July 21st, 2011 - Guatemala to El Sal

Guatemala came and went, and we are now in El Salvador.  Truthfully, Guatemala was fairly unremarkable.  My most distinct memory was the overpowering, suffocating heat.  The humidity was near 100%, and the average daily temperatures were in the low 100s.  The MEDCAP days were uncomfortable and long.  On the plus side, we were “nearly pierside,” which meant that although we still had to take a boat to get to land, the ride was 2-3 minutes, tops.  We probably could have rigged up some way to just walk from the ship to the pier, but skilled Navy personnel much smarter than me decided it wasn’t feasible, due to drafts, lines, ladders, walkways, and other terms I still don’t quite understand. 

On the plus side, the pier in Guatemala was a “cruise port” – meaning commercial cruise ships docked there and so it was slightly more interesting (and safer) than our other piers.  During our 10-day stop, we did not see a single cruise ship, but supposedly they do dock there.  What this meant for us was that we were allowed to spend time off the ship, at the pier, on 3 nights during the mission.  And on one of those nights, the command sponsored “beer on the pier” – during which time we were each issued 2 beers (I’m not kidding – the beer was provided by the Navy and we had to sign saying we received it).  Naturally, we still had a curfew (9pm), and alcohol accountability was extremely strict (had to show ID and have each beer marked off on a master list), but it was a morale booster nonetheless.  On the other nights, we were able to eat at the local restaurants and shop at the marketplace, but alcohol was strictly forbidden.  In fact, I personally know 3 people who lost all future liberty privileges due to ordering alcoholic drinks at the restaurant – they were caught by the ever-present shore patrol personnel.  The fact that 3 Navy officers (an O-4 and 2 O-6s) were formally reprimanded for drinking 2-3 drinks of alcohol absolutely astonishes me, but such is life on the ship.  Despite the regulations and strict policies regarding our time on the pier, it was a welcome change from the Groundhog Day routine we have become accustomed to.  I was able to sample some amazing local cuisine, to include tacos pollos, el carne, and ceviche camarones.  For those wondering, eating uncooked seafood in a third-world country is not the wisest idea.  The shrimp single-handedly knocked out a good 25% of the ship’s crew, myself included, for several days.  I am now a believer in the healing powers of Cipro and Imodium.  Traveling truly broadens the mind and loosens the bowels…  (And for the record, the ceviche was totally worth it.)

After Guatemala, we left for El Salvador (or “El Sal,” as we like to call it, although the locals dislike that term, apparently).  We managed to squeeze a 9-hour journey into 3 days.  Truly, we are probably 50-60 miles south of our last port, but the time needed to replenish our medical supplies and prepare for the next mission necessitates that the trip last at least 2.5 days.  This is nice downtime and allows everyone to prepare physically and mentally for the next mission stop.  During the voyage, we had the Comfort Open Mic night.  I have become friends with some very talented singers/ guitar players and joined them for the show – it was so fun to sing again, and the performance as well as the rehearsals once again provided a welcome change from the otherwise mundane daily routine.  Also during the transit from Guatemala, the DMS (Department of Medical Services – my directorate) hosted Cigar Night, where I learned that I am not meant to smoke cigars.  Maybe it’s an acquired taste – at least, that’s what I’m being told, in preparation for our next cigar night.

We arrived in El Salvador on the 14^th – a full week ago.  It has been a very busy week.  I mentioned that I am responsible for coordinating hospital tours in each country that we visit.  Usually this involves two tours – one of the local/ regional hospital and one of the military hospital, which is usually in the capital city.  There is an advance team that precedes our arrival by approximately 1 week in each country, and they usually provide me with a point of contact for the tours.  However, then it is a matter of arranging a tour date, finding someone to conduct the tour, locating translators, transportation, and force protection (security), deciding on participants from the ship, getting all the participants manifested, and then composing a report of the tour when it is all complete.  This is all manageable, but there are always unforeseen obstacles.  In El Salvador, on the day that we had arranged to tour the local hospital, there was some kind of political demonstration outside the facility and the tour was cancelled due to concerns for safety.  The demonstration lasted less than a day and the tour was rescheduled – twice.  This meant going through most of the above steps on 3 separate occasions.  Flexibility is one of the most important attributes on the ship, and I consider myself fairly flexible, but I was about ready to pull my hair out when I got the email notifying me of the third date change.  If all goes well, we will be touring the hospital tomorrow, so keep your fingers crossed.  Our military hospital tour (in the capital city of San Salvador) went off yesterday without a hitch, and we even managed to work in a nice lunch and some shopping, so these visits do have some benefits.

El Salvador has also provided me with my first opportunity to serve as one of the MEDCAP site leaders.  The responsibilities of a site leader include ensuring efficient patient flow, averting (or handling) disasters that may arise, providing tours for distinguished visitors, and in general just keeping the site running smoothly.  I was “voluntold” to lead the site at Polideportivo (say that three times fast) on our 3^rd or 4^th day here.  Thankfully, I was a worker bee at that site the day before (seeing 40-45 medicine patients that day – a very busy site), so I was able to get an idea of how the site would work.  I was a little nervous about being site leader – this is usually a job reserved for senior officers and there is quite a bit of pressure.  They always tell us, “it’s not about the numbers” – but every evening at the ops brief, they review the number of patients seen that day at the various sites.  If the number seems low for a given day, the person briefing usually makes an excuse or explanation to the Commodore of the ship on why that was the case.  So the numbers matter – despite what they say – and the number of patients seen at a site is generally a reflection on the site leader.  So, while I truly DO NOT CARE about the numbers, I knew I’d have to answer to someone at the end of the day, and I was a little nervous.  With that said, the day before (when I had seen 40+ patients), all the providers were angry at the site leader for pushing too hard.  So I didn’t want that problem either!

Let me say, being a site leader was fantastic!  I loved the behind-the-scenes planning that went on, dealing with minor catastrophes throughout the day, and in general keeping things running pretty smoothly.  I provided a tour to the embassy attaché and 14 local military professors (all “Distinguished Visitors”), who were very impressed with the care that was provided.  I gave 2 television interviews (via a translator) and met several local mayors.  (As an aside, by the third mayor of the day, when I was introduced in Spanish, I must not have looked sufficiently impressed, because then the person introducing us told me, in English, “No, this is the MAYOR” – at which point I tried to look appropriately deferential – but truthfully, there are a lot of mayors in the Sonsonate area, and it had been a long day.) 

My favorite part of the day came when I went to the front gate of the site – something that as a mere provider, there isn’t time or reason to do.  As site leader, I needed to check on patient flow and make sure the people working were doing ok.  At the gate, I got a reality check.  By the time the patients get to us as providers, they have passed several checkpoints and are well-organized, with wrist bands, scantron sheets, and baggies of water (for hydration) that have been provided to them by one of the NGOs (non-governmental organizations).  At the front gate, it is mass chaos.  As I walked up, I saw 5 or 6 El Salvadoran police officers, as well as several local and US military personnel.  They were all there for crowd control.  The gate was closed and separated us from the waiting patients on the other side.  The gate crossed a rather wide dirt road, and on the other side of the gate were hundreds of patients crowded together and pushing on the gate.  Right about when I walked up, we called for 10 additional pediatric patients.  The El Salvadoran guards opened the gate less than 12 inches and started pulling parents in with their children.  Before I knew it, there was a swarm of people shoving each other to get in and the other guards immediately stepped in for backup.  They over-pushed the crowd and closed the gate – almost catching a patient’s hand in the process.  I wanted to cry.  I had no idea how desperate these people were to see the American doctors.  When I talked to our gate guard (from the ship), he told me it was like this in every country, every time.  Most of the patients start lining up at 1am for the gates to open at 8am.  Hearing this, and seeing the desperation and hope in the patients’ eyes at the gate, made it infinitely easier to find a smile for these patients late in the day, when we had already seen dozens of patients and the end was nowhere in sight.  I wish I had done the gate visit sooner in the mission.

Anyway, at the end of my site leader day, morale was still pretty high, and we saw a respectable number of patients.  The biggest compliment came at the end of the day, when several of the medical personnel from the site came up to me and told me what a fantastic MEDCAP it had been.  This was despite working almost 45 minutes later than the day before (the day that everyone was grumbling about).  I felt bad, but we did make it back to the ship in time for dinner, and no one seemed upset, so overall a successful first day as site leader!  I have 2 more site leader days scheduled in Costa Rica, our next stop.