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.