ALL ABOARD

Well maybe not quite yet. Julie and I leave today for our across-the-seas journey. We'll fly from different airports to meet in Chicago where we will then take a 15 hour flight to Hong Kong. From there, we have a 3 hour delay before we head to Singapore (a 3 hour flight). We will be arriving around midnight on Wednesday which is around noon EST of the same day. We stay a few days in Singapore before we board the ship. After looking at the weather forecast, I am guessing it is the wet season in this area. Once on the ship, we will be sailing to 3 islands in the southeastern part of Indonesia. This ship is the same one that Renee and Kris were on, so we may cross paths with them along the way. The USNS Mercy is a 1,000 bed hospital and I am told there will be about 1,200 staff members on the ship during our rotation. The Mercy was the ship that aided the area of Banda Aceh after the tsunami in 2005, so its return is significant and meaningful in providing further care to the area of Indonesia. We are both very excited to be a part of Project Hope and begin this unique opportunity.

Liberty time!

On Sunday night, I got back from the 5 day MEDCAP and went straight to the showers. We had been bathing with baby wipes for 5 days, so I’m sure you can imagine my urgency for a hot shower! That night I relaxed and caught up with the rest of the pharmacy staff who had been onboard the whole time I was gone. On Monday and Wednesday I was on duty in the pharmacy. These days are pretty relaxing because there is plenty of staff on duty, and not a great deal of work to do. I usually catch up on my laundry, assignments, and blog during this time. I put all of our leftover supplies from Ang Sophy back into the stock for the other MEDCAPs and helped the other techs out with their duties. The military will not allow us to have access to the computer system, so I can’t actually complete any orders, but I do help in any other ways that I can. I made a batch of cefazolin 1g bags in the IV room since that is the antibiotic most often prescribed for our surgery patients. It was good practice and we can store it in the refrigerator for 14 days, so that will cover the rest of the surgeries in Cambodia. The pharmacists also ask me to research clinical scenarios and come up with possible explanations and solutions to them. This is probably the most helpful thing they can do for me. I have learned so much by trying to figure things out on my own, presenting my answers, and waiting to be corrected and instructed on key points that I missed. A few of the pharmacists are very recent graduates, so they have a lot of knowledge to share with me about clinical rotations and boards. One of them asks me a random board-type question every day, so I have started a list to help me study in the spring. Some of the other pharmacists have many years of experience under their belts and they are eager to teach me lessons that they have learned in their very respectable careers. Also, the technicians have been giving me advice and helpful hints in the IV room. I am really learning a lot from the entire pharmacy staff, and everyone is very knowledgeable and helpful in every situation that I have encountered. On Tuesday and Thursday I actually had liberty days! This means that I had the day off and I could take the liberty boat to the pier and do some sightseeing in the town of Sihanoukville. These days were exciting cultural adventures! When we arrived at the pier, we were bombarded with Cambodian men who all wanted to be our taxi driver for the day. They drove “tuk tuks,” which are large 4-seater carts that are pulled by a moped. They have a roof and side panels that can be put down if it is raining, or rolled up in nice weather. Most of the drivers spoke enough English so they could figure out where you wanted to go, but few spoke well enough to carry on a conversation. The town is a pretty nice place and we got to see a lot of different sights, plus the tuk tuk ride itself was a really cool experience. We went to a huge market, the beach, several restaurants, an area with wild monkeys, and an exhibit with a variety of reptiles and birds. Of course, my favorite place was the beach. It had such an awesome atmosphere, and it was unlike any beach I had ever been to. There were a hundred restaurants along the water and they all had reclining lounge beds and deep circular basket chairs with big round cushions lining them. The chairs were set out in front of the restaurant and they were so close to the ocean that when a big wave came the water would touch the first row of chairs. Each restaurant had its own BBQ buffet where they grilled up almost every kind of meat or seafood that you can imagine, as well as a full menu of traditional Cambodian food. And unlike restaurants in the states, you can order breakfast all day long! I loved this because the breakfast food here is so unique, and it usually isn’t something that we would consider breakfast anyways. The pharmacist with me tried some grilled squid, and someone else had fried shrimp which they said was amazing. The seafood is delicious because it is usually cooked the same day that it is caught. The market was also a really neat place. It was kind of like Walmart, except that each department was owned by a different family. It literally had everything you could ever need and they accepted American dollars. In fact, I think they would rather take American dollars over Riel. We spent a lot of time here because there was so much to see! There was an entire food section where the women sold fresh everything! There were all sorts of fruits, vegetables, meat, bread, rice, noodles, and many other things that were unrecognizable. I saw one woman cutting up the guts of some kind of animal and selling it at her stand. There were also sections for clothes, electronics, and souvenirs. It is crazy how much more they tried to charge us for a product just because we are westerners. Although the prices are still so low that it doesn’t matter much. A dollar means so much to them and so little to me, so I was ok with paying a little bit extra. The tuk tuk also took us to area where we could feed monkeys! It was a small strip of woods with a fence around it, not that a fence can stop them. We fed bananas and peanuts to almost a dozen monkeys! I was surprised how much they love peanuts! They wouldn’t even eat the bananas when they knew that someone else had peanuts in their hand. Two of the monkeys even had babies clinging to them! It was so cute! Then we went to the Snake House, which is a nice restaurant that also had exhibits of very diverse reptiles and birds. There were snakes, iguanas, lizards, crocodiles, and many colorful birds! We had a good time looking at all of the exotic animals and taking pictures of them. My liberty time was very fun, but I was glad to be helping with the mission again on Friday. I had a long day at the local MEDCAP in the outskirts of Sihanoukville, and I will write about it soon!

Pictures!

My home for the past 4 weeks! The USNS Mercy.




My pharmacy family with the Admiral! I'm gonna miss them!




Some kids I played soccer with after one of the MEDCAPs in Vietnam! They were so fun!




Just got off the helo to my overnight mission! The ride was amazing!




Just after we arrived at Ang Sophy school.




My tent cot! not very comfortable, but it kept the mosquitoes out!




A MEDCAP pharmacy is just a little different from the ones at home.




I gave stuffed animals to two sisters from Ang Sophy school.

more from Ang Sophy school

During the days at the MEDCAP we were working nonstop! From 8am when the first patient showed up at the pharmacy until our lunch break around 12:30, I didn’t pause once to look at my watch or even take a sip of water. During lunch, I scarfed down the edible portions of my MRE and chugged about 2 liters of water before getting to work in the pharmacy restocking the supplies that we had used all morning. Then at 1pm it was back to the grind until we finally finished the last patient of the day around 5:30pm. And by that time we only had an hour of daylight left. Our team was designed to see about 500 patients per 8 hour day, which would be 1,750 for the whole MEDCAP. But we kept pushing the envelope and tried to help as many people as we possibly could, and by the time we left we had seen 2,949 patients. The pharmacy had a team of 3 people and 2 translators, and we filled 5,809 prescriptions in 3 and a half days. Our translators and students were very helpful and we also had a preventative medicine tech helping us out. The other pharmacy tech and I would fill the prescriptions, then the pharmacist would check each one and tell the translators any special instructions, and then the translators would dispense the medication to the patient and counsel them in Khmer. Our system worked well and flowed smoothly all day, but it was nonstop work and the line of patients seemed to never end. We joked that we were a human conveyer belt. We worked really hard and poured sweat all day in the 100°+ weather. At the end of the day we had another delightful MRE for dinner and usually walked down the street to the local cafes. Each café is basically a house that has a large open area in front of it with tables and a tv. The family that lives there runs the business, and when customers show up, they bring out the chairs. Most of the time they serve food for breakfast, and the rest of the day they only have beverages. Cambodian people love to drink hot tea and iced coffee all throughout the day, but at night it is hard to find food for sale because each family eats together. We got to know some of the families who own the restaurants over the 5 days that we were there. Most of them didn’t speak English, but we usually had a student with us so we could have some limited conversations. For the most part, this is how every day went at the Ang Sophy school MEDCAP. The days kind of ran together since we were constantly occupied. However, on Saturday the Commodore and her team took a helo to visit the MEDCAP and see how things were going. She was very proud of the work that we were doing, and shook hands with each member of the pharmacy team with a coin in her hand that she transferred to ours. Apparently, it is a big deal to be presented with a coin in the military, and a lot of the sailors have showcases for their collections of coins. The Commodore also brought 2 huge bins of extra supplies for the pharmacy. We had been running out of medicine since the MEDCAP was helping many more people than we had originally expected. If we had not gotten the resupply we would have run out of almost every medication. Also on Saturday, one of the students from Ang Sophy had his mom make lunch for us! We all chipped in a few dollars, and she made white rice, chicken curry with coconut milk, marinated pork jerky (my favorite!), shrimp, bread, fried plantains, and watermelon! It was a delicious break from the MREs and it was nice to get a taste of some real Cambodian food. Then around 6:00 after the MEDCAP closed for the day, one of the translators took us to a Buddhist Pagoda. I was expecting a temple that looked like all of the rest that I had seen in southeast Asia, but this one was much more exciting! It was a temple that was build inside of a huge cave! When we parked, about 20 children eagerly came running to the vans to give us a tour. There were natural rock formations that were in the shape of animals and other objects, and statues of Buddha interspersed throughout the caves. The children were so excited to point out all of the rock formations and tell us what they were called in English, but when we tried to have a conversation with them they didn’t know many other English words. It was a mini business for them because they all expected a tip or gift at the end. They were adorable though, so everyone gave them something. I think that temple was one of the coolest sites that I have seen during my whole trip so far! On Sunday, we left Ang Sophy and came back to the Mercy, and I have never been so excited to take a shower in my entire life! Camping was a lot of fun, but we were all excited to finally get out of the heat and the mosquitoes. On Monday and Wednesday I have duty in the Mercy pharmacy and on Tuesday and Thursday I have liberty in Sihanoukville. And on Friday I will be at another local MEDCAP. I still have many adventures to share, so hopefully the internet will hold out! Thanks for reading!

5-day overnight

Whewww! What an amazing experience! Cambodia is a beautiful country with even more beautiful people! The helicopter ride was awesome! We left the morning of Wednesday June 16th by helicopter and stayed along the coast for a while and then made our way inland. The landscape started off really flat with sand, grass, and some palm trees, but suddenly there were mountainous rock formations that looked like they didn’t belong there. The land was totally flat, and then the rock faces came out of nowhere like someone just dropped them out of the sky! The rocks were covered with moss and vines at first and the farther central we travelled the more they were covered with lush green jungle. It really was a gorgeous sight to see from the air. We arrived at Ang Sophy school by 11am and the students were taking final exams, but they ran outside whenever they heard the helicopters coming and the whole community gathered around to watch us land. We quickly unloaded our gear and had some time to walk around the school grounds and talk to a few students before the rest of our team came in the next two helos. We were not scheduled to see patients on this day, so we mostly just set up the MEDCAP and did “COMREL” activities, or community relations. I traded in one American dollar and got 4,000 Riel (sp?). And for 100 Riels, or 2.5 cents, we could buy food at the vendors on the side of the road. It is crazy how far a dollar can get you in Cambodia! Take that dollar menu! When our entire team was safely on the ground, we had a meeting and planned out the next 4 days. For the rest of the afternoon, we explored the community and got to know some of the people we would be working with. We went to a Buddhist pagoda that was right next to the school, and ended up having tea with a monk. One of the students came with us and translated our conversation with the monk. He was really happy to spend time with us, and it was an interesting cultural experience. Then we met a member of the Peace Corps who teaches English at Ang Sophy school. He taught us how to say some basic phrases in Khmer (said “kmy”), and introduced us to all of his students. These kids were awesome! They were so eager to talk to Americans, and they really wanted to practice their language skills and learn more. We talked one-on-one to a lot of the students for a few hours, and their English was really good! The Khmer language is fascinating and very difficult to write and speak. To me, it just looks like a bunch of squiggly symbols in a row, and I have no idea how they write it so beautifully. I learned how to say hello, goodbye, and thank you, and that is the extent of my Khmer knowledge. Later, we played basketball and soccer with some Cambodian kids for the rest of the evening. Sports are a fun way to socialize and get to know someone when there is a huge language barrier in the way. You can create a friendship and a bond without ever having to say a word, so it was a good icebreaker to begin the mission. There is no daylight savings time in Cambodia, so it got dark around 6:30 and we sat around and ate our wonderful dinner of MREs. Every day, there were 3 MREs allotted to each of us, so I will be happy if I never see one of those things again. The MEDCAP team set up sleeping quarters in two of the classrooms, but it was really crowded with so many people in one room. So, the pharmacy team got permission to sleep in the pharmacy classroom so that we could keep an eye on the medicine throughout the night. So we set up the pharmacy supplies and our “tent cots”, and this would be our home for the next 5 days. The cots each had a tent attached to the top of it with mosquito netting in the windows to keep out the dangerous Malaria vectors. That night we played cards and watched a concert that was taking place on the school grounds. It was a pretty relaxing night to prepare for the busy days that were ahead of us. We accepted patients for 8 hours on Thursday, Friday, Saturday, and 4 hours on Sunday. As a 32 person MEDCAP team, we treated over 3,000 patients and filled almost 6,000 prescriptions. Overall, it was a huge success and we helped a lot of people! I will be posting more stories from each day soon! (Sorry about the postings being a few days late. The internet rarely works on the ship for obvious reasons...)

Adventure time!

The Malaria presentation went well! I think that we provided a lot of important information to the crew onboard. A lot of the sailors were confused about the Malaria prophylaxis that they were being told to take, and we had the opportunity to answer their questions and clear a lot of things up. So now hopefully everyone on board is taking their doxycycline correctly and we will not have to worry about any Malaria incidents. We got some really good feedback from the pharmacy staff and some of the doctors onboard to help us in our future presentations. Also, a few hours after our presentation, a message went out to the whole ship containing some of the important information that we had gone over. It felt good to be able to make a positive impact here on the ship, since most of my personal impact has been on shore at the MEDCAPs. For the past two days we prepped the pharmacy, organized all of the medications that are going out to the MEDCAPs, and printed labels in Khmer (the main language in Cambodia). It was a good deal of work because three of the MEDCAPs are “RONs”, which means Remain Over Night, so we had to prepare everything ahead of time and box it up on pallets to be transported to the sites. We dropped anchor in the port of Sihanouk, Cambodia this morning so a lot of our supplies for the MEDCAPs have already been taken ashore. The three RONs are 5, 7, and 11 days long, and they are very far inland (one of them is over 300 miles), so it would be impossible to return to the ship every day. And guess what?! I was chosen to go on one of these missions! As if I hadn’t already been having the experience of a lifetime, now I get to go on an even more exciting adventure! For the next five days I will be at a MEDCAP in central Cambodia. Tomorrow morning we will be flying by helicopter, or “helo,” to a high school that is the site of the MEDCAP. We will be camping overnight on cots with mosquito netting until June 21st when we will return to the Mercy. I am really excited!! We are not really sure what the conditions are going to be like, but we were told that it is a newly built school so hopefully it won’t be too primitive. School is in session right now, so there will be classes going on in some of the other buildings and we think that they will have electricity; however they will likely turn it off in the afternoon when the school day is over. Also, our OIC (Officer in Charge) for this mission informed us that there is a member of the Peace Corps who has been living here and teaching English at the school for a few years. He is really excited about us coming and he wants to help translate for us, which will be a huge help! He hopes that his students will be able to help as well, to practice their English and gain some experience with translating. Hopefully they will be able to teach us some words and phrases in Khmer too! I am so excited for this mission! And it will be my first helo ride!! Apparently the ride is about 45 minutes, and hopefully I will have a good view out the window so I will be able to see some of the landscape and jungle! I’m sure it is a gorgeous country and I can’t wait to see it, but we will also have to be very careful while we are there. Throughout Cambodia there are still some landmines in remote areas. Don’t worry though, we aren’t going to stray too far from the school, which is obviously a safe area. Also, I will be applying DEET insect repellant several times a day to keep away the mosquitoes, and taking my doxycycline religiously. I’m not trying to bring home any tropical diseases with me! My helo ride takes off at 9am tomorrow morning, and we should be at our site and setting things up before 10, so hopefully we will be able to see some patients tomorrow afternoon. I am going to stay up late again to watch the Brazil vs. Korea World Cup game. I guess when soccer and sleep go head to head, it is clear which one wins out for me. Though, this whole time difference thing is truly a massive inconvenience. Oh well! So I will not be posting for a few days, but don’t worry, I promise I will be safe! And the next time you hear from me I’m sure I will have some great stories to tell! (written June 15)

Packing…

I am getting REALLY EXCITED about my 7 day mission and trying to get all my stuff together for it. I just got the packing list and one of the items just made me laugh, so I thought I would share: Swimsuit (shower situation “unclear” - it might be some sort of trough that you stand in and pour water over your head)<-- haha, oh boy!!! Some of the other fun items on the list include: Baby wipes (in case there are no showers), Small denomination currency (we’re not going to the casino <-- their words not mine), Doxy and DEET (NOT a suggestion, but a necessity). The rumor flying around right now is that we are staying at an old UN peacekeeping site that is apparently some kind of large open base. This is going to be amazing! We will be flying into the central part of Cambodia and working in 2 small villages. My excitement has only been building since I found out that I would get to go on this mission. Only 3 pharmacy members were chosen to go: my preceptor Earl, a Navy tech, and me. Once Renee left I got even MORE excited, since the day she gets back is the day that I go! I am sure she will have some great experiences to share and so will I when I get back.