Continuing Promise 2015: Doh-mah-nee-kah

WiFi on the ship has been down for the past week and will be for the foreseeable future as someone plugged their laptop into the router in the middle of the night and hacked the password...now the seabees have to build a box to lock around the router so it doesn't happen again...they are busy out at site building ramps...
I'm currently out in Dominica enjoying a nice breakfast with good coffee...not galley sludge...Esther and I were able to get an early special liberty since usually we can't go out until after duty hours (1600-2030)...
Since arriving in Dominica on Monday July 27th I went out to site #2 on Tuesday which was an hour bus ride along the coast...this site was also at a school that is open air but we had a spacious room and lights and a fan...the best site since the mission has started...that's not say it's not without its challenges but the patients speak English with a few pockets of Creole so there was no need for translators...all the patients were very friendly and there was even a sports tournament going on...I believe its called the windward games...it's the 4 neighboring Caribbean islands that compete in basketball,volleyball, futbol, etc...

the navy band was also on site for a little bit...

The next day (Wednesday 28th) Emily and I were able to attend a SMEE at Princess Margaret Hospital with LT Phung and HM3 Fowler...we took a tour of the hospital which was also open air...it's a very weird feeling seeing that after going to the OR which is basically an upgraded double wide trailer the patient is wheeled outside across to the PACU...all the wards were big open bays full of those old school shopping cart like meds...like the kind you see watching the Pearl Harbor/ any WWII movie...everything they do is handwritten and there are only 4 pharmacists and 1 tech for around 260 bed so they do not have time to actually do their job they spend it handwriting labels and logs...we spent time explaining how to go about installing the laminar flow hood they acquired...they did not have a hood for inpatient IVs the nurse does it on the floor....we ended the day seeing a man who just died...a man we had seen within the past 30mins alive in the hallway...being wheeled on a gurney through the crowd uncovered...a patient had bled all over the floor so they almost slipped....another aspect that was interesting was that a peds surgery patient who was around 7yrs old was all alone...I think it would be rare in the states to have your child in the hospital and not be by their bedside...

Wrote this from my cell phone at the Fort Young hotel....all is well and I will upload more if the Wi-Fi comes up on the ship otherwise I will post a final blog once we land in Barbados

Continuing Promise 2015: This is a REALLY LONG TRANSIT

I know it has been a while since I posted...I was able to get on Facebook for a few minutes on the 21st to send my sister Katie a happy birthday message and post a picture of the Panama Canal...other than that I have had extremely poor luck connecting to the internet...Emily posted some pictures in her last blog post so I won't post ones that look exactly the same from the exact angle since we were standing right next to each other on the bridge...and with that #ThisTransitIsLong #ThisTransitIsLooooong #ShipLife #81StairsEverydayUpandDown 

JULY 18, 2015 SATURDAY

            Not much going on today besides Bingo on the mess decks…it was a huge crowd since there were cash prizes and a 3 night stay at the Hilton in Barbados for liberty. So much fun we played 4 games and there was so much competition and cheering it was really a great morale booster.

JULY 19, 2015 SUNDAY

            We spent most of the day in the pharmacy playing games…mainly werewolf…which I’m told is like mafia but I’d never heard of either…this group is so competitive and loud and hilarious...we've even started to recruit some UCSD dental students to play

JULY 20,2015 MONDAY

            Today was all about RISK...that is all that needs to be said...if you've ever played RISK you know friendships are gained and lost with nothing but world domination in mind...everyone is a salty sailor when it comes to RISK...we also had field day...which is really just commands way of giving us cleaning time from 0800-1100...they have a lot of different names that sound like it would be fun but its really just cleaning...Emily and I spent 3hrs cleaning scuff marks and tape residue off of cabinets...like scrub so hard with harsh chemicals we took the paint off in layers...

JULY 21, 2015 TUESDAY

            Today we went through the panama canal…the command actually cancelled some cleaning since it was field day yesterday and certain meetings so most people could spend time watching the ship go through the locks…we were actually able to go above the bridge and have a view of the front of the ship…they block the front off for crew members to handle the ropes and cables that come from the crew on shore at the canal…all of the enlisted pharmacy techs that were working today went to dinner with Emily, Ester, Jerline and I…usually we end up sitting at the NGO only tables (officers can sit there as well) but this time it wasn’t as crowded so we all got a table together which was nice…its really a family environment here everyone teases each other, has each others backs, and works hard together in the pharmacy and on site….we played RISK again...the LTs are in a very real power struggle and RISK has become life

JULY 22, 2015 WEDNESDAY

            Today Emily and I had our presentation on Dengue Fever and Chikungunya…Earl had set up time from 1900-2100 for our presentation as well as any other NGO groups that wanted to speak. All of the pharmacists and a few of the pharmacy techs attended which was very nice to have that support. The room we were in was neighboring the weight gym and had many pipes that made for a very noisy room…. definitely put us in a situation that required us to be loud enough and project our voice...I have very hit or miss presentation skills but this time even without really knowing the subject matter I felt confident...maybe its the sense of community with the pharmacy staff and NGOs here... The crowd was very supportive and had several questions….we even had one of the physicians with Latter Day Saints ask for a copy of the presentation because it was very professional and informative.

JULY 23, 2015 THURSDAY

            Today was the first day of our lecture series in the pharmacy. Each pharmacist picked a topic that we would discuss each day. LT Hand put it best in his opening statements to the discussion group: “Welcome to the first annual Comfort Discussion Series and what will most likely be the last Comfort Discussion Series”….So you know just another special treat for Emily and I.LT Hand’s topic was dyslipidemia and hypertriglyceridemia…we spent about an hour and 20 minutes going over patient cases, guidelines, and how you would explain certain things to patients….did I mention the difficulty when you don’t have access to resources and the internet to look up material…

JULY 24, 2015 FRIDAY

            Today we attended the CO Call where Captain Sears talked about what the mission has already accomplished and what to expect in the next few countries. This morning I also attended a lecture by one of the navy pediatricians about efficient and effective teaching…it was nice to here comments and different adjustments to better help and understand medical students during their time as students and residents…we got our berthing inspected today...and when I say inspected I say inspected...we had to take the "inspector" through both our lockers and rack...everyone's experience was a little different...mine was that the inspector went through EVERYTHING...my dirty clothes bag, every pocket, every nook and cranny...yeah I said nook and cranny...Today was Dr. Hsin’s (Jerline’s) topic discussion on sepsis. Jerline has a different approach to teaching where we were quizzed entirely off of the guidelines, definitions, and drug mechanisms of action and side effects. Since I have not had inpatient experience yet I was taking as much information as I could from Jerline and Dr. Moon (Ester) since they both were in residency programs this past year….we pre-packed some medications for Haiti and finished off the night with a few games of werewolf

Panama Canal Transit and more about Colombia

Today was spent transiting the Panama Canal.  For the last 2 days, we have been traveling from Colombia back to Panama City. To make sure that we did not reach the canal too early so we only traveled around 5 knots on the way back as well as doing "circles" yesterday somewhere in the Pacific Ocean.  The slower travel made for a perfect fishing speed and some of the crew caught a 150 lb marlin off of the stern.

We anchored off the entrance to the canal this morning around 1:30 am and made it to the first lock around 9 am.  We went through 2 sets of locks on the Pacific side and then entered the Gatun Lake. There of was one more set of locks on the Atlantic side that we reached around 3 pm.  Now, we are pier side in Colon, Panama to pick up supplies and then will head onto Dominica.

Here are some pictures of our transit.

Heading into the first lock. That row boat is what brings the lines out.

Going into the first lock. The men in blue are workers from the Panama Canal that get on to help navigate the boat through and get off at the second set of Pacific locks.

Tourists watching us go through the first set of locks.

This is how close the boats are to the sides of the canal. The red boat is an oil tanker going through behind us.

The boats are pulled through with the little tram like things attached by the lines brought from the row boat.

Going towards the second set of locks.

Going into the last set of locks.

Going through the last lock into the Atlantic Ocean. There is a car driving across at movable road in front of the lock.

On our way into the Atlantic Ocean.

It cost 320,000 dollars in toll every time the ship goes through the canal.

A little more about my time in Colombia:

On Wednesday last week, when I did not go ashore, I was able to shadow a nurse anesthetist in the operating room.  I was able to see 5 surgeries, including 4 hernia repairs all repaired a little differently.  

A few more days of transit and then we will reach Dominica for 10 more days of medical sites.

Goodbye Colombia

Sorry if there are pictures in weird places on the post.  The internet here is rather slow and they weren't showing up very well.

Today is the day that everything gets loaded back onto the ship from the two med sites in Colombia. We set sail tomorrow for Roseau, Dominica.

This post is a little bit about my time at the two med sites in Colombia. 

Last Thursday was our first day out to shore.  The ride to Juanchaco, Colombia was not the best for me.  What was supposed to be an hour trip from the ship to shore ended up taking over two hours.  We had to wait for our forced protection, the Colombian Navy, to ride with us into Juanchaco.  This was required for anytime we were in country to do the violence and political distress in the county.  Then, the boat I was on lost power steering so they had to manually steer the boat to the pier.  In those two hours, I found out that I definitely get sea sick without having a scopolamine patch on. I made it through and got to shore only a little less worse for the wear.

These were the boats we took to Juanchaco

Juanchaco is a small town with only around 2,000 residents.  To get to the med site, we had to walk ¾ of a mile down the beach and through the town to a school.   The pharmacy was set up in one of the classrooms of the courtyard and was the last stop for patients before they headed to discharge.  The first day we saw around 400 patients of all ages.  The most common medications that patients were receiving were Tylenol or ibuprofen and multivitamins. At the med site patients were able to see primary care doctors, dentists, optometrists, pediatricians , physical therapy as well as others.   The biggest hurdle was the language barrier. The pharmacists and some techs were able to consul the patients in Spanish because the had done this in previous Spanish speaking countries.  But, I have not had to use any Spanish in over 4 years so mine was definitely rusty.  Luckily we had a translator to help us, especially answer questions that the patients asked. 

The pier and beach that we pulled up to in Juanchaco

I went back to Juanchaco on Saturday, but this time the boat ride was closer to 1 hour.  We saw a similar number of patients. At the end of the day we were allowed to get food from the restaurant across the street from the site.  It was a whole fried red snapper, plantains, and rice.  When we came off the pier and were waiting to muster, 4 of use from Project Hope found a guy from Juanchaco wearing a Project Hope polo, so we decided to take a picture with him.

On Tuesday , Thursday, and Friday of this week, I went to the med site in Buenaventura for the first time.  This med site was further away from where the boat is anchored but we had faster ponga boats to get us there so the ride was only 45 minutes. Buenaventura is a bigger city so we walk a few blocks close to the center of town to get to the gymnasium where med site was being held.  Every time we walked past the crowd waiting for treatment, either coming or going, they cheered for us.

The pharmacy was in a back hallway so that the patients could go to the pharmacy last on their way to discharge.  This site was definitely busier than the site in Juanchaco and we did over 800 prescriptions everyday.  For lunch each day there, instead of eating MREs or peanut butter sandwiches, we got to order local food from a restaurant next door. You got a meat of some type, I always had chicken, rice, beans, something like cabbage salad, a cup of fruit juice, soup and a fried plantain all for 5 US dollars.

Yesterday was our last day of patient care and it started off rather interestingly.  We again had to wait for our forced protection, but once we were about 2 miles from the ship we stopped again.  One of the ponga boats had broken down and was having to be towed by the our Colombian forced protection.  In total we spent three and a half hours on the ponga boats to make to Buenaventura. Once we got to the city,  we arrived to cheers, as well as a woman holding a sign saying thank you in English.  Before we started seeing patients for the day, someone from the Colombian military came around with her so we could take pictures of her sign.  Even though we came late, we are able to see over 600 patients and fill over 800 prescriptions before we packed up everything to be taken back to the ship.

Now we have a 9 day transit to Dominica.  During that time we will have to help with a Field Day, a mass cleaning of the ship. We will also transit the Panama Canal and stop in Colon, Panama to pick up supplies.

Continuing Promise 2015: Colombia...ALL THE DAYS

 JULY 10, 2015 FRIDAY: BLOG POST #5

        0530 shower, breakfast, 0700 muster

         Today we attempted laundry. Out of 10 washers and dryers about half of them are out of service and since a lot of people went out to site we all had the same idea to wash clothes today…so we waited around for a free washer which usually takes 35minutes to run a load…we went back up to pharmacy and helped clean and watched movies…we went back down to switch our laundry at the 37minute mark and someone had already switched our clothes into dryers and started them so that was nice…not quite like back in undergrad when you would just find a pile of your wet clothes in the corner…

JULY 11, 2015 SATURDAY

            Day #2 at medsite #1 today I brought along $5 because there was a restaurant behind the site that was approved for us to get lunch if we wanted…the most popular dish was fried chicken, coleslaw, beans/peas, rice, soup, a fried plantain and guava juice…chicken was more just breaded but it was still a decent meal and it gave me a chance to try Colombian food. Today was supposed to be set up as a general health fair and you could tell on the walk to the site! There were tents and balloons and massive lines…in the brief before we got started they said they were expecting 20-30,000 patients to come through (we did about 860 scripts so we didn’t see anywhere near that number but still a large crowd). We got a warning about if any vendors were trying to offer us skee (or ski?) to get away because it was cocaine…you know Colombia after all…TODAY WE HAD AN INTERPRETER! Things went very smoothly on site…with the usually hurry up and wait…

            So once we got back to the pharmacy we heard that someone at site #2 got shot…turns out it was an engineer (called CBs in the navy) that got electrocuted…saying “shock” sounds exactly the same as “shot”…so there was a nice mini panic when the pharmacy was trying to get an emergency bag ready for a gunshot wound…also both helicopters were down so the patient had to endure the hour boat ride back to the Comfort…

JULY 12, 2015 SUNDAY

            The usual morning routine plus we swept and mopped the whole pharmacy…extra power hour so we cleaned the cabinets and whatever else we could find to do…this may have been part of another day’s activities but the days have started to blur together…Today I made 10 cefazolin ANCEF bags in the MIC hood…I’ve never used that kind of hood before and it was nice to actually practice making IV bags since most sites I’ve been too just have students observe…There were 2 separate patients that needed ANCEF bags for surgery prophylaxis which we did a dosage check for using 30mg/kg…patients weighed 29 and 30kg therefore the calculation looks something like this… (each vial contains 330mg/1mL)

            330mg/1mL= 900mg/x      x=2.7mL àput into 50mL normal saline bag
                   YAY! I math'd my way through it. LT X has actually impressed me with his speed of calculations in his head...his also shown me some short cuts for APAP and IBU dosing...he worked it out and proved it to me of course but man does it amaze me how some people's brains work

JULY 13, 2015 MONDAY

            Today I mixed Zosyn 3.375mg…everyone hates making the Zosyn because it takes a pretty long time to reconstitute…but I liked the practice…LT Xie went over the chemical structures of morphine and heroine and compared them…morphine has an OH group where heroine has COOH which makes it more lipophilic therefore crossing the blood brain barrier more easily and having a more addictive profile. I went over my notes on sedation and ICU since there are now plenty of patients on board getting surgery and if I ended up back in the OR I wanted to be prepared for any questions that would get thrown my way…

JULY 14, 2015 TUESDAY

            Today was my first day at medsite #2 in Juanchaco…this site is definitely what you think of when you think of rural places we would go to provide healthcare…today we rode out on the hospitality boats (canvas covers)…the ride to the site is longer and slower than to site 1…I listened to the Wilder Mind Mumford & Sons album all the way through consecutively 3 times + another random assortment of about 10 other songs…Mumford was a good choice for the slow ride as the sun was coming up over the coastline…can’t take in that kind of view with Bangerz or Turn Down for What blasting lol…I got stuck with a pretty crappy seat on the boat as it had no back and my feet didn’t touch the ground…really I was just on a storage box…this Army photographer had a much better seat

            So once we pulled up to the little pier in Juanchaco we were in a little beachside town that was mostly restaurants…there was a random horse and plenty of stray dogs…We walked on a sandy unpaved road for about 5 minutes until we turned and got to a concrete path that’s only big enough for 1 car…it was a nice scenic walk that definitely looked like the jungle with shanty houses that were all open air without glass windows…not quite like Vietnam jungle I picture from Forrest Gump but still the jungle…The walk took about 20 minutes and all along the way we had protection from Colombian Marines…some you could see and some you could just make out posted back in the brush…we were told there were recent cases of murder, kidnappings, and rape in the past 2 weeks as well as that we had diagnosed a few cases of malaria since we got to Colombia so security and the harping on taking doxy were high…It rained for about an hour...but I didn't have a problem..after all my awesome tactical pants are waaaaaterrrrprooooof (Yeah, I just said that like Oprah)...The site was actually set up in a school…it was much nicer than the site 1 there was a fan and light…granted the pharmacy was set up in a room right next to the port-a-potty’s but it wasn’t terrible because they were nicer port-a-potty’s that actually “flushed”. All the classrooms were open air without doors and just metal bars on the windows…it was a pretty large compound but I’m not sure how many grades there were in the school. WE HAD A GREAT TRANSLATOR today…Sintayehu and Aycock were actually getting some Spanish lessons so it was a pretty fun day…the volume of scripts is not even close to site 1 so we took time going over iron, prednisolone, Septra, IBU, APAP, amoxicillin, and Benadryl dosing…there were considerably more peds patients. Something else we noticed was there were many women who were getting their contraceptive implants removed from their arms…not sure if it was part of the nation’s healthcare plan for population control but almost every women that came through had one…what struck me was women that were only 17-19 years old had chief complaints of infertility and were worried they couldn’t get pregnant…very different from in the States where many people are having children in their 30s….it was also around 1000 and we got several questions from patients if there was any reaction with alcohol and albendazole because they already had some drinks this morning…island life man, living that island life…there was also a restaurant across the street we could get food from some people had a whole snapper fish meal and LT X had a sea snail dish…I opted for a quick break with a nice chicken fajita MRE whereas LT X waited for over 40 minutes to get his meal.

On the boat ride back I listened to a different playlist...you feel pretty bad ass pulling away from shore listening to the first 10 seconds of Spirit in the Sky by Norman Greenbaum...I also tried to see how many times I could listen to the same song on repeat...why because I have nothing but time...I listened to See You Again by Wiz Khalifa/Charlie Puth but after about the 13th time I switched to some Bob Marley...

#WhatDidIJustWrite #WhatADay #DistractWithPictures #ThundercatsHOOO

: random horse...really pony sized

you can see the Comfort from shore at Juanchaco

Me: She does exist (said like Santa in M&Ms commercial)

Sintayehu carrying empty totes blocking my picture

Aycock carrying empty totes...they joked that I should carry all 5 totes back...but they actually didn't let me carry any...

JULY 15, 2015 WEDNESDAY

            Today I went back to medsite #1 and did A LOT of checking…LT Phung forgot to drink plenty of water and started crashing really fast…she was basically napping but it was fine because Jerline and I were able to knock it out. Hedgespeth was pulling the meds, I was tallying and checking, Jerline was checking and handing out the medications. We were lucky enough to get 2 medical school student translators. HM1 Rana took it upon himself to stand at the door as a bouncer to keep patients from making multiple trips and messing up the flow of which patients were seen and had gone through discharge…It was a constantly busy day but we had fun…At site 1 to walk to the head (port-a-potty’s) you had to go under the bleachers on the other side…maybe like 5’5” clearance…LT Phung is slightly shorter than I am and I don’t have to duck at all but she was walking next to Hedgespeth and he had to duck and you just see LT Phung duck…it was hilarious…also Hedgespeth accidentally splashed some of the orange powdered drink from his MRE into his eyes…it got around his glasses and into his eyes…maybe like 3 drops worth but he acted like it was acid and that we has blind…very dramatic but very entertaining…A nice busy day full of pharmacy and getting to know the other techs I hadn’t spent a lot of time with yet…today we found out that they had seen all the patients there were at site 2 so they were going to shut it down early…made me glad I signed up for an extra day on site since I was now cut a day short since I was scheduled to go back to site 2 on 7/17…I was extremely efficient today...as soon as we got back to the Comfort I changed into gym clothes, got my laundry and put it in the washer, went to muster, when that was done I put clothes in the dryer and during those 40 minutes I went to the weight gym and did arms (biceps, triceps, and shoulders) and obliques...Family tell Danilo!

#NoDeadlifting2300To0300 #BecauseThatsAThingHere #ThrowItOnTheGround

JULY 16, 2015 THURSDAY

    The usual routine but I worked out again today...I know I'm on a roll...I went to the weight gym and did a 5k on the treadmill in the cardio gym...it took me 26 minutes which isn't terrible since I haven't ran since high school...all the stairs here on the ship and walking all the stairs at the Rosslyn metro station last rotation must've done something...

Continuing Promise 2015: Medsite #1 Buenaventura

 JULY 9, 2015 THURSDAY: Blog Post #4

            Today was the first day going out in Colombia. The first medsite is in Buenaventura and the second site where Emily went is in Juanchaco. I got up at 0459 and got ready as usual and went to the mess deck for breakfast. I didn’t eat but I grabbed an apple and granola bar just incase the MRE situation turned out to be only pork sausages and gravy as a choice.  Everyone going to site 1 had to muster in CASREC at 0545…hurry up and wait comes into play BIG TIME today. We were lined up in 3 lines for the different tender boats…I ended up at the front of the second line…first thought through my head was: “Great, just great…I’m at the front and have NO IDEA what I’m doing”…. turns out the lines were in alphabetical order. Another life lesson from the Comfort: no one pronounces anyone’s name correctly…I am now Haskett and Emily is just Hess…there was actually a pretty good selection of MREs to take to shore for lunch and I ended up with chicken fajita. At 0600 we made our way down the ramp to the boats. In Colombia we have to have forced protection…meaning military and police escorts…this is due to the nature of the area we are in and possible FARC activity. Because of this protection all the boats have to leave together…we were not aware of this and so once our boat was loaded we ended up having to float around in circles in the waves for hours…YES I REPEAT HOURS! We ended waiting for 2 and ½ hours just drifting around….I have the wonderful conditioning of long car and plane rides as a kid and basically fall asleep after about 30 minutes…a majority of everyone else not so much. Every boat had groups of people just getting so seasick that we even had to go back to the ship to drop them off because they couldn’t go to shore and do their job in their condition. Emily described that 12 people on her boat got sick…LT Xie thought it would be funny if we just posted a video of everyone getting sick as our blog post…but alas that is not possible because I was asleep and Emily got sick herself.

            Once all the boats finally got moving it took about an hour to get to Buenaventura. Of course it was another hurry up and wait situation getting off the boats and mustering up just past the marina. Next we walked 2 blocks to the site, which was in a sort of open-air gymnasium. The streets along the way were lined with crowds of people cheering and even taking pictures and videos of us. At the site the pharmacy was located in a back room without lights or ventilation. There were spin bikes and a treadmill as well as a few weight machines in the room. The day before a few of the staff members set up all the totes of medications. At site as patients come through we take their paperwork, find the medications, tally which medications we dispensed for inventory, check and verify the medication, and then counsel the patient. This would be a much easier process if there were an interpreter…I’m told that they usually have 1 or 2 assigned to pharmacy…but of course we did not get one today. (Logistical difficulties getting to shore the first day in tender boats and therefore surgical screenings were backed up and they took a majority of the interpreters). It was definitely a quick learning process but now I know a tiny bit of Spanish: uno tableta cada dia (one tablet every day). I helped check and pass out medications…after awhile I stopped trying to counsel patients because no one would answer to the name I said…maybe I butchered it…maybe I didn’t say it with the right inflection…either way its been a running joke with pharmacy that you end up saying the name 3 times no one answers but when someone else calls it out they stand up right away (even when there are only 2 people sitting there). There are many people with similar or the same name so it is also important to check the number on their wristband.

            We usually tell the patients to have a seat after we get their paper work so they don’t hover over the table as we go through the process. One lady actually went back to where the plastic chairs were, grabbed a seat and sat down right in front of the table…BOLD! After all we did just tell her to have a seat hahahaha!Throughout the day it becomes pretty repetitive to see multivitamins and acetaminophen dispensed and there are only 80 drugs in the formulary but I was able to catch a ciprofloxacin allergy with a H. pylori pack dispensed. The H. pylori pack consists of amoxicillin, levofloxacin, and omeprazole. The prescriber wanted to know if it was a true ciprofloxacin allergy but without an interpreter that wasn’t really an option. The pharmacists are given the authority to change almost any medication and directions as needed (many drugs run out over the course of the stays in country and are automatically switched to whatever is possible). We changed the H. pylori pack to doxycycline, metronidazole, omeprazole, and pepto-bismol. Reading the notes and chief complaints have also been very interesting and an adjustment from what we see daily in the states. One patient had a gunshot wound in the back many years ago where the bullet was never removed, lots of anemia, joint pain, many decayed teeth that got extracted, lots of fungal infections, blindness, pancreatic cancer, and one that has stuck with me in particular was a 9 year old boy whose chief complaint was small penis. Many of the patients have legitimate health problems but may be too difficult for us to treat. Hence why we dispense a lot of Tylenol and multivitamins. Many of the patient’s issues we can not treat because they do not have access to the medication…we don’t give out insulin because we do not have a fridge on site. There are actually no diabetes medications on formulary, which is very different from disease state treatment in the United States.

            There are also many partnering nations physicians so it is an adjustment to see some of their prescriptions. For instance I saw a lot of prednisone coming through for rheumatoid arthritis and osteoarthritis instead of NSAIDs because that is what the standard is for their country they practice in. An important event to note during this first day at the site seeing patients is that there was a riot….ok not so much a riot more of a protest…there was loud chanting and what seemed to be picketing. There was only 1 thin wall between the pharmacy and the street so it made Fowler a little uneasy…Not long after a Navy photographer stopped by and said they were chanting about a new hotel that was being built and the general healthcare issue or the region. It wasn’t nearly as hot as I expected but then again there were horror stories from previous countries where it was over 100 degrees and they dispensed over 1200 prescriptions. The day ended pretty smoothly with of course some more logistical issues and seasickness horror stories were shared at musters.

I can't tell if all the pictures uploaded or not with the internet connection on and off but there should be 2 pictures of the Comfort from the back of the tender boat I was on drifting around on, a few pictures walking to/of the medsite, and a "science project"...not looking for mosquito larvae maybe the man said mites?...I can't be sure it was loud in there

Continuing Promise 2015: Getting Adjusted to Ship Life

JULY 6-8, 2015: BLOG POST #3:

July 6, 2015

            Got up at 0500 to shower. Fowler had warned us that he gets up at 0515 and there is usually no hot water but I was going to give it a shot…FREEZING cold shower!...turns out that everyone after me had a warm/hot shower but I was the first one up so it took too long to heat up…all’s well though I count all the shivering during my shower as calories burned. It takes me less than 30 minutes to get ready but we headed up as a group at 0600. Breakfast was eggs and pancakes…no one ever complains about military breakfast but word to the wise always get syrup the pancakes were dry…like saltine cracker challenge dry. Muster was at 0700 so we got there at 0645…they had already started (they hadn’t officially switched to the 0700 muster time they told us the night before). You can’t walk through muster and we were supposed to stand on the opposite side with the officers but after a minute or 2 a sailor was nice enough to walk Emily, Jerline, Earl, and I through the laboratory next door and into the right spot. Everyone is very friendly and helpful on the ship. NGOs are treated equivalent as officers so we stand next to them in muster and are able to go through their chow line and eat in the officer’s ward if we want to. At muster the plan of the day is explained and any pertinent information is passed between members. We are part of DCSS (department of clinical support systems) and I believe there is also laboratory staff and radiology. The Sailor’s Creed is said and then everyone is dismissed to clean (sweepers) their departments. Next we went to the pharmacy and got a tour of the other wards on the ship, general introductions to the staff, and our schedule for medsites in Colombia. Usually the pharmacy has an afternoon muster informal in the pharmacy at 1600 (1630 after medsites) but that was cancelled.

            At 0900 we had an NGO meeting to sign emergency contact/next of kin and wireless access forms. We also watched videos about ship life, including but not limited to: trash separation, sewage, alarms, and everyday routines. We killed some time wandering the ship before lunch where we talked with Colleen, who is the team leader for Project Hope. Colleen spent around 30 years in the Navy and at one point she was a flight nurse. She had so pretty amazing stories about her time as a flight nurse in the Pacific. One description was that there was a mutiny on a merchant ship and the captain was stabbed several times. She explained the difficulties of getting there by helicopter, convincing the crew not to murder him, get the patient up on the helicopter, and then fly several hours to the nearest hospital…after everything he survived. After lunch at 1300 all of the Project Hope members met to have introductions since we are all in different departments and come from different places. Some of the members have been on the ship since the beginning of the mission so this is their halfway mark of 3 months out of the 6 month deployment. Anchors were lifted at 1630 and we were finally leaving Panama. We were able to hang out on the flight deck some…not long until the sun sets this close to the equator…by 1841 its dark and everyone heads down to berthing to sleep.

July 7, 2015

• Woke up at 0515, had breakfast, mustered at 0700

Today after muster in the pharmacy we helped prepackage extra medications for Haiti and Honduras. We counted our Zyrtec, hydrocortisone, and ibuprofen and labeled them in creole and Spanish. There wasn’t much else going on but we talked to the staff and traded life stories....

When we had a quick tour of the pharmacy last night on of the techs wasn’t feeling well and was trying to nap in the “cave” they have set up in the back…around lunch we actually saw him (Ziegler) being taken to sick bay in a wheelchair. So as I was sitting in the pharmacy OR came up to get meds and I was actually able to go with the anesthesiologist to watch the surgery. Turns out he was actually busy teaching a new nurse how to record and monitor everything but I was still excited to stand in and watch the whole surgery. (I was actually in charge of holding onto Ziegler’s wedding ring since I was going to follow him through PACU).Turns out Ziegler was dealing with appendicitis for about 3 days. No one was expecting a surgery since we weren’t in country yet but if you’re gonna get sick there isn’t really a better place than on a hospital ship. The docs ordered cefoxitin before surgery and once they opened him up 3 days of Zosyn was needed because the appendix ruptured as soon as it was touched. Part of the colon was actually eroded and fecal matter had gotten into the cavity. The whole surgery from the time Ziegler went under to when he woke up was 59 minutes. Everyone was thankful for calm seas. Next he was wheeled off to PACU and I made sure he got his ring back. Its nothing short of amazing that I saw the whole process before, during, and after surgery on a SHIP!

• Mustered at 1600, dinner, lights out before 2140

July 8, 2015

            Today there’s not much going on…got up at 0530 to get ready and then went to breakfast by 0600. Mustered at 0700 and hung out in the pharmacy. Went over what you do for high potassium (Ziegler’s K+ dropped to 2.8 during surgery)…you give insulin to drive the potassium back into the cell. I attempter to get on the wifi in the NGO lounge…no real luck. Next was lunch and then back to the pharmacy. We spent some time going through the shelves. The Navy isn’t very good at budgeting??? They had sent lots of brand Prilosec, Nexium, and Zithromax. LT Xie explained that overall they had about $2 million worth of meds for the mission and around $500,000 that normally stocks their pharmacy for crew.

 Below: Helos doing vert-rep...vertical replenishment....fly in on the right side and don't even have to land on the flight deck...they just get close enough and a crew hooks up the cargo (camera's always make things look further away but this is literally only about 12 feet above my head)

Continuing Promise 2015: Colombia

I will post from the beginning...delay due to wifi issues...constantly having to restart the router and change the password because it got out to Navy personnel...this is the only access NGOs have

Lesson #1, 2, 3....ALL THE LIFE LESSONS from the Comfort = LOGISTICS is really the mission

Family: Earl may force me to spend $20 on a calling card to use on the pay phones and call home so you know I'm alive...email is still fine however---I'll get to it...when I get to it

JULY 4, 2015 SUNDAY:BLOG POST #2

Transportation Day #1: OPERATION GET TO THE SHIP!

            So my day started at 0300. Got upto do some last minute packing and double checks. My parents were driving me to the airport so we left at 0330 to get to Dulles. I had already printed my boarding passes doing the online check-in the night before but I went to the American Airlines counter to check my bag (I would say its a Large Reebok sports bag). The attendant made a big deal about proving that I am leaving Panama so I showed my return flight information…even though its from Barbados and in no way does any of my paper work prove that I am leaving Panama. Once that got settled I then went through security…where I got my hands swabbed…for gun/explosive residue or drugs…who knows? There were only a few other people getting on flights that early in the morning, one being the older couple in front of me who hadn’t flown in years so they were confused at how basically everything gets put in different bins, you take off your shoes, and have to pull out laptops and such…so that was a nice process…then of course there was the TSA body scan. Once I got through security I waited by the train for Emily since she was only about 10 minutes behind me and we headed to the B gates together.

We got to the gate with over an hour before our 0600 flight so we grabbed a quick breakfast and took our malaria prophylaxis. We boarded the plane to Miami and then would board another plane to get connected to Panama. In Miami our connecting flight was all the way on the other side of the airport but we didn’t have to rush we had about an hour until the flight. Luckily I got to have the aisle seat on both flights so I didn’t have to worry about climbing over anyone…on both flights I also just fell asleep listening to my headphones. I woke up and SURPRISE! Found customs forms on my lap…no one explained how to fill them out and it has been a long time since I’ve seen one…it was in Spanish with a little bit of English translation…annnd it was in 6-point font. I’ve made plenty of study guides in 8-point font but this was pushing it…even with my “young eyes” I was squinting and my face was about 4 inches from the paper. Once we got to customs/immigration we showed our“Navy letter” but it really only confused people more…Emily’s agent didn’t really know English…mine did but there was confusion about how we were students but military and how we were only staying at the hotel for 1 night. Showing the hotel reservations and saying repeatedly we are leaving on the ship tomorrow was good enough for them to stamp our passports into Panama.

            It took us a good while to find the shuttle to the hotel…we just were told to go down to the end…but that’s where the employee shuttles were…this was at about 1200 so it was about 97 degrees and it was HUMID…oh god so humid…as soon as we stepped outside we just hit a wall of dense heat…we looked like idiots and everyone knew it but then after about 20-30minutes we saw the van pulling up with the Riande logo all over it! The drive was only about 5 minutes and when we pulled up we realized this was a RESORT…we knew it was a hotel/casino but this place was definitely NIIIICE...big pool, 2 bars (1 pool side), sushi bar, and restaurant. The room was pretty big as well…note to self: INSTALL RAINFALL SHOWERHEAD IMMEDIATELY (Family: write Danilo and tell him he better have the $ ready after basic because its necessary). All jokes aside we knew that we were going to have limited access to “the finer things” so we definitely took advantage of the Internet before we knew what we would get into on the ship.  Our preceptor Dr. Earl Roger’s flight was just a couple of hours behind us so we waited to see what the plans for dinner were…we met him at about 1700 in the lobby to discuss some expectations about what we were going do and how the process worked. Earl has been with Project Hope and Continuing Promise missions several times so he was a great asset explaining his past experiences. Next Emily and I decided it was time to eat dinner at the hotel restaurant…I had the filet mignon with mashed potatoes and it was definitely worth it since we didn’t know how the galley or MRE situation would be. I also had what seemed to be the tap water…we know we were supposed to just drink bottled beverages in foreign countries but this seemed like a perfectly acceptable and clean place…and I haven’t gotten sick so there…

JULY 5, 2015MONDAY:

Transportation Day #2: OPERATION GET TO THE SHIP!

Today is THE day! Emily and I get to start our adventure for Rotation #2 of our last year of pharmacy school aboard the USNS Comfort. So my day started out at 0600…the plan was to meet for breakfast around 0845 or 0900 so I was of course over doing it (although you can never be too early). I packed up my backpack since we had eaten a few of our snacks waiting for dinner and rearranged some things…and of course took advantage of the Internet one last time. We went and had the free breakfast in the lobby where we met: Earl, Jennifer who is a nurse and was on the ship earlier and had just taken a break to visit home and travel with her family to Ireland, Casey who is a NICU nurse from Alabama who was joining Project Hope for the first time, and Gerline who is a pharmacist but is with the University of California San Diego Dental Society. We all met back in the lobby at 1000 with our bags to take the shuttle back to the airport to meet the Navy to get picked up at 1200.

Soooo here’s where the whole hurry up and wait thing comes in play with the Navy…though I’m sure its with all branches…we got dropped off at departures and then waited around…ok sure we were there early so we knew we would be waiting…. then we waited some more…. we ended up not seeing anyone else that looked like they were going to the same place so Earl took a couple of laps around the airport and asked several information desks…we waited some more…eventually we met Alyssa who is with UCSD dental society as well who is a NEFTA, which is basically a PA of the dental world. She had been waiting in the airport since 4am that morning since she had cancelled and delayed flights, which made for a very long flight from Maine. Not long after a Colombian woman who is with the German military as a surgeon or physician found our group…4 of us wearing our Project Hope shirts made it pretty easy to find us and from looking at Facebook pictures on the Continuing Promise page you could tell what other NGOs would be on the ship…after waiting some more…since our pick up time of 1200 game and went…. we all went downstairs to arrivals and found a huge group of UCSD undergraduate kids, 2 World Vets, and a random assortment of military, RNRN, and Latter Day Saints groups all waiting to get picked up for the Comfort.

At around 1330 we finally saw a big bus and personnel…of course they had us wait some more before we could get on the bus. Next we packed our bags on the bus (all of us Project Hope people were the last ones which paid off when we got off the bus since they were the easiest to grab right away)…we waited around some more since some people still hadn’t arrived…the rumor was one Project Hope member who got off and went to Ecuador didn’t get an entrance stamp in her passport so they wouldn’t give an exit stamp. Eventually the higher powers decided that we actually were getting on the bus and headed to Fleet Landing. Once we got to Fleet Landing they collected all of our passports to get exit stamped by immigration. Immigration consists of just one man who lives in a tiny shack right by the pier…as soon as that happened a team of police and would could have been detectives hauled a body in a body bag into the back of a van literally within 5 feet of us…and that’s all I have to say about that (there were many merchant ships out there since it is not far from the Panama Canal so the person could have died on one of those ships). Ittook around 45 minutes-1 hour to get all of our passports stamped…surprisingly fast because it could have taken all night.Finally we boarded a tender boat and got on the Comfort…our bags were searched but just barely…we walked through CASREC (casualty receiving) and then wewere taken to berthing to get assigned an area for a bunk and lockers…I chose the bottom rack, which is only about 6 inches off the ground. We each were assigned one locker (2’ x 2’ x 2’) at the end of our rack which consisted of 3 shelves and 1 small drawer…I was able to fit everything in there and just used the second locker (half of a skinny high school locker) to hang laundry bag and put laundry detergent and other extras in there. The extra stick-on LED lights I brought have definitely come in handy because its dark most of the time and my locker is on the back side so there’s no extra light from the hallways. I actually seemed to have packed a smaller bag than everyone else…could’ve packed an extra pair of shoes but I thought that part of the list was excessive... The day ended with a trip to mess deck to eat linner (lunch/dinner), exploring the ship some, and a meeting for NGOs and new people to the ship.

·         Packing list:

o   Followed the provided packing list pretty closely:

§  3 Project HOPE t-shirts

§  1 Project HOPE polo shirt

§  1 Project HOPE hat

§  1 Project HOPE name tag

§  4 pairs of 5.11 tactical pants (2 provided by the SOP, 2 of my own)

§  1 nylon belt (provided by the SOP)

§  2 long sleeve dry fit shirts

§  more socks/underwear/bras than I care to admit but you can never OVERPACK those J

§  crocsàuse for the shower/around berthing

§  1 pair of sneakers…should’ve brought another pair (everyone’s shoes got smelly pretty fast)

§  4 workout gym clothes…lets get real these are my pajamas

§  1 rain jacket

§  2 sets of civilian clothes (the above mentioned workout clothes and a pair of jeans)

§  Toothbrush w/ protector

§  Toothpaste (travel-sized)

§  Floss

§  Razor

§  Deodorant/antiperspirant

§  2 shampoo (travel-sized)

§  2 conditioners (travel-sized)

§  2 body wash(travel-sized)

§  2 face wash(travel-sized)

§  1 lotion(travel-sized)

§  Tweezers

§  Nail clippers

§  Brush

§  Q-tips

§  2 XL and 1 M microfiber towels

§  Make up: the essentials

§  Small first aid kit

§  Pill box: Advil, Aleve, Benadryl, Excedrin, Zyrtec, Dramamine, Pepto Bismol, Meclizine, Immodium…

§  Chapstick

§  TONS of eye care: contact case, 3 types of eye drops, solution, extra pair, glasses

§  DEET

§  Sunscreen

§  Malaria prophylaxis

§  Purell

§  Small sewing kit

§  Ziploc sandwich bags

§  Baby wipes/ Clorox wipes

§  Laundry detergent pods

§  Laundry bag

§  Travel alarm clock

§  3 stick on LED lights! Berthing is dark most of the day so extremely helpful! Small flashlight and headlight...ALL THE LIGHTS!

§  2 locks/keys

In Panama looking at the Panama City skyline in the distance