long days

The past few days have been incredibly busy! I have gotten an average of about 4 hours of sleep each night, and somehow I am still alive! Haha! My night shift actually worked out pretty well. We mostly did pre-op iv medications for the next day. The military uses a computer system called CHCS, and we don’t have access to it yet, so I just watched to other night tech input all of the orders and learned the system from him. We mixed mostly cefazolin for the surgeries, and had a pretty slow night other than that. At midnight there were “midrats” served in the mess decks. “Midrats” are midnight rations that consist mostly of leftovers from dinner. We weren’t exactly excited to eat the same thing again, so we made peanut butter and jelly sandwiches instead. The rest of the night was relatively uneventful, but we had to stay in the pharmacy in case someone would need something stat. When I got off at 6:45am, I slept for a couple hours and then had to work again at 2pm until midnight. Somehow, that shift felt longer than the night shift. On Tuesday, I was at the MEDCAP at Phuoc Hoa so I had to muster at 5:00am and take the Bandaid to shore. On Wednesday, I had to prepack medicine on the pier. I was with one other pharmacy technician all day counting out meds and putting them in little ziplock bags to take to the MEDCAPs. The military and civilians who have liberty also have to stop by the pier and help us for about 30 minutes before they are allowed to take the bus into town. On Thursday, I was at the MEDCAP in Nhon Khan and when I got back onboard the Mercy I went to the closing reception for the Vietnam mission. There were a limited number of people invited, but I was one of the ones chosen to represent Project HOPE. I met up with some of the nursing students who are with Project HOPE too, and we went up to the flight deck for the reception. It was a really nice evening of mingling and meeting a lot of people. The commodore and the Japanese ambassador spoke and welcomed everyone. They served food and drinks, and then they cut the cake with a sword. It was a beautiful night and the Navy band was playing the entire time. Towards the end of the night everyone started to dance on the flight deck, and it was a really fun time. The band kept trying to call it and night and everyone wanted one more song, one more song, one more song. So we danced for a long time, and finally the party was over around 2300. The next morning, on Friday, I had to muster at 5am again to head to the pier and take a final inventory of all of the medications that we had left over. We spent the day counting everything that we didn’t use at the MEDCAPs in Vietnam and packaged it up to load back on the boat and take it to Cambodia. After our jobs are done for the day, we usually get a few hours of liberty while we are still on shore. We take the liberty bus to into town and get to spend a few hours walking around Qui Nhon and eating Vietnamese food. It is so interesting how to city comes alive after the sun goes down and it gets a little cooler outside! There are always so many people walking the streets and socializing at night. We have all had a lot of fun during this portion of the mission in Vietnam, but we have also had a lot of work to do. It seems like the pharmacy is always working so much harder and longer than the rest of the medical personnel on the Mercy. But maybe I’m just biased, haha. So today, we had to muster in the pharmacy at 7:30am. It was the first time that we had to stand in a military formation and stand at attention. Needless to say, I was clueless and probably stuck out like a sore thumb. Then we cleaned the pharmacy and restocked all of the medicine that had been at the pier. It has been another long day! Now I am waiting up until 1:30am for the World Cup match between USA and England. This game better be worth my lack of sleep! Come on USA!

Some pics of life so far...

It's not everyday that we fly these two flags together!




This is Ken, one of the awesome pharmacist that came with the Japanese boat. We got to work with him and some of the other Japanese crew during the MedCAPs in the city.



MedCAP pharmacy = ready to go!!! :-D

Hello from Vietnam!!!

Sorry this is so late getting out, but it is really hard to get internet on the ship. Our flights here were uneventful, but actually getting on the ship took a while. We actually met up with a Project Hope (PH) nurse in D.C. for our flight to South Korea. There was an even bigger group of PH people waiting to get their baggage from the plan in Hanoi. We all got our bags together and made our way out, but we were almost immediately stop by the wall of hot air that we hit leaving the airport. One of the volunteers near me said “just imagine… if it is this hot up here at 11 pm, how hot do you think it is going to be farther south in Quy Nhon?” I had to agree that the heat and humidity was daunting and knowing that it was even hotter and more humid where we were going was a little scary. A pleasant surprise for us when we got out of the airport was a very nice representative from PH that was there to help us get to the hotel. He gave us the choice of driving into Hanoi or staying at a “no-star” hotel near the airport. Since most of us had been awake for about 30hrs, we opted for the “no-star”. It had a bed… which was all I wanted at that moment but I never did get that air conditioner working. With only a couple hours sleep under my belt we headed off to the airport at 5:30 am. Once we got to Quy Nhon I was thoroughly exhausted, but we meet up with even more PH volunteers and found a nice little place to sit and get to know each other while we waited for the Navy transport to bring us to the boat. Among the group that we met up with were some nursing students and their preceptor from the University of San Diego. We had a nice time sitting there getting to know each other, and after a while a Navy representative came to fill us in on what was going on. Apparently the Vietnamese government wasn’t allowing anyone that did not come on the Mercy to board it, and they were having a little trouble getting our berthing (a navel term for area where you sleep) straight. That left us with a little dilemma… where to now? We ended up getting amazing rooms at a very nice hotel with some unexpected free time to enjoy the city of Quy Nhon. While at the hotel we met up with some very interesting people with UCSD (University of California – San Diego). They were a couple of dentist and a translator traveling from the U.S. and Canada. A big group of us decided to go out to lunch and experience some of the city. With the help of our translators, we had one of the most amazing meals!!! I felt like we just ordered the entire menu and shared it family style, and the presentation of it was so cool. One of the dishes was a fish (probably caught that morning) and the cut it in half and displayed the head up and the fins out which made it look like it was still swimming. The translator explained to us that in Vietnamese culture it was very bad luck to turn the fish over during any part of the meal, because it would turn the fisherman’s boat over. It was really cool to sit and share a meal with people from all over with such different lives and experiences in a cozy little restaurant by the sea. After a VERY restful night, we were able to leave for the ship in the late morning. It pretty much took us the entire rest of the day to get checked in and settled. Most of our group got the top “racks” or beds, which made for some very interesting climbing and a few choice words. Our first full day in the pharmacy on board the ship started bright and early the next morning. Renee had to report at 0645 but I got luck and did not have to muster until 0730. We didn’t do much the first day, but spent most of our time getting to know some of the people we would be working with and get comfortable with our new pharmacy for the next 5 weeks. One cool case that we got to see was a 17 year old male that underwent a cleft pallet repair. The surgery that he got wasn’t that uncommon for what the medical teams on the Mercy are doing right now, but what was interesting about him was his heart. Most of the medical staff on board showed up to listen to his heart murmur. The pharmacist we were working with that day took some time to bring us down to that ward and let us hear it for ourselves. It was REALLY COOL!!! We all heard the audio in class during school, but it was nothing like hearing it on a really patient. The next day Renee went out on a MedCap and I worked all day in the pharmacy on board. It was mostly uneventful but I did get to make a sterile transfer of some medication for an IV push on a baby and I got to deliver it to the ward the baby was on and see how she was doing after her surgery. Hopefully, I will have some more time soon to write about the MedCAP that I went on today!!! Until then, thanks for reading :-D

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!