during childhood. People here learn to hunt, butcher and prepare food out of necesity, and it is a ton of work. I reflect on the way of life for the Native Americans in our country who hunted buffalo in a group and working as a community to butcher the meat and drag it back to their camps. How the government and white people took their way of life away from them by killing all the animals for sport or fun. Here it is a pure form of living, one much more atuned to nature and the abundance the earth can provide.
     The pig tasted as delicious or better then the meat back home. At the party, we ate the pig, drank some beer and danced; it was a fun night and I think Antoinette liked the present of a pig. It is a present neither one of us is soon to forget.......yes I also bought her a nice new umbrella, not just a pig.  Below are some pictures, some a little graphic

Brian


Christmas Celebrations

Padre Jack with Christmas Dinner, very happy about his catch!

Here are the kids from Sargento Lores, a 10 minute boat ride upriver, who volunteered to come to Santa Clotilde to sing carols a few days after christmas. There were 7 close communities who participated, and Sargento Lores came in second place. I traveled to Sargento Lores two days before the competition and the day of, I presented them to a church full of people. Sargento Lores is an indiginous Kichwa community. The leader of the community more than anything to provide a good education and opportunity for their children. They are an agricultural community and grow yuca, plantains, and lots of fruits. They also have some cows, buffalo, pigs and chickens that they raise. They are artisans and make baskets, crafts of balsa wood, and bags. They wish they had a market for their artwork, produce, and animals. 
Then Liz, Paul, and Josia invited us over, along with Padre Jack and Erik, the visiting student from Canada. Liz was raised in Africa by missionary parents and made a traditional holiday meal of curry lentils and rice, and 10 different toppings including nuts, raisins, coconut, papaya, and banana. It was delicious! Then we watched Andre Rieu Christmas Carols with a japanese children's choir! The music and company were beautiful!

Christmas Mass with an artistic musical culturally-relevant reenactment of the Nativity Story, including accents about caring for each other and for the environment. It was amazing and really emphasized the true joy and meaning of Christmas. We have lots of talented youth here in Santa Clotilde!

Our Nativity Scene, built from scratch by our maintenance men with a traditional leaf roof, bamboo walls, and sod floor. All the animals resting on the sod are fashioned facing the crib of baby Jesus, who appears on Christmas morning. Complete with musical christmas lights, garland, and ornaments it keeps many kids occupied in awe. Traditionally all Christmas adornments are taken down on Jan 7th. One more day of festive music and decorations!

Our Secret Santa Gift exchange in the hospital kitchen, our usual reunion area.  We each described our "secret friend" until the group was able to guess who it was. My "secret friend" was a dead giveaway since she is know for being the best volleyball player in all of Santa Clotilde- Lleni Guerra. It was such a warm, happy celebration! Nothing replaces our own family, but I could say that our family in Santa Clotilde is a close second! 

Feliz Merry Christmas

Christmas Season 2013 started off with Brian and I cooking dinner for  our compadres, our godson Sander and his brother Jack. More than the stuffing dinner and pistachio pudding for dessert, they loved the balloons with a string attached!

Then Liz, Paul, and Josia invited us over, along with Padre Jack and Erik, the visiting student from Canada. Liz was raised in Africa by missionary parents and made a traditional holiday meal of curry lentils and rice, and 10 different toppings including nuts, raisins, coconut, papaya, and banana. It was delicious! Then we watched Andre Rieu Christmas Carols with a japanese children's choir! The music and company were beautiful!
Los Posadas... for 9 days before Christmas, signifying Mary's 9 months of pregnancy,  carols are sung by a group at houses around town. They carry a statue of Mary and Joseph as a re-enactment of their search for lodging. Centro de Salud Santa Clotilde is the final stop on Christmas Eve for over 500 kids, where we the "innkeepers" finally let them in... 
Once everyone enters, Padre Roberto has a Children's mass in the lobby of the hospital. He emphasized the details of Christmas... Where is Mary from? Where was Joseph from? Where was Jesus Born? Etc. The kids cooperate and know the answers... 
Answers: Mary of Nazareth, Joseph from Belen, and Jesus was born in Joseph's home town of Belen. And the children are welcome to partake in hot cocoa, panetone, and candy from Santa Clause.



6th Grade Graduation




Happy 6th Grade Graduation! The largest class of 102 kids graduated on December 9th. All graduates wore elegant ivory dresses with fancy silver heels or white shirts and a tie. For the ceremony, all the females are paired up with a male and they danced together the entire evening. They have "fill-ins" if there is an uneven number of males and females, and these kids wear different color dresses or shirts. There was a "godfather" of the ceremony, a doctor from the city, who financially supported the party. The kids desks and chairs were pulled out onto the sidewalk between two school    buildings and they were all dressed with white tablecloths. Families chose a table as they arrived. Each family brought their own pitcher and cups and filled up with juice in the kitchen before the plate of chicken, rice, potatoes, and olives were served. Each table also received a couple bottles of soda and beer, and then for dessert a "brindis", or alcoholic toast with coffee, milk, sugar, and aguardiente (local potent sugar-cane alcohol that tastes a little like tequila).  Seeing adults sit on little chairs with little desks made me laugh, but that is how things are done here. While graduates' names were being called, they stood in two lines of partners and advanced over the sidewalk dividing the grass. Meanwhile, the "security guards" were chasing down dogs who snuck in to the party to kick them out. Wawki (our dog) managed to get in a couple times but was quickly hunted down. Dinner was followed by disco lights and really loud music, and almost everyone danced. I showed some of my american moved and had everyone laughing. Brian and I were invited by Victor Hugo and Leynis who's son Victor was graduating. We knew that of people and had a really fun time dancing and sharing stories. The festivities lasted six hours, but we didn't make it to the end and headed home. 

End of the world.....really????


           Well if the Mayans were right then Antoinette and I are separated by 6 hours of river as I traveled up river to the community of Angoteros. I will be working in the health post all day today and then, the reason I came up, a meeting with the local authorities to plan for the inauguration of the new health post. On a side note I believe the Mayans never really said it was the end of the world I believe they felt it was the end of an era and the beginning of a new one, it was media and crazy people that said it was the end of the world, not the Mayans.
            Angoteros a community very native, a group named the Kichwa who have their own language, which is very difficult and of which I know about 8 words.  They are a quiet group and their elected leader the Apu is an older man, who also is of very few words even though he knows several languages and has traveled to several South American countries. There are some very beautiful aspects of their culture and some very ugly aspects. They continue their traditions, dances, teach their native tongue in the schools, but they also have an astounding amount of alcoholism and domestic violence. To an outsider gringo like me it is a difficult life and there seems to be lack of hope. There has been a lot of oppression and discrimination towards the people of the Amazon, most obvious starting at the turn of the century during the epoch of the rubber barons or epoca de caucho (rubber) y los caucheros. Several communities were enslaved, people chained together, taken into the jungle and forced to extract and carry the rubber to boats waiting on the river. Since then the government continues to ignore their rights, poverty and difficulties with a system designed for those with birth records, DNI (equal to a social security card), etc. These people do not have the funds to go to Iquitos to get their DNI paperwork filled out and then wait a minimum two weeks for it to get processed, where do they stay? what do they eat for these 2-3 weeks? Then to get social programs such as health insurance you need to have this DNI, to apply for the DNI you need your birth certificate, where do you get this in the middle of the jungle when you deliver at home??? We offer this service as the health network but many do not come in for several months and the same government states you need it filled out within 7 days of birth. For this reason some birthdates are not too accurate.  Next the government here might look around at other countries and maybe just give them money and a tiny plot of land where they cannot live the lives they are used to and tell them they can build casinos to solve all their problems, that seems to work well for native communities!
            In terms of the help given over the years by missionaries and NGOs it has not helped the long-term situation a whole lot. Over the years the people have grown accustomed to receiving everything for free without offering anything in return nor have there been efforts to create programs of sustainability. The people feel if they are going to help the church, NGOs, etc that these same groups will pay them as they had in the past. That is one of the dangers of just giving money, if no system is left in place then when the money stops, the people are right where they began. For example the two nuns in Angoteros cannot even ask someone to carry up a bucket of water from the river without them asking for money in return. It would be like asking to borrow flour or 1-2 eggs from the neighbor and the neighbor always saying sure that will be one dollar.  I am hopeful for the future of the river as the priests, nuns and now the health network on the river are working towards change in the people, a life of collaboration and partnership, not just of donor and recipient.  This may take 1 year, 5 years or 10 years, but we are moving in that direction and if we can instill this ideal in the younger generation than we can effect change and a better future.


Brian
written on 21 December 2012

Cleft Soft Palate


Patient transfer to Iquitos


I am typing on the rapido boat to Mazan, a 4 hour trip downriver. I have an elderly patient at my side along with his 2 sons. He is an elderly gentleman, who unfortunately fell last Sunday from the raised platform in his house from a height of about 6 feet. On arrival to centro de salud 2 days later during Toni’s call he appeared dehydrated, slightly agitated and feisty. All one had to do was look at his leg to see its positioning and swelling to know he broke his hip, or more accurately the neck of his femur. He is not a candidate for surgery due to his age, functional status and other medical problems.  This “abuelo” or grandfather has a large family, he had 11 kids, 9 of whom are still living . Most are in Iquitos but some still in the small town of San Jorge a few hours up river from Santa Clotilde. After several family discussions they wanted him to come to Iquitos for and x ray and an attempt at a reduction and stabilization of the bone, unfortunately none of this will likely change the consequences of the fall. He is likely to be bedbound and never walk again.
            No one really knows his true age as 7 family members all told me a different age between 87 and 102.  They also told me his oldest son is in his 80s, so that makes him close to if not 100 years old, the oldest person I have seen on the river. A majority of this region was Ecuador last century so some of these older patients were not actually born in Peru, however they, “never crossed the border, the border crossed them” as they say. 
We arrived at the hospital just fine and I ran into another patient who was being admitted. He had been referred, as an emergency case one week ago, but on arrival to the ER they examined him and deemed him not an emergency and discharged him as his exam was stable for them. He has since worsened, which is not a surprise to me and is back with fever and belly pain, he had a diagnosis of cholecystitis (inflamed gall bladder) with us and that is why we transferred him to Iquitos. He is now being admitted and examined later by the surgeon. The hospital is busy and the medical strike is over, so now we can get x-rays and send patients who need further exams, operations, radiology and labs we cannot do in Santa Clotilde. Hopefully by the end of 2013 we have our x-ray machine up and running, which will cut down some costs of transport and give us another medical specialty to learn and understand: radiology.

Brian
written 13 Dec 2012 

December 1: World AIDS Day






To honor the lives that have been taken by HIV
To increase awareness of HIV disease
To improve access to treatment
To promote prevention of transmissible diseases
Getting to ZERO new HIV infections










We celebrated World AIDS Day in Santa Clotilde with education and empowerment in the high school, skits, a parade, and free HIV screening. To our surprise, 2 of 30 patients were positive. In our small town of 6000, HIV in on the rise. Our midwife Blanca called an emergency meeting among some of our staff members to determine how we will proceed. Currently, if a patient is diagnosed with HIV, they need to travel to Iquitos (7 hours away) to get there basic labs, CD4 count, viral load, counseling, and medicines. There follow-up which ideally is monthly then every 6 months is also in Iquitos. Being that we have 40 patients diagnosed within Santa Clotilde and our satellite clinics, our goal is to be able to provide these services here at Centro de Salud Santa Clotilde. We have most of the necessary equipment already, but we need to find funding to buy the reagents and other materials and coordinate with the regional health office in Iquitos to be recognized as an HIV provider.

Thank you to our Midwives Blanca and Carmen and the dozens of other Centro de Salud Staff members who participated in World AIDS Day!

Extermination Team

Last night the lights went out at 11pm and I laid down in the pitch black call room, and I heard something flapping.. a bug.. but it was pretty far away. Then I heard it above the bed, high up close to the ceiling. So I covered my head with the sheet and just tried to sleep. But then it got REALLY close, and as much as I just wanted to sleep, I freaked out and threw the sheet off me and ran out of the room.

I ran into the laundry room where the two nurses and the night watchman Leonario were, and I told them that I was just going to sleep upstairs in my house... it's literally a minute away if you run up the  forty steps. Intead of conceding and being okay with me going home, they all stood up, armed themselves with their flashlights, and the extermination team marched to the call room. There it was, this sort of pretty brown spotted butterfly on the wall next to the bed. Leonario dutifully walked over and squished it with a stick, and it fell to the ground. Then I went to bed and slept peacefully until I was needed again in the hospital.

Antoinette
1 Dec 12

Mame

Mame is a fruit that blooms three times a year, and we're currently in the middle of a harvest. The world smells just like an apple orchard in autumn right now because we have three expansive Mame trees between clinic and our home. The fruit falls and starts to compose and smells just like cider. Kids are as agile as little monkies and climb the trees, managing to avoid getting bit by the colonies of ants that have made the trees their home. They down fruit by the dozens. The fruit makes great jam and another dish that tastes like apple pie filling, complete with clove and cinnamon. The fruit itself taste a bit like a washed out, cottony apple, but pleasant when chilled on hot day. All the little kids waiting in clinic chew on Mame that has fallen from the tree, and if they always ask permission to take mame or mango or papaya that grows nearby. They are very considerate and very happy to fill their bellies with such yummy God given goodies!

Happy Thanksgiving


Nothing like Liz's homemade pumpkin pie and Anita's chicken to top off a delicious Thanksgiving meal! With Brian on call, we managed to eat and relax for an hour or so before he was back to work. The stuffing, mashed potatoes with imported brown gravy, and string bean almondine were delicious!! We should definitely add stuffing and canned pumpkin to our wish list!

We were reminiscing about the Medernach and Lullo traditions and the yummy food that those back home were undoubtedly sharing.

We give thanks for our amazing family, friends, and coworkers for being so supportive and loving to us and each other. Have a blessed day!