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.

Brian

written 13 Dec 2012