Peru Clinic Progress Report

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Peru Clinic Progress Report

Date: January 5, 2008 Prepared by: Guillermo Huasasquiche, RMP - Med. Dir. PPA.

I. Demographic Information 1. City & Province:

Pisco, Ica

2. Organization:

Real Medicine Peru

(www.realmedicinefoundation.org)

3. Project Title:

“Real Medicine Foundation – Policlínico Peruano Americano”

4. Reporting Period:

December 1, 2007 – December 31, 2007

5. Project Location (region & city/town/village):

District- San Clemente; City- Pisco; State- Ica

6. Target Population:

District of San Clemente – 30,000. Province of Pisco (including San Clemente) – 125,000.

II. Project Information

7. Project Goal:

To provide long-term comprehensive health assistance to the people in the province of Pisco (pop: 125,000), specifically in the district of San Clemente (pop: 30,000).

8. Project Objectives:

1 – Treatment of acute and chronic illnesses in the urgent care center “Policlínico Peruano Americano.” San

Clemente is a very impoverished area and all services are offered free of charge. Much attention is given towards prevention and health education within all facets of the clinic’s operation.

2 – To improve the comprehensive health of the community through outreach programs, educational programs, and public health initiatives.

9. Summary of RMF-sponsored activities carried out during the reporting period under each project objective:

BACKGROUND

On August 15, 2007, Pisco, Peru experienced a deadly earthquake…7.9 on the Richter Scale. Over 1,000 people died, 40,000 families left without homes, 150,000 people left without water. The majority of the health infrastructure was damaged or destroyed in the earthquake and the people are in need of medical attention. The Real Medicine Foundation team was deployed to Peru on October 12 in an effort to assist those in need. The primary Objective of the project is to bring long-term free healthcare to the victims of the earthquake who have lost their homes,

possessions, and in many cases, loved ones. The areas most affected were Pisco, Ica, Chincha, Cañete, and Huancavelica. The site of the RMF clinic is in the San Clemente, Pisco. San Clemente is the poorest district of Pisco and the overwhelming majority cannot afford paid health services. In addition, outreach programs are being initiated to service the health needs in the very remote and impoverished mountain region of Huancavelica, installation of a school nurse in the grade school in San Clemente (3600 children), implementation of the first HIV program in the region, and implementation of program to bring US medical students to Peru to receive unique international medical experiences.

OBJECTIVE 1

The Policlínico Peruano Americano opened its doors on November 12, 2007. In the month of November, the clinic operated in a temporary capacity in a parish hall at the "Parroquia de San Martin", until December 7, 2007. On December 10, we transferred to our new location, which has a variety of modern and open spaces to offer quality

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services to the local population.

The first floor of the facility houses the waiting room, admission and triage, topical treatment, a doctor’s office, as well as restrooms for the patients. The second floor has the pharmacy, a medical consulting room, manager’s office, waiting room and a restroom.

On December 3rd, Glenda Gutiérrez Cuadra joined the team as a licensed nurse, she will be helping the children of the school “The Institute of Education José Carlos Mariátegui" in San Clemente, which is located three kilometers from the clinic. On December 17th, Richard Bernaola Zevallos joined our team as a Technical Nurse which will greatly expand our abililty to see more patients and lessen the workload of Nurse María Flores Medina.

The team of the Policlínico Peruano Americano treats all of the community’s health needs from 8am until 4pm, Monday through Friday.

OBJECTIVE 2

Health Education in school– On December 3rd, a nursing unit was opened at the school "José Carlos Mariátegui", under the supervision of Nurse Glenda Gutiérrez Cuadra. She will be in charge of offering first aid, administration of medicines, treatment and the referral of patients that require further care to the clinic. Also, very importantly, she will hold seminars and discussions regarding the promotion of health and preventative measures, in coordination with the teachers. We decided to hire Glenda as there is no other nurse or health professional working at this school and serving the 3,600 students, who attend in two shifts.

Inauguration of the Policlínico Peruano Americano - On December 10th, 2007, the inauguration of the clinic was

celebrated with many authorities of the San Clemente District attending, among them the Mayor of San Clemente, Cleto Rojas; the Commissioner of San Clemente; the Dominican Sisters; the Coordinator of CARITAS; Vanessa Vértiz (MSD Perú) of Merck & Co, Inc., the sponsor of the clinic, and her press team; Dr. Jaime Tasayco of the Instituto de Salud del Niño; Jerome Galea of the UCLA Program of Global Health, as well as the Founder of RMF, Dr. Martina Fuchs, and many others. Patients were treated the same day at our new location!

Christmas Celebration (“Chocolatada”) with the children - On December 24th, we had a party for approximately

120 children who received a gift and medical attention for themselves or their parents, if required.

10. Results and/or accomplishments achieved during this reporting period:

• Implementation of a Nursing Station at the School "José Carlos Mariátegui". • The inauguration of the permanent location of the Policlínico Peruano Americano.

• Creation and printing of medical history forms for children, adolescents, adults, and older adults. • Creation and printing of clinic treatment records.

• Hiring of a 2nd Nurse for the clinic.

• Real Medicine Perú was formed and officially inscribed in the Public Registry of Perú. • A Christmas Celebration (“Chocolatada”) was held with gifts for local children.

11. Impact this project has on the community (who is benefiting and how):

The community does not have sufficient healthcare. The presence of the Policlínico Peruano Americano helps to relieve the strain on the existing health infrastructure. In addition, the philosophies adopted at the clinic are based heavily on education and prevention. Not only are patients being treated for their illnesses, but they are being educated as to why they are sick and how they can prevent the sickness in the future. By taking this approach, we are setting ourselves apart from the other health options in the area and we are identifying ourselves as a leader in the medical community.

The medical community is also being further educated in specialties such as OB/GYN topics and HIV/AIDS so health services as a whole can be improved in the area.

We work alongside many different local organizations. By helping them in their goals, they in turn help us realize our goals and a much wider array of community services can be offered more effectively. This follows the RMF motto “Friends Helping Friends.”

12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition).

Total Number of Direct Beneficiaries: 1,833 (from 2 sources)

1) Policlínico Peruano Americano

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• Average per day: 32.5 • New Patients: 546 • Demographics: o Male: 221; Female: 429 o <1 years: 46 o 1 – 4 years: 167 o 5 – 9 years: 48 o 10 – 14 years: 27 o 15 – 19 years: 25 o 20 – 59 years: 238 o 60+ years: 99 2) School Campaign • Treatments: 24

• Blood pressure taken: 22 • Temperature taken: 6 • Medication administered: 18 • Refferals to Clinic: 4

• Attendees of health seminars and discussions: 1,109

(Please see Appendix A – Morbidity & Appendix B – Demographics)

13. Number of indirect project beneficiaries (geographic coverage):

There are 30,000 people in the immediate district of San Clemente and 125,000 in the city of Pisco. By focusing on education and prevention initiatives, we hope the direct beneficiaries are able to spread the word to their families and community.

14. If applicable, please list the medical services provided:

General Medicine: • Pediatrics • Adolescent • Women’s Health • Adult • Geriatrics • Pharmacy

• Nursing Station / Triage • Prevention and Education

15. Please list the five most common health problems observed within your region.

1 – Acute Respiratory Tract Infections 2 – Intestinal/Parasite Infections 3 – Osteomuscular System Diseases 4 – Urinary Tract Infections

5 – Dermatological Diseases and Infections

(Please see Appendix A – Morbidity)

16. Notable project challenges and obstacles:

1) The high demand of our services means that people have to stand in line for quite a while to be seen. At times it has been impossible to see everyone in one day as there have been as many as 80 waiting. 2) Some, although happily very few, come for very trivial matters, perhaps because the consultation and

medicine are free. This of course takes up valuable time from those who have more chronic or serious conditions.

3) To improve this situation and to avoid any negative comments, we will work on educating all the patients on what is appropriate and focus on the quality of our attention versus the quantity of patients seen.

4) By the end of December, we have seen around 800 new patients, causing some of our medicine supplies to be rapidly exhausted – the largest percentage of patients attended to being adults, the largest group among them women over 45 years of age. Also, we are observing conditions for which we do not have medication, which means we must purchase these medications.

5) The lack of an in house lab becomes more apparent and difficult every day. At this point, we have to diagnose many infectious diseases without a lab.

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17. If applicable, plans for next reporting period:

• Acquisition of medicine for chronic diseases.

• Visit of Jerome Galea, Jesse Clark and Kelika Konda, representatives of UCLA’s Institute for Global Health, to discuss projects regarding STD’s and HIV/AIDS.

• Discussion of an international medical student/intern rotation program.

• Obtaining the License of Operation for the Policlínico Peruano Americano, endorsed by the Department of Health and the City Hall of San Clemente, Peru.

18. Summary of Medicine distribution:

(Please see Appendix C – Medicine)

19. Success story(s) highlighting project impact:

1) We have received a great reception from the population of this part of the Pisco Province, who respond to us with a desire to ease their pains, and who leave very thankful and content after the attention given to them by the doctors and nurses of the Policlínico Peruano Americano.

2) Although San Clemente is an area impoverished and far away from the city of Pisco, this does not stop people living in far away zones from coming to the Policlínico Peruano Americano to be attended to. Even when

Department of Health facilities are closer to their homes they prefer to visit our clinic, showing the acceptance of our team and difference in our quality of care to the local population.

3) Word of our clinic is continuing to spread, word of mouth being the most effective up until now, but also by television, radio, and small union groups.

20. Photos of project activities (file attachment is fine):

Attached as separate Document

III. Financial Information

21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file attachment is fine). Please note any changes from plans.

(Please see Appendix D – Finances)

Thank you! Please email to: Martina C. Fuchs, MD PhD CEO Real Medicine Foundation 11628 Santa Monica Blvd., Suite 203

Los Angeles, CA 90025 USA

310.820.4502 phone 310.820.9479 fax

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EL APENDICE A - MORBOSIDAD

Los Casos Más Comunes

DIAGNOSIS CASES

PERCENT of TOTAL

Infecciones Respiratorias Agudas 270 33.5%

Infecciones Intestinales y Parasitarias 86 10.7%

Enf. Del Sistema Osteomuscular. 80 9.9%

Infecciones del Tracto Urinario 70 8.7%

Enfermedades de la Piel 68 8.4%

Enf. de aparente transmisión sexual 30 3.7%

Traumatismos y heridas 29 3.6%

Enfermedades del Sistema Digestivo 29 3.6%

Enf. Endocrinas, nutricionales y metabólicas 23 2.9%

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Reporte de la MORBOSIDAD (cont)

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DIAGNOSIS CASE S PERCENT of TOTAL DIAGNOSIS CASE S PERCENT of TOTAL

Faringoamidalitis Aguda 112 13.9% Absceso periodontal 1 0.1%

Rinofaringitis Aguda 69 8.6% Adenoma mamario 1 0.1%

Infección Urinaria 52 6.5% Adherencia prepucial 1 0.1%

Faringitis Aguda 49 6.1% Adulto sano 1 0.1%

Parasitosis intestinal 34 4.2% Amigdalitis crónica 1 0.1%

Gastritis Aguda 33 4.1% Cefalea vascular 1 0.1%

Infección Intestinal Bacteriana 31 3.9% Cefalohematoma 1 0.1%

Amigdalitis aguda 22 2.7% Cerumen impactado 1 0.1%

Cistitis aguda 18 2.2% Cervicalgia 1 0.1%

Osteoartrosis 18 2.2% Ciatalgia 1 0.1%

Dorsolumbalgia 15 1.9% Colecistits crónica 1 0.1%

Amigdalitis aguda supurada 14 1.7% Cólico de gases 1 0.1%

Hipertensión arterial 14 1.7% Contusión en frente 1 0.1%

Vulvovaginitis 14 1.7% Crisis hipertensiva 1 0.1%

Asma Bronquial 13 1.6% Cuerpo extraño en ojo 1 0.1%

Dermatitis inespecífica 11 1.4% Dermatomicosis 1 0.1%

Lumbalgia 10 1.2% Diarrea osmótica 1 0.1%

Sintomático respiratorio 9 1.1% Enf. Diarreica Disentérica Aguda 1 0.1%

Gastroenterocolitis aguda 8 1.0% Esguince en tobillo 1 0.1%

Lumbociatalgia 8 1.0% Estrabismo 1 0.1%

Sindrome de flujo Vaginal 8 1.0% Faringotraqueítis aguda 1 0.1%

Tiña corporis 8 1.0% Fimosis 1 0.1%

Cefalea tensional 7 0.9% Fisura anal 1 0.1%

Escabiosis 7 0.9% Forúnculo en pecho 1 0.1%

Impétigo 7 0.9% Forunculosis 1 0.1%

Artritis Reumatoidea 6 0.7% Gestación 1 0.1%

Dolor abdominal bajo 6 0.7% Giardiasis 1 0.1%

Dermatitis atópica 5 0.6% Glositis 1 0.1%

Diabetes Mellitus 5 0.6% Gonartritis 1 0.1%

Rinitis Alergica 5 0.6% Gonartrosis 1 0.1%

Artralgia 4 0.5% Herida en cuello 1 0.1%

Bronquitis Aguda 4 0.5% Herida en cuero cabelludo 1 0.1%

Dermatitis Alergica 4 0.5% Herida en mano 1 0.1%

Dermatitis del pañal 4 0.5% Herida en muslo 1 0.1%

Oxiurasis 4 0.5% Herida en pie 1 0.1%

Tiña pedis 4 0.5% Herida por mordedura canina 1 0.1%

Varicela 4 0.5% Herida post operatoria 1 0.1%

Ascariasis 3 0.4% Herida superfical en cara 1 0.1%

Caries dental 3 0.4% Hernia supraumbilical 1 0.1%

Cefalea migrañosa 3 0.4% Hernia umbilical 1 0.1%

Conjuntivitis aguda 3 0.4% Herpes genital 1 0.1%

Contractura muscular 3 0.4% Hipercolesterolemia 1 0.1%

Dermatitis de contacto 3 0.4% Hipermenorrea 1 0.1%

Dolor Abdominal alto 3 0.4% Hiperreactividad bronquial 1 0.1%

Enf. Diarreica Acuosa 3 0.4% Mastitis 1 0.1%

Estomatitis 3 0.4% Mordedura de araña 1 0.1%

Gastritis crónica 3 0.4% Niño sano 1 0.1%

Mialgia 3 0.4% Orzuelo 1 0.1%

Neuropatia Periférica 3 0.4% Otalgia 1 0.1%

Pitiriasis Alba 3 0.4% Otitis Externa 1 0.1%

Prostatitis 3 0.4% Otoacusia 1 0.1%

Reumatismo extra articular 3 0.4% Paroniquia 1 0.1%

Sd. Ansioso 3 0.4% Quemadura de II grado 1 0.1%

Sindrome vertiginoso 3 0.4% Quemadura II grado en cuello 1 0.1%

Tiña capitis 3 0.4% Recién nacido sano 1 0.1%

Artrosis 2 0.2% Sd. Emético 1 0.1%

Dislipidemia 2 0.2% Sd. manguito de los rotadores 1 0.1%

Dispepsia 2 0.2% Secuela de quemadura II grado 1 0.1%

Herida en dedo de la mano 2 0.2% Sialorrea 1 0.1%

Herida en labio 2 0.2% Sindrome de Down 1 0.1%

Herida en rodilla 2 0.2% Sinusitis Aguda 1 0.1%

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EL INFORME DEMOGRAFICO (cont)

New Patients vs Existing Patients

Existing

Patients 7%

New Patients 93%

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EL APENDICE C – El MOVIMIENTO de la

MEDICINA

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Medicamentos Presentación Inventorio Semana (07 Dic) Orden (09 Dic) Orden (12 Dic) Semana (14 Dic) Orden (15 Dic) Orden (19 Dic) Alcaldia Semana (21 Dic) semana(28 dic)

ACICLOVIR CAP 200mg 500 300 -20 300 0 -80

AGUA DESTILADA AMP 5ml 488 0 500 -7 -6

ALBENDAZOL TAB 200mg 970 -48 -110 -44 ALBENDAZOL FCO 100mg/ 5ml 232 -17 -19 -30 ALPRAZOLAM TAB 0.5mg 71 100 -10 -15 -4 AMBROXOL FCO 15mg/ 5ml 343 -4 -4 -3 -4 AMBROXOL FCO 30mg/ 5ml 124 -1 -1 -2 0 AMOXICILINA TAB 500mg 1755 -90 -131 -103 -176 AMOXICILINA FCO 250mg/ 5ml 284 -8 -8 -18 -18 ATROPINA AMP 2mg 0 0 0 0

BETAMETASONA TBO - Crema 0,05% 34 -7 40 -7 -7 -5

CAPTOPRIL TAB 25mg -15 -20 -20 -130 0 CARDIOASPIRINA TAB 0 0 0 0 CEFADRINA FCO 250mg/ 5ml 50 60 -2 -8 CEFADRINA TAB 500mg 483 600 -96 -20 -1 CEFADROXILO TAB 500mg 234 -32 -30 0 -40 CEFADROXILO FCO 250mg/ 5ml 0 -6 -6 -1 -1

CEFTRIAXONA AMP 1gr INYECTABLE 22 20 0 -5 0

CELECOXIB TAB 200mg 543 -34 700 -16 -203 -134

CIPROFLOXACINO TAB 500mg 484 -44 -148 -172 -236

CITRATO DE CALCIO TAB 0 0 0 0

CLINDAMICINA AMP 600mg/ 4ml 0 0 0 0

CLINIDAMICINA TAB 300 mg 72 100 0 -28 0

CLORAFENICOL AMP 1 gr 50 50 0 0 0

CLORFENAMINA TAB 4mg 3321 -49 -75 -90 -77

CLORFENAMINA FCO 2mg/ 5ml 281 -14 -20 -13 -13

CLORURO DE SODIO AMP 20%/ 20ml 0 0 0 0

CLORURO DE SODIO 9/ 00 1000 cc 0 0 0 0

CLOTRIMAZOL TBO - CREMA 1% 164 -2 130 -4 -4 -4

CLOTRIMAZOL TAB 500mg (VAGINAL) 240 300 -18 -34 -8

COMPLEJO B CAP 676 1000 -155 -74 -95 DEXAMETASONA TAB 0,5mg 575 0 0 -12 DEXAMETASONA AMP 4mg/ 2ml 537 600 -38 -7 -18 DEXTROMETORFANO FCO 15mg/ 5ml 78 100 0 -18 -4 DEXTROSA AMP 33.3% 50 50 0 0 0 DEXTROSA FCO 5%/ 1000cc 18 0 18 0 0 DIAZEPAM AMP 10mg/ 2ml 15 15 0 0 0 DIAZEPAM TAB 5mg 25 25 0 0 0 DICLOFENACO TAB 50mg -10 0 -10 0 DICLOFENACO AMP 75mg/ 3ml 294 -6 500 -74 -32 -14

DICLOFENACO GEL TBO - GEL 1% 41 50 -2 -5 -2

DICLOXACILINA TAB 500mg 1757 -40 800 -80 -125 -20

DICLOXACILINA FCO 250mg/ 5ml 70 -2 75 -4 -4 -40

DIMENHIDRINATO AMP 50mg/ 5ml 196 200 -3 -1 0

DIMENHIDRINATO TAB 50mg -49 -19 50 0 -45 -6

EPINEFRINA AMP 1mg INYECTABLE 10 10 0 0 0

ERITROMICINA TAB 500mg 1345 700 -112 -28 0

ERITROMICINA FCO 250mg/ 5ml 180 -1 40 -2 31 0 0

FLUCONAZOL CAP 150mg 300 300 -15 -26 -14

FRAMICETINA + DEXAMETASONA FCO 2.5ml - GOTAS OFT 80 0 0 0

FURAZOLIDONA FCO 50mg/ 5ml 97 -2 -10 -4 -1

FUROSEMIDA AMP 20mg/ 20ml INYECTABLE 9 10 0 0 -1

GASA PARAFINADA 0 0 0 0

SIMETICONA (GASEOVET) GOTAS 45 49 0 -1 -3

GENTAMICINA GTAS OFT 3% 98 -1 40 -1 4 0 0

GENTAMICINA AMP 80mg/ 2ml 50 50 0 0 0

GENTAMICINA AMP 160mg 130 150 -5 -5 -10

GLIBENCLAMIDA TAB 5mg 10 100 0 -90 0

HIDROCORTISONA FCO 250mg IM / IV 26 25 0 0 0

HIDRÓXIDO DE ALUMINIO FCO 30mg 59 -4 25 -13 -6 -8

HIOSCINA BROMURO (ESPASMO

ANTALGINA) TAB 10mg 355 -46 -8 -51

HIOSCINA BUTILBROMURO AMP 20mg/ ml 200 200 0 0 0

IBUPROFENO TAB 400mg 1579 -85 -877 -464 -104

IBUPROFENO FCO 100mg/ 5ml 308 -6 50 -38 31 -43 -37

KETOPROFENO TAB 100mg -21 100 0 -36 -85

KETOROLACO TAB 10mg 403 -10 600 -121 -66 -10

KETOROLACO AMP 60mg/ 2ml 278 300 0 -12 -10

LIDOCAÍNA SPRAY FCO 10% 5 5 0 0 0

LORATADINA TAB 10mg 1188 -63 400 -47 -106 -60 LORATADINA FCO 5mg/ 5ml 35 -4 -1 0 0 METAMIZOL AMP 1g/ 2ml 260 300 -19 -11 -10 METOCLOPRAMIDA AMP 10mg/ 2ml 51 0 50 0 0 METRONIDAZOL TAB 500mg 1662 1200 -24 -58 -36 METRONIDAZOL FCO 250mg/ 5ml 180 30 0 0 0 METRONIDAZOL ÓVULO 500mg 245 300 -15 -30 -10 MICOSTATIN 200 000 UI 0 0 0 0

NAPROXENO SODICO TAB 550mg 2541 0 900 2100 -259 -200

NEOMICINA + BACITRACINA TBO CREMA - X15G 38 50 -4 -5 -3

NEUROBION CAP 56 -10 -104 0 NITROFURAL AL (AMERITON POMADA) POTE 0.2% -40 3 -1 0 -42 OMEPRAZOL CAP 20mg 551 0 600 -49 0 ORFENADRINA AMP 60mg/ 2ml 288 300 -6 -6 0 PARACETAMOL TAB 500mg 3761 -112 3500 -296 -71 -167 PARACETAMOL FCO 120mg/ 5ml 395 -10 140 -26 100 -12 -3 PARACETAMOL GOTAS 100mg/ ml 248 250 -1 0 -1 PARGEVERINA + CLONIXINATO DE LISINA AMP 15mg/ 100mg 20 20 0 0 0 PARGEVERINA + CLONIXINATO DE LISINA TAB 0 0 0 0

PENICILINA CLEMIZOL VIAL 1 000 000 UI S/ SOLVENTE 4 0 0 0

PENICILINA BENZATÍNICA AMP 1 200 000 UI S/ DILUY 401 200 -6 200 20 -7 -6

PENICILINA PROCAINICA AMP 1,000,000 UI 52 50 0 0 0

PRAZIQUANTEL TAB 150mg (HELMIBEN) 100 0 100 0 0

PREDNISONA TAB 5mg 529 -102 600 -79 -165 -131

RANITIDINA TAB 150mg 240 -92 -202 -140 -228

RANITIDINA AMP 50mg/ 2ml 150 150 0 0 0

SALBUTAMOL TAB 4mg 669 -16 -15 -10 0

SALBUTAMOL FCO 250mg/ 5ml 97 0 -1 0

SALBUTAMOL INHALADOR 100 MCG / INH x 200 DOSIS 10 15 -2 -3 0

SALES DE REHIDRATACIÓN ORAL SOBRE 20.5g 11 33 27 -31 9 -11 -16

SOLUCIÓN POLIELECTROLÍTICA FCO 15 15 0 0 0

SULFETOXAZOL + TRIMETOPRIMA

(COTRIMOXAZOL) TAB 800mg/ 160mg 722 -64 500 -42 -90 -24

SULFETOXAZOL + TRIMETOPRIMA

(COTRIMOXAZOL) FCO 40mg/ 200mg/ 5ml 106 -2 -8 -2 0

UROPIRID (FENAZOPIRIDINA) TAB 100mg 444 -39 -54 -42 -54

CLORURO DE POTASIO AMP 20%/ 20ml 50 0 50 0 0

FRIOLE OFT 3 0 4 0 0

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Expense Breakdown

Clinical, $3,867.69 , 36% Administrative, $5,381.24 , 51% Travel, $1,414.45 , 13%

(Total: $11,903.20)

Monthly Expense Wages $ 3,890.67 Medicine $ 3,174.86 Rent $ - Food $ 596.70 Utilities $ - Purchases $ 1,377.33 Communications $ 94.83 Administrative $ 1,529.00

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Travel Expenses

Boarding, $689.33 , 49% Food, $301.50 , 21% Transportation, $385.17 , 27% Supplies, $38.45 , 3%

(Total: $1445.83)

Clinical Expenses

Equipment, $583.00 , 15% Supplies, $43.33 , 1% Medicine, $3,174.86 , 82% Miscellaneous, $66.50 , 2%

(Total: $7,658.09)

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Reporte detallado del Gasto

Date Amount (USD) Amount (SOL) Category Type Detailed Description Receipt #

22/12/2007 55.00 Administrative chocolatada toys E265

22/12/2007 38.00 Administrative chocolatada toys E265.1

22/12/2007 5.50 Administrative chocolatada bread E267

22/12/2007 40.00 Administrative chocolatada bread E268

23/12/2007 22.00 Administrative chocolatada chocalate milk E269

23/12/2007 51.60 Administrative chocolatada dinner E271

23/12/2007 10.00 Administrative chocolatada bags E273

05/12/2007 40.00 Administrative Communications movistar phone card E203

06/12/2007 40.00 Administrative Communications claro recharge E210

11/12/2007 4.50 Administrative Communications phone calls E236

20/12/2007 80.00 Administrative Communications 4 x 20 sol phone cards E261

24/12/2007 40.00 Administrative Communications phone card E277

27/12/2007 60.00 Administrative Communications MoviStar Saldo

27/12/2007 20.00 Administrative Communications Hola Perú

05/12/2007 450.00 Administrative Food Lunch for staff (1 month)

10/12/2007 226.00 Administrative Food celebration lunch after inauguration E231

10/12/2007 100.00 Administrative Food Wine for inauguration E232.1

12/12/2007 19.60 Administrative Food food (candy for clinic) E239

13/12/2007 60.00 Administrative Food snack for workers

24/12/2007 5.00 Administrative Food Lunch for Richard (nurse)

24/12/2007 25.00 Administrative Food snack for workers

03/12/2007 9.40 Administrative Forms copies E190

04/12/2007 6.00 Administrative Forms fax E200

17/12/2007 70.00 Administrative Forms Copias E285

17/12/2007 3.50 Administrative Forms Copias E285.1

17/12/2007 6.00 Administrative Forms Copias E285.2

22/12/2007 275.00 Administrative Forms Formatos de historias clínicas E288

26/12/2007 190.00 Administrative Forms Formatos y recetarios E290

24/12/2007 50.00 Administrative Miscellaneous carlos gallego x-mas gift E276

05/12/2007 79.00 Administrative Miscellaneous Financial/Transfer charges

08/12/2007 30.00 Administrative Miscellaneous business cards E227

19/12/2007 2.00 Administrative Miscellaneous Duplicado de llave E287

19/12/2007 30.00 Administrative Miscellaneous Escaneo de boletas

26/12/2007 30.00 Administrative Miscellaneous 0.5 days labor for benches (15 each)

03/12/2007 2.00 Administrative Supplies Folders E187

03/12/2007 1.50 Administrative Supplies Desk supplies E188

03/12/2007 3.00 Administrative Supplies Desk supplies E189

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04/12/2007 1180.00 Administrative Supplies shirts, vests, jackets w/ RMF logo E200.1

05/12/2007 20.00 Administrative Supplies bucket, mop, etc

06/12/2007 40.00 Administrative Supplies signs E209

06/12/2007 5.50 Administrative Supplies stationary E211

06/12/2007 93.00 Administrative Supplies printing ink & syringes E212

07/12/2007 8.50 Administrative Supplies cups E214

07/12/2007 4.00 administrative Supplies supplies for inauguration E215

07/12/2007 225.00 Administrative Supplies Shipping of new suplies (Flores)

07/12/2007 40.00 Administrative Supplies building supplies E217

07/12/2007 14.93 Administrative Supplies garbage bags E219

08/12/2007 5.50 Administrative Supplies supplies for inauguration E223

12/12/2007 23.00 Administrative supplies plastic bags for meds E242

12/12/2007 10.00 Administrative Supplies bus. Cards E243.1

12/12/2007 46.00 Administrative Supplies folders E243

13/12/2007 42.00 Administrative Supplies Movies for waiting room E246

14/12/2007 11.00 Administrative Supplies notebooks E254

18/12/2007 18.00 Administrative Supplies Folder de manila E286

22/12/2007 48.00 Administrative supplies Folder de manila E289

23/12/2007 12.30 Administrative Supplies cleaning supplies E272

23/12/2007 15.00 Administrative Supplies laundry - sheets for clinic

24/12/2007 10.00 Administrative Supplies cups for water

26/12/2007 15.00 Administrative Supplies toilet seat E279

26/12/2007 38.40 Administrative Supplies cleaning supplies E281

26/12/2007 11.00 Administrative Supplies towels for cleaning E282

26/12/2007 25.00 Administrative Supplies 12 sheets for clinic

27/12/2007 Administrative Supplies copy of video that Nacho filmed during inaguration

05/12/2007 280.00 Administrative Wages Night Guard (4 weeks)

07/12/2007 125.00 Administrative wages weeks lunch for emplyees

14/12/2007 125.00 Administrative wages weeks lunch for emplyees

19/12/2007 120.00 Administrative wages 2 days labor for benches (2 workers at $30 daily)

20/12/2007 105.00 Administrative wages 7 nights at $15/night

22/12/2007 42.00 Administrative wages Fio´s family x-mas gift E265.2

22/12/2007 2350.00 Administrative wages Pago al personal (16/12-22/12)

22/12/2007 75.00 Administrative wages Niña Sonia (50+25 de aguinaldo)

27/12/2007 125.00 Administrative wages payment to Nacho (TV anchor) for marketing

27/12/2007 50.00 Administrative wages Carlos (cuidar casa 3 noches)

28/12/2007 2350.00 Administrative Wages Pago al personal (23/12-29/12)

08/12/2007 3950.00 Administrative Wages Staff Wages (25/11-08/12)

15/12/2007 1975.00 Administrative Wages Staff Wages (09/12-15/12)

04/12/2007 100.00 Clinical Equipment Shipping (Macromedica)

04/12/2007 250.00 Clinical Equipment Shipping (Macromedica) E195

04/12/2007 20.00 Clinical Equipment Scale E196

04/12/2007 3.50 Clinical Equipment scissors E198

07/12/2007 820.00 Clinical Equipment racks for medicine E222

12/12/2007 200.00 Clinical Equipment furniture from As de Oro E240

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13/12/2007 90.00 Clinical Equipment metal rack for meds E252

14/12/2007 10.50 Clinical Equipment materials for benches E255

04/12/2007 1.95 Clinical Medicine Bencina E194

05/12/2007 6.36 Clinical Medicine ClNa E201

05/12/2007 9380.71 Clinical Medicine Medicine purchase (pereda) E202

11/12/2007 55.70 Clinical Medicine afrin E233

11/12/2007 71.54 clinical Medicine Shipping costs E234.1

12/12/2007 8.31 Clinical medicine CLNa & Bencina E238

11/12/2007 15.50 clinical Miscellaneous laboratory test for patient E234

20/12/2007 154.00 Clinical Miscellaneous x-mas gift for employees E263

20/12/2007 30.00 Clinical Miscellaneous x-mas gift for employees E263.1

17/12/2007 10.00 Clinical Supplies Papel Craff E284

22/12/2007 120.00 Clinical Supplies sheets E266

06/12/2007 150.00 Travel Boarding Miraflores (ayllu) E207

14/12/2007 1613.00 Travel Boarding

room, food, and some furniture (Miramar)

27/11-14/12 E255.1

17/12/2007 180.00 Travel Boarding Melgar (2 nights) E258

20/12/2007 97.00 Travel Boarding Melgar (1 night) E260

26/12/2007 28.00 Travel Boarding cleaners E280

01/12/2007 20.00 Travel Food food

03/12/2007 8.10 Travel Food Food E192

03/12/2007 22.00 Travel Food Food

07/12/2007 13.00 Travel Food food E220

10/12/2007 100.00 Travel Food lunch from virgen de chapi

13/12/2007 6.50 travel Food food E251

15/12/2007 38.00 Travel Food Food E255.2

22/12/2007 10.00 Travel Food ica E264

25/12/2007 50.00 Travel Food x-mas lunch E283

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26/12/2007 20.00 Travel Food Lunch

26/12/2007 10.00 Travel Food snack

27/12/2007 10.00 Travel Food Breakfast

27/12/2007 25.00 Travel Food Dinner

03/12/2007 2.80 Travel Supplies Provisions E186

04/12/2007 4.00 Travel Supplies water E197

10/12/2007 36.80 Travel Supplies supplies for inauguration (candy) E232

16/12/2007 21.95 Travel Supplies sun block E257

16/12/2007 49.80 Travel Supplies provisions & food E257.1

01/12/2007 7.00 Travel Transportation Bus (pisco-Ica) E184

01/12/2007 7.00 Travel Transportation Bus (Ica-Pisco) E185

01/12/2007 15.00 Travel Transportation taxis

03/12/2007 3.50 Travel Transportation Bus (pisco-ica) E191

03/12/2007 3.50 Travel Transportation Bus (Ica-Pisco)

05/12/2007 35.00 Travel Transportation gas

06/12/2007 24.00 Travel Transportation Bus (Pisco - Lima) E204

07/12/2007 75.00 Travel Transportation Bus (Lima - Pisco) E213

07/12/2007 15.00 travel Transportation gas E216

07/12/2007 30.00 Travel Transportation gas E218

20/12/2007 450.00 Travel Transportation Steves cash in hand to get back to LA

21/12/2007 15.00 Travel Transportation taxi

22/12/2007 15.00 Travel Transportation taxi

24/12/2007 22.50 Travel Transportation gas for motorcycle E275

24/12/2007 25.00 Travel Transportation gas for truck to pick up desk

27/12/2007 150.00 Travel Transportation Rene's viaje a Cusco

27/12/2007 5.00 Travel Transportation Lavado de moto

27/12/2007 15.00 Travel Transportation Gas

Total Expenses (Sol) S/. 31,990.15

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MOVIMIENTOS DE CUENTA

(DICIEMBRE)

Tipo Ahorros Cuenta 050-0052866 Moneda Dólares Saldo Contable (01/12/20007 $0.00 Saldo Disponible (31/12/2007) $4,993.50

FECHA DESCRIPCION CARGO ABONO

31/12/2007 INTERESES ACREEDORES 0.64

31/12/2007 COMISION MANT. CUENTA 3.2

27/12/2007 RETIRO EFECTIVO SOLES - CA 338.98

27/12/2007 IMPUESTO A LOS DEBITOS 0.27

20/12/2007 DEBITO - COMPRAS 10.2

20/12/2007 DEBITO - COMPRAS 52.38

18/12/2007 REEMISION TARJETA - CA 2

18/12/2007 IMPUESTO A LOS CREDITOS 5.54