The Amazon Medical Project

June, 2009

           Coming into Yanamono Stream, it could be seen from the mud marks on the tree trunks that the water had dropped about 18” from its peak level.
            The water was about a foot and a half deep beneath my house at the height of the flood. Now the plank sidewalk in front of the house is floating at the far end, and resting in mud by the stairs leading up to the door. I can pull my canoe into the shallow water and step onto the plank, but this will become more difficult once the water falls a little more. But, one day at a time.
            The clinic has been busy. We had taken care of more than 200 patients by June 19 or so, and I think we are now up past 300. And today is Monday.
            There has been a veritable epidemic of babies with pneumonia. One mom walked all the way from Nunez Cocha on the Napo River with her 3-month-old in her arms. The baby was fat and had received all her vaccines, but her breathing was so scary that Edemita confided that this child looked just like her own infant did, many years ago … just before he died. She said that even Wilbert agreed the baby was a candidate to be the first person to die in the new clinic. They nebulized her and gave her antibiotics all night, and she pulled through, as did the other child about the same age with a similar syndrome who shared the overnight room with her.
            Then there were several people with dysentery (diarrhea with blood in it). You don’t want to know the details. Oh, and what we think are several cases of leptospirosis. These folks come in with fever, headache, but not the profuse sweating typical of malaria, and they have fairly marked conjunctival injection (red eyes), and negative malaria tests. We do not have laboratory confirmation, but we are very suspicious – especially since Edemita openly scoffed at their claim of drinking chlorinated rain water. Doctora, she said, they do not chlorinate anything. They are just drinking agua cruda (raw river water) -- and the illness is passed through water contaminated with urine from various animals. Since Edemita knows everyone for miles around, is godmother to many of their children, and frequently visits their houses, she is usually right on these matters.
            Anyway, we treated them all for leptospirosis.
            We finished the month with 375 patients in all. The new clinic is working!

          04 julio, 2009 – Fourth of July, in the U.S. Just when everything was going so well … then a woman shows up with her two month old baby, who weighs two and a half kilograms, small even for a newborn. She says she has no milk in her breasts and has been feeding him a powdered formula. The formula has run out, and she is now giving him flour and water in his bottles.
           The baby was so pitiful. His head was the size of an orange, with the skin wrinkled and his brow furrowed miserably. He looked like a miniature old man. His color was bad, too, dark grayish brown, a stark contrast to his pale pink mouth, which he opened periodically to reveal toothless gums and a tongue crying for food. When I put my finger into his mouth, he sucked on it, but he was also beginning to make little hitching gasps, which probably represented the start of agonal respirations.
            His mother wanted us to give him medicine to fatten him up. We told her that the only thing he needed was food. I urged her to find a friend, relative or neighbor to be wet nurse for the poor child, but he is so far gone that he would probably die from refeeding syndrome anyway.
            I rarely cry over our patients. We do what we can, but there are limits to what can be done, and after all, we all die eventually. This little guy, however, was heartbreaking. The best I can hope for him is that he is already dead – which is likely – and therefore out of the misery that has been his taste of life for the last two months.
            And his mother refused family planning. Later, doctora, she said.
            Imagine my surprise, then, when she returned with her starving son on the next Vaccine Day, and he was actually alive and 200 gm heavier, now weighing in at a shade over six pounds. She had somehow found more baby formula and was feeding him regularly. We congratulated her, and admired him.

            One night, a boat came in at dusk, bearing a six year old who had been felled by a banana tree. Fortunately for the boy, banana trees are not really trees; they have neither bark nor wood. Nonetheless, they get to be fifteen feet tall or so, and ten inches or more in diameter, so when one loses its balance and topples over, it is a significant amount of weight that is falling. This one fell right on the boy, dislocating his hip. It takes a pretty major force to dislodge a hip bone from its socket, since the socket is deep, and the bone and ligaments and muscles holding it in are all fairly large.
            The boy was lying on his back, with his left hip turned in, flexed at the hip and bent at the knee, obviously in severe discomfort. I tried to give the hip a gentle lift and twist, hoping it might fall back into place on its own, but all I succeeded in doing was making the poor child scream. He had good pulses in his foot, and no other apparent injury, so I went to my books.
            I had never reduced a dislocated hip. I recalled the medical school adage intended to emphasize that we as physicians are expected to learn quickly: see one, do one, teach one. I had seen one such procedure. Once. I pawed through my book, and it looked as though it should be fairly simple. I gave the boy a good dose of ketamine, an injectable anesthetic that soon had him in la-la land, and went to work. Carmen held his pelvis firmly to the table, while I took hold of his thigh, bent his knee, and lifted and pulled and twisted gently but firmly. When the bone moved back into place, I could not only feel it, but along with Carmen and the patient’s mother, could clearly hear the loud thunk that signified success. Whew. Checked his pulses again, and they were still strong, so we rigged a splint from a leftover piece of lumber, and strapped his leg in place. If he were to bend his knee, the muscles would pull the bone back out again, so he will need a splint to keep the leg straight for three weeks, if there is no fracture of the hip socket, or six weeks if he did chip the bone when the hip got knocked loose. I told his very grateful parents several times that they need to take him to the city tomorrow and get an x-ray of that hip, then bring it back to me. I realized afterward that he will need crutches, and we do not have any in his size, but hopefully the Regional hospital, where the x-ray will be performed, will supply him with those. If not, we will work something out.

Then I went back to a late supper, feeling very full of myself for having succeeded. Now, I just hope he does well in the long run.