The Xavier Dos Santos family paddled four hours from the village of Mae Cue to arrive at our clinic in Jamari by 7:00 am. Their 2 year old, Sandrileide, was still breast feeing and completed the childhood immunizations for her age. Their 4 year old, Raison, had developed excessive bruising and the low platelets on his blood count indicated the possibility of an auto immune disease which would be further evaluated with blood samples taken back to Santarem. He was started on corticosteroids for his presumptive diagnosis of ITP. Loeidane, age 7, had a belly pain, weighed 17 pounds and was treated for intestinal parasites. Joselani, age 10, presented with cough, fever and weakness and was treated for pneumonia. After our morning clinic, the family slept in their hammocks during the midday heat before beginning their up river paddle back to Mae Cue.