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A neighbor fell through a weak spot in his floor and lacerated his leg, and a girl fell through a different floor and ripped a nasty hole under her arm; both required quite a few sutures. A twelve year old boy came in a week after a hunting accident in which he sustained a shotgun blast to his calf. There were the customary collisions while playing soccer, and several falls while drinking, and a mother and her baby who were both knocked in the head when the boat in which they were riding collided with another. There was a tourist who slipped and fell, and made the mistake of grabbing a very spiny palm tree in an attempt to stabilize herself; she came in with many spines in her hand.

Then, we had quite a selection of animal adventures. We saw five patients this year with snakebites, but only three were venomous (and none fatal). The other two were from non-poisonous snakes who became annoyed with people who came too close, and did not cause serious damage. There was the man who, while hunting what he thought was a paca, a large and tasty rodent, shot it, went to pick it up, and found it was not quite dead yet, nor was it a paca. It was a caiman (like an alligator), and it bit him on the hand. The same day, we saw a man whose buffalo had taken offense and stomped him, breaking and dislocating his elbow. This was beyond our capabilities, but we were able to get him to Iquitos for x-rays, reduction of the dislocation, and setting of his broken bones. Also that same day, a man showed us a serpentine, reddened blotchy streak running from his ankle up to his thigh. It had been there for several months, ever since he had felt a prick on his ankle while walking in ankle deep water during the flood. Dr. Gregorio took one look and recognized it as larva migrans, which is the larva of a dog tapeworm which when it finds itself in a non-dog host, migrates beneath the skin, leaving the characteristic trail. Fortunately, we had the medications to treat him. Another man was nailed by one of the river stingrays, whose venom is nasty stuff that causes wounds not to heal for weeks or months. He did heal, eventually, but came for many visits to the clinic before that happened. There was one piranha bite, one dog bite, and several stings from scorpions. One of these was to the hand of one of our neighbors, in his late 20's, who came in with slurred speech and electrical tingling sensations up his arm. There is a syndrome of paralysis which is occasionally associated with scorpion stings around here, but it usually affects older patients. Luckily, with medications and a little time, this young man recovered completely. Finally, there was one woman who was hit in the eye by a fish. How did this happen, I inquired? She was working at her piscigranja, or fish farm, and the beast splashed out of the water and into her face. How dismaying.

In addition to dental extractions, often multiple, for 37 people, Juvencio filled cavities for about 25 persons of all ages, did a few dental cleanings, and started work on making dental prostheses (false teeth) for a couple of the women in the village who have been without their teeth for years. This last is a slow and tedious process, but I think he is making headway. He has also been performing restorations of chipped or broken teeth, and all these dental services are greatly appreciated by the recipients.

Finally, we see quite a few patients who do not fit into any specific category, and some of them are very interesting (though I always tell my patients that while doctors live for "interesting cases," as a rule, you would prefer not to be one yourself).

I've started keeping track of emergency visits, i.e., patients who arrive outside of our normal clinic hours (8:00 a.m. till 11:30 a.m. and 2:30 p.m. till 5:30 p.m. six days a week, 9:00 a.m. till 11:30 a.m. on Sundays and holidays). Sometimes these are fairly routine ailments in patients who simply arrive, say, during the mid-day break, although we have most of these wait until the afternoon regular hours. "Emergency" patients are thus usually genuinely and sometimes seriously ill, and sometimes wind up being evacuated to a higher level of care. In 2015, we recorded 85 emergency visits, or about one and a half a week, on average.
The first such patient of 2015 was a baby 13 days of age, who came in with severe respiratory distress. Dr. Gregorio confided that he had doubts that the boy would survive, but he did, though it was a long night for both of them. He was followed a couple of days later by an eight-month-old infant with diarrhea and severe dehydration, and a number of our other emergency patients had this problem. In the US, diarrhea is a problem of generally minor proportions, and seldom injures children. Here, as in other developing countries, it is a major killer of small children, due to the dehydration which often accompanies the diarrhea, and has to be taken seriously. Other emergency patients had abdominal pain, usually in adults and usually manageable in the clinic, though we did have one man, one woman, and one ten-year-old girl with appendicitis, and one woman with what turned out to be a small bowel obstruction -- all these were taken to the government medical center at Indiana and from there went on to the Iquitos hospital. The ten-year-old girl also turned out to have a large, rare, but thankfully benign vascular tumor which was removed at surgery.
We also saw several folks with diabetes out of control, including one woman whose blood sugar was over 500, her hematocrit 10% (normal being 35% and up), and who had very poor circulation. She had spent the afternoon in the care of a shaman, then her family brought her to the clinic at 10:00 at night. We took her to Indiana, too.

Another of our transported patients was a woman only 47 years of age with diabetes (her blood sugar when she came in was 415), who had a gangrenous leg. She had put off seeking medical care because she feared amputation, but by the time her family convinced her to come it was too late. Edemita told me the smell of her leg preceded her. We got her to Indiana, and they took her to the Iquitos hospital, but she died despite all efforts.

We provide pre-natal care for pregnant women, but I strongly encourage mothers-to-be to get themselves to Iquitos, or at least to Indiana, to give birth in one of the government medical centers, where if a problem suddenly pops up, they can be promptly evacuated. Some women, however, insist on giving birth at home, and some of these come to the clinic when it appears they are getting into problems. Fortunately, most of the time, the deliveries actually are normal, it is just that the woman is getting tired of the whole thing and wants it over with. But I always worry that there might be a genuine and life-threatening complication, so I am not eager to tackle obstetric cases.


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