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.

Kiribati – Betio Continued

On Thursday I had the great pleasure to meet Admiral Willard (http://en.wikipedia.org/wiki/Robert_Willard), a four star Admiral who commands the Pacific Fleet of the U.S. Navy. His accomplishments include commanding two different aircraft carriers, running the TOPGUN school, and has twice served on the Joint Staff among other activities. I was asked along with a representative of each partner nation to provide some feedback directly to the Admiral on our experiences and how they can be improved. Along with his wife Donna, the Admiral was personally responsible for organizing and planning this mission. It was a great honor to be able to provide a suggestion for improving it in the future, a proposal I'm sure will be considered for the next mission. After our meeting was concluded he gave us his personal military coin, which how I understand it, is an even greater honor.

We were asked to vacate the Betio Sports Complex for several days as they were holding an amateur boxing competition against rival Fiji islands. The two day event plus Sunday being a national day of rest turned into a 3 day weekend for myself. Dr. Marks and Phengphan each went to a different outreach site, an opportunity I will get to experience in the Royal Marshall Islands.

On Saturday I attended a health fair confident I could lend some support based off previous experience with APhA health fairs at the school. What I wasn't counting on was this fair being Kiribati style. Instead of having patients walk through the various stations and be screened, the I-Kiribati prefer to educate through song and dance. This made for an interesting afternoon as the Navy and USPHS healthcare providers were forced to come up with skits on the fly. Another important thing to note is the difference between the Navy's definition of time, if you're on time you're late, and the I-Kiribati definition of time, it'll happen when it happens.

On Sunday, the day of rest, some of the doctors and I went on a self guided tour of the Japanese defenses from World War II. We first passed the bunker the Japanese Admiral that commanded the island used. The building was pockmarked and overgrown but still rich with history. He died in the bunker on the 3^rd day of the invasion. As told, the bunker had gasoline pumped inside and was ignited via grenade, so deeply entrenched its defenders. Further down the road we found the Japanese artillery guns, still pointing ocean side. These gun batteries were huge and surprisingly still in great condition, though I doubt it would launch the coconuts stuffed down the barrel. The artillery shells were prepared in the pillboxes and bunkers behind the guns and transported via a rail system to the guns. Ironically, the guns were manufactured in the UK and sold to the Japanese prior to the war. All the directions on the guns are in English.

Tomorrow we start our five final days at the Betio Sport Complex before we steam ahead to the Royal Marshall Islands.

Kiribati - Betio

On Sunday morning we arrived off the coast of Kiribati (pronounced Kirabas as ti is an s sound in I-Kiribati) and were eager to get off the boat and ashore to begin set up for our first clinic at Betio Sports Complex (pronounced Besio). The islands themselves are surrounded by reefs and are nothing but spits of sand studded with palm trees. It appears the highest place on the island is about 5 to 10 feet above sea level.

We stayed on the boat all of Sunday due to a small issue between the U.S.A. and Kiribati governments concerning the Navy's sovereign right to not surrender a list of the crew linked to Department of Defense activities, i.e. the Navy and Merchant Marine crew. The issue goes from Kiribati customs agents to the Kiribati President and from our Commodore to the Commander of the Pacific Fleet, and wouldn't you know, an agreement is reached. So Monday we get on ground and instead of using the planned helo-ops, we end up having to take a 35 to 45 minute RHIB ride in. Once we arrive at the Betio Sports Complex the reason is clear; the ground is overgrown with both weeds and trash and the paved parts in are disrepair. Looking around one would think the place was 13 years old but a dedication plaque indicates it is only 3 years old.

The area itself is rich with World War II history everywhere you look. We drove past the battle-scarred Japanese headquarters, pillboxes and bunkers poke out from the ground, and the Japanese artillery guns, though rusty, still appear to guard the coasts. Even the RHIB ride in to Tarawa is historical. It is the same path the Marines took storming the beaches. Several boats are stranded on the reef just as the Marine's amphibious landing craft were stranded, forcing the Marines to swim and wade inland or face certain death under the Japanese counterattack. The water level is only 3 to 5 feet above the reef that stretches up to 500 yards from the beach.

Kiribati itself is another one of these "beautiful disaster" island nations. The scenery and people are genuinely friendly, but the conditions they live in leave a lot to be desired. The islands are small and narrow to the point you can see from one side of the island to the other just by turning your head. This leads to overcrowding and a collection of refuse. The only way they get rid of their refuse that I've seen is to burn it. The U.S. Public Health Service environmental health people have even told us of beaches that are littered with human excrement. One even joked that they don't even need to do thorough tests for choleform bacteria; they can just fill a glass up and then hold it up to the light for visual confirmation. The "Kiribati Salute" refers to checking the bottom of one's shoes for surprises.

Another interesting cultural difference is the children. They are everywhere and into everything. The children are very nice, curious to see us and what we are doing, and aren't afraid to invade your personal space. Another joke is that they seem to let their dogs and children run free, but lock the pigs up. Speaking of pigs and sustenance, due to the islands lack of space and rather dry conditions, they are only able to grow food in crops in small amounts and fishing predominates the food gathering. Kiribati is actually expected to be the first country to disappear due to global warming and the rising of the seas.