Eclampsia
Saturday with Padre
Brian
Pura Vida
There are no movie theaters, no coffee shops, no shopping malls, no museums, no cooking classes.
There are two restaurants that serve about the same thing every day, but no bank or post office.
There are no cosmo magazines or billboards or radio ads.
Stir Crazy
Here it is pura vida. Just the simple life. Living is building relationships, seeing exactly where your food comes from, depending on the land and water for livelihood, depending on God and each other for support
Creativity
Paint a picture, cook a new meal, find a new food, read a book, watch the sunset, listen to the palm trees stir in the wind, feel the hot sun on your face, take a cool shower, listen to music, share some juice with a friend, play bottle caps with kids, awareness of everyday miracles
Undulating Peace
Miraculous Martha Luz
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| Victor Hugo and Padre Jack living a miracle |
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| The state of Loreto (green area) is the size of Texas. |
I arrived 45 minutes later from down river to find an adorable crying chubby pink baby in the incubator. Her first week was rough. She was breathing at 100 breaths a minute and her oxygen would drop to 75% on room air. Now she is on 1 liter of oxygen, breathing at a normal rate, eating and gaining weight. Although her lungs sound clear, we haven't been able to take off the oxygen. It may be Meconium Aspiration Syndrome or Pulmonary Hypertension or a resolving pneumothorax. We don't have X-ray, (or a neonatologist) which may help us distinguish.
Her parents want to leave because they have a 6 and 11 year old at home. Dad says school starts tomorrow and the kids paddle a canoe (alone) across a stretch of water to get to school. If there are lots of waves, the dad will take them because the canoe easily tips over. He is worried for their safety while here. I encouraged him to stay here because without oxygen, Martha Luz's oxygen level drops to 80%, which could cause brain damage or suffocation.
Life on the river is not easy. God has a way of working through people and bringing hope and strength where it seems there is none. Pray for little Martha Luz and her family.
International Medical Relief
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| IMR in Santa Clotilde |
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| Huitoto children doing traditional dance in Negro Urco |
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| Celebrating Independence July 28 |
IMR saw and treated over 3000 patients and de-wormed most all children. The dentists pulled over 600 teeth. The very sick patients were referred to Santa Clotilde. Despite the challenges of intense heat and humidity, bathing in river, snake and buffalo encounters, sleeping in tents, and the occasional montezuma's revenge, the group was able to focus on patient care and collaborate with the local health workers to provide care to a people often forgotten.
This beautiful newborn baby was born in the health post at Negro Urco. Due to limited space, two doctors were displaced from their room for an hour while this young teen delivered her first daughter with the support of her mother in law.
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| Three IMR participants relaxing on the roof of the boat as it sails downriver from Tacsha. THANK YOU INTERNATIONAL MEDICAL RELIEF FOR YOUR GENEROSITY AND GIFT OF SERVICE TO OUR NAPO RIVER POPULATION! |
Day Off at the Quebrada
Kids here care for each other. While the adults are out in the fields gathering food, the 11 year old watch 6 and 2 year olds. This little girl waits patiently behind the safety gate- sticks nailed to the wall. Here mother is actually inside cooking lunch and she's just checking out the action on her street. The sparse dirt road with grass on either side carries women with stacks of wood on their head, barefoot kids, pregnant dogs demonstrating public display of affection. It also guides pretty well dressed folks on their way to work at the municipality or hospital.
Toni
18 July 2012
CBS News in Santa Clotilde
Cousin Mike Paluska CBS News Reporter and his friend and cameraman John arrived in full jungle gear. Their cameras were attached to them as they moved through the clinic, hospital, and operating room to capture the reality of the Napo River.They understand that the good work done here for 50 years has been supported primarily by donations, and if we want to continue to provide quality care to the impoverished hard working people here, more needs to be done.
Cousin Mike survived despite jumping spiders, jungle meat, intense heat, cold showers, and being so far away from his number one girl.
Thank you Mike and John for all the hard work you put in this week and all the entertainment you provided! We can't wait to see the finished video!
Toni
8 August 12
Happy Birthday Padre Moe!!
Father Moe has been in Lima for the last few years. Despite him not being here today, the staff still gathered in the laundry room for a toast of sangria and beer, played guitar, and spoke the kindest words to honor Padre Mauricio on his birthday. We are so blessed to have such a friend!
Toni
11 August 2012
Armadillo vs heel
Toni
10 Aug 2012
Nice Day
Elise Frederick and Dr. Brent Burket from Mission Doctors
Association arrived yesterday. Today, after rounds and clinic we had a
wonderful time talking about Mission Doctors, our families, and sharing life
experiences. After an afternoon rest, we took a walk to buy food for dinners
this week. We found green lentils,
white beans, peppers, sugar, flour, bananas, cucumbers, and hot pepper sauce at
Don Baca’s and Dona Irma’s stores. We continued down the main path to the
church. The church is actually a big barn, constructed 50 years ago by a group
of Canadian farm boys that came to help out. In front of the church, where they were constructing booths of bamboo poles for "The day of the Indigenous." While watching bamboo be tied into place, we ran
into Cesar. Cesar is a kind modest man who recently had a metal plate (that was
placed 27years ago after a fracture) removed from his leg. He invited Elise,
Brent and I to have aguaje at his house. Aguaje looks almost like a pinecone
and after you peel the hundreds of little flecks off the skin, the deep yellow
layer of fruit over a big central seed tastes almost like an unripe avocado.
They were so good I ate four! Then they gave us 2 grapefruits and two smoked
fish with 4 plantains. The gesture of hospitality was amazing, and the fish was delicious.
Toni
7 August 2012
Leavin' on a jet plane.......
Actually it was a float-plane, and
it was quite an experience. We have been busy here in Santa lately as the
patients have been very sick. We have not had a ton of business, thankfully
because our acuity of patients is keeping us plenty busy. Earlier this week,
Monday morning in the early hours a family brought their 6-month old son in
with fevers. He had an abnormal neurologic exam with asymmetric pupils and
seizures. It appeared to us that
he had meningitis. After trying to stabilize him with antibiotics, a blood
transfusions, and anti-seizure medicine we realized he needed a CT scan and
couldn’t wait. We called the insurance program in Iquitos to see if they could
arrange an airlift. They were able to send a small float plane that landed on
the river.
I
traveled with the dad and the patient. We boarded the plane, which had one
small seat in the back where dad sat with baby in his lap. I sat scrunched up
on the floor beside him with my stethoscope and array of medications. Not much
room at all! We trolled around the river for about 15 minutes making sure we
had a strip of river long enough and free of sandbars to take off, and up we
went. In the plane it only takes 45 minutes to get to Iquitos. The plane was
tiny and reminded me of the plane I was more than happy to jump out of in
Hawaii when I went skydiving. However, I was now just praying this thing stayed
in the air and no rain was between us and Iquitos, as I had no parachute. We
did arrive safely on the river and took a small motorboat for about 10 minutes
to the port, up 30 stairs into an awaiting ambulance. The child had tachycardia (fast heart rate) and a seizure on the trip and since there was not even enough room to hang to
IV high enough I had to push fluid and meds into his other IV to try and slow
his heart rate down and stop the seizure. I was able to look out of the window
for about 5 minutes total during the trip. It is amazing to realize how remote
we are, how much forest there is and how immense the rivers appear. In the
distance you could tell where the communities are, as there were plumes of
smoke arising from the trees from the cooking fires. I most enjoyed seeing the confluence of the Ucayali and
Marinon rivers forming the Amazon.
Arrival to the hospital was a
frustrating and eye opening experience. The regional hospital is for those with
the national health insurance. There is another national hospital for those
with the other national health insurance (teachers, public workers, hospital
employees). The best hospitals are the private expensive hospitals. As we
entered we met our nurse, Elita who takes care of our patients in Iquitos. She
is wonderful and is contracted by us to make sure patients can navigate clinic
appointments, insurance forms and the hospital itself. She helped get our
patient seen immediately in the ER and helped facilitate his care. I was amazed
to find no doctors in the ER…..can you imagine if this were the case back
home???? The doctor on call for the hospital also was nowhere close by and it
is just me and the 2 ER nurses, who were helpful. However, they did not realize
the gravity of the illness.
I spoke with the doctor on call who
came in for about 5 minutes who said, “oh you have sick kid, let me write the
orders and the ICU will come evaluate him.” I was asking him if we could
intubate and start more anti-seizure meds. He said, “the ICU will take care of
that, they should be here in an hour” Finally, Elita located a peds resident on
the 3rd floor and when she walked in she said, “we need to
intubate.” THANK GOD, someone who
knew how to handle kids and knew where the equipment and tools were to take action. Together we put in a tube to the stomach, gave
phenobarbitol IV for the seizures, a breathing tube into the lungs and bagged the
kid for an hour before transfer to the ICU and a connection to the respirator.
We then were able to get a head CT. Appears the child has meningitis and still
not sure if it is bacterial or viral but he is receiving the right treatment.
However, with seizures and high fevers his prognosis is not good. If he lives
he is likely to have severe developmental delay. However all is not lost, we did everything we had
available, the baby is alive and both parents are in Iquitos with their child and they can make
decisions on how to proceed. I am sad for the child and family, but he taught
me how to get care in Iquitos. I now know I have to really stir it up, find a
doctor and get things moving. I was a little overwhelmed when I arrived not
knowing where to go, who was who, who to alert, etc. Now I will be a lot more
vocal in every other transfer I bring to Iquitos.
In terms of the hospital it is 3
stories, they have x-ray, one CT scanner and a lab. They have an adult and peds
ICU and floor beds. It is run down and dilapidated. They have two slow
elevators, paint chipping off the wall. It looks like a public housing
apartment in need of rehab. It is
amazing to me that the main hospital for a city of ~600,000 people has no
doctors in the ER and the doctor on call usually leaves after morning rounds to
go work in his/her private clinic to earn more money. I am also astounded the
people don’t speak out in masses to the local government, but I guess when you
don’t know what care is like on other parts of the world, or Peru for that
matter, you come to think the care provided is the norm. I learned we need to
do as much as possible in Santa Clotilde, because the help in Iquitos is not
adding as much as I had thought to patient care. That being said, some of the doctors are very good including Dr. Camilo Ruiz who is in the ICU and did a year of work in Santa Clotilde with Padre Jack several years ago.
Happy 4th of July
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| Homemade pumpkin pie by Liz for 4th of July and Nathan's Birthday |
Nathan lives on a farm in North Carolina. He raises chickens for eggs, grows in own food in a big garden, tends to many fruit trees, and also happens to be an amazing chef! He has been cooking delicious dinners for us daily. Nathan goes with the flow, doesn't get riled up, is a really hard worker and always jumps in were needed. He sat with our staff last night telling jokes until the power went out.
He is respectful, energetic and great to have as a housemate. We're trying to convince him to stay here, but he has strong aspirations to go to medical school, where I know he'll succeed in all respects!
Big Wooden Boat
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| Top of the boat... big enough to pitch 5 tents! |
This is amazing. Neo and Marcielo own this huge wooden boat. Marcielo is one of the only people in town who sell gas. He uses this boat to transport barrels of gas from Iquitos to Santa Clotilde and utilizes both the flat top and spacious inside. They have offered to donate the use of their boat to International Medical Relief, an internationally known organization who brings health care to those who need it most. International Medical Relief will be here from July 20th to the 28th and will travel upriver to Angoterros and down river to Mazan/Iquitos where they will offer free medical and dental care, free medications, reading glasses, and community classes.
Toni
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
Toni
Free Clinic Today!!
This Monday, July 2, is the 69th Anniversary of the formation of the town of Santa Clotilde. It revolves, surprisingly, around a huge soccer tournament of many teams from up and down the Napo river. To Brian's dismay, it takes place in our back yard, separated only by a wood fence which I'm pretty sure amplifies the sound of the play by play analyst on the loud scratchy speaker. There are festivities for five days straight. Last night was the señorita and mister Napo contest... like miss america on a smaller scale. The talk of the town this morning was that the señorita who won should NOT have won because she had on a mini-skirt instead of a gown and was NOT playing by the rules. There were also "traditional dances" with girls in traditional indigenous wear- a few strings and beads and feathers... and one even carried a live parrot as she danced.
To celebrate here at the Centro de Salud and contribute to the celebration, Dr. Juan decided that for two days, all clinic visits would be free. The usual price is 2 soles ($0.75). Manolo our lab tech went to the soccer field and announced the free visits on the loud speaker. I could not believe how many people showed up and waited for hours just to save $0.75 cents. It speaks toward the amount of poverty in our community and the great need for services.
Today we are celebrating with pizza... it's 10:23 pm and our first pizza is just coming out of the oven :) Brian made the dough by himself and did a great job... Mrs. Palermo would be proud! Black olive, onion, red pepper, tomato, and cheese! With fresh lemon squares that Liz and Paul made us for our anniversary ;)
Tomorrow is a day off!!! That makes tonight a great night!!
Toni
30 June 2012
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