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.