Saturday, June 13, 2009

Full Moon over Tumaco

The second day’s journey out to the Medical Site was a lot faster, but we paid the price. When the seas are rough and you’re riding a RHIB boat (high speed Special Operations rigid inflatable boat) be prepared to get wet.  We got soaked.  I loved it, but I don’t think the Dermatologist next to me did.  It reminded me of the days in Hawaii with Mobile Diving Salvage Unit ONE (Special Ops Dive Unit) tearing it up out to a dive site.  Yee haw!  Go Navy!   

The skies were overcast today and the air hung with humidity where you could just sense the coming rainstorms in the air.  As we boarded the bus from the Boat Landing Zone to the medical treatment site I readied my camera to movie mode to capture some of the scenery upcoming.  Perhaps when I have a better Internet connection I can put some of the video footage up on this blog.  It was 8 am and children were already outside playing soccer, dogs scampering through the streets, and slews of people walking making their way by foot, bike, and car (even canoe) to the site where the “almighty Americans” were providing excellent medical care, and most importantly it was FREE.   The houses that we passed were constructed loosely and hoisted on stilts of wooden posts with planks connecting them to each other.  There was water all around.  It was like a poor man’s Venice.  I shook my head in wonder- curious at how these living spaces are able to withstand strong thunderstorms or high winds, and if they even had a physical address that people could send mail to.  Heck, did these people in Tumaco even have a postal system?   I asked the young Colombian infantry soldier standing next to me on the bus wielding his loaded M4 Carbine machine gun if they had a “correo” (post office) here in Tumaco, and he said “por sopuesto” (of course).   They must post office boxes….. 

Upon reaching the school we saw a crowd of hundreds of adults and children waiting to be seen.  It was more chaotic than yesterday outside the fence of the school, but with intense security from the Colombian Infantry, the treatment zone inside was more orderly and organized.  I was directed to a new “office” space in the last building and assigned a translator named Gloria.   Gloria is in her 20s and as luck would have it, a 4th year medical student from Bogotá, Colombia.  Score!   I found out very quickly what an incredible asset she was.  Yesterday’s translator was helpful, but this woman knew the language, AND she knew medicine.  Throughout the morning we became quite the team seeing patient after patient with increasing efficiency.  The Spanish word we heard the most was “dolor” meaning pain followed by our question where does it hurt - “donde le duele”?  To this we would get a cacophony of a reply sometimes with intense emotion of the man or woman telling us how basically every part of the his/her body “me duele.”  The ensemble of saying such while touching the head, the back, the stomach, the knees and the toes brought about our reference to this as the Macarena Dance of Dolor.  Haha.  It shouldn’t be funny, but with the passion that some of these patients described their pain symptoms (whether embellished or not) is worth noting.  I couldn’t help but thinking that every person out there was passing the advice “Do the Macarena Dance and the American Doctor will give you Tylenol, Motrin and Multivitamins.  If you don’t do a dramatic presentation….then you may be out of luck!”   Sad thought but most likely true.   At the rate we were giving out Tylenol, Ibuprofen, and Multivitamins I began to wonder how long our supply would hold up.   

Several patients this morning related their pain symptoms to the lunar cycle.  At first when I heard a woman use the word “Luna” (moon) I asked her to repeat what she had said and looked to my translator. She looked as perplexed as me, and interrogated the patient in detail about this correlation.   The woman insisted that her “dolor de cabeza” (headache) was worse when there was a full moon, and less intense when there was a new moon.   I took her word for it, and gave her some Tylenol for the pain.  It must be a “Luna Llena” (Full Moon) over Temaco I said to Gloria.  Both she and the patient nodded.   When a young healthy and relatively well dressed guy told us the same thing later about his hand hurting because it was a full moon, we pressed him as to the reason why this would be the case.  He said he didn’t know, but that it was just the case.   Hmmm…..interesting cultural attribution for pain.   I saw a clinical study begin to formalize in my head.  Wouldn’t that be an interesting study?  

Outside our cement schoolhouse turned medical clinic we began to hear the pitter patter of rain and the sky opened up.   After such brutal heat the cool breeze and precipitation felt great.   Time for lunch and another MRE (meal ready to eat).  These MREs are prepared for soldiers in the field that are burning many calories in training or in battle.  Therefore they are jam packed with calories.  My lock sealed package containing Spaghetti w/ Meat Sauce told me to prepare for a 650 calorie bolus to my gut. I didn’t feel like going through the heat up process so I downed the pasta cold, and moved on to what was next- peanut butter and lemon pound cake.  Sorry, can’t stomach it.  I opted for a piece of bread and some Juan Valdez coffee, and headed back to see some more patients.   

The rain had driven some patients away, but the die hards remained.  One of these patients was a jovial 80-year-old man who in no way shape or form appeared to be 80.  His energy and spirit and healthy lifestyle in the farmland (campo) no doubt was the reason he looked twenty years younger, as he stood before me with his button down shirt and white cap on.  What he was missing though was his left hand.  It appeared to have been sawn off at the wrist and I asked him what happened.  While laughing he told me about how one of his farmhands over 40 years ago had gotten angry and kidnapped him, and threatened to cut his head off.  After some negotiating the slighted worker apparently consented to just cutting his hand off.  “Jesus Christo!”, I shouted.  “Si, Gracias Dios”  (Yes Thank You God), the man replied.   He didn’t need anything special.  Just wanted some Vitamins and to say thank you for coming to his town to help the people of Temaco.   Wow, what a refreshing patient to have at this point of the day.   I snapped a photo with him and bid him a wonderful day and much luck.  

The patients kept flowing in, and the complaints and questions and our responses and prescriptions much the same.  I tried as hard as I could to learn something unique about each patient, make them smile, and to get them to improve something in their lifestyle to get them healthier.  Exercise, eat more fish, dance, make a smile each day, and try to ride a bicycle.  To a lot of these prescriptions I would get a laugh and a smile, and that felt good.  I don’t think that they are used to their doctors here in Colombia (if they even have one) being caring and funny and talking to them much.  One older gentleman came in who definitely was not the role model for prevention.  I was able to decipher that he drank a lot of alcohol, and smoked a pack of cigarettes a day.  I sternly told him that he needed to change his lifestyle, and the guy actually listened.  He said that whatever an American doctor told him to do he would do, and so I proceeded to reach into his shirt pocket, take out his pack of cigarettes and threw them in the trash.  I asked him to hand over his lighter, and in turn gave him a bottle of water, and made him promise me that when I return next year (we’ll see…) that he would be running, swimming, and rowing a canoe each day.   With a smile and enthusiasm he agreed.  I couldn’t believe the way he looked at me.  It was as if I spoke the Gospel.  If I tried to take my roommate Mike’s (or any American for that matter) cigarettes away and throw them in the trash they would have a fit.    

The next patient was a 24-year-old woman who entered with her entourage of 4 young children.  This was evidently a fertile woman.  When I heard her chief complaint that she had not had her period for 6 weeks, I broke a smile, and said “Wow”.   Let’s go and see if there will be another member of the clan.  I helped her out by carrying her little boy (14 months of age) and holding the hand of her little girl (3 years old) as we made our way over to the lab for her to put some urine in the cup for a pregnancy test.   I babysat the kids when she went to the port-o-john and as little Jose played with my stethoscope realized how great it must be to have kids.   The lab technician put the indicator strip into the urine and as we waited the two minutes, the drums rolled……YES, two stripes meant pregnant and we all clapped and I told little Jose that he would have another hermano or hermana (brother or sister).  Happy Day for all!   I hope they have the funds to support all these kids.  Dad was away working so that was good.   

I was headed back to my medical corner when I heard someone yell my name from across the schoolyard.  It came from the Eye clinic.  A volunteer beckoned for me to come over and take a look at a guy’s leg.  I rushed over and saw an older gentleman farmer who was missing most of his teeth, and appeared to be going blind from cataracts.  He had a large gash on his left lower leg that was oozing blood.  “He cut it on the barbed wire outside”, the volunteer said.   No problemo.  To clean it up we used some mouthwash (Cepacol), which was just as disinfecting as any other.  The man winced a bit as it burned the bad critters away.  I scrubbed the wound and then threw some stitches in, antibiotic ointment, gauze pads, and ACE wrap and the guy was good to go.  “Time to get on the bus to the boats!” I heard.  “Ya termina!” I yelled back. Great way to end the day!   

But the day would be extended…..  When we reached the boat ramp we came upon a group of our own that was completely soaked.  Turns out that they had taken the big slow boat back to the ship, and tried to complete the exchange but the seas were so rough they had to abort the attempt and return the whole way back to the mainland. They had just spent the past two hours on the transport boat and were soaking wet!   “That must have sucked!”, I said.  Wet heads nodded yes.   

After waiting for about another hour, we were told to board the bus again and that we were all going to be transported back to the ship by helicopter.  “Yes!”  An even better way to end the day.   The flight crew aboard USNS COMFORT mobilized both helicopters and began transporting back and forth.  We donned our flight mask and hearing protection as well as life vests, and waited our “stick’s” turn.  A stick is a term for a group in a line.  There were four groups lined up in sticks.  Each stick would rush towards the helicopter and board when they were called and it was their time to go.    

I snapped some photos as we boarded and went airborne and was mesmerized by how fast a route it was.  Two minutes from ground to ship aboard the helo.  Before we knew it we were back on the ship, a bit waterlogged, but safe, and full of stories to tell over some good chow.   

As I looked outward at the setting sun on the horizon, I also could see the rising moon, full and looming over Colombia.  Hopefully all of that Tylenol if taken correctly by the people below was rivaling the pain brought on by this orbiting piece of rock.  


  1. I'm loving this blog. Thanks for sharing. What a great experience for all involved.

  2. have been away from bedside medicine for too long!!!LOL! we always call it A FULL MOON when things are the worst... whether symptoms,super busy ER/ICU when all the arrow/ GSW come in, ummmm??!!!!cranky doctors?JK!!!...Love the blogging and THANKS! for your service and to all the men and WOmen who serve!