5/27/15: Before I Depart
Hello Everyone! Before I begin sharing this amazing journey
with you, I just need to state a quick disclaimer. The postings on this blog
are of my own experiences and thoughts, and do not represent Project HOPE’s
positions, strategies, or opinions.
Ok, now that we’ve gotten that out of the way, I’d like to
tell you why I decided to apply for the Project HOPE rotation. When I first
heard about this opportunity during P2 year, I was instantly intrigued. While
other people were turned off by the idea of close living quarters and insane
tropical summer heat, I was still very curious. I decided to read
the blogs written by students and their experiences on the Project HOPE
rotation, which got me even more excited about the organization. I’ve also
always had an interest in public health, and would love to gain a better
understanding of international healthcare. Speaking of international, this will
actually also be my first time traveling outside the country, which is another
reason I applied for this rotation. Pharmacy school does not lend much time for
world travel, so I am beyond grateful that I am being given the chance to learn
about pharmacy and experience diverse people and cultures at the same time.
And of course, there is the amazing Project HOPE
organization itself, that I am so proud to be associated with. Project HOPE has been providing education and
humanitarian assistance to developing countries for almost 60 years. What is
truly special about Project HOPE is that they provide sustainable healthcare in
these countries. Not only do they provide medical care and medications to people in
need, but they also provide education to health care workers as well. These
healthcare professionals can then take what they have learned, and assume responsibility for treating and educating even more people, to create a sustainable healthcare
system in their nation. This makes me hopeful that even with a short amount of
time spent in these countries, we can leave an everlasting positive effect on
the patients and healthcare providers we encounter.
Now, I know this all sounds so exciting, but I must admit, I
am beyond nervous! Tomorrow I head out
on my first international flight all by myself to a country and language I am
not familiar with. Then I get to meet an entire naval ship full of new people,
and adapt to environment I’ve been told is comparable to “camping with 40 women
in one tiny space for an entire month.” Every aspect of this experience will be all
new to me, so I’m sure I will have lots to share. Wish me luck, I’ll update you
all on ship life as soon as I can!
5/29/15: First Day as a Shipmate
Well I would say that solo international travel was a great
success. I even managed to recall enough Spanish to make it through my Colombia
layover, and ask my flight attendant for an empanada and “Coca-Cola Light.” However,
I did encounter my first issue with communication on this trip, as I got
through customs and baggage claim and still was not able to contact Teneall to
find out where to meet her in the airport. Luckily, I wore my Project HOPE
shirt on my travels, and she wore hers as well, so we easily recognized each
other as we both walked aimlessly around the exit area. I was one of the first
people to arrive that day, so we travelled back to the hotel, and went our
separate ways to get in a quick nap before picking up the rest of the
volunteers later that evening.
Eventually Aquisi made it to the hotel, and we decided to
discuss our travels and excited/nervous feelings over dinner at the hotel
restaurant. While we were eating we noticed a group of women at a table
diagonal from us, and thought we heard them discussing “mustering.” I knew that
this was a ship term for “meeting,” so we decided to chat them up and find out
if they were joining us on the USNS Comfort. As it turned out, the ladies were
going to be volunteering on the USNS Comfort as well with different civilian
organizations. Some were nurses with the RN Response Network Team, and others
were physicians and dentists with UCSD Pre-Dental Society. We had a great time
talking, and I’m really looking forward to living and working with this group
for next few weeks.
This morning Aquisi and I got our first dose of what the
Navy personnel call “hurry up and wait.” We were told to meet in the lobby of
the hotel around 0900 to start catching shuttles to the airport. Due to the
large number of people trying to catch the shuttle, we decided to try and meet
back around 1100. Well, 1100 eventually turned to 1215, and Aquisi and I
decided we should probably get some lunch before we head to the airport.
Finally, after making it to the airport, meeting up with the Navy personnel,
and making sure everyone was on the bus, we headed to the ship around 1400.
First view of the
ship.
After a quick bag check, we entered the ship through
“Casualty Receiving (CAS REC).” As if that’s not morbid enough, we were soon
told that the dark red coloring of the floors was to camouflage the blood that
could cover them. Good news is, this ship is not likely to see any of that
during this mission. Then we travelled all the down to bottom deck where the
NGO berthing area is located, aka "home sweet home." I decided on a middle bunk,
which seemed best suited for my height, and we were each assigned two
lockers, which provided just enough room to store our belongings. We got a
quick speech from the “deck mother” Kate about respecting space and keeping
things tidy, which I think might be difficult with 40 women in such close
quarters.
The Casualty Receiving
deck, or “CAS REC.”
After taking some time to organize our things, we headed up
all 84 stairs to the mess deck for training and dinner. The food was
surprisingly tasty, and we even got some ice cream during the training
videos.
The last stop for the evening was the pharmacy department,
where we were introduced to the team and got a quick tour of the pharmacy
space. Unfortunately, we aren’t able to be very involved in the pharmacy work
on the ship, as we don’t have access to the computer system. Lt. Xie did make
sure that we would be added to the on-shore schedule, so we should be able to
work out at the med sites later this week.
Right now I am sitting in the NGO lounge, which is the only
room on the ship civilians have access to the internet. I’m old enough to
remember dial-up internet, so believe me when I say this internet is SLOW. It’s
about time to head down to berthing for 2200 lights out. I’ll need some rest
before 0700 muster tomorrow morning and my first full day on the ship.
06/04/15: Panama MEDCAP
This week Aquisi and I have been lucky enough to leave the
ship and travel to two different MEDCAP sites in Panama. Here in Panama we are
docked at a pier, which means we can easily leave the ship and take bus
transportation to the sites. Not as exciting as a helo ride to shore, but we
get to sleep in much later. I usually
wake up around 0515 to make sure I have sufficient time to get ready in the
dark. While I’m used to not leaving home without some mascara and hairspray, I
brought neither of those things on the ship with me. DEET, sunscreen, and a
water bottle are the staples during this mission. I usually head to the mess
deck for breakfast, grab an MRE (meal ready-to-eat) from CAS REC, and muster on the pier at 0645
before getting on the bus.
Both MEDCAP sites are located at local schools. At each
location there is a center courtyard where the larger waiting areas for general
medicine, dental, and pediatrics are set up. Surrounding the courtyard are
buildings with cement classrooms, which are converted into treatment areas,
radiology, and pharmacy. There are several more types of practitioners than I
expected, including general medicine, pediatrics, dental, women’s health,
radiology, mental health, nutrition, cardiology, and physical therapy.
Some of the waiting
areas at a MEDCAP site.
The pharmacy is strategically located just before the
discharge desk, as patients make their way out of the compound. Medications
were brought to the sites earlier this week, and stored in large red totes.
There are about 80 drugs on the formulary, including antibiotics,
multivitamins, NSAIDs, antifungals, and antihistamines. There are usually 4-5
pharmacy team members working daily, which includes two techs pulling meds and
tallying the drugs dispensed, myself, and one pharmacist checking
prescriptions. We are lucky enough in this country to have translators from the
local high schools who volunteered to help us during this mission. We have had
the pleasure of working with one translator named Dashi who is applying for
medical school in Panama. She has been such a pleasure to work with, and is truly interested in medicine and providing the best treatment for these patients. She has also been kind enough to give us some Spanish lessons, although she does tend to giggle at our terrible accents!
Medications and
supplies are stored in red totes inside the classroom.
The weather in Panama is certainly hot, but not as terrible
as I was expecting. The temperature usually ranges from the mid to high 90s,
but with enough water and a fan, the days are tolerable.
Some pharmacy team
members need a quick snooze before they start the hot and busy day.
The patients we have seen thus far have been very kind, and
grateful that we are there. We make sure to counsel every patient about their
medication, and they don’t often ask any questions. I’m not sure if this is due to
the language barrier, a difference in culture, or maybe even a trust issue. I
have seen a variety of health issues from ear infections, parasites, fungal
infections, malnutrition, hypertension, and chronic headaches. The majority of
patients, even those with chronic conditions, are prescribed multivitamins and
acetaminophen. Unfortunately we are only here for a short time, and don’t have the means to treat and monitor chronic conditions such as diabetes or heart
failure. It is incredible though to see how grateful these patients are for a
simple multivitamin or ibuprofen. I have gained a new appreciation for US
healthcare, and a much better understanding of the extreme lack of access to
healthcare that these people face.
Although I wish we could do more for these patients, my
experiences at the MEDCAP sites have been incredible. Each site averaged about
1,000 patients per day, and the pharmacy record was site at 1,400 prescriptions
at Site-1 in a single day. As we pack up Panama and head out to El Salvador I
am excited to see how the culture, people, and health disparities will differ. Hopefully
the internet will be speedy enough during transit to allow me to practice my
Spanish. I’ve gotten “uno tablet cada dia” down, but I’ve still got a long way
to go.
6/12/15: Ciao Panama!
We have officially left the pier in Panama, and travelled
safely through the Panama Canal on our way to El Salvador. Traveling through the Canal was an amazing, once in a lifetime experience. We reached the first lock
at around 9 am on Tuesday, and to be honest, I did not think we were going to
be able to fit the ship through. These areas of the canal are about 110 feet
wide, and the USNS Comfort is about 108 feet wide, so it was definitely a tight
squeeze. I spent a lot of time on the flight deck just looking at the scenery
and watching the mechanics of the Canal at work.
Heading through the
first lock of the Panama Canal.
The USNS Comfort has
an extra-tight squeeze through the locks of the Panama Canal.
There isn’t really much to be done as far as work goes while
the ship in transit. The pharmacy staff spent a lot of time preparing
medications before Aquisi and I got on the ship, and they actually managed to
finish pre-packing for every country on the mission besides Haiti. They have
had some trouble finding correct translations for the medication labels in
Creole, so pre-packing for that country has been halted for now.
I have been doing my best to keep myself occupied and not go
cabin-crazy. I love reading, so much so actually that I’ve finished five novels
since boarding the ship. I was spending a lot of time in my favorite blue deck
chair soaking up the sun, until I had a nasty photosensitivity reaction from my
doxycycline. No worries though; some fexofenadine, hydrocortisone, and several
extra layers of sunscreen later, I’m cleared for sunshine again.
My favorite reading
chair on the deck.
A couple of days ago I also had to opportunity to shadow an
anesthesiologist in the OR. He took me through the entire process of preparing
for surgery from picking up the medications in the pharmacy, to drawing up all
the correct medications, putting the patient to sleep, and waking them back up
again in post-op. The surgery was performed to remove nodules from the muscles of the
hand in a patient who was unable to move her fingers. The surgeon was nervous
before opening her up that the procedure would be lengthy, and he may not be
able to remove all of the nodules. Though luckily, he said the disease had not
progressed very far at all. He was easily able to remove the nodules in less
than an hour, and expected the patient to make a full recovery.
I’m sure there is far more to this ship that I haven’t
explored yet, and I look forward to telling you all about it!
6/15/15: Life Under Weigh
Today is day 6 out of 8 days of transit across the Pacific
Ocean. Since we are not seeing patients while we are in transit, I have had to
really take advantage of activities on the ship to keep myself occupied. There
is actually an entire office run by the “fun boss” that is
dedicated to keeping morale up on the ship. The MWR (Morale, Welfare, and
Recreation) office schedules Salsa lessons, fitness classes, and offers a wide
variety of movies and games for rent. Aquisi and I did our best to learn some Salsa
moves, and I have been taking advantage of the Spinning and Insanity
classes. We have also had quite a few
game nights in the NGO lounge. Cranium and a charades game called Heads Up seem
to be crowd favorites, and we’ve spent some long nights laughing so hard we
cried.
Salsa lessons are a big hit every Monday night.
I must say, besides the incredible experiences I have had on shore, the best part of this trip so far has been the people I have met. So many of the civilians on this ship have dedicated months of their lives and precious vacation time to volunteer on this mission. And for many, this is not the first or last time they plan on volunteering for a mission like this. They are some of the most caring, patient, and down-to-earth people I have ever met, and I am absolutely honored to be working with them. I wish I could pack them all in my duffle bag and bring them home with me!
Game night fun always includes tasty snacks and a competitive round of Cranium!
No helo rides this rotation, but it's still neat to look at!
We have had some great times with the Navy personnel as
well. Even while we are under weigh, we muster at 0700 and 1630 daily to go
over the plan of the day and make sure everyone is accounted for. As civilian providers, we are actually
considered at the same level as Naval Officers. It’s always humbling every
morning to stand with the Naval Officers and enlisted as they fall into
formation and recite the Sailor’s Creed. As civilians, we have all volunteered
to be on this mission, and we can easily forget that for these Navy personnel,
this mission is a deployment. They might not always be in the best of spirits, which
is understandable because they did not choose to be deployed or leave their families
for six months. That being said, the pharmacy crew has been so accepting and
open to us since we arrived. Every evening I look forward to our department muster
and hearing HM3 Hedgespeth’s “words of wisdom,” which always give everyone a
good laugh.
I’m going to be honest and say that some days under weigh are
much easier than others. Some days are a struggle to keep ourselves occupied
and content with ship life. We are very lucky to have such interesting and fun
people to interact with every day. I’m sure we’ll find some more nooks and
crannies of this ship to get into before we arrive in El Salvador!
6/17/15: Exploring and Learning
As promised, there were certainly some more nooks and
crannies to be explored on this ship. The Project HOPE team leader Colleen was
able to set up tours of the engine room this week for anyone interested. Quick
side note: Colleen is an AMAZING lady. She is actually a retired Navy flight
nurse with 30 years of service. She came onto this mission as a civilian to
lead the Project HOPE team and she has done an incredible job at getting us
acquainted with Naval ship life and making sure that we are all happy and
comfortable.
When I first heard we were going on a tour of the engine
room, I had flashbacks of the Titanic movie, and men shoveling coal in giant
machines. Well, it wasn’t quite like that, but I’m sure it was just as HOT! As
soon as we got down to the lower levels of the ship we could feel the heat
rising worse than anything we had felt on shore in Panama. We put in our
industrial ear plugs, and made our way down tiny ladders all the way into the belly
of the ship. It was truly amazing to hear from the engineers all the hard work
they had to do on a daily basis just so we all could take our “Hollywood
showers (actually being able to leave the water on while you soap up).” Another large issue the engineers have to
deal with is garbage. Garbage separation is a VERY serious thing on the ship,
especially since weeks before someone had put an aerosol can into the paper
trash and caused a fire.
The inner workings of the USNS Comfort!
Over the past few days we have also had the opportunity to listen
to presentations given by Navy
practitioners. One presentation was dedicated to
reviewing the updated ADA guidelines and basic diabetes treatment. I was
actually surprised at how much I remembered, and how well I could follow along
with the cases (thanks Dr. Havrda!). I
also listened to a presentation given by a pediatric endocrinologist who
discussed the exogenous and endogenous causes of childhood obesity. This talk
was particularly interesting because it was not a topic that we had previously
learned in depth. The endocrinologist explained that childhood obesity is a
known epidemic in the US, but is also a major issue in developing nations where
there is limited access to fresh fruits and vegetables.
We should be docked in El Salvador within the next couple of
days. I’ve had a great time being able to explore the ship and take advantage of
the activities MWR has to offer, but I m definitely ready to step foot on land. I can’t
wait to see what El Salvador has in store for us!
6/22/15: On Shore in El Salvador
This week we arrived safely in El Salvador, and I have
travelled to two different MEDCAP sites. I was really quite nervous about going
on shore in El Salvador, as we have been repeatedly warned how dangerous and
violent the gangs in this country can be. All personnel have to cover their
tattoos, and the RNRN team even questioned whether their solid red shirts would
be safe. I’m sure there are areas of the country that are more dangerous than
others, but from what I have seen, the people of El Salvador are incredibly
open and joyful, and grateful that we are here.
A sign welcoming the USNS Comfort to El Salvador.
The sites here in El Salvador are school compounds, and set
up much like they were in Panama. However the landscape, especially at site-2,
is stunning. There are a lot of mountains and green fields, and plenty of shady
areas in the courtyards. One of the first things I noticed about the patients in
El Salvador was that they were very open about their healthcare needs, and asked
many questions. The people of Panama seemed more closed off and less interested in conversation, so this is a very nice change.
The gorgeous view from med site 2.
One new addition to the El Salvador med sites is a patient education room. In this area patients can watch videos in Spanish about a variety of topics ranging from dental care to hypertension and diabetes. One of my major concerns with this mission has been the outstanding number of patients that the providers have been seeing. On a daily basis, a single general medicine physician has been averaging about 80-100 patients per day! With the language barriers and limited time with patients, I’m worried that providers aren’t able to provide adequate education about chronic health conditions. The addition of the patient education room has been a great success, and patients are able to learn and ask questions about their condition without feeling rushed. I have even been asked to provide some asthma education this week, which should be a lot of fun.
Another difference between El Salvador MEDCAP and Panama is
that we have seen some awesome entertainment!
At my first day on shore, the Navy Band came to the site near the end of
the day and played music with local El Salvadorian musicians. This may have
slowed patient flow down a bit, but no one seemed to mind. Patients, civilians,
and even Navy personnel went out to the courtyard to take pictures and dance.
It was an amazing way to end the day, and a great start to my last week on
shore. I am so impressed with the people and culture of El Salvador, I may never want to leave!
The Navy Band playing along with local El Salvadorian musicians.
6/24/15: Venturing Out of La Farmacia
I’m sure that we have all spent our fair share of time trying to decipher physician's handwriting. Now imagine a combination of rushed
writing, bad penmanship, and foreign physicians who are unfamiliar with US
prescribing standards. Needless to say, we have had some difficult times in the
pharmacy reading prescriptions, let alone trying to decipher the patient chief
complaint and diagnosis. So, I decided earlier this week that I should venture
out of the pharmacy and head straight to the source. NGO physicians in general medicine,
dental, and pediatrics were kind enough to let me step out of the world of
multivitamins and acetaminophen for a couple days and shadow them as they saw
patients.
First I sat with a general medicine physician known as Dr.
Tim, who was volunteering on the ship with the Latter Day Saints Charities
organization. Dr. Tim is fluent in Spanish, which I could automatically tell
put patients at ease, as they could talk directly to him, and not through an
interpreter. The chief complaints in El
Salvador did not seem to differ much from what I witnessed in Panama. We saw a
lot of fungal infections, prostatitis, and osteoarthritis. One interesting case
was a man with severe back muscle spasms who we could see was standing
unevenly, with a lot more weight being placed on one hip. Dr. Tim checked out
his back and hip for a while, and then finally discovered that the man was an
amputee, and had an ill-fitting prosthesis that was causing him this pain.
Unfortunately, we were not able to provide the man with a new prosthesis, but
we could offer him a pair of crutches and exercises to loosen his back
muscles.
A General Medicine sign that had been made by the children at the school.
I also spent some time with the dental team and a Project
HOPE pediatrician this week. There was a very large group of children at the
school yesterday, so dental took the opportunity to bring them all together to
watch a video about brushing and flossing your teeth. I was also able to watch
as they prepared and applied a fluoride treatment to the children’s teeth. This
must have been a nice change from the hundreds of tooth extractions they have
been performing in these countries. Pediatrics was also a fun and interesting
change of scenery from the pharmacy. I
would say the most common complaint from parents was that their child was not
eating enough or gaining weight. This was most often due to malnutrition,
constipation, and parasites. We dispensed quite a lot of multivitamins,
docusate, and Pin-X in these cases.
The dental team showed children in El Salvador a video about brushing your teeth.
Kim is preparing fluoride to apply to children's teeth in El Salvador.
There was one pediatric patient in particular though that I
will never forget. A teenage girl no older than 14 had been born with some type
of cerebral palsy, and had developed some pretty severe muscle atrophy due a
lack of exercise and physical therapy. She was so tiny, and her mother did not
have the means to afford a wheel chair, so she pushed her in a small stroller.
This family had obviously been struggling for a very long time. Yet, the mother
and little girl had smiles that never faded, and were eternally grateful just
to have the opportunity to be seen by our physicians. Thankfully, we were able
to provide this patient with a new wheelchair. She was absolutely elated, and
said that this was the greatest gift that had ever been given to her. It’s moments
like this that I am reminded of why I chose the healthcare field, and why I
applied for this rotation. An item that we could simply pick up at a local
pharmacy, or get through insurance in the US will significantly improve this
patient’s quality of life.
We were also lucky enough to have some more entertainment at
the sites this week. Children from the local school came to the compound to
hold a cultural exhibition. They dressed up in their native colorful dresses
and make-up, and performed dances and musical numbers. It was incredible to see
how much pride the El Salvadorian people have in their culture. Even those who
were not involved in the exhibition put on their “Sunday best” to come to the
med site, and took great pride in their appearance. One thing I found particularly interesting
about their dress was the aprons worn by the older women. They were all
homemade, and it was obvious that a lot of time and care went in to their production.
It was very interesting to see all of the different styles and colors.
Children performing native dances at the cultural exhibit in El Salvador.
Volunteering at the MEDCAPS in El Salvador has been an
incredible experience. I’m glad that I was able to work with the pharmacy team
and also venture out to experience a different aspect of patient care.
6/25/15: Time to Say Goodbye!
My time in El Salvador aboard the USNS Comfort is quickly
coming to an end. Today was supposed to be my last day at the MEDCAP, but the
schedule had to be rearranged so that those of us departing could have our
passports stamped today instead. We had never officially entered El Salvador,
which would have made for some difficulty when trying to exit the country. I am
so grateful for the time I was able to spend on shore in El Salvador. The
people, culture, and country were all so beautiful. I hope that I was able to make an impact on
my patients comparable to the impact they left on me.
I am so sad to have to leave the amazing group of people
that I have gotten to know over the past few weeks. Getting adjusted to ship
life was no easy task, and I don’t know how I would have fared if it weren’t
for the NGOs and Navy personnel who helped me out when I got lost, or gave me
hints on the best times to hit the shower and laundry room. Coming into this
rotation I knew that working with patients and witnessing the health
disparities in these countries would leave a major impression on me. I would
never have expected that I would gain so much from the people that I have lived
and worked next to every day. I’ve gained a new sense of patience, kindness,
and selflessness from these people who volunteer months of their lives to help
others in need.
The amazing USNS Comfort pharmacy team!
All of the incredible NGOs aboard the USNS Comfort for rotation 3!
Tomorrow morning the last tasks left to complete are to
clear my rack and head up to CAS REC to be officially deleted from the ship
system. A bittersweet moment for sure. I am so excited to be home to my family
and real mattress, but I will never forget my time spent aboard the USNS
Comfort. Thank you to everyone who helped me prepare for this rotation and
navigate life on the ship, and happy sailing to those still aboard!
