Market Research

What happens when the internet is not working, your time to work on a worthwhile project is counting down, and the weather is nice?
You do your market research on foot!
Googling (is that a verb?) this area previously had not produced beneficial results. I decided it was time to venture out of the hospital and find out what local hospitals and clinics there were in the area. This was to deem the "competition" for MRN and how it could improve its processes based on other available healthcare in the area.
With the help of wonderful MRN employees (Amy, Modeste) we were able to come up with a list of private clinics (and the one public hospital) in the area and a game plan to research them. Modeste and I ended up hiring a motorcycle taxi to take us to all the locations in the area; there are six private clinics in the immediate surrounding neighborhood (Ahala). By this time I had become very comfortable with riding the motorcycle taxi. I created a list of questions I wanted Modeste to ask the clinics as they were less likely to communicate with me [outsider]. We spent 1-2 hours completing this and celebrated our success over beignets. The information gathered from this endeavor was included in the field report created for Project HOPE.
What this research showed me is that when one doesn't have ready access to needed information, you have to get creative. Think outside the box and step out of your comfort zone. Its akin to going to the library and looking up the needed information in books; who does that anymore when you [normally] have the power of the internet at your fingertips. It's just not so in most other parts of the world.
Anyways - this was probably as fun an experience as I'll have doing "market research".

Cameroonian Pharmacy

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

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

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

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?

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!

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

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

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.

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

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!

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

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.

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

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

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

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...

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

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

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!

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!

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

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