First day of clinic

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I´m sitting in a 5-star hotel in Lima as I write this entry. Can´t even believe how amazing this hotel is! Ah the luxury of traveling in a 3rd world country... 😊

After a rough night spent running from our room to the bathroom, made even more interesting by the sound of at least 4 other people puking at the same time I was (though the buildings were spread out, you could hear everything in the little compound), daylight broke and I was feeling stable. Actually I felt like I had the worst hangover ever (dehydrated from not enough water the day before and losing it all overnight and then some). I didn´t eat much for breakfast, but was able to push through the residual nausea and board the boat for the first village. Our transportation to the boat was standing on top of this big truck and holding on for dear life as we bump through the dirt and mud roads to the village proper. Once at the water, we boarded the ill-fated boats from yesterday and set off on our next trek. A nice hour or 2 boat ride up the river deeper into the Amazon, and we arrived at our destination. Or at least "1km" away from our destination. Since it´s not the rainy season (fall-spring) the river is low, so the boat couldn´t make it as close to the village as we would have liked. We all set off on the "1km" walk to the village (at least the sidewalk was paved). I put it in quotes because 1km actually turned into closer to 2 or more miles. It was a long walk. Not bad in the morning though. I haven´t really mentioned the weather there, but the temperature was like low in the 70s and high in the 90s. Nights were great, but daytime in the sun was HOT. I basically got used to wearing a thin film of sweat throughout the entire day. Everything I wore became soaked by noon every day (just damp if we were lucky enough to be in a building out of the sun). I also haven´t mentioned the mosquitos. And oh yes, there were mosquitos. I found out that DEET is amazing. Spray-on deet became my best friend. I felt like I was doing an intense field-test of the stuff. I was assaulted by hundreds of mosquitos every day, but only got bitten a few times (where I missed a spot, or there were enough of them that finally a few would just break through and go for it). It´s not bad during the day, but dusk and dawn are killers if you´re outside without deet. (in fact, the first night in the rainforest when we arrived at camp, we all got together in this little building with big flourescent lights in order to separate the meds and count them out and organize. The mosquitos (and all kinds of other Amazon bugs and giant toads) were swarming us -- they must have thought a feast had been laid out in their honor!)

The walk to the village wasn´t bad in the morning. I was having little bouts of occasional nausea, but not bad. Able to drink water just fine so was doing ok. Once we got there, we picked out our locations for clinic, the pharmacy, the lab, and the dentist (we had a local dentist with us) and set up our little stations. Each team was composed of a doc (ranging from someone who just graduated internship, like me, to a board-certified, fellowship-trained specialist), a 1st year med student, a translator who may or may not have medical training, and possibly a midshipman from the Naval Academy (there are 3 on the trip with us). There were 8-9 stations each day. We also had a floating dermatologist, a couple of infectious disease docs, and a pediatrician. I was doing ok during the morning, and saw a few patients. I swear I think EVERYONE in the country complains of headache and dizziness, seeing black spots, and plus or minus "kidney pain" which is actually their description of low-back pain. I think the complaint of headache there is like Filipinos complaining of dizziness (which is anything from heart attack to fever to urinary tract infection). I did have a few things I could treat though -- infected bug bite, diarrhea, LOTS of urinary tract infections, and a couple of STDs. Everything else got a little packed of tylenol and/or motrin. I had a couple of people who probably had cancer and needed further care, so we made the appropriate referrals. Whether that actually happens or not though... Not very much high blood pressure, diabetes, dementia, or cancer there. They either don´t live long enough, or self-select so those people aren´t around (I think I heard somewhere that the average lifespan is in the 40s. Of course I´m sure that´s largely due to infant mortality.) I had brought some candy and little games/toys for the kids, but they were so grateful to get anything that I could have given them almost anything and they would have been thankful (also their culture I think is to accept everything gratefully and not say no... which makes it hard to say no when they offer you something you don´t want). When we set up the clinic, we had a check-in station (we kept records on each encounter, though VERY simple with just the key points of the encounter) where all the kids from age 2-14 got albendazole. For anyone non-medical who´s reading this, worms are a big problem in the developing world, and though everyone gets them, it´s the kids who are impacted the most. In childhood, it stunts growth and retards mental growth as well. They find that they can make up much of the growth that is lost in even in short periods of worm-free time. Most of the endemic population knows about albendazole (after they take it, the kids start pooping out dead worms, so they know it works...) and will travel from miles away and line up for hours just for the magic pill for their kids. They also know about vitamins. Though for many problems we saw in clinic we felt like we were just pissing in the ocean (here´s a pack of 20 tylenol for your cancer pain), the one difference we knew we made with everyone was vitamins (and albendazole for the kids). So important when you don´t have access to a balanced diet. All the kids got children´s multivitamins, the adults got adult ones, and the pregnant women got a bottle of prenatals. Most people there didn´t LOOK malnourished, but a vast majority of the kids had signs of protein malnutrition (light colored streaks in the hair of very dark-haired people is a dead giveaway). I´m sure they also had vitamin deficiencies. (As an aside, many people in the US don´t look malnourished either, but if you tested them you´d find an aweful lot who are vitamin deficient in one thing or another. Everyone take your multivitamin!!) You may wonder where we got the money for all this. It may please you to know that a small amount of your tax money is earmarked for humanitarian projects like that -- we had around $10,000 budgeted for supplies and meds.

The day continued and we saw more patients. By noon I was starting to feel like I was coming down with a fever. I took a few tylenol and took a break. I helped out in the pharmacy while I could, but within 20min of feeling like I was getting a fever, I was febrile, weak, and prostrate on the floor of the pharmacy with my head on my bag. At one point I felt like those little kids in Africa with flies all over them when I woke up and saw a fly on my hand but couldn´t care enough to even brush it away. I slept for a little bit, woke up and took more tylenol. After a couple of hours of that, my fever broke, and all of my symptoms dissipated as quickly as they came on. I woke up feeling better after a couple of hours, got up and started helping out in the pharmacy, and within about 30min of waking up, was almost back to normal. How weird. I finished out the day in the pharmacy and kind of took it easy. Everyone was very helpful and kept checking on me, but my immune system was doing just fine. We finished up in the village and I think we actually saw everyone who came. I still don´t know the exact number, but I probably a couple of hundred.

Our clinic was set up in a little classroom (the whole building was just the classroom) that had a few windows and open doors. Not much breeze and it got a little warm throughout the day. Just before we were going to head back, the sky opened up and it downpoured. Felt great because it cooled everything off (I make it sound like it was stifling hot all day every day, but mostly it was humid so you were constantly sweaty and damp making it FEEL like you´re hot and nasty all day). It stopped just in time for our "1km" hike back to the boat. This time I started getting a fever again on the way back. I didn´t have any tylenol handy though so just had to bear it out until we got back to our village. We boarded our work-horse trucks and I bummed some tylenol from someone hoping it would kick in fast. The only thing worse than bumping down those roads is doing it while achey and feeling like crap. The trip is made even more fun by the low-lying electirical wires everyone has to watch for to keep from getting clothes-lined (though I suspect that at 8mph it might not be that bad -- just the whole electricity part that might suck). When we got back I sulked back to my cabin and just plopped down on the side of my bed in my still-damp and now slightly muddy clothes. I looked at my watch and decided that I wouldn´t be eating much at dinner anyway even if my low-grade fever did break soon. So I peeled off my rainforest-encrusted clothes and rolled into the moderately-clean but hard foam mattress (like memory foam with out the memory or soft part). I was out by 6:30 and slept soundly until 6:30 the next morning, not even awakened by the hovering mosquitos looking for that deet-free spot (and some found it). The next morning I awoke feeling refreshed and almost human.

I´m going to take a break from writing for now... I´m just hanging out in Lima today, but am looking forward to just doing some relaxing. Also looking forward to more sleep since I only got about 4hrs last night. Lima has a pretty decent nightlife. I´m off to enjoy a gourmet, free breakfast in my 5-star hotel, then roll into my luxurious white, down covered bed, complete with down pillowtop. I can´t believe I get paid for this... 😊 I hope to write more soon!

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