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The Rotary Club members who came here to build the new clinic were so taken with the people and the place that they returned several more times. However, by mid-2008, it was clear that the Amazon River was eating the land on which the clinic sat at a pace that threatened to drop the clinic into the river within a year or two. Jon Helstrom was therefore consulted, and again came up not only with a floor plan for a new clinic (situated on Yanamono Stream rather than on the erosion-prone main river), but also the funding and people with which to build it. The new clinic, which opened in March, 2009, has the exam rooms, lab, office space, pharmacy, dental room, and overnight patient room of the original clinic; but it also boasts a comfortable living space for the doctor and nurses from Iquitos, a kitchen, and better quarters for the local clinic staff who often spend their nights there, as well as far more storage space than in the original clinic, and a much improved and expanded office (to accommodate the large number of patient files that have accumulated over all these years, and the documentation to go with them).

Way back in 1992, I began training Juvencio Nunez Pano, a local man then 22 years old, with a wife, three children, and a sixth-grade education. He proved to be an incredibly bright student, and quickly became my right-hand man, capable of examining a patient, recognizing all the diseases we commonly see, and prescribing and administering treatment. He continues to work as nurse, lab technician, dentist, and all-around engineer and fix-it man. The clinic staff also includes his sister Edemita, who began working in May, 1995, doing laundry and secretarial chores, and quickly made herself indispensable. I trained her in medical procedures, but like Juvencio, she also subsequently earned a college-level nursing degree from the Universidad Nacional de la Amazonia Peruana in Iquitos. She greets and triages our patients, looks up their histories, takes their vital signs, performs her own exam (and can in my absence treat many of the commoner ailments), and practically grabbed the family planning program from my hands ... a grandmother since she was 31, she understands the need. Then, there are three watchmen-handymen-gardeners, who keep the clinic from falling apart in the humid tropical climate and call me when an emergency comes in at night. In addition, we have had a few graduates of the nursing school in Indiana (the one between here and Iquitos, not the one between Ohio and Illinois) doing the practical work required in their programs, and occasional volunteer physicians from abroad. And now that I am spending more time in the U.S., we have a rotating cast of Peruvian physicians. No one trained in the city wants to stay long in the rainforest, but we do try to keep a physician on hand, especially when I am not personally here.

We now see 200 to 250 patients a month, for everything from family planning (a program offered by the Peruvian government, in which we enthusiastically participate), to treatment of intestinal parasites and various infectious diseases, to vaccines, to occasional trauma, such as the boy whom a medium-large caiman once attempted to have for dinner. We receive little material support from the government (family planning supplies, malaria medicines, and vaccines, when available), but the Ministry of Health officials in Iquitos have always been very supportive in a moral sense, since they cannot persuade Peruvian physicians to go to, and stay in, rural areas where there are no support facilities, no medicines, no physician back-up or time off, no place for their wives to shop, no television, and no money to be made.

The support that enables the clinic to continue functioning has come from a broad range of contributors. Explorama, as mentioned, not only feeds me and lets me live on their property, ride in their boats, and use their p.o. box and now even e-mail, but also provides the social support that keeps me in some kind of touch with my former world. Explorama's tourists have been another huge source of support ... the main source, actually. Their many donations of money and medicines, their courier service (many people bring items donated in the States, which otherwise would have no route of transport), and the occasional contribution from their ranks of someone like Paul Gakle, all help. Indirectly, the tourists are another fount of funding, since Grand Circle Tours/Overseas Adventure Travel, a tour company which brings many people to the Amazon, has been giving us a generous yearly grant for our Well Child Care program. The Rotarians of several cities raised over $35,000 for the materials for the original clinic, and nearly twice that much to construct the new one. Other Rotary groups have given generous grants, notably the Madison, Wisconsin Rotary Club; a club in Pennsylvania paid for the digging of a deeper well; and another group of Rotarians from Mount Horeb, Wisconsin, purchased the generator we use to run our dental drill, provided funding to expand and improve our solar system in the new clinic, and sent me to Lima one August for a course on ultrasound in tropical Medicine. In addition, various Rotarians have made individual contributions, such as the couple who brought Juvencio and his wife to the U.S. to visit in 1995 and again in 2000. An Optimist Club in Colorado provided the funds to purchase the vaccine refrigerator. Then there is the above-mentioned Paul Gakle, a retired engineer who visited Explorama before the original clinic was even built, and who became so interested that he took a course in writing grant proposals, using the clinic as his subject; as a result of which he has obtained a series of grants from The International Foundation. Finally, on grounds that I don't want to foster dependence, the patients themselves are asked for a small contribution to their own care. (Their payments average a little under $1.75 per person, a fraction of what it costs to treat them and maintain the clinic; and please note, treatment is never denied for those who can't pay.)

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