Today we had a teen come in who swallowed organophosphate (a pesticide) because she was mad at her mom. She was foaming at the mouth and twitching all over, and her pulse was 140 and she was writhing with abdominal pain. My brain rewound to pharmacology class with Dr. Mayer and board reviews and I know she must have eaten something... But what? and more importantly... what is the antedote? I couldn't remember! WWJD? What would Jack do? We called him over and he gave her some IV atropine that settled her down. I'll never forget that again! Now she's asking to eat, and that's always a good sign!
Current and New Operating Room
Elia- Brian's first patient with Plasmodium Falciparum- Severe Malaria. She came in with a high fever, anemic, and swollen from head to toe. She was adorable and one of the best eaters I've seen her... She would dive into a bowl a spaghetti and inhale it faster than brother Mike! It took her a week to get back on her feet and regain all her energy. Now she's home sweet home, hopefully sleeping soundly under a mosquito net!
After just three weeks in Santa Clotilde, we traveled back to Iquitos, the “big” city. We are here to meet with director of the ministry of health to plan for International Medical Relief’s (IMR) medical mission in July to the Napo river. We were introduced to this organization though Bob Para, a friend of Colette’s. IMR is a group dedicated to working with underserved populations around the globe, and we are humbled and grateful for their willingness to share time and resources with our communities on the Napo River! They plan to bring a group of about 25+ people including docs, nurses, a dentist, and others and spend over a week some of Peru’s most rural, impoverished areas. A lot of planning will go into this extraordinary, unprecedented event! Starting next month we will visit some of the larger communities to discuss and plan for the arrival of IMR’s medical team. We are in the process of looking for english to spanish translators, so if you know anyone interested in translating, email me and we'll coordinate!
I was just called about a man 2.5 hours upriver... A huge branch fell on his head his family brought him to the small clinic up river in RumiTumi. He fell unconscious when he got to the clinic, so the technico there started and IV and then called me. He gave me the details... 48 yr old man, his scalp is split open... about 20cm, eye swollen shut, bleeding out of his ears, nose, mouth... um... is there a neurosurgeon in the house?? We don't even have an x-ray machine here. He woke from his coma/concussion after 20 minutes and was talking and recognized his family. I recommended some meds and passed the phone to Padre Jack to coordinate transportation. Because there is not a boat there, and since you can't travel by boat at night, we arranged to send a boat to pick him up the next morning and prayed that he continued to improve. The next morning he felt well and refused to come into the hospital. As long as doesn’t have a basilar skull fracture he should continue to improve. Close call! Toni
We are starting a weekly curriculum of trainings called “charlas.” Our first charla covered neonatal resuscitation. Francisca allowed us to use her newborn 3-day-old baby (named Brian after you know who) as a live model. It was a surprise to some to learn that hanging babies by their ankles and slapping their butts in no longer in vogue. “And what do we do, doctorita, for the small health posts that don’t have oxygen, ambu bags, or the ability to intubate?” It was interactive and a lot of fun. Toni
Juan Jon, the Medical Director and our friend and neighbor is going to Angoterros, a small village upriver, tomorrow morning. Money was donated to build a new health post, and he will be there to see patients, supervise the construction, and work with the local health promoter and medical technician. Our call schedule would be tight, but we are lucky to have Allison and Laura, two fantastic family physicians from Canada who are spending a month with us. They are taking call in the hospital and seeing clinic patients and learning Spanish and studying for boards. Allison and I stopped in see our two-year-old patient with Malaria falciparum with secondary glomerulonephritis. She was laying in bed hooked up to her IV, bored and unhappy with how distended her belly was. Allison started playing peek-a-boo with her, and she was transformed. She grew the biggest smile and was laughing our loud!
Toni
Micael, our lovely gentleman with a snakebite on his hand, is sooo much better. He got bit on his finger and his entire arm swelled like a balloon. Today all the swelling was down except for in his hand. We needed to relieve the pressure, so we injected some local anesthesia and sliced his hand open from between his index and middle ringer almost to his wrist. Within hours the terrible swelling was so much better he could move his hand again! We’ve learned that the decision to slice open body parts is more of an art than a science… and we are merely novice artists.
Toni
The day has come that tiny little ants are recognized as an extra source of protein. They are no longer feared or loathed as the ruiners of food. Just dust off what you can and take a bite. I discovered that the itchy annoying bumps all over my body are not mosquito bites but actually scabies, which was generously shared by one of our patients. The relationship I have with scabies is not symbiotic, to say the least. 
Life on the Napo
We have been in Santa Clotilde a week now and are still trying to adapt. The weather has been great. I have no idea what the temperature is but it probably has been in the upper 80-90s daily and upper 70s at night. Sometimes it is humid but we have had frequent rains, which really cool it down. The heat is much like that of a July in Chicago except with more cooling rains; very pleasant.
So far we have not had any encounters with exotic wildlife, mainly insects. I noticed a few ants crawling on a board above one of the doors in our house, so I decided to spray a little insecticide…bad idea, about 300-400 more ants came pouring out of the board and fell to their death. I wasn’t too comfortable with the idea of more being up there (Toni didn’t mind them at all since they don’t bother us) so I sprayed again the next afternoon and another 500 came out and also fell to their death. These were just carpenter ants and they do not bite, I have quickly learned that the “selva” (jungle) is boss here. We are learning to live with the bugs. Our house is quite nice and screened in, but bugs are everywhere... this was their home first. The boards will be replaced eventually. Nothing happens on a strict time schedule, which is a beautiful thing most of the time.
The food here has been pretty good, I definitely have not lost any weight. We usually have a large lunch as the main meal of the day. Breakfast consists instant coffee and bread with jelly. Lunch is at 2pm and consists of rice and either chicken or fish along with plantains and beans. Dinner is leftovers or whatever you can scrounge up. In the afternoon around noon they always put out some fresh juice from a local fruit called a guayaba brazilero and some bread. The local cerveza Cristal is sold in 22oz bottles, and we have a few glasses during the week at night. The things I miss the most so far are good quality fresh brewed coffee and cheese. I definitely plan on bringing a perculator down later, a coffee maker would be good but since there is no power for half the day it would not stay warm….i think the perculator is the way to go. No cheese here on the river and the milk is sold as evaporated milk in a can.
I was able to check on the internet and message with my brother Jon at the end of the super bowl- sounds like it was a great game, I almost completely forgot it even was going on, amazing the media frenzy and coverage in the US. I do enjoy all sports and following several teams, but man do I know realize how much emphasis, time and effort into covering sports as a whole in the US. I am going to go check with the nurses to see how things are going as I am on call tonight. Buenas Noches.
Brian
07 Feb 2012
After the hospital tour and many introductions, we headed to our beautiful new home. In my blissful ignorance, I had forgotten, I guess, that there are bugs in the jungle. Now, I was expecting bugs, but never did I expect to be welcomed by thousands of termites around our cupboard, a millipede, carpenter ants, a lizard, and dozen of god’s little tiny flying dots getting too close to our bedroom light and falling to their demise on our bed. My first impression of the enormous dead dragonflies and bees on the floor of the new operating room was “wow, these are so cool, we should hang them on our wall!” And don’t get me wrong, those bugs were cool, but I’m not sure we need to add them to our home insect collection just yet. 
We received a warm welcome from hospital staff as we climbed up dozens of concrete stairs to reach the hospital after disembarcing on the riverbank. Everyone greeted us with a besito. We toured the hospital, which was larger then I remember from the pictures we had looked through. We transported a man on our rapido boat who was diagnosed with diabetes ten years ago and developed shortness of breath last night, with frothy sputum.We later diagnosed with a heart failure due a slowly progressive heart attack... he's doing well but receiving a stent which is standard of care in the US is not an option here. We were also radioed about a 4-year-old girl with a possible bowel obstruction. She had been picked up from her canoe where she traveled with her mother and the local technico by the hospitals emergency boat. She had a severely distended abdomen, no urination or stool in days, vomiting, and she cried, “mommy, but it hurts so much” as she rubbed her inflated belly. She was rehydrated, given antibiotics, an enema, and was scheduled for transport to Iquitos in the morning. The inpatient ward housed Daisy who has a leishmaniasis ulcer on her arm. One man has a colonic mass 13cm up, which has caused a chronic bleed. His hematocrit when he arrived was a mere 16. He is receiving daily blood transfusions until he is stable enough for transfer to Iquitos. Another patient had a tree fall on his leg and a branch pierced through his thigh… his open wounds are recovering well. 38-year-old women had so much lymphatic fluid around her lung that it had collapsed and was compressing her heart. Her chest tube is being pulled as I write, and she too will be transferred to Iquitos tomorrow. A 1.7kg baby born at 34 weeks at home was admitted at 10 days old for having a fever and cyanosis. Currently off antibiotics, feeding like a champ, and gaining weight. The list goes on…
Toni
