Rx Project HOPE

Market Research

2011-11-11T07:52:00.000-05:00

Cameroonian Pharmacy

2011-11-03T07:05:00.003-04:00

Recently I had the opportunity to visit a Cameroonian pharmacy while downtown, to purchase some medication. I knew exactly what I needed, the only problem was I didn't know if the medication was available here (or only in the USA). I entered the pharmacy and it was a very well-kept shop. Very neat, organized, clean, and full of everything. Mostly what I saw were medications lining the walls and further back in the back of the store. One section of the store was dedicated to beauty products.
That was it. No toilet paper, no chewing gum, no office supplies. This pharmacy had a small beauty section and the rest of the store dedicated to medications. I went up to the staff and unfortunately nobody spoke English. Between Lexicomp, some hand motions, and a few broken French words I was able to communicate what I needed. The pharmacist brought me a few medications that might help. I recognized the classes of the medication, but they were definitely ones I had not heard of. Luckily one medicine of the pile was pretty much what I was looking for and it worked. The pharmacist showed me the directions on the box and started counseling me on how to use it, I was glad to see that.
All-in-all a good experience. I'm glad I found what I needed. I'm also glad I was able to see what a Cameroonian pharmacy was like, to compare it to the States.

Vaccination Program

2011-10-28T10:03:00.003-04:00

This morning we spent a few hours in the immunization clinic. The clinic runs on Wednesdays and Fridays, from 7:30AM - 11:00AM. Vaccines are an important service offered by the hospital, with 95% of the immunizations for babies/children. The government has programs set up to provide certain free immunizations for babies/children.
At 9:00AM Mr. Adolphe (pictured) gave a short lesson in the importance of Vitamin-A vaccinations for babies, and asked questions of the mothers. Education is something we are pushing here at these immunization clinics. There was a full crowd today and only one nurse, so volunteer Kelly Fromuth was called into action. I was there simply to shoot pictures/video. I did end up trying to draw up some syringes to facilitate the process. It was very hectic watching them give immunizations. There were many crying babies. It was a whirlwind of activity for about 2 hours until all vaccinations were complete.
The babies are weighed and vaccinated at these check-ups, and the information is recorded on their vaccination card.
Its a very good service offered by the hospital, funded by the government, and hopefully after some analysis we may give some pointers to smooth out the process.

A day at the beach; Kribi

2011-10-25T12:49:00.004-04:00

The weekend of Nov 22-23, the Project HOPE team traveled to the beach town of Kribi. The drive is four hours long and included passing through many towns, rest stops, and lots of jungle. I am continually amazed at how lush & green this country is. Thankfully the road to Kribi is well built (by the Germans I believe, from many decades ago). Rules of the road still applied; meaning no rules. It is extremely dangerous, in my opinion, to drive in Cameroon.
We passed a 10km stretch of "Palm Tree plantations", where they grow palm trees to harvest the oil. It went on forever, it was great. Every town we stopped at, our car was swarmed by people trying to sell us their wares. We finally arrived to Kribi and the driver (Bala) and our guard (Yves) immediately bought dried fish. The fish from Kribi is the best, freshest in the country. We checked into the hotel, Hotel du Phare (best in the area) and went straight for the beach.
The beach was very nice, brown sand but not full of seashells/rocks/stuff. We are told the sand at Limbe (other beach resort) is black due to oil pollution and volcanic ash. The water was actually warm, way better than I expected. We hung out at the beach until it was time for dinner. We were invited to go to a family friends' house for a late lunch, then a restaurant in-town for dinner. The town of Kribi is very similar to Yaounde in some aspects. Kribi really starts to set itself apart once you get to the beach.
Dinner was delicious, Sole fish prepared with vegetables, plantains, and fries. I tried the head of the fish for the first time in my life. Its a common thing to eat in Cameroon, and some people prefer the head to the rest of the body. Lets just say, it was my "Andrew Zimmern" moment. I couldn't handle it. The night was spent on the beach with a good book.
The next day we had a wonderful "French" breakfast at the hotel, I had fresh coconut from a local vendor, and we spent the rest of the morning on the beach and purchasing goods. Being a tourist destination, many local vendors bring their items to sell right up to the hotel restaurant. I went for a walk on the beach and jumped in the Atlantic Ocean for a last time.
We left the hotel, which was very nice, and had a late lunch again at the family friends' house. It was delicious fish.
After lunch we went to a famous tourist destination, the Chutes del la Lobe. We took a canoe ride around the bay, saw the nearby fishing village, and went right up to the waterfalls. This is the only waterfall in the world that falls into the Ocean.

Unfortunately we had to leave Kribi after being there only one day. It was definitely a needed respite from continuous work at the hospital, and very nice of the Blaz family to set it up for us. We traveled another four hours back to Yaounde, arriving well after dark.

I want to give another shout-out to Jellybean. Megan sends a shout-out for JC & KMo. Kelly sends a shout-out to no one in particular.

Video series: Training videos

2011-10-20T10:21:00.005-04:00

I was sent here to Cameroon with an armament of electronics, all in the effort to assist me with capturing my time here with Project HOPE. Use of the video camera has been slow until now; I didn't really know what I should be recording with it. After seeing the YouTube videos created by Alisa/Emily during their Project HOPE rotation, I am inspired. I thought up an idea of recording educational videos for the staff here at MRN hospital. I have been working with Project HOPE volunteer [Kelly Fromuth] to come up with ideas/implementation for these videos.

We just finished shooting our first training video: How To Do An EKG. Although it was a bit rough around the edges, I would call it a success. We plan on analyzing the video and shooting a second one (hopefully more polished) to be used by the staff here. Other ideas include: hand sanitation, aseptic technique(s), vital signs, and more.

Stay tuned for updates on our Video Series.

Motorcycle taxis: will I risk it?

2011-10-18T04:10:00.004-04:00

Ever since coming to Yaounde and seeing the prevalence of motorcycle taxis I have wanted to ride one. They are a cheap mode of transportation here and everyone uses them. Apparently they only travel short distances (this was told to me by a taxi driver) so they can have quick turnaround of customers. I've seen all sorts of people on motorcycle taxis. From toddlers going to school, businessmen in suits going to work, and entire families (most I've seen is 5 people on one motorcycle).
I'm told it is a very dangerous method of transportation and there are many motorcycle accidents on a daily basis. I have seen some of the aftermath of motorcycle accidents (nothing too serious) at the Yaounde Central Hospital.
One of the main problems with the motorcycle taxi system is that anyone can purchase a motorcycle and start riding. There is no "Class M license" like in the States. There are no driving schools for motorcycles. No requirements. All you need is your identification card and enough money to purchase one.
True survival of the fittest.
I bring this up today because during our morning run (Yves, Haris, myself) we were constantly honked at by motorcycles. They dodge and weave to beat traffic. We were running at 6:30AM so luckily not as much traffic.
I think I have gotten over the desire to ride a motor cycle taxi. At first I thought it would be a fun roller coaster ride...now I think I might just get hurt. Who knows, maybe I'll do a short run.

We NEARLY ran out of food!

2011-10-17T08:18:00.005-04:00

Last Thursday we Nearly ran out of food at HOPE House. We had been warned by previous volunteers to keep on top of the food situation but its been pretty darn good so far. The tipping point was when we ran out of peanut butter (an important protein source for one of the volunteers here). The backstory: due to the previous Sunday being an election day (all stores closed) we weren't able to go to the supermarket to replenish. Thursday night we had cous-cous 'potatoes', at least they were shaped like potatoes. We didn't even know they were couscous. The next 2 days we scraped by on the bare minimum. Saturday morning we literally had nothing in the fridge so we ventured out to forage. We came across a roadside stand directly across from the hospital that sold 'beignetes' (basically donut holes). We were salivating. They are so good.
Breakfast on Saturday turned out to be very unhealthy and delicious, followed by a late large lunch. Needless to say, at the supermarket yesterday we STOCKED up on food.
One thing I learned...people can become a little more irritated if food runs out. So always keep the fridge stocked.

Cabaret with a surprise concert

2011-10-17T04:30:00.004-04:00

This event happened quite a while ago it seems. Saturday night, October 8, 2011. For the evening we decided to go to a cabaret to listen to Live Cameroonian music. After much trouble getting a ride, we crammed EIGHT people into a small station wagon and headed downtown. The cabaret was called 'Carousel' and when we arrived, we realized there was a concert that night. The famous Cameroonian pop star 'Lady Ponce' was headlining after a few local bands. We arrived about 10PM and ended up staying until 4:30AM. Did I mention Lady Ponce didn't arrive until 4:00AM? We were absolutely exhausted and by the end of the night (early morning, really) I was absolutely ready to crash. The bands we listened to were pretty good. It was a good experience over all. I'm glad we stayed for Lady Ponce to see who this star is, but I wish she had started a little earlier. Everyone was going crazy for her. People would go up on stage and rub money all over her forehead and give it to her. It was quite an interesting event to watch. I ordered chicken + fried plantains, in addition to eating some mystery roadside meat (chicken on a stick?).
I think I would prefer my cabarets to be a little more low-key. I learned a few Cameroonian dance moves thanks to our musically gifted friend Albert. Hopefully we can go to a cabaret again, I would love to listen to Jazz or French music. Cameroonian music is good too. But definitely don't want to be there that late.
On the way home we had car troubles. One of the cars blew a tire so we had to pack into one car. 7 people in a Mercedes this time, a little more breathing room. Since it was the day of the election, and all shops would be closed, we stopped at a bakery @ 5:00AM. We stocked up on bread and munched on donuts while we waited.

Hospital tours put things in perspective

2011-10-08T09:54:00.005-04:00

I haven't updated the blog in a while, and this will be a relatively long blog; I apologize in advance!

Every morning I come to Maria Rosa Nsisim hospital and I round with the medical doctor (and nurses). I take notes and notice differences between care provided here, and what I expect to see in a U.S. hospital. When I round, I keep in mind the resource limitations here at the hospital. The medical staff here are doing an excellent job providing care to their patients given the conditions. To put this [private] hospital into perspective and to learn more about hospitals in Cameroon, it had been suggested we visit [public] hospitals to draw differences.
On Wednesday we had that opportunity to visit both a (General) hospital and (District) hospital, both public. Just the ride to these hospitals was quite an adventure, and almost made me nauseous. I couldn't imagine a sick patient having to endure a ride to the hospital like that.
First we visited Yaounde General Hospital, which is the largest hospital in all of this area. Its patient base includes the surrounding areas outside of Yaounde as well. It is a teaching hospital with medical students and nursing students training, although we didn't get to tour any school campus there. It was a very large compound, it has been around for over 50 years (buildings are very old and showing their wear) although ongoing renovations for the past decade, and it was spread out with each department having its own building. We had a very nice nurse, Jacky, show us around to each department.
What I saw there put Maria Rosa Nsisim (MRN) into perspective. The General Hospital had a huge patient load (and large capacity), although it seemed people were waiting everywhere. The buildings as mentioned are very old. The equipment was very limited and many patient beds were in each room (standing screen dividers for privacy). The hospital is capable of treating many types of ailments and seems very well staffed. I spoke to a ER nurse as he was working on a motorcycle accident patient who had a bone sticking out of his leg; the nurse was prepping the leg for surgery. It was quite intense. It was also comforting to see mosquito nets in the maternity ward, to help prevent malaria. I was impressed by the scope of practice at the hospital but not happy with the cleanliness, apparent lack of infection control, and the sheer number of people at the hospital.
The District Hospital was a further drive away and the first building we walked into seemed very well maintained, clean, and newer. There were many people waiting on benches but none in apparent distress. After we toured that building and went across the street to the next building, I realized the first building was their "administrative" building with a few VIP patient suites. It was mostly administrative staff, MD offices, and various other rooms where patients would meet to resolve issues. The second building across the street was the actual hospital. It was in worse shape than the General Hospital. Similar issues were present for this hospital but it seemed even less resources were available. It was much smaller than the General Hospital and had a smaller patient load. Some beds being used did not have mattresses and were only the metal frames. All in all, I realized that MRN is off to a good start and I hope my work out here is beneficial to the people most in need.
There is definite need in this country for improved healthcare. They need to raise the quality of care here. I commend them for their efforts given the limited resources and conditions. All accounts given of the hospitals were based on brief tours (take everything with a grain of salt), and of course these are my personal opinions.

when in Rome, do as the Romans do.

2011-10-01T06:36:00.005-04:00

Had a chance for another cultural experience this morning! I was invited to play soccer with the local team at a nearby soccer field this morning. Due to rain, our scrimmage was delayed; we still played in mud. Soccer is very popular in Cameroon, and everywhere I look I see people wearing team jerseys. Last night Yves took us to the city center to purchase authentic Cameroon soccer jerseys, which I sported at the scrimmage today.
There were about 20-25 players split up. Everyone had jerseys/pennys and cleats. I was lacking the cleats so the entire match was a big mud slip 'n slide for me. My trail-running shoes were not cutting it on the field, but luckily I didn't take a dive for a mud bath. Being the rainy season, I assume every weekend that I play will be rainy & muddy.
These guys were very serious about their soccer. It was very clean (referee), no drama that I usually see from soccer players, minor pushing/shoving to get the ball, and many quick arguments after any penalties were called. They embraced me into their game but I think I will have to earn their respect. Its been 10 years since I've played soccer so to say I'm not up-to-par is an understatement.
They did offer me to kick one of the penalty kicks, which I made to bring us to 7-3. We still lost. Fun match nonetheless. Saturdays are practice scrimmage and Sundays are matches with other towns.

Management 101

2011-09-30T05:04:00.004-04:00

Another quick post for the followers. I wanted to update everyone on the work we are doing here at the hospital. This whole week we have rolled out our 'new manager training' program for the future hospital administrative staff. Every day we have been holding meetings based on our training program, which we hope to conclude by the end of my 8 weeks here. The meetings have been going very well and we are making great progress!
The management training is right up Tim Clark's alley, with his experience in the Pharmaceutical industry. This training is also putting my MBA to good use, a degree I have received questions about since I signed up for it.
Many meetings have been held during a time without any electricity/power, so it has been darker and hotter than we would want (and remember, this is the nicest building in this entire area). This is how it has been since we have gotten here. Internet cuts out and power cuts out frequently, but as Dr. Mukalay said to us yesterday: "Welcome to Africa". Makes you appreciate what you have in the States even more.
We have our task from Project HOPE, and we have our task from the Hospital CEO. Starting with this week and for the next 6 weeks we will make as much progress as we can, finish our assignments, and see Cameroon culture!

10 million viewers and counting!

2011-09-30T04:14:00.004-04:00

Bonjour!
Yesterday we were surprised to have a TV journalist come to Maria Rosa Nsisim for a promotional video/news clip about the hospital. Their aim was to increase awareness in the community about the hospital and also let viewers know what services are offered. Being the coveted HOPE volunteers that we are, Tim/Megan/Myself were asked to lead the explanations of each department. I personally covered the OR and Pharmacy. No make-up, prep, or lighting done; the video is el-naturale! Apparently it was showed last night on [Canal 2 International], one of Cameroon's most popular TV channels. We were told upwards of 10M viewers would see the 1min summary clip!
It was a nice little surprise to be asked to be on TV; since we get a copy of the entire video I might send it directly to Hollywood. Actor/Pharmacist possibly? I hope that more promotional videos and such are created within the coming months to put MRN Hospital on the map; this place is a boon in the area and with the work Project HOPE is doing (with the help of volunteers such as ourselves) the aim is for the hospital to be a center of excellence serving all types of people(s).

Au revoir!

P.S.
Megan wants to give a shout-out to K Mo and JC. I want to give a personal shout-out to the most important person on the other side of the Atlantic...Jellybean!!

Need to update while I still have internet

2011-09-26T08:07:00.001-04:00

Bonjour!
Just another work update from Cameroon. This is Day 7 of 52 for me out here in Cameroon. So far we have been adjusting to the time, temperatures, and lifestyle here in the town of Ahala (section of town where the hospital is located). We have been getting a sense of how the hospital works by observing the different services offered here. There has been a lot of meet & greet, and remembering (and/or pronouncing) everyone’s name is a challenge for me. I have met all of the key hospital staff so far, we have toured most of the areas, and now we are settling in for our first week of heavy-duty work. We have taken a teaching/consulting role here at the hospital for the time being; our task is to train their new hospital administrative staff. Time to put that MBA to good use! We will be rounding with the new CMO every morning and have regular meetings with the administrative staff. It’s all very exciting, as we are charged with building the hospital from the ground up (figuratively).

Au revoir.

Going out of town, literally.

2011-09-26T07:58:00.002-04:00

Our first weekend here in Cameroon was a success! We went out both days; spending Saturday touring the countryside with Eve and spending Sunday grocery shopping and dinner with the Blaz family. Saturday included visiting the town of Mr. & Mrs. Blaz and spending time at a family plantation. There we saw papaya trees, plantain trees, cassava (Cameroon potato), a cute goat missing its hind hoofs, a bat-pig, sugarcane, and various chickens/roosters. It was like visiting a farm with a litte more freedom for the animals. I tasted cassava, sugarcane, and Cameroon peanut butter for the first time. The family was very hospitable. Children were playing futbol in the mud. It was a good way to experience the rural areas. We came back to Ahala and hung out at a local bar, which happened to be family owned.
Sunday we went to [catholic] Church with the Blaz family, Cameroonian style. The choir was very lively, with each sermon being followed with song & dance. Church was followed by grocery shopping at an upscale supermarket (very, very expensive!) (but good to have the house stocked up), and a trip to Akono with Mr. Blaz to attend a campaign rally for President Biya. Many top Yaounde businessmen were in attendance; it was quite the event. There we also saw the very first Church built in Cameroon. We finished the evening with dinner at the Blaz compound, which happens to be situated next to Yaounde’s only golf course.
Next weekend we hope to visit a local wildlife preserve and go swimming!

arrived and hit the ground running

2011-09-20T11:52:00.003-04:00

Hello readers!
The Project HOPE team (Kamran, Tim, Megan) has safely arrived in Yaounde, Cameroon. I had quite some experiences in the travels; the layover in Paris + Casablanca were uneventful and slightly cumbersome. Finally made it to Yaounde at 3:10AM this morning and on little sleep.
The updates will be frequent and short. Today being the first day, I don't have much to tell about. We took a grand tour of the hospital today, the Maria Rosa Nsisim Hospital and met with the Blaz Family (founders/CEO/board director).
Yaounde is an interesting place, definitely culture shock for me. We don't have running water but we have a 32" plasma! (they are working quickly on the running water issue).
The highlight of the day was meeting with the Blaz family and hearing their vision. The hightlight of the tour was to see the NICU, I saw a 4 babies there and one of them only weight 750gm!! They are so tiny and cute. I hope they make it; unfortunately the infant mortality rate here is very high.
I don't know if I can load pictures but I will try to keep them coming. For now, enjoy the first sight you see at the International Airport in Yaounde`.

Setting off for Yaounde, Cameroon

2011-09-18T23:06:00.002-04:00

The time has come for the final Project HOPE rotation to begin! The trip has started with some flight difficulties; flight delays and extra layovers.
I hope to update the blog from Paris, France during my layover, and from Casablanca, Morocco. Finally I land in Yaounde, Cameroon @ Tuesday morning.
I hope my 8-week adventure is as good as the previous ones, and I hope to update this blog as frequently as I can with great photos & stories.
Stay tuned!

The Final Voyage

2011-08-14T13:59:00.018-04:00

OK- better late than never! After getting back to the states and getting in to the next rotation (which was not NEARLY as cool as being in the Pacific) it kind of got away from me to put up my final blog (plus I was having a tough time admitting it was really over). So here it is- the last stop of my amazing trip, FSM, and my final farewell:

We celebrated the 4^th of July by attending the opening ceremony

for the start of the FSM mission, and continued on with a softball game of the SeaBee’s (the Navy construction crew that was based on the island) versus the softball leagues in FSM. We lost terribly but got to enjoy

some sunshine, some rain, and some good company. We walked the island a little and explored, finding some restaurants and beautiful views. The next night Andy and I got to attend the opening reception which was on the LCU (the smaller boat inside the ship that takes us to and from the island). We had the band playing, good food to fill us up, and we got to rub elbows with everyone including the ambassador to the United States in FSM.

Some of the worksites in FSM were nicer than we had experienced before. At our first site we were in a classroom that had lights and a running fan that would turn on after noon which was a pleasant surprise.

The next site I was at I got to set up the camp (manual labor time!) and organize the workflow in our area. These were all outside tents, but we made the best with what we had.

A lot of the patients had skin and fungal infections due to the VERY high humidity (most days it felt like you were in a

swimming pool), so we quickly ran out of some of the creams and solutions and had to compound some of our own medications. It was a great experience to learn to work with what you have and use whatever resources possible.

Andy and I, along with the other girls from Project HOPE got to attend the closing reception at the ambassador’s house. This was a good time for us to say our tearful goodbyes to everyone as we had to leave the ship the next morning, a day earlier than originally expected (with the military

you learn to expect the unexpected). We got to enjoy a dance show put on by the locals, some great food, and listened to speeches from the Vice-President of FSM, the Governor, and various officers from our ship. At the end of the night we all reluctantly loaded back on the LCU and headed back to the ship. We spent a few hours late into the night saying more goodbyes and headed to our racks for our last night on the ship.

0630 muster came way too soon. Lugging the past 6 weeks worth of luggage down ladders to the LCU and boarding it for the last time suddenly made me realize this really was goodbye. We had some of the crew who weren’t leaving with us come down to the well deck to say goodbye, so with the last of the hugs and exchange of emails, we boarded the LCU to leave the Cleve forever.

After the well deck filled up and we pushed out the back for the last time we were greeted by our friends lining the top of the flight deck waving and yelling their goodbyes- that’s an image I’ll never

forget. They woke up early to to give us the official “goodbye” they said we deserved. With tears in my eyes I waved until they were out of site.

This is an experience I will never forget, something I am so unbelievably thankful to have experienced. I think everyone should take time from their lives to reach out and help other people, spend some time out of their comfort zone, and work through situations they never thought possible to complete. To everyone I worked with ‘thank you’ for being part of my team, to everyone that made this possible you will forever have a place in my heart for allowing me this opportunity, and to everyone that has followed or read this blog I challenge you to go out and make a difference no matter how big or small.

Thank you Shenandoah University, thank you Project HOPE, and thank you to everyone aboard the final voyage of the USS Cleveland- we did her well.

We near the end...

2011-08-09T15:06:00.004-04:00

August 9, 2011

This will likely be my last blog post before disembarking; we leave the ship early on August11th. We asked to stay on through Haiti but apparently this would conflict with other things like the MOU (Memorandum of Understanding) and other rotations. :)

Yesterday I was out at Baranca Gym for a MEDCAP in Puntarenas, Costa Rica. We saw the record number of patients through the pharmacy for this country, 437. There were more providers at the site that day, and everyone worked very efficiently. In Costa Rica our translators have been pharmacy students from San Jose. In this country once someone graduates from high school he or she can get a degree in pharmacy in another 5 years of schooling. The majority of the students working with us were in their 3^rd or 4^th year, and were extremely helpful! Everyone felt more assured that the patient was receiving thorough counseling and having his or her questions answered.

The students are coming to the ship tonight for a SMEE (Subject Matter Expert Exchange) where they will have dinner aboard, a tour of the ship and the pharmacy, as well as a discussion about pharmacy education in the U.S., Holland (from the Dutch pharmacist) and in Costa Rica. Some of the students even have rotations in the U.S. in Arizona this coming year!

For the past few evenings we have taken advantage of the partial liberty and left the ship to get dessert after chow. Two nights ago we got caught in a torrential downpour! The pier typically closes to walkers if there is lightening, so we were stuck hanging out underneath a local coffee shop’s awning waiting for it to clear. In the meantime it soaked our “civi’s” (civilian clothing) and it was amazing to see the lightening.

Just as eventful, our trip last night allowed us to try to local treat, “el Churchill,” an ice cream dessert with shaved ice, some type of red-colored, flavored syrup, powdered milk, ice cream, and it comes with a small can of condensed sweet milk to pour over the top. It was a complex dessert, and once mixed together pretty delicious. Interestingly, there was also a cruise ship docked in our port, the “Dawn Princess” from Australia. I was told that at least one of the passengers was treated aboard the Comfort. We watched the ship pull away right before our twice-weekly Project HOPE group meeting and picture exchange.

A few nights ago one of the doctors here with Project HOPE gave one of the most amazing presentations. He is an emergency medicine doctor that is on a disaster response team (DMAT) that responded to the September 11^th terrorist attacks. His recount, pictures, and experience were both saddening and inspiring. I would love to be involved in a team like this in the future. He explained that the team consists of about 30 people from all different disciplines including a chaplain, pharmacist, nurses, doctors, logistics, etc. They were called in and mobilized the evening of the 11^th. Teams are directly under the government (FEMA) and set up to be able to mobilize from anywhere within hours and remain completely self-sufficient for ~72 hours. The team works for a 14-day deployment. Project HOPE and the ship as a whole has an amazing group of highly qualified individuals who have committed much of their time, energy, and careers to service.

Tomorrow I am going out to site with Edge Outreach, an NGO performing water purification services and providing the site with potable water. The Edge team leader gave a presentation to HOPE about the chlorinating device and the organization.

Photos by: Alyson Landry, Project HOPE Public Affairs Officer

Puntarenas, Costa Rica

2011-08-05T18:07:00.004-04:00

August 4, 2011:

Yesterday I went out for the first time in Costa Rica to a MEDCAP at Fray Casiano, a school in Puntarenas. I worked with one of the lieutenants and a corpsman from the pharmacy.The site set-up was fairly well organized and there was a giant fan secured in the pharmacy that made the heat more tolerable. Overall, the day was very slow compared to those in El Salvador. We saw a total of 237 patients in contrast to the 500s we were seeing previously.

However, throughout the day we learned that many more patients were being referred for more severe problems than in other countries. It seems that because the general health of the population is better as a whole when compared to other countries, perhaps fewer people are seeking our services. The population even looks more “well”. Additionally, those that have presented to the clinic have more severe issues.

We have come to find that at each site there is nearly always an opportunity to try the local food, although this is all assumed, “at your own risk,” as many people have subsequently ended up in Sickbay on the ship. I tried a potato empanada, which was delicious! The other main dish that I saw being eaten, as well as enjoyed earlier in Costa Rica, was a typical plate or Casadas, which most often has chicken or fish, rice, beans, salad, and fried plantains.

Today I was out again on MEDCAP, but a different site, Baranca Gymnasium. The set up is very different between the school and gym, but these are both the major venues for this type of operation. The schools allow each area or discipline to have its own room, whereas the gyms are set up in a big circle with patients in the middle. Today the pharmacy was stationed right next to the physical therapy area, which was interesting to observe. Many disabled people were outfitted with new wheelchairs, others taught exercises, etc.

August 5, 2011

Today I had the opportunity to specifically observe anesthesiology in the operating rooms for the whole morning. I was with the plastic surgery OR and saw a double gynecomasectomy and an abdominal scar revision, as well as portions of a severe inguinal hernia, cataract, and axillary lypoma removal surgery in other rooms. I was able to observe two different anesthesiologists as well as meet and talk to a local Costa Rican anesthesiologist. She mentioned that the practice in Costa Rica is not much different from what she sees at her hospital. The differences in the drugs are minimal; however the equipment is not as advanced, and finally she mentioned that the system is generally less organized in her hospital. The anesthesiologists discussed the effects of different drugs in combination on respiratory depression. I was very unfamiliar with the volatilized agents, which I learned decrease tidal volume but increase respiratory rate, thus maintaining minute volume. However, when you compound three or four drugs for different effects: analgesia, amnesia, akinesia, etc., they may act synergistically (or not), but he explained that he always titrates to effect.

Also, I should mention that morale onboard has skyrocketed since being granted partial liberty. People may leave the ship in the evening between 1600-2200 and stay within a certain radius, but this is far enough to allow people to enjoy local establishments.

Pharmacy in El Salvador

2011-07-31T17:30:00.006-04:00

Sorry for the delay, as Emily has said, the internet situation is not ideal on the ship. In addition, google had decided that because I am in Central America, I must be able to speak spanish. So all of my google pages load in spanish...I'll do my best to continue posting!

18 Julio 2011

Last night at dinner I met up with Emily after our day out at the separate MedOps sites. She had just come to the Galley from the pharmacy and told me that I might be going on a pharmacy tour in a nearby town the next day. After a few phone calls by the pharmacists, I was cleared to go. The four of us left at 0745 in a taxi with a Police escort. I really never thought I would be in a position to have a police escort, but it happened today! I was with two doctors form the US Air Force and a pharmacist from the Netherlands. After a 25 minute ride, we arrived at the Sonsonate Hospital in one of the nearby towns. The hospital itself was actually very beautiful. There were lots of folering plants on the property and the building was one of the cleanest I have seen in the country thus far. However, some of the larger rooms with 10-20 patients each were not air conditioned and you could tell that some of the patients were uncomfortable. We made our way down to the pharmacy to ask them some questions about their products and services. This particular pharmacy actually had a substantial variety of medications, but they often experience shortages.

We had a chance to sit down with the pharmacist and go over some questions with her. Members of the USNS Comfort crew tour pharmacies in each country to see what medications as well as what services are abailable for citizens. This information is given to the providers who prescribe medications at the MedOp sites. This allows them to make proper recommendations so that their patients can continue treatment after the Comfort's mission here is complete.

After our hospital tour, we went across to a retail pharmacy. These are completely different than anything in the US. Patients can get nearly any medication without a prescription. They simply walk inside, tell the individuals behind the counter their symptoms, and walk out with what is deemed to be the proper medication. It is definitely an interesting system with fewer regulations than what we have in the United States. Below is a picture of just a few of the drugs available at the retail site, with the previously mentioned Dutch pharmacist in the background.

We left the retail site and had lunch in town before heading back to the ship. We invited our police friends and taxi driver to eat with us. I really have to say, everyone we have met in El Salvador has been wonderful. Even with the language barrier, you can tell the people are very friendly and really are happy to see us here. The policemen recommended a Mexican restaurant and it was delicious. I have attached a photo of my fajitas. It was nice to eat a meal outside of the noise and bustle of the ship's galley. Tomorrow I will be out for another MedOp and will try to blog about the experience soon!

Buenas Tardes....from El Salvador and Costa Rica!

2011-07-31T15:33:00.004-04:00

Hello! Finally an opportunity to update everyone on our adventures! Unfortunately the entire Internet was down from July 21-28! We were told that there was an issue with the modem and we needed a part that we would be picking up in Costa Rica. So we have been anxiously awaiting its return to post some updates! Additionally, the connection makes dial-up look lightening-fast, so it is nearly impossible to load any websites with pictures or large files. So our apologies, and we are now posting from the most wonderful local coffee shop at the end of the pier in Costa Rica.

Below are previous posts written but unable to be posted (dated when written)....

Written: July 16, 2011: Yesterday after a long bus ride from San Salvador we embarked on the USNS Comfort in Acajutla, El Salvador. Our general impressions of ship life are very positive; yet, it is extremely different than to which we are accustomed. To be effective you must understand military time, learn to eat quickly, and learn to shower even more quickly. We have had the extreme pleasure of meeting a wide variety of healthcare professionals from many different organizations and countries! We have met nurses, dentists, hygienists, veterinarians, surgeons, pediatricians, and pharmacists representing several different organizations and services including the Canadian Army as well as the Dutch Army and Navy. Additionally, all the members of the U.S. Military or Military Sealift Command have been exceedingly helpful to assist us in navigating the ship, answering questions, etc. We have also had the opportunity to take a walking tour throughout the ship as well as onto the flight deck and see the “helo”. After speaking with many of the deck crew we are beginning to decipher the color system of their fire-retardant uniforms: red – ordinance/fire crew, brown –captain/inspection, blue – chains, etc. It is fascinating and a complex operation up there. I hope that I can get the chance to ride in one to a site in Costa Rica.

Today was our first full day on the ship and we went through indoctrination (shipboard training) and were introduced to mostly all of the pharmacy personnel. Both Alisa and I will be going out on two separate MEDCAPS (clinical mission) tomorrow.

Written July 22, 2011: Yesterday I was out on site again for a MEDCAP at a different location, Pollide Portivo, a type of small stadium structure in El Salvador. There is a “roof” but semi-open sides, and has endearingly earned the name as the, “bird sanctuary.” Because of the open sides and tall roof with supporting beams many birds have made it their home. Though interesting to see, it is dangerous to stand underneath in the “kill zone”. Both Alisa and I,as well as many others, took at hit from our feathered friends. Each site offers a new organizational challenge to route patients through the care process to the correct places. In comparison to the first site at the school with individual rooms, this site featured all of the different disciplines and practitioners setting up in a semi-circle on the edge of the building, and staging patients in the middle. The day ran very smoothly and we had at least 2 translators at all times. However, whenever I felt able and/or the translators were otherwise occupied I would try my hand at distributing and counseling on medications in Spanish. Everyone I spoke with was very patient with my less than perfect verb conjugation and pronunciation; and appeared pleasantly surprised and grateful. On a few occasions after a few brief counseling points in Spanish the patient would respond with a long (very fast) story, question, etc. at which point I called in reinforcements. Communicating in Spanish with these patients felt wonderful and consistently challenging.

A few highlights from the day were jump roping with the children waiting at the site, as well as watching service men and women enjoy Pizza Hut (a far cry from the chow served on the mess deck) after being away from typical American take-out. I was also particularly touched when a young girl whispered for me to come over to the fence in front of the pharmacy and then gave me a rainbow-colored bracelet. It seems like a small silly thing, but it was an enormous gesture. It seems that most aboard agree that El Salvador has been one of the most enjoyable of all the countries that the Continuing Promise mission has visited.

Puntarenas, Costa Rica (our next stop) is a liberty port, everyone may get off the ship and duty for a short period. Alisa and I, like many many others on the ship, have planned to go zip-lining during liberty! For the military and civilians that have been on the ship for the entire mission this is a long-awaited occasion!

Today I had the amazing opportunity to visit and observe the OR. I was able to see a laparoscopic cholecystectomy, pediatric inguinal hernia repair, and an umbilical hernia repair. The surgery was fascinating as well as the complete protocol and procedures of the operating room in general, as I have never been in one. The laparoscopic work was very easy to view in detail; however, it was difficult to get close enough to the hernias because of sterility to see the intricacy. During these I was able to speak with the anesthesiologists about the different drugs, dosing, and disease considerations. He did an excellent job of describing the general regimen facets and many of the considerations based on the pharmacologic properties of the drugs.

Written July 26^th 2011: We have finished in El Salvador and are underway to Costa Rica. We watched the ship leave from El Salvador from the flight deck; consequently also the best place to see the sea or the stars. Because the Internet is down, so are the phones. The IT department has been providing satellite phone use (with a 2 minute limit) on the flight deck each night.

Once underway I have had a few fun and fascinating experiences. The first was a complete hospital tour with a Commander. He is both a radiologist and a helicopter pilot! We learned about the ship’s history, current capabilities, as well as future upgrades. We were able to see the intricate workings of the Casualty/Receiving (CASREC) area, ICU, CT scanner and Radiology, the patient wards, as well as the general “patient flow” as the ship was designed.

We were also given the opportunity to do a presentation on the requested topic, “Parasitic Disease and Treatment.” The audience was largely Project HOPE personnel (doctors, nurses, etc.), many of the pharmacy staff, as well as a variety of other doctors and nurses. We were fortunate to have the time, help, advice, and input from Captain (Dr.) Martin, an infectious and tropical disease specialist. The reviews and reception of the presentation were positive. We covered mostly the lesser-known parasites and those endemic to the area. We also included a case from the local MEDCAP site with pictures of Leishmaniasis. The presentation overall was particularly difficult, as we were putting the finishing touches on it without the assistance of the Internet.

Last night Project HOPE volunteered to help on the mess deck in the galley or scullery. I was in the scullery receiving trays. It is hot, wet, and dirty with uneaten food, but very fun! I imagine it would wear thin for those doing it from 0400-2000 everyday; but for me it was a race against the incoming line. There was also music, handmade signs, cowboy hats and a super soaker.

This morning has also been eventful. The ship is receiving replenishment from the USNS Lewis and Clark. This is one of the most skillful, highly engineered, and completely awesome operations I have seen thus far. The fuel line is strung between the two ships, as they continue to move at what I am told is 5-7 knots. The ships maintain ~200 meters in between and continue in perfect parallel. Pallets are delivered via line between the ships, and also transported via helo. The picture below shows the help ops, fuel line, and direct line delivering pallets across the ships.

Getting closer to 'shipping' out!

2011-07-22T21:33:00.002-04:00

It's been a while since I've posted, due to having few updates.
I'm glad to see my classmates, Andy & Andrea, who shipped out to Southeast Asia have returned safely and have great blogs about their trips!
So far in Cameroon things are going good. Project HOPE has gotten volunteers on the ground and working in the hospital. There are always logistical issues with missions such as this, but things are progressing positively. I'm very excited to arrive and 'get my hands dirty'. It looks like I'm a few immunizations short of my early September trip.

Next update will be closer to fly date.

*Make sure to follow our group, Alisa & Emily, who have recently gone to Latin America!

Pohnpei, FSM

2011-07-21T18:11:00.007-04:00

Well, all good things must come to an end, but we saved the best for last. Pohnpei, of the Federated States of Micronesia (FSM) was our final stop. The island, a lush, tropical garden situated in the Pacific about 500 miles north of the equator and a few thousand miles west of Hawaii, where it rains on average 17.5” every month, was a gorgeous location for our final mission with Project HOPE. Needless to say it rained regularly, sometimes more than four times a day, but between each quickly moving rain shower, the sun would shine and keep things nice and toasty-warm.

This weather made for interesting transport to and from the ship on the LCU (Landing Craft Utility), which has no roof or covering, so we were always praying that we would miss the rain, unfortunately it didn’t always work out how we wanted. We did get to watch a bunch of gorgeous sunrises and sunsets though. So, there were more than a few days, where if you didn’t soak your clothes sweating in the heat, you were rained on and soaked anyway.

The locals were used to the rain and heat of course, and again like in Timor Leste, despite the weather thousands of people made their way from all over the island to visit our clinics. The first week, I worked at Nanpei High School, a complex where for the first time our pharmacy was set up inside a building, and occasionally we were blessed with electricity and ceiling fans. During the second week, I was at Pohnpei hospital, where we worked alongside the Micronesian pharmacists and techs. They were great, and went out of their way to serve as translators for us, which was reassuring in that they already had some experience and training in counseling patients.

The people in general were very friendly and grateful, and many of them spoke English, which made all our jobs a little easier in that we didn’t have to rely on the interpreters as much as in Timor. The main health issues I saw were musculoskeletal problems, and so the pharmacy dispensed a lot of ibuprofen and acetaminophen. Apart from treating back and knee pain, we sent out a lot of de-worming regimens, which made up a good deal of the rest of the prescriptions. I suppose that was a good sign, but with a diet mostly consisting of fresh fish, fruit and vegetables, it is not hard to see why they were a generally healthy people.

After the clinics work was complete, the ship’s schedule changed and had to head back to San Diego a day early. As this was the last part of my rotation, quite a few people left the ship for good a day early to fly out of Pohnpei and head back home. But because our planed flights and accommodations didn’t coincide with this recent change of schedule, we were provided with other lodging. The lodging came as a surprise to the ten of us departing from Pohnpei though, as we were put up by the U.S. Ambassador and his wife at their residence. They fed us dinner with vegetables from their own garden, set up the rooms for us to sleep in, made us breakfast, and even drove us around for some souvenir shopping. It was quite an experience, and was a very special cap on the end of our time with Project HOPE. After a few more days on the island and after catching a tour to visit some waterfalls, some ancient ruins and swimming with manta rays, I did a bit of unwinding from, and finally boarded the plane and enjoyed a wonderful 33 hours of travel before arriving back at home in Virginia.

It is amazing how quickly the trip has come and gone, but it is an experience I will always remember. The wonderful people I was privileged to work with, all the people helped, the different and interesting cultures I interacted with, and the time working and living with the Navy are all irreplaceable experiences that will travel with me wherever I go. It was such a great time and I recommend it to anyone. I especially want to thank Project HOPE and Shenandoah University, but to everyone who made this possible, I want to thank you so very much.

Andy

Timor Leste

2011-07-15T08:14:00.018-04:00

Bon Dia!

That means good morning in Tetun- the language of Timor Leste! It was an amazing experience that has taught me so much.

We had really long days with transfers off the ship as early as 0530 (or O-dark-thirty as we like to call it!) but they were well worth it. Riding on the LCU (the transfer ship that is inside the USS Cleveland) was awesome but a real try for patience on those early mornings sometimes.

You wait for the Cleveland to fill with 9 feet of water (doesn’t sound right I know but it works!) and then the LCU backs out. It was an AWESOME thing to see though, just a little time consuming. It was well worth it when you got to see the patients we helped and become part of the community.

In Timor Leste I worked at various MEDCAP sites distributing medications, got to run a 7K that got routed incorrectly and turned into a 13K, and went to a COMSERV to paint a school that was built by a pervious mission, unload donations for the school and play with the school children.

I marked dosing cups, syringes, and medication vials with a Sharpie to show dosing, I would give all the children their first doses of azithromycin in order to make it easier on the parents for the remaining days (even though it sometimes induced tears) and I would simplify the directions as best I could. For other types of meds like inhalers and creams “show-and tell” worked great. I know it’s not the biggest of things, but any little bit that I could help them understand better made me feel great!Each experience has helped me grow as not only a health care professional, but as a person as well. I’ve met some amazing health care staff and military personnel and become great friends with the people on the ship I otherwise would never have had the chance to meet!

The people of Timor were very kind. Even though there was a language barrier, if you just explained something to them and organized them in the lines through the MEDCAP sites, they soon got the program and followed suit. Being a part of this mission has taught me many things. I have learned I can take the lead on situations and can become very creative to try to simplify things for patients. Many of the people of Timor can’t read English so I started creating different things to help the patience with compliance.

The kids of Timor loved it when you took their pics and getting to see them- it even helped some of them stop crying after an unwanted check-up. I will miss seeing their faces change as they see the pics and the curiosity in their eyes as they approached the pharmacy tent. At each site we say about 600-1200 patients and completed a plethora of scripts, but to me the satisfaction wasn’t in the numbers of patients we saw or scripts we filled; it was in knowing that maybe with my help I made at least one persons day a little better.

Welcome to El Salvador!

2011-07-13T19:25:00.004-04:00

We arrived without issue a few days ago to the El Salvador airport outside of the capital city, San Salvador. We decided to come a few days early to see a little bit of a new country and experience a different culture. Yesterday we visited the National Anthropology Museum as well as the Museum of Modern Art.

We have found the food to be excellent and the people to be extremely gracious and helpful. We have been generally able to communicate with our limited Spanish and their limited English. Hotel staff speak fairly fluent English; however, this is not the case in the general population.

This morning we were able to meet our preceptor, Dr. Earl Rogers, for breakfast and discuss our work to come. He encouraged us to see the country and enjoy a day before beginning some long and hard, yet, rewarding work.

Later, we took a taxi ride with driver, Romeo, to El Boquerón (literal translation to “Wide Mouth”) a volcano and national park. It was approximately a 40-minute drive from the city ending with a steep climb to the rim of the crater. The park was lush and beautiful with flowers and vegetation. We saw hummingbirds and butterflies on our trek to the top.

We found the crater surprisingly symmetric, steep, and preserved. Romeo informed us that the last eruption was in 1917, and although the country boasts 12 volcanoes only two remain active.

After the exciting stop at the volcano, Romeo drove us to Joya de Cerén, a recently discovered (1970’s) anthropological site exemplifying Mesoamerican culture and life around the 6^th century. It was buried by volcanic ash and rock, but rediscovered in the 1970’s by a bulldozing project! Today the World Heritage Convention through the United Nations Educational, Scientific, and Cultural Organization protects this site. The intricacy of the construction and the seemingly advanced techniques and artifacts were fascinating.

Although we saw both interesting as well as beautiful sites today, our travels also exposed us to the great poverty that this nation experiences. Some of the most unsettling or difficult visions were of starving animals (dogs, cows, horses), dilapidated and unsanitary living conditions, as well as many people walking, sitting, and living just on the road-side on the way up to the volcano. Homes are primarily made out of scraps of metal, plastic, and wood. We were ultimately left feeling although the country is full of beauty and rich history, it is clear why we are here to help, and there are many challenges this population faces for the future.

Timor Leste

2011-06-28T06:42:00.006-04:00

The days are flying by! We set sail from Timor after I participated in what I felt like two very productive, three-day clinics (A.K.A. MEDCAP #1 & 2). Well, I only worked one day at MEDCAP #2, but we saw almost six hundred people in half a day, so it felt like I served the three days. We had to stop seeing patients and start tearing down all of the tents and packing up at noon that last day to allow everything time for transport back to the ship for the long sail to Micronesia.
Of the thirty thousand or so patients seen so far by Pacific Partnership 2011 (the greater mission that Project HOPE is a part of), I’ve heard the Timor sites saw somewhere between five and ten thousand patients! And working on these sites is not the air conditioned, padded floor, community pharmacy or clinic of back home in the States. I saw the sun come up every morning, and we didn’t make it back to the ship until well after dark most nights. We work under a tent or canopy, with a few tables set on a dirt floor to hold the limited medications we have give. It is hot, sweaty, dusty, and all around uncomfortable work. But it is was a great experience etched forever into my mind, one I could never forget, nor would I trade it for anything.

The people of Timor were gracious, our interpreters were amazing, caring people, and all of the U.S. and partner-nations we worked with made the whole operation very satisfying. I hope things continue as such, and that our efforts made Timorese lives better.

Now, back on ship, we will prepare as best we can for our next set of clinics in the Federated States of Micronesia, specifically on the islands of Chuuk, Yap, Kosrae and Pohnpei. It will take us about a week of sailing to reach those islands, so we will have plenty of preparation time it seems. Ship life is still slow, and relaxing, but my fellow Project HOPE’ers and I are making the most of it. We get to spend a lot of time talking with Navy and partner-nation health professionals, and we get to learn more and more about the amazing sacrifices our military and others make serving around the world. We also are getting to see some amazing feats of United States Navy logistics in their RAS OPS (Resupply At Sea Operations). We watched as a Navy helicopter picked up pallet after pallet from the resupply ship, carried them over to our ship’s flight deck, and dropped them off, while never touching down once. Then, the resupply ship pulled alongside ours, and the two leviathans were attached with lines so that a zip-line of sorts could be strung up and used to transfer goods, which would fuel the ship, feed its personnel, and support all of the missions to come. It was amazing! Now that’s logistics. I heard from a Navy officer, during the operation that the ability to perform a RAS set us apart during World War II, and helped us win the Pacific campaign. If you watched the skillfully orchestrated operation I did, you would see why, in this single and small, yet incredibly complex piece of Navy life, we have the best military in the world.

Later today, I’m off to get a tour of the helicopters, the ship’s bridge (command center), and possibly later this week we’ll make it down to engineering to see what drives this great steel beast. It’s hard to believe that we are already in the second half of the mission, yet there is still so much left to do. Until next time…

Land Ho!

2011-06-15T23:41:00.007-04:00

Well, we did it. We traveled halfway around the world, boarded our ship, and figured out how to find our beds, the showers, and food - the necessities. Now, after only a little more than a day's sail, we are anchored off the coast of Timor Leste, where the first of our medical missions on this rotation will take place.
According to the schedule, I'll get to work at two different sites on the island in the next week or so, both of which will be around the capital of Dili. If it works out, I might also get to run in the marathon race (well, I'll run 7K, while others run the full marathon), which is a piece of the partner-building mission here in Timor. Plans change daily around here, so I can just do what they ask me, and wait for the next "brief" to find out what is new.

Ship life is great though, apart from being away from my family. Eating, sleeping, exercising and reading compose most of my day. Last night was special though, as we celebrated the 113th Hospital Corpsman's birthday, and suprisingly enough we have US Army on board, and so it was a dual celebration of the Army's 236th birthday as well. There was a really touching ceremony commemorating those who have served before, all long with all of the niceties such as cake, a juice-like drink, and some fun and dancing.

Another part of ship-life is the struggle for communication. So, whenever the internet or phones are working I try and contact my family back home, but neither are very reliable. Today, the Navy is busy with the current operations, which allows us civilians band-width enough to get some things done. After tomorrow, life should get quite a bit busier (and hotter) as we hit the shore and get to work. Until then...adieu

All Aboard the USS Cleveland!

2011-06-14T00:04:00.006-04:00

It’s official! We’re aboard the USS Cleveland, all checked in to our “racks” (beds) in our berthing units (rooms) and briefed and ready to go! Our first few days were adjusting and getting used to the Navy ship life. To get around the ship you have to go through quite a few narrow halls and be able to move through the different holes and ladders. Balancing and maneuvering through everything is a task in itself- then you have to actually figure out where you’re going. It’s not too difficult to figure your way around the ship since it’s a little smaller than some of the Navy hospital ships, but the trick is to remember which level or deck you need to be on. Everyone is really nice and will not only direct you where to go, but will also escort you there on the way. Every morning we muster (meet) on the flight deck at 0700 to delve out the days plans and answer any questions anyone may have. It’s VERY windy out there in the morning, but it’s nice to see the sunrise off the ship deck. So far there hasn’t been much to do since the crew pre-packed and prepped everything prior to docking in Australia so they’ve all told us to just familiarize ourselves with the ship and become accustomed to the Navy life. I’m in one of the top racks in my berthing area so I have to learn to climb a little more gracefully than normal in and out of bed since there aren’t ladders and I don’t want to squash the people below me! Everyone has been really nice about it though and even the seniors understand the difficulty of getting in and out of the 3rd rack. Showers are very quick and sometimes a little chilly- there was no hot water the other morning, but at least that makes it easier to take a fast shower! We get three hot meals a day and get to enjoy some down time to read, exercise in the gym, or socialize with the crews on board. There are people from the Navy, Marines, Army, Project HOPE, and other volunteers to socialize with and each person has their stories from home/ life on the ship. I felt a tad lost for the first day, but realized if I just got over being afraid to ask questions and start conversations, the people on the ship are more than happy to help out. We got a nice tour of the ship and got to see the LCH that will take us to shore on our MEDCAPS. It’s in the well deck (the part that is even with the ocean) of the ship where after people are aboard the compartment will fill with 9ft of water and the back will open up to let the boat out into the ocean. I’ve heard that after the first few times on the LCH the excitement wears off, but as for now I’m really looking forward to venturing out! My first MEDCAP is tentatively scheduled for June 22nd , but I may also have a chance to go on shore to run a 5K or volunteer medical services for a marathon on the 18th of June in Timor Leste (our next stop). We’ll find out soon if we’re allowed to run or not, but either way we’ll get to go ashore and help. When we go on shore we have to muster at 0430 and be on the LCH by 0600, which is going to be an EARLY day, but I’m down and ready for it! We’re supposed to get underway today at 1530 and head out to the open sea. We get to see the ship off from the upper deck, which is really exciting for us civilians that have never experienced it before! I’m so excited to get this journey started to help the people of Timor! I hope you enjoy my journey so far and the bit of pics I can get to upload J More medically pertinent stuff to come soon! YAY! G’Day Mates!

Good Day Mate!

2011-06-04T21:14:00.004-04:00

HELLO from Australia! Tomorrow is our final leg of our journey to head up to Darwin from Sydney to get ready to board the ship! I'm really excited to see yet another part of the world I've never been to! After 21 hours on a plane I'm really glad Andy and I decided to spend a few days in Sydney before another 6 hours of flying, although the movie selection was pretty good I'm not sure how much more sitting I could handle. We decided to stay in Bondi Beach to get in some scenery and experiences. We walked the coastal walk, met some people from all over the world, and got to see some amazing views! Since we've been staying in hostels I'm hoping this will somewhat prepare me for the ship life I'm about to lead for the next 5 weeks. Although the "racks" we're gonna stay in will be different then the bunks we're in now, at least I'm getting used to having to crawl and climb to get in and out of bed and share spaces with people I've just met. It's tough to get used to the routine of living out of a suitcase and sharing bathrooms and living spaces with strangers from all over the world, but I'm starting to like it! Everyone has their stories from where they've traveled to and where they came from. In just a couple of days of met people from Italy, Holland, Britain, France, and Brazil. I can't wait to see what the rest of the trip has in store for me. I'll send another shout out when I get to the ship and have more interesting things to blog about! I'm off to explore more of Australia!!

Project HOPE in Cameroon, Africa!

2011-04-27T10:22:00.003-04:00

Hello! Welcome to my section of the Project HOPE blog. I will be traveling later than the other Project HOPE students, but I am already very excited! I am so grateful for the opportunity to be the first Pharm-D/MBA student to do a rotation with Project HOPE!

Last week I had the opportunity to attend the 6th Annual Investment Forum (Strengthening Cameroon's Economic Growth Agenda) in Bethesda, MD. Matt Peterson was due to present the Project HOPE initiative as part of the panel discussion. He did a wonderful job giving a summary of what Project HOPE expects to accomplish in conjunction with Maria Rosa Nsisim Medical and Surgical Foundation (MRNMSF). The forum was a 3 day event, with our presentation on the 2nd day. There were about 15 business professionals and representatives attending the forum, and Mr. Peterson's presentation sparked a lively discussion.

This week I have met with individuals to get a low-down of what to expect in Cameroon and I received my iPad. There is still a lot to do before the trip.

Stay tuned for future blog posts!

Here we go again! Welcome to Year 3 of Project Hope and SU Pharmacy!

2011-04-12T11:20:00.003-04:00

Welcome back to the Shenandoah University School of Pharmacy Rx Project HOPE blog! We're very excited to be sending FIVE students this year on rotations with Project HOPE. Two of our students will be part of the Pacific Partnership 2011 and two will participate in the Continuing Promise 2011. For the first time this year, we will also be sending a student to complete a PharmD/MBA rotation as part of Project HOPE.

As part of the Pacific Partnership 2011, fourth year pharmacy students, Andrea Tanzella and Andrew Siler will join the USS Cleveland from June 10th to July 17th, along with pharmacist preceptor, Lance Satern. Andrea and Andy's rotation will include Timor Leste and Micronesia.

As part of the Continuing Promise 2011, fourth year pharmacy students, Emily Kirchner and Alisa McGehee will join the USNS Comfort from July 14th to August 12th, along with pharmacist preceptor, Earl Rogers. Emily and Alisa's rotation will include El Salvador and Costa Rica.

The first PharmD/MBA advanced pharmacy practice experience in conjunction with Project HOPE will take place in Cameroon, Africa. Fourth year pharmacy student, Kamran Saljuki, will be in Cameroon from September through October assisting with managing pharmacy services.

Please visit the blog often for updates on our students and to read what they are experiencing during their rotation. Also, stay tuned for video-blogs of their experiences!

The Spice Islands

2010-07-24T10:17:00.001-04:00

This has been a pretty eventful week. Last Sunday we were surprised to learn that we would all have one day of liberty and get to tour the island of Ternate. My group went on Monday. The two islands we are docked near, Ternate and Tidore, are known as the “Spice Islands.” People were sorting cloves and nutmeg along the side of the street. Our tour bus took us to several forts built by the Dutch, Spanish, and Portuguese. Then we went to the Sultan’s Palace and ended at the local beach. Our tour guide told us that the island only gets like 10 tourists per year, so we were a big attraction on the island.

Tuesday, I got to go on my second MEDCAP to Tidore. It was a very busy day. I got to go with a pharmacist from the US Public Health Service, an Indonesian pharmacist, and we had several other translators. Whoever was hosting us was really nice and even brought everyone a morning snack, lunch, and an afternoon snack. Everytime I turned around, someone was bringing me some excellent homemade food, which is a definite change from the MRE’s/not eating that usually takes place.

The end of the week I had my first-ever night shifts. I got to make all the pre-op IV’s for the next day and we got all of the discharge medications ready for all the patients getting off the ship. It is a good thing that the ship is large and anchored, because I don’t know how well I would have done if is was smaller and rocking. I got used to sleeping during the day. Because there are no windows down in my berthing, I don’t really ever know what day or time it is. However, I do not think it matters how much I sleep during the day, I am always tired by 5am.

I am trying to get readjusted to working days again. We are underway for one day as we travel to Ambon and on the 27th I am going on a 7 day overnight mission. I am really excited! We will be sleeping on the Australian ships that Brian slept on, and I have heard nothing but good things. There is even a rumor of a helo ride, but we will have to see.

Selamat Pagi

2010-07-19T17:18:00.003-04:00

That means good morning. I'm pretty much fluent in Indonesian now. I'm sorry it has taken a while to post a blog. The internet on the ship is very slow, and that is if we are lucky enough to catch it when it is working. But anyway, I went on my first MEDCAP last week. It was a 3 day 4 night MEDCAP which I feel very lucky to have gotten. Our transportation was an Australian LCH (Landing Craft Heavy) to our site in Moritai about 2 hours from where the Mercy was anchored. The ship was similar to the ones the allied forces used on D-day to storm the beach. The front of the ship has a door that drops down so soldiers could run out onto the land. The Aussies were great hosts as they fed us well and provided a place for us to sleep.

We went to two different locations on the island of Moritai. The drive on the first day was about an hour and took us along the coast of the island. There were many people in the streets seemingly awaiting our arrival. They were very friendly and excited that we were there. Our team of about 40 people worked well together and served well over a 1,000 people during the three days we were there. The pharmacy was super busy, but luckily, we had three or four Indonesian interpreters to help counsel the patients. One or two of the interpreters were actually Indonesian pharmacists.

The second location was at a school only about 5 minutes from the pier. There were a lot of kids running around keeping us entertained. People mainly complained of aches and pains along with some stomach issues. There were some infections as well that we were able to treat. It was a great experience and I look forward to getting to go out again soon.

This week I am not scheduled for MEDCAPs, but I will be heading inland for some other activities. Tomorrow, I head out to play some basketball as part of a community socializing activity. It would be nice if it was indoors but I'm definitely not counting on it; so, it will be interesting to see how long I last in 100 degree heat index. The following day I get to go on a tour of the area which will take us to various landmarks and to a beach. So I should have some more stories to come.

MEDCAP in Tobelo

2010-07-17T08:51:00.002-04:00

Yesterday was my first MEDCAP! We went out to a town called Tobelo and set up in a school. The school was many small buildings with a large open common area in the middle. So, all day it was possible to see the people waiting and kids running around playing. I arrived around 7am, but my preceptor had been there since before 6am and everything was pretty much organized and ready to go. Patients started coming in around 7:30 and we worked all day. I am told that we served over 600 patients and filled over 800 prescriptions. We had lots of help. Besides John and myself, we had an Indonesian pharmacist, an Indonesian medical student working as a translator, and later three Indonesian doctors from the town came just to help out. At one point in the day we had 5-6 translators all counseling at once. I could see them teaching how to use an inhaler and all of the motions looked like the ones I would have made. I wish I could have done the counseling myself, but all of the translators did a really great job.

There were a ton of kids running around and playing all day. I was told by our translator that many of them have never seen a Caucasian person before, so every time I turned around, someone was taking my picture. Sometimes they would also ask me to be in the picture with them. I kind of felt like a celebrity by the end of the day! There are a lot of pictures of me looking very hot and sweaty floating around in Tobelo.

I also got to try my very first MRE (meal ready-to-eat). I had the marinara with meatballs, as I was told to stay away from the cheese omelet at all costs. It tasted like Spaghetti O’s, which is much better than I expected. Overall, it was a successful day and I am excited to go on my next MEDCAP next Tuesday. Today, I am back on MID shift, which is 10am to 10pm. I am looking into getting some pictures up soon. Lastly, I want to send out a special "Happy Birthday" to my husband, Forrest, who turned 30 today. There will be celebrating when I return.

Arriving in Tobelo

2010-07-12T20:16:00.004-04:00

I have been trying to post a blog entry for several days now, but the internet on the ship is not very reliable. It has been down for about three days now, so I am just going to continue to write and post whenever I get a chance.

Today we finally arrived at our first destination, Ternate. I got a tour of the ship’s bridge yesterday evening and got to see all of the navigation gear, the guy steering the ship, and the navigation maps, which gave me a better idea of where I am. I haven’t seen anything but blue water and the occasional distant island for about a week. Not that that is a bad thing.

While we have been underway, there have been many activities to keep everyone busy. Last Wednesday, we picked up 28 palettes of medication, which the entire pharmacy has been diligently sorting and pre-packing. By pre-packing, I mean counting out 30 or so pills and sticking them in a little bag to be handed out at the onshore clinics. About 15 people have been working on this task all day, every day, so you can imagine the amount of medication that we picked up. I received my work schedule yesterday and it looks like in the next 10 days that I will be going on two MEDCAPS (these are the onshore clinics). The first one is Friday. I will be going out with my preceptor, John, and I am very excited! Brian was just informed that he is leaving today for a 5 day overnight. I think he will be sleeping on an Australian ship docked about three hours away. Everyone on the ship is really excited to get started.

Brian and I gave a presentation on malaria yesterday. We focused on prophylaxis and treatment for non-medical personnel and why they should be taking their doxycycline. About 50 people showed up and I think it went pretty well.

I think the most interesting event, so far, has been the “Crossing the Line” ceremony. It is a tradition with all sailors when a ship crosses the equator. They have just started allowing civilians to participate. It involved making pirate shirts, performing in a talent show, and being woken up very early the next morning. There was a lot of PT (physical training) and I was very, very wet by the end. Before the ceremony I was considered a slimy pollywog, but now I am a trusty shellback! It was a lot of fun.

home sweet home

2010-07-08T13:24:00.001-04:00

After a nice stay in Singapore, Kris and I are safely back in the US! We disembarked from the Mercy the afternoon of Thursday July 1st and spent a few days visiting sights in Singapore. We were even able to meet up with Brian and Julie for a few days! I absolutely loved the city! The public transportation system was amazing, and we could take the metro or a bus everywhere we wanted to go. We also took a bus tour around the city to learn a little bit of history and culture from the country. Some of our favorite sights were Sentosa Island, the Singapore Zoo and Night Safari, and the Botanic Gardens. However, we had time to explore most of the city, and see almost all of the highlights! We were kind of sad to miss the 4th of July at home, but we ended up going to a big party on the US Navy Center at Sembawang. There was a fireworks show and the navy band played songs like God Bless America during it. Then the band provided entertainment for the rest of the night while everyone ate burgers and hotdogs. We were really glad to still be able to celebrate an American holiday while in a different country. We met a lot of amazing people in Singapore and we were very sad to leave. But we arrived at the airport on Tuesday in the middle of the night, and started our journey home at 5am Wednesday morning. It was the longest day ever, but we are finally back and excited to share our experience with everyone!

last week onboard...

2010-07-08T13:22:00.001-04:00

The past few days have gone by so quickly! So on Friday, I was part of the local MEDCAP team. It was about a 45 minute bus ride outside of town, but there were still a huge amount of people to treat. It was the only local site, so we had much more pharmacy staff than all of the other MEDCAPs that I had been to. There were 6 pharmacy technicians, one Mercy pharmacist, 2 Japanese pharmacists, and a handful of translators that were all helping to make the pharmacy run smoothly. This large staff made for a much more manageable day compared to all of the others. During our lunch break we were able to walk down the street to some local vendors who were selling rice, meat, and pastries. There was even a fried toucan at one of the stands! On Saturday I was on the AM shift in the pharmacy from 7am-7pm, but the pharmacist let me go to the OR in the morning to watch a surgery on a 4 year old boy. They did a right hernia repair and right hydrocele fenestration. It was a really short and uncomplicated surgery, but it was really neat to see a different side of medical practice. I thought that I may not be able to stomach a surgery, but I was surprised how calm and at ease I was in the OR. In the afternoon, I got a lot of practice in the IV room with some tips and guidance from a really talented technician. We also had some excitement in the afternoon with a code situation. It was awesome to see the pharmacy react in a very quick, efficient, and calm manner in this circumstance! At the end of my shift, I repacked the supplies for the last MEDCAP on Sunday. We packed a lot of extra supplies which was a good thing because we really needed them the next day. On Sunday, I got to go to the final MEDCAP of our mission in Cambodia. It was a really busy day and we saw and treated over 1600 patients. Even though we took extra supplies, we still ended up running out of a lot of medications. Sunday night it was nice to have the whole pharmacy team back together again. We had missed the 5 members who have been out on the fly-away MEDCAPs! We all hung out in the pharmacy and shared stories about our individual experiences in Cambodia. I really loved it here and I plan on coming back someday to see all of the sights that we did not get a chance to see. Some of the people onboard got the opportunity to take a day trip to Ankorwat, an ancient Buddhist temple that is one of the 7 wonders of the world. They said it was an incredible sight, so I would really love to see it. Also, I would like to visit the capital, Phnom Phen, because I have heard that it is a fantastic city to spend time in. So on Monday at 1500 we started underway to Singapore! It is a bitter sweet feeling for me because I have loved my time onboard so much that I do not want to leave. But it will be nice to go home and see everyone that I have been missing for the past 5 weeks. I do love being underway though! It is fun to go out on the deck with the sun shining and the wind in my hair. I am really going to miss that feeling. Actually, I’m going to miss a lot about being on the Mercy. This was a wonderfully rewarding experience both personally and professionally, and I will surely never forget it! (written June 27 -- the internet on the Mercy is really unreliable, so I had to post this when I got home)

Finally on the Mercy!

2010-07-06T02:41:00.004-04:00

Monday, June 5th 2010
I am finally on the USNS Mercy and we have set sail! I arrived in Singapore a day early and then found out that we were getting two days of liberty to go back into the city. This was really great because Brian and I got to meet up and spend two days with Kris and Renee. It was really great to hear all their stories and get lots of advice on how to live on the ship and what to expect. We returned to the ship on Sunday night and set sail this morning. It was exciting to watch the ship pull away from the pier. Later in the day, everyone in uniform “manned the rails,” meaning they literally lined all the railings, as we said goodbye and passed the Japanese ship that had been accompanying the Mercy. The Japanese ship did the same. So far it is a very smooth ride with minimal rocking, but I have been warned that it may not stay this way.

So far, life on the ship has been busy. There have been several orientation meetings with the Captains and Commadore, the safety crew, and with the Project Hope team. Were were suppose to have a Man Overboard drill and a Abandon ship drill, but they are postponed until tomorrow.

I have a few more meetings this evening, one of which is for anyone that is new to the berthing area. The berthing area is an interesting place. It is a large room that sleeps about 100 people way down in the belly of the ship. Like Renee and Kris before me, I have the top bunk. Bunks are three beds high. I was a little worried I might fall out overnight or step on someone below me as I was climbing, but so far so good. The ship is also divided into sections to protect from fire, flood, etc. This means that in order to go to different sections, I need to climb stairs, walk across the ship and go up or down. There are approximately 80 stairs between the berthing area and the mess hall, where we eat. Needless to say, I am getting plenty of exercise.

The plan for the ship is to stop in Jakarta on July 5th and pick up medications, but we will not be getting off the ship. Then we sail for a few more days until we arrive in our first location on July 13th. There will be some down time, but there are many educational briefs planned in the mean time and Steel Beach, which means a cook out on the hangar level. Once we reach Jakarta, there will be medications for us to prepare. Brian and I are also scheduled to give a presentation on malaria , so there should be plenty to keep us busy, even if we are not yet working in the pharmacy.

ALL ABOARD

2010-06-29T13:39:00.003-04:00

Well maybe not quite yet. Julie and I leave today for our across-the-seas journey. We'll fly from different airports to meet in Chicago where we will then take a 15 hour flight to Hong Kong. From there, we have a 3 hour delay before we head to Singapore (a 3 hour flight). We will be arriving around midnight on Wednesday which is around noon EST of the same day. We stay a few days in Singapore before we board the ship. After looking at the weather forecast, I am guessing it is the wet season in this area. Once on the ship, we will be sailing to 3 islands in the southeastern part of Indonesia. This ship is the same one that Renee and Kris were on, so we may cross paths with them along the way. The USNS Mercy is a 1,000 bed hospital and I am told there will be about 1,200 staff members on the ship during our rotation. The Mercy was the ship that aided the area of Banda Aceh after the tsunami in 2005, so its return is significant and meaningful in providing further care to the area of Indonesia. We are both very excited to be a part of Project Hope and begin this unique opportunity.

Liberty time!

2010-06-29T09:58:00.001-04:00

On Sunday night, I got back from the 5 day MEDCAP and went straight to the showers. We had been bathing with baby wipes for 5 days, so I’m sure you can imagine my urgency for a hot shower! That night I relaxed and caught up with the rest of the pharmacy staff who had been onboard the whole time I was gone. On Monday and Wednesday I was on duty in the pharmacy. These days are pretty relaxing because there is plenty of staff on duty, and not a great deal of work to do. I usually catch up on my laundry, assignments, and blog during this time. I put all of our leftover supplies from Ang Sophy back into the stock for the other MEDCAPs and helped the other techs out with their duties. The military will not allow us to have access to the computer system, so I can’t actually complete any orders, but I do help in any other ways that I can. I made a batch of cefazolin 1g bags in the IV room since that is the antibiotic most often prescribed for our surgery patients. It was good practice and we can store it in the refrigerator for 14 days, so that will cover the rest of the surgeries in Cambodia. The pharmacists also ask me to research clinical scenarios and come up with possible explanations and solutions to them. This is probably the most helpful thing they can do for me. I have learned so much by trying to figure things out on my own, presenting my answers, and waiting to be corrected and instructed on key points that I missed. A few of the pharmacists are very recent graduates, so they have a lot of knowledge to share with me about clinical rotations and boards. One of them asks me a random board-type question every day, so I have started a list to help me study in the spring. Some of the other pharmacists have many years of experience under their belts and they are eager to teach me lessons that they have learned in their very respectable careers. Also, the technicians have been giving me advice and helpful hints in the IV room. I am really learning a lot from the entire pharmacy staff, and everyone is very knowledgeable and helpful in every situation that I have encountered. On Tuesday and Thursday I actually had liberty days! This means that I had the day off and I could take the liberty boat to the pier and do some sightseeing in the town of Sihanoukville. These days were exciting cultural adventures! When we arrived at the pier, we were bombarded with Cambodian men who all wanted to be our taxi driver for the day. They drove “tuk tuks,” which are large 4-seater carts that are pulled by a moped. They have a roof and side panels that can be put down if it is raining, or rolled up in nice weather. Most of the drivers spoke enough English so they could figure out where you wanted to go, but few spoke well enough to carry on a conversation. The town is a pretty nice place and we got to see a lot of different sights, plus the tuk tuk ride itself was a really cool experience. We went to a huge market, the beach, several restaurants, an area with wild monkeys, and an exhibit with a variety of reptiles and birds. Of course, my favorite place was the beach. It had such an awesome atmosphere, and it was unlike any beach I had ever been to. There were a hundred restaurants along the water and they all had reclining lounge beds and deep circular basket chairs with big round cushions lining them. The chairs were set out in front of the restaurant and they were so close to the ocean that when a big wave came the water would touch the first row of chairs. Each restaurant had its own BBQ buffet where they grilled up almost every kind of meat or seafood that you can imagine, as well as a full menu of traditional Cambodian food. And unlike restaurants in the states, you can order breakfast all day long! I loved this because the breakfast food here is so unique, and it usually isn’t something that we would consider breakfast anyways. The pharmacist with me tried some grilled squid, and someone else had fried shrimp which they said was amazing. The seafood is delicious because it is usually cooked the same day that it is caught. The market was also a really neat place. It was kind of like Walmart, except that each department was owned by a different family. It literally had everything you could ever need and they accepted American dollars. In fact, I think they would rather take American dollars over Riel. We spent a lot of time here because there was so much to see! There was an entire food section where the women sold fresh everything! There were all sorts of fruits, vegetables, meat, bread, rice, noodles, and many other things that were unrecognizable. I saw one woman cutting up the guts of some kind of animal and selling it at her stand. There were also sections for clothes, electronics, and souvenirs. It is crazy how much more they tried to charge us for a product just because we are westerners. Although the prices are still so low that it doesn’t matter much. A dollar means so much to them and so little to me, so I was ok with paying a little bit extra. The tuk tuk also took us to area where we could feed monkeys! It was a small strip of woods with a fence around it, not that a fence can stop them. We fed bananas and peanuts to almost a dozen monkeys! I was surprised how much they love peanuts! They wouldn’t even eat the bananas when they knew that someone else had peanuts in their hand. Two of the monkeys even had babies clinging to them! It was so cute! Then we went to the Snake House, which is a nice restaurant that also had exhibits of very diverse reptiles and birds. There were snakes, iguanas, lizards, crocodiles, and many colorful birds! We had a good time looking at all of the exotic animals and taking pictures of them. My liberty time was very fun, but I was glad to be helping with the mission again on Friday. I had a long day at the local MEDCAP in the outskirts of Sihanoukville, and I will write about it soon!

Pictures!

2010-06-25T08:16:00.004-04:00

My home for the past 4 weeks! The USNS Mercy.

My pharmacy family with the Admiral! I'm gonna miss them!

Some kids I played soccer with after one of the MEDCAPs in Vietnam! They were so fun!

Just got off the helo to my overnight mission! The ride was amazing!

Just after we arrived at Ang Sophy school.

My tent cot! not very comfortable, but it kept the mosquitoes out!

A MEDCAP pharmacy is just a little different from the ones at home.

I gave stuffed animals to two sisters from Ang Sophy school.

more from Ang Sophy school

2010-06-25T07:52:00.002-04:00

During the days at the MEDCAP we were working nonstop! From 8am when the first patient showed up at the pharmacy until our lunch break around 12:30, I didn’t pause once to look at my watch or even take a sip of water. During lunch, I scarfed down the edible portions of my MRE and chugged about 2 liters of water before getting to work in the pharmacy restocking the supplies that we had used all morning. Then at 1pm it was back to the grind until we finally finished the last patient of the day around 5:30pm. And by that time we only had an hour of daylight left. Our team was designed to see about 500 patients per 8 hour day, which would be 1,750 for the whole MEDCAP. But we kept pushing the envelope and tried to help as many people as we possibly could, and by the time we left we had seen 2,949 patients. The pharmacy had a team of 3 people and 2 translators, and we filled 5,809 prescriptions in 3 and a half days. Our translators and students were very helpful and we also had a preventative medicine tech helping us out. The other pharmacy tech and I would fill the prescriptions, then the pharmacist would check each one and tell the translators any special instructions, and then the translators would dispense the medication to the patient and counsel them in Khmer. Our system worked well and flowed smoothly all day, but it was nonstop work and the line of patients seemed to never end. We joked that we were a human conveyer belt. We worked really hard and poured sweat all day in the 100°+ weather. At the end of the day we had another delightful MRE for dinner and usually walked down the street to the local cafes. Each café is basically a house that has a large open area in front of it with tables and a tv. The family that lives there runs the business, and when customers show up, they bring out the chairs. Most of the time they serve food for breakfast, and the rest of the day they only have beverages. Cambodian people love to drink hot tea and iced coffee all throughout the day, but at night it is hard to find food for sale because each family eats together. We got to know some of the families who own the restaurants over the 5 days that we were there. Most of them didn’t speak English, but we usually had a student with us so we could have some limited conversations. For the most part, this is how every day went at the Ang Sophy school MEDCAP. The days kind of ran together since we were constantly occupied. However, on Saturday the Commodore and her team took a helo to visit the MEDCAP and see how things were going. She was very proud of the work that we were doing, and shook hands with each member of the pharmacy team with a coin in her hand that she transferred to ours. Apparently, it is a big deal to be presented with a coin in the military, and a lot of the sailors have showcases for their collections of coins. The Commodore also brought 2 huge bins of extra supplies for the pharmacy. We had been running out of medicine since the MEDCAP was helping many more people than we had originally expected. If we had not gotten the resupply we would have run out of almost every medication. Also on Saturday, one of the students from Ang Sophy had his mom make lunch for us! We all chipped in a few dollars, and she made white rice, chicken curry with coconut milk, marinated pork jerky (my favorite!), shrimp, bread, fried plantains, and watermelon! It was a delicious break from the MREs and it was nice to get a taste of some real Cambodian food. Then around 6:00 after the MEDCAP closed for the day, one of the translators took us to a Buddhist Pagoda. I was expecting a temple that looked like all of the rest that I had seen in southeast Asia, but this one was much more exciting! It was a temple that was build inside of a huge cave! When we parked, about 20 children eagerly came running to the vans to give us a tour. There were natural rock formations that were in the shape of animals and other objects, and statues of Buddha interspersed throughout the caves. The children were so excited to point out all of the rock formations and tell us what they were called in English, but when we tried to have a conversation with them they didn’t know many other English words. It was a mini business for them because they all expected a tip or gift at the end. They were adorable though, so everyone gave them something. I think that temple was one of the coolest sites that I have seen during my whole trip so far! On Sunday, we left Ang Sophy and came back to the Mercy, and I have never been so excited to take a shower in my entire life! Camping was a lot of fun, but we were all excited to finally get out of the heat and the mosquitoes. On Monday and Wednesday I have duty in the Mercy pharmacy and on Tuesday and Thursday I have liberty in Sihanoukville. And on Friday I will be at another local MEDCAP. I still have many adventures to share, so hopefully the internet will hold out! Thanks for reading!

5-day overnight

2010-06-25T07:45:00.003-04:00

Whewww! What an amazing experience! Cambodia is a beautiful country with even more beautiful people! The helicopter ride was awesome! We left the morning of Wednesday June 16th by helicopter and stayed along the coast for a while and then made our way inland. The landscape started off really flat with sand, grass, and some palm trees, but suddenly there were mountainous rock formations that looked like they didn’t belong there. The land was totally flat, and then the rock faces came out of nowhere like someone just dropped them out of the sky! The rocks were covered with moss and vines at first and the farther central we travelled the more they were covered with lush green jungle. It really was a gorgeous sight to see from the air. We arrived at Ang Sophy school by 11am and the students were taking final exams, but they ran outside whenever they heard the helicopters coming and the whole community gathered around to watch us land. We quickly unloaded our gear and had some time to walk around the school grounds and talk to a few students before the rest of our team came in the next two helos. We were not scheduled to see patients on this day, so we mostly just set up the MEDCAP and did “COMREL” activities, or community relations. I traded in one American dollar and got 4,000 Riel (sp?). And for 100 Riels, or 2.5 cents, we could buy food at the vendors on the side of the road. It is crazy how far a dollar can get you in Cambodia! Take that dollar menu! When our entire team was safely on the ground, we had a meeting and planned out the next 4 days. For the rest of the afternoon, we explored the community and got to know some of the people we would be working with. We went to a Buddhist pagoda that was right next to the school, and ended up having tea with a monk. One of the students came with us and translated our conversation with the monk. He was really happy to spend time with us, and it was an interesting cultural experience. Then we met a member of the Peace Corps who teaches English at Ang Sophy school. He taught us how to say some basic phrases in Khmer (said “kmy”), and introduced us to all of his students. These kids were awesome! They were so eager to talk to Americans, and they really wanted to practice their language skills and learn more. We talked one-on-one to a lot of the students for a few hours, and their English was really good! The Khmer language is fascinating and very difficult to write and speak. To me, it just looks like a bunch of squiggly symbols in a row, and I have no idea how they write it so beautifully. I learned how to say hello, goodbye, and thank you, and that is the extent of my Khmer knowledge. Later, we played basketball and soccer with some Cambodian kids for the rest of the evening. Sports are a fun way to socialize and get to know someone when there is a huge language barrier in the way. You can create a friendship and a bond without ever having to say a word, so it was a good icebreaker to begin the mission. There is no daylight savings time in Cambodia, so it got dark around 6:30 and we sat around and ate our wonderful dinner of MREs. Every day, there were 3 MREs allotted to each of us, so I will be happy if I never see one of those things again. The MEDCAP team set up sleeping quarters in two of the classrooms, but it was really crowded with so many people in one room. So, the pharmacy team got permission to sleep in the pharmacy classroom so that we could keep an eye on the medicine throughout the night. So we set up the pharmacy supplies and our “tent cots”, and this would be our home for the next 5 days. The cots each had a tent attached to the top of it with mosquito netting in the windows to keep out the dangerous Malaria vectors. That night we played cards and watched a concert that was taking place on the school grounds. It was a pretty relaxing night to prepare for the busy days that were ahead of us. We accepted patients for 8 hours on Thursday, Friday, Saturday, and 4 hours on Sunday. As a 32 person MEDCAP team, we treated over 3,000 patients and filled almost 6,000 prescriptions. Overall, it was a huge success and we helped a lot of people! I will be posting more stories from each day soon! (Sorry about the postings being a few days late. The internet rarely works on the ship for obvious reasons...)

Adventure time!

2010-06-20T09:51:00.001-04:00

The Malaria presentation went well! I think that we provided a lot of important information to the crew onboard. A lot of the sailors were confused about the Malaria prophylaxis that they were being told to take, and we had the opportunity to answer their questions and clear a lot of things up. So now hopefully everyone on board is taking their doxycycline correctly and we will not have to worry about any Malaria incidents. We got some really good feedback from the pharmacy staff and some of the doctors onboard to help us in our future presentations. Also, a few hours after our presentation, a message went out to the whole ship containing some of the important information that we had gone over. It felt good to be able to make a positive impact here on the ship, since most of my personal impact has been on shore at the MEDCAPs. For the past two days we prepped the pharmacy, organized all of the medications that are going out to the MEDCAPs, and printed labels in Khmer (the main language in Cambodia). It was a good deal of work because three of the MEDCAPs are “RONs”, which means Remain Over Night, so we had to prepare everything ahead of time and box it up on pallets to be transported to the sites. We dropped anchor in the port of Sihanouk, Cambodia this morning so a lot of our supplies for the MEDCAPs have already been taken ashore. The three RONs are 5, 7, and 11 days long, and they are very far inland (one of them is over 300 miles), so it would be impossible to return to the ship every day. And guess what?! I was chosen to go on one of these missions! As if I hadn’t already been having the experience of a lifetime, now I get to go on an even more exciting adventure! For the next five days I will be at a MEDCAP in central Cambodia. Tomorrow morning we will be flying by helicopter, or “helo,” to a high school that is the site of the MEDCAP. We will be camping overnight on cots with mosquito netting until June 21st when we will return to the Mercy. I am really excited!! We are not really sure what the conditions are going to be like, but we were told that it is a newly built school so hopefully it won’t be too primitive. School is in session right now, so there will be classes going on in some of the other buildings and we think that they will have electricity; however they will likely turn it off in the afternoon when the school day is over. Also, our OIC (Officer in Charge) for this mission informed us that there is a member of the Peace Corps who has been living here and teaching English at the school for a few years. He is really excited about us coming and he wants to help translate for us, which will be a huge help! He hopes that his students will be able to help as well, to practice their English and gain some experience with translating. Hopefully they will be able to teach us some words and phrases in Khmer too! I am so excited for this mission! And it will be my first helo ride!! Apparently the ride is about 45 minutes, and hopefully I will have a good view out the window so I will be able to see some of the landscape and jungle! I’m sure it is a gorgeous country and I can’t wait to see it, but we will also have to be very careful while we are there. Throughout Cambodia there are still some landmines in remote areas. Don’t worry though, we aren’t going to stray too far from the school, which is obviously a safe area. Also, I will be applying DEET insect repellant several times a day to keep away the mosquitoes, and taking my doxycycline religiously. I’m not trying to bring home any tropical diseases with me! My helo ride takes off at 9am tomorrow morning, and we should be at our site and setting things up before 10, so hopefully we will be able to see some patients tomorrow afternoon. I am going to stay up late again to watch the Brazil vs. Korea World Cup game. I guess when soccer and sleep go head to head, it is clear which one wins out for me. Though, this whole time difference thing is truly a massive inconvenience. Oh well! So I will not be posting for a few days, but don’t worry, I promise I will be safe! And the next time you hear from me I’m sure I will have some great stories to tell! (written June 15)

Packing…

2010-06-19T02:10:00.002-04:00

I am getting REALLY EXCITED about my 7 day mission and trying to get all my stuff together for it. I just got the packing list and one of the items just made me laugh, so I thought I would share: Swimsuit (shower situation “unclear” - it might be some sort of trough that you stand in and pour water over your head)<-- haha, oh boy!!! Some of the other fun items on the list include: Baby wipes (in case there are no showers), Small denomination currency (we’re not going to the casino <-- their words not mine), Doxy and DEET (NOT a suggestion, but a necessity). The rumor flying around right now is that we are staying at an old UN peacekeeping site that is apparently some kind of large open base. This is going to be amazing! We will be flying into the central part of Cambodia and working in 2 small villages. My excitement has only been building since I found out that I would get to go on this mission. Only 3 pharmacy members were chosen to go: my preceptor Earl, a Navy tech, and me. Once Renee left I got even MORE excited, since the day she gets back is the day that I go! I am sure she will have some great experiences to share and so will I when I get back.

Vietnam to Cambodia

2010-06-18T04:55:00.003-04:00

MedCAP’s are AWESOME!!! You have to get up REALLY early for them but it is totally worth it! For my first MedCAP (which stands for Medical Civil Assistance Program) I was replacing a volunteer who lost her shore card (which is the card that the Vietnamese government gave each person on the Mercy, and you can’t get on or off the boat). I had to muster at 0510 and I was so excited I had a lot of trouble sleeping that night. We went out to a school in the city and there were TONS of people! Most MedCAP days are 13 to 15hrs and you can see anywhere from 600-1100 people a day (depending on where your site is located). Even the days that you aren’t on a MedCAP you stay pretty busy. Shifts in the boat pharmacy are about 12hrs and we work every day (no days off in Vietnam). Time here is FLYING by, and I am loving every minute of it :-D!!!
Since I am a little behind on my blog post, I will try and catch you guys up… in Vietnam we saw approximately 19,000 patients and handed out over 33,000 prescriptions (not to mention the hundreds of surgeries that were preformed on the ship)! It was a crazy few weeks. The trip to Cambodia took about 2 days and most of our time was spent getting the drugs ready for the first two “fly away” MedCAPs. One of the MedCAPs will be gone for 11 days (basically the whole time that we are in Cambodia). The other one will be out for 5 days (which I am sure Renee will be telling you all about when she gets back from it). I will be going on the last “fly away” and will be gone for 7 days. They are expecting us to see about 800 patients a day and we are just about done getting all the drugs packed up for the trip. I am VERY EXCITED about my first helicopter trip!!! I leave in 2 days, so I might not get to post again before I go, but when I get back I will be writing ALL ABOUT IT!!!

A day to relax!

2010-06-13T21:50:00.001-04:00

Sunday is usually a day to relax a little bit on the ship, so after we mustered at 7:30am we really had no other responsibilities in the pharmacy. We did have several meetings to attend with the Project HOPE crew though. We attended a brief on Cambodia, and then we were addressed by two important officers. First, the Commanding Officer of the hospital onboard Mercy spoke to us, then the Commodore of the Mercy itself. They just told us about their different roles on the ship and gave us an opportunity to ask questions. After these meetings, we went up to the flight deck to attend the frocking ceremony for the military personnel who have recently made rank. Three members of the pharmacy staff had were being promoted, and we wanted to be there to support them as well as see what a military ceremony was like. It was only about a half an hour long, and each person was honored and then pinned by one of their officers onboard. When the ceremony was over, we stayed on the flight deck and took some pictures with the whole pharmacy staff. It was such a nice day outside, so I stayed on the decks for a good bit of the afternoon just enjoying the sun and sea. We were watching flying fish that were jumping out of the water in front of the ship, and for at least a half an hour a group of about 30 dolphins followed alongside the Mercy. It was really nice to have a relaxing day after all of the work that we did in Vietnam. They had a picnic and an ice cream social in the mess decks which were also great times to socialize with our fellow Project HOPE volunteers and pharmacy staff. I also went to a zumba class which was really fun and a great workout! Overall today was a fun and relaxing day to get reenergized for the long days that we will have again in Cambodia. And tonight I am staying up late again to watch the World Cup game against Germany and Australia. Tomorrow morning we are presenting an informational lecture on Malaria along with the nursing students from California. They are concentrating on the causes, symptoms, and diagnosis. And Kris and I are presenting the prevention, prophylaxis, and treatment options. Our fellow Project HOPE volunteers and members of the pharmacy staff will be there, and hopefully some of the crew will come to learn more about the doxycycline prophylaxis that they will be taking for the next month and a half. Hopefully the presentation goes well! Wish us luck!

long days

2010-06-12T14:14:00.002-04:00

The past few days have been incredibly busy! I have gotten an average of about 4 hours of sleep each night, and somehow I am still alive! Haha! My night shift actually worked out pretty well. We mostly did pre-op iv medications for the next day. The military uses a computer system called CHCS, and we don’t have access to it yet, so I just watched to other night tech input all of the orders and learned the system from him. We mixed mostly cefazolin for the surgeries, and had a pretty slow night other than that. At midnight there were “midrats” served in the mess decks. “Midrats” are midnight rations that consist mostly of leftovers from dinner. We weren’t exactly excited to eat the same thing again, so we made peanut butter and jelly sandwiches instead. The rest of the night was relatively uneventful, but we had to stay in the pharmacy in case someone would need something stat. When I got off at 6:45am, I slept for a couple hours and then had to work again at 2pm until midnight. Somehow, that shift felt longer than the night shift. On Tuesday, I was at the MEDCAP at Phuoc Hoa so I had to muster at 5:00am and take the Bandaid to shore. On Wednesday, I had to prepack medicine on the pier. I was with one other pharmacy technician all day counting out meds and putting them in little ziplock bags to take to the MEDCAPs. The military and civilians who have liberty also have to stop by the pier and help us for about 30 minutes before they are allowed to take the bus into town. On Thursday, I was at the MEDCAP in Nhon Khan and when I got back onboard the Mercy I went to the closing reception for the Vietnam mission. There were a limited number of people invited, but I was one of the ones chosen to represent Project HOPE. I met up with some of the nursing students who are with Project HOPE too, and we went up to the flight deck for the reception. It was a really nice evening of mingling and meeting a lot of people. The commodore and the Japanese ambassador spoke and welcomed everyone. They served food and drinks, and then they cut the cake with a sword. It was a beautiful night and the Navy band was playing the entire time. Towards the end of the night everyone started to dance on the flight deck, and it was a really fun time. The band kept trying to call it and night and everyone wanted one more song, one more song, one more song. So we danced for a long time, and finally the party was over around 2300. The next morning, on Friday, I had to muster at 5am again to head to the pier and take a final inventory of all of the medications that we had left over. We spent the day counting everything that we didn’t use at the MEDCAPs in Vietnam and packaged it up to load back on the boat and take it to Cambodia. After our jobs are done for the day, we usually get a few hours of liberty while we are still on shore. We take the liberty bus to into town and get to spend a few hours walking around Qui Nhon and eating Vietnamese food. It is so interesting how to city comes alive after the sun goes down and it gets a little cooler outside! There are always so many people walking the streets and socializing at night. We have all had a lot of fun during this portion of the mission in Vietnam, but we have also had a lot of work to do. It seems like the pharmacy is always working so much harder and longer than the rest of the medical personnel on the Mercy. But maybe I’m just biased, haha. So today, we had to muster in the pharmacy at 7:30am. It was the first time that we had to stand in a military formation and stand at attention. Needless to say, I was clueless and probably stuck out like a sore thumb. Then we cleaned the pharmacy and restocked all of the medicine that had been at the pier. It has been another long day! Now I am waiting up until 1:30am for the World Cup match between USA and England. This game better be worth my lack of sleep! Come on USA!

Some pics of life so far...

2010-06-10T20:55:00.008-04:00

It's not everyday that we fly these two flags together!

This is Ken, one of the awesome pharmacist that came with the Japanese boat. We got to work with him and some of the other Japanese crew during the MedCAPs in the city.

MedCAP pharmacy = ready to go!!! :-D

Hello from Vietnam!!!

2010-06-10T20:42:00.002-04:00

Sorry this is so late getting out, but it is really hard to get internet on the ship. Our flights here were uneventful, but actually getting on the ship took a while. We actually met up with a Project Hope (PH) nurse in D.C. for our flight to South Korea. There was an even bigger group of PH people waiting to get their baggage from the plan in Hanoi. We all got our bags together and made our way out, but we were almost immediately stop by the wall of hot air that we hit leaving the airport. One of the volunteers near me said “just imagine… if it is this hot up here at 11 pm, how hot do you think it is going to be farther south in Quy Nhon?” I had to agree that the heat and humidity was daunting and knowing that it was even hotter and more humid where we were going was a little scary. A pleasant surprise for us when we got out of the airport was a very nice representative from PH that was there to help us get to the hotel. He gave us the choice of driving into Hanoi or staying at a “no-star” hotel near the airport. Since most of us had been awake for about 30hrs, we opted for the “no-star”. It had a bed… which was all I wanted at that moment but I never did get that air conditioner working. With only a couple hours sleep under my belt we headed off to the airport at 5:30 am. Once we got to Quy Nhon I was thoroughly exhausted, but we meet up with even more PH volunteers and found a nice little place to sit and get to know each other while we waited for the Navy transport to bring us to the boat. Among the group that we met up with were some nursing students and their preceptor from the University of San Diego. We had a nice time sitting there getting to know each other, and after a while a Navy representative came to fill us in on what was going on. Apparently the Vietnamese government wasn’t allowing anyone that did not come on the Mercy to board it, and they were having a little trouble getting our berthing (a navel term for area where you sleep) straight. That left us with a little dilemma… where to now? We ended up getting amazing rooms at a very nice hotel with some unexpected free time to enjoy the city of Quy Nhon. While at the hotel we met up with some very interesting people with UCSD (University of California – San Diego). They were a couple of dentist and a translator traveling from the U.S. and Canada. A big group of us decided to go out to lunch and experience some of the city. With the help of our translators, we had one of the most amazing meals!!! I felt like we just ordered the entire menu and shared it family style, and the presentation of it was so cool. One of the dishes was a fish (probably caught that morning) and the cut it in half and displayed the head up and the fins out which made it look like it was still swimming. The translator explained to us that in Vietnamese culture it was very bad luck to turn the fish over during any part of the meal, because it would turn the fisherman’s boat over. It was really cool to sit and share a meal with people from all over with such different lives and experiences in a cozy little restaurant by the sea. After a VERY restful night, we were able to leave for the ship in the late morning. It pretty much took us the entire rest of the day to get checked in and settled. Most of our group got the top “racks” or beds, which made for some very interesting climbing and a few choice words. Our first full day in the pharmacy on board the ship started bright and early the next morning. Renee had to report at 0645 but I got luck and did not have to muster until 0730. We didn’t do much the first day, but spent most of our time getting to know some of the people we would be working with and get comfortable with our new pharmacy for the next 5 weeks. One cool case that we got to see was a 17 year old male that underwent a cleft pallet repair. The surgery that he got wasn’t that uncommon for what the medical teams on the Mercy are doing right now, but what was interesting about him was his heart. Most of the medical staff on board showed up to listen to his heart murmur. The pharmacist we were working with that day took some time to bring us down to that ward and let us hear it for ourselves. It was REALLY COOL!!! We all heard the audio in class during school, but it was nothing like hearing it on a really patient. The next day Renee went out on a MedCap and I worked all day in the pharmacy on board. It was mostly uneventful but I did get to make a sterile transfer of some medication for an IV push on a baby and I got to deliver it to the ward the baby was on and see how she was doing after her surgery. Hopefully, I will have some more time soon to write about the MedCAP that I went on today!!! Until then, thanks for reading :-D

MEDCAPs

2010-06-06T19:21:00.002-04:00

Getting used to military life is a big adjustment. I have had to wake up between 4am and 5am for the past 3 days! I spent another two days at MEDCAP sites since the last post. When we work on MEDCAPs, we have to “muster,” or meet, at specified times that are usually around 5 or 5:30am. Then our transport boats (they are called Bandaid boats, hehe) leave a half an hour later and the ride to the pier is about a half an hour. There is a Japanese warship that is protecting the USNS Mercy and sometimes they send their transport boats to help. I got to ride in a Japanese boat one time and the ride was much quicker, only 20 minutes! It is very interesting that American citizens are boarding Japanese vessels to enter Vietnam, considering our circumstances only 40 years ago. So on Wednesday I was at Phuoc Nghi, and on Thursday I was back at Nhon Binh. Both of these sites are fairly large, and every day they treat between 500 and 800 patients. The days go really fast because we are constantly working. I hardly have time to look at my watch, so before I know it we are eating our MREs for lunch, and then we are packing up and ready to leave. I love working at the MEDCAPs because I feel like I am really helping people, and I also like to stay busy. The only bad thing about it is the heat and humidity. The heat index is constantly over 100F and it has been as high at 111F. On the second day in Vietnam one of the pharmacists actually fell victim to the extreme heat. He had been out in the heat for 2 days, and drinking about 8 liters of water each day. However, he did not increase his sodium intake to balance the water and by noon he had completely stopped sweating because his body could not afford to lose any more sodium. So his body overheated and he almost passed out before another worker made him get in the bus in the cool air conditioning. The medic started bags of lactated ringers and half normal saline and they took him back to the Mercy for treatment. His sodium lab came back at a level of 119 (normal is 135-145). This was a big lesson for all of us and we started carrying salty snacks like crackers and pretzels to eat along with the massive amounts of water that we are all drinking. The MREs have a good bit of salt in them too, however it’s not exactly the most luxurious lunch, and we often do not eat the whole thing. Instead, we walk along the streets that are nearby and the Vietnamese translators help us buy fruit. I have tried so many tropical fruits that I have never even seen or heard of before. There is dragonfruit, mangosteen, rambutan, litchi, and many others. They are all really sweet and delicious. But by the time we get on the bus to go back to the pier, we are all really hungry again. When we get to the pier all of the providers and volunteers go straight to the bandaid boats and go back to the Mercy, but the pharmacy staff stays behind in the warehouse to restock all of the medications for the next day, and to prepack more medications if necessary. This can take anywhere from 1 to 3 hours and by the time we leave the pier we have already missed dinner on the ship. One of the days, the pharmacy sent dinners for all of us in a box because they knew that we would be at the pier for a while. There is nothing like eating a full dinner in the dark on a boat that is bouncing up and down with the waves. It was an experience to say the least. So today I was off and tonight I have my first night shift in the pharmacy, so it will be interesting to see how that goes. Hopefully I can make it through the whole night awake!

Onboard and hard at work!

2010-06-04T11:30:00.000-04:00

We are on the USNS Mercy! We were actually onboard a few days ago, but our internet access has just started working. All of our travelling went very smoothly until we got to Qui Nhon. We were supposed to be onboard on Monday afternoon, but we were caught up in some logistics with the Vietnamese government. They wanted to approve each and every person that got on the Mercy while it was docked in Vietnam. So we stayed in a hotel in Qui Nhon until our clearance papers came through. We were allowed on board on Tuesday, and it took pretty much all day to get oriented and unpacked. We got assigned to our “racks,” which is our beds. And they showed us where the “heads” were, which is the bathrooms. It is tough trying to get used to all of the military lingo, but I am catching on. On Wednesday, we met the pharmacy staff and had orientation to the pharmacy all day. We don’t have clearance for the computer system yet, so we can only really perform filling and prepacking responsibilities right now. The pharmacy team is like a family, and we get a lot of work done and have a lot of fun while doing it. On Thursday, I went to the MEDCAP site in Nhon Binh. The MEDCAPs are clinic sites that we set up in different places around Qui Nhon. The people get checked in at Patient Admissions and get their vital signs checked, and then they are sent to see either a physician, a dentist, or an optometrist. If a prescription is written, they are sent to the pharmacy and we fill and dispense the medicine that they need. The MEDCAP is at a school, so the pharmacy is a classroom, and we move the desks around to form a pharmacy and direct patient flow. All of the medications are prepacked in plastic Ziplock bags and stored in brown paper bags with the drug name and quantity. We set out the brown paper bags in alphabetical order so that when we get a prescription all we have to do is find the bag, grab a ziplock, and stick the label to it. The hard part though, is finding the patient that the drug belongs to. All of the patients are coded with a barcode and number, so we have to match the number on the drug to the patient. This is easier said than done when you have 50 people who speak a different language all crowded into a tiny classroom. We accomplished this task as quickly as we could, and dispensed the medications. The pharmacist at this MEDCAP could speak Vietnamese, which was very convenient. She counseled each patient and then discharged them when she was finished. It was a very long day, but it was very rewarding to see all of the people that we helped. Many of them have no access to medical care, and to be able to provide free care and free medication is amazing.

On our way!

2010-05-28T22:43:00.003-04:00

Kris and I fly out tomorrow to Vietnam! We are very excited to finally be on our way and for this mission to begin! We will have a 14 hour flight from Dulles to Seoul, South Korea with a little break in the airport, then a 4.5 hour flight to Hanoi, Vietnam where we will stay overnight. In the morning we will have a short 1.5 hour flight to Qui Nhon, Vietnam where we will meet up with the Project HOPE Medical Directors for a 45 minute bus ride to the USNS Mercy. Smaller boats will take us to the Mercy and we should be onboard and ready to get to work by about 3pm Monday ICT (Indochina Time). Hopefully everything goes as planned! We'll let you know when we are safely aboard. Also, keep in mind that ICT is 11 hours ahead of EST (Eastern Standard Time). So we will most likely be contacting family at odd hours (sorry!)

Year 2 and going strong... new rotation information!

2010-04-19T10:20:00.003-04:00

Welcome back to the Shenandoah University School of Pharmacy Rx Project HOPE blog! We're very excited to be sending FOUR students this year on rotations with Project HOPE. The students will be part of the Pacific Partnership 2010 that will visit the southwest Asia region.

Fourth year pharmacy students, Kristina Angelone and Renee Summerson will join the USNS Mercy from May 29th to July 3rd, along with pharmacist preceptor, Earl Rogers. Kris and Renee's rotation will include Vietnam and Cambodia.

Following Kris and Renee, fourth year pharmacy students, Julie Horak and Brian Cox will join the USNS Mercy from July 3rd to August 8th, along with pharmacist preceptor, John Nett. Julie and Brian's rotation will include Cambodia and Indonesia.

Please visit often after May 29th to follow their experiences!

It’s over…

2009-09-28T11:29:00.002-04:00

My last week was spent in Majuro, the capital of the Marshall Islands. It is much more westernized here and it was evident as soon as we first stepped foot on the dock. We were even working in a hospital with an inpatient pharmacy and air conditioning! Well except the pharmacy was the only room in the building that it didn't work. We did have fans and electricity though! And the American kind of electricity, the kind that doesn't require an adapter or a transformer. It's the small things….

It was interesting to see how they worked in this hospital pharmacy. The techs were allowed to fill and dispense prescriptions without the pharmacist's approval. Not much different than the last 5 weeks where we had Australian sailors and pretty much any spare body helping us dispense prescriptions, but it was interesting to see this in an actual institution. I had no doubt in the tech's abilities to do this job especially since their formulary was also severely restricted.

It is simply amazing how fast my time with Project Hope and the U.S. Navy passed. It was a wonderful experience and one I will surely never forget. I implore all of my pharmacy, medical, and professional colleagues as well as my friends to pursue such an opportunity to assist those in need if ever presented the chance. Participating in this medical mission trip has allowed me to work alongside specialists in their respective fields. It was also incredible to be able to interact with doctors from Canada, Australia, Chile, and South Korea as their kindness never ceased.

Jabwot

2009-09-11T06:36:00.002-04:00

I had the pleasure of going to an outreach on the island of Jabwot. Our team was flown in by helicopter and my first impression as we flew over the island was that it was deserted. We soon found out that it pretty much was. We walked for fifteen minutes through a serene jungle, minus the occasional falling coconut, until we finally saw the village. Going in we were told to expect a census of 100 people. After checking everyone in at the clinic, we found there to be 54 people. Thankfully, all of the islanders received excellent care from a nurse that lived there and were generally in sound health.

After talking to one of the village elders I found out that the children have many opportunities to get off of the island and make a career for themselves. She had two sons in Arkansas and another in Hawaii. Though with 13 children, I guess some of them are bound to get around. We did see one patient who came in contact with a local predator. A fisherman had suffered a run in with a shark, was bitten in the wrist, and lost use of the tendons necessary for movement of the wrist. The doctor was able to refer the patient thanks to the Marshall's excellent referral system and follow-up care.

I was able to work right next to the two doctors and hand-deliver the medications so my job was done as soon as they had seen the last patient. The veterinary team unfortunately was up to their elbows in pig and dog neutering and soon enlisted our help. My first job, fend off the angry sow with a shovel while her male piglets were castrated. My second job, hold a piglet down while it was being castrated. Thankfully there was no third job. I figure the first two would look good enough on my resume.

Perhaps they'll let me pull teeth at the next site.

A good day

2009-09-07T07:04:00.002-04:00

Today was a good day. We arrived in the Republic of the Marshall Islands and headed to the island of Kwajalein where an Army base is located. We didn't get hung up with passport or sovereignty issues and were allowed to take liberty on the island. I had Subway (it was a close call between that and Burger King) and the establishment across the way happened to have 50 cent Guiness Stout Bottles. The Pacific Fleet Band was there jamming out with some Michael Jackson and Jazz. The breeze off the ocean was the icing on the cake. Today was a good day, and it was much needed after the last two islands.

Kwajalein is a strategic military holding as it is home to a ballistic missile weapons intercept program, space operations support, and is one of five sites in the world with radar stations used to operate the GPS systems worldwide. The Republic of Marshall Islands is also the former home of nuclear tests conducted by the US, the most recognized atoll being Bikini Atoll. It is important to know that all the Marshallese located on Kwajalein were moved off this island to another, Ebeye. Refugees of the nuclear tests were also moved to Ebeye. One of our mission sites is located here and the population is estimated to be 12,000 living on a 0.5 mile patch of land. I've heard one of the commanders refer to it as a "little Tijuana."

Dr. Marks and I will not be participating in Ebeye MEDCAP but will travel on to Majuro in 3 days. In between, we are being flown out to two separate atolls for outreaches. Ailinglaplap and Jabwot await us with open arms, hopefully.

Kiribati – Betio Continued

2009-08-30T03:28:00.002-04:00

On Thursday I had the great pleasure to meet Admiral Willard (http://en.wikipedia.org/wiki/Robert_Willard), a four star Admiral who commands the Pacific Fleet of the U.S. Navy. His accomplishments include commanding two different aircraft carriers, running the TOPGUN school, and has twice served on the Joint Staff among other activities. I was asked along with a representative of each partner nation to provide some feedback directly to the Admiral on our experiences and how they can be improved. Along with his wife Donna, the Admiral was personally responsible for organizing and planning this mission. It was a great honor to be able to provide a suggestion for improving it in the future, a proposal I'm sure will be considered for the next mission. After our meeting was concluded he gave us his personal military coin, which how I understand it, is an even greater honor.

We were asked to vacate the Betio Sports Complex for several days as they were holding an amateur boxing competition against rival Fiji islands. The two day event plus Sunday being a national day of rest turned into a 3 day weekend for myself. Dr. Marks and Phengphan each went to a different outreach site, an opportunity I will get to experience in the Royal Marshall Islands.

On Saturday I attended a health fair confident I could lend some support based off previous experience with APhA health fairs at the school. What I wasn't counting on was this fair being Kiribati style. Instead of having patients walk through the various stations and be screened, the I-Kiribati prefer to educate through song and dance. This made for an interesting afternoon as the Navy and USPHS healthcare providers were forced to come up with skits on the fly. Another important thing to note is the difference between the Navy's definition of time, if you're on time you're late, and the I-Kiribati definition of time, it'll happen when it happens.

On Sunday, the day of rest, some of the doctors and I went on a self guided tour of the Japanese defenses from World War II. We first passed the bunker the Japanese Admiral that commanded the island used. The building was pockmarked and overgrown but still rich with history. He died in the bunker on the 3^rd day of the invasion. As told, the bunker had gasoline pumped inside and was ignited via grenade, so deeply entrenched its defenders. Further down the road we found the Japanese artillery guns, still pointing ocean side. These gun batteries were huge and surprisingly still in great condition, though I doubt it would launch the coconuts stuffed down the barrel. The artillery shells were prepared in the pillboxes and bunkers behind the guns and transported via a rail system to the guns. Ironically, the guns were manufactured in the UK and sold to the Japanese prior to the war. All the directions on the guns are in English.

Tomorrow we start our five final days at the Betio Sport Complex before we steam ahead to the Royal Marshall Islands.

Kiribati - Betio

2009-08-25T04:52:00.002-04:00

On Sunday morning we arrived off the coast of Kiribati (pronounced Kirabas as ti is an s sound in I-Kiribati) and were eager to get off the boat and ashore to begin set up for our first clinic at Betio Sports Complex (pronounced Besio). The islands themselves are surrounded by reefs and are nothing but spits of sand studded with palm trees. It appears the highest place on the island is about 5 to 10 feet above sea level.

We stayed on the boat all of Sunday due to a small issue between the U.S.A. and Kiribati governments concerning the Navy's sovereign right to not surrender a list of the crew linked to Department of Defense activities, i.e. the Navy and Merchant Marine crew. The issue goes from Kiribati customs agents to the Kiribati President and from our Commodore to the Commander of the Pacific Fleet, and wouldn't you know, an agreement is reached. So Monday we get on ground and instead of using the planned helo-ops, we end up having to take a 35 to 45 minute RHIB ride in. Once we arrive at the Betio Sports Complex the reason is clear; the ground is overgrown with both weeds and trash and the paved parts in are disrepair. Looking around one would think the place was 13 years old but a dedication plaque indicates it is only 3 years old.

The area itself is rich with World War II history everywhere you look. We drove past the battle-scarred Japanese headquarters, pillboxes and bunkers poke out from the ground, and the Japanese artillery guns, though rusty, still appear to guard the coasts. Even the RHIB ride in to Tarawa is historical. It is the same path the Marines took storming the beaches. Several boats are stranded on the reef just as the Marine's amphibious landing craft were stranded, forcing the Marines to swim and wade inland or face certain death under the Japanese counterattack. The water level is only 3 to 5 feet above the reef that stretches up to 500 yards from the beach.

Kiribati itself is another one of these "beautiful disaster" island nations. The scenery and people are genuinely friendly, but the conditions they live in leave a lot to be desired. The islands are small and narrow to the point you can see from one side of the island to the other just by turning your head. This leads to overcrowding and a collection of refuse. The only way they get rid of their refuse that I've seen is to burn it. The U.S. Public Health Service environmental health people have even told us of beaches that are littered with human excrement. One even joked that they don't even need to do thorough tests for choleform bacteria; they can just fill a glass up and then hold it up to the light for visual confirmation. The "Kiribati Salute" refers to checking the bottom of one's shoes for surprises.

Another interesting cultural difference is the children. They are everywhere and into everything. The children are very nice, curious to see us and what we are doing, and aren't afraid to invade your personal space. Another joke is that they seem to let their dogs and children run free, but lock the pigs up. Speaking of pigs and sustenance, due to the islands lack of space and rather dry conditions, they are only able to grow food in crops in small amounts and fishing predominates the food gathering. Kiribati is actually expected to be the first country to disappear due to global warming and the rising of the seas.

Shellback Ceremony

2009-08-21T18:01:00.002-04:00

Dr. Marks and I began our shellback ceremony at 1800 with an announcement from Davy Jones himself! He heard about all of us slimy pollywogs, 47 in all, on board and was demanding we show up for physical fitness the following morning. The one and only King Neptunus Rex himself would be present with his court of trusty shellbacks for our physical test. The shellback ceremony is also known as the crossing the line ceremony. It is done to commemorate a sailor's first time crossing the equator and is administered by those who have been initiated.

Our first night we had to do a talent show in front of all of the trusty shellbacks. Possessing no inherent talents, I decided to "borrow" someone else's. Dr. Marks and I decided to copy Dr. Stolte's and Dr. Clements Thursday Night Live spoof from Phollies. We were imitating Craig (Will Ferrell) and Arianna (Cheri Oteri), the Spartan cheerleaders, from Saturday Night Live. We planned three cheers, my personal favorite being "Who's that pharmacist in my pharmacy" with Dr. Marks popping out and saying "It's me It's me." We also laced it with several jokes and references to what we have seen so far on this mission.

We were psyched, ready to get it over, and suddenly it was our turn to get on. We ran onto the flight deck with pom poms flying and executing perfect scissor kicks. All of our practice and hard work paid off. We got three lines into our skit and everyone stood up, and booed us off stage. Whew, that part was over.

We woke up at 0600 the following morning. I'm not sure if I am allowed to reveal the next part in its entirety, but here are some choice words. Water. Duck walk. Peanut Butter. Jelly. Calisthenics. New hairdo. Green eggs, bacon, oatmeal, and ham. Calisthenics. Oranges. Tuna fish and rice slip and slide. Calisthenics. Swab the deck. Leap frogs. Fire hoses. Bowline dragon. Row row row your boat. Make the baby laugh. Dunk tank. 2 hours later and I am now a trusty shellback.

Dr. Marks and I can now both say this with pride for having made it through. It's a great honor to be a part of this naval tradition as I imagine not many civilian pharmacists will be able to display their shellback certificates in their offices. This was another unique experience that this rotation has granted me with.

Good Samaritan Hospital

2009-08-18T04:15:00.002-04:00

Our third and final clinic was at the Good Samaritan Hospital, donated and built by the Italians. Catholic nuns live, work, and run the hospital. Getting to the hospital itself is a nice 30 to 45 minute drive depending on how crazy the driver is. We pass through palm tree plantations which equates to 50 foot palm trees in neat rows as far as the eye can see. I hear the Solomons are the world's largest producer of palm oil. Supposedly it's also where one third of the world's tuna that is canned comes from. We also pass the island's only self-serve car wash, a shallow portion of the river the few automobile owners can drive through and splash water onto their car. This tradition was started by the United States Marine Corps back in WWII when they gained control of the islands. The hospital itself is set against a backdrop of mountains perpetually shrouded in clouds.

The view is quite soothing for the amount of volume we are seeing. Yesterday we had a personal best of 500 prescriptions! The pre-packed medications we gave the providers have certainly saved us a large number of prescriptions as well. We have also been very lucky to have a few of the Australian sailors as well as English medical students help us in the pharmacy. We are able to quickly train them to be autonomous in dispensing prescriptions. This is quite different from the U.S. where there are several checks and balances before the prescription leaves the pharmacy.

It's quite incredible what the nurses do here at the hospital. They are very well trained, love what they do, and this is a blessing for Guadalcanal. I imagine it is almost impossible to entice doctors to the island. It is one of the only islands where malaria is still an issue, healthcare reimbursement is next to nil, and the bustling city life is dirty and dangerous. The WHO lists the Solomon's as having something like one doctor per 155,000 people. The hospital is lucky enough that Sister Dolly, the head nurse, has two Cuban doctors as friends that will visit once a week. This it's self is boggling to me coming from America where Patient First's and quick-care clinics are starting to become as populous as retail pharmacies.

But now the Solomons are behind us and we are moving off towards Kiribati. The experience here has been very eye-opening and full of some life lessons. Hopefully Kiribati will be just as exciting.

Gallery of Pictures

2009-08-17T07:35:00.008-04:00

Steve has taken the lead in writing about our adventures (and is doing a phenomenal job), since I am doing the SITREPs (Situation Reports) for Project HOPE, but I will add what I can to keep you updated. I have found that posting pictures to the blog is very difficult due to the internet capacity, so I am adding pictures to my own gallery which you can all access. Please go to http://gallery.me.com/alla.marks to view the first set of pictures from our mission. I will be posting new pictures whenever I can and will describe the picture above a little later in my blog to create some suspense and anticipation.

Tomorrow is our last day in Solomon Islands and we will be sailing to Kiribati on Wednesday (your Tuesday). Our first island has presented several challenges and accomplishments. We definitely have had to adjust to the heat, which is much more intense than Samoa and Tonga. We drink several bottles of water during our MEDCAP and sweat it all out. I found out the hard way, through an allergic reaction, that sunscreen with DEET, is not compatible with my face. So far, the mosquitos have not been bad, but Solomon Islands has the greatest prevalence of malaria, so everyone is diligently taking their doxycycline or mefloquine.

In terms of accomplishments, Steve and I have been on site every day of each MEDCAP (while other departments get work/rest cycles). The days are long, hot and busy, but very rewarding. We have had the opportunity to counsel on albuterol use with a spacer, discuss antibiotic options with the physicians, and instruct medical students from England and members of the Australian Navy as to how to dispense and counsel. I was able to assist a medical student in administering ceftriaxone IM to a patient, since she had never given an injection to an actual patient. Immunization delivery certification definitely came in handy! The team work during this mission is simply amazing. We have physicians, nurse practitioners, dentists, dental technicians, optometrists, and pharmacy staff all working together in a collaborative manner. Physicians actually ask us for advice (and even follow our suggestions) as well as step in after they are finished with clinic to help us get prescriptions out so we can pack up and get back to the ship. Pharmacy, of course, is the last stop for both medical and dental patients. The islanders are so patient...they stand in long lines to get registered, then to see a physician, then to get a prescription. If they want to be seen for more than one service, they have to get back in line to be registered again. Sometimes, it is very difficult for us in pharmacy, since we have such a small formulary of medications and we are only treating acute diagnoses or relieving symptoms. Simply giving acetaminophen to help with pain to a patient with tuberculosis or breast cancer definitely tugs at my heart, knowing that it does not resolve the cause of the pain. A lot of patients have serious chronic conditions that cannot be addressed by the Pacific Partnership, so they are referred to the local hospital without a guarantee that they will actually follow through or get the level of care that we are blessed to receive in the US.

Adjusting to military life is interesting. I, who am not a morning person at all, have started to work out before breakfast (served at 7am), since so many people do. Meals and meetings define your day. There is no training or preparation for hazardous physical activities. For example, yesterday we had to use Jacob's Ladder to get on the ship (pictured above) since the waves were too high for the regular gangway (which itself is extremely long and difficult to maneuver, especially with your heavy backpack filled with 6 bottles of water and MRE for the day). You have to time jumping off the RHIB onto the ladder as the swell rises then grabbing with both hands and climbing up one rung at a time without looking down. I am sure you can all appreciate the death-defying feat that Steve and I both accomplished (without falling into the water).

Well, it is rounding midnight and we are mustering at 0730 to go to the MEDCAP. Stay tuned for more exciting escapades.

A week on the H.M.A.S Betano

2009-08-13T05:13:00.002-04:00

Dr. Marks and I had the great pleasure to stay on the Australian LCH's this past week. I was on the Betano and she was on the Wewack, sister ships who will be decommissioned next year. Let me just say, the Australians have been awesome and they welcomed us with open arms. Of course, there's a crew of sixteen or so on each ship and I think they were happy to have some new people to talk to.

On the Betano, we had a younger crew with a CO who knew how to have fun. The LCH's have very large tank decks for holding supplies and ours had been converted to a party deck after the first day at anchor. It was complete with weight room, pool (no diving), and a movie screen projected onto the side of a module. A module was what we slept in and it resembles an eighteen wheelers trailer, but much smaller. We were racked 3 high and I banged my head a few times on the bunk above before learning my lesson.

The Australians also were a great help at the clinics. They helped the dentists with extractions, pre-packed meds for us, handled crowd control, and all the while they did it with a "No worries mate." Afterwards, exhausted and sweat-soaked (I really want to drive in how hot it was), we would pile into the flatbed and head to the Auki Lodge to have a few refreshments, Solbrew, before heading back to the pier to catch a zodiac to the ship. From there we'd enjoy a hardy meal and cool down in the pool.

Sadly, the Australians will be heading back home after next week so we will lose a very large support arm of the mission. Cheers!

Visale and Auki

2009-08-13T05:01:00.002-04:00

Our first week of clinic was quite the ride. The amount of sweat we shed was evidenced by the liters upon liters of water we had to drink to avoid heat related injuries. It's hot.

It's fair to say Dr. Marks and I were quite grumpy (Sorry Nicole!) at the beginning but we've adapted. We're getting closer to the equator and it will only get hotter. We're doing it the Solomon way – just sweat it out!

The clinic has been seeing 700 people a day through the combined services (optometry, medicine, dental) and we've been busy averaging 300+ prescriptions a day. We got smart very quick and had the Australian guys pre-pack all kinds of medicine to give to doctors to dispense to alleviate the burden on us. Even so, we average 200 people a day we still have to counsel in Pigin English. If you see Dr. Marks around school just ask her to show off her Pigin skills; she has learned a new language!

The islanders have shown up in full force and line up at 3am for our 9am clinics! Just about every other person has some sort of fungal infection and I've seen several cases of tinea corpus. Malaria is a problem here but we are referring those patients to the host nation for care. We're also quite lucky to be able to work with two pharmacists from the host nation. It is incredible how they've managed to deliver high quality healthcare with the extremely limited funds. They work 12 hour days and are on call during the weekends and JohnMac(enroe) travels across the Bay to get to the hospital.

The Solomon people are very friendly and intelligent. They live off the land and farm for themselves. The islands as a whole are very poor and they crowd our clinics because the healthcare is free and they may not have the funds to afford it otherwise. Besides betelnut, I've noticed another odd behavior of the Solomon people. They litter indiscriminately. As soon as they are finished with something it's either thrown on the ground or in the water. From afar, the beaches are beautiful, but as soon as you get close you'll notice trash is just below the water. Tomorrow we retrograde (pack-up) and head to the hospital in Honiera.

Opening Ceremony – Solomon Islands

2009-08-06T17:22:00.002-04:00

This is the hottest weather I have ever been in. It feels like you are walking through water and the sun is but a mile away. It's even hotter on the flight deck of the USS Mustin. We were on the deck to celebrate the opening of the medical, engineering, and veterinary clinics that would be held through the islands. Several high ranking officials from various armed forces were there. I had the distinct pleasure to meet Rear Admiral Robin M. Watters who is Chief of Staff for the U.S. Pacific Fleet. Also among us was a two star Australian Defense Force General, Solomon's Prime Minister, U.S. Ambassador, and members of the Solomon Parliament.

Riding in from the Byrd to the Mustin, we were met with stares from the islanders who packed the piers to watch our arrival. Looking back out into the bay, the Byrd struck an imposing figure among the smaller fishing vessels. Walking from the pier to board the Mustin I saw my first case of the long term effects of chewing betelnut, an anxiolytic and stimulant. The telltale sign of betelnut: rotten teeth stained a bright blood red. To say the least, that was an experience but probably less traumatizing to me than to the dentists with us. As a quick side note, the USS Mustin is a guided missile destroyer and is quite the impressive piece of machinery to have the opportunity to tour.

Tommorrow we leave for our first clinic via helicopter. We will stay 7 nights aboard an Australian LCH (Landing Craft – Heavy). Think of the ships in Saving Private Ryan with the front loading door. Expect to hear more about our experience upon our return to the Byrd August 14.

Iron Bottom Bay

2009-08-05T18:16:00.002-04:00

Today we have arrived in the Solomon Islands. Another beautiful island with sapphire blue water set against mountains. We arrived in the Solomon's between Savo and Guadalcanal islands, escorted by the USS Mustin, a missile guided destroyer. The destroyer was mainly for show as several high ranking military officers were stationed. They were here to celebrate Guadalcanal day with a welcoming ceremony onboard the Mustin.

This time of year 67 years ago U.S. and Australian navies were pulling into the Guadalcanal region to battle the Japanese forces. Allied forces engaged in naval, aerial, and ground battles starting August 7, 1942 against the occupying Japanese Forces. The naval forces were engaged in the middle of the night and the superior nighttime warfare of the Japanese naval forces dealt heavy casualties. Twenty nine Allied cruisers and destroyers sunk to the bottom of the canal. Thus the name, Iron Bottom Bay.

Even though Allied forces sustained heavy casualties, the Japanese sustained even heavier casualties attempting to reinforce their ground troops. The Japanese lost 38 ships and 31,000 lives (compared to the 7000 Allied). This was the turning point for the Pacific front as the Allies now were pushing the Japanese forces backwards.

It is quite the honor to be here at this time and traveling the same route the Allied forces used in their assault.

Hope you enjoyed the history lesson. Dr. Marks and I just found out we will be putting boots to ground in a couple of days so look forward to hearing about the clinics we will be participating in.

Culture Shock

2009-08-05T18:06:00.002-04:00

Today two of our many orientations dealt with culture shock. These presentations were geared towards the armed forces that were present, which by the way is everyone but the 6 civilians. They were teaching about how to identify and prevent one's self from becoming culture shocked. I then realized I was culture shocked but not by the Pacific Islanders. I am now living with the Military culture. Everything the military does is, not surprisingly, very structured. We all meet at our pre-arranged times every day at the same time even if there is nothing much on the agenda. I soon found myself planning around when my next meal would arrive (0700, 1200, and 0530). As the chaplain said today "You may not be military, but for this mission, you are."

All of this aside, the people I am living and working with are wonderful. I've made friends of French engineers, Canadian dentists, a South Korean dermatologist, Australian engineers, and a variety of healthcare providers from the armed forces. The Commodore and his crew have gone out of their way to make all of us "newbies" feel at home. The majority of officers on the ship do practice a certain medical specialty.

The ship itself is about as large as a cruise ship with a helo landing pad where the pool should be. I find it very akin to staying in a hotel. The major exception is that this hotel has a tendency to sway back and forth. The second busiest parts of the ship behind the mess halls are the fitness rooms. Everyone is encouraged to participate in daily physical fitness in order to prepare for the intense heat and humidity of the islands we are visiting. At 2100 it was about 90 degrees and humid enough to make it feel like you were breathing in water. I guess this is to be expected as we are now nearly on top of the equator.

Dr. Marks and I eagerly await our turn to go ashore either aboard the helicopter or the rigid hull inflatable boat. The next couple of sites they are predicting upwards of 750 people a day. Reports have even come back from the advance echelon team citing instances where people will travel for days for medical aid and patients will often show up by the truckload.

Final thoughts on Tonga and PP09

2009-08-04T16:33:00.002-04:00

I've been putting off the writing of this post for some time now. We left Tonga on a Sunday and spent three days sailing to New Caledonia, PP09's only liberty port. We were working while we were underway, preparing medications for the Solomon Islands, but I had time to write. I guess that, subconsciously, I associate the writing of this blog entry with the end to what has been a truly remarkable experience. Even now, as I stare out over tarmac, it hasn't fully hit me that my time with PP09 is done.

My last week in Tonga was probably the most memorable. In addition to the adventure that was Tuesday, on Wednesday I was called upon to prepare some IV medications for a trauma patient. I had prepared sterile medications under far worse conditions while in Samoa, so doing sterile work in the Tongan hospital was a walk in the park. The fun began after I delivered the medication. The local nursing staff had not used this particular medication before and was unfamiliar with its administration. After our surgical tech tried several times to convince the nurses of the proper technique, I was called in to defuse the situation. I would like to say that I was my calm, authoritative demeanor, my natural leadership ability, or my irrefutable charm that made them believe me, but I suspect the flashy drug reference I showed them on my touchscreen iPod may have played a role.

On Thursday, things got interesting when we had a patient present with typhoid. Technically she didn't list that as her chief complaint, but the bloody diarrhea in Dr. Ho's office gave it away. True to form, Dr. Ho wanted to give chloramphenicol, a drug rarely used in the US due to its toxic side effects. Thankfully Dr. Newman, our fearless cardiologist, was there to suggest something a little less toxic.

Friday was our last day of clinic in Tonga and my last day of clinic for PP09. We were only open for a few hours in the morning with the rest of the day being allocated to packing up our clinic (the Navy calls this process "retrograde", but I refuse to use retrograde as a verb). When we had seen our last few patients (I'm happy to report that the lady with typhoid was responding well to treatment) and finished packing, the hospital staff held a closing ceremony for us. In Tonga, the traditional way to say goodbye is by sharing kava. Kava is a plant whose roots contain a chemical known for its anesthetic and anxiolytic properties. It is brewed into a tea and served in a coconut shell. You don't savor kava, you chug it…a feat that is difficult to do gracefully.

Sitting on the floor in an elongated circle, they served us one at a time. Using a half of a coconut shell, a large Tongan nurse scooped up the kava from a vat and walked over to me. She towered over me as I sat cross-legged on the ground. Given the inherent elevation differences of our positions, the coconut shell was presented directly to my face. She gazed down upon me impatiently as I hesitated, but for an instant, to inspect this mysterious concoction. It was a watery, light brown mixture with no apparent odor. Without a moment to lose, I grabbed the shell and slurped it down. Now coconut shells are not like bowls; their edges are rough and inconsistent, so a certain amount of spillage is unavoidable. Handing the shell back and trying to slyly wipe my chin at the same time, I began to wonder why they drink this stuff. It does not taste bad, but it's not good either. It is a little earthy, but ultimately it is quite flavorless. Then it hit me…I couldn't feel my lips…or my tongue! I even had a slightly numb spot on my chin where it dripped. It was quite fascinating really…something akin to drinking lidocaine. I'm not sure I'd like to adopt this custom, as I found the lack of sensation more unsettling than relaxing. Nevertheless, I felt honored to be included in the ceremony.

After the kava ceremony we exchanged gifts. We presented each of the hospital staff with certificates of appreciation and they gave us each a trinket or souvenir of some sort. I was given a lali (pronounced La-Lee) a sort of percussion instrument. It is hand carved from piece of wood and really quite beautiful. Apparently these were used in place of church bells. When the gifts were all given the dancing started….and everyone knows I love dancing. Like a fish to the frying pan…or an Irishman to a tanning bed…you just can't keep me away…

The ceremony officially over, everyone was standing around, talking, and taking photos. A bunch of local children where there and soon became the life of the party. At the sight of a camera, they'd cluster together for the shot then swarm you to see how it turned out. The remarkable thing about Tongan children is that they are all tough. At the pharmacy we had several 3 year old children that could swallow pills. Even during dental extractions, very few of the kids would cry…and our dentists were scary ;) After the ceremony, the kids were literally climbing all over us. Dr. Farwell and I decided to have a race, each with a kid sitting on our foot. Farwell is huge…a sort of Arnold SchwarzenDoctor…so he won by a mile, but the kids had fun.

The kava finished, the gifts given, and the goodbyes said it was time to leave. For most of the medical team, Tonga was just a stop on their journey. For me, it was the end. I rode to the pier on the back of an old flatbed truck with the last of our supplies; trying to soak up as much of the experience as possible. My time with PP09 has been amazing from the start and is an experience I won't soon forget. I am saddened that it is over, but moreover I'm grateful for the opportunity and forever humbled by the experience.

New Caledonia – Sat-Mon

2009-08-02T04:03:00.002-04:00

What an incredibly long series of flights to get to New Caledonia. As a first time international flyer, I found 24 hours of flight time to be quite tasking. New Caledonia is beautiful when you fly into Noumea's airport, flanked by mountains on one side and water on the other. The airport terminal was small and getting through customs, baggage claim, and out the door took all of 50 feet. H1N1 is a big concern in the area and all incoming passengers are screened via a thermal imaging device that looks at the eyes for elevations in internal temperature.

From the airport it was an hour's drive into the actual city of Noumea through some of the 1500 odd mountains in New Caledonia. The city itself is very busy, filled with a quite diverse mix of poorer Pacific Islanders, Chinese and Japanese business owners, and well-to-do French citizens. Everyone speaks French and touring the city has been quite the challenge being on the other side of the language barrier.

On our first day, the U.S.N.S. Richard E. Byrd moved from anchor in one of the bays to portside at the cruise ship marina. This ship is humungous! It has been drawing quite the crowd from the locals and to get back to the ship with a taxi driver all I've had to say was take me to the big American ship.

Tommorrow, Monday, we are leaving port and getting underway to the Solomons. We've been hearing about the impact John Nett (Big John) and John Hammill (Little John) have had on the missions thus far and we are very excited to begin our work in 3 days times.

Time to try and get on this sleep schedule….

July 21th Strange day in Tonga

2009-07-27T23:01:00.002-04:00

The day started out normal enough. As usual, our clinic was the most popular place in town and patients were coming in by the busload. My preceptor, John Nett, was given the honor of being the sites Officer in Charge (OIC) and was kept pretty busy with both pharmacy and OIC duties. We broke for lunch around 1230 and enjoyed a delicious MRE under a tree on the beach. It was a rather agreeable setting until the rain came. In typical tropical fashion; it was sunny once moment and raining the next. It was as if someone tripped a switch and turned on the rain. Not being the type to allow a little rain to ruin a perfectly good meal, I simply grabbed my stuff and continued to enjoy my pouch of vegetable lasagna and my bag of osmotic cranberries under an awning of the hospital. Not as nice as on the beach, but still quite agreeable. Seeing as the rain has cooled things off a bit I opted for coffee…Field Joe to be precise.

For the uninitiated, MREs often contain a small packet of Nescafe instant coffee powder. To make Field Joe, you simply pour the powder in your mouth and follow it with as much water as your cheeks can hold. Then simply shake your head side to side and presto…fresh coffee, brewed right in your mouth. Sadly, I did not invent this wonderfully creative caffeine delivery system; the art of Field Joe was passed down to me from the all knowledgeable Dr. Cota, CDR, USN when we were on Savaii. For those of you wondering…it's awful and worse yet, the taste seems to linger for an unnaturally long time. But it served its purpose and before long I had all the energy I needed to finish the day strong.

As we were putting the finishing touches on our final prescriptions of the day (354 in total), word came that the weather was too rough to run the RHIBs. This meant that, for the moment, we were stuck on the island. What do you do when you find yourself stuck on a tropical island with no way home? Simple, you remember your Boy Scout survival training and seek out the necessities: food, water, and shelter. So we went to the bar.

The Mariner Café & Bar is literally the only establishment on the island. It is a small outdoor café/bar with 5 tables under a covered patio. Our entire medical team that day was around 25 people. When we pulled up the Mariner we realized that we were not the only ones stranded on the island. The engineering and veterinary teams had beaten us there…about 50 people in total. Needless to say, the place was packed and we soon ate nearly every bit of food in the place.

It was now getting late and word again arrived that there was no chance of getting back to the ship that evening. We now had to find accommodations for 50 plus people on an island without a proper hotel. Luckily we had the mission commander there to help. Through a herculean effort, he somehow found a place for everyone to sleep. I was lucky enough to get a rack aboard one of the Australian LCHs that was docked at the pier.

No sooner than I step inside the LCH do I hear "Safeguard! Safeguard!" go out over the Australian PA. It was very dark on the pier and one of the girls coming aboard the LCH missed her step in fell between the ship and pier and into the ocean. The people immediately behind her said she simple disappeared in front of them. She managed to fall through a gap no more than 18 inches wide without hitting a thing and without making a sound. Luckily, one of the tallest people on the entire mission was right behind her and was able to pull her out quickly. It was absolutely amazing that she was able to walk away from that with no more than a wet uniform.

The Australians were great. Not only did they find towels and dry clothes for the girl who fell in, but they really went out of their way to make us all feel at home. We had warm, comfortable beds and a hot meal in the morning. They even played Born in the USA over the PA as the morning wakeup call. The only bad part of the night was the lack of a toothbrush, for I still had the taste of Field Joe in my mouth.

2009-07-23T23:29:00.002-04:00

July 18th Kingdom of Tonga

2009-07-23T04:01:00.002-04:00

It's Saturday night and with help from a frosty cold, supposedly formaldehyde laden, but none the less delicious Tongan beer, I've finally caught my breath. The Tongan clinic is a hit. Each day we get busier and busier. We are bringing patients in by the busload…literally! In five days we've seen roughly twenty five percent of the islands population. Today was a half day and we still managed to fill 180 scripts. Friday we churned out 411. I'm not going to sugarcoat it…we're pretty awesome ;)

But don't get the impression that we are just a prescription factory…mindlessly turning out script after script. Much to the contrary, this has been the most clinically oriented pharmacy of the entire Pacific Partnership mission. Every day I'm talking to the physicians; discussing dosing or drug selection. For example, we have seen a lot of tinea type skin infections in Tonga. Because we lack the medications indicated as first line treatment, each physician took a different approach initially. However, after some discussion we were able to agree on a treatment and standardize our approach to the problem.

Perhaps the biggest contributor to the clinical orientation of our pharmacy is the location itself. We are setup in the hallway in front of the hospital's pharmacy. The local pharmacist, Salome, has been terrific. She is very knowledgeable and has been helping us with translation and counseling. She has also allowed us access to her pharmacy and her medicines. This has dramatically increased our ability to provide care. The drugs that the Navy purchased for PP09 are all for treating acute illness. We have virtually nothing for chronic conditions. The pharmacy at Nui'ui on the other hand is stocked with a respectable selection of medications for a variety of conditions. Our physicians are now able to prescribe medicines for diabetes, heart failure, hypertension, and a variety of other conditions that we could do nothing for in Samoa. Furthermore, we will remain at this site for two weeks. This allows us to conduct follow up care; something that was impossible in Samoa. We can bring patients back to check the efficacy of their therapy, for routine wound care, or to complete a complex procedure. From the patient's perspective this lends credibility to our operation and makes us easier to trust. If they have questions or are unhappy with the care we've provided, they know right where to find us.

Working so closely with the physicians here has been one of my biggest challenges, but at the same time it is what I've enjoyed the most. One physician in particular, Dr. Ho, has been particularly challenging and fun to work with. Dr. Ho is a partner nation physician from Singapore. His style of medicine is noticeably different than that of the US. As soon as I started receiving his scripts, I knew I would find him interesting. One of the first things he wrote for was Ponstan tds 2/52. Now I could figure out that 2/52 meant two weeks and I reasoned that tds was equivalent to TID, but what the heck is Ponstan?

Now if any of my professors are yelling at their computer screens saying that I should know this drug, let me first say that I checked…I searched every PowerPoint and every note that I ever took in pharmacy school and the word Ponstan, or even its generic name, does not appear anywhere. But I digress…

Apparently it is an NSAID of sorts that works well for menstrual pains and is commonly used in Singapore. Who knew? Well it wasn't long before I was a familiar face to Dr. Ho. We were persistent thorns in each other's sides. He would use an abbreviation that I didn't know or would opt for an uncommon treatment approach and I would be right there in his office asking questions. I learned quickly that you need to be prepared if you are going to challenge Dr. Ho on a therapy choice. He's good, he knows his stuff, and he is always prepared to defend is position. A few times I came into his office, Sanford Guide in hand, thinking I had a superior approach to therapy; only to find out that he'd already considered my idea and dismissed it. He always seemed to have at least three good reasons to back up his position. Even when I'm wrong, I have found that I enjoy these encounters because I have never left his office without learning something.

Tomorrow is, by Tongan law, a day of rest and we all can use it. Monday morning we start back up again and, as tired as I am right now, I find myself anxious to see what the next week brings.

July 13th – 14th Pangai, Kingdom of Tonga

2009-07-22T05:17:00.002-04:00

We had a smooth sail from Samoa. Our two day journey to the Kingdom of Tonga provided us with some much needed rest and some time to prepare for our Tongan mission. Having offered up Saturday as a sacrifice to the International Date Line, we arrived on Monday and I was anxious to get ashore and start working. Two Australian LCHs (Landing Craft Heavy) had joined us and will be used to bring our gear ashore. Unfortunately, Mother Nature had other plans on Monday. Heavy rain and rough seas tossed the flat-bottomed LCHs about too much to transfer our gear aboard. Instead we spent all day Monday in a constant state of readiness…waiting for the green light that never came.

On Tuesday, I awoke to calm seas and a busy schedule. Monday was supposed to be our setup day. Now we have to setup and open our clinic on the same day. At 0700 I raced from my room to the galley to see how much food I could pack away in the 10 minutes I had to eat breakfast. It turns out that I'm a remarkably slow eater. By 0715 I was on a RHIB headed to the town of Pangai, on the Tongan island of Lifuka.

I arrived on shore with my stomach growling and was disheartened to learn that my haste this morning had been in vain. Due to some miscommunication, our gear would not be ready for offload until 1000. 'Hurry up and wait' is a concept I've become quite familiar with during my time here.

Lifuka is a fairly small island; only 5 kilometer long and less than a kilometer wide in most parts, but it is beautiful. The beach is lined with coconut palms and small wooden boats are moored just off shore. It looks delicate on approach; the island is basically a low mound of sand atop a massive coral reef. It would take little more than a heavy rain or strong wave to wash it into the sea. In fact, that is a major reason why we have come to Tonga. In addition to medical care, we will be conducting emergency preparedness drills and helping them prepare for a natural disaster.

Our clinic site this time around is Nui'ui Hospital. It is the island's main hospital and is, by far, the nicest medical facility I've seen since joining with Pacific Partnership. The hospital is a one story building shaped like a T. Although not laid out like a US hospital, it does have all the major components. There are recognizable patient rooms, a dentistry clinic, a surgical suite, a laboratory, and a pharmacy. It even has an ambulance garage.

John and I made short work of setting up our pharmacy. We spent a good amount of time before we arrived in Tonga redesigning the formulary that was built for this mission. Our resulting formulary is much more compact and optimized for this mission. In no time, we were setup and ready to fill prescriptions. We saw 64 patients in our first day and filled 132 prescriptions. Not bad for a half day and an empty stomach, but tomorrow will be the real test.

Pacific Partnership on Facebook

2009-07-20T09:33:00.002-04:00

Become a fan on Facebook of the Pacific Partnership Mission

http://www.facebook.com/pages/Pacific-Partnership/120670700152?ref=ts

Additional ways to follow the Pacific Partnership Mission

2009-07-16T15:57:00.002-04:00

These are some sites related to the Pacific Partnership Mission:

On Twitter, http://twitter.com/PacificPartner

The official blog, http://www.cpf.navy.mil/subsite/pp09/index.html

US Navy updates online, http://www.navy.mil/local/pacificpartnership/

From the USNS Richard Byrd

2009-07-12T22:12:00.003-04:00

2009-07-12T21:49:00.002-04:00

July 8th – July 9th Final Days in Samoa

2009-07-12T20:57:00.002-04:00

On Wednesday I celebrated my birthday in style: by filling 533 prescriptions for 252 patients! Media exposure of our clinic over the past two days has really gotten the population excited about what we are doing here. Thursday was our last day of clinic and we were only open from 0800 until 1300. The local news station, however, told the public that we would be there all day. There was nearly a riot when we closed registration. A few hundred people were crowding the registration desk in the building's entryway. Another 20 or 30 people were loitering around the back door of the pharmacy, looking for a way to enter the building. The police had to be called in to disperse the crowd and thankfully the situation resolved without incident. While the situation could have ended badly and I do feel bad about having to turn people away, I hope it serves as an eye opener for the local healthcare system. I hope they are driven to improve their system and restore the public's faith in their abilities. I also hope that the public stands up voices their concerns. Our presence in Apia has exposed the public's desire for quality healthcare. Let Pacific Partnership 09 serve as the catalyst that transforms the healthcare system of Samoa.

Tomorrow we set sail for Tonga. I'll leave Samoa with fond memories that will last a lifetime. I've learned so much here, done and seen things that I couldn't have imagined just a few short weeks ago. We may not have transformed their healthcare system, but we have sown the seeds. If I'm lucky enough to return to Samoa in the future, I'm confident that I will witness the fruits of our labors.

July 7th Apia, Samoa

2009-07-12T20:54:00.002-04:00

On the second day of clinic, we changed our hours from 0800 – 1600 to 1200 – 2000 to accommodate the work crowd. Business was good: 230 patients and 442 prescriptions, but I'm starting to notice a trend in the type of conditions we are treating. In Sataua, we were serving an immediate need. The people on the island of Savaii have very limited access to healthcare and the conditions we treated reflected that. We saw several conditions or disease states that were the result inadequate healthcare. I wrote earlier about the patient with elephantiasis. This condition can be completely avoided if the filariasis is treated early. We also saw a lady that had a large cyst on her upper leg that prevented her from sitting properly and dramatically decreased her quality of life. The examples go on and on, but if it was not for our clinic many of the patients on Savaii would still be suffering.

In Apia, healthcare is much more accessible. The city's main hospital is in the center of town and care for Samoan citizens is nearly free. Samoans need only pay a $5 tala administration fee to obtain their medical record. The actual care is free. As a result, the conditions we saw in Apia were much more acute. Gone were the progressive complications of long neglected diseases; replaced with simple cold symptoms or muscle aches and pains. On the whole, this is a good thing. Such basic conditions reflect a fairly healthy society, but we are missing a golden opportunity.

Each day we saw more and more patients. When asked why they waited in such long lines to be seen by us instead of going to the hospital, the nearly unanimous answer was that the quality of care we were providing was far superior to the local hospital. This is the opportunity we are missing. We are setup in a community center. All the local translators and helpers are volunteers with no medical background. Instead of treating simple conditions that the local doctors are already capable of treating, we should have been working alongside the local healthcare providers. Had the local medical community been represented at our clinic two things would have happened. First, we could have had a tremendous exchange of knowledge. There were several tropical skin conditions that our physicians had never before seen. The local physicians would certainly know better how to identify and treat these diseases. Furthermore, we could have taught them more advanced treatment procedures and diagnostic techniques. Secondly, the peoples' faith in their local healthcare system would be strengthened had they seen their physicians and nurses working, as equals, alongside our team. We could have helped them identify why the public views their health system as inferior and helped them improve. By treating only short term conditions in total isolation from the local health system, we have set ourselves up to achieve only short term goals. The people in Apia clearly need our help, but a more lasting contribution would be to help them improve their health system thus rendering our services unnecessary.

July 5th – July 6th Clinic in the Capital

2009-07-12T20:42:00.002-04:00

Returning to Apia, I was pleased to see that the Byrd was pier
side. This would make it much easier to get on and off the ship. We got back on board with just enough time to shower and grab some food before we left again to set up clinic in Apia. The site chosen for the clinic was a large community center near the center of town. The main part of the building was a massive open room with a stage in one corner and a kitchen in another. With Apia being the capital as well as the most populated city in Samoa, we were expecting to see larger numbers than what we encountered in Sataua. However, I was still shocked to see just how many chairs had been set up in the waiting areas. It was a sea of plastic. Hundreds of chairs…we were going to be busy.

The building's kitchen opened up to the main room through a series of windows that could slide to one side to allow for the serving of food. It seemed the natural choice for the pharmacy location with one exception: It was overrun with ants and cockroaches. A call went out to the Navy's preventative medicine team and they responded with a backpack sprayer of permethrin. I have to admit, I was a bit skeptical at first. After all, permethrin is what we use on little kids to kill lice. I expected to return the next day to find a room full of angry cockroaches, alive and ready to fight. Thankfully these bugs capitulated to the chemicals and I returned the next day to find massive cockroach casualties.

With the roach problem behind me, my focus returned to how to deal this onslaught of patients that had been predicted. In Sataua, John Nett and I were alone and making it up as we went along. Here in Apia, we had help from a Navy pharmacy tech and series of lessons learned from our experience in Sataua. Before long we had the pharmacy organized and a workflow established. We saw 180 patients the first day and filled 270 prescriptions. We were busy, but it was smooth sailing all day. Never did I feel rushed or overwhelmed.

July 5th Update on Savaii

2009-07-10T20:24:00.002-04:00

We've packed up our gear and sent it ahead to the Samoan capital of Apia on Upolu. We have a bit of down time now as we wait for the ferry to Upolu, so I've had time to tally our pharmacy numbers. In 3 days the pharmacy saw 368 patients and dispensed 689 prescriptions!

July 2nd – July 4th Sataua Clinic

2009-07-10T20:23:00.002-04:00

We opened the clinic at 0800 and it became immediately apparent that we have some rather large holes in our formulary. We're missing some key antibiotics, we have almost no GI meds, and our selection of antifungals is painfully limited. But on the plus side, we do have enough 100 count bottles of pseudoephedrine to start several meth labs and enough bisacodyl to keep the entire island on the porcelain for several days. Joking aside, I find that I rather enjoy these oddities. It gives me the opportunity to work directly with the physicians and challenges me to find creative alternatives for therapy.

Most of our patients speak very little English, but it's clear they are grateful for our help. The lines, in every part of the clinic, are long, but I have yet to hear one person complain or see anyone get upset. In the pharmacy, we are hand writing all of our prescription labels on small stickers or plastic bags. This takes time, but the people here are nothing but understanding. If it wasn't for the 90% humidity and the lack of internet access I might just open a pharmacy here.

Our medical clinic is busy, but dental and optometry are at capacity. Access to healthcare is limited on Savaii, but it is still possible to get care. The hospital is staffed by nurses and a doctor visits the hospital once a week. The same is not true for dental and eye care. These services are virtually nonexistent on the island and travel to Apia, the capital city, is too expensive for much of the population.

As the days progress, the clinic gets more and more interesting. We had a patient with a severe abscess requiring IV cefazolin. Under normal conditions, this would be prepared in a sterile environment. Under our conditions, it was prepared on an old weathered desk sterilized with Purell. Later we had a patient with elephantiasis resulting from lymphatic filariasis. He had been suffering from the condition for over three years. The origin of the name, elephantiasis, was clear. His legs were massive, at least 8 inches in diameter at the ankle. And his skin had become thick with callus and hyperpigmented. It was an amazing sight; one that evoked both fascination and sympathy.

July 1st Hitting the ground running.

2009-07-10T20:16:00.002-04:00

0030 Climb Jacob's ladder to board the USNS Byrd.

0100 Finish check-in and receive room assignment

0115 Scare roommate as I burst in carrying a backpack and large duffel bag

0130 Receive a quick ships tour

0200 To bed (or cot as it were)

0500 My roommate is up…so I am as well

Our team musters in the helo hanger at 0630. We have five providers on our team: a general physician, a pediatrician, an optometrist and two dentists. All told, there are 12 of us on this mission. We are going to a hospital in Sataua, Samoa on the island of Savaii, where we will establish a clinic.

The scenery on the helo ride in is amazing. Savaii has but one road. It circles the island near the shore. The islands center is mountainous and bathed in shades of green that I've never before seen. We are only a few hundred feet above the jungle, but it is so thick that individual trees cannot be distinguished; they simply blend together as if one giant organism.

We land at a small air strip where some vans were waiting and drive to the clinic site. The hospital is on a beautiful piece on land; a small peninsula with a bay on each side. The hospital itself…not so beautiful. It is an open air building consisting of several small rooms all joined by covered walkways. The facility is old. Several windows are cracked or missing all together. The paint is peeling and what little equipment they have has been neglected. It is immediately apparent that we have a huge opportunity to really help these people.

Within hours, we've transformed the facility. It now has two dental bays, two medical exam rooms, a surgical suite, and optometry room, and a pharmacy. I have only worked in a handful of pharmacies in my time, but unless there is a Walgreen's on top of Mount Everest, I'm pretty sure the pharmacy we setup in Sataua has the best view of any pharmacy in the world.

From behind the pharmacy counter (built out of a series of old lecture podiums) I look east, over a bay filled with crystal blue water. Waves break over lines of coral exposed by the low tide. On the far shore are coconut palms swaying gently in the wind. There are no other buildings in sight, just nature…it's absolutely beautiful.

As I take in the view, fatigue takes hold. I'd been running on adrenaline for hours now. The meager three hours of sleep I've achieved in the past 24 hours are finally catching up to me. I'm exhausted, but excited for tomorrow and the opening of our clinic.

July 3 Nicaragua Here I come

2009-07-08T21:50:00.004-04:00

We dropped anchor at 6:30 this morning in the waters surrounding Nicaragua. When I headed out to the deck for my first sight of Nicaragua, I was surprised to see just how close we were to the shore. We were still a little out to sea, several miles, but I could clearly see buildings and other structures on the coastline. It was a different side of Nicaragua than I had seen before.

I had a late call away around 8 this morning to take me to shore since we did not drop anchor until this morning. This would be our first day in Nicaragua and the site needed to be set up. Now, the military sends out an ACE team who will do all of the prep work before we actually get on site. They will scope out where we will be and create a plan for where to set up and how the flow will work. This usually is done a few days in advance of the boat’s arrival.

To get to shore in Nicaragua, we took at hospitality boat for about 30 minutes to the Corinto seaport. This was the first tim,e I had been at such a massive port. There were huge ships in the harbor. Some of them were as big as the Comfort. When I asked why we couldn’t bring our ship into the port, I was told that it would be very expensive for us to pay to dock the ship for 10 days and with our ship anchored where it was it can be seen for miles up and down the coast.

Once we arrived at the port we were told to show our IDs to be allowed in the country. This was a bit of a problem for me because the ship’s admin department had collected all of the civilian’s passports the night before in order to get them stamped. Since we had entered the country by sea, we were told that there would be a problem at the airport if we tried to leave without proof that we had entered the country. After consulting several of the officers, it was determined that no one but the lead officer would show their ID at the gate.

It is a 30 minute bus ride from the port to the first site at the Ministry of Health Clinic in Chinandega. I really enjoyed the ride because it gave be a chance to see the beautiful rocky coastline and gave me a majestic view of the white hull hospital ship that I call home. The ship miles out from shore was a awesome sight to see against the deep blue sea, bright blue sky and the dark brown boulders of the shoreline. I am sure that I will remember it for the rest of my life. I can only imagine what it is like to be a citizen of Nicaragua seeing the ship for the first time. I know I was never prouder to be part of an organization that has such a beautiful symbol of promise and hope.

As we drove down the streets and through towns, I couldn’t help but compare Nicaragua to El Salvador. There were things that were very similar and things that were very different. The bright colored buildings are the same in both countries but in Nicaragua fewer houses are what I like to call “finished. When I say finished, I mean that they have be stuccoed and painted. Another difference that I could see right away is there is a feeling of poverty that was not noticeable it El Salvador. The buildings weren’t finished, the people’s clothes were not as clean and there was liter in the streets. In addition, the roads are not marked an paved as nicely as El Salvador. One thing I will say in favor of Nicaragua is that there is some beautiful scenery. Volcanic mountains are magnificent and the coastline is unbelievable. I am impressed at where there is poverty beauty still abounds.

After our short ride to Chinandega, I was ready to get to work. I was glad to have a chance to get a good workout moving boxes around the pharmacy and unloading the pallets, but when we arrived around 10 there were no pallets to be found. The pharmacy had a total of 19 pallets to go to both sites and I know there were plenty of other departments that had pallets as well. It is a long process and takes quite a bit of time to move that much product by helo from the boat to the shore and then get it sorted out by site.

While we waited Lt. Baidoo bought us a coke from a local vendor and we explored the clinic. After we had gotten the layout of the place and developed a plan for our pharmacy room we ventured right across the street to a little store. One of the guys bought some bread. This bread was folded into triangle and filled with something very sweet. The bread tasted a bit like a Danish here. I also tried what looked to be a sugar coated emanpanada, but it was empty on the inside. It tasted like a sugar cookie and was very good.

Once we were told that they hadn’t even loaded the pallets, we sat down across the street and began to play with some kids. A small little girl appeared with a coin cordoba in her hand, and she went to purchase some candy at the store. She seemed very curious as to what we were doing. I went over and took her picture. After that, we were instant friends. I asked what her name was in Spanish. From that point on, Anita thought that I understood Spanish, and we had a very long conversation (I have no idea what she said). I took her photo again, but she told me that she wanted to fix her hair. Then she introduced me to her brothers and their friends. We played with them for a while and then Carl Caluya bought everyone some ice cream from a street vendor.

About that time word came that some high ranking officials were going to view the site, so we had to move 10 feet to be inside the clinic gate. While they waited, Anita’s brothers kept us entertained with a very fast paced game of marbles. These kids were good. I think one of the soldiers told them that he would buy the winner some candy and gave both of them their choice of candy when the afternoon was done. Once the officials arrived around 2pm, we were told that we had to leave to catch a helo back to the ship. None of our pallets had arrived so we couldn’t do what we were supposed to do. A bit frustrated, we headed to the air strip.

Nicaragua is a very interesting country in that the waves get really rough around the middle of the afternoon. For that reason, all of those making the daily commute will arrive on shore by boat and will depart by helo. Luckily, the air strip was only 6 minutes away by bus.

When we got to HLZ (Helo Landing Zone), I was surprised to see a bus full of Operation Smile patients. On July 2, the Comfort joined forces with Operation Smile for this country. For those of you who are not familiar with this organization, it is a group of medical providers and surgeons who specialize in cleft pallet surgeries. Eighty-seven patients were already identified prior to our arrival today and were waiting with their escorts to head to the ship.

The ship was using both its Navy helicopters as well as several Army Black Hawks that were loaned to us from a military base in Honduras to transport patients. Since there were so many patients and only 11 seats per helo, we waited for several hours to get back to the ship. We also had to wait until the Black Hawks were clear to fly on and off the ship. (I was told they had to qualify, not sure what that means, but they didn’t actually take people flying for several hours until their paperwork was complete).

After waiting for such a long time, we were rewarded with the first Black Hawk ride of the day. This was a great experience because it was the first time I had ridden with the helo doors wide open. The trip took about 10 minutes and the feel of the air against my skin was refreshing after a long hot day. I had so much fun and like a tourist that I sort of am I took tons of pictures from the air.

We didn’t get much accomplished today, but it still was a great experience. I was able to try some local food, had a chance to get to know some of the other soldiers on board the boat, and made new friends with the local kids. In fact, we still refer to the day as our COMREL day. COMREL stands for community relations and usually consist of a group of military and civilians who go out into the community and perform community service deeds. All in all it was a great day.

July 6 - USNS Richard Byrd Update

2009-07-08T09:17:00.005-04:00

This is an excerpt from a Project HOPE e-mail concerning student John Hammill:

Regarding the subject of the email, I wanted to pass along an update on John Hammill. I received a satellite phone call from his preceptor, Dr. John Nett, and all is going very, very well. The most important thing he wanted to emphasize was how impressed he is with John and how thrilled he is to have him for a student. It sounds like they are working out very well together and, if things continue on course, should be a great experience for all. You have provided us with excellent students (as I'm sure they all are!).

As you may know, the "Johns" and one Navy pharm tech are the only pharmacy specialists on the mission, so they are really the subject matter experts on board and are being leaned on heavily, which is a very good thing. The team has been working ashore everyday since 1 July and it sounds like they actually spent several nights ashore away from the ship in a remote area. When Dr. Nett called me today, he was talking under a palm tree on a pristine Pacific beach, so I don't think there are any complaints! The Medical Officer on board said they are installing a wifi system, so hopefully they'll be able to access the Internet soon. Once we start receiving our Situational Reports, I'll forward to you. Dr. Nett didn't have his notes with him when he called, but said they've written over 700 prescriptions and have seen over 300 patients in just the few days they've been working.

July 2 Sailing on the High Seas

2009-07-07T23:55:00.001-04:00

We are moving today. At 11:00 am this morning, we heard the call to hoist the anchor so that we could set sail for Nicaragua. We were so excited that Lt. let us go to the bow of the ship and watch them bring up the anchor. The anchor is massive and has to be hauled up by a large machine. As the links of the anchor’s chain are brought up there are certain markers on how deep the anchor has gone. With each marker they will ring the ships bell to announce how many feet deep the anchor is coming up from.

In addition to watching for the markers, the sailors also have to wash the muck from the ocean off the chains and the anchor. That is a lot of hard work. The fireman’s hose they use has a great deal of force behind it so you have to be pretty strong to hand on to the hose and still be able to wash the chain off. Lt. Victor, one of our pharmacist, gave it a try. It took about 30 minutes to raise the anchor and for them to declare “Anchor’s Away.”

Because this was our only day to pack for Nicaragua, the pharmacy was frantically trying to count medicines and label them. Even though we had roughly twenty volunteers at any given point during the day, we ran into a few snags along the way. The first problem was that we ran out of plastic bags to put the meds in. Nicaragua is our last stop and unfortunately some of our supplies have run low with no chance of restocking. Once we found some paper bags we began to run out of staples to close the bags. Then we realized we only had to small packages of labels left. However, with a little ingenuity from the Chief and HM2 McSherry we were able to use the IV label printer to make more labels and some packing tape to close the bags. When all was said and done, we ended up packing 19 pallets and 10,000 pounds of medications for the people of Nicaragua.

NIcaragua is slightly different then all of the other countries we have visited so far because it has mandated that whatever medications that we take into the country have to be left there. To many, this seems like an unusual request, but my past experience with this country tells me that the Ministry of Health does not have the money to provide healthcare to all of its people. We weren’t opposed to this plan because we are not heading to any other humanitarian assistance ports for this trip but this might have limited exactly what came ashore if we did have to go to another country after this.

In the middle of the transit day, we had two scheduled events to look forward to: a bridge tour and the abandon ship drill. Tracy, the Project HOPE coordinator, set up a bridge tour for us. Third mate Joe was the person who gave us a tour and explained how things worked. He is part of the MSC (Military Sealift Command). Joe took time to explain our route back to see and then over to the Coast of Nicaragua. On the maps it looked like we made a backwards J to get to the coast. We have to go back out to sea to “exchange” some water on the ship.

Meg asked if she could drive the boat for a little while and the helmsman agreed. After Meg finished, I asked if I could drive. It was really easy since the seas were not rough at all. In fact, I barely had to move the rudder 2 degrees in the 10 minutes that I was driving the boat. According to Joe, we were going about 18 miles an hour and to be honest, I couldn’t even tell that we were moving at all from the bridge. I am grateful for the bridge tour because it gave me a chance to learn a bit more about sailing and to see all the equipment that is involved in making a giant ship move.

Another scheduled item for the day was a fire drill and an abandon ship drill. At 3:15, the call went out that this was a fire drill. Two of the pharmacy personnel, McSherry and Chief Bone, are tasked with fire duty and are firefighters for the ship. For this drill, everyone will go to the place that they normally muster, take roll, and wait there until the drill is over.

Right after this drill, we roll right into the abandon ship drill. For this drill, we go to the pharmacy put on our long sleeve shirt, life jacket, and hats. We need to have the long-sleeve shirt and hat to protect us from sun exposure in the event that we needed to stay in the lifeboat for an extended period of time. Once fully garbed, we hurry to the flight deck were several sailors are holding signs with numbers. Since I muster with ancillary services, my number is 3 and will be placed into lifeboat 3 in the case of an actual abandon ship. It is really neat to observe the blue and orange sea of people everyone from the whole ship piled onto the flight deck around the helo waiting for those in charge to account for everyone on the ship. Once it is confirmed that all were present and accounted for, the drill is over, and we head back to the pharmacy for the rest of the day.

One of the other things that Project HOPE set up for our day of traveling was to serve in the galley. I was really excited about this because I wanted to see how the kitchen worked to prepare enough food for hundreds of people. However, when I got there I found out that I was serving on the mess deck. This is a thankless job for anyone who has ever done it.

For the 2 hours that food is being served, these men and women stand alert waiting for someone to spill something or make a mess on the salad bar. To be honest, until I did this job myself I didn’t know that these people existed. They simply appear out of nowhere to supply extra bowls, sweep and mop the floor, do anything to keep the area clean. If that is not enough, after dinner, they must wash down all of the tables, put away the napkin holders and salt and pepper shakers. Then, they will sweep and mop the floor. It really is a hard job.

Working in this humbling capacity taught me a great deal. The first thing is that I should always appreciate the people who work behind the scenes. They work very hard and seldom get credit for their long hours. Second is to take a few minutes out of my day to tell them how much that I appreciate all of their efforts. The last thing it taught me was to become more observant of my surroundings. There many, many people who have seeming insignificant jobs around the ship but without them the Comfort would not run smoothly.

Today has been long and full to the brim with new and exciting experiences. There is always something interesting to do or see on board the ship. Each day brings an adventure and when I close my eyes to rest, my mind always begins to wonder what the next day will hold.

June 30th It feels good to be needed.

2009-07-07T16:27:00.005-04:00

The journey from Washington Dulles to Apia, Samoa was long and arduous. Between the time zone shifts and crossing the date line twice in one day (is that possible?) my total travel time was lost to me. Nevertheless we arrived at the pier in Apia around 2330 Tuesday, June 30^th. The ship was anchored about a mile off shore. While waiting for the RHIB boat (rigid-hulled inflatable boat) to collect us, we were exchanging introductions with the Navy personnel and others that had just arrived to Apia. When I mentioned my name, Petty Officer Akins' eyes widened. "You're John Hammill? We've been looking for you!" he said. He then presented me with a piece of paper that contained orders to pack a small bag with clothes and supplies for a 3 day RON (Remain Over Night) mission and report to the helo hanger at 0630.

We will be traveling to the village of Sataua, Samoa on the island of Savaii. My preceptor, John Nett, and I will be the pharmacy contingent for this mission. In fact, with the exception of a single Navy Pharmacy Technician, we represent the entire pharmacy team for the whole Pacific Partnership. It feels good to be needed.

July 1 Fun on the Comfort

2009-07-06T22:51:00.002-04:00

This past week has been a very busy week for the pharmacy. Most of the time we will have a 3 or 4 day prep time when moving from one country to another; however, since the Nicaraguan port is only a few miles away, we only had one day transit time. I am told that what normally happens between countries is all of the medications that were used in the last country are brought back to the pharmacy where they will be sorted and counted. Then the pharmacy will create new pallets for each of the sites that we will visit. This process usually will take all of the 3 days en route to another county. Since we didn’t have that time, we have worked really long days and recruited many other volunteers from different departments throughout the ship.

After prepacking and labeling 19 pallets of medication and several long days, we are ready for some fun. The galley pulled out all of the stops on one of our last days in port and they served us steak and lobster one night for dinner, topped off with a delicious slice of blueberry cheesecake. Keep in mind that cafeteria food is never that great but that dinner was not bad. It was a welcome surprise after a long hard day.

One of the other ways we have to relax after a long day is to participate in any of the many exercise classes that we have going on throughout the day. There is a yoga class held on the flight deck around sunset. It is so beautiful. The sky is brilliant and the stretches really do a lot to help you unwind those tensed muscles. For those looking for more intense workouts there is the PX90 class. Now I haven’t been that tempted to go to that class after Julie told me how hardcore that turned out to me.

The class that I love to attend is Zumba. This exercise class is based on Latin dance steps which fits well in ouand is quite fun. Instead of being in a gym, everyone gathers in CASRAC (the triage, staging area). Our instructor turns on the Latin music and class starts. With this class you are constantly moving but it is so much fun since each person adds their own little dance step into the mix. We usually have a few onlookers stop as they pass by to see and to enjoy the class for a brief moment. The class is a really great aerobic workout and surprisingly enough, I wasn’t sore in the least the next day.

In addition to the exercise classes, the Fun Boss also sets up evening events for our entertainment. One night we played bingo. Some of the prizes were really nice but others were funny. The one person who won the ipod also won the portable DVD player as well but Lt. Victor did win a tee-shirt. All in all it was a fun night. Some of the other events that the Fun Boss set up are movies on the flight deck, Comfort Idol, and karaoke. It is a great way to meet other people in other departments as well as keep up the moral.

One other interesting thing of note is that we do have a celebrity on board (which I didn’t know about until I had already met him). I sat down to dinner with a few ladies from Project HOPE who were having dinner with one of the Navy physicians on board. We had a lovely dinner, and it was nice meeting his acquaintance. It was only after dinner that one of my other friends came up to me extremely jealous. I couldn’t understand why until she told me that the Navy doctor that I had just ate dinner with was Andy Baldwin from The Bachelor.

Dr. Baldwin is very popular on the ship. People are always stopping him to ask him to pose for a photo. Off the ship, he is highly sought after as well. One of the other Project Hope ladies, Diane has the pleasure of working with the patients and sending them to see the next available doctor. There were 3 young teenage girls who were waiting in line and were called next to see one of the women physicians. Diane went to escort them over to her, but they shook their heads and pointed at the Dr. Baldwin. They wanted to be by the “handsome doctor.” He really has made quite an impression.

Although we have worked very hard each day, we have had some fun and a chance to relax. The days are long and the work may be a bit tedious at points, I remind myself that I am still in the middle of the Pacific Ocean surrounded by blue waves and emerald green islands with dazzling sunsets and the gentle rocking to and fro each night as I close my eyes to sleep.

June 25-28 Loma Larga

2009-07-02T01:05:00.002-04:00

My RON mission was at Loma Larga at a school. To get to there, you either have to take an hour and a half boat ride or 10 minute helicopter ride to the landing zone. Then you load up on a bus and travel for about 45 minutes through beautiful mountain scenery. As you can see from my last posting, I was able to get a helo ride.

On the way to the school , there were several interesting things of note. One of my favorite things was the cow crossing signs. These signs are created just like our dear crossing signs except they have a picture of a cow on them, and truly, cows are everywhere. You will see them just walking down the road finding their own spot to graze for the day. I think that in this country the cows have free range. In fact, most of the time when there are traffic issues causing the bus to slow its steady pace, it is due to the cows in the road.

Another interesting thing that I saw was a woman waiting at the bus stop at the corner of Loma Larga. She had her arms crossed at her waist seemingly carrying a small bag in her arms while waiting for the bus. As the bus drew nearer, I was amazed that the bag was alive. The woman had a live chicken neatly folded against her stomach, patiently waiting on the bus to arrive. I thought it was so interesting that the chicken seemed very content tucked into her arms. It obviously didn’t know that it was going to be dinner that night. That was definitely something that I was not expecting to see.

Once we arrived a Loma Largo, I was amazed at just how big an operation this mission was. There were already several lines of hundreds of people formed outside of the school. Each line was labeled as to what type of medical care those in line would receive. We have general medicine, OB/GYN, optometry, pediatric medicine, dentistry and many more. I had expected to see one school building with a few doctors and nurses set up, but our operation took up several buildings. There were even tents set up where kids could color and play while parents were seen. This was a massive undertaking.

The pharmacy was already set up when I arrived. Several of the pharmacy staff who had been on a RON mission in San Alejo had transferred the meds from their site and set up the pharmacy for us to take over. In the pharmacy, we have several Cardinal totes that are labeled with the contents on the outside. All the medications inside are already counted, bagged and labeled, so the process of filling the prescriptions can go smoothly. All we have to do is grab the bag, place a name on it, and fill in the blanks. For example, the amoxicillin label states, “Tome___mls cada___horas por ___dias.” Using this method 3-4 people can fill anywhere from 1,000 to 3,000 scripts in one day.

To help make our process run more smoothly, El Salvador has provided us with translators from a university. They were a lot of fun as well as a good source of information about local customs and cultures. Jennifer was a student who was studying to be an English Teacher. Castillo, who always made me smile, suffers from scoliosis which could have been fixed had he grown up in the States. Claudia was full of energy and laughter all day long. All the translators were so helpful, and they helped make the slow moments entertaining.

One of the El Salvadorian translators from the Latter Day Saints group made a special trip over to the pharmacy at the end of the week to tell me that I had beautiful eyes. I thought he was talking about my blue eyes since that is unusual for this country so I told him that everyone in my family has the same color eyes. Then he corrected me and told me that the form, shape, eyelashes, todo… was very pretty. I was quite flattered and really didn’t know what to say at that point, so I told him thank you and then went back to work. That was another highlight to my week.

For those of you who don’t know me too well, I am a people watcher. I love sitting and watching people go by. One thing that I have learned is that every country has its own unique customs and clothing. El Salvador is no different. They have the “apron.” All of the older women have big fancy aprons that they tie around their waist. They remind me of the aprons that you would see hot dog venders using at a baseball game only way “girlier.” Each apron is unique in that it is covered with embroidery, ribbons, and lace. Some of them are really beautiful while others are so busy with colors and ribbons that you wonder what the creator was thinking. After asking one of the translators about the aprons, she told me that all of the women have them and that they are really handy to use. She said that you will see all of the vendors at a market with them because they are a great place to keep change when people make purchases.

The people of El Salvador are a proud people. When they came to clinic, the first thing I noticed was how well everyone was dressed. All the little girls were dressed in their finest “Easter” dresses and all they boys had on clean clothes. The adults too would have on nice clothes as well. For them, the Comfort visiting their country was a big event and they wanted to look their best.

You could also tell that the people were proud of their country because they wanted everything to be nice for our visit. One day, during clinic, the site director noticed that there was some trash in an alley near the school. By the time he had gotten up a work detail to clean up the trash, it had already been cleaned by the people of the village. In addition, the country had transported in Port-a-Johns to the site for the clinic staff as well as the people waiting to be seen. They kept several potties just for the workers and every day they had someone come and clean them out. It was a really nice jesture for the host country to make sure that we were taken care of for us.

The thing that I loved the most about my visit to the school was the people. One of the very first people to make an impression on me was a little old lady. After giving a try at a Spanish counseling session, the woman I counseled said that she understood what I had said. I went to leave and she grabbed my arm, then gave me a big fat hug and kiss on the neck. Then she gave me several blessing in Spanish and told me how grateful that I was there. I was a very humbling and rewarding experience.

Another experience that moved me was a little girl who was given a pair of glasses by the optometry site. She came over to the pharmacy with a worried face and asked one of the translators if she needed to pay for the glasses. When they told her that she didn’t need to pay for the glasses and that they were hers to keep her face broke out into the most beautiful smile I had ever seen. The people here can really touch your heart. That is why we are here. They are the whole reason we are here.

June 25 Helo Ride

2009-07-01T23:51:00.002-04:00

Helo Ride!!!
Today was the big day!!! After checking the travel manifest last night, I discovered that I was going to be one of the lucky few who travelled to their site by helicopter. I was consumed with excitement as I lay down to bed last night. I woke up several times during the night because I was so excited and also afraid that I would be one of those people who overslept and held up the flight (even though I was still getting up at my regular time). It has been stressed repeatedly that you must be at the flight deck on time or you will be left behind.

My call away time was at 7:10 this means that an announcement over the ship’s com reminds everyone on that call away must be at the flight deck within 10 minutes. Once you get to the flight deck, you pass a table usually stocked with MREs and water. Because of the food shortage we had a boxed lunch containing ham salad kits, chips, and soft batch cookies. Once you have grabbed you meal for the day, you will head to the waiting room.
Normally, you will sit in the waiting room for about 20 minutes. One of the officers told me that you have to have long sleeves in order to fly in the plane. I have learned that it is always good to keep a light weight long sleeve jacket or shirt near you at all times since you will need it for abandon ship drills and helo rides. After donning my jacket, we were called to the prep area.

In the prep area, a soldier briefed us on how to enter the aircraft, how to get in and out of your seatbelt as well as what to do in both an overland and oversea crash. The soldier giving the brief had done it so many times before that it took less than 3 minutes to cover all the basics. Once properly briefed, we are given a weighted floatation device to place over our heads and around our waist as well as a helmet with goggles and ear protection. The helmets are stretchy, so they will fit almost any head and have enough pressure to drown out most sounds.

As soon as we were fully garbed, we headed to the helicopter. Once we were all settled in and the doors closed, we went straight up into the air. After riding in so many planes, it was a strange sensation to just lift straight up into the air. The ride was smooth and surprisingly quiet. The scenery was magnificent. El Salvador is a very mountainous area with lots of islands dotting the coastline. Since this is the rainy season, the whole country is covered in a blanket of lush vivacious green. It is a beautiful country.

Riding in a helicopter is an amazing experience. You can see for miles!! The country is so beautiful words can not describe it all and pictures can only say so much. There are huge green islands that populate the vast seas. You really cannot get a perspective at how many there are or how big they are from the deck of the boat. It is awesome to see this country from the air.

Our flight was about 10 minutes long which was slightly disappointing because the experience was so neat. I was grateful for my ride in more ways than one. To have the experience was awesome, but it was also great not to have to ride a boat for an hour and thirty minutes on rough seas to reach the same destination was also a blessing. We have had a great deal of problems with the transportation at this port.

Since we are not at our original port, we must find alternate ways to get our supplies, meet officials, and move personnel. With the recent tropical storm, the sea has been a bit rough. In addition, the helicopters have been up and down in the hanger with fuel issues due to cost and supply issues. On several occasions there have been trouble with the hospitality boats in the rough seas. Several people have gotten sick and a few people have been thrown into the floor of the boats on more than one occasion. These transportation issues are at the heart of the reason why so many people are doing RON missions at this port.

Once we arrived at the helo landing zone (HLZ) we were boarded on an air-conditioned bus for our 45 minute journey to Loma Larga School. The ride was really nice because it gave me a chance to see the beautiful countryside. Like I mentioned earlier, the country is awash in a brilliant green. Every now and again there a these beautiful trees that are covered with bright orange flowers which makes beautiful contrast with all of the green surrounding it. These trees are called “Arbor del fuego,” which means “Tree of Fire.” After such a neat bus tour of the country, I was ready to get to work.

Life onboard the ship June 24

2009-06-26T22:43:00.004-04:00

Right now, my day begins early in the morning with helo and boat call a ways beginning around 4. These reminders go over the com to make sure that people know that they have about 10 minutes to get to the flight deck for their transport. Then a call of “Reveille, reveille” goes out about 6 am, but my day starts about 6:30 am. I dress quickly and then climb all the way to the top of the boat to mess hall aka “the galley.” Right now, breakfast consist of eggs, bacon, and pancakes. We are short of supplies right now so no cereal. We are also out of fresh fruits and vegetables, but a supply should be coming tomorrow if the seas cooperate. We even ran out of MREs last night and everyone going ashore had to have a boxed meal prepared for them.
The food in the galley is not bad but the meals are heavy on the starches. We always have some sort of potatoes at each meal and rice at least once a day. I am told that we normally have a salad bar to eat from, but since we are out of fresh food, we have not had that luxury. Normally, there is always soup or chilli available as an option for the afternoon and evening meals. There is always soft serve at dinner for those of us who crave ice cream after a long hard day. What is interesting is that all of their portions are one-size-fits-all and that usually is enough to feed the hungriest sailor.  I also believe that all of our meals are fortified with fiber to counteract the effect of the daily MREs. I definitely will not go hungry here on board the ship, but I look forward to some fresh fruits arriving sometime soon.
At 7:00, I report to the pharmacy to see what the plan of the day form me will entail. For the last few days we have been working on spreadsheets that record and tally how many meds have been given out and who needs more supply. We also spend much of the day waiting on shipments of meds and prepacking what meds we still have onboard. One interesting thing to note is that all of our meds come from the USA. We are not allowed to buy meds from our host country because they may not have been manufactured in FDA approved plants. One might ask why can’t we treat the people with medications from their own country and the truth is that we can’t bring their medications on board the ship because we may accidently use those meds on US citizens on the ship.
After an hour our team will muster at 8:30 downstairs in Radiology. Muster is the navy term for meeting. We will go over the POD (plan of the day) which includes a quote of the day, military history of the day, lunch and dinner menus, and other trivial knowledge. Then one of the officers will give a brief about things that need to be done or updates for the day. Then we are off to our stations for the rest of the day.
One of the things that I enjoy is the call for Sweepers. Around 8 am and 3pm each day there is a call over the com that “Sweepers, sweepers. Help keep our ship clean.” This is our daily reminder to clean our assigned station. In the pharmacy, we are in charge of cleaning our work spaces, but we also need to clean several places outside of the pharmacy. One morning, I had to wash the handrails along the side of the stairs and down the stairwell until the next floor. Another time, I was in charge of wiping down the blue AT&T phones right around the corner of the pharmacy. Everyone has a task to keep the ship clean.
As civilians on the ship we are in charge of doing our own laundry. Our assigned days for laundry are Tuesdays and Thursdays and then everyone can do laundry on Sundays, but there is usually a line for the washers and dryers. On days that I am aboard the ship working, I can run downstairs and put my laundry in. It is important that you use only high efficiency laundry soap otherwise it gets very sudsy.
At night lights out is around 9:30 in my overflow berthing because so many people have to be up by 4 am. Evening prayer is said over the com at 10:00. You can stay up as long as you want but for most people the day starts very early. In saying that, I need to get to bed pretty soon since I am heading out tomorrow morning for my 3 day trip to Loma Larga.
Photo Album

Preparation and Down time June 23

2009-06-26T22:28:00.006-04:00

On Monday, I headed to the pharmacy for my pharmacy orientation. Joe took us for a little tour of the ship and then walked us through the process that a patient would go through when they came aboard the ship.
The only patients on board are the patients who need surgery. They are screened at the clinic sites and then the patient with their escort will be transported to the ship either by helicopter or hospitality ship. A patient once aboard the ship will be take to CASRAC to fill out the necessary paperwork to be admitted to a hospital.
Once they have been admitted, they will spend the night in the “Comfort Inn.” The Comfort Inn is a ward where patients can sleep well the night before the surgery. There are 80 beds in this ward but generally only 40 are used. Most of the escorts will sleep on mattresses on the floor or cots that can be placed near their loved one.
The next morning patients will begin being prepped for surgery in the staging area of the OR. When the surgeons are ready the patient will be taken back to the OR. They then head to PACU where the patient will stay 30 minutes to 3 hours depending on their pain management and their recovery progress. After the PACU the patients will head to one of two wards: the ICU or the AFT 2 (the outpatient ward).
Most patients are only on board for a total of 3 days. Patients are usually discharged the day after their surgery with Percocet for pain and some type of oral antibiotic. There are a few exceptions to this length of stay. The longest a person has stayed on board is 8 days and some of that time the patient was in the ICU.
The pharmacy has a very important role to fulfill. It has been very slow for the past few days since we really don’t start seeing patients until the 3rd day in port. Most of our drugs were prepacked for this country en route, so there hasn’t been much for us to do. (There are 4 other pharmacy students from UCSD on board. I don’t think that the Lt. knew that they were coming).
The first order of business for the day was to get two sets of “uniforms” prepared for us to head ashore. When we first got on the boat, we were given two cans of permethrin spray. In order for us to go on land, we have to spray a pretty heavy layer of permethrin on our clothes (one can for each uniform). This treatment will help to repel bugs as well as protect us from contracting certain insect related diseases. So the lot of us headed down to the aft armed with gloves, goggles, and hangers. Once sprayed the clothes are hung on the line near the aft and let them dry for about an hour. Then head down to mission laundry to get our clothes washed before the next day. This coating on our clothes is good for 6 washings. The military uniforms are sprayed so well that they can wait a year before getting their uniforms treated again.
One of our other projects over the last few days has been to prepack meds that will be sent as replenishment stock to each of the sites. We started out with children’s chewable vitamins. We dump all of the vitamins into a large bin and then take vials that are marked with a line around the middle that shows you what approximately 30 vitamins looks like. Then we bag them and label them. We also had to bag albendazole. We spent most of the day today cutting the tablets in two with box cutters and there was powder everywhere. The pills are shaped funny so a regular pill splitter wouldn’t work. At least the chief had a good sense of humor about it and made everyone stickers that said, "I got De-Wormed today." We also have one pill counting machine which helped a great deal when counting the 10,000 Motrin that arrived today.
Soon I will head out to Loma Largos for three days for an overnight trip. I will be staying ironically in the Comfort Inn located near our site because we are so far away from the ship to return each day.
Photo Album

Traveling, Traveling, Traveling

2009-06-26T22:26:00.003-04:00

My day began early in the AM waking slightly before 4:15 am. Since I had read the packing list a hundred times and packed the before, it only took me a few minutes to get ready for the adventure of a lifetime. Arriving at the airport around 5 when it opens, I was amazed to see so many people crowding the ticket area. I never imagined that the tiny little airport would be so busy at that time of day. After a long line at the checkout counter and an even longer one at TSA, I finally made it to my gate where I was informed that had I been 3 minutes later, I would have missed my flight! Luckily, I made it and the flight was short and uneventful as all flights should be.

Arriving at Atlanta, I filled my 2.5 hours exploring the airport, devouring a smoothie, calling my folks for the last time, and finding my new gate assignment. When we boarded the plane, I was delighted to find that I had been booked in business class. It was the first time I had the pleasure of being waited on as if I was someone of importance. They provided me with a wonderful lunch: chicken and vegetables with pasta, fresh garden salad, a whole wheat roll, and a heavenly brownie cheesecake. The food was phenomenal and hours later I would be so thankful for that meal and the stroke of fate that fed me.

On the plane ride to El Salvador, I began to worry about not being able to find my transportation from the airport to the boat. I had not received anything except my flight Itinerary. I began searching my flight to see if I could see anyone else wearing a Project HOPE shirt or hat but to my surprise there was no one else on my plane that was heading to the ship.

When we landed, I was fortunate to make it through customs and immediately spot another "HOPEY" volunteer. With a group of about 6 of us we made it through baggage claims and headed outside where we met several more volunteers waiting on our ride to the ship. Once everyone had gathered we were told that we could not find the bus. We sat there for about 4 hours frantically searching the parking lot and making phone calls to the ship where our leader was informed that the bus indeed was there.

We were all starving by the time we figured out that our bus driver indeed was there at the airport; and in fact, he had been there since we arrived. He was holding a sign that said "CONFORT" which is a local hotel so we were told that he was not our ride. In addition he was told to pick up the CONFORT volunteers and all of our shirts said Project HOPE. This little mix up was a blessing in disguise because it allowed us to get to know the other members of the HOPE team.

Once on the bus, it was a 3 hour ride across the beautiful countryside of El Salvador. With it being the rainy season, the sky was a gunmetal gray and everything was newly bathed in fresh rain. The landscape of El Salvador was breath-taking. The lush green color of new life flowed over the land as we traversed the country. I was amazed at how nice the houses looked along the road with the architectural flourishes that adorned some of the homes and businesses. I was surprised to see how clean most of the streets were compared to what I had seen in Nicaragua just 5 short weeks ago.

Our bus journey ended as we rounded the corner into an El Salvador Military base. Everyone on the bus was so excited we began to frantically search the shoreline for a glimpse of our new home. We piled out on the pier, snapping as many pictures as we can. We were greeted by several officers and civilian seamen, but there was no Comfort.

The original plan was for the Comfort to dock at La Union. El Salvador was supposed to dredge the port so the Comfort could dock there, but for some reason the port was not dredged. Because of our ship's size and the port is not as conducive for the ship, the Comfort has to dock 12 miles away. Traveling by a small hospitality boat, it takes about an hour and a half to traverse the distance and go around a small island to get to the bay were we are anchored. Our group had the pleasure of taking a smaller transport boat called a hospitality boat over to the Comfort.

That was a delight in and of itself. I was lucky to get on the first boat ride over to the ship for the second hospitality boat wouldn't arrive on ship until 2 hours later. It was dusk with a light mist on the air when I donned my lifejacket and found a seat that offered a breeze under the canvas awning. With the steady humming of the engine we rode the waves up and down, up and down. With green and red flashes of light from buoys guiding us to our destination, we skimmed over the sea.

The smell of the recent rain combined with the salt water of the sea made an interesting aroma of adventure. As the sun set and darkness enveloped the rest of the world, the only light remaining was the one light on the back of the ship illuminating our American flag. With a sporadic spry of sea water teasing my hair and clothing, it began to sink in that I was in the middle of a tropical place preparing to board a huge ship. Bobbing up and down with the thrum of the engine and the gentle murmur of shouted conversations, I swelled with pride at being able to be a part of something bigger than myself.

Once our ship game into view we began to wonder how we were going to board such a massive floating vessel. The captain explained that the Comfort would lower a life boat down the side of the ship and we were going to tie our hospitality boat to the lifeboat. We needed to be very careful transferring from boat to boat. With the swells, you had to pick the right timing to jump over to the other ship. Once everyone had been transferred to the lifeboat and all the luggage had been switched over, the crew of the Comfort hoisted us aboard.

We ended up getting to the ship about 8:30 pm central time. We had to fill out some forms and have out temperatures taken in order to move on to the galley for a late night meal. Dinner never tasted so go after hours of traveling. After an abbreviated ship orientation, we headed down to overflow berthing where I would get my bunk and locker assignments. Tucked in to my middle bunk, I was ready to close my eyes and get some well needed sleep.
Photo Album

Blogspot

2009-06-25T22:12:00.003-04:00

The internet access is very bad on the ship right now due to where we are anchored and the fact that the internet on whole ship on has 1 megabyte to draw from making things very slow and difficult to upload. Right now I am at the Comfort Inn in San Miguel, El Salvador participating in a RON (remaining over night) venture. I will have access to the internet during the next day or so but then I will be back on the ship and we will have to see how that goes.

I am doing fine and am having the adventure of a life time. I will see if I can send some pictures here shortly.

Beth Johnson
P-3 Student
Shenandoah University
Bernard J. Dunn School of Pharmacy
efurrow@su.edu

Project HOPE volunteer team for El Salvador

2009-06-25T15:13:00.003-04:00

Meet the Project HOPE volunteer team for El Salvador, including SU student Elizabeth Johnson.

http://projecthopeinthefield.blogspot.com/2009/06/meet-project-hope-volunteer-team-for-el.html

2009-06-23T23:43:00.001-04:00

Welcome to Rx Project HOPE. This blog is to share the experiences of 3 fourth year pharmacy students of Shenandoah University Bernard J. Dunn School of Pharmacy who will be partaking in the inaugural experiential rotations with Project HOPE (www.projecthope.org).

Elizabeth Johnson will be going to Latin America from 6/22 to 8/28 on board the USNS Comfort. Benedict Baidoo, Pharm.D. will serve as her pharmacy preceptor. Her experience will include the following nations: Columbia, El Salvador, Nicaragua, and Panama.

John Hammill will be going to the Pacific from 6/24 to 7/3 on board the USNS Richard Byrd. John Nett, BS Pharm, MBA will serve as his pharmacy preceptor.

Stephen Creasy will also be going to the Pacific from 7/30 to 9/18 on board the USNS Richard Byrd. His preceptor has not been named yet.

The Pacific trip with the USNS Richard Byrd will visit the following nations: Samoa, Tonga, Marshall Islands, Solomon Islands, New Caledonia, and Kiribati.

This unique experience has been made possible by many individuals. On behalf of Project Hope, many thanks go to Matthew Peterson, Program Manager, Special Projects; Dana Fitzsimmons, Team Leader, Medical Outcomes Specialists, Pfizer Global Medical; and the Project Hope staff for their hard work and dedication in making this possible. On behalf of Shenandoah University, much gratitude goes to Dr. Alan McKay, Dean, School of Pharmacy; Dr. Bryon Grigsby, Vice President of Academic Affairs and Senior Vice President; Dr. Tracy Fitzsimmons, President, Shenandoah University; Ms. Wanda Coffey, Experiential Coordinator, School of Pharmacy; and the School of Pharmacy staff for their assistance and support in making the experience a reality.

Please visit the blog often to learn of the experiences of the pharmacy students as they partake in this adventure.