Saturday, June 20, 2009

Strategic Pause

The past two days have been what is referred to as a “Strategic Pause.”  I like to call it a much needed break.  It’s a time to recharge the batteries, get rested up, physically fit, and mentally ready before we hit the ground running again in El Salvador.   Seeing hundreds of patients each week, many you can help, and many you cannot, takes its toll.  I have only experienced one country thus far and it kicked my butt. I look around and know a lot of these heroes have been on board since day one and this will be their 6th country in the last 3 months!  There is a phenomenon known as “Compassion Fatigue” and it has been found to occur in humanitarian providers when they try to relate and give some love to patient after patient after patient.  There is only so much we can give, and eventually, (especially in the 3rd world) the burden and guilt of not being able to help patients more can get overwhelming and providers can break down.  We have been advised to look out for each other as medical providers.  El Salvador is going to be logistically challenging with long 1-2 hour boat rides ashore, followed by lengthy bus rides to the medical sites.  Doing this day after day after day in the heat is going to require the best spirits we’ve got and the utmost resolve. 

To help with this, the first part of our “Pause” occurred yesterday with a Steel Beach Picnic.  In the Navy these are terms for a big BBQ on the flight deck with fun and games and the ability to wear anything you’d like (within reason).  After Dr. Bacon’s spin class, I donned some shorts and a polo shirt and went topside to partake in the action.  Up top the sun was blazing, a basketball court was set up, the band was playing, and the grills were cooking up some burgers and dogs.  

Someone brought over a Hawaiian Lei and gave me the honors (I suppose this was the theme) and suddenly we were dancing on the Steel Beach.  The shower I had just taken after spin class immediately became a waste as I started pouring sweat once more. Ah, it’s all good.  This is fun!  

I applied some sunscreen (mother would be proud), and went about getting a burger.  You can’t set your expectations too high aboard the COMFORT with the food.  That is why we have come up with a completely different rating scale for the ship.   My good buddy and fellow doctor Karen Jacobson taught me this scale.  A burger that may rate a 3 in the regular world takes on a rating of at least a 7 onboard COMFORT.   Put some ketchup on this burger, throw on some cheese, and it’s a COMFORT 9!   

One of the coolest operations I have seen in the Navy is what’s called Underway Replenishment or “UNREP” for short.  Today USNS COMFORT was refueled by USNS Peary.  Unless it is nuclear powered, a ship at sea obviously has a limited supply of fuel.  Instead of having to depend on pulling into a foreign port to fill 'er up, we do it by bringing an Oiler alongside the ship and running the fuel hoses between the two while steaming at 13 knots side by side.  It is remarkable to see.  I first experienced an UNREP when I was 20 years old and a Midshipman on “summer cruise” in the Persian Gulf.  At that time, I was on board the USS Chosin (CG65), a Ticonderoga Class U.S. Navy Cruiser (read- incredible ship that can launch a lot of cruise missiles and also coordinate and track everything in the air with its Aegis Radar system).  How do you get the hose from one ship to the other you may ask?  Well, that’s what I wondered when I was a scrawny 20 year old, and when the Chief brought the gun out, I was like “What the heck??”  What happens is a gun shoots a small line across the brim between the two ships. This is secured, then a firmer line is fed across, and then the fuel hoses are taken across and fueling begins.  

The coordination between both bridges (the ship drivers) needs to be perfect to maintain a constant and unwavering gap between the two ships of 150 ft.  To do this they are in constant communication, maintaining steady course and speed and always making minor adjustments to stay aligned.  Refueling takes hours so the hyper vigilance of the navigator and ship captain are intense during this time.  It is tradition to pass gifts (such as cookies) back and forth over the line.  Another tradition is what’s called the “breakaway” where one ship, after completion of UNREP, will haul in the lines, increase speed, and break away, all while playing music very loudly, and with many of the crew topside dancing and waving goodbye to the other ship.   

Another maneuver that takes place during this time is called a Vertical Replenishment, or “Vert-Rep” for short.   When both ships have a helicopter landing zone, helos can be used to transport (lift) cargo from ship to ship.  After we were all fueled up today, the USNS Peary’s helo made several trips back and forth and I caught some photos of it as I was reading my book outside.   Watching the helo fly sideways and backwards made me scratch my head.  Incredible that these birds are flown by 20 somethings, and maintenance is done by some kids who are just 18 years old.   

The pilots and maintenance crew of our Helicopter Squadron on this ship (named the Witch Doctors) are incredibly talented and professional young men and women who play a pivotal role in transporting personnel and patients back and forth from the ship each day.  Without them and their hard work, our mission would not be possible.    

Last evening we had the Colombia Close-Out Brief.  The Close-Out briefs are awesome (I got to see the Panama one as well). They highlight the hard work that all of us did in that country, giving the department leaders (Medical, Surgery, Dentistry, Veterinary, Engineers) the chance to showcase their team’s work.  Our trusty leader CAPT Anderson from the Department of Medical Services eloquently spoke about the 16000 patients we saw and over 60000 prescriptions filled as a whole during our time in Colombia.  This was close to 5000 more patients than we had seen in the previous country of Panama.  He told us about the words the Mayor of Tumaco gave at the Closing Ceremonies, where he stated, “Tumaco was founded 365 years ago and has suffered much strife, poverty, and corruption.  After the gracious visit of the USNS COMFORT to our region, we are healthier, smarter, safer, more energized, and most importantly, filled with hope for a brighter future.   Day ONE of the New Tumaco is today, thanks to the Barco Blanco (White Ship).”   Looking around the room during the brief I could see the character of the people in the room. What everyone here has in common is that we are not just medical and service providers, but we are also good people- people with empathy, compassion, and the will to sacrifice to improve the lives of others.  I am so grateful to be a part of this mission.  


  1. " UNREP" reminded me of the refueling done by fighter jets.....also how when my father manned an oil tanker back in the day. Keep the blogs coming, very interesting reading. Thanks for all you and all the women and men aboard ship!

  2. Another thankfull reader here. Delta, Wi.

  3. "Strategic Pause"...I certainly understand the need for pausing! Seeing so many patients in such short time with the conditions you are working in/with, does takes it's toll!

    Loved reading about the steel beach and picnic! There is a whole new appreciation for hamburgers. I hope the trip to El Salvador has given each of you the time you need to regroup and recoop as it sounds like grueling days lie ahead.

    Keep smilin', keep dancin' and thanks so much for keeping bloggin' {{{hugs}}}

  4. I am surprised by all that you cram into 1 day, and then on top of it to have time to write all this! Wow! It is the coolest though. One day you'll have to print it off and have it bound for your future kids.

  5. Thanks for all that you do, and for keeping us up to date with your bloggs.
    When the going gets tough just remember that you can only do your best, and whatever little you can do will make a big difference in someones life. While you are out there making a difference please remember to take care of you.