It was an early morning clinic in the Belén area of Iquitos. Women, most of them with children in tow, trudged up the wooden stairs of the stilted home where our clinic was located for the day. There were two exam rooms for the cervical screening, and I set up a Dermatology consult table on the edge of the waiting area. Lena and Mimi travelled around the neighborhood with a local volunteer, announcing by bullhorn our cervical screening and dermatology consult.

I didn’t notice him at first – he didn’t really stand out among the scores of barefoot kids, most with impetigo, scrapes and cuts, and a measure of nervous curiosity. But as his mother approached for a consult on her youngest child, I noticed the sad eyes of five year old Genider. He was pale and wan with a shy smile. I noticed his blue tinted fingernails and toenails, with clubbing of his digits. He was a blue baby, his mother explained.

It’s a bit of dark medical humor that the biggest emergency in dermatology is the condition of “blue”.  Well here I was, on the banks of the Amazon, faced with that very diagnosis.

He couldn’t run and play like other kids, his mother told me, even after the heart surgery he underwent 3 years ago, when he was 2.  Did she have any records? Had he been seen for follow up? She promised to bring me the reports from his surgery in Lima, payment for which  required the family to sell their home and move in with a sister-in-law. The Amazon fisherman father’s wages didn’t go very far, and the family still lives in poverty, not able to afford to take Genider back to Lima (only accessible from Iquitos by air or by an 8 day boat trip) for follow ups.

He was born with tetralogy of Fallot with pulmonary atresia (TOF-PA) – serious heart abnormalities. In the US, surgery is performed during the first year of life, with the possibility of follow up surgeries later in childhood. Although we don’t understand all of the causes of Tetralogy of Fallot, poor maternal nutrition during pregnancy and maternal infections during pregnancy are both potential etiologies. This is easy to imagine in the Belén community of Iquitos.  We talked about getting Genider to Lima for follow up and reevaluation. It had been 3 years since his surgery, and his health was declining.  His mom has 2 other children and no local relatives for support. She really had no way get her son to Lima for the tests he needed.

Rosa, the amazing woman who manages the day-to-day operations of Amazon Promise, the charity we work with, sprang into action. We photographed the child and the meager records his mom produced, and started emailing our contacts. Many international organizations partner with Amazon Promise, and their network is impressive. Within days, we had a response from an Israeli cardiac surgeon with Save a Child’s Heart. Yes, this could potentially be a case they could help with. But before flying the child to the other end of the earth, he needed local evaluation.

Rosa was able to arrange an EKG and Echo in Iquitos, but the CT angiogram could only be performed in Lima. Our family is happily sponsoring Genider’s flight and accommodations in Lima, where it can take days of queuing up for the public hospital’s speciality services. As soon as we get these results, we will await the decision of Save a child’s heart to see if Genider is a surgical candidate.

Life isn’t easy for Genider’s family, and during this time of Thanksgiving, we are so very thankful for our health, for our children and family, and for the amazing good fortune of being Americans.