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
We are really enjoying your updates! Love the detailed account of your day-to-day!
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