Shenandoah University School of Pharmacy and Project HOPE – and NEW Adventure for Year 5!

Welcome to year 5 of the joint venture between SU SOP and Project HOPE that offers unique, life-changing advanced pharmacy practice experiences (APPE) to help the international community!  This year we expanded the experience to six (6) fourth year pharmacy students (P4s). 

For 2013 and for the first-time, pharmacy students will be doing land-based experiences in Monte Plata, Dominican Republic and Vijayawada, India with Project HOPE.  Arsen Dadja and Tom Summerson will be leaving May 29^th through June 28^th for India.  Jillian Sweeney and Derek Etube will be leaving June 26^th through July 26^th for the Dominican Republic, followed by Evy Moreira and Sara Ateeqi from July 19^th through August 28^th. 

Please visit the rxprojecthope blog frequently to follow their adventures and learn of their new experiences on land-based international APPEs!

Exploring Sihanoukville, Cambodia

I had many opportunities to explore the city of Sihanoukville, Cambodia since I did not go on an overnight MEDCAP.  A 20 minute boat ride takes us to the pier and then a 10 minute bus ride drops us off at the Golden Lion Traffic Circle.  Getting off the bus proved to be crazy.  There were so many people trying to sell bracelets or tuk tuk rides that you physically had to push your way through them to be able to go anywhere, even to just get off the bus.  It was a bit scary the first time, but now I don’t make eye contact, hold on tight to my bag, and am really good at just saying no.  What’s funny is the people ask, “later, later” or “if you change you’re mind, then you’ll come to me.”  I just repeat my previous no.  If you agree to later, they may follow you around for a while.  I said no and still had a tuk tuk driver follow me around for over an hour.  I now fully understand the tourist t-shirts in Cambodia that say “No tuk tuk today or tomorrow.”

One of the saddest things in Cambodia is the street children selling bracelets and sunglasses.  They are so young, but that’s part of the gimmick.  It’s so much harder to say no to a child.  I’ve heard many street children have a sponsor who pays only for English speaking classes.  Other than that, they do not regularly attend school because they are selling stuff.   Common phrases you may hear from them include, “Open your heart, Open your wallet” and “You lie to me, you lie to yourself” (most often heard after explaining you have no money).  M'lop Tapang is an organization in the city working to stop the exploitation of children.  They operate a restaurant and shop.

On my first liberty day my liberty buddy and I took a tuk tuk due to a torrential downpour.  Our driver was a little creepy and definitely listening in to our conversation.  At one point I said, “My dad would have a panic attack if he knew what I was doing right now” because we were just two girls exploring Cambodia.  The driver began laughing before we did.  Then he just kept laughing long after it was funny.  At any rate, he definitely overcharged us with a whopping $4, but the drive was worth it just to be out of the downpour.  The first things we bought at the market were ponchos!  They are a must have during the Cambodian rainy season; an umbrella just won’t cut it.  Afterwards, there were surprisingly many days without rainfall.

In the city there are several places offering massages, pedicures, and manicures at very affordable prices.  I’ve even seen advertisements for fish massages, where you stick your feet in a container of water and the fish eat the dead skin.  There was no way I was going to get a fish massage!  I did get a couple of full body and foot massages though.  During the foot massage, the masseuse remarked on how white my legs were.  In the states this would be an insult, however here white skin is considered very pretty.  Skin whitening cream is commonly found down the lotion aisle in supermarkets here.

I had the opportunity to see two Buddhist temples in Sihanoukville, Wat Leu and Wat Kraom.  Wat Leu was located at the highest point in Sihanoukville and offered views of the entire city.  There I was able to talk with a monk who’s been everywhere, from France to DC to Target and Starbucks.  A lot of monkeys were roaming around the temple and I got the opportunity to feed one of them a banana.  In fact I just starting walking toward them with a banana and a few of them charged me.  One reach up, nicely took the banana from me, and proceeded to peel it open.  However, later another one tried to jump on me.  That did not go over so well, but thankfully I left the temple unscathed. 

I also made the trip to the Kbal Chay Waterfalls.  The falls were gorgeous.  However, there was a good bit of trash by US standards.  A good bit of trash is the norm in Cambodia, where the sanitation system isn’t first rate.  At the falls there was a chair covered with flowers that you could sit in to take photos, but you had to pay use it.  Also, several people were selling food.  They would walk around with a dish on their head filled with their wares.  I waded into the falls for a photo opportunity.  As I was coming back, one of the ladies was kind enough to assist me as the rocks were quite slippery.

My time on the USNS Mercy is coming to an end, as I leave on August 11.  I am so appreciative of the opportunity to see more of the world and provide health care at the same time.  I would like to thank everyone aboard the ship.  It’s inspirational to hear health care providers taking a month without pay to serve people in need.  Also, thank you to all the military members for all  you do to keep us safe.  I know the USNS Mercy is a “cruise ship” compared to the average Navy ship, but I’m ready for a change of pace (aka being able to sit up in bed and not having to wear shoes in the shower).  Best of luck to everyone remaining on the ship and have fun at the steel beach picnic on the flight deck!

Working in Cambodia

Cambodia:  MEDCAP 1

I had the opportunity to participate in 2 days of MEDCAP 1 in Cambodia on July 30 and August 2.  The first difference from Vietnam I noticed was the weather.  It was cloudy and much cooler than in Vietnam with a refreshing, gentle breeze.  However the humidity was so heavy I always felt there was a blanket of moisture covering my skin.  By the end of MEDCAP all the boxes and papers felt a bit water logged.  There was a torrential downpour a few times during the first day.  Thankfully I was dry in the pharmacy, but some of the patient’s didn’t fair so well underneath a pavilion that tried to blow away in the wind.

MEDCAP 1 was located in the city of Sihanoukville at a school named Hun Sen Cheung Kor.  The school consisted of two buildings in a L-shape with a courtyard in front.  Due to the rain almost the entire area was extremely muddy.  My shoes were atrocious by the end of the day.  I couldn’t understand how so many of the Cambodians wore flip-flops and their feet didn’t have much mud on them.

There were so many more children at the MEDCAP in Cambodia!  It’s nice to see their wide smiles and hear their laughter.  A few tried hanging out near the windows on the back of the pharmacy.  However, the pharmacist did not like that idea and continually reminded them to move along.

During the afternoon of the last day of MEDCAP a mother frantically walked into the pharmacy with her child.  We could not understand what she was saying, but it was clear she wanted help for her child.  The child was not moving and had a blank stare on her face.  With the help of our translators, she was ushered down to the pediatrics area.  Not much time passed until a provider appeared in the pharmacy asking for some Tylenol to give ASAP for a child that had a febrile seizure.  It was the same patient and I was happy to know she was promptly received care.

A Lesson in Painting

On August 1^st I volunteered to assist with an ENGCAP in Kampot, Cambodia.  My duty was to paint the shutters and windows of a health clinic undergoing renovations.  A nurse practitioner from the Latter Day Saints and I double teamed the windows for about 5 hours and only fully completed one (painting shutters with a paint brush is more time consuming than I thought).  We were given information on how to properly paint a window (brush out the runs, fully cover the existing color, etc).  The project needs to be finished on the 9^th of August and the hope was to complete each window with only one coat of paint.  Thankfully I’ve heard the finer points on painting before and was confident in my ability with a paintbrush.  However, there is a very good reason paint shouldn’t be used in wet, humid environments.  As the rain ferociously bombarded the ground, we noticed that our carefully painted shutters had runs in the paint.  It did not matter how many times it was brushed out.  At any rate, it looks great from a distance.  I came away mostly unscathed from the red paint.  Only a bit of paint made it’s way onto my nails and glasses!  Also in that area, the military is finishing up a maternity ward it built for the clinic and is updating the community center.  I wish them luck finishing their project.  I can’t imagine working 10-14 hours outside everyday.

On a side note, the 2-hour drive there was pretty frightening.  The road was paved, but it some areas the potholes went from one side of the road to the other.  Gravel had been placed to fill the holes, but it mostly just got pushed to the side.  Our van driver did his best to avoid the potholes by veering from side to side of the road.  It was a very bumpy ride and I can only imagine what it would have been like had none of the road been paved!  The drive did offer magnificent views of the Cambodian jungle and a snapshot of life in rural Cambodia.  I saw several people working in rice patties, families eating meals together, children playing, and water buffalo trying to cross the road.

Blog Update!

July 15^th

            Yesterday was my first day on MEDCAP.  I was able to go out with my preceptor and one of the Navy pharmacy personnel.  I was so excited to finally see how the clinics were run here and what site we would be at.  We mustered at 0530 and took a boat and a bus ride to our site.  This was the 4^th day of MEDCAP 1 so the other pharmacy personnel had already unpacked the medications the pharmacy and we just needed to become acquainted with where all the drugs were and set ourselves up for the day. I was really hot outside but our room was not too bad because we had several fans and windows allowing for airflow. We began seeing patients come in about 45 minutes after we arrived.  We had 3 or 4 translators at all times and we arranged it so that some of the Vietnamese volunteers gave each patient a number when they came so that we could more easily determine which patient belonged to each prescription.  In Vietnam, many of the people have the same or very similar names, so the numbers helped us reduce the chance of giving the prescription to the wrong patient.  The only down side to having so many volunteers help us is that I didn’t get to have a lot of patient interaction.  Some people would shake our hands, smile, and say thank you after being counseled which was actually my favorite part of the day.  Some people actually went out for lunch but I decided to stay in and try my MRE (meal ready to eat) for the first time.  It actually wasn’t that bad.  It’s kind of like a goody bag.  You know what the main course is, but all the sides and desserts are a surprise so it’s kind of fun! 

We went out again today but it was the last day of MEDCAP 1 so they cut us off around 1300 with only a few patients trickling through until about 1500.  We then had to pack up and clean our area out.  There were so many people coming in to see if we needed help, it made it go by much quicker.  We only saw around 200 patients on the first day and about 170 on the second, which is apparently much fewer than in other countries.  I’ve heard they saw about 800 patients per day in Indonesia and the Philippines.  Even though we didn’t see as many patients, we still seemed to keep busy the entire day.

Overall, it was a great experience.  We were told that the people were very thankful to have us there and you could tell that they really appreciated all of the services that were provided.

MEDCAP 1 Site - Elementary School

MEDCAP 1 Pharmacy Team

July 16^th

Today I was able to go out and volunteer to help out with ENGCAP, which stands for Engineering Civil Assistance Program. I thought that we were going to be painting a school or something along those lines, but they split the volunteers up into two groups and my group went to a clinic that was being renovated.  Instead of painting, they handed us a hard hat, gloves, and a bunch of rakes, shovels, and other tools… I had no idea what I had gotten myself into.  The back of the clinic was full of dirt, bricks, and waste products.  The clinic had actually been throwing needles out the windows into the back yard along with other biohazardous waste.  There was a big pile in the corner where they had burned the waste, however a lot of the needles didn’t burn so we had to be really careful where we stepped.  We proceeded to rake out the area and break down the brick so that they could pour concrete over the entire area and make it all level.  Basically, I pushed dirt around all day in the blazing sun.  Well, not all day, it was more like I worked for five minutes and then rested for 20! Haha!  It was quite the experience spending the day with a bunch of construction workers.  I have so much more respect for all of them.  They have a really tough job and somehow they still managed to laugh and joke around in all that heat.  I could barely speak, I was so tired!  There were three kids, that lived next to the clinic, that came out and were trying to talk to us.  They knew very basic English like “hello”, “what’s your name”, etc.  They were really cute and friendly.  One of the volunteers did some “magic tricks” for them.  The older ones figured it out but the little one was fascinated by him and was giggling the entire time!  It was priceless. Across the street, there was a small stand selling drinks and snacks.  It was attached to a house where a bunch of people were playing games and hanging out.  They had a chicken and duck pen, which would eventually result in food on the table.  The pen was really large and it occurred to me that they probably were more humane to their food animals than in the US because it is not all so mass-produced.  The family didn’t mind us looking around and one man even came out with a smile on his face and tried to communicate with us.  I couldn’t believe how nice and welcoming they were, I half expected them to tell us to get off their property. 

When we got back to the pier, one of the guys on the ENGCAP and some other people from radiology wanted to go eat dinner on the beach so I decided to go with them.  It has been great to be able to get off the ship and eat the local food.  I feel really lucky because a lot of people have not been out in Vietnam yet and I have already been out on six days.  Being in the pharmacy really gives you so much opportunity.  I feel like I am having too much fun!  The next two days, I am scheduled for the PM shift in the pharmacy, which is from 1500 to 2330.  Tomorrow will be my first real day in the pharmacy so I am really excited.  It feels like I am going in for my first day of work!

 Breaking bricks!

Hanging out with the neighbors!

July 17^th & 18^th

            My first two shifts in the pharmacy were great.  I was lucky to be scheduled with military technicians that really knew what they were doing and were proactive in teaching me the system and letting me try it for myself.  I was able to enter orders, fill prescriptions, and even get a little extra experience in the sterile compounding hood.  I did a few add-a-vials and got to do an antibiotic reconstitution with sterile transfer.  It was exciting because it was my first time doing that since our lab class and it was actually going to a patient!  I even got to attend a couple of lectures during the daytime so I felt like I was learning a lot.  I have been really impressed with the “technicians” who work in the pharmacy.  I put technicians in quotations because these guys joined the Navy and then actually went to school to become Corpmen.  A Corpman is actually a combat medic who is trained in all aspects of healthcare.  These guys are really smart and have a lot more education than I would expect from a “pharmacy technician”.  They can put IVs in patients and they know a lot about the medications they work with.  They actually do most of the counseling to the patients.   They even do presentations for us that are at the level of a graduate student.  It has been really impressive, I have a lot of respect for them.  

Goodbye Vietnam and Hello Cambodia

Tour of Vinh City

On the 21^st of July I went on a tour of the area surrounding Vinh Vietnam.  Unfortunately our tour guides did not speak very much English and there were times I wasn’t sure what I was looking at.  However, I still had a good time and learned more about Vietnam.  Much of the tour focused on Ho Chi Min and communism.  Stops along the tour were Ho Chi Min’s birthplace, the Ho Chi Min Museum, and the Soviet Museum.  The Ho Chi Min Museum was gorgeous with pagoda inspired buildings and tranquil gardens.  The museum included a jeep Ho Chi Min rode in, clothes Ho Chi Min wore, and a memorial to Ho Chi Min.  At the memorial there was a special spot to leave flowers.  I noticed many people looking as though they were praying to the statue of Ho Chi Min.  I found this interesting as most people in Vietnam are atheist, but many practice ancestor worship.  Ho Chi Min was everywhere, as a statue in the park to paintings for sale to plates to eat off of.  It became quite apparent that the people of Vietnam have a great respect for Ho Chi Min and view him as a hero.

Ho Chi Min Museum

Ho Chi Min Museum

At the Soviet Museum we had a tour guide.  She wore a beautiful Ao Dia, a traditional Vietnamese dress.  As we discussed her dress, she told me that I could pull off an Ao Dia myself and that several places sold them in the city.  I was very tempted.  Practicality won out in the end and I did not purchase one…

Ho Chi Min Statue in the Soviet Museum

The last stop of the day was a Temple.  It was elaborately decorated on the inside with gold while the smell of incense hung in the air.  The temple set on top a mountain and offered beautiful views of the Lam River below.  It was a very peaceful, yet hot, environment.

View of the Lam River

 

Surgery

On the 21^st I had the opportunity to observe a surgery on an inguinal hernia of a three-year-old girl.  I did not have the opportunity to see much of what was going on, as there were seven other people also trying to observe, plus the three physicians doing the procedure.  The observers were Japanese and Vietnamese physicians and one medical student.   Since they are much more likely to perform a surgery than I am, I tried to stay out of their way as much as possible.  I was able to observe the teamwork between the three physicians as they worked to improve a little girl’s life.  During the surgery a drape was placed, so only the area of the body being operated on was seen.  That being said, I couldn’t forget the precious face of the little girl as the surgeons were performing their operation.  I hope she had a successful recovery from the surgery!

I had the opportunity to see some of the patients as they left the ship on the 24^th before we began sailing to Cambodia.  The patients looked so happy and waved as they passed.  It was nice to see the faces of the inpatients that received some of the medications provided by the pharmacy.  Also leaving us on the 24^th was the Japanese Ship, Oosumi.  The ship had stayed by our side from Indonesia until the end the Vietnam.  We went outside on the deck to wave goodbye to our Japanese counterparts.  I wish they could have stayed with us throughout Cambodia too.

Fun and Games

On July 24^th we held the Pharmacy Olympics.  Games included pin the tail of the water buffalo, pharmacy trivia, building the tallest tower out of boxes of prednisolone acetate ophthalmic solution in 1 minute, and a scavenger hunt.  We played in teams of two.  Josie, an Austrialian pharmacist, and I partnered up to form the Pharminators.  I’m not sure how Josie felt about being my team mate afterwards, but let’s just say that pin the tail on the water buffalo just isn’t my game.  However, we did redeem ourselves by winning the tower building contest with a whopping 24 inch tall tower.

Pharmacy Olympics

The ship provides activities to keep everyone entertained.   One night we had an ice cream social.  The navy band made it a party with their excellent playing.  Another evening we watched Mission Impossible: Ghost Protocol on the flight deck.  It was very windy and everyone’s chairs and popcorn kept wanting to blow away.  However, the weather did make the big sandstorm in the movie much more realistic!  In addition, we had a licensed acupuncturist aboard.  People could sign up for free, so I decided to try it.  I could not feel the needles as all, although there was some tingling and warmth.  I had needles in my ears, neck, lower back, knees, and ankles.  The overall experience was very relaxing I would highly recommend it.

We  left Vietnam and have been in Cambodia for the past couple of days days.  Cambodia offers exciting sites through tours I have booked and MEDCAPs, as well as lots of rain (it is the rainy season right now).

Vietnam: MEDCAP 5

I ventured into Vietnam on July 18^th, 19^th, and 20^th to assist with MEDCAP 5 (Medical Civic Action Program) at the Hung Loi Primary School.  All MEDCAP sites in Vietnam were located in the Hung Nguyen district of Nghe An.  The school I was at consisted of two, two story buildings surrounded by a concrete barrier.  The surrounding area included rice paddies and wilderness.  Two families had stands set up outside the school selling drinks, fruit, and jewelry.  The children of the families were adorable and would run into the school to play with some of the members working there.  The pharmacy was set up in one of the classrooms.  We had a lot of room to work, with the medications set up on wooden school tables lining 3 walls.  The room had ceiling fans.  However, with temperatures around 100 degrees and high humidity we still did a lot of sweating.

Family Outside of MEDCAP site

 

Three pharmacy team members form the USNS Mercy staffed the pharmacy, along with two Japanese pharmacists and one helper and three Vietnamese translators. 

Pharmacy Team Day 1

Pharmacy Team Day 3

With a total of nine of us working, we were able to dispense the medications without much of a wait.  I loved watching the teamwork between not only the different countries working together in the pharmacy, but also how the different health professions came together to provide the best patient care possible.  I was told Vietnam was not as busy as Indonesia and the Philippines.  Our patient totals were around 80, 200, and 300 on days one, two, and three respectively.  Many of the patients were older females with wrinkles, white hair, and black teeth.  I thought they were adorable (yes, even with the poor oral hygiene).  Later I learned that the discoloration of the teeth was due to chewing betel nut, a small fruit of the areca palm (I highly suggest googling for a picture of the betel smile).  Each family received only one ticket to get aid at the MEDCAP.  Often an elder member of the family was chosen to receive medical care, reflecting the respect placed upon the elderly in Vietnam.  I did not have much interaction with the patients due to the language barrier and our highly efficient interpreters.  I will say though that a smile is universal!

Working in the Pharmacy

The Japanese pharmacy members helped keep things fun in the pharmacy by bringing origami, stickers, bubbles, and fans to pass out to the patients.  Thankfully I also received some bubble solution with the coolest bubble wand ever.  I spent about an hour during our mandatory two hour lunch break to blowing bubbles with the translators.  

The Navy Band performed at our MEDCAP for two days.  Since we had a slower moment in the pharmacy, one of our translators, Harry, and I went down to listen to the band play “Moves Like Jagger” the first day there were at our MEDCAP.  I leaned in to have her take a picture of me with the band in the background and ended up getting pulled into some dancing.  Unfortunately the only other people that joined in were Harry and a darling little Vietnamese girl.  We still had a good time though.  The next day we were too busy to go watch the band, but we could hear the music in the pharmacy, resulting in a couple of mini dance parties in the pharmacy!

The Navy Band

Did He Really Just Say That?

As a side note, we had to take a 45 minute boat ride and then an hour bus ride to get to and from our MEDCAP site.  By the time I arrived back at the pier the first day I was really hot and not looking my best.  Even so, I received my first ever Vietnamese marriage proposal.  I was with a pharmacist who speaks Vietnamese and she was able to translate.  The conversation went like this:

Vietnamese guy:  “Ask her if she has a boyfriend.”

Me:  laughing

Vietnamese guy:  “Ask her if she’s willing to marry a Vietnamese man.”

Me:  laughing harder

Vietnamese guy:  “Tell her I’ll learn English for her.”

Me: laughing even harder

I was so stunned and found the situation so amusing I just couldn’t stop laughing.  I probably should have handled that situation a little better…

July 13th

I knew I wouldn’t be able to blog for a few days due to my schedule being so busy for the past 6 days. On Tuesday, the 10th, we mustered at 0700 to go to the pier to sort the medications from the Vietnamese government. We took a 45minute boat ride from the ship to the pier and when we got there it was hot! When we got off the boat, someone said “Pharmacy! That’s your box.” I laughed a little because it was a tiny, closed up trailer and we had about 22 people with us! I couldn’t believe they were serious. It was a long, hot day but we made a lot of progress. The medications were all in boxes and we had to count them out and divide them up into six different MEDCAPS. It took a long time for some of the drugs, like acetaminophen, because there was so much of it. We also sorted the medications into bags and labeled them so that they were ready for dispensing. We were told the MEDCAPS in Indonesia saw about 800 people per day so we were expecting a lot of patients. It was frustrating though because a lot of the drugs ordered by the pharmacy either didn’t come or were replaced by something not relevant for use. For example, they ordered erythromycin eye ointment and received erythromycin topical ointment. We worked all day on Tuesday and took the boat back around 1830 (6:30pm), which was perfect because we were able to sit and watch the sun set over the mountains. It was gorgeous. I was exhausted from the heat and fell asleep really easily right after my shower. We repeated this on Wednesday except we had a few less people so it wasn’t as hot and we got to go out for lunch! We took a bus to the beach and ate at a Vietnamese restaurant along the water. It was quite different than eating in the states. We had crab, shrimp, fish, squid, and some of us had a coconut to drink! It was all fresh food and quite the experience. We went back to the pier after that to continue with our packing and sorting. We then returned to the ship around 1900 (7:00pm), which was awesome because it was the end of the sunset and then the darkness fell. I have never rode on a boat in the middle of the ocean at night and it was an experience I’ll never forget. I sat outside, on the upper deck and watched the stars. It was really surreal.

I was scheduled to be at the pier yesterday, the 12th and today to finish packing but luckily we finished all of the pre-packing for all 6 MEDCAPS by about 11am yesterday. We decided to go out for lunch to treat ourselves. We hopped on a liberty bus and went to a large shopping center. It was basically a big mall but it had a grocery store in it. When we walked in we wanted to get a group picture and one of the Vietnamese clerks from one of the stands came running into our picture in the front. Then she grabbed my arm and asked her friend to take a picture with me. She was so happy. It was really nice to see that the people were so friendly to us. I noticed as I was walking around that the people looked very serious and just kind of stared at us, but as soon as I smiled at them, their faces would light up and they would smile right back at me. I just kept thinking “everyone smiles in the same language”… kind of cheesy, I know, but it is really true, especially on this mission. It was really cool to be able to see the villages and the homes people live in.

You can tell that this country is more controlled by the government than others. The buildings constantly alternate from rich to poor. Apparently, we are actually in a touristy area so there are a lot of hotels and beach restaurants, so it is difficult to really determine how the people live in the more rural areas. Today, the department head of the pharmacy decided we didn’t need to go out to the pier, so we mustered at the pharmacy at 7am. I really wanted to learn how the pharmacy worked and learn the system so I was sticking around in the pharmacy with my preceptor in hopes that I would be able to become acquainted. Suddenly, the department head came in and told me that I had been signed up to watch a surgery that day! I quickly went downstairs to the OR and signed in. They gave me the option of seeing a cataract surgery, an undecended testicle, or a hysterectomy. I chose the hysterectomy. The surgery had already begun when I came in so it took me a little bit to understand what was going on. They had just opened the women up and were working on getting the uterus out. I watched the entire surgery and after they removed the organs, I was able to look at them and see the ovaries and the uterus and the fallopian tubes. The uterus was apparently much larger than normal because it had fibroids in it which was causing the women a lot of pain and a lot of bleeding. It was kind of gross but I couldn’t stop staring at it. The thing I found the most interesting about the surgery was the way the doctors interacted. There were two main surgeons, an American and a Vietnamese doctor. They also had a Japanese doctor and another Vietnamese doctor assisting. They had a translator there but for the majority of the surgery, they were able to communicate without using the translator. The only time they used her was when they were discussing differences in their techniques or how they usually perform the surgery. They were asking why the other one typically did it one way versus another and then they would compromise and choose a way they both agreed on. They really seemed to respect each other. It also seemed as if the American doctor was teaching the Vietnamese doctors, which was really cool. I was able to watch a second surgery directly after the first one, which was a cervical polyp removal. This patient was much younger and I was able to see her before the surgery. She seemed so frightened to come into the operating room. I could only imagine what it must be like going on to a foreign ship and then come into an operating room full of foreign doctors who are speaking a language that you don’t understand and then having to undergo such an invasive procedure. (if you’re a women, then you understand) She was awake the entire time with only an anti-anxiolytic to help calm her. The surgery only lasted about 20 minutes and then she was able to go back to the holding room to be with her escort. Later that day, I went to a lecture on neuro rehabilitation which was really interesting. On most days, twice per day, the department of medical services offers lectures on different topics. I wasn’t aware of this previously but I am going to try to go from now on.