Heaven on the Pacific

As I have already had cause to mention, every week on this mission reveals to me a new dimension that brings into sharp focus the enormity and the impact of this mission on the people we are serving. We sailed for 3 days from Indonesia to Philippines, two days after I got back from my MEDCAP in Indonesia. We have been in Philippines for about ten days now. I spent the first week in Philippines working as an Inpatient Pharmacy Technician on the ship’s Pharmacy. My duty as an Inpatient Technician was help fill prescriptions for pre and post-surgical patients. I also prepared and delivered IVs to the various wards that housed these patients. I got a better idea of the valiant work that these selfless surgeons on the ship are doing while delivering medications to these wards. The number of patients we are serving aboard the ship and the complexity of the cases have blown me away! I have seen children with cleft pallets operated on and transformed. I have seen cataract patients successfully operated on among others. I have witnessed the immense gratitude of these patients and the palpable joy on their faces.

                                                               Making an IV

Perhaps my most humbling experience on this mission is the opportunity to observe a couple of surgeries at the operation room on Saturday the 23^rd of June 2012. Dr. Robert Baxt and Dr. Sharon Weintraub, both fellow Project Hope volunteers conducted both surgeries. The first surgery was a routine procedure to repair a right inguinal hernia on a 2-year old boy. The operation was hugely successful and after forty minutes under the surgeons’ scalpel, the little angel’s life was eternally transformed. He was in fact discharged from the hospital later that evening after a life-changing procedure that most probably averted a lifetime of pain and misery for the little boy. This assertion was given a further credence by the second surgery I witnessed that day. This was also a left inguinal hernia surgery on a 43-year old man. This procedure was anything but routine; it was a procedure to repair an 8-pound hernia the size of a large cantaloupe. According to the surgeons, it was pretty much the biggest one they have seen in their long time in practice. The patient has been carrying this hernia ever since childbirth and had not had the means to get it operated on till now. I fail to see how this patient could possibly have engaged in any physical activity prior to this surgery. Dr. Baxt pointed it out to me that this was the fate the little boy who was operated on earlier was looking at had he not been operated on. The surgical operation on this older patient took a little more than two hours to complete. It was the sort of procedure that will ordinarily make me queasy and uneasy. However my sense of curiosity and my eagerness to be a witness to this transformative procedure got the better of me and gave me the guts to stay through the whole of this rather graphic procedure. Observing these accomplished surgeons make an incision on the lower abdomen of the patient, pull all the parts of the patient’s gastrointestinal tract that had descended into the scrotal sac through the inguinal canal, causing this rather massive hernia, putting these parts of the tract back where they belong in the stomach, closing up the canal and stitching up the incision was surreal and humbling to say the least. The look of gratitude on the face of the patient as he woke up from his anesthesia, just before he was carted from the operating room to the recovery ward was priceless and will forever be ingrained in my mind. Life as known by this patient will never be the same again. He will be able to engage in activities that he had hitherto not been to partake in. His self-confidence and outlook in life will be hugely boosted all because a group of selfless and philanthropic individuals on a big hospital ship happen to stop by. I had wanted to visit this patient at the recovery ward to see how he was doing but was told by Dr. Baxt at dinner the next day that he had already been discharged earlier that day. I am really happy for this patient for his speedy recovery and the new lease of life he’s been given by this operation.

                                                                   At the OR

I also had the privilege to be on a Surgical Civic Action Program (SURGCAP) team on Sunday 24^th June 2012. This is a team that goes Inland to screen patients eligible for surgery on the ship’s operation rooms. On this day we travelled to Calbayog City in Philippines to conduct this screening exercise at the city’s sports complex. I was part of a team responsible for taking and recording the vital statistics of the patients to be screened. We were met by a large crowd at the gate of the complex waiting for the chance of a life-changing operation. We screened in excess of 450 patients on this day and booked 140 appointments for various surgical operations to be conducted at the ship’s operation rooms for the last week of our mission in Philippines. Even though we’re doing tremendous good on this mission, I still couldn’t help but feel bad for the numerous people we had to turn away because we didn’t have the capacity to take on more. I truly wish we had the capacity to help everybody who needed help but I also know that is unrealistic. What broke my heart perhaps was the story of this elderly lady who broke down in tears when she was given the bad news that we were unable to take on any more patients. She had ovarian cysts and recounted through an interpreter how she had travelled a long distance to be there in the hope of getting relief from her condition. According to her she has no means of obtaining care for her ailment and we were her last hope of ever getting her condition operated on. This rather sad story really did put a damp on my day but the realization that we have been able to offer relief for hundreds and will be able to do that for a few hundred more patients with similar stories did help me put it all in a better perspective.

                                                        Taking down vital stats

Alexis and I also had the opportunity to do a presentation on viral gastroenteritis for all the personnel at the Pharmacy department and other invited guests on Monday the 25^th of June 2012. We thought it was a relevant topic to present on because of the outbreak of gastroenteritis on the ship two weeks ago. In the presentation we educated our audience on the causes, epidemiology, pathophysiology, prevention and treatment of the disease.

This wonderful adventure is sadly on its last leg but its life-changing experiences will fuel me forever. Stay tuned as I wrap up on this awesome adventure.

6/25/12

I officially have 1 week left on the ship! It feels like it’s gone by so fast, but at times very slow. This experience so far has been AMAZING, but I miss my boyfriend, friends, and family and my big comfy bed! Anyways, I’m definitely going to make my last week on the USNS Mercy a week to remember!

Since I posted last, I’ve only got a few updates. However, some very interesting things have happened. With this being week 1 in the Philippines, we’ve had all new surgery patients and cases. With that being said, each day, two pharmacy staff members have the opportunity to go observe some surgeries. The day I went, I witnessed a routine hernia repair on an older man. The whole surgery took about an hour. We met the anesthesiologist and he explained to us that since he was elderly and actually had a cataract surgery planned for the following day, he didn’t want to completely anesthetize him. He received an epidural, benzos, and local anesthetic. During the surgery, he would open his eyes and kind of look around and it made me nervous! But the docs assured me that he couldn’t feel anything and wouldn’t remember anything afterwards. It was really funny because there were times during the surgery too when it would be dead silent and he would start snoring! The doctors joked that only an experienced anesthesiologist could do that.

Towards the end of the surgery, one of the nurses came in and asked me and the other student to come over to another OR because they had a tumor they wanted us to see. We both looked at each other, said cool!, and followed her over.  The patient was a 16-year-old girl with an ovarian cyst that made her look like she was 9 months pregnant. It was huge! They were at the point in the surgery where they had already cut down to the surface of the cyst. The next step was to drain some of the fluid inside of it so they could then remove the cyst much easier. They ended up draining 6 LITERS of brown fluid from the cyst!!! It was so disgusting but so awesome to see! After draining, they removed the rest of the cyst and it looked like a deflated basketball. The thing was humongous! The doctors were taking turns getting their picture with the cyst because they were so amazed by it’s size. As the were sewing her up, it hit me that this girl was a small, petite person who had been plagued with the burden of carrying this thing around for YEARS. It made it so clear to me that this mission is not only helping people with life-saving care, but changing the lives of those who couldn’t afford or didn’t have the means to do so themselves. This girl has such a bright future ahead of her and I’m anxious to see her recovery and reaction to her stomach size when she starts the healing process.

We were only in surgeries for 2 hours, but that 2 hours definitely changed everything this mission meant to me. It was a life-changing experience to witness those people.

Other than the surgeries, the days have been somewhat normal. I have been making more and more IVs and been enjoying every minute of it. One day, some of the Navy guys did a station exercise with practice problems set up around the room. There are about 8 students here and we took turns working through the problems and eventually went over the answers (it took us awhile since some of the questions were hard!). I really enjoyed this exercise because it made me more familiar with hospital pharmacy drugs and calculations. The guys here are great and most of them really enjoy working with us and showing us the ‘Navy way’ of doing things. Sometimes the ‘Navy way’ isn’t the most practical or most direct but it works for them here. Pharmacy operations are definitely different than the normal US practices, even though the government runs it. The software isn’t very new, there’s not a wide variety of meds, and you can’t just order something and it be here the next day, but the system works for the situation and is quite effective regardless. There are some glitches but it’s definitely been interesting to see their way of doing things.

That’s all I got for now! I go out for my MEDCAP on the 29^th and 30^th so I’ll definitely have some updates before we get to Subic Bay to disembark!!

DAY 4: 06/12/12

The windows were creaking, doors banging together viciously and the wind whistling through the small crevices in the wooding wall separating the classrooms. I had been startled out of my cot by the commotion resulting from the ferocious thunderstorm taking place at the early dawn at 0300. I got up, surveyed our immediate surroundings and when I was satisfied that everything was in order, I took some fever medication to mitigate the intensifying feverish conditions and went back to bed. I woke up again at 0530 and to my utter surprise saw a crowd waiting in the rain. This was the last day of clinic on the mission and evidently the locals were anxious to be seen as early as possible. We had our early morning muster as usual at 0700 and discussed a number of topics. Among those discussed was the fact that we will be working shorter hours that day because we were scheduled to leave early the following morning and therefore had to have enough daylight to wrap up our operations on the Island.  We were much more efficient on this day and delivered treatment to a lot of patients. We still had a lot of the medications we brought to the mission left and decided to be very generous by filling maintenance medications like lisinopril, hydrochlorothiazide for a 6-month supply instead of the 30 and 90-day supply we had been dispensing to the patients hitherto. We wrapped up operations for the day at 1400 and got together as a group for our afternoon huddle. We deliberated on the day’s activities and the mission as a whole. Our operations commander conveyed to us at this meeting that we had treated in excess of 500 patients that day. There was however a sizeable crowd still gathered outside who could not be seen and looked very disappointed and even agitated. It was decided at this meeting that we will distribute the remaining supplies and some nonprescription medications to the waiting crowd, to ensure that everybody that made an effort to attend our clinic will at least get some sort of care. The three clinics therefore gathered their remaining supplies of sunglasses, toothbrushes, toothpastes, dental floss and other like items. The pharmacy department also augmented this impressive collection with the remaining multivitamins, shampoos and some other nonprescription medications. We set up stations for the various supplies available and ushered the crowd through the stations from the entrance in an orderly fashion. This way the each patient moved from station to station picking up toothbrushes, sunglasses, vitamins and other supplies displayed and was ushered out of the camp after visiting the last station. It proved to be very efficient and key to ensuring that everybody was served in an orderly fashion. I was at the dental station demonstrating to the locals the use of the dental floss. The sight of me baring my teeth and flossing away elicited a chuckle or outright laughter from anyone who saw my demonstration.

                                                             Demonstrating flossing

The pharmacy team went back to the pharmacy, cleaned the place up and packed up the remaining medications. We then joined other members of the team to break down our tents, together with some other heavy gear we had on the site and transport them to the helicopter landing site for our departure early the next morning.


We enjoyed some delectable Indonesian cuisine for lunch at the Mayor's house. We got together with some of the locals who had still gathered at the camp after lunch, took pictures and played volleyball with them. We had become very attached to a number of the locals who lived on the school compound in the past three days. For dinner, the resident doctor treated us to a buffet of authentic Indonesian food. Among the food served was rice cooked in coconut juice, noodles and fried whole pork. We came back to our camp some few hours later to witness a long table lined up with even more food at the forecourt. A local church had decided to organize a farewell church service for us and had all brought food for us, as part of the service. There was a glut of food for us today! After a brief sermon, a speech from the Island’s mayor and another from our operation commander we were invited to sample the meals available. Most of us were too full to take another bite but nevertheless got up for some few scoops in order not to offend our hosts. We kept the fun going by singing songs with Ray, one of our interpreters displaying such dexterity on the guitar. I went to bed that night on a very full stomach thinking about the magical three days I had spent on this island and all the wonderful people I have encountered on this mission. I do not know whether we will cross paths again or whether I will ever be coming to this part of the world again but I do know that the memories and experiences I have attained on this mission will forever be etched on the tablets of my heart! 

Weekly Update 6/18/12

Sorry for not including very many pictures... Kofi has much more patience than I do!! Also, the internet out here has been AWFUL! This is my 4th attempt in 2 days for uploading this blog.

Since arriving back from my MEDCAP, the ship life has been somewhat quiet but definitely not dull!

One of the islands in which one of the MEDCAPs was stationed had an active volcano. From the ship I could see the smoke steadily streaming out. I found out that the volcano had actually erupted a few weeks ago but it was determined to be safe for the MEDCAP to go out still. The scene was still pretty incredible to see.

The first few days back on the ship, I was very appreciative of the things I missed. Hot showers, real toilets, and hot food were so spoiling! The only thing was that the ship was rocking bad. And after being on land for 6 days, I was not feeling so hot with all the swaying. I simmered down after about 2 days and then I adjusted back fine.

One night, the Captain came over the loud speaker saying all decks were closed due to inclement weather. This is unusual since the smoking deck is always open at-your-own-risk so I knew it must be bad. Of course, everyone in the pharmacy immediately jumped up and swarmed at the windows in the hall. The sky was completely gray and you couldn’t even see the water it was raining so hard. After the storm passed, it remained windy the rest of the night. Apparently during the night, one of the transport boats was severely damaged by the wind and being smashed into the Mercy. Also, the ramp used to get patients from the Mercy to the transport boats was destroyed and now sits at the bottom of the ocean. It remained very windy for the next few days and therefore all plans to leave for closing ceremonies were cancelled. Everyone getting off for flights as well as patients getting off after treatments, had to be lowered down to the transport boats by the life rafts. It was quite the ordeal for all the people to get off the boat. Helo ops were not an option due to the winds.

In our downtime for the rest of Indonesia, we watched movies and played games in the pharmacy pretty much all day. We did take some time to palletize the Philippine MEDCAP medications on some mornings.

Four of the girls I met when we got on in Guam left on the 14^th. I was sad to see them go since I started my journey here with them and wouldn’t be finishing it together. They were some pretty amazing people that I will definitely be friends with for a long time. And I’m glad I got to spend an amazing few weeks with such great people.

That Saturday, the 16^th, we got an official holiday routine! Finally, we got to sleep in since we didn’t have to muster until 0930 instead of the usual 0700. We even had abbreviated meal schedule since they served brunch. Some of the Project Hope people still here and I decided to rent a Wii and some games from MWR. We spent the day playing Mario and Just Dance, which was definitely a great break from everything. After dinner I brought the Wii down to pharmacy to store for the night but we actually ended up playing for hours! It was hilarious to see our Commander and all the Navy guys (and girls) to play Just Dance and actually be in to it. We had a great time with everyone and it was definitely nice to relax and hang out together.

As we began our 3-day journey to the Philippines, we received a news release warning us of a typhoon currently hammering the location we were headed to. As we got close to the Philippines, the weather picked up and it was extremely windy outside and therefore the ship was swaying bad.

On one of the days we were in transit, there was a ‘frocking’ ceremony held. This is a formal ceremony in which people eligible for promotions are pinned and recognized. There was one young man from our pharmacy department being promoted so we all went to support. It was pretty neat to see the official changing of ranks and formal dress of the ‘frockies.’

There was also a birthday celebration one afternoon during transit. The Army turned 237 years old! They made a huge cake and celebrated all the Army personnel on board. It was pretty cool seeing all branches of the military hang out together and celebrating.

After leaving Indonesia, some people started getting sick. As it became more prevalent, officials determined we had Viral Gastroenteritis spreading on the ship. As of yesterday, at least 30 people have been quarantined on one of the wards to prevent further spreading, if possible. Preventative Medicine also decided to remove all self-service food items from the Mess Decks since they thought that might be a possible source of the virus. So no salad, no fresh cut fruit, and any sandwich bread has already been pre-saran-wrapped to prevent hands touching everything. It’s been weird at meal-time since our options are so limited now. So far, 2 people in the pharmacy department have come down with the virus and are in isolation down in one of the Wards with the other contaminees.

Yesterday, the USNS Richard E. Byrd came up next to us for a few hours to refuel us and restock some of our supplies. It was an amazing sight to see! The helicopter was lifting pallets of supplies off the ship and dropping them off on the Mercy while they refueled. The whole process took hours but was very cool to watch. Kofi and I stood on the outer deck for awhile talking to one of the Navy guys about how the whole process works and some facts about the ship. He was very friendly and helpful.

Well, that’s all I have for an update!  Hopefully I’ll update you all again soon now that we’re in the Philippines.

DAY 3: 06/11/12

I was up and ready for the day at 0530 today. I had already had one full day of work on the mission under my belt and knew what to expect. I was invigorated by our exploits as a team the previous day and was stoked and ready to work harder to achieve better results today. I had no doubt in my mind that we will do better in terms of the number of patients we take care of and our quality of delivery. We were better acquainted with our formulary: what is on it, where they can be located and their major counseling points. We knew the major drugs prescribed by the providers present on the mission and the most prevalent disease states and conditions presented on the mission. A cursory look outside the perimeter of our camp revealed that the locals had already converged outside the camp waiting to be seen. It was a bigger crowd than I witnessed in the early morning of the previous day. I did also see some buses parked where the locals had gathered. I found out later from the resident doctor that those buses had actually transported patients from neighboring villages to our clinic. I knew it was going to be a hectic day, but I also knew that this indefatigable and resourceful team of ours was up to the task. I was ready to go!

We, as usual had our morning muster at 0700, after we had had some breakfast. It was suggested at this morning’s muster by one of the providers that the pharmacy provide the three clinics with some of the medications popularly prescribed by them to be given to the patients after they are seen, in an effort to take some of the load off the pharmacy department. This was accessed by our Pharmacist to be a good idea since a majority of the medications requested did not require extensive counseling. Ibuprofen, the NSAID of choice for most of the providers, particularly the Dental Clinic, adult and pediatric multivitamins and albendazole were some of the medications approved. This proved to be very efficient in treating and dispatching the numerous teeth extraction patients who were only prescribed painkillers and other patients whose conditions only warranted uncomplicated regimen. It really did help to relieve some pressure off our department, considering the size of the crowd today.

We were however still inundated with prescription to be filled. I was however actually enjoying the busy work. I felt more confident about my counseling skills, I could locate the medications on the prescriptions with little effort and we had developed a more efficient way of reconstituting our drugs. We had also established good rapport with our interpreters and were in sync with them. I had gotten to know more about the culture of the locals and could relate with them better. Everything was working seamlessly well and nothing was going to slow us down! The whole mission had seen 670 patients when we shut down operations at 1530. It was a very productive day for us and it was all made possible by virtue of our astounding teamwork.

                                               The wonderful team at the Pharmacy

A couple of the team members and the interpreters found it fitting to head to the beach and cool off after the evening’s muster. We took the opportunity to see more of the village on our way to the beach and fraternize with the locals. I volunteered the customary greeting of “salamat sorre” to every local I encountered. They always responded to my greetings with giggles and an obvious sense of amusement. They still loved us and trooped out of their houses to catch a glimpse and greet us! Sitting in front of one of those house with his mother and screaming “Mister, Mister” was this adorable and playful little kid. I went over to acknowledge him and say hello. I unleashed the Indonesian phrase of the day I had learnt from our interpreters: “Nama saya Kofi” and then pointed to the kid to say, “my name is Kofi, what is yours?” The mother instantly replied “Obama”. I asked: Obama? The mother nodded in agreement and I instinctively whipped up my camera! I just had to get a picture of Obama, with the consent of the mother!

                                                                     Obama

The beach had an awesome and scenic backdrop with sprawling, peaceful mountains, green and lush vegetation. A lot of the locals were already there at sunset to take a swim. Some had also followed us there. It was a breathtaking and welcoming environment with kids running around playfully with no care in the world. The water was calm, inviting and full of revelers. I would not be left out of the fun so I wasted no time diving in and having a swim. The cool water was just the escape I needed from the sweltering heat. I had a wonderful time carry kids on my shoulders as they jump into the rushing waves and also taking pictures with all the locals who requested them. We came back to the camp, cleaned up and honored the invitation by the wife of the Mayor to her home for dinner. Dinner was noodles cooked in spicy vegetable soup, just what I needed to fight off the cold I felt coming on then. I went to bed that night feeling a bit feverish and had to take some medication.....

                                                                   At the beach
 

MEDCAP 2: Day 6

I was up and moving by 0415. I quickly got dressed and started packing up my cot and mosquito net. Everyone was bustling around to get everything packed up. I had just gone to the bathroom for what I hoped was the last time there when I heard the helo. I got SO excited to know we were being saved! It dawned on me to check my watch and it was only 0530 so I knew something was up. Sure enough, word at muster 15 min later was that the helo had only dropped some nets and logistic men and wouldn’t be returning until the afternoon after placing MEDAP 5 (Kofi). So we weren’t saved yet…

After hearing that news, I was crabby and smelly (no real shower for going on 6 days) and tired. We finished cleaning up the school area and walked over to the helo site. After about 30 minutes the OIC decided we would just hang out back at the school for a few hours so we would be out of the sun. He also gave us liberty but made it clear that if you heard the helos you betting be running because they weren’t going to wait for anyone. We went back to the school and sat on the steps again for about an hour before a group of 4 of us decided to take one last walk down to the market. So we walked and talked for the ½ mile journey. It was me, Flying Officer Warren (Sam), 2^nd OIC Moreno-Chow, and the Dental Hygenist Shannon. As soon as we got there, I went straight to the store with the cold drinks a bought an ice cold soda. It was SO refreshing, I could feel my bad mood melting away. We just so happened to walk by the beach just as our translators were leaving by boat. We frantically waved and wished them well. We walked around and bought some snacks and such before heading up the hill back to the school. When we got back, we sat and chatted for about an hour before I finally laid back on the tile and fell asleep. I woke up a while later very stiff and uncomfortable, but feeling quite refreshed. However, my uncomfortable nap quickly left my memory when a local woman brought over a whole container of fresh, fried bananas. I cannot even describe how AMAZING fried bananas are. I was definitely in heaven. I ate 2 and would have had more if they weren’t so filling. We began to chat again as a thunderstorm rolled in. The rain didn’t stop the guys from playing basketball with the kids though. I couldn’t help but think to myself that the storm was delaying our departure. I was beyond ready for a shower! We mustered again around 1200 to get our stick assignments for the helo ride back before walking back over to the field. Thank the Lord I was on stick #1!! That meant a shower sooner than later! So we walked back up to the field where by now all the bleachers and areas surrounding were filled with people watching and waiting. We waited for what seemed like eternity with people constantly asking us for photos. I was so disgusting, I can’t imagine why they would want a picture of me. Some people would even just walk up, not say anything, snap a photo, and then just walk away.

Finally, around 1300, the helo came and got the COMS guys going to the next MEDCAP. About 15 min later, another helo came for stick 1 (me!) and we left as quickly as we arrived. The first thing I did when returning to the ship was shower, of course. I then threw on some PT gear since that was the only clean clothes I had.  I immediately threw the nasty clothes I was wearing in the wash. We had to muster 1 last time as a group once all the people were back and I refused to wear those clothes without cleaning them. It felt soooo good to be back on the ship and get clean. My gear didn’t get back until later that evening so I had to wait to do all my laundry with everyone else getting back that night. I was so exhausted by the time I went to bed I couldn’t fall asleep. My thoughts were cycling over the experiences from the past 6 days as I finally closed my eyes in my own bed. 

MEDCAP 2: Day 5

We got up at 0530 for 0630 muster to start seeing patients at 0700. Before we mustered, I sat on the steps while Sam and I shared one of the avocadoes we received last night. It was perfectly ripe and fresh and creamy! As I sat there trying to enjoy my breakfast, I couldn’t help but notice that I was already sweating profusely and I knew then that it would be a long day. However, shortly after muster, our interpreters arrived with lots of yummy snacks and it made me smile at their kindness. We have definitely been blessed with some amazing translators. They brought cakes, cookies, more mini bananas, banana chips, and “mocktails.” It definitely brightened my day!

We immediately starting to get patients flowing through and our last treatment day began. I got a lunch break around 1130 for about 40 minutes. Otherwise, we went straight through from 0700-1900. There was a point around 1500 when we had to stop filling prescriptions and do a full inventory of our remaining supplies per the OIC (Officer In Charge). We were closed for about 30 minutes. By the time we were back up and running, we had a room full of people waiting and a large stack of prescriptions waiting to be filled. It was like this for the rest of the day! Dental had stopped taking patients around 1100 due to lack of lidocaine needed to perform procedures and sent some people over to help us out. We got a volunteer to help us fill and once we got an extra person, things seemed to flow much better.  Dr. Bemiller even came over after seeing her last patient to help us finish up. It was definitely a group effort and I’m so lucky to have had the chance to work with such amazing people. Without a group effort, the day could have possibly ended pretty miserably. After we finished filling our last prescription, I went and sat on the steps outside of the pharmacy, as usual, to reflect upon the day.  And again, there were some of our troops playing basketball with the kids. It amazed me that no matter how hot or how long of a day we had, they would still play with them.

As patients slowly filtered out, equipment and more people came in. They began to set up speakers for our piesta (festival)! As we sat and watched, our interpreters brought out the ‘mocktails’ and we sat there together reflecting on the week and playing some games. The drink was of course non-alcoholic and made with young papaya and juice. As the crowd grew, the local officials began a ceremony with out OICs in which they exchanged kind words and gifts. When they were finished, they invited everyone to dance. It took a few minutes until the local governor took initiative and started a congo line in which he, as the leader, would start a dance move that everyone else had to copy. It was pretty hilarious since us Americans are so tall compared to most of the Indonesians. I sat and watched everyone just taking it all in. About half-way thought the dance, a young man came up to me and asked why I wasn’t dancing. He may have asked me to dance as well but I wasn’t sure since his English wasn’t very clear. I told him politely that I was perfectly content to watch and dancing wasn’t my thing. He sat down next to me and we sat in silence watching everyone else. Slowly people began to leave the dance area as the music transitioned to a new song. The young man excused himself to catch up to one of his buddies. About 20 minutes later the music stopped, people starting leaving, and we began to clean. As I got up to get my things together and get ready for bed, one of the translators stopped me and another girl on the MEDCAP explaining that these 2 young men wanted to trade mementos. We both stood there slightly taken off guard, frantically trying to think of something to give them. The interpreter said even an American dollar would be cool to give them and I thought, prefect! So I went to get my wallet and met back with my friend, the 2 guys, and the translator a few minutes later. The first guy handed my friend a glow-in-the-dark beaded rosary which was really cool! The guy I traded with gave me a heavy metal necklace with his name engraved on the dog tag. I told the interpreter that I couldn’t accept this gift! He relayed the message to the young man and he was insistent that I keep it as a memento and thanking me for the American dollar. I was extremely flattered and shocked that he was so willing to give such a personal item to me for just $1! We said our goodbyes and took a picture since it was already 2200. We mustered shortly after that and were told to be up by 0415 to start packing up our gear since the helos would be arriving around 0600. I therefore hit the rack immediately after the meeting.