Mission to Somotillo

The mobile medical strike team (MMST) led by CAPT Jeff Cole assembled at 7am on July 9th in the casualty receiving area onboard USNS COMFORT  Our mission- get to the remote rural town of Somotillo in northwestern Nicaragua ASAP to relieve fellow humanitarians and wreak as much positive goodness on this town over a five day period as humanly possible.  This was it.  What we had trained so hard for. 

Donning our high speed sunglasses, stethoscopes, and lifejackets we ran up the stairs to the main deck to get on the uber fast RHIB (rigid hull inflatable boat) and get quickly to shore.   “Go ahead and take a seat!”, shouted Gunnery Sergeant Roberts. “It’s going to be awhile!”  Sure enough, the strike team was foiled once more on achieving an expeditious delivery to target.  We took a seat, and some of us even laid down for a snooze on bed of lifejackets.  

After finishing three books over the past few days, I was glad I snagged a few more before leaving on the mission this morning.  I whipped out my IPod and a murder mystery by Dean Koontz and tried to stay focused on the five-day mission that awaited us.  My teammate, Dr. Mike Barretti, cursed the situation and then cursed that I was reading books.  Barretti means well, trust me. He finally has made a valiant effort to quit smoking and for that I am proud of him.  

 A few hours later we descend onto the RHIB held by a single tether line to the ship crane above.  Sure hope it doesn’t snap, I thought, while preparing to do a inverted dive and duck if it for some reason it did.   We touched down safely and were on our way.   Instantly the feeling of Navy pride returns as we are skimming the water toward shore.  Barretti is making the best “Washington Crossing the Delaware” stance he could and I snap a photo.  

This is what it must have felt like back in the day (well sort of).  Just at that moment, CAPT Sheehan leans over and informs me that the Carinto harbor that we are about to enter was mined by the United States just under three decades ago during our “clandestine” operations working against the Sandinistas.  Sure hope they are cleared now.  Wow, what a difference a few decades

 and the fall of the Soviet empire makes.  I see that Sheehan has quite a bit of knowledge on Latin American history and a penchant for political science, so I make a mental note to pick his brain over the next few days about the “true” state of affairs here in Nicaragua. 

By the time we reach shore it is 10am and we board the bus for the bumpy ride through Chinandega northward to Somotillo (about 3 miles from the Honduras border).  Wow, this is the Short Bus!  I sandwich my legs into the small seat space by the window (why did I have to pick the seat with the wheel well???) and knees jab into the back of my teammate in the seat in front of me.  Next to me sits a lady volunteer and I thank her for being a member of the team and helping on the mission.  I tell her that she should join the Navy (always recruiting J) and she tells me she doesn’t want to shoot guns and be sent to the front lines in a war zone. Really??? I begin to form an answer, but then decide it is not even worth it. Back to the book.  We pass by Chinandega, and see the sign- 60km to Somotillo.  My legs have lost feeling by this point, but I ignore it and press on.  

Off to the right hand side we catch a glimpse of an enormous volcano (it must be 10,000 feet) with steam spewing from the top.   I come to find out the name of the giant is San Cristobel and it is one of seven volcanoes that are semi-active in the country.  

By the time we reach Somotillo the Dean Koontz book is almost history, and it is just past noon.   We carefully approach the target site making sure to hit every pothole along the way, and once secure, we charge the building (Centro de Salud – Raymundo Garcia) and announce the cavalry is here!  Our fellow humanitarians, weathered and spent from their numerous days here, are overjoyed to see us.  Ready to go, the first thing we do- lunch!  Luckily the Centro de Salud (in addition to a large amount of flies) has a set of rocking chairs that instantly remind me of Cracker Barrel.  Dr. Schwartzman (heart sweat man), Dr. Arthur (fellow Duke grad), and I man the rocking chairs and ingest our MREs.  The relieved troops leave for the trek back to the ship and the new MMST sets up shop.  The area where we are seeing adult patients is full of flies, BUT it is air conditioned (when the electricity is working).  I look at the bright side.   Barretti doesn’t.

It always takes a few patients to get back in the swing of things after being back onboard the ship for a while.   The Spanish isn’t quite flowing right.   You are caught off guard by a different regional style of the medical Macarena “dolor” dance.  But eventually things get going, and you’re back in a routine again.  This town is interesting.  For one, it is definitely “el campo” (the country) and all these people are farmers, or do something related to agriculture.  Somotillo is an impoverished town with little to no infrastructure and this tells me that 1) there will be less chronic health problems due to obesity 2) there will be more rashes, allergies, GI issues, skin infections, parasites due to lack of hygiene and 3) there will be A LOT of children because there is not much else to do around here besides create them.  

 

As the afternoon progresses I am working without a translator, which I am able to do, but boy does it get tiring.  A female patient asks me if I am from Cuba, I say no, she asks me if I am from Mexico, I say no, and finally she says United States?  Yes.  Peculiar.  Later I come to find out from CAPT Sheehan that Cuba (and to some degree Mexico) have had a large impact on the medical care and medical training of the people in Nicaragua.  This woman had never seen a doctor from the United States helping (especially one that could try to speak Spanish).   

 By the end of the day I was desperately in need of a coffee, and so I ventured out into the dirt road looking for some instant café.  There were lots of roosters running about, and guys on their “Tricicletas” – that’s what they called them here for the bikes to transport people around.  I found a food stand and it was super filthy.  I surveyed the scene where the coffee was prepared and that was not as bad, so after some discussion my gut and I agreed to give it a go.   

What’s the worst that could happen?  The senora preparing the coffee invited me into her “shack” and I saw on a hammock her small baby that had recently been born eight weeks premature.  The woman begged me for some vitamin drops for the babe and to give her some extra money.  I gave her some help and returned with the drops in time to pick up my coffee.  It wasn’t that bad (and as I’m writing this no issues to speak of). 

 

We packed up shop around 4pm and boarded the buses for the long haul back to Chinandega where we would be spending the night at the Volcanoes Hotel.  Thank goodness for Dean Koontz and his easy to read murder mysteries.  Just as the killer was about to strike, BOOM! , a tire blew out on the right back wheel of the bus, and we ground to a halt.  I have never seen a tire changed so fast by the driver of a bus.  He found a rock on the side of the road, and backed up onto it (using it as a jack), and changed that tire like a NASCAR pit crewman.  Most of us used the extra time to visit the bushes on the side of the road to take care of some business. 

 We were slowed by a banana carrying truck the rest of the way, so by the time we reached the hotel the Koontz book was complete (they got married).  I gave the book to Barretti and he scoffed at first, but ended up taking it.  We’ll see if he reads it.  The Volcanoes hotel turned out to be extremely nice.  A quiet place, with view of the volcano in the backyard, and a nice bar and restaurant.  The MMST settled in for our first night ashore and did what a joint medical team does after a hard days work.   Until tomorrow…..

 

 

 

 

Nicaragua 98.9 FM

The sea state here off of Nicaragua is the worst it has been yet. When you run on the treadmill it becomes an intense alternating hill workout as you run downhill when the ship rolls one way for ten seconds and then run desperately uphill as it dips the other way for 10 seconds. Last night I lay in bed rocking from side to side, and even when I braced myself against the railing I could feel my internal organs moving back and forth. I could not fall asleep. And when I finally did, I would constantly get startled awake during a severe roll of the ship as I slammed into the rail of my bunk.

But alas, morning came and I was awoken this time at 0430 by Gunnery Seargeant Robert’s voice shouting “Serial Callaway, Serial Callaway, Muster Team such and such in the Casualty Receiving Area with Combat Cargo (that’s his call sign). Every night before bed Gunny posts the manifest for the different groups going out the following day. It is commonplace to check and see what boat or helicopter you are assigned to and what time your “Serial Call Away” is. I looked last night and next to my name it said, helicopter, 0730, PAO! What the heck? PAO is public affairs officer. I found out that my first day ashore in Nicaragua I would spend doing interviews with a radio station and a TV station talking about the mission. “You know how to talk to the media Doc!” That’s what they told me. True, but I haven’t done any interviews in Spanish before. This should be interesting….

In an earlier blog entry I mentioned the phenomenon in the military called “Hurry Up and Wait.” Well this morning it was ringing true. We were supposed to go by helicopter, they fell behind schedule, then we were ordered to go down to take a boat, then after waiting another 45 minutes, were ordered to take the helicopter again, then the swells got really bad, the deck was pitching back and forth, the helicopter couldn’t land, so in the end we ended up in the RHIB boat going ashore (3 hours after we were supposed to leave). I’m glad that Julie Moreno (Surgeon General’s assistant) brought me the latest Economist for something to read during this dwell time. Thanks again, Julie!

The RHIB ride turned out to be the best mode of transportation anyhow.

By this point in the day, the sun was shining brightly, and it felt great to get sprayed a bit as we were skimming quickly across the water towards shore. LCDR Morris (Navy Surface Warfare Officer) was with me for the day and she was grinning from ear to ear. She said,“THIS is why I joined the Navy!” I nodded and replied, “You’ve got that right, ma’am! So many people don’t know what they’re missing!”

We rounded a beautiful jetty of rocks with a white lighthouse and a statue of an important Nicaraguan leader (couldn’t quite see the features or inscription from this distance to tell you who exactly). But what I did see were the waves behind the jetty and the incredible right to left surf break that was occurring. Note to self and others- great waves in Central America.

Once we reached shore, we spotted our escorts- Air Force CPT Rebecca Garcia (Public Affairs Officer Extraordinaire), U.S. Navy Petty Officer Second Class Lenin Sanchez (originally from Nicaragua) and the driver Luis from Managua. No bus. Today it was a ride by SUV. We made our way to the town of Chinandega- population approx. 100,000, Nicaragua’s fourth biggest city. The country of Nicaragua lies between Honduras and Costa Rica in Central America, has a population of about 6 million people, 80% of whom earn less than 2 dollars per day. Over the past three decades they have experienced a lot of turnover in government, insurrection and war, including the Contra-Sandinista conflict in the early 1980s (Contras backed by the U.S.) But all is stable now in Nicaragua (for the most part), and the purpose of Continuing Promise is to demonstrate the U.S. commitment to working together towards peace, mutual education and health. With this in mind, I would make sure to emphasize this in the interviews. But over the next few hour I simply wanted to get a feel for this country and its people. I stared out the window of the SUV and just took it in- lots of children on bicycles, even more “cataneros” (bicycle taxis with covered rear cab), a very bumpy road with potholes, people here carrying things on their heads as well, cows on the streets, and sign after sign for Coca-Cola. Now we know who advertises the most in Central America and is perpetuating this “diabetes” thing. Hey, at least they were being active. More than the U.S. can say. The houses bore the same beautiful pastel colors and Mayan influenced décor as many of the houses did in El Salvador, but with a unique Nicaraguan style that I can only describe as “edgy”.

Because of our morning delay, by the time we reached Chinandega (30 minute drive from the Boat Landing Zone) we had missed our TV time slot, and would have to be content with the radio interview. Fine by me. Go with the flow. Semper Gumby. I had brought an extra change of clothes this time just in case we happened to get stuck out here overnight. The weather guy announced last night that a Tropical Storm was moving in today, but weather guy is always wrong, so it would most definitely be sunny. And it was!

We arrived at the radio station about noon- Radio Mas Stereo 98.9FM- “Noventa Ocho PUNTO Nueve!!” That’s how I was instructed to say it. They have a website. www.radiomasstereo.com A very friendly gentleman and nice lady (both in early thirties I’d say) greeted us and brought us into the control room.

We shot the stuff for awhile in Spanish, the nice lady asked me about the shoulder pain she was having (no doubt from her heavy shoulder bag) and then after about 20 minutes the station owner showed up carrying ice cold bottles of guess……Coca-Cola! He expressed his gratitude for the help that COMFORT was providing the people of Chinandega and Nicaragua as a whole. We began the broadcast and I did my best rendition of “Noventa Ocho PUNTO Nueve” I could. They seemed to like it. Then I launched into an introduction, gave some facts about our Mission - where people could be seen, how long we were going to be here, and then I got tongue tied. This was hard to speak at a fast pace in Spanish on the radio. So I just said it again- “Noventa Ocho PUNTO Nueve!” and they smiled and nodded in approval. Luckily the phone rang at that point and a caller had a question. I beckoned Petty Officer Sanchez to help with the translation, and through him I was able to explain some treatment modalities for the caller’s Kidney Stones and Urinary Tract Infections. Bottom line- drink more water and not Coca-Cola! We also talked at length about the enormous problem of Gastritis (Irritated Stomach) in Latin America and how it can be due to parasitic worms, spicy food, not enough water, too much alcohol, and stress. Towards the end of the interview the manager came in and offered some spicy rice and beans along with some more Coca-Cola and all I could do was chuckle- Noventa Ocho PUNTO Nueve! J

The interview must have had an impact because as we were leaving a few people came DIRECTLY to the station for a medical evaluation. Our driver Luis had been listening to the interview from the SUV and he said that most people here in Nicaragua typically listen to the radio for news vice the television. So hopefully the radio spot will help get the word out about the opportunity for medical care and the civic and humanitarian projects that the USNS COMFORT team is providing in partnership with the host nation of Nicaragua. I’ll let you know the turnout we get in a few days…..

We had not had lunch yet, so after the radio interview we found a relatively modern restaurant called “Tip Top” which I can best relate to a Kentucky Fried Chicken/Chic-Fil-A in the United States.

Looking for a non-fried option the gentleman behind the counter offered grilled chicken and I agreed. When he plopped an entire small chicken down in front of me I was stunned. Good thing I was hungry. It hit the spot after shipboard food and MREs. After lunch we ventured across the street to the Town Center where there was a playground area for kids. LCDR Morris chatted with some of the kids nearby and they ran over to CPT Garcia and I and started yelling “Gringo!, Gringo! Gringo!” and motioning to the swing set.

I replied “No soy Gringo”, but I don’t think it had much of an effect. They believed Garcia. Next thing I know I was swinging on a swing trying to get as much altitude as possible, with the little boy next to me trying to get even higher. It was some good community relations for the day. They were adorable.

The ride back to the ship was by RHIB again and by this point in the afternoon the skies were threatening rain. The seas were picking up big time, and we all prepared ourselves for a wet and wild ride back. 

For someone who loves adventure and adrenaline, riding a RHIB is a lot of fun.  

Safely back onboard the ship, I shouted one more time “Noventa Ocho PUNTO Nueve!” Viva Nicaragua! Viva Los Estados Unidos! Estamos unidos! (We are united!).