Nada mas

I'm home.

It's hard to describe how I'm feeling right now. I left for Peru not really knowing what to expect. What I found was a beautiful little community where life was simple, people were kind, and there was always the feeling that you were not alone. People were always there for each other, and the Santa Clotilde Centro de Salud was a perfect example of this. This place was special, not only because of the services it offered to the inhabitants along the Napo, but because it was supported and made possible by the inhabitants themselves. Everything was a group effort, from the smallest tasks to the biggest undertakings. It was a privilege for me to be a part of this, and my experience in Santa Clotilde has undoubtedly changed the way I look at healthcare and my role as a physician. It was overwhelming walking around my neighborhood today. From the jungle to the urban jungle, the difference in way of life is incredible. In the jungle, you learn that life can be simple and still bring great happiness. I miss Santa Clotilde already, and am already thinking of when and how I will be able to go back.

My last day in SC was nothing short of amazing. After clinic and the weekly general meeting on Friday, we took the boat to a place called Huiririma. As we broke off from the Napo, the water turned from brown to a shimmering black. Once we arrived in Huiririma, we took a stroll and then jumped in the river. The water was beautiful and cool, very welcome on a such a hot day.

Brian on the boat to Huiririma

Approaching Huiririma, the water is a beautiful reflective black

The dock

Some kids watching peanuts dry - I tried one while it was still fresh, it was delicious!

Mazato - a fermented drink made from yuca, traditionally chewed and spat out in a container later to be mashed

Fanning the fire under the mazato

Another tool in the mazato-making process

Beautiful Huiririma

On the boat ride back, we stopped at Manolo's family's chakra, a small farm on the bank of the river. We brought back corn, as well as fresh sugar cane to chew on. Once back in Santa Clotilde, I had my final serving of chicken and plantains at the polleria around the corner, accompanied by all the friends I would leave the next day. After a necessary party at the local discoteca, I went for a walk to take in the quiet serenity of Santa Clotilde by night. The stars lit up the sky brighter than I'd ever seen before, their light augmented by the hundreds of fireflies all around. A few short hours later, I said goodbye to Santa Clotilde and began the long journey home.

Thanks for reading, everybody. I was happy to share this experience with all of you, and wish you all the best on your respective journeys.

Adios,

Erik

Jungle Fever

It's been just over 3 weeks now in Santa Clotilde, and I've been reflecting quite a bit on the differences in how medicine is practiced here compared to what I see in the busy urban centres back home. 

For example, I've seen two patients now who came in with what I would consider classic appendicitis: right lower quadrant pain, fever, anorexia, nausea, vomiting, and specific tests on the physical exam very suggestive of the diagnosis (Rovsing and obturator signs). Both of them had parasites. One got much better after a course of IV fluids, pain meds, and anti-parasitics. The other didn't improve overnight and we proceeded to operate. Just goes to show that the differential diagnosis is a little broader around here.

Then there are differences that are a bit harder to swallow. About a week ago, a little boy who had been discharged after I arrived here came back. He was irritable with nausea and vomiting. He had a long medical history, born with a cleft palate that had been partially repaired. While his lip and nose were closed, his palate remained to be fixed. Meanwhile, this little boy was shockingly small for his age, weighing in at just over 5 kg at the age of 3. The assumption was that his cleft palate was making it hard for him to eat, and so he was malnourished. Without the ability to measure protein and electrolytes, that was hard to confirm. But Saturday he rapidly deteriorated, and entered a comatose state. He was unresponsive, with nonreactive pupils and gasping for air. All signs pointed to increased intracranial pressure, but without brain imaging we couldn't tell where that was coming from. Was it cerebral edema, or was there a tumor with mass effect? He died shortly thereafter. He was scheduled to go to Iquitos the next day.

Finally, I've been getting a crash course in Dengue. On call one night a 16 year old girl walked in with 3 days of fever, headache, widespread body pain, and now presented with nausea and vomiting. Her hematocrit was elevated with low-normal platelets. I admitted her with a probable diagnosis of classical dengue fever, and sure enough the following day her platelets fell and her hematocrit rose. Dengue can be fatal because it can cause spontaneous hemorrhage and eventually shock. There is no cure, only supportive treatment with IV fluids and tylenol to control fever and pain. We've had 6 or 7 more cases of dengue since then, which prompted us to fumigate. At 6:00 AM. Needless to say I've been bathing in deet since this little outbreak of ours. The trouble is, dengue mosquitos bite during the day, but then malaria mosquitos bite at night. So you're hooped 24 hours a day.

This week in pictures: 

The usual around here: chicken with fried green banana, served with mayo and Inca Cola

After almost 3 weeks, finally went for a nature walk! With the heat and the unrelenting rain, I hadn't had too much time to explore. Here's a view of the Napo.

The cemetery, on the bank of the Napo

Ants hard at work

The end of our walk brought us to a serene little area which turned out to be a fish hatchery of sorts - my first swim in Peru, much needed!

Walking back into Santa Clotilde

Panorama of the view of Santa Clotilde from the top of the 'mirador'

Remember Karl Lewis? He was the kid who came in with a nephrotic syndrome. He has responded extremely well to steroid and diuretic therapy, and now runs around playing all day. While he was extremely shy at first and didn't want to talk to me, he's warming up slowly and will now shake my hand. I'm aiming for a full conversation by the end of the week.

Before treatment

After treatment

Only a few days left here. Saturday I take the boat to Iquitos to start the long journey back home. Time has flown by so fast! Thanks for reading, and stay tuned for the last update before I head on home.

Happy new year!

Happy new year everyone!

Here are the highlights from the last few days:

For Dr. Toni's birthday, Dr. Brian bought her a pig. Yes, a whole pig. After the beast was slaughtered, I helped cut up the meat. It was still warm - so weird! The next day we had an incredible feast up at Toni and Brian's place, live music and beer included. It was a warm and beautiful day, and I'm sure a birthday that Toni won't soon forget.

Toni and Jefferson, our biologist, shaking a leg and checking out the band

Toni and Brian officially opening up the dance floor

Me figuring out how to use the panorama feature on my phone!

New years here was a lot of fun. I cooked up some spaghetti and meat sauce and garlic bread for the group, which was a big hit. Most of the ingredients, especially the beef, had to be brought in from Iquitos (thanks to Blanca, our obstetrician). Dr. Toni (a true Italian from the Chicago area) was thrilled. After dinner we decorated the dining area in the traditional yellow, had some champagne, and headed out to the town center for a huge party where neighbouring pueblos from the Napo congregated to bring in the new year.

Enjoying some post-meal dessert - Manolo, one of our lab techs, seems unimpressed

Panorama of the party in the town center

The most people I've seen in one place in a while

Happy new year, girls! Manolo, again unimpressed

Some interesting things I've noticed during my time here so far:

• Everybody checks the money: anytime you pay for anything and hand over a bill, it gets a good tug, a rub, and a once over to make sure it's real.
• Dancing: in North America we often dance in groups. Here, that's a big no-no. You go up to the partner of your choice, ask them to dance, and sit back down when the song is over.
• Cheers: arriba (glass up), abajo (glass down), al centro (glass in front), a dentro (down the hatch)
• Dolphins: there are actually dolphins in the Rio Napo (saw some when I was waiting for the Rapido in Mazan). Dr. Julio calls them bufeos colorados, and says that some people say that they swim up to shore and turn into gringos. This brings me to my final point, 
• Superstition: people here believe in spirits. For example, a spirit called the 'Tunche' haunts the jungle at night, whispering names and making sounds. I was also told once that I shouldn't sleep in the call room because there are phantoms there. 

Interesting medical case of the day:

A 15 year old girl comes in with a 1-month history of an itchy rash on her left shoulder and arm, running down the  distribution of the ulnar nerve right down to the pinky and half of the 4th finger. While a diagnosis of herpes zoster is tempting, she has no pain, only itch. Does the rash follow a true dermatomal pattern, or is it along a line of Blaschko? If it's the latter, lichen striatus is the more likely diagnosis.