Haiti (part 1 of an as-yet-undetermined-number of parts)

November 21^st, 2011

This may well be the last installment of Melissa’s CP11 blog – as I have been home for 2 ½ months now and my motivation to write about the final parts of the mission – and my memory of the details – are lacking at this point.  But the chronicle wouldn’t be complete without at least trying to describe our last-but-definitely-not-least stop, Port-au-Prince, Haiti.

The COMFORT had been to Haiti before, on previous CP missions and more recently, after the earthquake in Jan/ Feb 2010.  Several of the crew on our mission had been aboard the ship during the earthquake/ disaster response (DR) mission.  These crew members had been telling stories for months about the devastation and ruin that had overtaken Port-au-Prince – but everyone who had been there said the same thing: you have to see it to believe it.

I don’t know what I was expecting, but when we anchored offshore on the 17^th of August, PAP looked much like any other town we had seen.  In fact, from a distance, the landscape was very pretty – green hills in the background and of course, that gorgeous Caribbean blue water surrounding the island, which makes everyplace picturesque. 

I was the site leader at the surgical site on the first day (the 18^th), so was one of the first people to take the hospitality boat to land.  Unfortunately (or fortunately, depending on how you look at it), there was no bus ride to the clinic site – we were set up within walking distance – about 200 yards – from the BLZ.  Because of this, I didn’t really get to appreciate the local area, as we were set up essentially on a military base.  However, as site leader, I was immediately introduced to some of our local help – several NGO (non-governmental organization) personnel who helped facilitate patient referrals to the ship.  Many of these NGOs were from the States, and had permanently relocated to Haiti, to run orphanages or work in medical clinics or provide any assistance possible.  Several of them had been in Haiti for 2 or 3 previous CP missions, and most had been there during and in the aftermath of the earthquake.  We had not been lucky enough to work with similar individuals in other countries – probably because their assistance wasn’t particularly necessary elsewhere.  In Haiti, I cannot imagine how we would have accomplished anything without these ever-present NGOs – if for no other reason than the fact that most of them spoke Creole!  After 4+ months of immersing myself in medical Spanish, I was surprised how little French I could come up with (despite years of classes in high school and college – don’t tell mom and dad).  And anyway, as it turns out, French and Creole are similar, but NOT the same.  The NGOs were invaluable in many ways, not the least of which was bridging the language barrier.

The surgical site ran similar to other countries, except that instead of patients being referred by the local ministry of health, they were referred by NGOs.  I was responsible (again) for ensuring smooth patient flow and maximizing the number of patients that could be screened on our first day at the site.  The front gate was where I got my first taste of Haiti.  The first 2 children to enter the gate were some of the sickest patients I had seen over the entire mission.  The first looked to be about 9 (but was actually 19, I learned later), and had severe ascites and anasarca.  It turned out that she had severe liver failure.  The second patient was a 7-year old boy, and he wasn’t necessarily sick per se, but his right eye was completely protruding from its socket – he desperately needed surgery for a trauma that he had suffered years before, but couldn’t afford it.  I cannot imagine the effect that this cosmetic deformity had had on his confidence and ability to socialize with other kids.  The remaining 150 or so patients that we saw that day were equally critical.  The common theme was that all the patients had desperate medical needs – there were no oh-by-the-way requests for vitamins or the incidental “my knee hurts” – these were all major medical or surgical cases – but any help we could provide would be far too little, and invariably too late.  Really heartbreaking.

On the second day, I was a “worker bee” at the medical site – also located at a BLZ so no local travel.  Whereas in most other countries we set up our MEDCAP sites in pre-existing buildings (schools, gymnasiums, auditoriums, etc.), there was no freestanding building at the Port-au-Prince MEDCAP.  The site leader and setup team had been out the day before, and had set up several tents, tables, and hundreds of chairs, all in a dirt field directly next to the water.  There was no breeze, and no electricity (except that provided by one generator – which was used to power the X-ray machine).  It was hot - in the high-120s on average.

The patients came by the many hundreds.  I saw my personal record number of patients that day – 42.  Way too many to be effective.  Pretty much every one though had a huge impact on me.  Most of them had horror stories about losing multiple family members in the earthquake – one man (boy, really, he was 21) described hearing his father call for help under the rubble but was unable to get to him, so eventually, 3 days later, he heard his father die.  One of my translators volunteered to translate in the hope that somehow, he would make it onto the ship, where his brother had supposedly been taken after the earthquake for medical care – and no one in the family had heard from the patient since that time.  It was absolutely heartbreaking.  As was the trend during the mission, I saw many patients who were suspected to have cancer, and most of these suspected patients turned out to, of course, have cancer.  Cancer that, in the States, would be very treatable and often curable, but in Haiti, I was told, “you can make some recommendations for pain medications, but otherwise they won’t get any treatment.”  The near-complete lack of resources got to be very frustrating and again, heartbreaking.  That was one of my longest and hardest days.

I spent the next two days caring for pre- and post-operative patients on the ship – no less heart-wrenching, unfortunately.  The day after that, we were told of Hurricane Irene’s approach toward Haiti.  Because of certain Navy docking concepts that aren’t entirely clear to me, it was going to be necessary to pull up anchor, sail back out to sea, and wait out the storm.  This was obviously NOT in our original SOM (scheme of maneuver).  This meant lots of hurried patient discharges, late night surgeries, and cancelled procedures.  Ultimately, the COMFORT pulled back out to see on the 22^nd, and remained floating/ sailing aimlessly for just over 2 days.  We headed back to Haiti on the 24^th, and weren’t sure what we would find.  In our 2 days at sea, we had prepared ourselves to convert from an HA (humanitarian assistance) mission to a DR (disaster response) mission.  As it turns out, the areas in which we were working were not too terribly damaged, although our dirt-field MEDCAP site was converted to a huge mud pit.  The MEDCAP was moved to the previous surgical site, and opened back up for business the next day.  Because of our detour at sea, my hospital tour had been cancelled, then rescheduled.  I was also scheduled to attend a tour of the Brazilian attaché to MINUSTAH (la Mission de Nations Unités of something something Stabilisation in Haiti – the UN, basically), and of a local cholera clinic.  The descriptions of those tours, though, will have to wait, as my fingers are out of typographical practice and I need to take a break.  Apparently this was NOT my last blog entry.  And you thought I’d be done when I got back!

Costa Rica continued...

So, I never promised I’d finish this blog on my actual deployment.  Here’s the next installment.

The remainder of Costa Rica was fairly uneventful, after my first few days as site leader.  In the interest of morale, the ship’s Commodore granted us “non-liberty liberty” in Puntarenas, the port town where the ship was moored.  As I mentioned, this was a cruise terminal, so was relatively touristy and therefore safe.  Over the course of the 14-day mission stop, we were allowed 3 evenings off the ship, in a strictly regulated “liberty zone,” with the same “shore patrol” personnel that were ever-present during liberty.  This pseudo-liberty gave us an opportunity to enjoy the local cuisine (food only – alcohol was strictly forbidden) and shop for souvenirs, all while wearing civilian clothes.  As I’ve mentioned before, the chance to get out of combat boots and our heavy uniforms was always welcome and really improved everyone’s spirits.  Unfortunately, some of my assigned nights ashore followed very long MEDCAP days, but I managed to take advantage of all available “off ship” time.  There were several great ice cream shops in our liberty zone, and I had my first ever banana split with corn flakes on top and mango and jello at the bottom.  Corn flakes: thumbs up (really!).  Mango and jello: not so much.

Mango and jello notwithstanding, many of you will be surprised to learn that I was quite adventurous with the local food.  You will be less surprised to learn that I paid for it in Costa Rica as much as I did in other countries.  I maintain that consuming raw fish in developing nations is not the wisest idea.  Unfortunately, my most severe GI bug of the entire mission came at the end of one of my site leader days in Costa Rica.  The day was otherwise going smoothly and I was even able to see patients (in addition to running the site).  One of my last patients of the day mentioned that her stomach was upset, and I realized that my stomach was upset too.  Before I knew it, I had to excuse myself and spent the remainder of the afternoon vomiting behind the auditorium where the MEDCAP was ongoing.  When we finally made it back to the ship later that day, my ASLs escorted me to Sick Bay, where I was given TLC, Cipro, and a fantastic medication called Zofran.  That night happened to be one of my “non-liberty” nights.  Not wanting to miss out on one of these rare occasions, I used the opportunity to find a local convenience store where I purchased ginger ale and crackers.  Not the most auspicious night out, but enjoyable nonetheless.

Costa Rica was also where we were given our second (and final) “beer on the pier” (BOTP) extravaganza.  Loyal readers may remember this event in Puerto Quetzal, Guatemala, where we were issued 2 beers after showing appropriate ID.  This BOTP was no different, except that we were prohibited from leaving the pier (and thus wreaking havoc on the town of Puntarenas) once we had had our beers.  This rule resulted in the world’s most inefficient and ridiculous arm-banding/ cutting/ list-making/ ID-showing experience, but it was still fun.  We ended up getting pizza in town, and bringing it back to the pier, and thus enjoyed pizza and beer together on the pier.  I love the ingenuity and tactical mindset of our nation’s sailors. 

As in the previous several countries, I arranged a tour of the local/ regional hospital in Puntarenas.  The scenery around the hospital was incredible (gorgeous ocean views), but the hospital was one of the least capable facilities that we had seen.  This surprised me, given the otherwise comparatively advanced medical system present in the area.  I was also able to travel to the nation's capital (San Jose), as part of an Emergency Medicine SMEE (subject matter expert exchange).  Yes, I realize that I am not an Emergency Medicine Subject Expert, but I happened to be good friends with one, and it would have been considered rude not to go...right?  Plus, I would never turn down the opportunity to tour Costa Rica with a local physician!  We got to see the Poas volcano (very cool) and several parts of San Jose.  We also managed to make it to the larger regional hospital in the city, so the trip was validated, in my mind, at least.

We left Costa Rica on or around the 12^th of August (hard to remember, now, honestly).  Then began our last long voyage at sea.  We transited the Panama Canal (for the second time), and I couldn’t believe how long it had seemed since our first trip through back in April.  I really felt like a seasoned sailor, watching all the new additions to the crew and their excitement at passing through the “ditch.”  Funny to think I had been in those same shoes (or on that same boat, haha!) less than 4 months earlier.

At this point, those of us who had been on the ship from the beginning of the mission were starting to feel the strain of 4+ months at sea.  Many of the crew (I would estimate at least half) had turned over by this point, and we were surrounded by new people (we called them “NPs”).  I have to say, we were not friendly to the NPs.  It’s a little embarrassing, in retrospect.  For the most part, we (the “core crew” of physicians and nurses who had been on the ship “from the beginning”) did not bother to introduce ourselves or become friendly with the NPs.  You might even say we excluded them.  We were a little resentful, I think, of their enthusiasm, their optimism, their excitement about the mission, and their good humor at what had become truly awful food in the galley and a ridiculously pathetic selection of merchandise in the ship’s store.  They thought the abandon ship drills were “fun,” they hopped out of bed at the first sounds of “Reveille,” and they (unknowingly) took our regular seats at the nightly operations briefs.  In general, they considered themselves “ship’s crew” (the nerve!), and we didn’t like it one bit.  Many of these NPs had boarded the ship at the end of the Costa Rica mission stop, and were scheduled to fly home at the end of the Haiti stop – so their participation in the mission lasted 2 weeks or less.  We were jealous of this, I think, but again, in retrospect, having the NPs on board was a smart move, on someone’s part.  After 4+ months, the rest of us were exhausted.  We needed fresh blood and motivation to get us through our most difficult stop of the mission: Port-au-Prince, Haiti.

How’s THAT for foreshadowing?

Costa Rica LIBERTY!!!

July 27, 2011

We continue en route to Costa Rica, with scheduled arrival tomorrow afternoon.  As soon as they call liberty, I will be on the first bus to the hotel to meet up with Scott, who arrives today!  Lots to do before then, as liberty ends at 2400 on July 31^st, and I have a hospital tour scheduled for 0900 on August 1^st, so everything needs to be coordinated before I leave the ship tomorrow.  I’ll write more if I can!

August 4, 2011

It’s funny when I write things like “nothing stands between me and liberty except 3 days at sea,” how comically ironic that turns out to be.  Some of you may know this already, but on the night before we were scheduled to arrive in Costa Rica for liberty, the entire ship was buzzing with excitement in preparation for the next day.  After an otherwise mundane ops brief that evening, the Commodore stood up and announced, without any fanfare, “I have some bad news.  It doesn’t look like we’ll be arriving in Costa Rica tomorrow.  You should probably call your spouses and let them know.”  It was an issue with getting clearance to discharge waste products from the ship into port in Costa Rica – somehow the permit had not come through in time.  Knowing the reason behind the delay in our arrival did nothing to cheer anyone up.  After the ops brief, people were just moping around the ship.  No one smiled at anyone else, and everyone just looked miserable.  The next morning, they still conducted our mandatory liberty briefs (to remind us how much to drink and the off-limits establishments), but no one really paid attention and everyone just looked dejected.  In the middle of our brief, the ship’s master came over the 53MC and announced that “we will be pulling into port as scheduled.”  The entire ship’s company erupted into applause and cheering, and all of a sudden, the liberty brief seemed a lot more relevant.  Spirits were lifted and we all started packing and preparing to get off the ship.  Unfortunately, due to a 30-foot draft and significant tide fluctuation, we weren’t able to pull into port until about noontime.  Then, the port authority came through with several new identification requirements to disembark from the ship.  After the longest afternoon in history, crewmembers on leave (me) were allowed to go ashore at about 5pm.  I had to have an escort take me to the hotel (where Scott was waiting), so I grabbed several friends (who otherwise would have spent another 1-2 hours waiting for liberty to be called).  We took a taxi to the hotel and Scott and I were reunited!  It was fantastic. 

We are in port in Punta Renas, Costa Rica, which is also a cruise ship port.  There has been one cruise ship here since our arrival.  It is fairly touristy and the hotel we stayed in, the Double Tree, was very nice.  The food was delicious – I have become a big fan of ceviche, a very popular dish in Central and South America.  Scott and I went ziplining and mountain biking as part of the ship’s tour program, and then also took a private tour of Tortuga Island – a really fun day that included snorkeling and relaxing.  He was able to meet most of my friends from the ship, and he fit right in, as I knew he would!  I got to watch some videos of the kids that he had brought from home, and that part made me happy and sad both.  I cannot wait to see them in 1 month!

The 3 days of liberty unfortunately flew by and Sunday night, I reluctantly returned to the ship at about 10pm.  The next morning, I was manifested for the Costa Rican hospital tour.  It was SO difficult to go back to work knowing Scott was still in country and literally minutes down the road.  He was able to entertain himself, obviously, but I had a hard time focusing during the tour and was pretty grouchy that day.

The next day, Tuesday, I was the site leader at one of our 2 MEDCAP sites.  Astute readers may remember that I had been a site leader before, about halfway through our mission in El Salvador.  I had a great time that day and spent my time giving tours of a very well-organized site and putting out small fires.  This time, it was site set-up day, and I was responsible.  It was a really challenging day – a much different experience from my first day as site leader.  At 7:15 that morning, we walked into a large gymnasium where pallets of our medical equipment and supplies had been delivered the day before.  I had been given a diagram of the gym by the ACE team but was otherwise on my own.  So, in the span of 15-20 minutes, I had to determine the best locations and setup for the medical providers, dentists, optometrists, pharmacy, lab, physical therapists, and discharge planners.  In addition, with the help of 2 amazing ASLs (assistant site leaders), we set up our patient flow plan – from mass chaos outside the entrance of the site to organizing patients into 4  groups – optometry, dental, general medicine, and pediatrics, and getting them inside the gym with all their paperwork completed to see a provider.  I had never done this before so relied heavily on the ASLs.  Unfortunately, or fortunately, depending on your perspective, the Costa Rican government and ministry of health were very interested and involved in our setup plan.  As this is country #8 of our CP11 mission, we have a pretty good idea of what does and does not work for patient flow.  The Costa Rican representatives had some very specific ideas on site setup.  We tried to accommodate them, in the interest of building relationships and partnering with our host nation colleagues, but it quickly became clear that the plan they had advocated for was disastrous.  Hundreds of patients were milling around in the 100+ degree heat, going to see the wrong provider type, without any paperwork, and no one was happy.  It was difficult to change the setup once we had started, so we did what we could to make the best of it.  By the end of the day, we had a good flow going, and we managed to convince our Costa Rican counterparts that a few critical changes would vastly improve things.  They agreed, so once the patients had left, we made some significant modifications to our patient flow plan.  The next day, Wednesday, I was site leader again.  It was really rewarding to see the changes that we had implemented the day before result in such an improvement in patient flow.  It was a perfect demonstration in logistics and flexibility (ok, maybe not perfect, but pretty fricking good).  They always tell us, “It’s not about the numbers,” but to some extent it IS about the numbers.  A well-organized site means nothing if you can’t see a good number of patients.  On the first day, we ended up seeing just over 400 patients (after completing site setup by around 9am).  The second day, we saw almost 650.  Not the most we’ve ever seen, but a respectable number.  The CO of the ship visited the site yesterday, and I was actually proud to show him around.  He referred to our patient flow as a “silent drill team parade” – it was that smooth!  I give 100% credit to the ASLs, but it was still really rewarding to be a part of the process. 

In addition to the whole site setup and patient flow plan, there were the continuous small fires to be tended to.  Any unhappy patient, provider, or host nation representative gets fielded to the site leader.  In addition, there are the political introductions to be made and the hourly discussions with the ACE team and the ship med ops team about site operations.  My biggest challenge of the day came when one of the translators told a patient that (essentially) she could choose which doctor she wanted to see.  We had several Costa Ricans doctors working with us, but she only wanted to see an American doctor.  Very quickly, the other 45 patients waiting with her decided that they too only wanted to see the American doctors.   Since one of our mission objectives is to build relationships with our host nation providers, this didn’t go over well.  I ultimately had to tell the patients that they could see the next available provider or they could leave the site to return the following day (at which time they would also see the next available provider, regardless of nationality).  I emphasized that we were working side by side with our host nation providers, but the patients were NOT HAPPY about seeing one of their own doctors.  (Truthfully, I can understand where they were coming from, as most had been waiting for 8+ hours and had probably been promised by their local government that they would see an American doctor, but for many reasons, this just wasn’t a good idea.)  I stood my ground, as unpopular as that made me with the patients, and it took about 30 minutes of discussion (during which time no patients were seen, out of principle), but eventually all the patients ended up seeing providers in the correct order.  No one left the site, and it all worked out fine.  Surprisingly, this was the first time in any of our missions that this had come up.  The translator that had started the mini-riot was stationed in a different area for the rest of the day.

The next day, I once again served as the site leader.  It was a busy day, but much smoother - there were no international incidents and no injuries (our CO’s definition of a great day).  

En route to Costa Rica and the UNREP - July 24th and 26th, 2011

July 24, 2011

Adios El Salvador!  At this point, there is nothing standing between me and liberty in Costa Rica except for a 3 day ocean voyage.  Yippee!  Our liberty stop in Costa Rica has been long-awaited by everyone on the ship (just like Ecuador was earlier in the mission), and is even more so for me since Scott will be visiting!  

Since my last writing, I organized and attended another hospital tour, which went well, but the term “herding cats” came to mind several times.  I think I will restrict the number of participants in the future – it got a bit hectic.  After every tour we have managed to find a respectable restaurant for lunch.  This time, while I was asking the bus driver for recommendations, one of the senior officers said to me, “I think we can make it back to the ship for lunch.”  This was his first (and last, I’ve since decided) tour with us.  I just looked at him and said, “No, sir, I don’t think so.”  And then got an even more senior officer to agree with me. =) 

After that tour, I had another “worker bee” day at the MEDCAP site.  The heat index that day was “only” 109, but it was the hottest I remember feeling on our whole mission.  There were 6 providers in one classroom, and no breeze at all.  We were all sweating through our t-shirts and I drank over 3 liters of water.  It is not easy to muster up empathy for patients when you feel that miserably hot, until you remember that they have been waiting in those same conditions to see a provider, some of them for more than 12 hours.  That definitely put things in perspective.  Also, knowing it was our last day seeing patients before liberty helped quite a bit.  Not my most productive day at the site, but I was able to keep smiling until the end, so I consider it a success.

We are expected to get underway from El Salvador in the next hour or so.  I’m going to check on the preparations!

July 26, 2011 – The UNREP

Our big lament over the last 4 days was the fact that the ship’s communications system failed – or, in ship lingo, “comms went down.”  This happened abruptly on Friday and was apparently a failure of the “whiskey-8” (I have no idea what that is).  Once the site of failure was identified, the replacement piece was urgently shipped to meet us in Costa Rica, where we arrive in 2 more days.  (At least, that is the information we received originally – as it turns out, the replacement part arrived today, so comms is now back up – I’ll get to that later.)  The information technician was flown down to El Salvador, where he boarded the ship, ready to receive the missing part.  You can probably imagine that a complete loss of contact with the outside world creates some problems.  For the first 2 days of comms being down, we were still pierside in El Salvador, and some people were able to use 3G on their cell phones.  I was able to at least email home using this feature (on someone else’s Kindle) to tell Scott why I couldn’t call or send or receive emails from the ship.  However, once we left El Salvador, the 3G disappeared and so did every connection with the rest of the world.  The ship does have a limited number of satellite phones, which were available for 1-2 minute “morale calls,” basically enough time to tell our families we were safe and incommunicado.  After that, the only need for computer use was for intra-ship email, or use of the intra-net.  Since we finished our El Salvador mission on Saturday (the day after comms went down), there wasn’t a whole lot of intra-ship information to pass.  The people responsible for medical operations (Med Ops) were able to use the satellite phones to talk with the ACE (advance) team who are already in place in Costa Rica, but otherwise, not much got done.  I would never admit this to anyone except you, my loyal blog readers, but it was a teeny tiny bit liberating and relaxing not to have any outside communication.  Instead of everyone heading to the phones or computers after dinner, we all hung out and watched movies, played games, and talked.  As the days passed (4+ full days without comms altogether), the lack of communication got more and more frustrating, but there’s something to be said for complete lack of control over these things, and the fact that everyone (to include the Commodore and ship’s crew) was in the same boat (ha ha ha).  So how did the piece arrive early, you ask?

Well, today was my first (and probably last) Navy UNREP.  This stands for Underway Replenishment, and is actually composed of a COMREP (Communicating Replenishment? – not sure on this), and a VERTREP (Vertical Replenishment).  After much coordination, preparation, and briefing, as well as fancy maneuvering and velocity changing, the Comfort met up with the USNS Lewis and Clark (supply ship) at around 6am this morning.  I was sound asleep for this part, but basically, the two ships were connected by a fuel line (to take on fuel) and a zipline-looking apparatus.  After that, hundreds of pallets were transferred from the Lewis and Clark onto the Comfort via the zip-line (COMREP).  In addition, the helos that are stationed on the Comfort ran back and forth from ship to ship all day transferring additional pallets through the air (the VERTREP).  The very first item to come across the COMREP: the whiskey-8.  Within a couple of hours, the IT folks had it installed and outside emails came pouring in.  They kept the internet restricted to command and operational personnel, though, given the 4 days of backlogged work that needed to be accomplished.  However, by late last night, we were back to full-speed (i.e., slower than dial-up) internet ship-wide.  A huge morale booster, since Scott would be coming to visit me in Costa Rica in 2 short days, and we had no way of communicating!

In addition to the whiskey-8, the UNREP provided us with a fresh food supply, real ice cream (a fantastic treat which we already enjoyed last night), more paper towels (we were completely out), and a number of pharmacy and lab supplies that were badly needed.  Overall, there were over 600 pallets transferred over about 10 hours, so I’m sure there was other stuff delivered, but food, ice cream, and paper towels have been the most obvious replenishments so far.  I was able to watch the UNREP from the bridge (the control area for the ship) and talked with the ship’s Master (a civilian mariner) during the process.  It was wicked cool. =)

I mentioned that with no communications, people were sort of forced to spend time together.  These ended up being some of the best nights we’ve had on the ship.  It has been weeks since the sky has been clear enough to see stars at night, and the first 2 nights we were at sea (after leaving El Salvador), there was not a cloud in sight.  On top of that, there was no moon, and we were in the middle of the Pacific with not a single light around us – even the flight deck and upper weather deck were completely pitch black.  This made for some amazing stargazing.  I have never seen so many stars, and the Milky Way was unbelievably bright.  We saw 15-20 shooting stars over a few hours – and all around the flight deck you could hear people laughing and shouting when one crossed the sky.  It’s surprisingly easy to have deep conversations when looking at millions of stars and nothing else.  In an interesting coincidence, when comms came back up, a cloud cover set in and no stars were visible at all.  Maybe the communications failure was strategically planned…

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.

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.

A "Typical" Day at Sea

June 14^th, 2011

Happy Flag Day…

Did I mention that I have 7 roommates now?  That’s right, there are 8 of us in my stateroom – myself, Carrie (another Air Force internist), Audrey (the JAG – lawyer – for the mission), Stephanie (a Public Affairs officer), Becky (the “Fun Boss”), and 3 Canadians – Isabelle, Tanya, and Tracy (a dentist, hospital administrator, and nurse, respectively).  We are a diverse group – Carrie, Isabelle, and I are off the ship most of the time we’re in port, while Becky almost never leaves the ship and Tracy works nights on the inpatient ward.  Thankfully, everyone is VERY respectful of the extremely tight living quarters and the need for personal space.  However, 8 women in one room, no matter how respectful, is a lot (“enough,” some would say).  It is crowded and messy, especially while we’re at sea (like right now), and everyone is on the ship all day.  This morning, I counted 19 pairs of shoes on the floor – not including the shoes we were all wearing.

While I’m sure this information fascinates you, it occurs to me that if I am counting shoes and reporting on that, there must not be a lot going on.  I’ve been meaning to write for a while about a “typical” day on the ship – so here goes.

Ok, really, there are 2 typical days on the ship – shore (mission) days and underway (at sea) days.  On most grey hull ships, the shore days are low-key (liberty) and at-sea days are more stressful – but as with many other things, the situation on the Comfort is the opposite.  I’ll start with an underway day, since that’s today.  At 6am every morning, the 1MC (overhead PA system) calls out, “Reveille, Reveille.  All hands heave out.”  Yes, that is exactly what they say – I’ve checked.  No, I don’t know what it means.  There is no heaving out going on in our stateroom.  For me, it means, you have 30 more minutes to sleep.  Sometimes I don’t even hear Reveille – on occasion there is a compassionate person on the mike who announces it very quietly.  Most of my roommates are up around this time, but are quiet enough that I can usually fall back asleep.  Those who know me know that I will wake up at the last possible second.  So at 6:30, my alarm goes off and I stumble out of bed.  There is always a light on in the room (for safety in case of a middle-of-the-night egress), so I get dressed by that light – I never turn on the main light.  I am ready to walk out the door at 6:45.  And then comes the first obstacle of my day: the stairs.  It is 66 stairs UP to the mess deck (cafeteria).  There is something about being awake for 15 minutes and having to climb 66 stairs in heavy boots that is very disheartening.  One of these days I’m pretty sure I just won’t be able to make it.

But remarkably, so far, every morning, I have climbed all the stairs and arrived at the mess deck (albeit a little out of breath – you’d think it would get easier doing it every day, but it doesn’t – it’s the last flight that does me in).  There are 3 dining areas in the mess deck – the main deck, the chief’s mess (for E7s and above), and the ward room.  On other ships (“real” ships, as my Navy friends say), the ward room is where all the officers eat.  On the Comfort, there are so many officers that the ward room is restricted to O4s and above.  Thankfully, I made the cut.  The ward room is much nicer than the general mess deck.  You can serve yourself (rather than being told you can have rice OR pasta, but not both), go back for seconds, and the lines are much shorter.  The ward room is less crowded and therefore quieter – which makes for great conversations.  Also because it’s less crowded, we tend to eat with the same people every day – and since I like the people I eat with, this is a good thing.  Another advantage is that there is no one rushing us along – in the main mess deck, seats are at a premium, so when you’re done eating, you’re done.  We like to lounge around after meals and just talk.  Anyway, so every morning I head to the ward room.  Breakfast is the best meal of the day.  It’s funny, because at home I usually don’t even eat breakfast, or if I do, I’ll have a ½ bagel or an English muffin.  Here, I have to limit myself.  I usually have a pancake or French toast, 2 hard-boiled eggs, a bowl of cereal, and fruit.  The coffee is awful, so I get my caffeine in the form of fountain Diet Pepsi (not as good as fountain Diet Coke, but I’m definitely developing a taste for it). 

At 7am on the dot, the 1MC announces, “Secure the mess line.”  One of my first days on the ship, I heard that and thought they said, “Secure the meth lab” – so that’s our running joke.  “Secure” is a Navy word.  It’s used liberally around the ship, usually to mean something is closed, off-limits, prohibited, or safe.  We have to “secure for sea” (fasten down all movable objects), the ward room is frequently “secured for DV luncheon” (closed, obviously), a sign in the bathroom tells us if we keep clogging the toilets, they will be “permanently secured” (this one makes me laugh, because it’s such an idle threat – are they really going to permanently close the toilets?).  My favorite was one day at breakfast, when there was no milk.  When I asked one of the FSAs (food service…agents?  assistants? Not sure – one of the mess deck workers), he told me, “I’m sorry ma’am.  The milk is secured.”  I just couldn’t think of a reason why we were securing milk.  Anyway…

After the mess line is secured, we all get in line to put our trays away, into the “scullery” – the dish cleaning area.  In front of the scullery are 3 bins, where we separate our trash into paper, plastic, and metal/ glass.  This is done everywhere on the ship – all trash must be separated.  This is because paper can be incinerated on the ship, but plastic and metal/ glass are held “on deck” until we are in a country where we can pay to recycle or dispose of it.  After we turn in our trays, we head to “quarters” or “muster,” which is held daily at 7:15.  Muster is another Navy word – and they love it.  We muster constantly.  Basically it is roll call, and is done to make sure no one has fallen overboard since the last muster.  We have a fairly large department (85-90 staff), but have gotten the muster down pat and are usually all present and accounted for by 7:17 or so.  Then we are read the POD – the Plan of the Day, which includes any useful information about training, activities, or secured offices for that day.  After that, we usually have an internal medicine meeting and a brief lecture among the internists.  After THAT, the day begins.  While we are at sea, there is usually some kind of training or lecture scheduled in the morning and one in the afternoon.  We also have fire drills and abandon ship drills after every mission.  In the mornings, I try to find a computer where I can check email or work on my computer in my stateroom (on blogging, lectures, etc.).  I also do laundry twice a week (we have assigned self-service laundry days, so if you miss your day, you’re out of luck until 3-4 days later, so I do it every time just to be safe).  The ship’s laundry will do most laundry for us, but I’ve gotten one too many still-damp and smelly towels back and I just prefer to do it myself.  If I can find a functional TV (no small task), The Daily Show and Colbert Report are on AFN (Armed Forces Network) from 9-10am.  Lunch is served from 11:30-1pm, and I like to go as early as possible so I can be hungry again at 4:30, when they serve dinner (no, I’m not kidding).  After lunch it’s usually more internet time or meetings, then a workout after lunch has digested. 

At 4:30, it’s “Dinner for the crew” over the 1MC.  As much as I try to hold off, the response is Pavlovian, and I am hungry about 5 minutes after I hear the announcement.  Lunch and dinner are remarkably similar meals (both much heavier than I would eat at home), and I try to have a salad for at least one of them.  Unfortunately, we have run out of lettuce (or maybe it’s secured), so they’re serving cabbage instead.  For those wondering, cabbage does not equal lettuce.  Not even close.  Not even with a lot of ranch dressing, and not even if you cut it into lettuce-sized pieces instead of thin strips.  If I never see cabbage again, I’m ok with it.  For a while, they were also serving extremely under-ripe green tomatoes, and calling them tomatillos.  They weren’t.  We knew this when, after refusing to eat them for 2 weeks straight, they started turning red and delicious.  That was pretty funny.  My other favorite Comfort recipe came this weekend.  Saturday night was pasta night (my absolute favorite meal on the ship), and Sunday, they served “tomato soup,” which was, as it turns out, pasta sauce.  They didn’t even try to dilute it or add milk or spices or anything.  So when I get home, that’s going to be my new meal – pour some Ragu in a bowl and tell the kids it’s soup.  For all my complaining, I will say the food is, well, actually, it’s pretty bad.  Once again, my Navy friends tell me that the food on a grey hull ship is amazing.  They have all done tours on other ships and can confirm that the Comfort meals are not typical of Navy meals.  Thankfully, there is a seemingly endless supply of peanut butter and jelly, so I have made more than my fair share of sandwiches (on stale Wonderbread, but this is still better than some of our lunch options).

After dinner, as I mentioned, we all kind of hang around the ward room until they once again secure the meth lab.  We kill time for about 30 minutes (usually hanging out on the flight deck, where there’s a nice breeze and sunset), then we meet back in the ward room for “Internal Medicine Peer Review” – one of my favorite parts of the day.  I’m not sure if this is a Navy thing or what, but 4 of the 6 internists, and several of the radiologists and the dermatologist, are big-time gourmet tea drinkers.  So they started having tea time, and of course the rest of us had to join in.  And now it is our nightly ritual, to sit and drink tea after dinner.  Around the same time this started, we were told we had to have some kind of peer review program in place, so we decided to call that tea time (so now it’s an official meeting and we can’t be forced to miss it for other, less important/ fun meetings).  We usually discuss patients for about 5 minutes then resume other conversations.  After that, it’s the COPS brief (the Current Operations brief).  This is a source of entertainment if not information.  Every night, the brief consists of the weather report (hot and humid), current events (usually one story relevant to the country we’re visiting), the plan for the next several days (more of the same), the medical summary for the day (how many patients we saw at the sites and on the ship), the Navy band report (they continue to play music), the Public Affairs Office report (where they tell us how many Facebook friends CP11 has), and a message from the CO (the hospital commander) and the Commodore (the ship’s commander).  When we pull into a new country, we get a cultural brief, a legal brief, a safety brief, and a brief about the upcoming MEDCAP sites.  On a good day, the COPS brief lasts about 15 minutes, but sometimes it can go on for a full hour.  My favorite part is the band report (just because I think it’s funny that we’re getting a report on the band) and of course the medical report, where we get to impress everyone by showing how many patients we saw that day.  A typical day at the MEDCAP is 700-900 patients – Colombia was a bit less as we had fewer providers out there.  The guy in charge of the medical brief is pretty funny and is one of the internists, so frequently joins us for tea time.  As is common in group conversations, we come up with some key phrases that turn into inside jokes – and he manages to work these into the ops brief seamlessly.  So far he’s used “Danish butter,” “Jamaican handshake,” and “hot jungle popsicle” – which are all very benign phrases (in origin) but end up being hilariously funny when the origins aren’t known.  Makes us all laugh to hear how they are worked in.

After the COPS brief is the FOPS (future operations) brief, aka “the hot wash.”  Not sure why it’s called that.  It’s where the down-and-dirty logistics planning takes place for the next day – who goes out on which boat, how many buses will be needed, etc.  The only time I’ve had to go to the hot wash was when I planned the trip to the oncology hospital – that’s where I got confirmation of my transportation, security, local cell phone, and translator.  Most of the time during the hot wash, we go back up to the flight deck for some fresh air.  By this time it’s dark out and we can usually do some stargazing – I got to see the Southern Cross!  There have been a few days on this deployment that for some reason, I haven’t gone outside at all.  That is a huge mistake, I realize now.  Being stuck inside the “skin of the ship” all day makes time go by much more slowly and makes me feel sickly.  Being outside in the fresh sea air is much better (except in Peru, where the smell outweighed the benefits of the sea air).  After our time on the flight deck, we’ll either watch a movie, check email, or call it a night, depending on what the next day’s schedule looks like.  And that is a typical “at sea” day for me.  When we’re in port or at anchor (during missions), my off days are pretty typical, except there’s less outdoor time, because the helo’s are flying missions and the flight deck is secured.  And now you know what that means. =)

Anchors Aweigh (again…)

13 June 2011

Back at sea as of yesterday morning.  We were all happy to say goodbye to Colombia.  As it turns out, our presence in the country was not universally welcomed.  I mentioned before that we had 900 security personnel at the MEDCAP site in Tumaco.  This meant a large influx of Colombian police and military forces (from outside the local area), which resulted in the capture of one of the key FARC leaders (the narcotrafficking group).  In retaliation for this, on Friday night, there was another explosion/shooting in Tumaco.  There were several casualties, and the Comfort was once again asked to assist with medical care.  For logistical reasons (leaving anchorage less than 36 hours later), the command elected not to accept these patients.  I have mixed feelings about this (I feel we could have stayed anchored for a few days longer to help out, as our medical care is clearly far superior to the system in Tumaco, and we have 2-3 extra days that we could eliminate in our next country), but obviously it was not my call.  I know there was a lot of information that was factored into the decision (much of which I am not privy to), but I can’t help but think we could have really made a difference in those patients’ lives – our ability to provide trauma care and resuscitation far exceeds Colombia’s – especially in Tumaco, where, as I mentioned, most of the physicians are on strike.  Well, everyone said Colombia would be our most challenging mission (so far), and they were right.

Saturday I was scheduled to take part in a doctor-to-doctor exchange (the SMEE), where we were to meet with local physicians to discuss medical practices.  Per routine, we awoke “in the fours,” (this should give you some foreshadowing here – nothing good can come from waking up that early), mustered for our boat at 5:30am, and arrived at the SMEE site before 7am.  No more than 45 minutes later, we were informed that all shore activities for the day had been cancelled, due to security issues from the previous night’s events.  We were then bus’ed back to the BLZ, where we were told no boats would be running until 3pm.  So then we drove to the HLZ, where, after a 2+ hour wait, we were able to catch a helo ride back to the ship.  The helo ride was fun, but did not make up for the early wake up call or the 6+ wasted hours – not to mention the supposed “risk” we faced by being off the ship due to security issues.  Our instructions for the mission are to “be flexible and keep a sense of humor” – two commands that I was unable to follow after our exercise in futility on Saturday.  After returning from the site, I had lunch and a nap.  When I woke up, I still felt inflexible and humor-less.  Later that day, one of my fellow internists mentioned that his 3-year old daughter had refused to talk to him on the phone, because she was mad that he had missed her birthday last week.  It struck me that Abi will turn 3 in a few weeks (and I obviously won’t be there) and I started thinking about how big the kids are getting and how I’m missing so much by not being home and I just started to tear up.  It was right in the middle of our nightly COPS (Current Operations) brief, so not too many people noticed, but I was still embarrassed.  The guy who had told me his story (that set me off) felt terrible for upsetting me – so then of course I felt terrible because, well, he was the one whose daughter refused to talk to him.  The nice thing is, we have a really great group of people in my department.  We’re all in the same boat, so to speak (get it? – that joke never gets old), so after the COPS brief, my fellow internists and other friends were all more than willing to lend a sympathetic ear, a hug, and their own sad stories.  That night also happened to be the Commanding Officer’s birthday, so after the COPS brief, they served delicious cake (unlike the regular dessert cake, which is the opposite of delicious).  It was a mellow kind of night – for everyone – but the cake helped.  After that, we all hung out on the flight deck, enjoying our last night off the coast of Colombia, and watched a movie.  I finished up the night by watching every video I had of the kids – sounds like torture but it actually cheered me up.

The next day I woke up feeling better but not normal.  It was Sunday, and was deemed a “semi-down day” (our second one of the mission).  At church last week, the chaplain said, “On the ship, every day is Monday – except Sunday!”  This is partly true.  When we are in port, both Saturday and Sunday are working days, so although church services are held on Sundays, many people cannot attend due to mission requirements.  So far, we have only had 2 Sundays at sea, when we haven’t had to work.  A semi-down day means that instead of mustering in uniform at 7:15am, we could muster in uniform at 10am.  For some reason, though, they moved church services to 8:30 (instead of 9), so I wasn’t able to sleep in for too long (and, inexplicably, they still called “Reveille, Reveille” at 6am).  They served “brunch” from 10-12, which consisted of grilled cheese sandwiches and rice, with a side of bacon (guess that was the “br” in brunch).  Not sure who comes up with these menus. I kept waiting for the mimosas and eggs Benedict to come out.  After that, it was a relaxing day, followed by our second scheduled “steel beach picnic.”  A steel beach picnic is basically a cookout on the flight deck (our “steel beach”).  At our first steel beach picnic, right before we crossed the Panama Canal, everyone wore PT gear and sneakers (instead of the hot and uncomfortable full ABU or NWU uniforms and boots that we usually wear), and there were lounge chairs set up on the flight deck, along with games, contests, and a live performance by the Navy band (who were INCREDIBLE).  Unfortunately, yesterday, the weather didn’t cooperate, and so they moved the steel beach picnic inside to the mess deck (cafeteria).  And made us wear our uniform.  And there were no games or music or lounge chairs.  So, we ate hot dogs on paper plates on the mess deck.  Not much of a picnic – I wish they had just postponed it to another day.  We finished up the day by watching a movie and then we all went to bed early – everyone was sort of disappointed in our much-anticipated “down day.”

I realize this particular post is not as uplifting as some of my previous ones, but this is as much a memoir for me as it is a chronicle for my friends and family, and I want to be honest with myself and you all as to what is going on.  In general, this deployment is not terrible – the people are fantastic, my job is not too strenuous, and I am almost never concerned about my safety.  It could definitely be a lot worse.  But it would be lying to say that we’re never homesick or that we don’t drive each other crazy sometimes, or that I don’t get frustrated with the mission and lack of communication and feelings of futility with day-to-day and month-to-month operations.  I try not to think about it too much, because it’s a short journey from thinking about how much I miss the kids and Scott to thinking about how much I REALLY miss the kids and Scott and then getting through the already grueling mission days is that much harder.  I’ve made some amazing friends and we’ve had hours upon hours of conversations – some deep, some just entertaining and fun.  The ship is small enough that most of us know each other – at least by face if not by name.  But the smallness of the ship can be a source of frustration, too.  People who start to get on your nerves keep showing up – 3 meals a day, plus musters, meetings, mission sites, etc.  In the deployed setting, when 900 people are in a confined space, eating together, working together, living together, working out together – there are no secrets and no escapes.  When you’re feeling frustrated, you can’t just stay away from the people who frustrate you.  There is no private space (other than your bed, if you close the curtains around you) or place to vent without possibly being overheard – especially when, for example, the friend you want to vent to is roommates with the person you want to vent about.  Even a phone call home takes place in an open hallway, in a bank of 10 pay phones, with conversations open to everyone.  And while talking to Scott and the kids is the highlight of my week, I don’t want to waste precious phone time complaining about life on the ship – when I know things are much harder at home.  So, I’m grateful to have friends here and a blog to voice my frustrations to… =)