July 1st (but posted on July 14th)

July 1^st, 2011

Another month down – and we are in Guatemala, country #6 of 9.  We are definitely in Groundhog Day mode: wake up, eat, work, workout, eat, ops brief, bed.  Repeat.

One of my best friends here is the ship psychiatrist, Liz.  She tells us that in any group activity, there are 4 phases: forming, norming, storming, and performing.  Forming apparently happens during the first couple of weeks of a group’s existence – this is where everyone is on their best behavior and roles and relationships begin to be defined.  After that comes the norming stage, where people start to learn the ropes and settle into a routine – and everyone generally gets along.  Based on all the drama and incidents on the ship these past few weeks, however, Liz feels that we are currently in the “storming” phase.  This is where people’s true personalities come out; fatigue, apathy, and homesickness really set in; and conflicts inevitably arise.  Apparently storming is a good thing, as a group cannot “perform” without passing through the storming phase first.  However, it makes for some uncomfortable and unpleasant interactions.  Within our DMS (medical) directorate, things are fine, but there is a lot of cross-directorate hostility (arguing with surgeons, medical operations, logistics, and even the supply crew).  Hopefully the storming phase is short and we can move into performing soon.  With all this conflict, we are definitely ready for our next liberty port – which isn’t for another month, unfortunately.  However, since the last time I wrote, we passed the halfway point – a huge milestone that makes each day more bearable.  Also since the last time I wrote, I missed two important days – Scott’s and Abi’s birthdays.  It made for a sad week (overall), but I comfort myself knowing I’ll be home in 65 more days…

I haven’t written in a while, but that’s because, well, as I mentioned, there doesn’t seem to be much going on.  I really didn’t write at all in Nicaragua, our last country.  I have to say, when I looked at the SOM (scheme of maneuver) for this trip, I kind of grouped Nicaragua, Guatemala, and El Salvador together – geographically this makes sense, and we’re hitting them all sequentially, and I really didn’t know anything about any of the countries themselves, so in my mind they were all smooshed together.  I would like to revise my original thinking. 

Nicaragua was gorgeous.  We were once again at anchor, about a 10-minute boat ride to the shore.  The BLZ was located in San Juan del Sur, a small coastal town that is actually fairly touristy (if you can call it that – it’s a really small town).  It’s also a very affluent town (at least the coastal part was), so there were beautiful mansions spread on the hillside overlooking the ocean.  The BLZ had an actual restaurant which took American dollars (at quite a markup, obviously), but this was a first for us and it was wonderful to get local, flavorful food.  The landscape was green and lush, due to the heavy rainfall during this time of year.  We were actually able to go to another local restaurant one night for a physician-to-physician exchange – the physicians from the ship met with some local Nicaraguan physicians for social and professional interactions (but mostly social).  This was very good for morale (at least among the physicians), and we’re hoping to continue this meeting in future countries.  I was involved in planning this event, however, and it was a logistical nightmare.  A site has to be selected by the ACE (advance planning) team, vetted by the NCI (security team), and then contacted to make sure they can (and will) accommodate a large group.  Then, local physicians have to be contacted and invited to participate – this seems like an easy task but with minimal internet capabilities, it’s much, much harder than you would think.  Lastly, the hospital and ship commander have to approve the event, and transportation to and from the restaurant (to include boats to and from the BLZ) has to be arranged.  Thanks to the diligence and persistence of some of the DMS physicians, though, it worked perfectly.  And was totally worth it.

The other nice part of Nicaragua was that our translators were local medical students.  I never realized I’d be so grateful to have a med student working with me.  They spoke English very well, but more importantly, they knew what questions to ask the patients during the interview.  In previous countries, most exchanges would go something like this:

Me (to translator): can you please ask her how long she has had abdominal pain?

Translator (to patient): something long and involved in Spanish

Patient (to translator): something even longer and more involved in Spanish

Translator (to me, 5 minutes later): she says that her daughter used to live with her but now lives across town and wants to know if there is another MEDCAP site where her daughter can be seen.  She also wants to tell you that her back hurts and she needs a CAT scan.  (No, I am not joking.  This is really what happens.)

Me (to translator): ok, we can talk about that in a minute.  Can you ask her again about her abdominal pain, how long she’s had it and maybe if she is constipated?

Translator (looking confused): Constipated?  I don’t know that word.

(Several moments spent trying to explain constipated – I finally learned the word for it in Spanish so that has helped.)

Translator (back to patient): lots more words in Spanish, to include something that sounds like “poopoo”

Patient (to translator, gesturing wildly): (what we refer to now as the “me duele” dance – the act of pointing to every body part that hurts and saying “me duele a qui, y a qui, y a qui”)

Translator (back to me, several minutes later): she says that she washes a lot of clothes and she has kidney stones and her liver hurts.  She also wants to know if she can get her eyes checked out…

Me: sigh. 

With the med students, the conversation goes something more like this:

Me (to patient in Spanish): how can I help you today?

Med student (to patient): something short and to the point in Spanish

Patient (to med student): something long and involved, in Spanish, interrupted several times by the med student asking other questions in Spanish

Med student (to me, a few minutes later): it sounds like she has gallstones, and I recommend that she get her gallbladder out.

Now, admittedly, you have to take everything a med student says with a grain of salt, but at least the history taking was much, much more efficient.  And the students were thrilled to be there working with us, which always helps.

Sadly, we left Nicaragua on Sunday morning and have now arrived in Guatemala.  I went on a tour of a local (regional) hospital yesterday, which was eye-opening as always.  Today I’m writing up my report from that tour and giving a presentation to the medical providers on what to expect from the local medical system.  Somehow this has become my task in each country – to arrange and attend a tour of the local hospitals.  I actually don’t mind, because it’s something different to do than seeing patients at the MEDCAP sites.

Ending this abruptly so I can have at least something to post.  I’ll try to be better.