Home

Got home last night. Incredible that you can waste two entire days for a two hour flight! The last week of Project Hope I though I would never get home, but once home it was like I had never left.

What a great experience! I knew before I left that I would be touched by the patients who live in daily povery, that there would be days I would cry for the patients who did not have access to services that we not only expect, but demand immediately. For example, I met a gentleman who had been hit by a car while riding his motorcycle. He fractured his left hip, femur, and tibia. His hip and femur were repaired surgically, but his tibia was left displaced and dangling. Five years later he could not walk, you did not need an xray to see the fracture, and he would move the bones back and forth for you when you could not believe what you saw. Without work he does not have insurance or cash to pay for the surgery, without a working leg he cannot work. Stories such as this are plentiful in Central America.

What I did not expect was to meet so many wonderful people on board the ship. People from all over the world with a lifetime of stories to tell. People with accomplishments and resumes full of exciting adventures and accomplishments. It was so fun just to sit down and chat and exchange stories and information. The physicians and NPs on board the ship not only challenged each other to obtain a higher degree of competence; but they challenged me, an NP student they will never see again, to reach up and out across the world to gain the most out of work and out of life. As role models the raised my expectations of myself as a student, a professional, a friend, and a mother.

Costa Rica

We have been out to sites in Costa Rica for four days now. Surprisingly, many of the people are poor, but they seem to have access to healthcare. The government mandates that businesses provide all employees with health insurance. The employees pay a set percentage of the premium so those who make more pay more. Those who are not employed do not have insurance and have to pay cash for healthcare unless there is a life threatening emergency. Still, it seems that most of the people coming to us have had appropriate care. The problem arises when they have to wait several years for non-emergent surgery. Non-emergent and unnecessary are not synonymous. I have seen several women with cervical dysplasia who had to wait two years for treatment. A 19 month old with congenital hip dysplasia was on a four year wait list for surgery; the mother had been told by then it would be too late. There is a private system where they can pay to have surgeries performed for cash but most cannot afford it. In some ways, this is more frustrating than those who have no healthcare at all because their expectations for what we can do for them are higher. Scores of surgeries are performed on the Comfort but they are limited to those with a quick recovery which does not require extensive follow up.

The people of Costa Rica are warm and happy. They love to joke and laugh. Our translators are medical students from San Jose who give us great insight into the culture, the health system, and the daily issues that the people of Punta Arenas face. They have also helped me compile a list of great places to visit in Costa Rica. Unlike El Salvador, we are allowed to leave the ship at night and eat at the nearby restaurants. This makes living on the ship a lot easier since the food is the greatest hardship of all!

Last night one of the physicians traveling with Project Hope gave a commemorative presentation on 9/11. He was on the disaster relief team that was present at the World Trade Centers for two weeks immediately following the disaster. His pictures and heartfelt descriptions put a personal twist on the event that one just cannot get by watching the news. This is one example of what has made this excursion so out of the ordinary. I have met people from all parts of the world and they all have fascinating stories to tell.

It is hard to believe that we will be leaving for home next week and graduating on Saturday! I am quite homesick, but not yet ready to leave.

from Lori

August 1, 2011
Project Hope 2011: El Salvador
Hello everyone!
We landed in San Salvador on July 14 and were met at the airport by Earl Peterson, a soft spoken southern gentleman, and experienced Project Hope volunteer who greeted us with open arms and escorted us to the Hilton for our overnight stay and boarding of the ship the following day. Not knowing what to expect and knowing nothing regarding military life - I followed the lead of those who had committed to previous missions. I could not have completed the first week without the direction of Randy and Faye to show us the way.
A typical day starts with getting up at 5A, having meals with the enlisted personnel, muster (roll call), going out on MEDCAPS (giving care at the sites), and with our off days consisting of laundry, working out, reading, and catching up on sleep. Over 900 patients are seen daily from general and family medicine, ophthalmology, ENT, women’s health, accompanied with pharmacy, physical therapy services. Sites close down after all the patients are seen and we come back to the ship around 16:30 -17:00. Dinner is served between 17:30-19:00, and an overview of the day’s activities by the various commanding officers at 19:30. Afterwards you’re exhausted, shower, and retire to your berthing quarters to get a few hours of sleep and do it all over again.
The days are long, hot and exhausting at times but rewarding; it’s when you get that firm hand shake, smile or hug from that individual who walked and stood in line for several hours to get to the site to be seen by a health care provider. For many patients, this is the only healthcare they have had in several years, prescriptions are unable to be refilled due to the financial expense and this may be the only care they receive until the mission returns to this area.
The unexpected kindness and respect from all aboard is truly refreshing. I had forgotten what it felt like to say hello to everyone you meet, strike up a conversation or sit and enjoy a meal with someone you don’t know but feel like you have known them all your life. People aboard the ship go out of their way to help you. Not just tell you how to get there but actually take you there. This has been particularly helpful, since I have been lost on every part of the ship for the past week. The military personnel know that look ……….????????. No one gets irritated, brushes you off, raises their voice or lets you struggle. I am surprised no one has thrown me overboard from all the questions: where is……..? It’s taken a week but I think I am figuring it out. When I have found the red floor I know I am going in the right direction.
The Comfort is just as the website portrays it – a white navy vessel with red crosses on it. But what it doesn’t demonstrate are all the combined efforts of the different branches of the military – US navy, army, and air force working with nations from Canada, Columbia, and the Netherlands to join in the efforts in providing humanitarian care and working as one. But what surprises me the most is all the NGO’s, the non-governmental organizations- doctors, dentists, nurses, and other health care providers worldwide who have volunteered their time to this mission. Without all the sum of these parts this mission could not function as a whole.
Got to Costa Rica and had liberty at Punta Leona for four days before starting on the second half of the mission. Lots of sun, walks along the beach, and zip lining and touring Jaco Beach. We are about to check out after lunch to return to the ship. MEDCAP starts tomorrow. Lori

Post from Beverly

July 23, 2011
Lori and I flew together from Miami to San Salvador having no idea what to expect from our adventure. We arrived at the airport and were greeted by a Project Hope veteran named Earl. Earl is a pharmacist who went on Hope’s first expedition in 1958. He now brings pharmacy students who compete for the privilege of traveling on the mission. He is retired military and so soft spoken you have to lean in close to hear him. Incidentally, Earl met his wife on his first Hope mission.
At the hotel we met several people who would be traveling along with us. Some had traveled on Hope before and had many stories to tell. All were interesting, some were sad, most were funny. The next morning we were all excited to be heading for the ship. The bus was supposed to arrive at 10:45 AM which turned into 1:00 PM. We then drove around the city three or four times picking up various other people who would be joining us. We took another trip back to the airport and then finally headed towards the port. The 1 hour ride to the port took nearly five hours!
As we drove around San Salvador the first thing I noticed was a McDonald’s. As we continued to drive we saw Subway, Pizza Hut, Burger King, KFC, Wendy’s along with Sears, Nine West, and even Wal Mart. Everything was so Americanized. Except for the housing; corrugated aluminum houses in various stages of disrepair were crammed together on hillsides and in valleys. There were forty or fifty crowded almost on top of each other and surrounded by large piles of trash and garbage. Amongst all the American retailers and impoverished citizens was the most beautiful foliage and flora I have ever seen. They have the same hibiscus flowers we have, but the colors are more brilliant and the blooms are twice as big. I really wanted to spend a few days getting to know the people of the city and find out what their lives were like; but we moved on to the ship.
The Comfort is physically much larger in person than you expect from the pictures. Brilliant white with a giant red cross on the side, it stands out more than any other in the port. Once on board, the first thing that you notice is that this is a collaborative effort much greater than the United States Navy and Project Hope. There are military personnel from the U.S. Army, Air Force and Coast Guard as well. Additionally, there are military from Canada, Holland, Brazil, Columbia, and a variety of other countries. Several private and religious organizations are also prominent.
It is an extraordinary experience to encounter such a variety of people. Surprisingly, with so many people in such tight quarters everyone remains amiable. Manners are displayed by all and impeccable. Those who have been on board longer help the newcomers find their way around (which by the way is a lot more difficult than one would expect). This is my first close encounter with military personnel. The maturity and professionalism displayed at all times is refreshing; especially when you recognize that most of them are late teens and early twenties.
We arrive too late the first night to do much but eat, find our bunk, and go to bed. Our second day is orientation to the project and the ship; which is like orientation everywhere. The third day we at last get to go out to our first medical site.
We see nearly 1000 people the first day. There are medical experts from every field working together to offer as much help as possible in such a short period of time. As a student, I am not only welcomed, but sought after. Physicians and practitioners with unusual and text book cases seek me out to show me the nuances of assessment that we don’t always get to see in the United States. Detailed history and physical assessment are the key to diagnoses in our outdoor makeshift clinics. Simple procedures are performed on the spot. Family Practice from crib to crypt is flourishing here. I have seen and learned more here in four days then I learned in nearly two years of training.
The people of El Salvador are happy, extremely clean, and grateful for all things we offer; big and small. The difficult encounters are those that could be easily fixed in the U.S. but ruin lives in Central America. A 14 year old boy who has what his mother calls “a hole in his heart” and has heart sounds suggestive of a VSD is thin, gaunt, and low on energy. Back home, we could fix his heart in less than one hour. A 72 year old woman arrives our last day in El Salvador blind in her left eye and no peripheral vision in her right. Her blindness is caused by simple cataracts; had she arrived the day before we could have fixed it. We referred her to the host nation, but in El Salvador she may be too old to have the surgery. Fortunately, there are only a few of these cases that stand out. Most of the patients present with complaints of headache, dizziness, stomachache; usually symptoms of not drinking enough water or malnutrition from parasites. We give out vitamins and acetaminophen; along with education, education, and more education. And we get back a lot more than we give.
July 26, 2011
We have not been able to post anything as of yet. The internet and telephones have been down for several days. You never realize how dependent you have become on these electronics until you have to do without them. I well remember the days when long distance calling was rare due to cost and mailed letters were the only form of communication. We have been out of touch for less than a week and all of us are feeling a strain.
We left El Salvador the evening of July 24. It was a really a great experience in many ways. The people of El Salvador are warm and friendly. They have a system of socialized healthcare and have many services available to them. The problem, as was explained to me by one of the many translators, is that the services are not close to home for most people. A trip to San Salvador costs money and most of the people do not have automobiles. Additionally, once they make the trip there are no guarantees that the procedure will be performed when the patient arrives or scheduled for another day. We met a young 23 year old mother of a 7 month old who had a PAP smear result which showed CIN 2 (moderate dysplasia). She had a letter which described the necessary cryosurgery and where she would have to go to get it. She did not have the resources to travel to the city and stay in a hotel while she awaited her appointment. In some ways, the citizens have access to many services that United States citizens do not, but there are other difficult conditions that prevent access.
Speaking with the discharge planner about this same young woman she told me that many of the postsurgical patients from the USNS Comfort are discharged to a central location or taken to the port exit to await a ride. In this country people are used to a long and difficult road home. Some of them call for a taxi, some wait outside for a family member, and others have no idea how they will get home safely. In the U.S. this would be unheard of for somebody one or two days post op waiting for a ride in the street.
Today has been a very exciting day. It is the day where the ship is refueled and restocked with supplies. One would think that boxes would be loaded at the dock and fuel would be dispensed at the port. Not so. We travel out to sea and meet a ship called the Lewis & Clark. The two ships travel side by side while gas and supply lines are thrown from one ship to the other. Fuel is dispensed through these lines and palettes of packages are pushed across ropes to the other ship. The Navy’s helicopter picks up supplies from the Lewis & Clark and drops them onto the deck of the Comfort. It is a process which the military makes look easy, but it is quite difficult. The ships have to travel exactly the same route without any deviation in rough seas for close to twelve hours.
We are expected to arrive in Costa Rica on July 28. Hopefully, at that time I can post some of this info.
July 30, 2011
Well, we have been in Costa Rica for two days. The ship is on “Liberty” which is similar to vacation only you still have to get up ridiculously early and be checked in by 7 AM. We have been exploring Costa Rica a little during the down time and have seen some beautiful landscapes and beaches. I took some pictures but forgot my USB cord so will have to upload when I get home.
During our exploration of the area, we were stopped at a check point and were asked for our passports. I was not carrying mine with me, but I did have my US drivers license and my USNS Comfort pass. However, this was not enough. The police then decided to search my purse, the vehicle we were in, and were telling us we could be in big trouble. Out Civil Rights were totally irrelevant in Costa Rica. Memories of old movies where people are hauled off to jail and left indefinitely raced through my head. My cell phone does not work here and I did not have the ship’s phone numbers with me. My American sense of justice and freedom for all was causing me to feel angry, but I knew it was best to hold it back. Fortunately, someone thought to show them a picture of the ship. Their attitude changed immediately. They shook our hands, thanked us for being there, gave us all our stuff back and let us go. I am really not sure what they wanted. I hope they are trying to stop the drug trade and not blackmailing American tourists. I now have a much greater appreciation for justice system in the U.S. Even though it often makes mistakes, at least out officers are forced to respect individual rights.
Tomorrow we will all go back to the ship and begin surgical screenings. I am looking forward to getting back to work. It is such a great opportunity to fine tune my assessment skills. Hopefully, the internet and phones will be working on the ship and I can post more frequently.

Beverly Griffis

Explanation of pics

I meant to label the pictures I just posted but didn't. The first two pictures are of Lori and Owen, our interpreter in El Salvador, and Beverly getting sage advice from Faye, our Project Hope leader and pediatric NP. The next two pics are the stadium site where we set up our clinic and our protection. The other three pictures are from Costa Rica liberty, one of the beautiful beach, one of Lori and Gary and Jeff, two ER docs and HOPE volunteers, then me roughing it on the beach here. My pics do not do the beach justice. It is gorgeous.

Costa Rica Liberty pics

More El Salvador pics

El Salvador pictures

Internet finally

Hi Everyone,

Well, it has been awhile. Unfortunately soon after Lori and Beverly arrived and we started our mission in El Salvador, our internet went out for some time. I had a few posts prepared that I was going to put up as soon as the internet (as did Lori and Beverly) came back on but that didn't happen. Anyway, suffice it to say that El Salvador was an excellent experience. I'll let Beverly and Lori post more about it since it was their first mission stop. I will say that they came on board, got oriented, and went right to work without missing a step. Currently we are on a short liberty break in Costa Rica before starting the mission here on Monday. It is a spectacular country from the little I have seen. We are all staying just north of Jaco Beach in a resort in the rainforest. I'm posting a few pictures but they don't do it justice.

Adjusting to Civilization

Today is day 5 of being back to civilization and it seems that it has been the hardest by far! I never thought that I would actually miss life on the “Comfort”. Of course, I am grateful to be home with my family as I missed them terribly! However, there just seems to be emptiness in my heart. I miss having fulfillment from pursuing the daily mission of caring for the less fortunate. Although, I certainly have my own missions at home, it just doesn’t provide the same satisfaction.

Taking part in Continuing Promise 2011 has made an incredible impact on my life! I feel blessed to have the experience to meet such wonderful people, discover a new meaning to life, and learn such valuable information at the same time! I have always been told that “the most valuable things in life are often the hardest to achieve”, but I never fully understood the true meaning of that saying until now. Undoubtedly, the mission was physically and mentally exhausting, but the reward that is gained far outweighs the challenge. Not only was it rewarding to help others; it was reassuring to work alongside so many others who provide selfless care day after day in such desperate circumstances.

Unfortunately, I didn’t get to post on the blog as much as I wanted to due to poor internet connection and lack of time. Therefore, I wanted to take this opportunity to give a synopsis of my overall experience. Furthermore, the last 3 days of the trip I was bedridden with a food borne/viral illness which left me feeling extremely weak. Thankfully, some of the same providers that work so hard in the clinics, made themselves available to nurture me back to good health. I never thought I would be so sick that I would need 3 liters of fluid bolus over 2 hours!

I will cherish this experience for the rest of my life and want to thank everyone there who helped make it a memorable one! To anyone else considering embarking on a similar journey; I would highly recommend it!

El Salvador

Beverly and Lori arrived last night and are currently having orientation (a long, tedious process). However, tomorrow we will go out for our first clinic day and I am sure they will find that much more interesting. I'm glad to have them on board and am looking forward to another excellent rotation with FIU NP students. They should soon have internet (sort of) access and they should start putting their thoughts and experiences on the blog. Kim, Luz, and Nicole, hope you will also continue to write as you process the experience now that you are back home.

Guatemala Pictures 2

Guatemala Pictures

Nicaragua Pictures 2

Nicaragua Pictures

Mission Complete

I am writing this post from a lounge chair in my backyard with tears in my eyes. I am extremely happy to be home, surrounded by my family and pets, yet I still have a heavy heart. Guatemala was different and more difficult for me than Nicaragua. The heat and humidity in Guatemala was oppressing. The MEDCAPS were held in 3 elementary schools. A breeze was hardly felt in any of the sites. I am not sure if the lack of a breeze was due to how the schools were built. Even though the heat was unbearable, I hardly heard any of the providers complain about the heat. It was something that you had to deal with by drinking lots of water. On some days I became slightly dizzy and had a headache. This was my body telling me to hydrate. I would educate parents on the importance of drinking water, and the consequences of not drinking enough. I had to use my own advice on myself. The heat was not the only factor that made Guatemala different than Nicaragua.

The poverty level was increased and the educational level was decreased. This could have been due to the areas that were selected for the medical sites. Some of the reasons that parents (the majority were mothers) brought their children to be evaluated were the same. They included headaches, not growing well, and the need for parasite medicine. Guatemala was harder for me because I saw sicker children that needed more help than what I (we) could provide. I saw children with failure to thrive and congenital anomalies that had to be referred back to the community for treatment. Not being able to give immediate help was more frustrating to me than the heat. I know that I did the best that I could under the circumstances, but that does not make the sadness of not being able to help go away any easier or faster.

My last patient of the mission was one of these cases. It was a 15-month boy that had had fevers for 7 months; with history of seizure and taking depakene. The parents brought all the imaging and the results of all the exams that had been done prior. I desperately wanted to help this family. He was a healthy 15 months old upon examination. If I had not been told that he had had a fever, I would not have been able to tell. This was a very complicated case. I consulted with 3 physicians about this child. It was decided to draw blood at the site, and run the labs back at the ship. I explained to the parents what we wanted to do, and asked them if they could come back the next day for the lab results. They told me they had left their house at 2 am, arrived at the site at 6 am, (I saw them at 1:30pm). I offered to call them by phone to give them the results. They chose to come back the next day to receive their results in person. I was impressed by how involved the father was in the care of this child. Up to this point I had primarily seen mothers bring in their children. The labs were drawn and I waited till 11:30pm to get the results and get copies to give to the parents the next day. I unfortunately was not scheduled to go out the next day (it would’ve been my 8^th straight day) to give the parents the results. All the results came back negative. The parents were told that he probably had drug fever and he should go back to see the neurologist. I was told that the parents were happy with the care their child received. I should be happy that we were able to give the parents some kind of diagnosis for their child. I wish I had some way of following up on this patient to see what happens. I wish I could follow up on all my patients I referred back to the community.

My experiences were not all bad or frustrating. Even though I speak Spanish, I still learned some new words. I learned new Spanish words for milk, baby bottle, candy, junk food, right now, military hospital ship, and diarrhea. I was thanked and blessed by many mothers for taking care of their children. I could see in their eyes how grateful they were for everything we did for them. Even it was just providing reassurance that they were doing things correctly. I could see a mother’s love for her child or children with every child that I saw. A mother’s love is the same in every country. I have met some incredible people on this mission. All the physicians were knowledgeable in their area of expertise, and wanted to share their wealth of experience. I admired the military for everything they do before this trip, now I admire them even more.

I had some sad times, and I had some wonderful times. I might not have been able to fully express my feelings in this post, but it is an experience that I will never forget. I am grateful to FIU and to my job for giving me the opportunity to participate. I have made new friends, learned new things, and visited new places. Participating in Continuing Promise 2011 is a decision that I will never regret.

Now I have to transition to life back on land. My room last night was so quiet it was difficult to sleep. I had not realized how quickly I had gotten accustomed to sleeping with the engine noise. I have not driven a car in over 3 weeks, and now I have to drive in Miami traffic.

I look forward to reading the posts from the next two students.

Good bye

Yesterday was a sad day for me as I had to say good bye to Kim, Luz, and Nicole. They brought so much energy and fun to the ship and I already miss it (despite their claims I would feel otherwise). Each brought something special to the mission and I got really lucky in having them as my students. Quite frankly they made my job extremely easy. I think now that they have or will soon have good internet access they will catch you up on their experiences and perhaps some reflections on it and also some picture which are so hard to upload from the ship. Oh, the rocking just started which means we will soon be out in open waters (and I hear rough ones). Time to get the dramamine out. In a few days I will post my own reflections on Guatemala. In some ways a really tough mission both of because of what we saw, what we could and couldn't do, and the conditions we worked under.

farewell

Today is our last day and it is with mixed emotions that I write this. Tomorrow morning I (we) will be disembarking from the ship, The time has passed so quickly I am not sure I have truly been able to appreciate what I have had the opportunity to be a part of. I have been honored to work along side amazing practitioners who have been committed to teaching me even when it was over 100 degrees outside, 10 hours into a 16 hour day, with lines of children and families still waiting to be seen. I won’t go so far as to say I have gotten my feet wet with regards to practicing independently, maybe just my toes, but the experience will stay with me for a lifetime.

I have seen so many truly needy families, adolescents who work instead of attend school, or for some, in addition to attending school. Families torn apart by illness, I saw one family- a grandmother and three young children whose mother had passed away just 8 days prior to their visit with me. Unfortunately all of their ailments seemed to be related with the pain of heartache and mourning, I told the grandmother that there wasn’t a pill a could provide or a treatment I could suggest that was going to ease their pain, they just needed time to heal. She began to cry and I could see the strength drain from her face, she was alone with the children. As she wept she was holding her 3 year old grandson on her lap, when he saw grandma cry his little bottom lip began to quiver and he began to cry, I wanted to sit and cry with them because it was breaking my heart to see them. I think she just needed to cry and someone to listen, I sat with her for a while and just allowed her to talk, that was the best, and only, medicine I could provide.

I went out for 7 days in a row and all the days have blurred into one. Luz and I had the chance to go out to one of the local hospitals to help teach/translate NRP updates and a lecture of therapeutic hypothermia and perinatal asphyxia. The lectures were intended for the physicians and med students but due to an emergency patient that needed to be tended to only the nurses were available, we gave the group the option to hear the lecture or not as it may be beyond their scope, they requested that the lecture be presented anyway because they felt that they provide care at times that is intended to be done by a physician. The lecture was presented and the nurses were great, made me proud to be a nurse... they asked insightful questions and seemed to be soaking up all the information to the fullest. There is some horrible statistic in this country regarding the number of babies that die each year, I can not remember the exact number but they seemed to grasp the enormity of it and were interested in learning simple life saving measures, if just one baby is saved we/they have made a difference.

There is a program put out by the AAP (i think) called Helping Babies Breathe, it was created in response to the fact that in many countries if a baby does not take a first breath spontaneously they are set aside and pronounced dead. The class teaches proper drying and stimulation of the baby, how to use an ambu-bag properly and deliver good breaths and proper suctioning of the nose and mouth. We were taught the basics on teaching the course, it seems like such basic care but to many babies and families it is life or death.

The most difficult part of this mission, for me, has been the limitations on what I can really do. The children who so desperately needed care were the ones who could not be helped directly at our med sites. I saw a child with CP whose mom was told that the cause of the child’s malformation of her feet was due to a seizure she had 6 months ago, we spent some time discussing CP and the associated physical and possible cognitive sequelae. I treated an 11 year old boy who had one leg longer than the other which caused him to limp and have pain, I referred him back into the community to see ortho and for possible corrective shoes, maybe surgical repair. But what I have heard is the most likely solution is a trip to a local carpenter and have him construct a shoe lift.

One case that really surprised me was a 5 year old girl, cute as can be, and the complaint listed by triage had to do with her ear, I could not really make out exactly what the issue was. Once the child sat down with me I immediately realized that she had a malformed ear, with just the lobe on the right side and she was missing her thumb on her right had, mom was concerned that as she grew she would have problems with the internal structures of her ear and wanted to be sure she would be ok. What surprised me was that mom not once mentioned anything about cosmetic concerns, she told me about how the girl had learned to write with an adapted way of holding the pencil when I spoke to her about the possibility of having a ear molded and surgically attached she looked at me like I had three heads, the service is available on the sister ship the Mercy (I have been told).


This has been a lesson in learning that I can’t fix everyone, sometimes education is all I have to offer, sometimes just listening is all I can do and all a person needs. This has been a humbling experience, a lesson in humanity and humility. All we need to survive are the basics, the rest is fluff. Parental love and concern are the same in every country. Children are resilient, families adapt and communities come together when the need arises.

I am sad to go but of course looking forward to going home, I will always carry with me the experiences I have had here, the knowledge I have gained. At the end of each day the exhaustion would take over but I had to remind myself that this was just a moment in time for me relatively speaking, soon enough I will be home with A/C, access to medical care, a cabinet full of snacks, essentially all the “luxuries” of home. At the end of the day for me I found that laughter was the best medicine, I enjoyed sitting around with our group sharing the good and bad of the day and if I was lucky I went to bed with a belly ache from laughing.

Many people said this trip would change my life and it has. I have made lifelong friends. I have learned more about medicine that I thought possible in such a short period of time, I have relearned the art of a thorough physical assessment and exam. I have learned a little more about myself and my strengths. I will try to appreciate all that I am blessed to have. When I think that things are bad I will remember the children who had the strength and courage to keep smiling in spite of it all and the mothers that keep it together. I will draw strength from them and remember things could be worse. I will eat all the food on my plate because there truly are starving children somewhere, in far away lands and in our own backyard.

First few days in Guatemala

This is going to be a short blog as I have been off the ship at med sites for the past two days and on again tomorrow, and exhausted. The days are long, extremely hot, dusty and did I mention hot??

The people we are seeing in Guatemala are very different than those in Nicaragua, there is a higher poverty rate, people appear to be in more need. The chief complaints are very similar, nutrition, weight concerns, parasites, everyone seems to have a belly ache and headache, especially after school. Most of the children are chronically dehydrated and truly have no idea about the importance of hydration, this is a catch twenty-two though, the water probably isn’t clean & most probably contributes to the GI complaints, yet dehydration introduces new problems. I have been talking to the families about boiling the water, but for most families it is not practical.

Interesting day yesterday... the locals brought a cow to the center of the area we were, slaughtered it, and prepared it to be cooked... cooked it and most people enjoyed a meal. I did not, I chose to eat chicken, I assume plucked off the street somewhere and cooked, but 24 hours later I am here, no issues. Local food is a part of the experience and learning the culture.

I saw a child yesterday who has all symptoms pointing to Ehlers-Danlos syndrome, the unfortunate thing is that I believe his mom had some handicap herself and truly did not understand the condition that he may have. I fear that he will not get the follow up and care I recommended for the best outcomes.

Today was long but I didn’t have a case that sticks out though, could just be related to my exhaustion but between all of the providers we did see several derm cases, unfortunately dermatology was not on-site today so some were asked to come back for consult with dermatology.

Well, I am off to the evening brief and probably bed, yes it is only 7:15.

Guatemala

Hello from Guatemala. Sorry it has been a few days since I posted. First it was internet issues then very busy out at clinical sites in Guatemala. On Thursday morning, Kim, Luz, and Nicole did a great presentation on Chagas Disease. It was very well received. They spent much time on it and it showed. Great job! We also ported in Guatemala that day. Not quite docked but a much shorter, much smoother small boat ride in. The site I went to the first few days was quite a distance though. It is also very, very hot and humid so I've been soaked by the end of each day. The people here have been really great and are very gracious when we see them. There seems to be much more need here than we saw in Nicaragua and it reminds of last year in Indonesia. Especially today when saw a woman with blood sugar of 550, severe diabetic ulcer on toe, and no sensation in front half of her feet and then the woman who has an ischemic stroke 2 years ago and her blood pressure today was 220 over 140. Yikes! A number of other serious cases and a lot let visits for general aches and pains. Okay, off to bed as another 4am morning tomorrow.

Living on the Comfort

Nothing in my life before has prepared me for living onboard a navy

hospital ship. I’ll describe a typical day when leaving the ship to go

on a MEDCAP and a typical day onboard the ship.

MEDCAP: Hopefully go to bed the night before at decent time (10p).

Wake up at 4am and be at the mess hall for breakfast by 5am. Have to

be ready for muster (roll call) by 5:15am-5:30am. In Nicaragua we had

to board hospitality boats to go onshore. On most days the swells were

so high, we would have to wait by the ramp until it was safe to board

the hospitality boat. Some days by the time I boarded the boat it was well

after 6am. By this time I had already been up for over 2 hours. After

the short boat ride to shore, we would board busses that would take us

to the sites. One site was about 30 minutes away, with an incredible

view of a volcano. The other was about 15 minutes away. Patients would

already be waiting for us at by the time we arrived. After everybody

arrived at the site, muster would be called again. Patients would

start to be seen roughly between 8:30a-9a, depending on the time we

arrived. We would see patients until about 3:30p-4p. We took lunch

sometime in the middle. After “closing shop” for the day, it was

another bus ride back to the pier. On my last day there was a fishing

competition on the pier. I think the winner was a 17 pound mahi mahi.

Once again we had to wait for the hospitality boat to arrive to take

us back to the Comfort. Once onboard the Comfort, it was down to our

berth for a shower and back up to the mess hall. It really ddid not matter what was for dinner, I was hungry. After dinner there is

always a short brief about how many patients were seen and what the

weather would be like the following day. After the brief, there was

some chit chatting in the mess hall, and then back down to our berth

for bedtime. It was usually around 10:30p.

Onboard: When we don’t have to leave the ship, we can wake up slightly

later. Instead of 4am, it is 6am. Breakfast is until 7am. It is not

the best food I have eaten, but I have been able to find some things

that are edible. The scrambled eggs with pancakes have been my usual breakfast. We then have to muster by 7:15am. During the muster,

the plan of the day is given. I have found it very informative that

during the muster a little piece of naval history is given.

At the end of every muster a quote of the day is given. After that it

is pretty much free time. There are educational opportunities that are

available. They are not mandatory, but I have learned so much from

attending them. The physicians are very knowledgeable and like to

share their experiences. Then it is lunch. Everything here pretty much

revolves around food. After lunch, I could possibly go the gym or take

a nap. I’ve done both. There are 3 gyms. There is the cardio gym,

spinning gym, and the weight room. In the spinning gym, there is the

option of participating in an insanity workout. It was tiring and fun

to have such an intense workout while the ship is rocking. If not

working out, or napping, I would do laundry. Laundry days are Sundays,

Tuesdays, and Fridays. Laundry days are a workout in itself. To go

from my berth (room) to the laundry I have to climb 96 stairs, go

across one of the floors and then go down 50 stairs. The laundry room

is way too hot, so I would put my clothes in the washer; go up 50

stairs to the sym. After the gym, go back down those 50 stairs. Then

up the 50 stairs, and down 96 stairs to return to my berth. The last I did laundry Nicole told me that I was going the long way. I did not have to go up that far and then back down a different flight of stairs. Oh well, I'll know for next time. I little extra exercise never hurt anybody. LOL! To go the mess hall from my

berth it is 81 stairs. I try to take everything I need for the day in

the morning so I don’t have to go back down. I can tell that I am in

better shape now than when I first arrived. I am only out of breath

right before reaching the mess hall level. Before I would be tired and

out of breath 2 to 3 levels before the mess hall. Then its dinner, the

brief, and hang out time. Hang out time includes playing cards. Lights

out at 10pm, even though you can stay awake for longer.

After leaving Nicaragua there was a “strategic pause” on the ship. I

have never seen so many happy faces. This pause meant that muster was

not at 7:15am. We had to muster by 10am. It felt good to wake up late.

On the way to Guatemala, dolphins and a whale were seen. I didn’t see

any of them. I was disappointed. :(

En route to Guatemala, we worked in the "scullery." We gave the guys a break and cleaned the dishes for them. (They were still there to help us out). The "scullery" accepts the dirty dishes and silverware and washes them. There are 2 windows that accepts the dirty plates. Our dishes became backed up, and the guys gave us tips on how to do it faster and better. Kim was great at pushing the button for the garbage disposal. I will admit that I was a little afraid that it was going to explode in my face. Surprisingly I had fun. I think we all had fun. The music was blasting and the time went really fast. I give so much credit to the guys for doing their job and having fun while doing it.

I am excited to step onshore in Guatemala and meet new people. I’m

also excited to actually feel land under my feet. By the time I go to

the first Guatemalan MEDCAP I would’ve spent 7 days onboard. I’m ready

not to feel the rocking anymore. Even though sometimes onboard I don’t

feel the ship moving.

Almost there (to Guatemala)

We are due to arrive in Guatemala shorty, truth be told I have been told we are essentially here but going in circles waiting for our allotted time to enter the port.

During these days that we have been “underway” there have been many class offerings, meetings that review the work that was done in Nicaragua both medically and the engineering and preventative medicine work that was done. There is a huge focus on clean water, one statistic relating to clean water, or lack there of has to do with children. I forgot the exact number but diarrhea is the leading cause of death in children under 5 in these areas. We were told of children who played in the sewage drain off from their bathrooms near their school daily, and no adult knew better to tell them not to do it. I guess I should correct myself, it is not that they simply didn’t know better, there were no other options, the kids were happy playing in it, and possibly no one had ever educated them on the fact that the drainage contained feces and disease. I learned of villages where the water in the man made, hand dug wells was dark as mud, yet the locals drank from it regularly. They had to be careful not to scoop up a frog in their glass, because the frogs too enjoyed playing in the water.

There seems to have been a tremendous initiative by both the military and a group called Edge Outreach that focuses on providing clean water and making it sustainable for for the local people. There are amazing things being done in these communities, it is unfortunate that we are here for such a short period of time that follow up and continued education is limited, albeit impossible. I have to assume that the hope is that the teaching we be passed down through generations. One problem, or barrier to sustainability may be the lack of education, or the work it takes. For me, I think, wow, if someone could come into my village and teach me how to clean my water to make it potable to drink, the people will be healthier, the children will live longer, the further generations will be made possible. Water is essential to life. These people are most probably unaware of the health benefits of clean water because there communities have survived for years and generations on the existing water. They may not make the connection that babies are dying due to their water source, that so many illnesses that they suffer from may be linked back to the water.

A valuable lesson, although I am not sure what purpose it serves, is that we can’t save everyone. There are cases that have been seen, and I am sure the next stop will bring some of the same, that the collective “we” can’t save. This is heart breaking, especially since we are geographically so close to Miami, to the US in general, where life saving procedures can be done. Geographically we are close, but for these families medical treatment in the US is truly worlds away, it may as well be Mars.

I hear the words...”finish your food, there are starving children somewhere” repeat in my mind. Luckily most of the children I have seen appear well nourished, but one can be fooled by seeing a child who may be the appropriate weight but is truly lacking essential vitamins and minerals that his/her family does not have access to. I have had several children asked their mother for water while I am examining them, WATER?? I do not recall a time in the US that I have has a child essentially beg, as he/she would for candy, for water. Maybe the water we were provided tasted better than there’s, maybe it was fun because we were giving it to them in baggies as it was coming for the purified water from Edge Outreach, so it was kinda like a water balloon... despite the reasons it was a little sad to see these kids a little desperate for some water. Teaching is difficult when the family is truly functioning within their means and there is not possibility of expanding their diet or food source. Teaching really has to focus on capitalizing on what they do have available. One thing common to so many cultures is...there seems to be no shortage of candy & sweets. Just as in the US, those who are poverty stricken may eat just one meal per day.

Last night we had “scullery” duty... Luz may be explaining it in her post so I won’t go into detail. All I will say is that we were on the receiving end of dirty dishes of nearly all the 850 people on board (divided between two windows), Dr. Roark manned the one window with a fellow Hope volunteer while Kim, Luz and I were at the other window. It was an experience, I would do it again without a problem. The good thing is you get to see what people AREN’T eating, so you make a mental note of what not to eat.

Each day I am reminded of how lucky so many of us are to have access to clean water, food, shelter. Our children do not play in poo water during recess... I realize that this degree of poverty is not limited to places outside of the US.

Our trip is over halfway complete, the thought of going home is bittersweet. I am truly looking forward to our next mission stop that we are (slowly) approaching. I expect I will learn more with each patient and each day...

Fun Times!

Last day in Nicaragua

Have not been able to blog for a few days due to difficulties with the internet, I will try to catch up. So we have been out several days in Nicaragua to the med sites. The primary complaint remains to be concern about possible parasites, low weight and “kidney pain”.

I have had some interesting cases, one child who had an impressive murmur whose mom mentioned it in the history as a secondary finding, he had been seen by local cardiologist but no follow up recommended. After consulting with one of the Navy doctors it was determined that he had possible VSD, I recommended he return on a day when we would have a cardiologist and the capability to do an echo. I was thrilled to find out that he did return, our photo journalist was with me the day I saw him and she let me know that he came back to the med site as recommended on a day when she happened to be there.

I have hopefully helped some children get glasses, we have optometry on site and luckily they have been super accommodating when it comes to fitting these kids in. ON one particular day I know that the optometrist (one guy with the help of tech’s) saw over 100 patients, truly impressive. Each time I presented a case for a child I felt could truly benefit from a thorough eye exam and possible corrective lenses he agreed with a smile. Some of the schools these children attend do not have water and certainly do not have the luxury of air conditioning, yet they do the best with what they have. If I can be instrumental in helping them being able to see better which in turn will help to improve their abilities in school and potential for learning which may in the long term improve their quality of life, this is an opportunity that can’t be missed.

The way that these sites work is that a patient is registered to see just one service due to the high number of patients seen in one day they generally are not permitted to pass from one service to the next. However, there is a great deal of collaboration between the services and whenever possible a child would be referred to return the following day and given a bracelet to indicate that he/she did not have to wait in line again, people waited in lines for hours. In some cases if the condition was severe and/or the family lived at such a great distance various services would fit the child in, this was a window of opportunity for these patients to get medical care they so desperately needed. I saw a child with horribly decaying teeth, I’m no dentist but he clearly had dental caries, my concern was that in a short period of time he would have an abscess and the infection would soon enter the bone. Dental saw him that same day, unfortunately I was so busy I was no able to follow up to see what the outcome was.

There is a common theme each day/each med site, which is education,education, education... regarding the importance of remaining hydrated, proper nutrition, getting vitamins from natural sources, and education regarding appropriate height/weight for children.

I have had to prescribe albuterol to a small child, he really needed a spacer as well. Forgive me if I mentioned this in a past bog... but I will tell you again. We were able to create a spacer with an empty water bottle, tape and some gauze... it has been pretty cool learning from the experienced providers and learning to work with what you have. So I sent this mom and her child home with a spacer made of an old water bottle and some albuterol and she was so grateful.

One of the things I was really looking forward to on this trip was being able to help a population of people who truly needed help and I feel I have done that, they are appreciative of even the smallest bit of assistance. This community seems to live by the idea that it “takes a village to raise a child”, in many instances the child was brought in by a neighbor, a friend, extended family member. The children would wander in the waiting area from person to person and everybody seemed to know each other. I saw people who were at the med sites from open to close, all in search of medical care and some also seemed to be there for the social aspect of such a gathering. It was an opportunity to be provided with clean, cold drinking water and a slightly cooler environment, as we did have large fans.

I have such great respect for those people who have been on the ship for months and will remain on the ship for months after I am back home. Now that we have been here for a week I feel I have adjusted to the schedule, and to life on ship and I could (and would love to) stay on ship for the duration of the mission-scheduled to finish in Haiti and be back in the US by early september. The one thing that it difficult, lets just say impossible, to adjust to is the food... I am entertained by the creativity of those who have been on ship for months with regards to the methods they have developed to be able to create an edible meal from what is served. I have heard a grown man giggle with delight while licking up the last bit of ice cream he was lucky enough to get, apparently they had soft serve ice cream early on in the mission but it ran out very early so when there was a small amount available it was like finding a pot of gold at the end of a rainbow.

I have heard people excited about the “smell of lettuce”, lettuce is another scarce resource around here, on most nights salad is actually chopped cabbage with various salad bar like toppings, including hard boiled eggs- we are in close quarters, as a public service a beg people not eat eat the combo of cabbage and hard boiled eggs!!! Fresh fruit is also worth standing on line for, the line forms quickly and the fruit goes fast. Lets talk about milk, we do not have fresh milk on board so they use this milk-ish substance that is kept cool in the one of those rotating slushy machines, the consistency varies daily, some days it comes out in chunks, other days you can actually convince yourself it is milk and ok to drink. I drink it in my coffee (another necessity when waking at 4am) daily and I have survived thus far.

This continues to be an amazing learning experience, it has been such a rewarding experience to work with/collaborate with such knowledgeable practitioners. One thing that I have realized is that working in the conditions we are in, the heat, humidity, lack of resources, tremendous number of patients being seen, morale is always up. Our team is smiling on the way out in the morning and still smiling on the way home, we all may be exhausted but the reward from these patients is so much greater than the sacrifice. I truly do not feel as if I have sacrificed anything to be here, I feel honored and lucky to have this opportunity and I only hope what I am learning here will stay with me throughout the years. It is an exercise in being able to work with in the means available to me as a practitioner and within resources available to the patients. I saw a patient who had an appendectomy 5 years ago and was coming in for follow up because they were not able to make it back to the doctor for follow up after surgery, this just gives you an idea of the limited access to care in some of these communities. I have learned a tremendous amount in such a short period of time. We will be leaving sometime in the next 24 hours for Guatemala, I am sad to leave this beautiful country but looking forward to the next stop. If I have positively impacted just a handful of the hundreds of patients seen, I did what I came to do. It has been an even exchange though, I have taught them about medicine and they have taught me a little more about humanity.

Pictures

I am so excited that this is the first day that I have had wireless access long enough to actually post pictures! Hope you enjoy!

Nicaragua Mission

We are on day 9 of the mission and it has definitely been an unforgettable experience. Life on the ship gets a bit tough at times because of the tight quarters and inability to “escape” for privacy. However, the military personnel as well as the other civilians have all been extremely welcoming and their passion for humanitarian is contagious. On the days that we go to the clinical sites, the buildings are extremely hot and it does get exhausting at times. On the other hand, our sacrifice is nothing compared to what the natives experience on a day-to-day basis. The natives have deeply shared their appreciation for the care that we are able to provide for them. They treat us as if we are “royalty” and they cherish all of the advice that we have to offer. I have been fortunate to care for and educate many families about basic dietary/nutrition needs as well as disease process and primary prevention. Much of which we take for granted in the US. It is amazing to see the natives standing in line for hours in the hot sun and/or rain just to have an opportunity to get a few moments of “quality care” from the Americans. It is also sad when we encounter patients with significant health problems that we identify, and then have to refer back to their host nation’s providers for follow up. I often wonder if they feel “disappointed” that they are placed back into the same local healthcare system (or lack thereof). Although, I wish we could address more of the major concerns, it is definitely rewarding to see the impact that we make on so many others. Just the simple courtesy and respect that we give to our patients is enough to make a lasting lifelong impression for those that are less fortunate! Until next time……

Post from Luz

Hello everybody it's Luz. I am having trouble logging in and this post is under Randy's name.

Today is Sunday, June 26, 2011, or I am told it is Sunday. The days blend together and I am not quite sure why. I have been onboard the USNS Comfort for one week. I can't believe time has gone by that quickly. We (Kim, Nicole, Randy, and I) have gone out 4 times this week. There were two sites that we would go to see patients. One was a civic center (Centro Civico in San Juan del Sur) and a school (Escuela Humberto Mendez en Rivas). The Nicaraguan people came to be evaluated by professionals in specialties that included general medicine, family medicine, women's health, pediatrics, dental, and optometry. They were truly grateful that we were there to provide them with free services and medicines. I have had some kids that have been wheezing. The 1st thing I wanted to do was find a nebulizer machine and give them a treatment. Here the only thing I had was an Albuterol inhaler, or so I thought. I was taught by the very knowledgeable physicians and nurse practitoners how to make my own aerochamber for the little kids. All I needed was a pair of scissors, a water bottle, tape, and the inhaler. To my complete amazement my makeshift aerochamber worked surprisingly great for my asthmatics. After 2 puffs of teh inhaler my little asthamtics were no longer wheezing. I was so happy that I was to build something so very useful. I was touched by how the parents would dress up their children to come see us. The little girls would be in dresses and the little boys would be in button down shirts and pants. I was saddened by the fact that we couldn't provide all services that were needed. I have found that the Nicaraguan people are sweet and loving. We sail away later today, and I will miss this country (especially the slice of avocado that was heaven sent during one of the MEDCAPs). God Bless Nicaragua.

Leaving Nicaragua

Finally our internet is back working. Poor Luz spent hours last night trying to post pictures without any luck. Today is our last day in Nicaragua and it has been a great and busy first week. Today one of the pediatricians came up to me to let me know specifically what a great job that Luz has done when working with him. He said beyond seeing more patients that most of the other providers, she spent more time doing education with them than others and was the first provider he has seen who walks their patients to pharmacy, etc. The other providers have had similar comments about Kim and Nicole. Okay, as for the other stuff. Wish we had a picture getting off the transport boat on Friday. Many people got sick on the short ride and then the actual getting off was pretty scary. They have had to cancel functions because of the danger involved in being transported to and from land. The food, well what can I say. Luz has a great picture I hope she can post soon.

Hello

Hello from Nicaragua. As you may have read in the blog from the past few days it has already been an adventurous trip, including the always exciting task of getting on and off the ship to go to our clinical sites. It was never that difficult last summer. Luckily no injuries so far. Kim, Luz, and Nicole have been real troopers. It can be hard to adjust to this setting but I’ll let them tell you about that. The noise, the food, the lack of privacy, etc. I will tell you that we all went out together for long clinical days at very hot and humid sites both Monday and Tuesday and we all will go out again tomorrow and Friday. They all have been doing an amazing job and that isn’t just my opinion but also the opinion of all the other providers at the sites. The providers are very impressed with their knowledge, skills, hard work, and positive attitude. The internet is again a source of major frustration. Well, just have to accept that one. I’ll write more as we go along but I will let the students be the primary bloggers as it is their experience that is most interesting.

Today was our second day out onshore (MEDCAP). To go onshore we had to navigate the swells and go onboard a hospitality boat waiting to take us onshore. It was once again an indescrible experience. We thankfully made it onshore safely (only a camelback fell in the water... it was rescued very quickly). We made it shore, and arrived at Escuela Humberto Mendez after a bus ride. . The students were sad we took over their school for a week (not really). In total 544 patients (in different specialities) were seen today. The temperature with the heat index was 106F. HYDRATE was the word of the day. The return trip was uneventful(very thankful again). It was the quickest offloading of people I've seen so far. It was probably due to fact I was in a boat full of military personnel that jumped of the boat like little bunny rabbits (I don't think they will like that comparison). It was a bit difficult to take the patients to shore (especially after surgery) due to the Helos not flying today and the high swells. My hats off to the crew of the Comfort to safely take the patients to shore.

First few days in a nutshell

We arrived to the town of San Juan del Sur via bus on Saturday. Along the drive the poverty was apparent as was the beauty of this country. We drove along shore for a bit with a picture perfect view of a volcano, I will have to look it up to see which one it was.

Everything has been great so far, truly an experience. Boarding the
ship from a smaller boat in the large swells was a mission in itself, truly hard to accurately describe the experience- adrenaline pumping to say the least. The timing of each persons disembarking the boat is carefully timed by the Civilian Mariners, it is like a choreographed dance with fancy footwork to be able to safely land safely on board the USNS Comfort. Nearly lost some people between the ship and the smaller boat...but we
all survived!! The boarding/check-in process is… a long process. We were met my Faye, a representative from Project Hope who made sure we all were fed and led us to our rooms.

Myself and the other students are in the "overflow" area since we are
here as students, large room, lots of bunks... nice people though. The
ship constantly rocks due to our position in the water, this is
calming at times and other times it feels as if you may roll out of
bed or sustain a head injury in the shower. We are finding our way
around, everywhere we go requires a series of steps, unavoidable diet
plan.

Yesterday we had general orientation and spent some time orienting ourselves to the ship, this continues to be a work in progress, Luz has been the best so far at keeping us from getting lost. Last night we attended the debriefing for the day regarding the activities of the day and the progress so far. Made me appreciate and little bit more the work being done in these countries.

Went off ship to one of the clinics set up on shore, (pictures to follow).Up at 4am, Luz and I were first to arrive to the muster site, unaware that they called for each boat overhead, oh well, lesson learned.
I was paired up with a wonderful pedi NP and we saw about 30 kids, some
with primary care issues others with major medical problems. The
challenge is turning people away with little to no treatment after
they have waited for hours for care. Sometimes they simply do not need
care beyond a kind word and reassurance that all was ok and normal
with their child, other times we don’t have the resources to care for
them at the level they needed. There were a great many who did benefit
from the medications and services we have available.

One child in particular that stood out was seen by a practitioner for double ear infections and discharged with meds, on the way out he began to seize, one of the military personnel came to get the PNP I was working with as they were unsure of what was happening with the child. Together we went to assess the child, when we approached it was clear that he was having a seizure, blank stare, unresponsive to everyone around. Due to our limited supplies the usual suspects, supplemental oxygen, IV start kit, IV or rectal meds… were not available. The pharmacists was quickly at the patients side and offered meds not on the formulary, for use in an emergency, luckily we were able to administer Diazepam, unfortunately with little to no effect. He remained in what seemed to be a postictal state with short intermittent seizures. The local ambulance was called and the patient was taken to the hospital. The sad part is, this patient had a history of this since the age of two (he is 6 now) with seizures that occur frequently, the treatment of choice has been NS bolus and discharge. It was gratifying to be able to diagnosis this child along side such a wonderful medical team, we can just hope that he gets the treatment he needs for further care.

Aside from the scorching heat (96 outside, 116 degrees inside with humidity) and lack of circulating air, today was a good day.

the anticipation

Waiting in the hotel for the bus to arrive to take us to the ship, finally. I have been told to get used the the hurry up and wait mentality, I'm trying, it will be an adjustment.

I have met some wonderful people, all here for a common purpose. No one is "doctor" or "nurse", just call me by my first name... Takes away a bit of the anxiety as I am in a limbo, professionally.

Luz and I took a cab ride this morning to market area with local vendors... got offered some mysterious food that looked yummy but neither one of us could really identify it, so needless to say we skipped it.

There is still so much that is unknown, the anticipation lingers, as does the excitement. Looking forward to getting settled into my new (temporary) home.

Arrived in Managua

While descending into Managua, Nicaragua, I had a magnificent view. I saw mountains and craters filled with water. Seeing the beauty of this country eased my anxieties. I was nervous, anxious, and excited about participating in Project Hope, but now I am only excited. In the hotel lobby we (Nicole, Kim, and myself) ran into volunteers from rotation 2. They gave us some pointers and explained some things to us. They alleviated my anxieties even more. Now I am ready to board the USNS Comfort tomorrow.

Off to Central America

FIU is teaming with Project Hope again this summer and this year we have 5 nurse practitioner students going to Central America for Continuing Promise 2011 on the USNS Comfort. Luz Gomez and Nicole Navarre (Peds NP students) and Kimberly Harris (FNP student) and I will be flying to Nicaragua tomorrow to catch the ship for the first leg of the mission in Corinto. We will then head to Port Quetzal,Guatemala. After that we head to El Salvador where they will leave and two other students will join me, Lori Brown (adult NP student) and Beverly Griffis (FNP) student. We will be in El Salvador for a few weeks then on to Costa Rica, first for 4 days of leave time, then the final leg of our mission before returning to Miami. I expect as was the case last year, the internet will be spotty, but hopefully we will still be able to post regularly and include pictures.

Ambon, sea sickness, Darwin, profile

After Jailolo, Ambon was somewhat of a letdown. We worked sick call a number of days which is not nearly as exciting is going into the field. However, I did see my first eel bite (not joking). The major concern with an eel bite isn't so much the bite, but the things that might be in the water that could enter via the bite. I called in the Infectious Disease expert and she said there were potentially a number of serious things that could occur but they were unlikely so she just had the patient double their doxy (taken for malaria prophylaxis) and wait and see. Luckily it cleared up quickly. Many other providers (before I consulted with ID) suggested multiple antibiotics to cover all bases but her conservative approach made sense. I did go ashore one day to a site near Ambon. It was a hospital in a small beach town. The people there seem to have more access to basic care although still saw a few active TB cases and some cases needing surgery that wasn't available. Also out of control BPs and diabetes. I still took the treat and reinforce adherence approach. Perhaps the more interesting aspect of this stop was being able to go ashore for leave. The city itself was so chaotic. I've never encountered traffic quite like it with cars and scooters all over the road with many near hits and a few hits. Stop lights and pedestrian crosswalks are suggestions rather than absolutes. The streets are dirty and sewage is open. Before we left Ambon was told the seas would be rough. However, I got a little too overconfident after not getting sick to that point. Well, spent the next 36 hours being seasick. Was very happy when we arrived in Darwin. Was very happy to arrive in Darwin. A truly charming little city and a nice way to end to mission. I was profiled on the Project Hope website so link is included and picture in helo. http://projecthopeinthefield.blogspot.com/2010/08/fiu-professor-hope-volunteer-and.html Hope you enjoyed the blog. Perhaps at some point I will put some pictures up.

Farewell Indonesia

We are pulling up anchor as I write this and the next stop is Australia.Today, all the Indonesian translators left the ship, most heading back home to Jakarta where we originally picked them up. They were all very friendly and fun, not to mention hardworking and such an important part of this mission. It was an emotional day for all of us... having to say goodbye. But we have all made new friends on board and will all see each other again...thanks to facebook! Lots of e-mail addresses were exchanged.

Randy, Vanessa and I spent our last day on' sick call' duty. So no more work, yippee! Smooth sailing ahead I hope. Actually, we may be heading into some rough weather conditions, maybe up to 7 foot seas. Most everyone says we should not feel much of it due to the size of the ship. I am not taking any chances and have already started taking my dramamine!

We should be in Darwin on the 5th, most of Project Hope will be heading in different directions at that time. The ship will continue it's mission into Timor Leste, Papua New Guinea, Guam and I think it will end in San Diego. Vanessa and I will visit Sydney for 2 days before returning home.

This has been a great opportunity for me and I have learned so much, not just about medicine and how to diagnose and treat people, but also things on a bigger and more global scale. This mission was most importantly about the relations between Indonesia and all the partner nations that were represented here,known as the Pacific Partnership. My part was small, but I am proud to have partaken in this mission.

This will be my last entry into this blog. Thanks to all of you that followed our adventures! Thank-you to FIU for making this possible for us. I wish all the future FIU students the best and hope they will continue to send students on these missions.