So...onward we go.

So...onward we go.  Lauri just left for a day seeing one of the original reforestation projects -- a 90 min drive or so -- that does not mean it's very far -- the roads, once you leave the main highways are something else.  And...we thought the roads in Peru were bad!!

Yesterday, I was sent, along with the newest doc, to a village that is visited monthly by the mobile clinic.  It is not a "green" village (meaning no illegal logging or burning), but it is a "blue" village, next to green, so they are making progress.  We saw only 6 patients -- apparently last year they were seeing 20-30 in a day, so not sure why the change.  The sickest yesterday was a 46yo woman with shortness of breath -- could see it as she walked in.  While I initially suspected emphysema, her loud heart murmur and huge heart quickly led us elsewhere -- what appears to be severe mitral valve insufficiency likely the result of rheumatic heart disease years ago.  they have a particularly nasty strain of strep here and lots of rheumatic heart disease and fever.  She was on no meds, so we started several and will see her back in two weeks.

The roads to and from the village were really something -- good thing we had a good driver.  For one stretch there were elevated "boardwalks" on each side of the road for the motor bikes -- apparently put there by the palm oil plantation owner.   So...I presume, they can get the workers to work.

Just this  moment saw a 56 yo man with 2-3 wk hx. of cough, weight loss, at least one episode of coughing-up blood.  His TB sputum smear is clearly positive -- Little "red snappers" everywhere.

This morning started very early with the roosters crowing about 3, followed by thunder the rest of the night, with no rain.  Then, the usual call to worship at 4:30 -- rather fitful sleep after that point.  

This AM have helped one of the docs with a needle aspiration of a thyroid -- but, was unable to get the fluid that I think is there (ultrasound suggests it).  

All for now.  Thanks, Brian, for doing the blog.  I am sure my notes seem very disconnected, and, they are.  Mostly random thoughts and observations.  Looks like, since the clinic is quiet at present, we will have our daily ed. session early.

Jim and Lauri

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