Catholic Mass aboard a Ship

The days run together out here and after a while you forget which day of the week it is. Weekends and weekdays are all treated the same way. There is a certain time of the week though that does stay sacred and that is Sunday and we are all given a chance to give thanks and worship.

Tonight we had a very special guest aboard to lead Catholic Mass- the Bishop of South America’s Northwest Region. About 50 of us gathered in the Wardroom in our Coveralls and Working Uniforms facing a makeshift altar of a card table draped with white tablecloth, Jesus on the Cross, two candles, and a statue of the Virgin Mary. We joined in song as we waited for the Bishop to arrive. As he walked in and we stood, he related to us that he had taken the RHIB boat (fast boat) over to the Ship at night from shore, and was a bit soaked J. We helped him get dried off and luckily the ceremonial garb had been kept dry in a dry bag. I was raised and confirmed Catholic, and even served as an altar boy back in Lancaster, PA, but this was the first Catholic I had been to onboard a ship, and from a distinguished high ranking member of the Church. It felt good to take a break, convene together, and have some time to think about things. Sunday was always a day that my family got together when I was growing up, and here too aboard the USNS COMFORT we were family.

Two weeks into this mission and it feels like I have been out here for a few months. So many experiences happen each day, peaking the senses at all times, making the perceived time seem longer than the actual time. That is my theory anyway. It is the same type of feeling that I had when I was going through the intense experience on TV.

It’s go, go, go, and rarely have a chance to step back and reflect. Tonight was good for that.

The reflection must have been calming because I awoke the following day feeling as bright eyed and bushy tailed as ever. Even without coffee I was raring to go at 5am ready to hit the shore and see patients all day long. We were assigned to the RHIB boat again today, but today the water was glassy and we were able to pick up speed and not get wet.

Amongst our crew was CAPT De La Pena, a 70-year-old Family Practice doctor, who is a bulldog and funny as all get out. For him to be hard charging as a Navy doc at this age is commendable (I think he joined with he was 52 J). Also in the mix was Petty Officer Waters, a fairly new Navy recruit (age 20 I think) who I had noticed working all sorts of thankless jobs such as dishwashing, cleaning the johns, scrubbing the decks, and now she was headed out to the site to help out. I was happy for her. She’s the type of young service minded youth that is good to see. And she wasn’t afraid to speak her mind either, which made for a good laugh most of the time.

Things were a bit disjointed at the site today. We arrived early, and I saw the largest group yet waiting to be seen outside the fence of the school.

In particular I noticed a lot of children (ninos). Supposedly there were several busloads of families from the “campo” (country) that had been bused in overnight to be seen. This was going to be fun I thought. The most interesting patients (and often the most appreciative) are from the rural areas. We waited for about an hour and they still had not let the patients through the gates. There had been some confusion and fighting outside about who would get to see the doctors first, as the government had pushed the “campesinos” (country people) to the front of the line. This was not taken well by some. Eventually they barged through the gates and my translator and “nurse” Maria and I set to work. Much was the same patient in and patient out, and to keep myself sane I would try to have each patient leave with a smile, even if it meant just talking with them about their lifestyle, what they liked to do for exercise, what they liked to eat, and give them some advice on living healthy. I asked them about their families, their love life, their goals, and dreams, and to tell a story about the country or the city or their youth in Colombia. As opposed to many of the patients that I have seen in urgent care settings in the United States who just want to get in, get their medication and get out as soon as possible, their was a different type of appreciation and respect for doctors here in Colombia. These people literally hung on every word a “U.S. Doctor” (me) said to them. The most productive part of these visits was health education, teaching the patients about the importance of exercise, what foods to eat, to not smoke, not drink alcohol, limit sweets, and lose weight. They may have been fooling me, but these patients clearly took what I said to heart and started making lifestyle changes even right there in front of me as they turned over their flasks, cigarettes, chocolates and hard candies. It was this lifestyle education (clearly missing for some) that I found most rewarding, as it is this knowledge that will sustain and make a difference into their futures.

This afternoon my favorite patient of the day came in. A 75 year old gentleman, looking a bit hunched over, with his shirt draped over his shoulders, came in with his daughter. She explained that he had traveled over four days from the country (much of it by boat) to get here to Tumaco. Four days ago he was working on the farm and to avoid colliding with a branch had put his arm out and proceeded to dislocate his shoulder. As I removed his shirt I saw his left shoulder clearly out of socket anteriorly. Wow! Four days ago?? When one dislocates a joint the muscles contract around and unless you pop it back in immediately, it becomes increasingly difficult to get that joint back in articulation the more time that goes by. This 70 year old farmer was extremely strong and this was going to be challenging without any anesthesia to relax the joint. I asked his permission to yank on his arm to try and see if I could force it back in, and he replied, “Yes, whatever it takes. I have traveled long and far in a lot of pain. What is a little bit more?” I used all my strength to try and force the head of the humerus bone back into the normal shoulder socket. It would not budge. Damn! I took off my uniform top, as I was sweating up a storm. “Let’s go over to the physical therapy room where I can put you on a table to get some leverage.” There was a stretcher set up on a stand that had been functioning as a PT table and I put the man up on that in a prone position. I then instructed an assistant to take a sheet and wrap it around his body to provide leverage the opposite direction to which I would be pulling traction on the man’s left arm. I had my friend and Dermatologist Dr. Carrie Hall who was nearby push on the Humeral head as I pulled the man’s arm downward with all of my might. It still was out. The man winced in pain, but said Sigua! Sigua! (Continue! Continue!). We realigned and took our positions and then on the count of three, I pulled again as hard as I could.

As I released the humeral head slid back into normal position! The old man rolled over with the biggest smile on his face that I have ever seen. He shook out his arms and shoulders, looking like a Colombian Michael Phelps shaking out his muscles on the blocks before a race. As we rigged up a shoulder sling for the man, his daughter and he could not stop saying thank you, and I smiled and said you’re welcome. This was a team effort. Yes indeed it was.

Day 6 ashore. 70 patients seen today. 457 patients and smiles this week. Total Colombia patients seen by USNS COMFORT Team- 9,968

Desperately in Need of an Ice Cold Beer

It was way too early. At 5 am I sleepwalked my way through breakfast and put on my headphones to listen to some Pearl Jam and broke out the book “Three Cups of Tea” about Tom Mortenson and his success in building schools for children in Pakistan. I needed some motivation to get through this upcoming 72 hours ashore in Colombia. We repeated the drill of getting from boat landing zone through town, and to the medical site. We were again greeted by droves of waving young children and adults waiting to be seen by U.S. medical providers. I asked one woman how long she had been out here and she responded “a las dos de la manana” since 2 am in the morning. Heck she should have just camped out overnight.

With thousands of patients to be seen, a hard rule was laid down by the government that they had to make a choice of what problem was bothering them most - and that is all they could be seen for. So for instance if a patient came in and was treated for back pain, and they also needed reading glasses, they were not permitted to go to optometry to get those glasses. The surgeons were also completely booked up on the ship, and we were told no more surgical candidates would be considered. This set the tone for the days to come. I closed my eyes and mentally checked myself, preparing my mind for the upcoming discouragement. I needed to put on my 3^rd world glasses and make myself believe that simply seeing these patients and providing them with some basic medications would make a difference in their lives.

The translator I was assigned today was a young 19 year old girl named Maria from Bogota, Colombia. I noticed right off the bat that she was quite shy and I tried to help her feel at ease by offering her some coffee and some items from the MRE for the day. I explained to her that the best method of interrogation for these patients is if I say hello and introduce her and then she fires off the questions as I fill out the encounter sheet and offer my advice and she translates it back. This technique I noticed worked best because it makes the translator a type of “buffer” and compassionate bearer of the bad news. Even though I understood most of what was being said by the patient and could have spoken more, to have someone from their own country say “the U.S. doctor apologizes that he cannot help you more, but he can offer you pain medicine and vitamins” seemed to be more effective and less devastating for the majority of patients. I introduced Maria as “mi amiga” (my friend), and “mi emfermera” (my nurse) which I noticed she took a lot of pride in after seeing a number of patients. As we got more comfortable working together she became more and more engaged with the patients. I have a lot of respect for these translators who are volunteering their time to do this service. Every so often Maria’s friend and fellow translator Carolina every once and awhile would pop her head into the exam space and say hello. Carolina had a very warm presence about her and a beautiful smile. She is the vision of what I always have had in my minds eye of a Colombian woman- slender, with olive skin, long dark hair, and gorgeous brown eyes. She had a Roman Numeral II written after her name and I asked why? Turns out that one of the other translators name was also Carolina Pinzon. Lots of commonality of names down here in Colombia. I think the name I have seen the most repeated is Maria.

Maria and I had a good system down and we were seeing patients at lighting speed. Most had good attitudes and just wanted their pain taken care of, or some medicine for a rash. I made a point to ask every patient what they ate, and what sort of activity they did. If they smoke or drank, I came up with a plan for them to stop. Everyone was told to drink lots of water, no sugar or postres (cake), and went through a stretching routine with me before they were allowed to go pick up their medication and vitamins. They also were not allowed to leave until they responded to “dame una sonrisa” (give me a smile).

I must have been getting low on blood sugar, or just couldn’t deal with the heat, or the incessant claims of no money and no health insurance, but late in the morning I snapped while seeing a patient with an infection in his middle finger after a botched orthopedic surgery repair of a complex fracture. The man carried his X-rays with him and was basically dripping pus from his infected hand all over the folder containing them. This would never happen in the United States. “Why didn’t you go back to have it fixed”, I asked? The man replied that he didn’t want the surgeons to mess his hand up more, and that he was scared to go back. I squeezed more pus out of the wound and stared at the gentleman’s middle finger which took about a 45 degree turn midway at the proximal joint. This was simply UNSAT (what we say emphastically in the military for unsatisfactory). Normally I would incise this wound and drain the pus and put him on strong antibiotics, and then get him into surgery ASAP to fix his hand. In this situation, my hands were tied with no more surgeries allowed and limited ability to do minor surgery here in the field. I tried to get as much of the pus out as possible and instructed the man to keep it extremely clean, and take the full course of antibiotics that I gave him. And then I struggled with whether to tell him to go back to the surgeons that had botched his repair in the first place. The man said he was willing to wait two years for when and if the COMFORT ever came back to have it done then. And he said “voy a llegar al primer dia” (And this time I will get here the first day to sign up for surgery).

After seeing the middle finger guy, I was ready for a break and some lunch. The lack of follow-up and good care made me so mad that I again had to close my eyes and talk myself down. “Don’t get sucked in to each case, dissociate yourself from it Andy, look at the big picture” With that I shook it off, and decided to go talk with some of the locals who were selling different types of fruits by the roadside. A man with a machete cut open some oranges and papayas and I paid him a few pesos for some. He also sold me some “zapotes” which after tasting them are a bit like sweet pumpkins. I then splurged and at the corner stand had the nice Colombian ladies give me an ice cold bottle of Coca-Cola to be drank with a straw. Ahhhh that hit the spot.

The afternoon was again filled with much of the same, and I tried to focus on the positive cases and doing as much as I could. I was getting tired. The lack of sleep the night before was truly taking its toll as evidenced by the Colombians complete and utter inability to understand my tired Gringo Spanish. A woman came in who was deathly skinny and who had eyes that bulged, and I immediately narrowed down the diagnosis to either anorexia, hyperthyroid (Graves disease), or a big parasite in her gut. The most likely cause was a hyperactive thyroid and so I looked on the pharmacy sheet for the medication to give her and it was nowhere to be found. Can’t even give her what she needs and it would only last her a bit of time anyways…. I walked over to the pharmacy to make sure and yes indeed, no PTU.

I pleaded with her to go and see a doctor here in Colombia. She said she couldn’t afford it and didn’t have health insurance. Doesn’t your husband? She wasn’t married. Doesn’t your work provide? I don’t have a job. I looked into this woman’s eyes and realized the reality of the situation- she was going to die soon because she simply did not have access to care.

I needed an ice cold beer.

Luckily we were headed to the hotel Villa del Sol that evening, and after about two hours of waiting for the bus and the room, we were able to change out of our sweaty uniform and dirty boots, grab a cold shower (no hot water), and crack open a semi-cold bottle of beer. Whew it had been a long day.

Dinner that evening at Villa del Sol was delicious compared to the Ship and the MREs and so we savored it. We also welcomed the chance to watch CNN International on the TV in our room and heard about the killing that had occurred at the Holocaust Museum in Washington, D.C. My roommates for the next two nights were Pediatric Neurologist and Air Force Major David Hsieh and Navy Commander and Family Nurse Practictioner Jim Keilak. All three of us supposedly snore, and upon realizing this we wished we had a tape recorder to capture the orchestra of sawing to come that evening.

As we lay down to sleep on rock hard mattresses we inspected for bed bugs. By visual inspection I decided my bunk was good to go. Jim took a bit more caution and sprayed Permethrin all over his bed. Can never be too safe I suppose…. Jim had turned the Air Conditioner on a few hours ago, and there apparently was an issue because the thing started leaking water all over the floor. We placed a bucket underneath and hit the wall panel in which it was installed a few times, and it stopped leaking for a bit. But as my eyes closed for the night I heard drip…..drip……drip……