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.

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.

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.

1 Dec 12


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!