Thursday, June 25, 2009

Halfway through the Mission - I was once a Newbie too

The motley crew that I flew into Panama with three weeks ago left two days ago.  On their way out in revolving door style, they tagged an incoming crew of about one hundred new people to replace them.  They came from all over the United States- Navy Reservists, Project Hope, UCSD pre-dental society, Latter Day Saints, and more.  Wide eyed, excited, not knowing what to expect, full of enthusiasm, and making new friends left and right.  Those of us who have been on board for awhile (I hardly can include myself in this group) were ordered by the boss to get these newbies up to speed on protocol as soon as possible. In this entry, I would like to touch on some “Newbie” behavior that was observed and cannot go without being mentioned (and this was me just a few weeks ago, so I am making fun of myself too).

1)  Writing everything down- Inevitably on the first day at morning meeting, everyone has pen and paper out, fastidiously taking notes of anything said by anyone.  “The Mets won last night”, someone says.  Write it down.   “I had to get up twice last night to use the john”. Write it down.   Chief reads the Plan of the Day detailing the movies playing today, food selection, trivia question of the day.  Write it down.  All of this information is on your email people!  Write it down.  Oh it is?  Doh!!

2)  Relentless enthusism- During the evening meeting last night after a broiling and exhausting day, the boss asks if there are any questions.  There is a newbie that asks a question about nothing to do with the topic at hand.  “Do you know what is for breakfast tomorrow?”   Or on the boat today from a Dentist.  “Can I drive the boat?”  “No!  You are a dentist, not a coxswain.  Please sit down.”

3) Taking photos of unextraordinary items.  The rate of photos taken is at its peak upon first arrival and then inevitably falls off during ones time here.  The first few days newbies will take photos of everything- the trash cans, a lobster tail, a life jacket, a soda machine, a spin bike.  It is unbelievable.  This morning while waiting to board the hospitality boat ashore we were instructed by U.S. Marine Corps Gunnery Sergeant Roberts to not take any photos in order to enable a safe boat entry.  A newbie did it.  They pulled out their camera to take a photo of one of the lifeboats.  “Put that camera away!!”, yelled Gunny.  We were boarding….  Another newbie couldn’t resist.  They tried to stop their desire, but their hand overruled their brain and they whipped out their camera and snapped a photo of the steel post by the steel door.  It was an awesome shot.

The boat ride out to the dock was packed with newbies this morning, and a few of the docs and I tried to use the lengthy transit time of one hour and 30 minutes (helo took 5 minutes) to give some advice to the new docs on seeing patients, how to fill out the forms, what to expect, etc.  We were about halfway there when the stank hit us.   Pee Yoo!  It was a mix between the smell of  a flipped over Port-O-Potty and a Sewer Leak.  

We looked out into the water and there was trash floating everywhere.  “Must have rained a lot last night”, said the Captain of the boat.   Large rains wash the trash in the ditches out to sea.  A very rudimentary sewer system.   People leaned over the side to snap photos of the garbage.  I was one of them.  It was brilliant.

The helicopter that had left an hour after our boat from the ship, passed us overhead.  We waved.  Despite the garbage, the lengthy boat ride had been nice.  Beautiful volcanoes were visible in the backdrops, as the sun rose above their peaks.  Some El Salvadorean fishing trawlers headed out to make a day’s catch.  El Salvador has a brand new Port (just finished this year) in La Union.  We passed by it in the small boat and I became curious why the USNS COMFORT had not been able to pull up here (the Port was plenty big enough).   I asked the skipper and he told me that the previous El Salvador government had spent all of their money on this Port, and run short on being able to secure permitting and they had no Tug Boats.  The new El Salvadorian President was sworn in just three weeks ago, and considers this Port part of the prior administration and does not as of yet have it as a top priority item.  Reminds me of some of the Bush to Obama priority changes.  Occurs in every country.

One of the new guys on board, sitting next to me during the boat ride is CAPT Maurice Sheehan, a Nurse Practitioner in the Public Health Service, Psychiatry trained, former Navy special operations, who just returned from a year in Afghanistan.  He lives in San Diego now, and we swapped some good stories of times in San Dog.  The man has 35 years of service to the country, and is still deploying left and right.  Impressive.  When we reached the school site, he and I went to the Tienda to get some café and a pupusa.  Esmeralda was not here today, and I hoped that she was able to receive some help for her eye.  A traditional El Salvadorian food is called the Pupusa. 
The name adorns the title of stores, and food stands throughout the country.  This mashed corn wrap is a staple of the diet and folded into it can be all sorts of things from cheese, pork, and even some sort of colorful flower (that after I requested was told was out of season).

Today, I was able to obtain a relatively quiet room to work, and also was lucky enough to snag a native El Salvadorian named Krissia to help translate.  It allowed things to run much smoother, and my dolor de cabeza would be less intense today.    Full up on some coffee we set to work and encountered several interesting patients.

A 24 year old man came in with an injury to his left arm that had not healed correctly. He had fallen off of a horse seven years ago, and broke the lower part of his humerus (upper arm) clear in half.  Unfortunately he did not obtain any treatment at that time, and the injury healed such that he now could not flex his arm past 90 degrees, but also could hyperextend his arm to almost 40 degrees the other direction.  When he did so it appeared that his arm was on backwards.  
We took some X-rays and requested a surgery back to the ship to rebreak the arm and set it, but unfortunately our site leader, CDR Ed Taylor told me the Orthopedic doc did not have the equipment necessary to do such a surgery.   I wrote a referral out to town and hopefully the guy will be able to have his arm reset.

As I mentioned in my Preventive Medicine blog entry from Colombia, the people here in the agrarian regions of El Salvador demonstrated socioeconomic driven behavior towards activity and healthy eating habits as well.  This lifestyle of living off the land through hard work lends itself to lengthy life span and staving off chronic disease.  Today alone I had a 92 year old patient, and 87 year old patient, and LT Jacobson had a 102 year old!   None of them smoke or drank alcohol, none of them had owned a car, and none had access to processed food or sugary drinks.  I applauded them and prayed for a paradigm shift like this in the future of our own country.

My translator taught me the El Salvadorean word “Bolado” over lunch.  Bolado is the equivalent to the phrase “Dakine” in Hawaii or simply “stuff.”  It is what a person from El Salvador says when he is referring to something but doesn’t say the actual word because it is inferred by tone, or he/she simply forgets it.  I tried to use the word Bolado as frequently as possible throughout the afternoon and got some instant smiles.  Take care of your Bolado.  Make sure to take Bolado three times per day with lots of water.  I need to use the Bolado.  I’m still not sure I’m using it correctly, but thanks Krisia nevertheless for teaching me that.

Before heading on this mission I was able to participate in the Memorial Day Parade in Washington, D.C. with the Special Olympics Lions Club.  As a Lion, I was proud to ride atop the float with several Lions who are WWII and Vietnam veterans.  Lions Club International is the largest service organization in the world, and has contributed greatly to our humanitarian mission this year by providing eyeglasses for those in need.  
Today we passed by El Clubo do Las Leones (Lions Club) building in La Union.  I saw the familiar emblem and smiled to know that the Lions were here in El Salvador.  Having met two outstanding International Presidents of the Lions Club- Al Brandel (current President) and Kay Fukushima (past President) I made a note to stop by this esteemed organization’s chapter in La Union.

One of the patient’s I saw today was a special needs patient female named Jennifer who because of mental handicap was blind, and struggled with speech and seizure disorder.   The girl’s mother is terribly worried about her daughter and the lack of support she has, and the lack of knowledge on her daughter’s condition and future prognosis.  After looking at the girl’s CAT scan of her brain, and providing the mother with the knowledge that there is nothing that could be done for her daughter medically, I had an idea to refer her to the Lions club for help in finding a group of other special needs patients in the area or even in San Salvador.  I hope that these connections with the Special Olympics and Lions can span the Americas and provide this girl with some guidance and hope.

Chief Caldwell, a very nice female Chief Petty Officer Corspman on the COMFORT team busted into my “office” at 3pm and said, “Doc Baldwin, you have to get going.  
It’s time for you to get back to the ship!”  I’m glad she had been keeping track.  LT Jacobson, LCDR Bacon, and many of the others had already taken off on the boat retrograding back through the sewer smell.   It paid off to work late though, as we were dropped at the helicopter zone and soon found ourselves in a chopper passing over the hospitality boat full of newbies below.  Sure enough as I looked down, I saw a few of them pointing upwards, cameras in hand, snapping away.  Newbies.


  1. Have you had pupusa before? did you have it with curtido? that's the pickled cabbage . There are a lot of Salvadorean places in LA as I'm sure in DC too.

    Isn't it sad how the sea, rivers doubles as the sewer? It is the way in a lot of places in the world, very sad.

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  3. I just read the entire blog from beginning to end. I commented earlier and I'll leave it be and just say that what you do is remarkable.

  4. Thank you for taking us along your journey. You are an eloquent writer-- keep up the blogging. I love reading about your humanitarian efforts!!!


  5. Once again a brilliantly written blog post. (and once again I cried as I read it) I hope you are able to get the Lions to help the girl.

    Please stay and your fellow team members are remarkable.