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At any rate, we had four babies born at the clinic in 2015, three of them in February. The first of these was one of our neighbors, who came in during regular clinic hours and had an uneventful delivery by about four in the afternoon. That is my preferred sort of obstetrics. The next was a woman in her mid-30's, with seven children at home but a new common-law husband who naturally wanted a baby that he had fathered. Of course. She arrived with the birth sac intact but the infant's head well down into her vagina, and shortly gave a great heave and popped out a very blue baby boy, along with enough amnionic fluid to drench my skirt (I had not had time to change into surgical garb, nor even to don gloves). He came around with oxygen, and I hope will develop normally. Then, a couple of evenings later, a woman in her early 20's came in near midnight and gave birth to her second child just inside the clinic door. At least this one was quick. The last delivery came in the late morning in July and occurred within a couple of hours, though this was her first baby and she complicated matters somewhat when she sustained a large vaginal tear during the infant's passage.
Other emergencies included various of the trauma patients described above, and others with respiratory illnesses, and there were several obstetric cases, which seem always to arrive at night. Among these were several young women who were miscarrying, and one who came to the clinic not once but twice thinking she was in labor, and got taken both times to the Indiana medical center, only to give birth at home two weeks later. And one of our neighbors, who almost always comes in after hours, and never manages to pay her bill (small though it is), showed up at 8:00 at night with a towel draped over her head (signal that you are REALLY sick), moaning, dizzy, weak, and anxious for the previous three hours. She lives nearby and could have come during clinic hours, but did not. She had no serious illness, and the clinic staff comforted her and sent her home.
Finally, there was a 26 year old woman who came in because she felt her heart was racing, and she was light-headed. There was good reason for that... her heart was dashing along at a rate of 233 beats a minute, with a blood pressure of only 70/60. The most likely cause of this problem in a young woman is paroxysmal supraventricular tachycardia, which can certainly be uncomfortable but is not usually dangerous. However, she could have had ventricular tachycardia, which is potentially more worrisome. Also, treatment of PSVT is usually with a drug which we do not have at the clinic, and I don't know if they have it in Iquitos, either, since we transported her to Indiana, they took her on to the city, and she came back with tablets of amiodarone, a potent anti-arrhythmic drug usually reserved for ventricular arrhythmias. So, who knows? I suspect she had PSVT, and they just don't have adenosine in Iquitos. But we won't know unless she comes back when we have our handy little telemetry meter and can document her real rhythm, or get a copy of her electrocardiogram from Iquitos, which is not likely to happen.

So, we do what we can. We cannot save everyone, but happily, most of our patients survive.
Now we will see what 2016 brings.


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