Day in the Life....

2006-10-26T03:29:00.000-04:00

Thursday October 19, 2006

I was not able to sleep at all last night…just kept on thinking about the patient with PCP. I knew that he probably died during the night, and prayed that he was comfortable, and did not have to suffer as much. This morning, when I returned to the ward, my worries were true. The patient did in fact die in the early morning. As I talked to the nurse on duty to get the full idea of what had happened, the patient’s younger brother came up to me and gave me his blessing. “awkun chruun neak grew”. He was in the process of taking the belongings of the patient home. I could see in his eyes the relief. Before the family left, I was able to talk with the younger brother for a little while. He told me that his brother had been sick for awhile. In and out of the hospital was expensive for the family. Whenever his brother was admitted into the hospital, either his sister in law, or himself would take turns watching over. It has been really difficult for them as well because they also work. The younger brother was factory worker, and his sister in law, lived in the country side. Caring for a family member would require not working which was not feasible since they have to pay out of their own pockets for inpatient hospitalization, for medicine, and for all the blood work, and other diagnostic tests that are ordered by the doctor. There is no form of health insurance hear in Cambodia. There is no free care, or welfare that supports the poor. The poor cannot afford to get sick.

We take so many things for granted in the States. But it’s because we can. We have resources, options and choices. We are for the most part free of corruption, we have laws to protect us and to enforce and uphold them with honesty. Here in Cambodia, corruption is the norm. As long as you have money, you can get away with anything. At times the more you think about it, the more you wonder why this is, the more disheartened one becomes.

2006-10-26T03:25:00.000-04:00

Wednesday, October 18, 2006

Yesterday was our first day of introducing the new medication, and vital sign documentation sheets to the medical and nursing staff. Last week we oriented the doctors and nurses to the new system, and I was relieved to find everyone agreeing to the new standards.
Today, I arrived to find that half of the new folders were not even written in, and some just had the vital signs written on the sheets. When I asked why things were not written in the new books provided, one of the nurses said that they didn’t have time, the other said that they didn’t know where to write things down. The doctor said that he didn’t have time to write the medications over twice… I realized that this was going to be a long process. I was frustrated at first, because to me, it seemed easier to just write the results on the new documentation sheets provided. It is more organized and easy to read and follow. However, being use to old ways and habits makes it extremely difficult to change. So I decided to work with one section of the hospital at a time, and to dedicate 2 weeks to each section (the pulmonary ward is divided into 4 sections).

I realized that in order to make this project work and get them to become more involved, I would have to literally go through with the nurse and doctor, each patient file, and show them what to do. Luckily this first section did not have too many patients. As it turned out, the nurses and doctor was quite receptive when I carefully explained to them exactly what and where to write certain medications, results, etc. It was a good feeling because they were able to see that the new system was going to be more efficient in the long run. I am eager to see what they will do tomorrow.

As I was saying, this week, I am working in the P4 section of the pulmonary hospital. We have a very sick patient, who is HIV + with PCP in his lungs. He’s only 45 but looks like he is 60 years old. The poor man has been in the hospital for a week, and has been on a non-rebreather since Sunday....(for all you non medical people, just bear with me). I was finally able to get a working O2 sat monitor for the hospital that was donated by CHC, checked his oxygen saturation….finding it to be only 75% on the non-rebreather. Usually if the patient doesn’t respond to this type of oxygen delivery, intubation is the next step. I was shocked to find that he was still mentating, but it was only a matter of time before his little heart was going to give up. I knew that if we didn’t do something…he was going to die. This is where I feel helpless….because there is only so much you can do in this type of setting. We lack the supplies, the medication, and the technology that I am so use to back home

I was frantically looking around for an ambu bag, and asking Dr. Sarin…the CHC pulmonary doctor if it was possible to send the patient to the ICU for intubation. However, the buildings are not connected together by hallways or elevators. If we were to transport the patient out of the pulmonary ward, we would have to put him on a gurney, carry him down the stairs, and about a 5 min walk to the main building, up another couple of staircases, while carrying a huge 100lb oxygen tank with us. So we walked over to the main building, to see first, if there was any room available for our patient. As it turned out, the only area that we would call the PACU, post-anesthesia care unit/ SICU (surgical intensive care unit), was already filled, and the “urgent care” area of the hospital…which was like an ER/ critical care area was insanely flooded with patients waiting to be seen. Every place was full and did not have much of anything for our patient.
So we were left with the realization that he was going to die, and the only thing that we could do was to tell the family what their options were. It was only a matter of time now. As we explained the situation to the family, I was surprised at how well they accepted the prognosis. They were still very thankful for the effort and help that we gave to him. It was really nice to see how involved and important the role of family is in our culture. I realize. They are the care givers, the ones who feed the patient, bath the patient and make sure that they take their medicine. If they feel that the patient is not doing well, then they are the one who call the nurse or the doctor…so different from western practice. Family involvement is extremely important and valued in the Cambodian culture, which can be both good and bad. There is no patient privacy, but almost all patients feel comfortable with their family members there by their side.

2006-10-13T03:52:00.000-04:00

Monday, October 9, 2006

The meeting with the Chief of Medicine and all the doctors went pretty well on Friday. Dr. Sarin Chan, (a CHC staff) and I have been working on changing the medication, vital sign, and diagnostic order documentation sheets in hoping to improve the medical management for the pulmonary ward in a more organized manner. I found that by doing this, it will help to utilize the nurses more, and will help the doctors with monitoring what meds were given to the patients and whether or not they took it. It will also help us know if labs were done and when, and if certain tests that were ordered obtained. Anyways, the presentation went pretty well, and it seemed like the doctors were receptive to the change. The week I will be meeting with the nursing staff to present the new documentation sheets.

This past weekend, I joined Boo Thim’s family on a weekend trip traveling to Sihanoukville. It’s an area about 4 hrs south of Phnom Penh where most of the locals go to enjoy some beach and sun. We took our time to enjoy the beautiful countryside that Cambodia has to offer. I sat starring out the car window in amazement at the raw beauty of this country. As with the good, there is always the bad as well. Driving through towns, there are houses made out of wood. Some up on stilts, some with roofs make out of grass, some out of metal. It was funny to see a small shed of a house, and then right next to it a huge elaborate stone house, equipped with a satellite dish on the roof. There were children running around naked and bare foot, some swimming in ponds in and around the rice fields…so care free. I could not help but think to myself, how dirty the water that they were swimming in was, whether or not they’ve ever gotten sick from swimming in these ponds, and how many times they’ve done it before.
As we drove in and out of towns, we’d pass through the open market place, filled with people selling fruits, vegetables, fish and meats and many more. It is definitely a sight to experience. As I passed through the “fish and meat” section, the smells and sights of bloody fish, and chicken being butchered would make the average American horrified and probably become a vegetarian. Lets just say there is no sanitation protocol in this type of market. Nevertheless, I love it. The market place is where you learn how to bargain and trade. You must be quick with math, and use lots of common sense. You learn to pick the best fruit or vegetables to get your money’s worth. That is why I love going with Ming Thera. She teaches me how to bargain, how to know if someone is ripping you off, or trying to. I learn about the common ingredients that are used in many Khmer dishes. There is definitely a lot to learn.
As I walk through the market I notice that the majority of traders, sellers and shoppers are women. Most are mothers and daughters. They are admirable to me. I see how much work and effort everyone puts into buying and selling. It is the women who hold the money in most of the families. They are the one’s buying the food for their families, they are the ones selling the produce for their families.
The weekend ended with me getting food poisoning from eating fruit purchased along the side of the road. I guess it wasn’t washed well, so I ended up staying awake all night last night with the worse stomach ach, diarrhea, and nausea. I couldn’t make it to the hospital today, so I stayed home praying that it was just a 24 hr bug, and thank god it was. I am never going to eat that fruit again. I’ve learned my lesson.

2006-10-04T21:29:00.000-04:00

Wednesday October, 4, 2006

I took a day off from working at the hospital to go with Boo Thim to check out another hospital that CHC works with in Svey Rieng. It is a town that is located southeast of Phnom Penh, close to the Vietnam border.

The car ride to Svey Rieng was breath taking. With all the rain that Cambodia has been receiving that month, you can not help but notice the impact it has on the vegetation. The rice fields were colored with many different shades of green. There would be florescent green squares that scattered through out and with beautiful palm trees growing in between. Occasionally, there would be a couple of water buffalo’s and cows grazing along or in the fields, a perfect setting for a postcard picture of Cambodia’s countryside.

CHC building
CHC started their TB-community based home care program there around 1996, because it was found to be the poorest town in the country. The outreach program was started by Boo Thim wtih 3 or 4 other CHC members who worked to provide door-to-door health care service to TB patients and their families. Because of being so poor, many people in this town found it extremely difficult to seek medical care. Transportation to see a doctor, the cost of the service of the doctor, and the cost of medicine would make many, if not all, be in debt. Even if they were able to pay for the medicine, the check up and the transportation initially, there was the chance of noncompliance with taking the TB medicine, running the risk of making the disease worse and/or resistant to the medicine. So, CHC decided that a community-based approach would be the best solution to the problem. They would be able to monitor the patients and their families, educate them on the disease, and monitor their compliance to TB medication. 10 years later, the number of people who have non-active TB through medicine compliance was about 99%, proving that this approach was more than effective.

Recently, CHC is incorporating a community-based approach to HIV/AIDs patients, using the same methods as with TB patients. What they found was that patients who were found to have active TB had a higher chance of also being HIV+. On going research is currently being conducting on treating the patients with both TB and HIV.

This is just a little part of the whole program, and I would advise anyone who is interested in this research to check out the CHC website for more detailed information. It is an extraordinary program that shows that with commitment, dedication and perseverance, lives can be changes forever.

2006-10-02T03:28:00.000-04:00

Sunday October 1, 2006

It’s been a week since I’ve been living here with Thim’s family. This weekend was a relaxing one, but I am already starting to feel homesick. There is no internet access here in the house, and we are pretty far from the center of the city. They live just outside the city, so it’s difficult to explore the city on my own. The only way to get around is by car, and that would mean for Boo (uncle in Khmer) Thim or his wife to drive me around. I am not use to this lifestyle. I hate being a bother. I realize how difficult it is to rely on other people when you’re so use to being so independent. There is only so much that you can talk about with the rest of the family before you run out of things to say.

So I’ve retreated back to my room with only my IPod and my laptop to entertain me. I bought to movies – Superman returns and the second Pirates of the Caribbean…both of which I’ve watched already. I’ve been catching up on some reading and have tried to work on things for the hospital but limited by lack of resources…i.e….internet access.

We went to breakfast this morning, dropped Boo Thim off for a meeting that he needed to attend , and drove to Kein Svey…a little town just outside of PP. They are known for their fresh vegetables and fruit so Ming Thera (aunt Thera) wanted to buy things to make lunch and dinner. It was something to do until Boo Thim was finished with his meeting.

We returned back to the house and the housekeepers started with lunch. I enjoy watching them use the wood stove to cook all of the traditional Cambodian foods. I’ve entertained myself by trying to help out…cutting the vegetables, peeling the fruit…but they insist that I not do anything. Like I mentioned before…I’m not use to this way of living. I decided to help out anyway and they all look at me like I’m crazy. I told them…I insist, that I can’t just sit around and do nothing. They start laughing and hand me a knife.

Back home my family owns a Cambodian restaurant, but I have always worked as the hostess and waitress and never really cooked traditional Cambodian food. I realized how intricate a simple dish was…and how much preparation and time it took to cook things here. But then again…no one was in a rush to go or do anything else. The lifestyle here is very laid back, something also very different from back home and from living on the US NS Navy ship. It seems like we are always in a rush…eating…never really having time to enjoy and savor the food that is prepared and the company around us. This is a nice change for me. But I still miss my independence somewhat.

The weather has been surprisingly cool. It has been raining everyday…but only for a short period of time and then stops. Ming Thera says it’s still the rainy season until mid November and that’s when it starts to be dry, but still cool. She says I picked the best time to live in Cambodia.

2006-10-02T03:23:00.000-04:00

Friday September 29, 2006

There are those who take action, and there are those who watch. You never know what category you are placed in until you are put in a situation that makes you the “doer” or the watcher.

It seemed like a normal day for me again. Getting up at 5:30 am and leaving the house with Thim, his wife Thera and their son Martin at 6:30am. We drop Thera off at the Institute of Foreign Languages first, drop Martin off at school and then Thim and I grab some breakfast before we head to work at the CHC office. We end up going straight to the hospital instead of the CHC office since today was Thim’s day to work at the outpatient Infectious Disease department at the MKS hospital.

As I arrived to the pulmonary ward, I am greeted by Mr. Saroen the manager or ward director…I think (I’m still trying to get everybody’s names and titles to match with their faces ). “Jum reap sewer Bo, sok sa bye jeer day?” I think my Khmer is getting better everyday! He takes me to the nurse’s room where “report” is given. I quickly introduce myself to the night staff that is about to leave, and listen as they go over who was admitted during the evening/night, and who was discharged or to be discharged.

They start the list. They are going way to fast…names…ages…diagnosis (did I mention everything is either written in Khmer or French)…I’m sitting patiently, trying to listen carefully to the words that I know. Ok…so my Khmer is not that great…so isn’t my French. One of the nurses then says something I understand – death. Someone died yesterday at about 1pm. It was the lady who Dr. Sarin, another CHC doctor, and I were discussing at the CHC office yesterday. We suspected that she had a blood disorder causing fragmentation of her red blood cells leading to either TTP or DIC. I remember looking at her labs and after reading up on the disorder discussing that we needed to do something fast…or she could die. It wasn’t fast enough…so she died. That was report.

The morning began, with nurses getting vital signs, doctors going in to round on patients. I was still trying to get oriented to the place. I met with the chief nurse of the ward and discussed my assessment and observation of what I thought needed to be improved. He seemed to have taken my opinion well and agreed with my plans on improving some of the poor and out dated practices used. I also met with a social worker – Samnang who not only speaks English really well, but was also a patient of this program. He knows how the system works and I realized he is someone who can be really helpful to me.

As he is showing me around and helping me assess patients, we run into a man who was looking for the lab to drop off his HIV blood test. Normally, the nurse who took this man’s blood is supposed to take the patient to the lab, but since he/she was not bribed with money, the patient was left to wonder around looking for the place himself. So Samnang and I decide to take the patient ourselves.

On our walk over, I see two guys carrying a kid from their motorbikes yelling for help. The child looks about 13 -14, lifeless, gasping for air. We both yell for help…and at the moment…I think CPR…but stop myself from doing mouth to mouth. We run to ask where to put the child…everything feels like slow motion…like a dream…I don’t know what to do. Nobody was helping. Someone finally gets a gurney and we bring the child to the pulmonary ward. We get him to a bed…there is no ambu bag, no oxygen available. Everyone is just standing around. The child is blue…eyes rolled back…he is lifeless…takes one last breath…and dies. Did that really just happened? My heart dropped. I couldn’t control my emotions. This f**king sucks!!!! So many things going through my mind. My heart was beating so fast. What did I do? I felt like I could have done more. I should have done more. Did I do enough?

The guys who brought him were Cambodian Americans as well, who worked in Phnom Penh helping kids who are addicted to drugs. I found out from the men who brought him that he was a street kid…hooked on heroin…he probably overdosed when they found him. He had no family, none that they knew of. So the only thing that we could do was find an ambulance to bring the body to the temple.

That was my day. My head was hurting…I felt like it was all a dream. I will never forget that feeling…that feeling that I could have saved this kids life, but I didn’t. It sucks. Two deaths my first week on the job.

2006-10-02T03:22:00.000-04:00

Thursday September 28. 2006

Where do I begin....

I arrived on the 23rd of September after a long 28+ hr plane ride (again) from Boston to Phnom Penh. It took me about 3 days to finally get over my jet lag. I am staying with Dr. Sok Thim (the research director and co-founder of the Cambodian Health Committee) and his family. They are one of the nicest people you could ever meet, and I am just grateful that they have invited me to be a part of their family. They have two little boys, ages 4 and 2 who keep me entertained everyday. It's funny for me to see these little kids speak such perfect Khmer, while I still struggle. But, on the flip side, Thim and his wife are excited to have me living with them so that I can speak English to their kids and help them practice.

I have officially started working with the Cambodian Health Committee this past Tuesday. My job here is basically to improve the quality of nursing care in the pulmonary department at the MKS hospital in PP. Sounds simple…but when I arrived to the hospital this past Tuesday to meet with the doctors, nurses and other healthcare workers and tour the department, I realized quickly that there was A LOT of work to be done, and I could not help but feel a little overwhelmed.

The pulmonary department is located within the MKS hospital (the biggest public hospital in Phnom Penh) with the capacity of holding more than 300 beds. The pulmonary department was just recently renovated and has the capacity to hold 120 beds. So far only 1/2 is being utilized with the majority of patients diagnosed with TB. The building is divided into two floors, with the first holding HIV negative patients and the second floor with HIV positive patients. CHC (the Cambodian Health Committee) takes patients who are HIV+ and have TB (from the second floor) and admit them into their ARV/TB therapy research program.
CHC began working with this department in 2004, since the majority of patients admitted are TB patients who are infected with HIV. These patients are one the most discriminated groups of people in Cambodia but with the help of CHC, through education, care, and research, there is a better understanding of the disease.

As I toured the wards, I realized how basic and poor the quality of care in this facility is. First of all, the layout of the wards is one that is brand new to me. Everything is open to the outside. Each room is connected to the outside hallway, almost like little dorm rooms. Patients lay on mattresses that are about 2 inches thick, with a straw mat placed on top. There are no monitors or machine beeping to alert you for help. There are no calls lights or means of letting nurses know if help is needed except for the patients’ family members walking in and out of the patients rooms. Doctors round and access patients from 8-12pm and then are all off for the day. They usually leave for lunch and then around 2pm there is one doctor supposedly on call until the next day. The system has many holes and the lack of organization and management makes everything pretty chaotic!!!

Pulmonary Ward

CHC building

TB paient

2006-08-27T01:39:00.000-04:00

Friday, August 25th, 2006

Our patient with the huge abdominal tumor is recovering nicely. Her operation was a complete success. The tumor weighed an incredible 44 lbs!!! To have the operation go well was such a relief knowing that she will now have a better quality of life. I am truly happy for her and her family. She can not thank us enough…her eyes say it all…such gratitude…enough to make me want to cry. But I also cry for the others that we were not able to help, the ones that we had to turn away because they were either too complex or because we didn’t have enough time. We will be leaving for East Timor tomorrow, so there are no patients being admitted on board. It was decided that we do diagnostic tests such as x-rays and CT scans…better than nothing. I know what we are doing is better than nothing, but the hardest part about this mission is saying “sorry…we can’t do anything for you”. I won’t forget their faces, pleading for us to do something for them, anything.

Yesterday, I went on shore for immunizations. The crowd at the hospital was insane!!! People of all ages where waiting, pushing, standing on top of each other to get their eyes checked, teeth cleaned and pulled, and immunizations. I can honestly say that I can now give IM injections with my eyes closed. I think we saw about 400 people total and gave about 800 – 1200 shots total, but there were still a lot of people waiting. Again….having to say no to people was so hard to do, we had to stop because it was getting late.

Today is the last day for the mission in Kupang. We are planning on discharging all of our patients tomorrow and set sail to East Timor for the last leg of this mission. Then back home for about 2 weeks and then off to Cambodia for another 3 ½ months.

Speaking of Cambodia…I have had to pleasure of meeting a volunteer doctor working with Aloha Medical (another NGO on this ship) who worked in the Thai/Cambodia refugee camps during the time that I was born! He also worked with Dr. Tom Durant, the doctor whose fellowship that I am apart of. It is truly a small world! I had my doubts about coming onto this ship. But now, for some unknown reason, I feel like I am on the right path. I really do feel like the people you connect with come into your life for a reason…that you were meant to cross paths…and it is what you gain that will get you to where you are going….so Cambodia it is…

2006-08-22T23:08:00.000-04:00

Tuesday, August 22, 2006

We arrived to Kupang, Indonesia on Sunday. On Saturday, there was “Crossing of the Line” ceremony…a Navy Tradition that is done when the ship sails through the equator. I never thought I would have the opportunity to witness let alone be a part of this ritual. I found it to be ironic how serious that Navy was about this ceremony, since it is basically people dressing up as pirates and pretty much “hazing” their shipmates. Those who have crossed the equator are known as the “Shellbacks”. You must have a certificate to prove that you are one. If you’ve never crossed the equator, you are known as a “Wog”. Usually, if you look it up on the internet, there is an explanation of the whole ritual. We had a lot of fun… it was pretty much all fun and games…a nice break from starting work again.

Pediatric ward 8 wogs
Shellback Initiation

Shellbacks

Nursing wogs

Today I’m working on ward 1 – adult ward. A lot of patients were admitted to the ship this time…more than Tarakan. It is going to be a busy week, but that still doesn’t make the time on this ship fly by. The days seem to drag on…and we are slaves to mealtime. We admitted a young woman who was found to have a huge abdominal tumor. She looks like she is 9 months prego and ready to pop! The plan is to operate on her, remove the tumor that is slowly taking her life away. However, after the death of our patient in Tarakan, extreme precautions are being taken. She has now undergone, 3 CT’s of her abd, chest and pelvis to prepare for surgery tomorrow. Blood is being collected and stored for precaution as well. Tomorrow we’ll get to see what is in stored for us….

2006-08-22T23:07:00.000-04:00

Sunday August 20th, 2006

Tarakan is a beautiful island. As the ship drifted along its coastline, you can see how green and lush the island is. The weather has only gotten more and more beautiful as each day passes here.

Tarakan Beach

Stands along the shoreline

The week started out like any other week, with everyone preparing again for the long hours of providing care to the people of Indonesia in Tarakan. I feel like we have progressed immensely and are more efficient in providing care The hospitals and facilities in Tarakan are organized and surprisingly clean. I was very impressed with how organized and more educated on health the people are here. I went to give immunizations on Friday, and noticed that most if not all of the children were updated on their immunizations. They looked well fed, and clothed. Maybe it was because I was in the more wealthy part of the city, but compared to our last mission, they seemed pretty much up to date on health related topics.

Hallway at the Tarakan Hospital

We’ve worked on education and training, teaching the local nurses BSL/CPR, teaching local techs on using hospital equipment properly and safely. We’ve given immunizations and physicals to people of all ages…provided teaching on oral hygiene and care…provided eye glasses eye exams and surgeries…giving people the chance to see the world again…both literally and figuratively, impacting the lives of these people.
Nursing Students

The days became routine, mustering at 6:30 in the morning, caring for patients on and off the ship, surgeries, discharges, teaching…until it took a death of a patient to make us stop and realize what kind of impact we were having or are having on these individuals. I felt like at some point, we got caught up in trying to fix people. Yes, we can do surgeries and change the lives of some people. Taking a tumor out, reconstructing a cleft lip, fixing a broken bone…all help these individuals. The fact that the death of this young woman happened on the ship made me realize that we are not perfect…that we cannot fix everything. In a way, it was a blessing in disguise. I feel as though, we should not be focusing on surgeries…but that in order to make a positive impact on the lives of these people, in order to provide humanitarian assistance…you need to have an approach that will be safe, certified and long term. As a nurse, it is the teaching, the education for these people that will make an impact…it’s the impression that is left behind. To me, it is the primary care that is the most important in type of mission.

Giving Immunizations

2006-08-07T23:32:00.000-04:00

Tuesday, August 8th, 2006

Wow, I can’t believe it is August already. We are back on the ship…left Singapore yesterday, and are planning on arriving at Tarakon, Indonesia on the 11th of August.

My stay in Singapore was yet another eye opening experience for me. At first, the anticipation of getting off the ship was all I could think about…all that anyone living at sea for months could think about. It was almost a guilty feeling at first. I could not wait to have my own real bed, my own bathroom, real good food to eat, to drink, to shop, to dance. How easy it was to just want materialistic things. The more I was around shopping malls, fashionable looking people, the more I wanted to buy more things, even though I knew that I didn’t need them. I wanted to be pampered…heck I convinced myself that I deserved to be pampered. I got my hair cut, my nails done, a massage. It was a great feeling.

However, as I’m sitting here, looking back at my pictures from the different missions in Indonesia, the realization hits me again that there are people out there who don’t have the opportunities that I have. They don’t have to option of deciding that they want to be pampered for a day. They don’t have to option of saying - I want to know what it’s like to live in a third world country. They are just living with what they have. That is their lifestyle. They see death, sickness, poverty everyday.

As we are sailing to our next destination, I know that I will have a lot of time to think, to contemplate on what my purpose for being here is. It is hard not to think about these things when you have a lot of time to yourself. I go outside and am surrounded by the ocean, the sun, the sky, the stars, the moon. I think about home. I think about what I will do when I get home. I think about those who I have touched while I’ve been here. I think about those who I will touch. I think about those who have touched me. I know that those that I’ve encountered will always be a part of me and I know that I will be apart of them. There are things that happen to each individual that is beyond our control. The patients that were picked to come onto the ship, to have free health care, are they lucky? Were they just there at the right moment, and at the right time? I guess nobody really knows why people’s paths are crossed, why one person gets picked and another doesn’t. Why one person can touch your life while another just passes by. I just hope that whatever I do, here, now, in the future, that I am doing a right thing. I know that I too am only human, that I can just try to do the best I can while I’m out here. As much as I want to bring happiness to those less fortunate to me, I hope to find it in myself as well.

2006-08-07T23:21:00.000-04:00

Monday, August 1, 2006

We’re sailing to Singapore for a little rest and relaxation before we start our next mission in Tarakon, Indonesia. Yesterday was the last day in Banda Ache. I had a chance to go on shore Saturday, touring the city with those who did not get a chance to leave the ship.
USNS Mercy from Banda Ache

Banda Ache Mosque

Banda Ache Monument

It has been a little over a year since I was here last. Such a difference a year makes. This time around, we arrived in a boat. I realized how fitting and significant it was this time traveling via a boat. It allowed me to see up close and personal to where it all began. We could see the roads, buildings, cars, the people and how they went about their daily lives. There were still areas along the shore line where foundations remained, a reminder of what had happened last year. Houses were being rebuilt, stores and markets were lively. The streets were filled with cars and people coming and going. Life went on. It was evident that all the aid and support that was given was being utilized appropriately.
We took a bus around the area, drove past the Grand Mosque, stopped at the Abadin Hospital and a mass grave site. What a breathtaking site the mosque is. I remember last year, there was a picture of that same mosque. It was the only building left untouched by the tsunami…everything else around it…annihilated. It was such a profound moment, to see that after all the devastation they still had a symbol of their religion intact and untouched. Something to give them hope, that everything will be ok. And now to see that same mosque, in the center of the hustle and bustle of the city, surrounded by buildings, cars, and people, only reinforced that Banda Ache is doing well.
Abadin Hospital in Banda Ache

Old helo landing at Abadin Hospital

Although I did not get a chance to work on shore this time around, I was able to reconnect with one of my patients from last year. This story is a successful one. His name is Bahri. If I can remember correctly, my friend Emily S and fellow ward nurse from last year, called him the “Indonesia rock star”. He had been part of a rebel militia prior to the tsunami and it was during that time, that he lost his arm from a gunshot wound. When the earthquake and tsunami hit, Bahri sustained a badly broken compound fracture of his femur. He was at the Red Cross hospital for a about a week until he was found by one of the MGH and Navy doctors and brought aboard the Mercy.

His leg was badly infected as well. Over the one month hospitalization aboard the Mercy, Bahri went through 5 surgeries on his leg. He became septic, and at one point it was suggested that his leg would need to be amputated. But thanks to the amazing work of orthopedic doctor from MGH, Bahri was able to get a metal rod specially delivered from Boston. He was the last the leave the ship last year. He still had his PICC in his arm and was transferred to the TNI military hospital for further treatment.

Now, a little over a year later, I had the great pleasure of seeing him again. Thanks to Dr. Seicrest, an orthopedic Navy doctor, who was able to find him and bring him back onto the ship. Bahri looked great! He looked healthy and happy, and was walking!!! We took another xray of his leg, and everything was in place. It was a moment that made me realize how wonderful it was to have been part of this mission and last years mission. To see the look on his face, and how thankful he was to everyone who helped him was enough. I can honestly say that by making a difference in one person’s life is all it takes to continue these types of missions.

Reuniting with Pt. Bahri a survivor of the Tsunami from last Mercy mission

2006-08-01T02:02:00.000-04:00

Wednesday, July 26, 2006

I heard Banda Ache has changed incredibly. I don’t think I’ll have a chance to leave the boat and go on shore to see the difference. Keeping my fingers crossed. We have more volunteers that came on board a couple of days ago, who are only here for about 1- 2 weeks. To only be fair, they get priority on going on shore. So, here I am, back on the wards, taking care of post-op surgical patients. I don’t really mind it, but I did love being immersed in their environment. Seeing how they live.

There is a sad case on my floor. He is known to us as Mauldin, B (for Bravo). The people here don’t have first names. Everyone goes by their surname. Here in Indonesia, family terms are commonly applied to everyone. “Bapak or pak” is used as Mr. (father) and “ibu” as Mrs. (mother). Younger people are referred to as “bang or bung” meaning older brother, and “kak” for older sister.

He is a 20 year old boy who was found to have osteosarcoma of his right leg. The leg had a tumor the size of a basketball growing. It was open, leaking with pus and had the most awful foul odor. When asked what happened to his leg, he contributed it to the Tsunami. I could not imagine this poor 20 yr old boy living with this growing on his leg for over a year. The pain that he and his family endured must have been difficult.

We brought him on board and found that the cancer in his leg had already spread to other bones in his body, to his lungs and his liver. There was nothing we could do to help him, but to amputate the rotten leg. The docs said he probably has a couple of months to live.
There is nothing they can do for him.

Then I think of my dad. It’s been over 3 yrs since he’s been free of cancer. He was diagnosed with a grade 4 glioblastoma (probably the worse type of brain tumor). I keep on thinking that if we were living in Cambodia, he would not be alive. I realize how lucky we are to be Americans - to have access to such up-to-date technology and treatment, and to have the option of treatment.

I wonder if Mauldin is at peace with the decision that he made. He could have stayed on shore, not knowing he has cancer, not knowing that he will die soon, but living with a rotten, cancerous leg. Instead, he chose to come aboard the ship. He found out that he has cancer, that we can’t do anything for him but to amputate the bad leg, and that he WILL die soon. Is it better to know or not to know? Is ignorance bliss?

2006-08-01T01:02:00.000-04:00

Sunday, July 23, 2006

Transporting pt. back to Nias

We left the island of Nias yesterday, and arrived to Banda Ache late last night. Looking back, the days seemed to mesh together. I never knew I could work this much…12 hr shifts everyday for 6 days straight.
The mission began just like Simeulue, with patients being transported via boats and helo’s. On day 2, I had the opportunity to go on shore and give vaccines/immunizations at their hospital in Gunungstatoli.

Girls from Nias hospital

As we pulled up to the dock, the smell of the durian fruit permeated around us. There were little made up sheds where the local market was set up. Everything reminded me of Cambodia. We walked up a short distance to the hospital, and already there was a long line, making it difficult for us to even get into the hospital. We had to go through the back of the hospital, with all of our supplies and man power.
I was assigned to screen patients for vaccines/immunizations. We were given a small room with no window, AC or fan. After about 5 minutes into setting up the vaccines, we were drenched with sweat. No matter how much you wiped the sweat off your face, it would just pour out like running water. Nevertheless, we saw over 70 people of all ages. It was a rewarding feeling to be with the patients and families, and see them in their own environment.
The hospital is still in the rebuilding process. We set up our stations in the fairly new main building. Each department had a room assigned. There was a Physical therapy room, an immunization room, OB/GYN, Internal Medicine, Dental, Eye, Pharmarcy, and Surgical room. The ER was probably the size of my unit back home, (maybe half that size).

Immunization Team in Nias

During the rest of the week, I worked on the wards back on the ship. Those who needed major attention was screened and sent on the “Bandaid Boat”, back to the Mercy. The patient population was a mix of adult and peds awaiting some type of surgical procedure. The procedures ranged from simple cataract surgeries, to hysterectomies, goiters, cyst removals, amputations, etc.

There was one family in particular whose story is one that I will never forget. Two weeks ago, Mr. Zebua and his wife were riding their motorbike back to their house when they were hit by a car. The husband sustained a broken arm and leg while the wife had only her leg broken. They both sat in the local hospital for about 5 days with minimum amount of care given. When the Mercy arrived they were immediately brought onto the ship with their two children, Septiama, their 8 year old son , and their 18 yo daughter (whose name I can’t remember).
The wife, Deslina was operated on first. She had an open tibia fracture that required a metal rod placed. The husband’s leg however, was so badly broken and infected that an amputation was required. It was heartbreaking to witness the reaction of his wife and kids to the news. For them, it was something that would affect the whole well-being of the family because he was the only source of income. However, for Mr. Zebua, he knew it had to be done. He showed tremendous strength and courage for his family. On post-op day one, he was adamant about getting out of bed and walking, to show his 8 yo son that he was still the same person. Before they left to go back home, I told him how much I admired his courage and strength. Terra makisi…thank you very much…

Nias Kids from ward 8

2006-07-27T03:40:00.002-04:00

Friday July 14th, 2006

We arrived to the Indonesian island of Simeulue Tuesday night (July 11th) after a 4 or 5 day boat ride from Chittagong, Bangladesh. While en route to Indonesia, we occupied ourselves by preparing lectures for possible teaching opportunities, had a movie night on the flight deck and had a “steel beach” cook out to celebrate the 4th of July.(We missed it while working with Operation Smile in Bangladesh).

"Steel Beach" day on the flight deck

On the way we picked up about 20 – 25 Indonesian interpreters from Banda Ache, only to find out that only 3 spoke English. Talk about miscommunication!!! Anyway, I found out that I was one of the first to go on shore to help “meet and greet” people from the hospital and set up areas for teaching/training. We ended using speed boats to travel to and from the boat. That was probably the highlight of this week’s mission for me.

The hospital there is amazingly clean. Before anyone enters the building, we have to take our shoes off. The hospital was brand new, just recently completed last year after being completely ruined from the earthquakes in 2005.

We are performing minor surgeries on board, cataracts, goiters. My only “heavy” patient is a 60 yo found to have a pneumothorax requiring a chest tube to be placed. Apparently, she fell down two weeks ago, was having pain and SOB, went to the hospital, they didn’t know what was wrong with her so she sat there for abut 2-3 days. When we arrived, we did a CXR which showed that she had a large pneumothorax with a nearly complete right lung collapse. She is doing much better and hopefully will be able to go home tomorrow.

Planning on finishing up with primary care on Saturday, doing immunizations, physicals, teaching, etc. Our next stop is the island of Nias.
RHIB boat ride with Dr. Emily Windham to Simeulue island

Simeulue hospital
Another view of the hospital
touring the hospital
please take shoes off before entering hospital
Indonesian family
A Mosque in the hospital

2006-07-07T03:09:00.000-04:00

Wednesday, July 05, 2006

Last day of Operation Smile. Almost all of our patients left early today, along with the Bangladesh translators and most of the Operation Smile doctors and nurses. We still have 2 patients left who needed to be monitored overnight since they got their surgeries today.

I am the proud mother of a little boy. Actually, today I took care of a 6 week old infant boy who is diagnosed with Hirshsprung’s disease. The mother is a 25 yr old who had 7 children. She comes from a remote area outside Chittagong, Bangladesh. Two of her children died from having as she stated through a translator, the same problem as this one. The baby was having problems eating, and was very malnourished. Luckily one of the doctors that went on shore found mother and child and brought them on board the ship.

At about 9am, the OR called for my little baby Wazal. He had such little feet and little itty, bitty hands. He weighed only 3.2 kg (which is about 7lb) and probably one of my cutest patients thus far. His little belly was firm and distended, one of the classical signs of Hirshsprung’s. The plan was to do a transanal bowel resection – a procedure in which they pull the colon through the anus and take the “bad” area out. (See the really cool pictures below, but warning it may be a little gruesome). When the doctors were done, they cut out about 12 inches of the baby’s colon. I had the opportunity to stay in the OR and observe the procedure which was headed by two female doctors, one from San Diego and the other from Chittagong. The surgery went extremely well.
Me and Baby Wazal
X-ray of baby's "megacolon"
Transanal bowel resection...ewww...
resected colon
Observing in the OR

2006-07-05T00:31:00.000-04:00

Tuesday July 4th, 2006

Happy 4th of July!!!!

The past few days have been pretty busy getting patients prepped for the OR. So far we’ve worked on almost all 65 patients ranging from 6months – 38 yr old with cleft lips and palates. 18 left early today, and we’re expecting to finish the rest by 2pm.

It seemed like weeks have passed since I was admitting patients in Cas/rec the first day of arrival on Saturday morning. I can’t believe it’s only been day 4 of Operation Smile. So far, everything has been going smoothly. The surgeons have been “cranking” the patients out, in an assembly line-like fashion, trying to get as many people operated on. We’re expecting a really bad thunderstorm tonight and possibly tomorrow, so we’ve stopped receiving patients from land, and are hoping to have everyone recovered by Thursday.

It is the 4th of July, and everyone back home is probably barbecuing, and getting ready to watch the fireworks. It is one of my favorite holidays. I miss my family, my boyfriend and all of my friends. But then I think of little Shirina and all the kids that got a beautiful smile.

There were three little girls ranging from 5 – 7 yrs old that I took care of on my ward. One of my favorites – Shirina, was a 7 year old girl who had a complete cleft lip (a very noticeable deformity) whereas her other friends were only palates (inside the roof of the mouth). I found her sitting at the edge of the bed this morning holding a small mirror in front of her and just starring at her new face! Although she wasn’t smiling and was probably in a heck of a lot of pain, I could tell she was pleased with the results and was smiling inside!!!! Her dad could not thank me enough! The mission was well worth the home sickness today.

It is amazing to see such drastic results on these patients within a matter of hours. A cleft lip only takes about 1.5 hrs, while a palate takes about 2. It’s very basic in terms of pre-op and post-op care. When patients come out of the PACU, they are brought to the post-op ward where discharge teaching is immediately done with the parents. It was wonderful to see the looks on each parents face when they saw what their child looked like after the procedure. What an amazing and fabulous organization. I was glad that I was a part of this mission.

Here are some pictures of the cleft lip/palate kids

Bibi and Shirina before surgery
Shirina after surgery
Before and after

2006-07-05T00:29:00.000-04:00

Monday July 3, 2006

Saturday July 1st was the first day of Operation Smile. After having nothing to do for about four days, we were very eager to start work. I was assigned to work in cas/rec, also known as the ships casualty and receiving or their ER. As patients arrived to my section of the ER, my anxiety grew…and so did my patients. Where were my translators? How do I do an assessment on a child without telling the parent what is going on? How to I keep these kids from crying? Where are all the toys? Getting kids to cooperate is extremely difficult!!! Before I knew it, we were consumed with work. Vital signs, x-rays, labs, call report, need food, where’s the water, where’s the bathroom, who’s throwing food, time to transport them to the wards…next in line….chaos surrounded me. It was interesting to see the mesh of both cultures immersed together. Women’s beautiful brightly colored sari’s clashed with the monotonous colors of the blue uniforms and fatigued uniforms of the military.

Happiness, anger, sadness, anxiety, frustration, and relief littered the air. Some of the children were screaming, the women crying. Some were sitting quiet, afraid to say or do anything unless they were found it was ok. Some were laughing and playing, amazed at where they were. Some were nauseous and exhausted from their travels and the rocking of the ship. At one point, there was a food fight led by some of the Bangladesh men. They would not eat the food that we were serving them because they were not familiar to the tastes and textures. To a tongue use to food flavored with spices, a bland turkey sandwich was not appetizing. Frustration and anger ensued from everyone being hungry and cranky. So, to voice their frustration they decided to throw the sandwiches at anyone “foreign” that walked by. You could see and feel the frustration on both sides. It was a very hectic day, but we eventually worked out the differences. Looking back, it must have been scary for them to be in such a strange and unfamiliar environment with different smells, sounds, surroundings and tastes.

2006-07-01T11:23:00.000-04:00

Friday June 30, 2006

The closer we are arriving to our destination, the more bad weather that is encountered. Last night while I was lying in my bunk, I knew that it was pretty bad outside because of how much the boat was rocking back and forth. They were saying that we would be hitting 16ft waves at some point during the night and were warning us of the possibility of falling out of bed. Needless to say, I slept throughout the night pretty well. The rocking put me to sleep. I wonder if I was rocked to sleep when I was a baby.

Yesterday I was able to attend an HA or humanitarian assistance planning meeting with the department heads. It was pretty interesting to see how difficult it is for the military/navy to go ahead and try to provide any type of HA without foreign countries feeling threatened. That is probably why Project Hope is “teamed up with the Navy”, to act as a buffer. What was also interesting was the dynamic of the planning committee. There was only one female present and that was Commander Comlish from the Dept of Nursing. Everyone else, Surgical, Medical, Environmental, Infectious Disease, Finance etc. were male.
There were disagreements on how and what to do on these missions once we are cleared to work with the “host nation”. One ID doctor was adamant about “de-worming” as many people as possible to help decrease malnutrition and to start immunizations. However, from a nursing standpoint, wouldn’t it be important to teach the patients about how they get worms and what else they can do to prevent getting it again? That would require teaching. Do they need medicine? Will the medicine prevent the patients from getting worms again? If so, then for how long? These were questions that the Chief Nurse was asking. Her debate was that we can’t just go into a developing country and act as though we’re better than them and doing them a favor. What if you de-worm a child and the family thinks that he will never get worms again. But after a couple of weeks or days, the child gets sick and is found to have worms. It makes us look like we’ve just lied to them. It was clear to us that for a humanitarian mission stand point we needed to see what the other countries needed and ask if they wanted us to help.
Same thing with immunizations. We can’t just go in and give people immunizations without finding what they have or have not received. How do you go about finding this information? What other NGOs are present and what have they done? These were all problems that were discussed at the meeting. It was really interesting and def. a lot of hard work!!!

Tomorrow, the patients arrive. We’re expecting about 100 patients and 100 escorts. All are to be prescreened for TB on land before the get into the helicopters and come on board. Because TB is so prevalent in this area, a confirmed CXR (chest x-ray) will be done before they get here. I would love to be on shore and do some of the prescreening procedures. I would love to be doing anything right now. Everyone is getting impatient waiting around for work….

2006-07-01T11:22:00.000-04:00

Wednesday, June 28, 2006

I woke up this morning feeling nauseous. I can’t possibly be sick of this boat already. I could feel my body rock ever so gently side to side. “Try not the get sick” I thought to myself. “You’ve only been here for 3 days”. As I got out of my so called bed, (I mastered getting in and out without any cuts or bruises), I could feel myself swaying right to left, trying to make it to the bathroom, in the dark, without knocking into a chair or locker or wall. Not a fun feeling to wake up to.

Yesterday was pretty much the same routine. It has been pretty boring these past few days with the internet down. When the internet is down, so are the phones, causing it to be very difficult to get in contact with loved ones and friends back home.

Meal times are pretty much the main activity for people to look forward to. At breakfast today, the topic of conversation was the internet!!! It was finally up. I quickly engulfed my food and ran downstairs to the phones. The navy strategically placed these phones at the very back and bottom of the ship to make it difficult to get to. (What a bunch of smart people they are). If you are too lazy to walk all the way to the end of the boat and down the 88 flights of stairs then you don’t get to use the phones. Makes the lines short!!

We had a fire and “man over board” drill this afternoon. You’re required to have a long sleeve shirt and a hat with you at all times while on board in case of a fire. So we wore our long sleeved shirts and hats and had an “all hands on deck” meeting (everyone on board the ship) in the “mess hall” or cafeteria for the drill. We then proceeded to our designated areas on the flight deck with our life vests on top of our long sleeved shirts, underneath the hot, hot sun, and in the humid air waiting for them to call our names on the black tar matt. Pheww…. Did I mention we were in the hot, hot, hot sun!!!! I felt like a baked potato. It was another interesting experience. I had my Red Sox hat on…and I heard some snickering as I entered that room from good old Yankee fans. But from what I’ve heard, the Sox have won 10 games in a row…and are ahead of the Yanks...missing home already!!!

Can’t wait for patients to arrive. I feel like everyone is starting to get antsy…just aimlessly walking around, trying to find something to do. I decided to occupy my time with doing my laundry. I find it very cathartic. The smell of clean linens and clothes makes me feel at home. Weird huh! Anyway…did I mention that I can’t wait for patients to arrive?

Well look at the time…5pm…social time!!! Wonder what’s for dinner…

2006-07-01T11:21:00.000-04:00

Monday June 26, 2006

It’s about 7pm and the ship has left Singapore heading up north to the country Bangladesh. Apparently it will take about four days of sailing to get to our destination. We had our first meeting with the Navy nurses and corpsmen today. Introductions were made and there was a briefing of what to expect on the missions ahead. The plan so far is that we will be working with Operation Smile – a volunteer organization that repairs cleft palates and facial deformities in developing countries. The surgeries will be done on the ship, and hopefully having patients leave within the next day post-op. I will be working again on the wards as a Med/Surg nurse, providing pre-op and post-op care to most if not all pediatric patients. This will be a challenge to me since I’ve only cared for adult patients. (Note to self…must brush up on pediatric skills). However, who knows if the mission will change. We were told that the mind set for all volunteers to be in, is to be flexible and not to have too high expectations of the missions.

It seems as though we are short on volunteer nurses. Apparently a handful of volunteer nurses and docs from the first rotation were not happy with their experience in the Philippines. There were a lot of logistical problems in terms of getting to land and working in the actual country. That is one of the cons with working with the Navy and being “stuck” on a ship. Depending on whether or not these foreign governments will let us provide care and what kind of care, determines how these missions play out. Another obstacle is the means of transportation. Getting to land from the boat requires either being shipped via helicopters or by speed boats. If the weather is bad, (and I’m assuming since we’re heading into monsoon season here in Asia that it will be), that will affect our opportunity to go on shore to see patients and vice versa. Should be interesting. It is still too early to predict what will happen. I’m keeping my fingers crossed that things will go smoothly.

2006-07-01T11:20:00.000-04:00

Sunday June 25, 2006

Little Arab Street in Singapore

So we finally made it back to the US Mercy after a grueling 28 + hr plane ride from Boston. I managed to lose my rabies vaccine on the way here. Actually, it really wasn’t my fault. The flight attendant threw my vaccine out when I asked him to change the ice that was in the thermos. I guess when he went to go dump the ice out…so did the vaccine. Fortunately for me, there was some on the ship.

The ship is currently docked in Singapore with the crew on liberty for the weekend. The plan so far is to set sail on Monday afternoon to Bangladesh. Not sure as to what the mission plan is, but hoping to be able to get on land and work with the local hospitals. The Navy is sending a team out early to work out the logistics with the Bangladesh gov. I hope they do some good negotiating skills because it would be a shame for us to sail all the way up there and not be able to do anything.

There are a few familiar faces from the Project Hope side. I was relieved to find Karen Holland and Joy Williams (both MGH nurses) at Logan, and both who will be staying for the whole duration of the trip. It’s definitely nice to have familiar travel buddies with you. The other volunteers are really nice and easy to get along. So far we’ve toured Chinatown, Little India and Arab Street together, as well as experienced the ever so popular Night Safari. (that wasn’t anything special…but since everyone said we should go see it, I figured heck why not).

I need to get use to sleeping in these coffin-like bunks again. I thought I would be better to sleep in the middle bunk this time, since last time I slept on the bottom. But after hitting my knee and head every time I get in and out of the bunk, I think I might have to reconsider. But this would mean that I would have to remake my bed…and I’m a little to lazy to do that right now. Maybe when I get totally bored out of my mind, I’ll rearrange my sleeping situation. As for now…I guess I’ll continue to get bruised and abused until I master the art of hopping into and out of my “bed”.

The plan today is to take a trip into downtown and go shopping. For the months of June though October, Singapore is having this massive summer festival sale where apparently everything is discounted. The infamous shopping area called Orchid Rd. is lined with tents and thousands of people negotiating and bargaining for good prices - should be interesting. I know plenty of friends back home who would die to see this.
On that note…time to go shopping. How ironic is this…I’m here as the Durant Fellow for refugee/humanitarian relief and I’m shopping in Singapore….