Señor Frog

Brian found him in the kitchen in our dish rack. I picked him up and tried to show him to Mikey (via Skype) but he just peed on me and jumped away. I found him and released him outside. I felt like he had some message for us. A list for animal symbolism of the frog from a cool website: I've been drawn to symbolism lately.
  • Luck
  • Purity
  • Rebirth
  • Renewal
  • Fertility
  • Healing
  • Metamorphosis
  • Transitions
  • Dreaming
  • Opportunity
  • Intermediary

Breastfeeding Week!

Happy Breastfeeding Week! And nothing finishes off a week of parades and festivities like a breast feeding contest, right? Here we have 7 mothers with their babies less than 6 months suckling for the grand prize of a basket of food and goodies! All contestants must be exclusive breastfeeders (almost all women here are), be up to date on all their shots, have attended all their well child checks, and have the longest latch. Congratulation to Rosse, the young women in the red chair. Her baby was born here at the Centro de Salud by Cesarean Section for failure to dilate and maternal fever (chorioamnionitis) and fetal tachycardia. Rosse had Histiocytosis X and a splenectomy as a child, and without a spleen she has a weakened immunity she improved quickly with antibiotics. Obviously her and baby are doing very well and has won #1 Chuchutera in Santa Clotilde!

Guess the rash

15 month old kid comes in to clinic. Mom said she doesn't want to eat. I see these blisters on her hands. But of course!  This is classic ________ I told her! First person to guess right gets free room and board in a luxury home in the amazon jungle for 1 week!

Bat in the Batroom



Ahhh. Nothing better to avoid melting in the 3pm heat than a 2 hour nap with our perrito Wowki :)

Happy Nurses' Day!

Today we celebrate Nurses’ Day, with the “brinda” which is a toast with an alcoholic drink (along with duck stew, yucca, crackers, suckers, and soda). With everyone together in the kitchen, there were blessings 
and sharing of appreciation for our hard working nurses. 

Brian told how his mom Gloria (aka mamacita) has been a nurse for 30 years. He saw her hard work and compassion for patients, and heard her advice about always respecting nurses, and we celebrate our nurses here at Centro de Salud, all nurses 
around the world, as well as 
mamacita today!

Kids left behind

In Iquitos, after transporting a man with a broken neck and another with an infected gallbladder, I had the pleasure to visit Aurora. Four months ago, Aurora brought her 35 year old sister America Veronica to our Centro de Salud. Veronica had end stage cervical cancer. 

Twenty years ago, Padre Moe and Jack helped transport the mother of Aurora and Veronica to Lima seek treatment for her cervical cancer. Although she had advanced cancer, she was cured. 

Aurora held out the same hope for her sister Veronica. Unfortunately Veronica's cancer was too far advanced to cure, so she returned home to Iquitos and spent one more month with her five children before she passed. This photo is taken the home of Veronica, Aurora, their younger sister. There are two beds like the one you see, clothes piled in suitcases and hung over  mosquito netting because they don't have dressers. The three boys shown here are Veronica's youngest kids. Her two older children are in high school and weren't present for the picture. The two girls in the picture are Aurora's two kids. They have very little materially, and none of these kids have a father caring for them... but they have each other. They have Aurora and their Aunt and their grandma who do the best they can. Thanks to Auntie Sharon, these kids will receive a little extra every month to supplement the money Aurora makes selling her empanadas around town. If anyone else is interested in donating to Aurora or families with similar hardships, we could make that happen. Donations will go through Friends of PANGO, a non-for-profit that Brian and I are starting to help families along the Napo River.

30 August 2012

Choppin' Garlic

Josefa is working hard in the hospital kitchen making chicken soup. We were up at 6am to do an appendectomy and didn't finish until 8:20, so all six of us stopped in the hospital kitchen for breakfast. When we devoured half the pot of chicken soup, Josefa busied herself to make another pot. I turned to see where the tapping was coming from and found Josefa using an axe to chop the garlic. This ax is no competition for our fancy garlic presses, and it one full sweep she could flip it over to butcher the chicken what will become lunch. If you are looking for a versatile new kitchen utensil, here it is... the axe!


It seems like just yesterday that wowki was the little pup... but now we's the big kid on the block! Here's wowki taking this new little leashed puppy on a walk during hospital rounds in the morning. The staff of 20 at rounds were all laughing at how cute it was.  The 8 year old kid was really worried that wowki would hurt his puppy, but he soon learned that dog play was okay and joined in the laughter.


This was her 11th pregnancy. She has 9 live children at home. She arrived this morning seizing and 36 weeks pregnant according to her sister-in-law. We gave her magnesium to stop her seizure and labetolol to lower her blood pressure, but she was is not urinating and her urine was almost pure blood. Her creatinine was 1.6, which is a sign of severe kidney damage.  We brought her to the delivery room and she delivered a beautiful little baby boy within an hour. The baby is still a bit floppy from the magnesium but I suspect he will do just fine. Mom is still a little disconnected after her three seizures and the magnesium, and her body is full of bruises from the natural healer trying to "suck" the bad spirits our after her first seizure. When she seized again, the family had enough sense to bring her in here to Centro de Salud Santa Clotilde. If they had not brought her in, she would have continued having seizures, suffered extreme brain damage, and put the baby's life on the line. Happy birthday and God bless you little boy!

Saturday with Padre

 I arrived back in Santa Clotilde from my part of the IMR trip on Friday evening July 27th,  and Padre was “manning the fort” all alone. I took call Saturday when Toni and Julio were still on their journey back up river. Padre received a call from Angoteros  early Saturday morning that they had a woman who labored at home, but the baby would not come out due to an arm prolapse (arm comes first and then head and baby cannot be delivered) This happened at 5am in her house, she arrived to the health post in Angoteros at 630 am and started on the boat to CSSC at 7am. They arrived at 1pm with our team waiting. The baby’s arm was still hanging out and surprisingly not totally cyanotic.  (the story has already been elaborated to the baby actually waving at us from the vagina) After a few minutes of Doppler we did discover heart tones of the baby and rushed back to the OR. Padre and I scrubbed and did the c-section under local lidocaine, once the baby was out mom got Ketamine. However,baby was limp and non-responsive when we pulled her out, I scrubbed out of the surgery and Victor Hugo took my place as assistant. I had the help of one our nurses Dani and we rescessitated the baby. Thick meconium caused the issues (along with the 8 or so hours of arm prolapse), the baby’s heart rate was there but less than 100, cyanotic. I used a “trompa” to suction out the meconium. We do not have the fancy meconium aspirators we have back home and the trompa will not fit inside and ET tube, so I could not intubate to suction (Neonatal guidelines in US).  I took the trompa , which is a plastic cylinder that catches the meconium and is connected to 2 tubes, one to enter baby’s mouth and the other for the provider to suck on creating negative pressure. It was thick and I had to remove quite o bit of meconium, when I removed one large plug the baby improved immensely and started to cry. We provided some postive pressure ventilation (ambu bag) to help her breath along with supplemental oxygen. An IV was started and she got Gentamicin and Ampicillin (antibiotics) in the delivery room.  I do have to admit the trompa is set up so I cannot actually suck in the meconium all the way through the cylinder, however of course something went wrong and on my last suction I got a mouthful of meconium. What is meconium???? Well it is all the stool that was built up over the pregnancy that is expelled usually after birth, sometimes in the  amniotic fluid causing risk for aspiration in the baby. GROSS!!!!! However mom’s serologies were negative for any dangerous infections. I brushed my teeth and used Listerine afterwards and am still healthy. The mom is doing great, the baby is not out of the woods. She has and erb’s palsy of her arm from stretching and damaging the nerves to the neck and arms, but she is alive. Still tachypneic (fast breathing) and on oxygen, but truly a miracle to have made it this far! When Padre was finishing the operation and the baby was being put into our incubator, Toni and Julio arrived…..welcome back, you missed all the fun!


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


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

Victor Hugo and Padre Jack living a miracle
She was in her house. The same house her other children were delivered, but something was wrong. Amidst her labor pains, she felt something different, something tickling her leg. Indeed it was her child's hand grasping for life. Her husband is a Kichwa community leader and a well informed man, and he knew that the mother's and baby's live were both in danger.

The state of Loreto (green area) is the size of Texas. 
Angoteros (where the arm prolapsed) is the purple arrow. Centro de Salud Santa Clotilde (CSSC) is the blue arrow. There are no roads. The family has only a wooden canoe with a small outboard motor. Time was of the essence, we know that most babies with prolapsed arms don't survive if they are this far from a hospital. They immediately went to the Angoteros Health Post, where the nurse technician there wisked the family onto the emergency speed boat and arrived here at CSSC 5 hours later. Gray clouds hung over CSSC, knowing the baby likely wouldn't survive. To our surprise, Martha Luz would hear nothing of gray skies. Upon arrival, Padre Jack found heart tones and immediately rolled the patient to operating room for a cesarean section. She was born weak, without a cry. For 20 minutes Brian helped her breath with a ambu bag.

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

IMR in Santa Clotilde
Thank you to IMR for spending a week in service to the people of the Napo River Basin. IMR brought 50 participants including doctors, dentists, nurses, PA's, a pharmacist, and students. There were also 25 translators present to assist with communication.  Half the group went 5 hours upriver to the remote villages of Angoteros Campo Serio, Rumi Tuni, Diamonte Azul, and Huiririma. This area is primarily Kichwa, an indigenous tribe of subsistence farmers with Ecuadoran roots and a strong spirituality. Half the group went downriver where we find communities of indiginous Huitoto. All of these communities lack access to doctors and dentists.

Huitoto children doing traditional dance in Negro Urco
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.  

Three IMR participants relaxing on the roof of the boat as it sails downriver from Tacsha.


Day Off at the Quebrada

Fredy, the night watchman and friend, took us on a walk to a nearby quebrada. A quebrada is a branch of the river where kids play, women wash clothes, and others go to relax and swim. On the way, we encountered groups of playful, laughing kids, unsure if their curiosity or fear of us was stronger. Curiosity won out and they ran over and smiled for the camera. Nathan Schenkman (son of Katherine Kaplan OB/Gyne who volunteers with us annually) a pre-med student from North Carolina and Alicia Stapleton, a 4th year med student from Loyola Chicago were here volunteering and joined us on our walk.

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.
We passed the children, a big black sand hill with kids rolling down the sides covered in black, an open field, and finally arrived at the quebrada. Kids were swinging on vines and plopping into the water, others were floating on their back letting the current carry them around the many bends of the river. Our dog Wooki was terrified of the water, but none the less had an involuntary bath. The water was cool and refreshing and the sound of crickets, frogs, and birds brought a sense of peace. We are so blessed to have friends like Fredy, Nathan and Alicia and little tranquil places to escape to now and then.

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!

8 August 12

Happy Birthday Padre Moe!!

Happy 75th Birthday Padre Maurice! Padre Moe is a friend, mentor and inspiration. He worked for almost three decades here at Centro de Salud Santa Clotilde (CSSC) where he took every opportunity to teach the staff and understand the needs of the community. He stood up for patients, didn't tolerate injustice, and worked hard every day in the hospital, the church, communities and taught with compassion and love. He  introduced us to the amazing voice of Juan Diego Flores, a Peruvian opera singer. He's invited us to think through the history, present, and future of Centro de Salud Santa Clotilde. He is thoughtful, has a great sense of humor, and is a happy spirit. He shared a DVD of his 50th anniversary as a priest with the incredible voices and musical talent of his great-nieces and nephews. He is a great cook. He mixes up a great gin and sprite. He sent us cheese all the way from Lima!

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!

11 August 2012

Armadillo vs heel

Otoniel was walking through the jungle, heard a blast and felt a sharp pain inside his boot. Someone had set up an animal trap... a sawed off shot gun (armadillo) and he had tripped the wire and destroyed his foot. He arrived two days later after finally finding gasoline to fill the small motor on his little wooden boat. He arrived and the smell of rotting foot was evident from across the room. We pulled off all the dead tissue for days until the infection and smell finally subsided. There is a whole in the middle of his heel because the bullets destroyed the posterior part of his calcaneous (heel bone) and just left a hole full of bone marrow. The bone is visible and we are still pulling out ammunition. He'll need an X-ray and maybe calcaneous reconstruction? Any orthopods out there with open calcaneal fracture experience? It will need to heal from the inside out and he'll probably need surgery. We'll refer to the hospital in Iquitos next week.

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. 

7 August 2012