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.
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. 
Dana was brought her by her grandmother, who raises her, after falling into a pot of very hot water. She was running near the pot, which was on the ground on an open flame, had a seizure, and fell into the pot of water. Luckily her grandma was there to pull her out and bring her for help. She had burned 20% of her body. Our nurses meticulously cleaned the wound daily and changed her dressings. Within two weeks, she was playing catch with a ballon and by three weeks, she was doing cartwheels!! She was initially shy and didn't talk much, but as she became comfortable with us, we would talk and laugh together, and do gymnastics, and run up stairs. We have no physical therapist, but a biomedical student named Oscar who is here visiting from Mexico took the initiative to start physical therapy with her. Playing is obviously the way to a child's heart, and play had helped her heal.
