Amazon Medical Project Inc

Annual Report - March 2022

Dear Clinic Supporters –


Yet another year has come and gone, and despite some setbacks, I do think it was an improvement on 2020.  However that may be, it is time to give you the Annual Report for the Amazon Medical Project for 2021. 

Our patient census remained low.  With only 1722 patients in all, it was the first year since the clinic’s early days that we served fewer than 2000 patients.  I think this was partially due to lingering COVID effects – travel on the river is now nearly back to normal, but for a long time, it was limited to at least some degree; and there were succeeding waves of COVID disease -- in fact, we had to close the clinic for a couple of weeks early in the year when several of the clinic staff fell ill (again; they had all gotten COVID-19 in early 2020). 

But I think much of the change was attributable to not having a doctor on staff for too much of the year. I returned in late March, for the first time since having left when the pandemic first burst onto the scene. I had been in the United States for just over a year, my longest stay since I began coming to Peru in 1990. I was also at the clinic in July-August, and again in October-November, but these were shorter trips than I used to make, and unfortunately the pandemic has made it harder than ever to keep a Peruvian physician on staff. We had one in January, until he fell ill with COVID, then decided he would not come back, leaving us without a doctor until the middle of March. At that point, a newly graduated physician joined us, and stayed for three and a half months, when he left to do his year of national service. He was followed by the young doctor who had worked with us for a couple of months last year, but he didn’t join the clinic until mid-October, then personal business took him to Brazil for all of November. 

Weighing In
All this meant that there were only five full months, and two half months, with physician presence, except for my own relatively short stays. Even when the docs were present, word had spread that there was no doctor at the clinic, and it takes time for the news to get around that yes, there now is a doctor – whoops, and then he’s gone again.
Still, we provided care for a wide range of problems.  I have always thought that the most important service we offer is family planning.  When I came, there was almost no woman over the age of twenty who did not have multiple children; today, many young women are studying, or working in Iquitos, and are not even thinking about having a baby until they are well into their twenties; and the older women no longer have eight or ten or fifteen offspring.   For decades, when talking to women about birth control, I had to ask how many living children they had, and how many dead ones.  Now, if I ask about dead babies, the women look startled, and reply emphatically that they have not lost any.  That is a remarkable improvement, for the women (who are not as run down as they used to be, with pregnancy after pregnancy throughout their lives), for their families (who are less likely to be poor since there are fewer mouths to feed and fewer bodies to clothe), and for the rainforest (which has to be cut in order to plant crops to support the families, so smaller families mean fewer incursions).  In fact, family planning visits accounted for 14% of all the patients we saw, and I am proud of that. 
Girl & Monkey

There were 45 people with pneumonia, which was actually a few more than in recent years.  Some of these were probably COVID cases, though we did not have the testing necessary to make that diagnosis with certainty.  Nonetheless, there used to be far more people with pneumonia, and it was one of the major killers of all those babies.  With vaccines for pneumococcus and influenza, we are seeing much less pneumonia overall than we used to, and I can’t remember the last time an infant died of it in the clinic – another marker of progress. 

There were only four cases of malaria all year, which was good news. We saw 34 assorted cases of trauma ranging from various injuries sustained during the daily futbol (soccer) games, to people who collided with falling branches, to people who collided with one another, usually while inebriated. Since there are no roads, we do not see traffic accidents, but there are occasional mishaps with boats. A couple of people ran afoul of boat propellors, and there was a small boat carrying four adults, two children and an infant, which sank when it got caught in the crossfire of waves from two larger boats passing in opposite directions.  One woman nearly but not quite drowned, and was brought to the clinic with hypothermia.  She did recover, and miraculously, the kids and the baby were all kept safe. 

There are always a few people who step on nails, and every year brings several machete cuts, including one man who slipped and fell while carrying his machete, and slashed himself deeply across the palm of his hand.  This happened when there was no doctor at the clinic, but Edgardo and Elmer did a very nice layered closure (sutures inside the wound to hold everything together, then stitches in the skin), and he healed well.  Another man slashed his ankle while using a weedwhacker (cutting weeds used to be done with machetes, but now weedwhackers dominate the market, at least for people well enough off to afford them).   Then there was the 7-year-old who managed to jab a shovel into his foot while digging worms with his sister, preparatory to a fishing expedition. 

And there are always a few animal adventures.  There were a couple of dog bites, none of them too severe.  There were a couple of scorpion stings as well.  I have never heard of one of these being mortal in Peru, but they are reportedly quite painful.  Happily, we now have anti-venin for these animals, and it seems to work pretty well to relieve the pain.  We also have anti-venin for Loxosceles spiders (the brown recluse family).  These bites are usually not painful when they occur, but can cause significant necrosis of soft tissues later, and we did see one or two probable Loxosceles bites in the course of the year. 

We also saw five people with poisonous snakebites.  Four of them were relatively minor, and the victims all healed uneventfully.  The last person bitten in the year was not so fortunate.  I surmise that he received a very large dose of venom, and though we gave him antivenin, he immediately developed significant swelling in the leg where he had been bitten.  He refused to let us take him to a higher level of care, and went home against medical advice.  A few days later, his family brought him back, but by then, he had gangrene at least up to his knee.  That time, we did take him to the government medical center at Indiana, and they transferred him on to Iquitos, but it was too late and he died the next morning.  He was our first patient to die of snakebite in quite a few years, and I still feel bad about him. 

Skin problems are endemic in the tropics, due to the warmth and humidity which are a perfect combination for the growth of fungi (athlete’s foot, vaginal candidiasis, ringworm, jock itch, all are fungal infections) and also due to the poverty and poor diet, which combine to leave people’s immune systems not quite up to par.  

Juvencio Lab

Many children are not vaccinated against chicken pox, so we always see a few cases of that.  Scabies are common (and usually include multiple family members), we have one patient with psoriasis, and each year there are a few people who come in with herpes zoster (“shingles”).  One woman had a lesion on her leg which I suspected was a fungal infection, but I couldn’t be sure, so I took a biopsy back to Wisconsin, and she turned out to have eczema, a sort of a combination of dry skin and allergic reaction. 

There were only 81 people brought in with diarrheal illnesses, which is less than half of what we saw just two years ago, and is a testimony to the importance of clean drinking water.  As water treatment plants are brought to more and more villages (usually by volunteer groups), the number of cases of diarrhea declines. 

In addition to 44 dental extractions, Juvencio performed fillings or other repairs for 17 people.  These services are available from fully trained dentists in Iquitos, but the cost is steep, and our patients are glad to have access to Juvencio’s services. 

We were only able to vaccinate 129 people, about a third of what we achieved in the year prior to the pandemic, since the availability of vaccines was severely restricted.  At first, the vaccines just stopped arriving, since flights were suspended in the first months of the pandemic.  Then when the vaccines for COVID came out, the government made those a priority.  I can’t really argue with that, since the coronavirus devastated the country.  The death rate from COVID-19 was over 5,000 per million population, by far the highest rate in the world.  The government is working hard on getting people vaccinated, and it has made a huge impact.  But this meant that other vaccines were put on the back burner.  Hopefully 2022 will see more availability of the routine vaccines.  

Mom and Baby

Then, there were a number of people who didn’t fall into any particular category of ailment. There was one patient who had aching in the muscles of her neck and upper back, a common complaint. However, when I examined her, I also found a number of bruises on her upper back. This was concerning – spontaneous bruising is often a sign of a serious illness -- but it turned out that she had been seen by a shaman prior to coming to the clinic, and he had performed a ritual which involves sucking out the evil vapors, thereby leaving her with a collection of hickies. 

There was a 21-year-old who came in while I was in the U.S., who had severe stomatitis, or mouth inflammation/infection.  From the photos the nurses took, it looked like he had “thrush,” oral fungal infection, which occurs in people with leukemia or AIDS or other conditions which severely depress the functioning of one’s immune system.  The lesions were so painful that he was unable to eat, and he was rapidly losing weight.  We told him he needed to go to the government health system for more evaluation; whatever he has, it is almost certainly bad, and it is beyond our capacity to diagnose. 

Another man had hives all over his body, for the last six months, according to his report.  He, like the previous patient, was someone we had never seen before, so we know nothing of his past health.  He could have leprosy, syphilis, severe allergies, etc., etc., and we again advised that he go to the Regional Hospital for more evaluation in the clinics there.   Yet another man, also new to the clinic, had itching for the last seven months, had lost the outer edges of his eyebrows and had a face slightly reminiscent of a lion.  This all suggests the possibility of leprosy, and we sent him to the program in Iquitos for that. 

And there was a teenager with prolonged bruising around one eye, who worried me.  But we sent her along with a note to Dr. Baca, a wonderful ophthalmologist in Iquitos, who treated her at no charge and diagnosed an allergic condition for which he prescribed expensive eye drops, for which the clinic reimbursed her family.