The Spice Islands

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

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

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

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

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...

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!

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

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!

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!

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

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

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!

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…

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

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!

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

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...

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!!!

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

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!

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!

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!

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!