Los Angeles

     Hello everyone!!!!  We have not blogged in a long while, and although we have been away from Peru for almost 3 months now it has been for good reason. Antoinette and I are in a 4 month formation program in Los Angeles, CA with Mission Doctors Association (missiondoctors.org). As we have mentioned previously this group, since 1959, has been supporting doctors on mission throughout the world including Zimbabwe, Uganda, Papa New Guinea, Thailand, and Kenya. We currently have doctors in Guatemala, Cameroon and Peru (when we head back to Santa Clotilde). Our formation program is very interesting and we are in class from Monday through Friday learning helpful skills to aid our work outside the U.S and away from the culture and way of life we are so accustomed to here at home. Our curriculum consists of several topics such as mission theology, communication, Myers-Briggs, cultural awareness, emotional health, moral theology, surviving overseas, health overseas, and enneagram to name a few. Although we were already in Peru for one year, we recognize the importance of these classes and how it will help us to communicate, avoid burn-out and not make common mistakes when working abroad. I think we are more aware of ourselves and will be able to live and work a more balanced life when back at Centro de Salud Santa Clotilde.
      Speaking of Santa Clotilde, the work carries on!  I would like to thank Fr Jack, Dr Juan and Dr Julio along with all the midwives, dentist and staff for continuing the good work while we are gone, as well as the volunteers and students from Mission Doctors, Loyola, UBC and U of Minnesota.  Some exciting news comes back to us from Peru such as: a visit from the national Ministra of Health who sat  down and had a conversation about our reality. Progress is being made on our x-ray machine slowly but surely, and another doctor from El Salvador, Cuban trained is also working on the river. Our logistics coordinator Javier and Padre Moe are working diligently to restore in working fashion the barcasa, our barge that will be able to make trips up and down the river, even all the way to Iquitos for vaccines, supplies, patient transport, and our Amazon experience for visitors.
     We are in training until the end of May and then back to Chicago for a while, then back down to the selva which I think about daily. Keep us and all on the Napo river in your prayers!

April 21, 2013


Italo was a 5 yr old with difficulty breathing and swollen lymph nodes in neck. I've never seen such an impressive X-ray. He had Leukemia or Lymphoma. Pray for Italo and his family.

The fragility of life

     We have our trip planned home to start our formation for 4 months with Mission Doctors Association in Los Angeles, but the last week in Santa Clotilde kept us more than busy with an in your face view of reality here in Peruvian Amazon. The week was non-stop as several emergencies came in to our Centro de Salud. The first was a child from Cabo Pantoja, the community on the border between Ecuador and Peru, six hours up river in speed boat from our hospital. Italo, a very smart and pleasant 5 year old boy came in with several months of fevers and night sweats with swollen lymph nodes on exam. His likely diagnosis was a lymphoma. We performed a lymph node biospy and sent the sample to Lima for pathology. He was stable during the day but at night due to the compression of the swollen glands in his neck had some difficulty breathing but his oxygen saturations remained within normal range.
    On Wed morning began a 3 day series of difficult stories that I am now reflecting on exactly everything that happened. We recieved a call from our nurse tecnico stationed in a small community 4 hours up river in Rumi Tuni, he had a pregnant lady come in with difficult labor in her 10th pregnancy, she had labor pains for 2 days but came in because of an acute worsening of pain the night before, he felt the baby's head and a tense abdmonen, we knew the patient would need a c-section. So immediately Toni and our midwife left Santa Cloilde in our emergency boat, a delivery kit, and our USB adaptable echo and laptop. They arrived to find a woman in distress with a stillbirth and hemorrhaging, on the echo Toni saw an unusual thing, bubbles inside the abdominal cavity. They started a second IV and pushed fluids and pain meds and started on the way back to Santa Clotilde. Toni called me just prior to departure and we started to prepare the OR for an emergency c section and found donors for blood that was awaiting in the fridge for their arrival. When they arrived we went directly into the OR after she received 6 liters of fluid on the trip down, we started her blood transfusion, antibiotics and a 7th liter, awaited her labs to ensure she did not have signs of severe infection and bleeding issues (DIC in medical speak) and proceeded with spinal anaesthesia and the c section. As Dr. Juan Jon and Toni entered the abdomen they found the bag bulging into the abdominal cavity, a uterine rupture with bleeding, the baby was a stillbirth as expected. The mother tolerated the procedure well and after a difficult repair a tubal ligation was performed to prevent a high risk of death for mom if there were to be another pregnancy. A baby lost but a mother of a large family saved.
     Shortly after Toni left a health post in the town of Tacsha Curaray, that is 2 hours down river from us, came in their emergency boat bringing a gentleman with a right femur fracture. This man was on his farm with his cattle when a rope tied to one of his cattle was on the ground looped loosely by his foot, the cattle startled and stampeded and the rope pulled the man's leg and he was dragged for a short distance. His leg is stable as is his blood count, he will need to go to Iquitos for an operation when we have the means, a doctor free and our emergency boat ready
     That same night, Wednesday, night Dr. Juan was on call and it was busy, 6 admissions, including two very sick children. Juan had a 18 month old child come in with severe dehydration. He started fluids and she started to respond, but still very sick. At 5am another child entered with seizures that were controlled with diazepam and lumbar puncture performed to rule out meningitis. Meanwhile Toni continued her travels as she left a day early on Thursday morning to Iquitos with Italo whose airway compression from his lymphoma worsened and was more critical. After rounds the child with dehydration continued to worsen developed a fever and then started also having seizures. As we tried to look for papilledema we noted cataracts and with mom's history of weight loss (40% of her weight, supposedly) we were unsure if this was a congenital malformation, brain tumor or metabolic disorder leading to the illness. Shotly after we were able to stop the seizure the child went into arrest and despite CPR, ambu bag for air with oxygen and atropine and epinephrine this child died. Our other child from 5am with seizures was getting better. We also had another elderly gentleman with likely lyphoma also head to Iquitos for a consult with the oncologist and a bone marrow biopsy, we also did his lymph node biospy earlier in the week.
     We thought all was settled, I was preparing for my trip to Iquitos to meet Toni for our flight to Lima. I was bringing down 3 more patients to the regional hospital, one as an emergency as he had an open fracture of his arm and two others who had their outpatient appointments, one for vertebral tuberculosis and the other for basal cell carcinoma on the face.
     I was finishing up paperwork and packing when I recieved a phone call at 1am from our nurse Elita in Iquitos saying she was just notified from the hospital that Italo, the child who went with Toni had died in the hospital.  Toni arrived with the patient in the ER and he was stable, attended to by medical interns. Toni was helping them by presenting the story and making recomendations. However there is NO DOCTOR in the emergency room at this regional referral hospital for a city with a population of 180,000 people. The pediatricina did not show up for several hours, meanwhile Toni stayed with the patient this whole time. The chest x-ray of Italo was heart breaking he had a very large chest tumor (mediastinal mass), when he cried his compression was worse and his oxygen dropped. He went to CT accompanied by Toni, no other doctors, nurses nor pediatricians, but he could not lie flat on his back due to his oxygen and shortness of breath. The radiologist was upset he could not lie flat and just told her to "get him out of here" She went back to the room with him and advised the nurse not to agitate him as his oxygen drops and that he needs to be seated not lie flat. He as watching sesame street on her laptop, coloring when she left him. He was dead an hour and a half later. We know he had a very bad, aggressive disease and we are not sure if he would have lived, but he certainly should not have died in a hospital supposedly with the resources of a surgeon to do a tracheostomy an ICU and ventilators.  We are glad to be coming home for a break to mentally recharge before we head back to continue to fight in Peru.

20 Jan 2012

Toni's brithday

     Just after Christmas on Dec 28th is Toni's birthday. To celebrate I wanted to throw a party and following tradition provide a nice meal for our guests. Since Antoinette is allergic to poultry; the food staple of chicken was out. I decided to buy a pig to serve. However, here in the jungle buying a pig is not as simple as going to the grocery store and buying a ham, or pork chops or ribs. One of our co-worker's mother raises pigs about 45 minutes up river. The morning of the 28th he left and picked up a pig, i thought a 30-40kg pig would suffice, he came back with a 62kg pig, and although it cost more than I was expecting to spend it was very cheap in comparison to the same amount of meat back home. He came back in the early afternoon with the hog tied and hanging froms it legs on a post.  We carried it outside of the kitchen and then proceeded to prep the pig. It was the first animal i have ever killed (other than a bird with our BB gun a long time ago...even then i think it was my brother that pulled the trigger- we both felt very guilty afterward for killing a living animal). They first boiled a huge pot of water then showed me where to stab the heart, after a few loud wails from the pig he took his last breath. (warning some more graphic pictures below) I felt as if i was re-enacting images that were evoked while reading "The Lord of the Flies" in high school. Then the other guys teaching me the ways of butchering and preparing a pig did the rest. They poured the boiled water on the pig and scraped off all the hair leaving only the skin, then they opened up the underside from neck to rear and took out the viscera. Then we sectioned the pig and cut away the fat. That night we prepared a rub and let it sit overnight in various fridges as it was a large amount of meat; the next day the whole pig was cooked for the party on Sat night.
     It was a much different feeling eating this food, as i think about the whole process, i did not feel guilty as I did with the small bird killed during childhood. People here learn to hunt, butcher and prepare food out of necesity, and it is a ton of work. I reflect on the way of life for the Native Americans in our country who hunted buffalo in a group and working as a community to butcher the meat and drag it back to their camps. How the government and white people took their way of life away from them by killing all the animals for sport or fun. Here it is a pure form of living, one much more atuned to nature and the abundance the earth can provide.
     The pig tasted as delicious or better then the meat back home. At the party, we ate the pig, drank some beer and danced; it was a fun night and I think Antoinette liked the present of a pig. It is a present neither one of us is soon to forget.......yes I also bought her a nice new umbrella, not just a pig.  Below are some pictures, some a little graphic


Christmas Celebrations

Padre Jack with Christmas Dinner, very happy about his catch!

Here are the kids from Sargento Lores, a 10 minute boat ride upriver, who volunteered to come to Santa Clotilde to sing carols a few days after christmas. There were 7 close communities who participated, and Sargento Lores came in second place. I traveled to Sargento Lores two days before the competition and the day of, I presented them to a church full of people. Sargento Lores is an indiginous Kichwa community. The leader of the community more than anything to provide a good education and opportunity for their children. They are an agricultural community and grow yuca, plantains, and lots of fruits. They also have some cows, buffalo, pigs and chickens that they raise. They are artisans and make baskets, crafts of balsa wood, and bags. They wish they had a market for their artwork, produce, and animals. 
Then Liz, Paul, and Josia invited us over, along with Padre Jack and Erik, the visiting student from Canada. Liz was raised in Africa by missionary parents and made a traditional holiday meal of curry lentils and rice, and 10 different toppings including nuts, raisins, coconut, papaya, and banana. It was delicious! Then we watched Andre Rieu Christmas Carols with a japanese children's choir! The music and company were beautiful!

Christmas Mass with an artistic musical culturally-relevant reenactment of the Nativity Story, including accents about caring for each other and for the environment. It was amazing and really emphasized the true joy and meaning of Christmas. We have lots of talented youth here in Santa Clotilde!

Our Nativity Scene, built from scratch by our maintenance men with a traditional leaf roof, bamboo walls, and sod floor. All the animals resting on the sod are fashioned facing the crib of baby Jesus, who appears on Christmas morning. Complete with musical christmas lights, garland, and ornaments it keeps many kids occupied in awe. Traditionally all Christmas adornments are taken down on Jan 7th. One more day of festive music and decorations!

Our Secret Santa Gift exchange in the hospital kitchen, our usual reunion area.  We each described our "secret friend" until the group was able to guess who it was. My "secret friend" was a dead giveaway since she is know for being the best volleyball player in all of Santa Clotilde- Lleni Guerra. It was such a warm, happy celebration! Nothing replaces our own family, but I could say that our family in Santa Clotilde is a close second! 

Feliz Merry Christmas

Christmas Season 2013 started off with Brian and I cooking dinner for  our compadres, our godson Sander and his brother Jack. More than the stuffing dinner and pistachio pudding for dessert, they loved the balloons with a string attached!

Then Liz, Paul, and Josia invited us over, along with Padre Jack and Erik, the visiting student from Canada. Liz was raised in Africa by missionary parents and made a traditional holiday meal of curry lentils and rice, and 10 different toppings including nuts, raisins, coconut, papaya, and banana. It was delicious! Then we watched Andre Rieu Christmas Carols with a japanese children's choir! The music and company were beautiful!
Los Posadas... for 9 days before Christmas, signifying Mary's 9 months of pregnancy,  carols are sung by a group at houses around town. They carry a statue of Mary and Joseph as a re-enactment of their search for lodging. Centro de Salud Santa Clotilde is the final stop on Christmas Eve for over 500 kids, where we the "innkeepers" finally let them in... 
Once everyone enters, Padre Roberto has a Children's mass in the lobby of the hospital. He emphasized the details of Christmas... Where is Mary from? Where was Joseph from? Where was Jesus Born? Etc. The kids cooperate and know the answers... 
Answers: Mary of Nazareth, Joseph from Belen, and Jesus was born in Joseph's home town of Belen. And the children are welcome to partake in hot cocoa, panetone, and candy from Santa Clause.