Problem-solving in a two week absence of cell service

Camilo was a patient sent down from Angoteros in a coma. He never woke up.

We brought him up from the dock on the orange plastic board, and I tried to get some history from his wife. He had had a high fever for a week. The day prior to his arrival, he had been talking normally, but when he woke up, he seemed to be in a coma. Jimmy had started fluids and antibiotics and sent him downriver; he can only check a hematocrit, urinalysis, rapid malaria, pregnancy test, and rapid HIV in his clinic.

His wife told me that he drank masato every day. “Every day?” I asked. “We go to work in the chacra. How are we going to work in the chacra without masato?” I think my question puzzled her. I asked about her children and her life in Angoteros. “We are agricultores,” she told me. “I have had fourteen children, but eleven of them died when they were babies.”

“Are you sure you want to transfer the patient?” I asked Jimmy when he called. “It sounds like the patient might die, and it is complicated to transport cadavers, and expensive. ”   “Yes, yes…the patient’s wife is very worried; she does not want her husband to die,” he told me.

And indeed it was complicated with Camilo died, because the cell service went out the day he arrived. Cell service goes out occasionally, when the rains are heavy. We wanted to communicate the patient’s death to his son in Angoteros, and to figure out how to get the body home. We still had internet, thanks to the solar-powered WiFi, but Angoteros is too remote for internet. “There is some cell service from Copal Urco if you go to the top of the hill in the Jaime Carranza neighborhood,” Karen told me. “Right under the tree.” The family of the deceased did not own a phone, so they followed me on the 15 minute walk uphill. And sure enough, at the top of the hill, under the tree, people were gathered, holding their cell phones to the sky to catch a bit of the signal from Copal Urco, several hours upriver.

“How long has their been cell service in Santa Clotilde?” I asked Isela.  “Maybe five years? Before, we would all line up at the pay phone. There were no secrets then!”  she laughed.

Limber, the técnico in Angoteros, had worked out a plan. The mayor of Torres Causana, close to the patient’s home villaged, had offered to donate 60 gallons of gasoline.  As medical director, I needed to write up an “informe médico”, describing the death and the “extrema pobreza”, and then bring the death certificate to Vichu, the rápido company.

But first I found my way to the house of Orlando, our motorista,  to ascertain his availability.  I knocked on his door, then found my way to the Neo, the nurse who coordinates our referrals, to confirm the arrangements, then off to Vichu to organize the 60 gallons of gasoline that the mayor of Torres Causana had donated.  The woman at Vichu was not about to give me sixty gallons of gasoline without talking to her boss, so I walked over to Gilat, the pay phone company, to call the head of Vichu in Iquitos to secure the donated gasoline.  Then back to Vichu to bring the Vichu employee to Gilat to call Iquitos.

But that was 60 gallons, and Limber had offered , and we needed 20 more. Off to Don Oscar’s house to plead our case. Now that everything was arranged, we needed to locate the deceased; the patient had died at 3 am and the family had taken away the body in the early morning. Jens had an idea that the family lived on the edge of the jungle, downriver a bit; he went out with his flashlight to locate the deceased and inform them of the plan.

But it all worked out, and the family was pleased to bring Camilo home to rest.

How did you coordinate things in the past?  I asked Robin, our head of maintenance.  “The walkie-talkies helped, but it was still a lot of running around,” he told me.  So many things we take for granted.