Belen

Today marked day 1 of clinic work in the "floating village" of Belen, the poor suburb of Iquitos. The neighborhood spills into the Amazon, about half consists of floating houses reached by canoe, and the other half are built into the riverbed on stilts.

Reaching the clinic involves walking through about 1/3 of the miles long Belen market which is filled with just about any animal, vegetable, organic or inorganic object you could hope to purchase. Today's special appeared to be turtles.

In the herbal medicine aisle we were offered a free love potion perfume whose smell was astonishingly reminiscent of used diaper. We declined. Although I did try to pursuade my unmarried compatriots to give it a try and let me know how it worked out.

The village is in the midst of a Dengue fever outbreak, not a shocker given the amount of trash, human waste, and puddles of highly questionable water literring the alleys. The government has arranged for trash pickup twice a day but the citizens protested explaining that it's much more convenient to keep throwing trash into the street or river.

This was demonstrated for us when a patient reached past us with an empty juice bag. we stepped aside, assuming he was going for the trash can. Nope, he was reaching past us to throw the bag out the window. It landed on a rooster.

I spent most of the day vaccinating and doing well-baby checks; a fun job assignment no matter what country you're in. They take their vaccinating seriously here. I was instructed to insert the needle all the way up to the hilt every time, even though I had easily penetrated to muscle a good 3-4 cm earlier. Poor bebes.

My friends administered tourniquet tests for hemorrhagic dengue. Basically you take the patient's blood pressure and then reinflate the cuff to 1 1/2 times that amount. The cuff stays inflated for 2 minutes, then you take it off and count the number of petechiae (little red rash spots) that appear. If there are more than 2, the person has a tendency to bleed and is admitted to the hospital. Neat.

Tomorrow we take a canoe trip to some of the water bound villages a bit further away.