Boats, mototaxis, and stretchers

The hum of the motor from the back of the rapido, loud festive music blaring in front, and the windows rattling from the temped breeze blowing in feels surreal. Alicia and I are returning from an emergency transport to Iquitos. Two patients had arrived to Santa Clotilde the day prior in critical condition. Jany is a 49 year old woman who arrived so weak she was unable to walk, and bleeding from her gums and the site of an injection that was administered last week. She had severe anemia, probably from chronic blood loss. We diagnosed her with probable sepsis and disseminated intravascular coagulation and she was in a coma by the time we left Santa Clotilde. Carola is a 48 year old woman who fell from 2 meters on her head and broke her neck. When she arrived she was paralyzed from the chest down and had severe tingling and pain in her arms. Although she could move her hands, she had a hard time with small movements.
We traveled 4 hours by boat to Mazan, then put them on mototaxi’s and brought them to the Centro de Salud in Mazan. There, we gave some antibiotics, ensured they were stable, and drove another 15 minutes on mototaxi to the port on the other side of Mazan.  After 3 hours in Mazen, we loaded the stretchers onto the boats again and headed to Iquitos. In Iquitos at the Nanay port, we carried the stretchers up to the street and waited for the ambulance. It arrived but had enough room for one patient only. We took Jany first since she was unconscious, and then the ambulance came back to pick up Carola. We had in depth discussions with the internist and spine surgeon in Iquitos regarding diagnosis and management of our two patients.
We also stopped to visit the 6-month-old patient Jordan with seizures and meningitis who Brian had airlifted to Iquitos two days prior. He was intubated and sedated, but stable. His mother, who had been weeping uncontrollably as the plane took off with her husband and only child, had found the strength and hope to stand strong for her son. We were talking and laughing about everyday things and it was really nice to be able to keep her company for a while.

After ensuring that they were stable and well cared for, Alicia and I headed back to the Vicariate where we spent the night. It was a restful and rejuvenating 8 hours of sleep after a day of boats, mototaxis, and stretchers.
7 July 2012

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