Life onboard the ship June 24

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.
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Preparation and Down time June 23

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.
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Traveling, Traveling, Traveling

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.
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Blogspot

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

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

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.