Monday, June 15, 2009

Force Protection

There is nothing better than waking up to the chirping of birds, and the nice cool breeze blowing off the water.   That’s how things started off today around 0530 and for a moment I thought I was back in Hawaii again.  The hotel where we were staying had an immaculate collection of flowers and by the looks of it we could have been back in Hawaii.  All of us well rested, we put on our uniforms and headed down for breakfast.  Things just kept on getting better and better because the coffee they served us was the best coffee I think I have ever had.  I asked the guy to pour me three cups.   Heck I could have stayed there all day drinking coffee.    

In fact I was so into coffee this morning that right when we got to the site I visited the little food stand and ordered some more from the nice ladies inside.  They were full of questions and before I knew it I was behind the counter with them snapping photos. 

With two coffees in hand (one for me, and one for my nurse and translator Maria) I made my way to our “office.”  It wasn’t the tidiest of offices I have ever worked in.  In fact it wasn’t even close.  But it worked and that is all that mattered.   

Maria and I embarked on our second day of this three-day stint ashore and we decided to put our discouraging day behind us, and made it a goal to make every patient leave with a smile and feeling better than when they stepped into our office.  We were upbeat, jovial, and there were Buenos Dios, and Buenas Tardes all day long.  People would come in and complain and complain and Maria and I would somehow in the end make them smile. 

It is not often that a physician will ask where you live, what you eat, what exercise you do, what you like to do for fun, how many kids you have, what your goals are in life, where have you traveled?  I wish I could have captured the quixotic looks that I got from some people when I asked them “Que comes” (what do you eat).  Most of them said, “Well I eat normal Doctor”.  But what types I insisted, and they rattled off pescado, pollo, carne, verdures, arroz con coco, and platanos.  I like bananas.  I don’t love them, but I love the word for them in Spanish- platanos.   

One of the biggest laughs we had this morning came when we were talking with an older gentleman and his daughter about a rash the guy had over most of his body.  It was partly due to lack of good hygiene and lots of sweating.  I encouraged the gentleman to duchar (to bathe) every day and use plenty of sopa.    Mucho sopa.  Sopa is muy importante.  Very important for cleanliness I said.   The daughter and her father looked dumbfounded.  Unbeknownst to me, the word for soap in Spanish is jabon.  Sopa is the word for soup.

We couldn’t get the image of bathing with chicken noodle soup out of our heads for a while.  That is the power of things getting lost in translation and provided for some good humor for both the patients and us.   

Ask yourself this question…..If a medical team from Johns Hopkins or Harvard set up a tent outside your town and offered up free prescriptions for many of the drugs you usually have to pay for, and also offered free glasses, eye exams, even surgeries that you were planning to have by the local surgeon, and pay a lot for, but now could be done for free by perhaps even better doctors, what would you do?  

To what extent would you go to get the free and more skilled surgery vice having to pay thousands for it on your own?   How demanding would you be? 

And would you say thank you even if you didn’t get your way?  Would you understand that others in your town need to be seen as well?  And if you got to go twice you may exclude someone from being seen at all?    

These are all questions that I posed to myself to try and understand the social behavior I was seeing every day out here in Tumaco, Colombia.  I found it fascinating what a wide range of socioeconomic status there was in the patients we were seeing- I drew these conclusions based on how people dressed, whether or not they had shoes, were wielding a cell phone, had a photo ID, etc.  Some showed up at our site with high heels and their best Bebe outfits on or Armani and carried a tremendous air of entitlement. Some had expectations beyond comprehension, and we routinely had to talk people down to Earth and let them know we are not miracle performers and cannot to Neurosurgery here at a makeshift hospital clinic at a holed out Elementary School.   On the other hand, there were some that were truly poor, truly sick, some that had hiked for days to get here to get medical attention and were extremely appreciative, some that gave out hugs, and even more that said muchas gracias doctor.  I could feel my whole mood and energy shift each time I encountered a different side of this range in the patients.   I could see it in my assistant Maria as well.    

So much of how we feel and what we do is driven by attitude.  If I had an attitude meter I would have ranked each patient by that on a positive and negative scale, and then correlated it with their socioeconomic status, where they live, age, gender, and type of medical issues.  Perhaps I will do this in El Salvador.   It would make for an interesting study.  My hypothesis- those from the country, those that are older (both men and women), that truly are the poorest, and ironically that have the gravest of medical ailments (hernia, cancer, broken bones) will have the more positive attitude.   

Today we would need that positive attitude because at 2pm the pharmacist barged into our medical space and pronounced that we were completely out of pain medication.  We were all out of Ibuprofen, Tylenol, and Aspirin.  Zero, Zip, Zilch left.  I looked at the full room of patients to be seen, and stared back at the pharmacist and said “Huh? Are you serious!?”  How we did not have an unlimited supply of these drugs that we give to virtually every patient was beyond me, but the immediate task at hand was how to handle the patients in front of us.  We thought outside the box, giving prednisone to quell some pain and inflammatory processes, and pepto bismol for the antacids (which we also had run out of).  The site leader CDR Bill Scouten (pediatrician extraordinaire) called it a day and ordered shutdown of site and back to the hotel we went.  Early day.  Big question was what on Earth were we going to do tomorrow without any pain medication.  

The Villa del Sol Hotel where we were staying had a piscina (pool) and I when we got back to the Hotel I had a sudden urge to swim some laps.   Only problem was that I hadn’t brought a bathing suit.  No matter.  Boxer briefs would have to do and splash was in the pool.  Felt so good to stretch out in the pool and get some exercise.   A few of us then ventured out to the beach and stuck our feet in the water of the Pacific Ocean.  We very quickly removed those feet from the Pacific Ocean when one of our legs came in contact with a dirty diaper floating nearby.  We then saw the large degree of other trash floating in the water.  Ok, this was definitely not Hawaii.    

As we were walking back to the Hotel, machine gun fire “pop, pop, pop” was heard not too far away.  We ducked and looked around.  There we stood on the beach in our skivvies bracing for gunfire.  More came and it went on for some time, and then a helicopter buzzed overhead.  We were nearby the Marine Infantry base so no doubt a training exercise but damn that scared us.  

Dinner this evening was some excellent fish, along with Chicken Foot soup.  I realized that this was called Chicken Foot soup when my big spoon picked up a scoop of soup and I almost put a chicken’s talon in my mouth.  Wow!   It sure was good.  So that’s what they were doing with all the machine guns.  Kiling the chickens..... 

After dinner we learned we would have the chance to go to the Grocery Store in town tonight, but first needed to have a force security briefing by the military group coordinating our force protection.  What I learned next was truly fascinating.  A Commander from the U.S. Embassy entered and gave us a list of phone numbers to call in case of kidnapping or other dangerous encounters.  We were told that on the way to one of the sites today the Veterinary Doctors came across a pile of dirt squarely placed in the middle of the road and were turned back because of supposition of an IED (Improvised Explosive Device) placed inside or a potential ambush site.  The Colombian Marines did a safety sweep in the woods around the location.   This is the type of professionalism that these Marines displayed.  They were always locked on and had their M4 Carbine Machine Guns on the ready at all times.  We learned from the Commander that 1/3 of the cocaine that reaches the United States comes from this area of Colombia and the FARC is very active here.  The bounty for a Colombian Marine’s head is priced at $2000.    He said this area is the most dangerous in Colombia, but at present with the thousands of forces here for our protection it is the safest.   That got me thinking…..for both Governments to provide this level of protection and care for some lowly vitamin and Tylenol givers from the United States, meant that the danger was truly there, and the larger diplomatic ties at stake for Colombia-U.S. relations were huge.   I recalled reading a bit about the Colombian American Free Trade Agreement last year that didn’t make it through congress.  The potential economic impact for the future of this relationship as well as the pursuant restriction of the drug trade are immense for both our countries.  If they were to allow even one American on a humanitarian mission to their country get kidnapped or killed, the impact would be devastating.  Yes, this is real.  And yes, this makes sense now.    

It was after nightfall as we boarded the bus bound for the SuperMarket.  The reggae/rap/Latin music blared and at each door and in the aisle we had Marines wielding their machine guns protecting us.  As we sped along we also saw Marines on either side on motorcycles escorting us with a gun wielding motorcycle backseater aboard.  It was the strangest situation, because the music was great, we all were a bit rowdy after having a beer or two, and we were in a caravan with intense force protection to the grocery store. 

The bus dropped us off and sped away not wanting to spend too much time in one spot for fear of someone placing a bomb.   The Marines had set up a perimeter around the Supermarket and had done a thorough search and secured the inside.  The place was ours.   We each picked up a shopping cart and went about our shopping.  Colombian coffee, toiletries, some snacks.  I even ran into a guy in the butcher’s shop who I had treated yesterday in my office for his knee pain!  He held up a pig’s foot and asked “Lo Quieres” (you want one) and then thanked me for my help yesterday.  “De nada mi amigo”, (You’re welcome my friend).  “Buenas noches” (Goodnight).

The bus returned and the Marines beckoned us to board quickly and soon we were driving again with our entourage through the streets of the Red Zone protected by the Colombian Infantry and eventually arrived safely back home at Villa de Sol.  

I went straight to bed looking forward to the morning and hopefully waking again to the sounds of birds and feeling at least for a second that I was in Hawaii again.    


  1. I like reading about your work - thanks for sharing.

  2. I can picture the faces of your patients when you told them to take a bath with "sopa"! I couldn't continue reading for a while because I couldn't stop laughing! It makes me remember the time when Collin made the same mistake :) Adoro a mis gringuitos.

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  4. Loved those chicken feet...had one in Chi-town! BTW.... The "Buddha" Rodelio, from Sunda, ,(did you meet him?) was so nice, sat with us for awhile while we took in his crispy "pata" and "pansit" comparing it to ours.....Did you know he was born in Subic Bay?? of your old Navy bases.
    Did working "@ the bedside" make you think of completing your residency? or is it still the MPH.....

  5. You have a gift for painting word pictures, Andy. Please keep the blogs coming. And, you are right about the CFT...VERY needed but not likely to pass in this current political climate. Sad.

  6. I've been out of the blogging loop for over a month now, but I find this very telling with all of our national medicare discussions going on.
    Whatever our political climate, we do need you out there helping those that so desperately need your help.