Medical stuff

Very interesting medical things here.

We do not have a blood bank, but when a patient needs a blood transfusion, they check their blood type and then a family member donates blood (after checking for blood type, HIV, etc.) Hospital workers sometimes donate blood as well, if there is no family member available.

The process is simplified by the fact that almost everyone here is O+. There are three or four people in town who are A+; when I started asking about it, they say, “oh yes, Rosa is A+, and Maria…” I found it fascinating that this tight-knit community would know who had which blood type.

Some diseases here that I have only read about. One patient has trachoma in his eye. He is a young man with seizure disorder who has already lost the vision in one eye after Stevens-Johnson syndrome from his anticonvulsants. Trachoma is an eye infection; with time and inflammation the eyelid starts to turn inward and the eyelashes can damage the cornea. He was seen by an eye doctor here who removed his eyelashes to avoid more trauma to the cornea. There is a Scholtz tonometer here to check ocular pressure in glaucoma; it looks like a bit of a medieval metal instrument, but I hope to get it figured out soon, because it seems that many people have eye complaints. There is lots of malaria, mostly Plasmodium vivax, which is the more benign malaria. Declan and I sleep with a mosquito net, but we still have lots of mosquito bites.

I helped Toni reduce a radial (arm) fracture on an arm under ketamine anesthesia. They have no Xray machine here; you have to palpate whether or not a fracture is present, and give the IV anesthesia and pull on the hand to reduce the fracture, then apply a cast. The casting material is not the best, and it does not dry well. There was a little boy here with a tibial fracture the day I arrived; they brought his bed out into the sunshine for several hours to help it dry. I know there are people in the US who use ketamine as a hallucinogen; I wonder what it would be like to have your fracture set under ketamine. I have, of course, never set a fracture. I tried to look it up online, but the internet connection was spotty, so Toni looked it up in her Washington Manual and we practiced on each other before we worked on the patient.

Toni is amazing! She is so inspirational and positive. She jumps up to do anything, whether it is making pancakes (just add vinegar to some canned evaporated milk to make it taste like buttermilk!) or doing a paracentesis or doing a D&C or mixing up grout to fix the leaking sink or teaching me to make “refrescos” from the fruit that grows in our yard. She is never grumpy, she always has energy, and it is clear that everyone loves her.

We have seen leishmaniasis, which is a skin ulcer caused by a parasite transmitted by a sand fly. Treatment is 21 days of IV medication. We saw one 75-year-old man whose whole eye seemed to be replaced by some kind of growth; there was not too much we could do for him. O__ is a two year old boy who seems to have typhoid fever, and seems to be finally getting better, after several weeks of fever. He lives 8 hours upriver by canoe; his mom had to leave O___’s 2-year twin under the care of her 11-year-old daughter while the child is in the hospital. We wanted to send the child to Iquitos for more diagnostic studies, but Iquitos is a long way away, and his mother does not think she can be away from her other kids for so long.

There are tiny monkeys in the trees and a grapefruit tree in our front yard. Toni did not want to tell the neighbor children about the monkeys, for fear that they would try to capture them as pets. Anagaly’s daughter has a tiny pet monkey that clings to her chest; the daughter’s Tshirt is stained with monkey urine. We saw a woman in triage yesterday who was worried that her daughter may have broken her arm; the arm did not seem to be broken, but I noticed something wiggling underneath the mom’s shirt. I asked to see it; she reluctantly pulled out a baby green parrot! She had recently taken it from the nest. Illegal, of course, but very common. We went to a little manatee rescue place in Iquitos; there are apparently Ecological Police who periodically conduct raids on the markets in Belen and other places, to decrease the traffic in exotic animals which may be endangered.

leishmaniasis

sunset on the Rio Napo

View from our porch at sunset

Toni doing a telemedicine consult with a medical assistant at a health post two hours upriver; he was worried that the pregancy was not developing well, but Toni was able to do ultrasound measurements to confirm that the woman was only about seven months pregnant.