Thursday May 20

Thursday May 18, 2010
Today is our clinic in Belen but before we go to the clinic you’ll need a little more information about this section of Iquitos. As you remember from the first journals Belen is a center of local commerce, in addition to the market previously described, many of the larger stores frequented by the locals including Quisneros, the Iquitos “K Mart” are located on the outskirts of Belen. The rest of Belen is a huge teeming slum sitting on the banks of the Amazon. I would guess between 75-100,000 people live there, most in shanty house cobbled together from whatever can be found, however there are some substantial concrete houses as well as the floating houses that ride on the river when the water is high and sink onto land when the water goes down. There are also some floating houses that are always on the water and are usually reachable only by canoe. The concrete houses are often occupied by rather well to do businesspeople who live in Belen because their businesses are there. Rooms rent in Belen for $1.00 a day however these usually have no bathroom facilities except an outhouse or the river. Belen is the poorest and at night the most dangerous section of the city. We are warned never to go there at night and when we go in the daytime we are accompanied by the translators as well as some local security loaned from the military that police Belen. The danger is more from robbery and muggings not physical violence. The people are poor. We are Americans, hence we are rich. We have cameras and other items that could be fenced to feed a family for several weeks or even months so why not share the wealth? The sanitation in Belen is the worst in the city. The river is used for everything – you will see a floating outhouse and downstream you’ll see kids swimming and women washing clothes. When the water is high as it is now the river picks up all the garbage sewage and refuse and takes it away.
Our clinic is in the basement of a large Catholic church – but don’t have in mind a big fancy place. Although it is made of concrete and has a basement and an upper level church so if the water is really high the church stays dry, it is not at all grand. The basement does have a concrete floor but is just one big rather dirty room with a toilet stall at the far end. (In Peru most toilets are US style but never have seats and TP does not come with the bathroom nor does soap, paper towels or hot water. The really good restaurants and other establishments have TP or soap – nobody has paper towels. So hand santizer is our friend and is carried everywhere along with extra TP). The security people organized the crowd that is forming outside while we organize the room for our clinic. Thankfully there is some furniture that we can use to set up our four nursing and one pharmacy stations as well as triage. We will not be able to see every one because we have to leave Belen before dark which means we will stop triage at 4Pm so we can be walking out through the market at 5. Camilla, Paul’s wonderful fulltime Peruvian nurse gives out number and limits the numbers she gives out to the number of people she thinks we can see. In the end we saw 84 people in Belen which is a smaller number than we have seen at the two previous clinics.
This is in many ways the most difficult clinic we have done because of the problems people presented. Perhaps the most remarkable was a woman Sue saw whose son had been killed in an accident and since he provided the entire income for them both she had no money and was grieving and hungry. As in many places there are no soup kitchens in Belen so she had no where to go. After seeing her Sue couldn’t eat her own lunch and was in tears grieving for all the hungry people. I think the person that struck the biggest chord for me was an older woman with diabetes and a blood sugar of 450 who was on Metformin. She could not get the posta to do more – they told her to go to the private clinic and of course she had no money for that and we don’t treat chronic problems because we can’t provide follow up and she really needed that. I referred her to Camilla who is sometimes able to help people negotiate the system and get what they need. But I fear that she will die of ketotic coma some night and it is a terrible shame. She too was in tears just with frustration of trying to get what she needed. I had a hard time with the letting what is, be. The Peruvians have to live with their system and we can’t fix it I hope that Camilla can get her appropriate care at the posta or at a private clinic but it is possible Camilla won’t be able to find her again. The other person that tugged at my heartstrings was a 13 year old girl who was having sex with a man who had multiple partners and who was likely a lot older than she. She likely had an STD for which we treated her but she will be pregnant and run down by the time she is 15 and likely have HIV. Yet I am sure some of her motivation is survival – he probably helps her family with food and if it is not him it will be someone else. Not surprisingly we saw a lot impetigo and other skin rashes, the usual dizziness from inadequate fluid intake and hard work in the hot sun, parasites which I am sure nearly everyone in Belen has, and back and muscle pains. The children present with colds most attributed to the change in weather as fall moves into winter in the southern hemisphere. They had a couple of cold snaps right before we came. (Cold means 70 F). Many people attributed their maladies to this.
As we were leaving Belen I noticed a mother dog with 3 small puppies sleeping under the stairs and all I could think of after all the human misery was the miserable life those three cute puppies would have if they managed to survive the next few weeks. We have seen some healthy animals but most are managy, thin, and have injured limbs from encounters with motor cars. There is a free spay and neuter clinic but it is open only when visiting vet teams come from outside the country. There are also several nice veterinary clinics in the neighborhoods but these dogs will never visit one. Even the dogs at the POPP compound although they are healthy have skin stuff and Ly the big boxer who loves to sneak into our room and hide under my bed STINKS a lot. (Additionally Brenda is allergic to dogs so we can’t let him in even if we could stand the smell).
After a long day we went home to rest and prepare for our event at the Mental Hospital and then off to the jungle adventure.