Peru Clinic Progress Report

Transcription

1 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 ( 3. Project Title: Real Medicine Foundation Policlínico Peruano Americano 4. Reporting Period: December 1, 2007 December 31, 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, 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, On December 10, we transferred to our new location, which has a variety of modern and open spaces to offer quality

2 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 17 th, 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 3 rd, 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 10 th, 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 24 th, 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 Patients Seen: 650

3 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 years: 27 o years: 25 o 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.

4 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 to: Martina C. Fuchs, MD PhD CEO Real Medicine Foundation Santa Monica Blvd., Suite 203 Los Angeles, CA USA phone fax Martina.Fuchs@realmedicinefoundation.org

5 EL APENDICE A - MORBOSIDAD Los Casos Más Comunes DIAGNOSIS CASES PERCENT of TOTAL Infecciones Respiratorias Agudas % Infecciones Intestinales y Parasitarias % Enf. Del Sistema Osteomuscular % Infecciones del Tracto Urinario % Enfermedades de la Piel % Enf. de aparente transmisión sexual % Traumatismos y heridas % Enfermedades del Sistema Digestivo % Enf. Endocrinas, nutricionales y metabólicas % Otros %

6 Reporte de la MORBOSIDAD (cont) Casos específicos

7 DIAGNOSIS CASE S PERCENT of TOTAL DIAGNOSIS CASE S PERCENT of TOTAL Faringoamidalitis Aguda % Absceso periodontal 1 0.1% Rinofaringitis Aguda % Adenoma mamario 1 0.1% Infección Urinaria % Adherencia prepucial 1 0.1% Faringitis Aguda % Adulto sano 1 0.1% Parasitosis intestinal % Amigdalitis crónica 1 0.1% Gastritis Aguda % Cefalea vascular 1 0.1% Infección Intestinal Bacteriana % Cefalohematoma 1 0.1% Amigdalitis aguda % Cerumen impactado 1 0.1% Cistitis aguda % Cervicalgia 1 0.1% Osteoartrosis % Ciatalgia 1 0.1% Dorsolumbalgia % Colecistits crónica 1 0.1% Amigdalitis aguda supurada % Cólico de gases 1 0.1% Hipertensión arterial % Contusión en frente 1 0.1% Vulvovaginitis % Crisis hipertensiva 1 0.1% Asma Bronquial % Cuerpo extraño en ojo 1 0.1% Dermatitis inespecífica % Dermatomicosis 1 0.1% Lumbalgia % 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%

8 El APENDICE B - El INFORME DEMOGRAFICO

9 EL INFORME DEMOGRAFICO (cont) New Patients vs Existing Patients Existing Patients 7% New Patients 93%

10 EL APENDICE C El MOVIMIENTO de la MEDICINA

11 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 AGUA DESTILADA AMP 5ml ALBENDAZOL TAB 200mg ALBENDAZOL FCO 100mg/ 5ml ALPRAZOLAM TAB 0.5mg AMBROXOL FCO 15mg/ 5ml AMBROXOL FCO 30mg/ 5ml AMOXICILINA TAB 500mg AMOXICILINA FCO 250mg/ 5ml ATROPINA AMP 2mg BETAMETASONA TBO - Crema 0,05% CAPTOPRIL TAB 25mg CARDIOASPIRINA TAB CEFADRINA FCO 250mg/ 5ml CEFADRINA TAB 500mg CEFADROXILO TAB 500mg CEFADROXILO FCO 250mg/ 5ml CEFTRIAXONA AMP 1gr INYECTABLE CELECOXIB TAB 200mg CIPROFLOXACINO TAB 500mg CITRATO DE CALCIO TAB CLINDAMICINA AMP 600mg/ 4ml CLINIDAMICINA TAB 300 mg CLORAFENICOL AMP 1 gr CLORFENAMINA TAB 4mg CLORFENAMINA FCO 2mg/ 5ml CLORURO DE SODIO AMP 20%/ 20ml CLORURO DE SODIO 9/ cc CLOTRIMAZOL TBO - CREMA 1% CLOTRIMAZOL TAB 500mg (VAGINAL) COMPLEJO B CAP DEXAMETASONA TAB 0,5mg DEXAMETASONA AMP 4mg/2ml DEXTROMETORFANO FCO 15mg/ 5ml DEXTROSA AMP 33.3% DEXTROSA FCO 5%/ 1000cc DIAZEPAM AMP 10mg/ 2ml DIAZEPAM TAB 5mg DICLOFENACO TAB 50mg DICLOFENACO AMP 75mg/ 3ml DICLOFENACO GEL TBO - GEL 1% DICLOXACILINA TAB 500mg DICLOXACILINA FCO 250mg/ 5ml DIMENHIDRINATO AMP 50mg/ 5ml DIMENHIDRINATO TAB 50mg EPINEFRINA AMP 1mg INYECTABLE ERITROMICINA TAB 500mg ERITROMICINA FCO 250mg/ 5ml FLUCONAZOL CAP 150mg FRAMICETINA + DEXAMETASONA FCO 2.5ml - GOTAS OFT FURAZOLIDONA FCO 50mg/ 5ml FUROSEMIDA AMP 20mg/ 20ml INYECTABLE GASA PARAFINADA SIMETICONA (GASEOVET) GOTAS GENTAMICINA GTAS OFT 3% GENTAMICINA AMP 80mg/ 2ml GENTAMICINA AMP 160mg GLIBENCLAMIDA TAB 5mg HIDROCORTISONA FCO 250mg IM / IV HIDRÓXIDO DE ALUMINIO FCO 30mg HIOSCINA BROMURO (ESPASMO ANTALGINA) TAB 10mg HIOSCINA BUTILBROMURO AMP 20mg/ ml IBUPROFENO TAB 400mg IBUPROFENO FCO 100mg/ 5ml KETOPROFENO TAB 100mg KETOROLACO TAB 10mg KETOROLACO AMP 60mg/ 2ml LIDOCAÍNA SPRAY FCO 10% LORATADINA TAB 10mg LORATADINA FCO 5mg/ 5ml METAMIZOL AMP 1g/ 2ml METOCLOPRAMIDA AMP 10mg/ 2ml METRONIDAZOL TAB 500mg METRONIDAZOL FCO 250mg/ 5ml METRONIDAZOL ÓVULO 500mg MICOSTATIN UI NAPROXENO SODICO TAB 550mg NEOMICINA + BACITRACINA TBO CREMA - X15G NEUROBION CAP NITROFURAL AL (AMERITON POMADA) POTE 0.2% OMEPRAZOL CAP 20mg ORFENADRINA AMP 60mg/ 2ml PARACETAMOL TAB 500mg PARACETAMOL FCO 120mg/ 5ml PARACETAMOL GOTAS 100mg/ ml PARGEVERINA + CLONIXINATO DE LISINA AMP 15mg/ 100mg PARGEVERINA + CLONIXINATO DE LISINA TAB PENICILINA CLEMIZOL VIAL UI S/ SOLVENTE PENICILINA BENZATÍNICA AMP UI S/ DILUY PENICILINA PROCAINICA AMP 1,000,000 UI PRAZIQUANTEL TAB 150mg (HELMIBEN) PREDNISONA TAB 5mg RANITIDINA TAB 150mg RANITIDINA AMP 50mg/ 2ml SALBUTAMOL TAB 4mg SALBUTAMOL FCO 250mg/ 5ml SALBUTAMOL INHALADOR 100 MCG / INH x 200 DOSIS SALES DE REHIDRATACIÓN ORAL SOBRE 20.5g SOLUCIÓN POLIELECTROLÍTICA FCO SULFETOXAZOL + TRIMETOPRIMA (COTRIMOXAZOL) TAB 800mg/ 160mg 722 SULFETOXAZOL + TRIMETOPRIMA (COTRIMOXAZOL) FCO 40mg/ 200mg/ 5ml 106 UROPIRID (FENAZOPIRIDINA) TAB 100mg CLORURO DE POTASIO AMP 20%/ 20ml FRIOLE OFT EL APENDICE D - FINANCIA

12 Monthly Expense Wages $ 3, Medicine $ 3, $ Rent - Food $ $ Utilities - Purchases $ 1, $ Communications Administrative $ 1, Expense Breakdown (Total: $11,903.20) Travel, $1,414.45, 13% Clinical, $3,867.69, 36% Administrative, $5,381.24, 51%

13 Travel Expenses Supplies, $38.45, 3% (Total: $ ) Transportation, $385.17, 27% Boarding, $689.33, 49% Food, $301.50, 21% Clinical Expenses Miscellaneous, $66.50, 2% (Total: $7,658.09) Equipment, $583.00, 15% Supplies, $43.33, 1% Medicine, $3,174.86, 82%

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15 Reporte detallado del Gasto Date Amount (USD) Amount (SOL) Category Type Detailed Description Receipt # 22/12/ Administrative chocolatada toys E265 22/12/ Administrative chocolatada toys E /12/ Administrative chocolatada bread E267 22/12/ Administrative chocolatada bread E268 23/12/ Administrative chocolatada chocalate milk E269 23/12/ Administrative chocolatada chocalate milk E270 23/12/ Administrative chocolatada dinner E271 23/12/ Administrative chocolatada bags E273 23/12/ Administrative chocolatada chocalate milk E274 05/12/ Administrative Communications movistar phone card E203 06/12/ Administrative Communications claro recharge E210 11/12/ Administrative Communications phone calls E236 20/12/ Administrative Communications 4 x 20 sol phone cards E261 24/12/ Administrative Communications phone card E277 27/12/ Administrative Communications MoviStar Saldo 27/12/ Administrative Communications Hola Perú 05/12/ Administrative Food Lunch for staff (1 month) 10/12/ Administrative Food celebration lunch after inauguration E231 10/12/ Administrative Food Wine for inauguration E /12/ Administrative Food food (candy for clinic) E239 13/12/ Administrative Food snack for workers 24/12/ Administrative Food Lunch for Richard (nurse) 24/12/ Administrative Food snack for workers 03/12/ Administrative Forms copies E190 04/12/ Administrative Forms copies E199 04/12/ Administrative Forms fax E200 11/12/ Administrative Forms copies E235 13/12/ Administrative Forms copies E245 17/12/ Administrative Forms Copias E285 17/12/ Administrative Forms Copias E /12/ Administrative Forms Copias E /12/ Administrative Forms Formatos de historias clínicas E288 26/12/ Administrative Forms Formatos y recetarios E290 24/12/ Administrative Miscellaneous carlos gallego x-mas gift E276 05/12/ Administrative Miscellaneous Financial/Transfer charges 08/12/ Administrative Miscellaneous business cards E227 19/12/ Administrative Miscellaneous Duplicado de llave E287 19/12/ Administrative Miscellaneous Escaneo de boletas 26/12/ Administrative Miscellaneous 0.5 days labor for benches (15 each) 03/12/ Administrative Supplies Folders E187 03/12/ Administrative Supplies Desk supplies E188 03/12/ Administrative Supplies Desk supplies E189 03/12/ Administrative Supplies Folders, paper E193

16 04/12/ Administrative Supplies shirts, vests, jackets w/ RMF logo E /12/ Administrative Supplies bucket, mop, etc 06/12/ Administrative Supplies signs E209 06/12/ Administrative Supplies stationary E211 06/12/ Administrative Supplies printing ink & syringes E212 07/12/ Administrative Supplies cups E214 07/12/ administrative Supplies supplies for inauguration E215 07/12/ Administrative Supplies Shipping of new suplies (Flores) 07/12/ Administrative Supplies building supplies E217 07/12/ Administrative Supplies garbage bags E219 08/12/ Administrative Supplies supplies for inauguration E223 08/12/ Administrative Supplies supplies for inauguration E224 08/12/ Administrative Supplies supplies for inauguration E225 09/12/ Administrative Supplies supplies for inauguration E230 12/12/ Administrative supplies plastic bags for meds E242 12/12/ Administrative Supplies bus. Cards E /12/ Administrative Supplies folders E243 13/12/ Administrative Supplies Movies for waiting room E246 14/12/ Administrative Supplies notebooks E254 18/12/ Administrative Supplies Folder de manila E286 22/12/ Administrative supplies Folder de manila E289 23/12/ Administrative Supplies cleaning supplies E272 23/12/ Administrative Supplies laundry - sheets for clinic 24/12/ Administrative Supplies cups for water 26/12/ Administrative Supplies toilet seat E279 26/12/ Administrative Supplies cleaning supplies E281 26/12/ Administrative Supplies towels for cleaning E282 26/12/ Administrative Supplies 12 sheets for clinic 27/12/2007 Administrative Supplies copy of video that Nacho filmed during inaguration 05/12/ Administrative Wages Night Guard (4 weeks) 07/12/ Administrative wages weeks lunch for emplyees 14/12/ Administrative wages weeks lunch for emplyees 19/12/ Administrative wages 2 days labor for benches (2 workers at $30 daily) 20/12/ Administrative wages 7 nights at $15/night 22/12/ Administrative wages Fio s family x-mas gift E /12/ Administrative wages Pago al personal (16/12-22/12) 22/12/ Administrative wages Niña Sonia (50+25 de aguinaldo) 27/12/ Administrative wages payment to Nacho (TV anchor) for marketing 27/12/ Administrative wages Carlos (cuidar casa 3 noches) 28/12/ Administrative Wages Pago al personal (23/12-29/12) 08/12/ Administrative Wages Staff Wages (25/11-08/12) 15/12/ Administrative Wages Staff Wages (09/12-15/12) 04/12/ Clinical Equipment Shipping (Macromedica) 04/12/ Clinical Equipment Shipping (Macromedica) E195 04/12/ Clinical Equipment Scale E196 04/12/ Clinical Equipment scissors E198 07/12/ Clinical Equipment racks for medicine E222 12/12/ Clinical Equipment furniture from As de Oro E240 13/12/ Clinical Equipment material for benches E250

17 13/12/ Clinical Equipment metal rack for meds E252 14/12/ Clinical Equipment materials for benches E255 04/12/ Clinical Medicine Bencina E194 05/12/ Clinical Medicine ClNa E201 05/12/ Clinical Medicine Medicine purchase (pereda) E202 11/12/ Clinical Medicine afrin E233 11/12/ clinical Medicine Shipping costs E /12/ Clinical medicine CLNa & Bencina E238 11/12/ clinical Miscellaneous laboratory test for patient E234 20/12/ Clinical Miscellaneous x-mas gift for employees E263 20/12/ Clinical Miscellaneous x-mas gift for employees E /12/ Clinical Supplies Papel Craff E284 22/12/ Clinical Supplies sheets E266 06/12/ Travel Boarding Miraflores (ayllu) E207 room, food, and some furniture (Miramar) 27/11-14/12/ Travel Boarding 14/12 E /12/ Travel Boarding Melgar (2 nights) E258 20/12/ Travel Boarding Melgar (1 night) E260 26/12/ Travel Boarding cleaners E280 01/12/ Travel Food food 02/12/ Travel Food food 03/12/ Travel Food Food E192 03/12/ Travel Food Food 04/12/ Travel Food food 05/12/ Travel Food food 06/12/ Travel Food Food E205 06/12/ Travel Food Food E206 06/12/ Travel Food Food E208 07/12/ Travel Food food E220 07/12/ Travel Food food E221 08/12/ Travel Food food 09/12/ Travel Food food E228 10/12/ Travel Food lunch from virgen de chapi 11/12/ Travel Food food 12/12/ Travel Food food E244 13/12/ Travel Food food E249 13/12/ travel Food food E251 14/12/ Travel Food food 15/12/ Travel Food Food E /12/ Travel Food food E256 17/12/ Travel Food food 20/12/ Travel Food food E259 20/12/ Travel Food food E262 21/12/ Travel Food food 22/12/ Travel Food ica E264 22/12/ Travel Food food 23/12/ Travel Food food 24/12/ Travel Food food 25/12/ Travel Food x-mas lunch E283 26/12/ Travel Food Breakfast

18 26/12/ Travel Food Lunch 26/12/ Travel Food snack 27/12/ Travel Food Breakfast 27/12/ Travel Food Dinner 03/12/ Travel Supplies Provisions E186 04/12/ Travel Supplies water E197 10/12/ Travel Supplies supplies for inauguration (candy) E232 16/12/ Travel Supplies sun block E257 16/12/ Travel Supplies provisions & food E /12/ Travel Transportation Bus (pisco-ica) E184 01/12/ Travel Transportation Bus (Ica-Pisco) E185 01/12/ Travel Transportation taxis 02/12/ Travel Transportation taxis 03/12/ Travel Transportation Bus (pisco-ica) E191 03/12/ Travel Transportation Bus (Ica-Pisco) 03/12/ Travel Transportation taxis 04/12/ Travel Transportation taxis 05/12/ Travel Transportation taxis 05/12/ Travel Transportation gas 06/12/ Travel Transportation Bus (Pisco - Lima) E204 07/12/ Travel Transportation Bus (Lima - Pisco) E213 07/12/ travel Transportation gas E216 07/12/ Travel Transportation gas E218 08/12/ Travel Transportation gas E226 09/12/ Travel Transportation gas E229 11/12/ Travel Transportation gas E237 12/12/ Travel Transportation gas E241 13/12/ Travel Transportation gas E247 13/12/ Travel Transportation gas E248 14/12/ Travel Transportation gas E253 20/12/ Travel Transportation Steves cash in hand to get back to LA 21/12/ Travel Transportation taxi 21/12/ Travel Transportation taxi 22/12/ Travel Transportation taxi 23/12/ Travel Transportation gas E278 24/12/ Travel Transportation gas for motorcycle E275 24/12/ Travel Transportation gas for truck to pick up desk 27/12/ Travel Transportation Rene's viaje a Cusco 27/12/ Travel Transportation Lavado de moto 27/12/ Travel Transportation Gas Total Expenses (Sol) S/. 31, Total Expenses (USD) $ 10,663.38

19 MOVIMIENTOS DE CUENTA (DICIEMBRE) Tipo Ahorros Cuenta Moneda Saldo Contable (01/12/20007 Saldo Disponible (31/12/2007) Dólares $0.00 $4, FECHA DESCRIPCION CARGO ABONO 31/12/2007 INTERESES ACREEDORES /12/2007 COMISION MANT. CUENTA /12/2007 RETIRO EFECTIVO SOLES - CA /12/2007 IMPUESTO A LOS DEBITOS /12/2007 RETIRO EFECTIVO SOLES - CA /12/2007 IMPUESTO A LOS DEBITOS /12/2007 RETIRO EFECTIVO SOLES - CA /12/2007 IMPUESTO A LOS DEBITOS /12/2007 RETIRO EFECTIVO SOLES - CA /12/2007 IMPUESTO A LOS DEBITOS /12/2007 DEBITO - COMPRAS /12/2007 IMPUESTO A LOS DEBITOS /12/2007 DEBITO - COMPRAS /12/2007 REEMISION TARJETA - CA 2 18/12/2007 IMPUESTO A LOS CREDITOS /12/2007 ORD. PAGO RECIBIDA 6,935.54