Annual Report - March 2022

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. 

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. 

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.  

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.