Restful Rhythmic Rain

Mmmmmmmm. After the hot hot sun blazed for days, if finally rained all night and day, and is still cool and overcast. I LOVE cool relaxed rainy sundays! I picked a few new books from Liz's library (canadian who has lived here for 20 years) and I'm about to read Around the World in 80 Days, a classic that I never read. Then tonight we're projecting a movie, popping popcorn, and breaking open a box of vine and a bottle of cocona (local fruit) wine with some of the staff and visitors. Brian has been on a vaccine campaign for 9 days, and finally returns tomorrow! I'm really looking forward to him getting home! Life is fuller when he is here :)

Masato + naive stomach =

Victor Hugo sharing Masato with Carolyn (boiled, chewed, spit out, fermented yucca, shared by family, neighbors, friends, and strangers that sustains workers in the fields and families in their stilted houses. It's a food staple and ancestral tradition of communion).

Carolyn is a 4th year medical student from Loyola who is rotating with us for the month. She has done an amazing job on both inpatient, outpatient, and making fudge and pancakes!
Judith, one of our many fantastic nurse technicians and good friend, starting an IV on Carolyn the next day. Apparently Masato along with many other factors including a new diet, the extreme heat, and endemic parasites are a lot to handle all at once. Thanks to Judith, 0.9% Normal saline, and a fan, we saw a dramatic recovery within hours and Carolyn was back to work the very next morning!

Thanks to Carolyn for her hard work all month!

September babies



             ! FELIZ PRIMAVERA                           
                HAPPY SPRING !

Chronic Wound Healing

 He fell off a bridge at 25 years old and cannot move his legs. He's had this ulcer for over a year that won't heal. There is hypertrophic granulation tissue at the orifice and a strip of undermining over the sacrum that extends about 10cm, that won't close. In the past we have removed the hypertrophic tissue and were more aggressive with debridements, but that did not seem to make any difference. We can't do cultures but he was empirically treated for osteomyelitis for 6 weeks with clinda without improvement.
 Any ideas?

Nutrition Classes

Yoli initiates a series of nutrition classes for local pregnant women and mothers. The benches were full of people of all ages who listened attentively about food choices, textures, and portions for children of different ages, as well as pregnant and lactating mothers. A mix of local foods were displayed. Future classes will include parents and children bringing local crops, age appropriate meal planning, and learning recipes and tips from each other. With the endemic problem of malnutrition, we are starting with this small step to help insure kids are given a fair chance at growth and development.

Patient list

Patient diagnosis list:

Femur Fracture, shoulder subluxation, back contusion. Put in traction 18 yrs
Greenstick fracture-reduced and casted today
Hip fracture for the third time in the same place, elderly lady already has a pin
Hematogenous Osteomyolitis with pneumonia and big liver in 11 yr old
Tumor on rib cage with empyema in lung and very loud heart murmur
Broken nose, his wife hit him
Nephrotic Syndrome- 2 yrs old on steroids.
Glomerulonephritis- pray it's post-strep. he only urinated 10ml today
Tuberculosis- sputum finally negative
Tuberculosis- sputum still positive
Bacterial Diarrhea
Head laceration-stitched up
Miscarriage with severe hemorrhage, D&C and blood transfusion (9 hr boat ride to get here)
Ulcer on hip after stroke
Pressure ulcer for almost 2 years... it won't heal.
Schizophrenia- seeing ghosts at night and voices

8 yr old chronic cough

Today was a good day. Padre Jack is back... until tomorrow. This morning we rounded in the hospital and discussed in detail some of the complicated patients, including Shermuly who is 8 years old and has a chronic cough. She was treated for TB for 6 months last year even though her PPD and sputum AFB were negative. Her CT scan is below. She improved a little bit with the treatment but then had a recurrence of her chronic cough. She came in a few days ago with fever, retractions and pneumonia that responded to Penicillin. She has persistent diffuse crackles and clubbing of her nails. We're sending her to Iquitos for further studies. If anyone (especially radiologists/pulmonologists) have any ideas, please comment below and let us know!!

Then I admitted a guy with tropical pyomyositis, a pocket of pus that forms in the muscle. He's had fevers and leg pain for 20 days. We numbed his thigh and stabbed it with a scalpel... about 7 cm deep, and encountered the pocket of pus. We put a drain in and I imagine he'll be better within a few days.

Then at 1pm we had an administrative meeting to discuss the future of CSSC and some other pressing issues. For example, we have emergency boats up and down the river to transport patients here and to Iquitos. Many of the motors are broken so when emergencies come up, we're stuck waiting until the motor is fixed... Our motor that was supposedly fixed today in Iquitos and on it's way up broke down again.. so we have no boat to transport the 3 patients who were ready to go to Iquitos tomorrow. We discussed helping communities build chicken coops, fish ponds, collecting debts that are owed to us, charging patients on a sliding scale rather than flat fee for care, and more.

At 7pm we had a conference call with Canada, Chicago, and Lima to try to coordinate some PANGO projects for this and next year. Brian and I are starting a Non-for-profit in the US and we hope that through this, we could secure some funds of the many new and ongoing projects we have here.

There is really never a dull moment here. The town electric goes out in 45 minutes, so I will head home from my office and do a few dished (to avoid an ant invasion) before I go to bed.

Conjunctival Cyst

His whole eye was inflamed last week and after antibiotic and steroid drops it left this cyst. Now what?

Muyuna: current of water contrary to the main current

Muyuna is the Kichwa word for an eddy, which is the swirling of water and the reverse current created when it flows past an obstacle. It is a current of water running contrary to the main current, or a circular current. 'The' Muyuna is a beautiful tranquil Parish space on the edge of Santa Clotilde. It is a two story circular building made of all local lumber, set on a hectare of green wooded land.  
                                                                                             This morning we met with Padre Edgar to discuss the possibility of a cultural center, a space where the local indigenous communities could record and preserve their heritage, culture, and traditions. The five indigenous communities include the Kichwa, Maijuna, Sequoia, Huitoto and Orejona. The recent history over the last 150 years here in the jungle is one of oppression and abuse by rubber barons. For generations local communities were enslaved and in the process the culture and spirit were altered. Today, communities choose to remember and hold on to their dear traditions, and tell stores of both good and bad times to their children and grandchildren to help them understand both the pain and strength that runs through their blood. 

                                                                       There are few indigenous peoples left in the world. This is very alarming being that now, in an age of global warming and environmental disaster, we are left with few cultures look to and learn from in order to live in a way that preserves the earth for both our generation and those to come. Streaks of shame run through the history of our own country, where indigenous peoples were mistreated, enslaved, and torn from the land of their ancestors. This has left a scar so deep that many only know to fill it with alcohol and gambling. Others, however, gather strength and perseverance by giving back to their communities and working against all odds to maintain their traditions and cultural identity.

                                                                             In contrast, most of the Napino Peruvian Indiginous communities still live on the land of their ancestors. One community in particular, the Maijuna, were recently granted a title to their land, on which their ancestors also hunted and gathered, after a Swiss group spent 10 years working with them. Their is historic memory in the elders and right now we have the opportunity to capture it, not only for local generations to come, but to share their message with other concerned citizens of the world.  


Here on the Napo River in the Peruvian Amazon, many beautiful people and cultures and lands are being threatened in the name of modernization and progress. The local Catholic Parish is working hard on conscientization, the process of developing a critical awareness of one's social reality through reflection and action. Last month the parish held a Social Justice conference where the apu's and other local leaders came from up and down the river to gain deeper insight into how their land impacts the world.

                                                                          The Muyuna is the answer to this call. The space is ready. There are the beginnings of a fish pond/hachery fed by a natural stream in order to bring sustainability to the locale. There is a space to plant seedlings to be distributed to communities along the river to help with reforestation. In the actual building, we envision a documentation center which houses a research library, audio-visual archives, a GPS mapping project, and a documentation team. There will be tranquil dormitory space for visitors to rest while collaborating with the documentation project or coming to learn about a "new" ancient way of life.

We are looking for anthropologists, cultural experts, organizations and foundations to collaborate with local communities to realize our collective dream of looking to the past to heal the future.