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.