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One day in March, I had paddled over to the Lodge for lunch, and had tied my trusty vessel at the walkway to the guides' house, and had not taken time to turn the craft around before going to the dining room. I had brought the laptop with me so I could check e-mails at lunch, and when I headed for home afterward, thoughtlessly dropped it into the canoe, stepped in myself, and initiated what should have been a simple turn.
This time, it wasn't. The current right there, where the Yanamono Stream melds with the Yanacaño Stream, is fierce. Edemita tells me it is because all this water, which is now the Amazon River (no longer our minor streams), is rushing to get into that single open channel that leads through the rainforest to the Napo River. At any rate, the strength of the river's flow there is tremendous.
I tried to swing the canoe's nose around, but the current pushed the canoe back sideways, parallel with the bridge. I probably would have been able to back up and turn, had there not been a two by four extending out from the elevated walkway. My back wound up pressed against this, and I was unable to press back against the current. I tried to push away with my foot, and succeeded only in catching it between the top edge of the canoe and the bottom edge of the lumber, scraping my ankle painfully. Then I realized that with my back against the wood, and the canoe broadside to the current, the right side of the canoe was slowly raising up as the river pushed against the left side, which was going down … which was going to lead to water rushing in over the edge -- oops, yes, here it comes! -- just as the bag with the laptop slid down the now-tilting seat and into the water.
At this point the only thing to do was give up (well, that and utter a few curses). The water was only waist-deep at that time, so I exited my overturning craft, quickly plucked the bag from the water and deposited it back on the walkway (thank goodness I had at least had the sense to put a plastic bag over it all), did the same with my paddle, then turned to the business of righting the canoe. With my weight no longer in it I was able to swing it around and get its nose pointed in the right direction. Then I reloaded it and made it home without any further adventures. I was a bit shaky, though. This is just the sort of situation where people get hurt. I was lucky.

Then one morning, I had a snake.
I was doing my Sunday morning housecleaning, when I looked behind the cushion chair in the front room corner and saw what looked like a crumpled rag on the floor. Then my vision focused a little better, and the "rag" became a snake. The patterns were rounded and clear and looked boa-like, but his head was shaped like an arrowhead, which made me nervous.
When I went for coffee, I enlisted Jairo and Aroldo to accompany me back to the house and identify the snake. If it was a boa, I was happy to have him stay. If it were a fer-de-lance, I would prefer that he leave. I wondered what method they might use to dispatch him, were he poisonous, but it turned out to be quite simple. Jairo arrived carrying a long, heavy piece of lumber. There would be no delicately choreographed swordplay between man and viper, with feints and dodges and pirouettes, as happens in the movies. If violence were to be necessary, it would be a quick, brutal, straightforward application of blunt force, with as much distance as possible between the man administering it, and the recipient viper. It certainly made more sense than trying to dispatch the animal with a machete, which would leave the operator's hand within easy reach of the snake should he miss on the first try.
However, the lumber proved unnecessary. They agreed it was a montona, a boa which lives in the rafters and eats mice. Of course, fer-de-lance eat mice, too, but as the boas kill their prey by squeezing rather than by venom, they are less likely to bring harm to humans who share the house.

April 2015
15 April -- Edemita tells me that a few days ago the toilet outside the waiting room area became so sluggish they can no longer use it. The other two, which are farther back in the clinic and therefore closer to the septic system, are still working, but apparently not very well. Each day I look at the graphs, hoping for a leveling off, but each day the water has climbed a little higher.
Edemita says they are very busy in the clinic -- there is yet another strike by the government health care workers.

I have never been stung (yet) by a scorpion, but it seems they are quite painful. There is not a lot to do about it, however, except to give pain medications and wait for the pain to pass. Once in a while, though, someone develops a neurologic syndrome. One of our neighbors, 29 years old and healthy, was nailed one night by a scorpion, in the web space between his thumb and the rest of his hand. Shortly thereafter, he developed a sensation like that of electricity coursing through the extremity. Not long after that, he became weak in the legs, to the point where he could hardly walk, at which point his family brought him to the clinic. Furthermore, when he arrived he was quite dysarthric -- he could barely speak at all, and what he said sounded like he was drunk. He was not. What was happening was that his tongue was becoming paralyzed. Then he developed seizure-like movements in his limbs.
Fortunately, treatment with diazepam (Valium) brought an end to his symptoms, and by the morning, he was pretty much back to normal, though he probably will be very wary of scorpions from now on.

July 2015
When I left off reporting in late April, the river continued to rise. And continued, and continued, slowly but inexorably. When I returned at the end of May, the water had peaked, but not until early May, and it reached a level only a scant few inches below the level of the 2012 record flood. Nor was it in any hurry to subside … often, once the flood has topped out, the river drops quickly, but not this year. By early June the water was still four feet deep beneath the clinic and my house, and it dropped only very, very slowly.
It is finally back within its banks, however, and Yanamono Stream, as of a day or so ago, is once again flowing into the Amazon, instead of the Amazon roaring through the stream. Most years, we are flooded for two or three months. This year, we were under water for all of February, March, April, May and June. Sheesh.
It is thus a tremendous relief to see the land re-emerging, though of course what emerges first is not really land but muck. It dries slowly, but I can now walk to meals without a walking stick or boots, which is an immense pleasure.
Life is good.

Appendicitis used to be rare in Peru -- I was here ten years or more before seeing a case of it -- but it seems to be becoming more common, though it still does not approach the frequency with which it occurs in the U.S. At any rate, a ten year old girl came in on a busy afternoon with a fever near 40 degrees (104 Fahrenheit), and a negative malaria smear. We saw three or four other patients that day with fever and general misery, all of whom were found not to have malaria, and initially, I classed her with them, as a viral syndrome. She returned the next morning, however, with bad belly pain, tenderness in her low back, and still with a high fever. Gregorio was convinced she had appendicitis, and I agreed that was certainly possible, but I was also suspicious of pyelonephritis, infection of the kidneys. Or perhaps a small bowel obstruction, since her belly seemed to be swelling, which is not usually seen with appendicitis. She had several symptoms which were not really typical of appendicitis, and very little pain where the appendix generally lives.
What was clear was that she needed more diagnostic capabilities than we possess, so we took her to Indiana, and they got her to Iquitos. Gregorio accompanied her and reported that by the time she arrived, her abdomen was becoming noticeably more swollen.
It turned out that she did have appendicitis. But that was not all. She also had a mesenteric cyst, a rare form of vascular tumor that can mimic appendicitis or a host of other illnesses. Fortunately, these tumors are usually benign, and hers was removed, along with her appendix, and when she came to the clinic a week later to have her stitches removed, she was cheerful and pain-free.

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