MEDCAPs

Getting used to military life is a big adjustment. I have had to wake up between 4am and 5am for the past 3 days! I spent another two days at MEDCAP sites since the last post. When we work on MEDCAPs, we have to “muster,” or meet, at specified times that are usually around 5 or 5:30am. Then our transport boats (they are called Bandaid boats, hehe) leave a half an hour later and the ride to the pier is about a half an hour. There is a Japanese warship that is protecting the USNS Mercy and sometimes they send their transport boats to help. I got to ride in a Japanese boat one time and the ride was much quicker, only 20 minutes! It is very interesting that American citizens are boarding Japanese vessels to enter Vietnam, considering our circumstances only 40 years ago. So on Wednesday I was at Phuoc Nghi, and on Thursday I was back at Nhon Binh. Both of these sites are fairly large, and every day they treat between 500 and 800 patients. The days go really fast because we are constantly working. I hardly have time to look at my watch, so before I know it we are eating our MREs for lunch, and then we are packing up and ready to leave. I love working at the MEDCAPs because I feel like I am really helping people, and I also like to stay busy. The only bad thing about it is the heat and humidity. The heat index is constantly over 100F and it has been as high at 111F. On the second day in Vietnam one of the pharmacists actually fell victim to the extreme heat. He had been out in the heat for 2 days, and drinking about 8 liters of water each day. However, he did not increase his sodium intake to balance the water and by noon he had completely stopped sweating because his body could not afford to lose any more sodium. So his body overheated and he almost passed out before another worker made him get in the bus in the cool air conditioning. The medic started bags of lactated ringers and half normal saline and they took him back to the Mercy for treatment. His sodium lab came back at a level of 119 (normal is 135-145). This was a big lesson for all of us and we started carrying salty snacks like crackers and pretzels to eat along with the massive amounts of water that we are all drinking. The MREs have a good bit of salt in them too, however it’s not exactly the most luxurious lunch, and we often do not eat the whole thing. Instead, we walk along the streets that are nearby and the Vietnamese translators help us buy fruit. I have tried so many tropical fruits that I have never even seen or heard of before. There is dragonfruit, mangosteen, rambutan, litchi, and many others. They are all really sweet and delicious. But by the time we get on the bus to go back to the pier, we are all really hungry again. When we get to the pier all of the providers and volunteers go straight to the bandaid boats and go back to the Mercy, but the pharmacy staff stays behind in the warehouse to restock all of the medications for the next day, and to prepack more medications if necessary. This can take anywhere from 1 to 3 hours and by the time we leave the pier we have already missed dinner on the ship. One of the days, the pharmacy sent dinners for all of us in a box because they knew that we would be at the pier for a while. There is nothing like eating a full dinner in the dark on a boat that is bouncing up and down with the waves. It was an experience to say the least. So today I was off and tonight I have my first night shift in the pharmacy, so it will be interesting to see how that goes. Hopefully I can make it through the whole night awake!

Onboard and hard at work!

We are on the USNS Mercy! We were actually onboard a few days ago, but our internet access has just started working. All of our travelling went very smoothly until we got to Qui Nhon. We were supposed to be onboard on Monday afternoon, but we were caught up in some logistics with the Vietnamese government. They wanted to approve each and every person that got on the Mercy while it was docked in Vietnam. So we stayed in a hotel in Qui Nhon until our clearance papers came through. We were allowed on board on Tuesday, and it took pretty much all day to get oriented and unpacked. We got assigned to our “racks,” which is our beds. And they showed us where the “heads” were, which is the bathrooms. It is tough trying to get used to all of the military lingo, but I am catching on. On Wednesday, we met the pharmacy staff and had orientation to the pharmacy all day. We don’t have clearance for the computer system yet, so we can only really perform filling and prepacking responsibilities right now. The pharmacy team is like a family, and we get a lot of work done and have a lot of fun while doing it. On Thursday, I went to the MEDCAP site in Nhon Binh. The MEDCAPs are clinic sites that we set up in different places around Qui Nhon. The people get checked in at Patient Admissions and get their vital signs checked, and then they are sent to see either a physician, a dentist, or an optometrist. If a prescription is written, they are sent to the pharmacy and we fill and dispense the medicine that they need. The MEDCAP is at a school, so the pharmacy is a classroom, and we move the desks around to form a pharmacy and direct patient flow. All of the medications are prepacked in plastic Ziplock bags and stored in brown paper bags with the drug name and quantity. We set out the brown paper bags in alphabetical order so that when we get a prescription all we have to do is find the bag, grab a ziplock, and stick the label to it. The hard part though, is finding the patient that the drug belongs to. All of the patients are coded with a barcode and number, so we have to match the number on the drug to the patient. This is easier said than done when you have 50 people who speak a different language all crowded into a tiny classroom. We accomplished this task as quickly as we could, and dispensed the medications. The pharmacist at this MEDCAP could speak Vietnamese, which was very convenient. She counseled each patient and then discharged them when she was finished. It was a very long day, but it was very rewarding to see all of the people that we helped. Many of them have no access to medical care, and to be able to provide free care and free medication is amazing.

On our way!

Kris and I fly out tomorrow to Vietnam! We are very excited to finally be on our way and for this mission to begin! We will have a 14 hour flight from Dulles to Seoul, South Korea with a little break in the airport, then a 4.5 hour flight to Hanoi, Vietnam where we will stay overnight. In the morning we will have a short 1.5 hour flight to Qui Nhon, Vietnam where we will meet up with the Project HOPE Medical Directors for a 45 minute bus ride to the USNS Mercy. Smaller boats will take us to the Mercy and we should be onboard and ready to get to work by about 3pm Monday ICT (Indochina Time). Hopefully everything goes as planned! We'll let you know when we are safely aboard. Also, keep in mind that ICT is 11 hours ahead of EST (Eastern Standard Time). So we will most likely be contacting family at odd hours (sorry!)

Year 2 and going strong... new rotation information!

Welcome back to the Shenandoah University School of Pharmacy Rx Project HOPE blog! We're very excited to be sending FOUR students this year on rotations with Project HOPE. The students will be part of the Pacific Partnership 2010 that will visit the southwest Asia region.

Fourth year pharmacy students, Kristina Angelone and Renee Summerson will join the USNS Mercy from May 29th to July 3rd, along with pharmacist preceptor, Earl Rogers. Kris and Renee's rotation will include Vietnam and Cambodia.

Following Kris and Renee, fourth year pharmacy students, Julie Horak and Brian Cox will join the USNS Mercy from July 3rd to August 8th, along with pharmacist preceptor, John Nett. Julie and Brian's rotation will include Cambodia and Indonesia.

Please visit often after May 29th to follow their experiences!

It’s over…

My last week was spent in Majuro, the capital of the Marshall Islands. It is much more westernized here and it was evident as soon as we first stepped foot on the dock. We were even working in a hospital with an inpatient pharmacy and air conditioning! Well except the pharmacy was the only room in the building that it didn't work. We did have fans and electricity though! And the American kind of electricity, the kind that doesn't require an adapter or a transformer. It's the small things….

It was interesting to see how they worked in this hospital pharmacy. The techs were allowed to fill and dispense prescriptions without the pharmacist's approval. Not much different than the last 5 weeks where we had Australian sailors and pretty much any spare body helping us dispense prescriptions, but it was interesting to see this in an actual institution. I had no doubt in the tech's abilities to do this job especially since their formulary was also severely restricted.

It is simply amazing how fast my time with Project Hope and the U.S. Navy passed. It was a wonderful experience and one I will surely never forget. I implore all of my pharmacy, medical, and professional colleagues as well as my friends to pursue such an opportunity to assist those in need if ever presented the chance. Participating in this medical mission trip has allowed me to work alongside specialists in their respective fields. It was also incredible to be able to interact with doctors from Canada, Australia, Chile, and South Korea as their kindness never ceased.

Jabwot

I had the pleasure of going to an outreach on the island of Jabwot. Our team was flown in by helicopter and my first impression as we flew over the island was that it was deserted. We soon found out that it pretty much was. We walked for fifteen minutes through a serene jungle, minus the occasional falling coconut, until we finally saw the village. Going in we were told to expect a census of 100 people. After checking everyone in at the clinic, we found there to be 54 people. Thankfully, all of the islanders received excellent care from a nurse that lived there and were generally in sound health.

After talking to one of the village elders I found out that the children have many opportunities to get off of the island and make a career for themselves. She had two sons in Arkansas and another in Hawaii. Though with 13 children, I guess some of them are bound to get around. We did see one patient who came in contact with a local predator. A fisherman had suffered a run in with a shark, was bitten in the wrist, and lost use of the tendons necessary for movement of the wrist. The doctor was able to refer the patient thanks to the Marshall's excellent referral system and follow-up care.

I was able to work right next to the two doctors and hand-deliver the medications so my job was done as soon as they had seen the last patient. The veterinary team unfortunately was up to their elbows in pig and dog neutering and soon enlisted our help. My first job, fend off the angry sow with a shovel while her male piglets were castrated. My second job, hold a piglet down while it was being castrated. Thankfully there was no third job. I figure the first two would look good enough on my resume.

Perhaps they'll let me pull teeth at the next site.

A good day

Today was a good day. We arrived in the Republic of the Marshall Islands and headed to the island of Kwajalein where an Army base is located. We didn't get hung up with passport or sovereignty issues and were allowed to take liberty on the island. I had Subway (it was a close call between that and Burger King) and the establishment across the way happened to have 50 cent Guiness Stout Bottles. The Pacific Fleet Band was there jamming out with some Michael Jackson and Jazz. The breeze off the ocean was the icing on the cake. Today was a good day, and it was much needed after the last two islands.

Kwajalein is a strategic military holding as it is home to a ballistic missile weapons intercept program, space operations support, and is one of five sites in the world with radar stations used to operate the GPS systems worldwide. The Republic of Marshall Islands is also the former home of nuclear tests conducted by the US, the most recognized atoll being Bikini Atoll. It is important to know that all the Marshallese located on Kwajalein were moved off this island to another, Ebeye. Refugees of the nuclear tests were also moved to Ebeye. One of our mission sites is located here and the population is estimated to be 12,000 living on a 0.5 mile patch of land. I've heard one of the commanders refer to it as a "little Tijuana."

Dr. Marks and I will not be participating in Ebeye MEDCAP but will travel on to Majuro in 3 days. In between, we are being flown out to two separate atolls for outreaches. Ailinglaplap and Jabwot await us with open arms, hopefully.