Happy Thanksgiving

Nothing like Liz's homemade pumpkin pie and Anita's chicken to top off a delicious Thanksgiving meal! With Brian on call, we managed to eat and relax for an hour or so before he was back to work. The stuffing, mashed potatoes with imported brown gravy, and string bean almondine were delicious!! We should definitely add stuffing and canned pumpkin to our wish list!

We were reminiscing about the Medernach and Lullo traditions and the yummy food that those back home were undoubtedly sharing.

We give thanks for our amazing family, friends, and coworkers for being so supportive and loving to us and each other. Have a blessed day!


Phlyctenulosis is a hypersensitivity reaction of the cornea to toxins. The most common cause of phlyctenulosis is a staph. BUT, here in the jungle, tuberculosis is alway high on our differential until proven otherwise. This kiddo came in with a red eye and little pustules where the brown iris meets with white of the eye. They responded quickly to Gent drops. PPD negative.


9 year old girl fell and came in with a purple swollen elbow. Can you see the fracture?

Sting Ray Stings!!!

More painful than a snake bite is the sting of a ray! She was wading across the stream to leave her son with her relatives and a piercing bolt left her speechless. One week later, the area on her heel where she was struck is healing nicely without signs of infection, but the pain brought her back for more ibuprofen.

Guess the diagnosis- lumbar X-ray

29 yo male with severe unintentional weight loss over months, cachexia, fevers, and a draining fistula in his flank... Transported to Iquitos for an Xray. Who knows the diagnosis?

Hormiga Curuwinsi

Miguelina: Yes, doctor. My husband eats them fried
Toni: But don't the legs get stuck in his teeth?
Miguelina: (with a confused look on her face) I don't eat them but my husband does
Toni: Oh... so you pull off the legs first?
Miguelina: Yes

Jose, Miguelina's son, walks up to us, looks at me, smiles, looks at the fan covered in bugs and says "Oh, you already pulled the heads off". Then pulls off the back segment, pops it in his mouth, squeezes out the juice, and spits out the exoskeleton. Nonchalantly followed by...]
Jose: You want one doctor?
Toni: hhmmm. Jungle protein? I thought to myself... our dads did just bring us 20 packets of dental floss...

This weeks patients

Yesterday morning Inesta arrived in labor. She knew she was carrying twins. On exam she was 5cm and we felt little toes and the body in the cervix, so we moved her to the operating room and two healthy boys were born by cesarean section, the first weighing 2.600 kilograms and 2.010. These are the youngest of 8 kids and her second set of twins. Here at CSSC, the family member (usually husband) washes all the laundry, including all the drapes and towels from the operating room and the bed sheets. The husband also goes to the land behind the hospital to bury the placenta.

This morning Nanci and her husband Wilder arrived from a town over an hour down river. Their other 5 kids were delivered at home, but after her water broke and the baby's arm prolapsed, and Wilder knew that without help, the baby wouldn't survive. She arrived and Carmen our midwife brought the doppler to check for heart tones. She wasn't able to find heart tones, but we were reassured when the baby gripped her hand and didn't want to let go. Finally heart tones were found, and shortly thereafter the little boy was born by emergency cesarean section, with a strong cry and moving both arms.

Over the last week, we have also had two precipitous natural deliveries, two snake bites, a patient with dengue hemorrhagic fever, premie with severe malnutrition and congenital abnormalities, a 6 year old with with whole body swelling and glomerulonefritis, a 75 year old man with severe anemia and dehydration, 2 women with kidney infections, kids with pneumonia, a man with pyomyositis his gluteus that drained a pop can full of pus when we opened it, a woman with a miscarriage, another who was struck by stingray barb, etc etc.

One 10 year old girl got bit by a moth called a chicharra machacuy. Although scientific sources (wiki) tell me that it's not poisonous, she arrived with frequent strong muscle spasms of her whole body, extreme generalized muscle weakness (she couldn't even stand by herself), and hyperreflexia that could not be otherwise explained. With IV fluid, one dose of diazepam, and time she recovered. 30 hours after the bite, her only residual symptom was paresthesia (numbness) in her leg that was bitten, but has complete recovery of strength and reflexes.

Brian has taken on a lot of the administrative work, and I have been coordinating volunteers and donations. After our trip back home we have a renewed energy to work and learn. Seeing family and friends was great, and although we stay very busy here, we frequently think about and pray for everyone back home. 

Back in the Saddle

After a brief trip home for my pediatric boards and to visit friends and family I am back on call. We arrived in Santa Clotilde yesterday after a few days in Lima for meetings and to start the process of getting our permanent Peruvian medical license. Being home was nice, we had a great time seeing friends and family and I ate to the tune of putting back on 11 pounds. I have a renewed energy to work after being able to reflect on our work here in Peru. I have been told and probably rightfully so to not post too many graphic medical pictures, so i will continue to post them, but try to give a warning and post them at the bottom of the articles :)
Don't worry tonight's blog will have no gross pictures, one good one I wished i would have taken today was of the face/skin of the patient listed on Toni's last "guess this rash" blog, he came in today with no rash only some scarred areas that are only a little lighter...kinda like Michael Jackson. Today was busy and we had two very sick patients one who suffered a snake bite in the hand yesterday and came in today bleeding from the mouth and had swelling up to his shoulder. He had a little reaction to the anti-venom and has a purpuric vesicle (purple blister) at the bite site, but now is sleeping with arm elevated, no longer bleeding and swelling improving. My other critically sick patient is a 5 week baby boy with congenital anomalies, born premature and not feeding well. His weight was 1.8kg, now is 1.4kg today. I am not sure if he has long to live, but is responsive getting antibiotics, feeding on newborn formula and mom's breast. Mom and dad's first baby so this is very difficult. I have never seen a sicker kid that I was not expecting to see, in the ICU, ER and with premature babies we expect to see sick kids or at least are not shocked, but when this kid arrived from up river today after a 5 hour boat trip in one of our emergency boats, I was floored. I could show pictures, but they are too sad and too graphic example of malnutrition (see previous comment) to put up. He needs any luck he can get; if he is like some of the other patients from Angoteros he should fair well.  The health technico that brought this little guy gave me an update on the kids that Centro de Salud previously cared for. Yadiera had a congenital heart defect repaired and is growing and doing great per report, and Martha Luz who was born via arm first then was stuck and somehow survived the trip down river and a crash c-section and meconium aspiration is also alive and growing. I was a little afraid to hear the answer when I asked if Martha Luz was doing okay and pleased to hear the report. Okay the power is gonna cut out soon, like it did on me last night during the 4th quarter of the Bears game (yes i did see the game on our DirecTV in the jungle.) I feel like i should get it for free with my plug for it online.  Goodnight and Happy B-day to my sister one day early!

12 Nov 2012

Happy Doctors Day!

Ernesto RN and Doctor Juan give Centro de Salud Santa Clotilde two thumbs up!

Yadira and other staff thanked the doctors with a theatrical performance

Dance troop numero uno

Victor Hugo had a baby!? cat!? Nothing like laughter to celebrate Doctors Day!

Guess the Rash

Guess the Rash. This boy is 12 years old with no past medical or significant family history. His rash has been getting worse since it first appeared two weeks ago. He also has some ear pain and on ear exam his canal is full of white material. As you could see, the rash is on his head/face and extends to his upper trunk. He is afebrile and non-toxic. It is unlikely this rash would be seen in North America.