Christmas Pageant

The Christmas Pageant at the Parish! All 10 communities put together a skit to two local Christmas carols. This group (along with a couple others) has a young girl carrying a LIVE baby Jesus. The kids were so enthusiastic and put a ton of work into this evening. As one of the judges, I has a front row seat. While I wanted to help this young girl support the baby's head a little better, I left that up to the parents who partook in the skit. Happy Birthday Baby Jesus!



Tongue Growth

A 7 year old came in with this firm growth on her tongue, since birth. It's not painful but recently has gotten somewhat bigger. She also has a fullness under her left jaw since she was 3 months old. The mass is firm and looking close, clear fluid filled vesicles are evident. It seems to me to be lymphangioma circumscriptum, a cystic benign hamartoma of the lymphatic system. Any other ideas? We have worked with an amazing ENT from colorado who will be here in September and has agreed to remove it. Thank you Dr. King!

Brain Bleed


This 44 year old man came in to our hospital on Christmas day after falling backwards, hitting his head, and not waking up. He has a wonderful wife and five children, the younger of whom is 5 years old. He had pinpoint pupils, decreased reflexes, and only responded to strong sternal rub. He had course breath sounds and a fever. We evacuated him on a hydroplane with the diagnosis of brain trauma, skull fracture, and aspiration pneumonia. This is what we found on the CT scan hours after his arrival. That same night, the neurosurgeon on call put two bore holes in his occiput and drained the large white hemorrhage. He's recoveing well, talking, eating, and very stable. Thanks to all our staff and to Padres Jack and Moe for always going above and beyond to provide the best care for our patients! 

Guess the fruit

I was amazed to learn that this beautiful fruit growing an the bushes in front of the franciscan mission
is a cashew!! The nut is inside the green kidney looking structure on top, and the fruit is actually refreshing and juicy! One little cashew from each fruit helps me understand why they are so expensive!

Feliz navidad 2014

Charlie was unhappy and shaking with fear at this plastic Santa Clause! I don't blame him. We were at a Christmas party a few days before Christmas and he had the same terrified reaction to a santa pinyata that was pulled up and down as children swung at him. He's a bit sensitive past his 8pm bedtime. 






I'm 15 months old!

I'm working on my 7th tooth. I like to chew on my frozen teething ring for 2 minutes. Then I get bored and find other fun things to do, like play with spatulas and ladels or kick around the soccer ball.

Today I decided that my peaches and cheerios would taste much better if I were just half dressed. So I pulled my arm out of my shirt. To my surprise, they tasted just the same. Live and learn!
I LOVE to lay on the cool tile floor in the afternoon jungle heat. I stare for a while at the lightbulbs on the ceiling, then flip over and find tiny ants to squash with my extremely accurate pointer finger. I beat on my chest and pretend I'm a gorilla, or make elephant noises, or yell as loud as I can to remind mommy and daddy that I need all of their attention.

Charlie's favorites

We had six months back in Peru, this time with a baby. Before we left we wondered.. What will life be like with a baby in Peru? Family time might be nice... with our own house and our evenings together. I arrived in Santa Clotilde with few expectations. I decided not to not take call, and worked from 8-2. I went home to nurse charlie at 11 every day, and then took care of him and prepared dinner in the afternoons. At first, life felt like it had a good balance. The first time charlie met Zulma his nanny, at 6 months old, he gave her the biggest hug I've ever seen. She cared for charlie and played with him while we worked. We came home in the afternoons and to a perfectly clean, organized house, Charlie bathed and fed and rested and playing with her on the floor with a few toys, laughing and enjoying life. He was happy, stimulated, and ready to cuddle and nurse. I remember the first time he tried chapito- boiled and blended ripe plantain with a little milk... he was about 8 months. I gave him a little cup of it, and he chugged it down, and boy did he yell when I tried to take the cup away from him. He LOVED it! The only food that competes with chapito was Lily's aguaje curichis. This is a frozen popsicle of a local fruit aguaje, with milk and vanilla and sugar. He sucked the sweet treat down out of the bit off corner of the plastic bag and practically inhaled the whole thing, despite brain freeze and frostbit hands. Most of my memories revolve around Charlie learning to crawl and chew and cruise, and be amazed by the birds and jump up and down at the sight of the dog or latin music.


Work is a bit of a blur. I have do have some saved blogs to post that I never got around to doing because we had very shotty internet. I do love work and the satisfaction that comes with seeing kids and adults alike return to health. And I love the intellectual stimulation that comes with complex presentations and being present for baby births. I love teaching on rounds, and learning from both patients and colleagues. I love to hear about natural remedies and local beliefs around the causes of different illnesses. 

-Antoinette

In the hospital now are 3 babies with pneumonia, a little boy who burnt his hand in hot oil, another who burnt 15% of his body with boiling water, a girl with a snake bite, another with cerebral malaria, a mom and baby we delivered by cesarean section (her third c-section). We have a woman with cognitive delays and severe anemia, one with pyelonephritis, and two patients with paralysis who have been living here because they have no place to go. My wish for this week to have a visit by a physical therapist who speaks spanish for a month or a few months. The need here is great!

Charlie is walking (with lots of support), crawling like a worm around the floor, jumping and patting his chest to the rhythm of music in his jolly jumper... or on our laps. He love to listen to music and has overcome his fear of the very loud blender. The wandering chickens, dogs, birds, occasional monkey, and tall trees blowing in the wind never cease to amaze him. He LOVES bath-time, like everyone here who's hot and sweaty. I fed him chicken liver for the first time, smashed up with boiled potato. There is not easy access to iron fortified foods here, so liver is one of the only options... He ate it. I tasted it... I taste all the food I feed him...  and did not like it. He loves mashed spaghetti, lentil soup, cream of broccoli soup, sweet potatoes, boiled plantains blended with milk, oatmeal drink, and carrots. This his is usual diet. He's growing like a weed. He smiles when he wakes, smacks his lips when he wants to eat, and laughs our loud at animal sounds. He has four teeth and has left bruises on my legs with them. Luckily I still have all my body parts... his teeth are as sharp as razors.

Pray for Margarita (a sick patient who passed this week) and here family.

Wish: allergy and lubricant eye drops, a physical therapist who speaks spanish

-Antoinette

The tightrope


26 June 2014

For most of the beginning of May, we’ve had over 20 patients hospitalized and a record number of emergencies and transfers to Iquitos. We’ve sent many patients home healthy, including a boy who got shot accidently in the side of his back/neck/face by an animal trap. All bullets are permanently embedded in his body, luckily having missed all vital organs. We also have watched many kids recover from asthma, pneumonia, diarrhea, tropical myositis, malaria, orbital cellulitis, and neonatal sepsis. Adults have stabilized with heart failure and heart attacks, liver failure, kidney stones and urine infections, dengue, HIV, and severe anemia. We have transferred patients to Iquitos with testicular cancer, stomach cancer in a pregnant women, tuberculosis coughing up lots of blood, a kid with bilateral arm fractures who fell from the top of a tree, a guy with a spinal cord injury and paralysis of his legs, and most recently, we sent a kid today by float plane to Iquitos who had sepsis, pneumonia, meningitis, osteomyolitis, and anemia. It’s 9pm and we’re waiting for two patients from 12 hours upriver, a young woman with severe anemia (a hematocrit of 3) with probably leukemia, and the other an older woman coughing up blood with probably tuberculosis. Brian and I have two young Peruvian doctors here working with us, doing their obligatory year of service. We’ve also had wonderful volunteers walk this journey with us. We’re tired, we give our all to Charlie and to our patients, and while it’s amazingly rewarding, we end up sitting at our dinner staring into space, being too caught up in the wave of patients to be able to even process the experience.  We do our best to support to each other, laugh together, ensure proper nutrition and attempt for good nights sleep.


Saint John Baptist de Lasalle


I grew up in a group called Lasallian Youth during my high school years, which was a service organization responsible for many of my life long friendships. It was a formative supplement to the great life example set by my parents, and no doubt part of the inspiration that lead me to Peru for three years.

Today is a big deal here, the feast of St. John “Juan.” Everyone celebrates by making “Juane’s,” which is a piece of chicken, egg, and olive in a ball of rice, all wrapped in a banana leaf and tied tight at the top to keep everything inside. It’s then boiled, which makes it also a “safe” food to eat on the street since it’s well sealed. It is supposed to be representative of John the Baptist’s head… post guillotine. It’s easy to forget that gruesome detail while eating this delicious meal!

Love of his Life


Last week Samuel was admitted with a heart attack and the priest came to anoint him. The plans changed and he decided instead that he wanted to marry his partner of over 40 years! Right there, 30 minutes after the decision was made, Brian and I were witness to the marriage of this beautiful couple and stood by their side as Godparents. He later started to talk incoherent for a short time, and when he returned to his normal state, he said that he saw a set of stairs with a bright light at the end, but nobody was there so he decided to turn around. Apparently the angels were also celebrating this union before God. He will share the rest of his days with his “new” wife and life partner.



-Antoinette


We now have a new blog. 


Follow us at Santa Clotilde Mission
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