Final Day of the Mission

Today was Sunday. The day of rest. But not for the Navy Medical Strike Team. Today was our ultima dia (final day) of providing medical, optometry, and dentistry to the kind people of this rural town in Northwest Nicaragua. Sure, hundreds of the population had come through the line more than once and gotten a second and third and even fourth medical opinion at the same medical clinic, but we were helping and that is all that mattered. I loved the people at this site. They lived off the land and although poor, they had solid values. Once again, still in a slumber, I paid an early morning visit to the Food Stand of Erika and Cristina and baby Angel for several cups of instant coffee and even had to go for a Coke Light this morning and one of those Gelatin things out of the Yellow Bear container. They badgered me again for not getting them a whole assortment of medications for the baby, and I once again told them I was doing my best. I know Latinos are melodramatic with their body language, but the Nicaraguans take the cake. They are feisty! If I don’t hear the word “dolor” (pain) again for quite some time I will not be disappointed.

After the patients are let into the gate, they assemble into different lines marked off by ropes based on what specialist they need to see. This morning I peered out the window and saw a big someone seeking services that had come to the incorrect clinic- a cow. Yes, that is right, a cow had gotten into one of the lines and was waiting patiently to be seen. Unfortunately we had to turn the cow away, but called one of our vets who administered some vaccinations, and the cow ultimately got what he came for. I snapped a photo through the blinds as they took the cow away and chuckled.

My translator today was a middle-aged woman from Managua named Denise. She spoke English so well, I didn’t realize she was a native Nicaraguan. We moved fast today wanting to help as many people as possible on our final day, and having an outstanding communicator helped out tremendously. I was especially grateful when Maria came along- a 17 year old girl that was late on her menstrual period. I asked how late, and she said just over a month, looking terrified. We did the test, and sure enough she was pregnant. When I delivered the news, she was devastated and scared. Tears streamed down her face. She was trembling. In Spanish I tried my best to console her and ask if her parents knew and if they would be supportive. Maria shook her head no. Between sobs, she told us how her parents had told her that if she got pregnant as both her older sisters did that they would disown her. At this point I took her hand, and looked desperately on Denise, and together we were able to get Maria to have some hope. She wanted to go to Veterinary School in Managua, was unmarried, and we tried to encourage her. It was going to be tough, but she could do it. Unplanned pregnancy- an issue that affects the entire world, but especially challenging in this region.

At lunch I spoke more extensively with Denise about life in Nicaragua. She told me that her parents took her throughout Nicaragua countryside when she was growing up, so she was able to see the differences between urban and rural living of the people. Over the past few decades there have been so many upheavals from socialist influences, corruption, civil war, coups, farm redistribution, and now a cycling back to the Sandinista leader everyone knows as just “Daniel” (Daniel Ortega), who was elected by the highest candidate percentage of the vote (although just 38%) in the past election. Denise shook her head side to side when talking about this….politics. There is so much more to be done and for a just democracy, there needs to be fair elections. I listened some more and then changed the subject...I emphasized our desire to partner and learn and assist Nicaragua in education and public health issues, and she said “Thank you. For this we are most grateful.” And we got back to doing just that….

There is an ER doc in our group, CAPT Andy Johnson, that is super talented and the head of Emergency Medicine at a great Navy training program in Portsmouth Navy Hospital. We call him “The Machine”, because he consistently outdoes the rest of us in the number of patients he sees each day. He has a focus like none other, and works straight through lunch. Throughout the mission the 200 mark had so often evaded Dr. Johnson’s grasp. Today was the final day, and as the afternoon was winding down, we got hourly updates from Dr. Cole on Dr. Johnson’s status. Sure enough, around 3:30 pm Dr. Johnson triumphantly marched into our room- “Two Hundred and Seven!” That got a standing ovation and many looks of astonishment. I dropped my stethescope.

We saw so many patients this final day that we overloaded the pharmacy. We took turns helping out in the back handing out packets of vitamins, and medicine for pain and gastritis until all were taken care of. Chief Weber walked in with a several day old baby that was crying. It was a great sight. Big Chief Weber and the tiny infant. And then the baby spit up and it was an even better sight.

The five days in Somotillo was wrapping up. We had done our job- 6000 patient encounters during our time here. In a demonstration of our commitment to the partnership with the Nicaraguan Ministry of Health and the Town of Somotillo we presented them with a token of our thanks, and they in return presented our team leader Dr. Cole with a very large bottle of aged Nicaraguan rum. We all clapped and thought it an awfully nice gesture. That evening we enjoyed that rum, telling story after story from the travels of our past months together. Dr. Ed Taylor entertained us with the playing of a Nicaraguan flute and many of us dressed in the host country attire as we celebrated the culmination of mission that we will remember forever.

Now starts the journey home. From Corinto to Managua, and Managua to Miami, and then eventually back to Washington D.C. where this journey started back in May. This seven weeks has been filled with so much emotion, reflection and memorable times. A mission where we made new friends, helped thousands, educated, were humbled, and made many throughout the Americas smile. I am glad that I wrote down these reflections. On this journey I have met some of the most incredible, talented, and compassionate health care providers in the world today. We crossed the Panama Canal and the Equator for the first time together. We saw upwards of 60,000 patients over the past two months, worked long days in the heat, helo rides, boat rides, good times and bad times together. I hope that it provided a view into the great work and important component that Humanitarian Assistance/Disaster Relief makes in our Global Security Strategy today. It truly influences the relationships amongst the governments and on an individual level of how the United States is viewed. This “soft power” is crucial in bringing our nations together in peace and partnership enabling a more prosperous and safer future for all. This is Continuing Promise 2009. Until next time…from the USNS COMFORT. Go NAVY MEDICINE!

Nicaraguan Coffee and Six Fingers

The weekend is here in Nicaragua and for the Navy Medical Strike Team that means two more days of humanitarian assistance in Somotillo, Nicaragua. We are starting to get into a routine, and today we were up in plenty of time for breakfast and without the disaster from Friday morning. Snoozing in and out along the way on the bus sitting next to Dr. Lynn Sterni, I apologized each time I fell asleep on her shoulder. I think I am becoming narcoleptic. Either that or caffeine has no effect on me any more. Probably the latter. When we arrived at the site I visited my friends Erika and Cristina and baby Angel at the food stand, and Erika made me two strong cups of coffee as I held little Angelito. The premature baby had had diarrhea for the past few days so I questioned whether he was able to get any sleep the past night, and they answered yes, that the medicine had worked and the baby had slept. “When are you going to give him a bath?”, I asked. Sure enough that’s what they were preparing to do as the father cut a plastic bag of water and poured it into a metallic bowl, and in went little Angel for a good scubbing. The chickens scrambling nearby took a moment to observe. They would be lunch in a little bit. If they only knew… Cristina shooed them away and she showed me the green T-shirt she had on today which said “Jamiaican Me Crazy”. She had no idea what it said or where Jamaica was, so I told her what it meant. She smiled.

My translator today was a gorgeous 19 year old woman named Ariadna from Managua. I couldn’t for the life of me figure out why she was here volunteering her time to translate. She was not part of the Mormon church crew and just didn’t seem the type to do community service on the weekend like this. She was shy and her English needed some work. I was patient and by the time we had seen a dozen or so patients she had the hang of it. It was only upon further questioning that I was able to ascertain that she was starting a job next week in Managua at a call center where she would have to be speaking English. So this weekend was her forced practice. Not a bad idea. Smart girl I surmised. And she told me she had a fascination with Looney Tunes Band Aids (Tweetie Bird to be exact). I obliged and she put one on her arm and then in a show of team spirit put one on my arm as well.

An elderly woman came in mid-morning (I think her name was Matilda) who had six fingers on each hand and six toes on each of her feet. Most cases of polydactyly (extra digits) people have a non-functional appendage, but this woman had an extra “pinky” on the lateral portion of the hand that had full functionality and worked very much like an opposable thumb. It made for a handshake like none I had felt before. She was a very sweet woman and proceeded to give unsolicited hugs to both Ariadna and I in a show of thanks. Genetic mutations such as this are fascinating to me, so I asked Matilda whether any of her family shared this morphology. Her sister had extra digits as well, and sadly she was not able to have children (she had lost three due to miscarriage). You could just sense and feel the long life and wisdom this woman had had.

For lunch I showed Ariadna how to eat an MRE (she was mesmerized), and I decided to risk eating the quesadillas that Cristina and Erika were preparing. Over by the stand I saw the two main Chiefs for the site – Chief Francis and Chief Weber. They are the ones who make the site function logistically (busting their tails in the searing heat all day) and I tip my hat to them. Chief Weber is permanently based with the USNS COMFORT in Baltimore and is going to ride in the Baldwin PA Health Ride we are doing in October – www.healthride.org Please check it out and make an impact in combating childhood overweight and obesity.

Every patient I see I make sure to ask what type of work they do. People in the Somotillo region are mostly farmers that grow corn and beans. This morning I met a guy named Jose who grew and processed coffee. I told him about my love for coffee and he told me all about Nicaraguan coffee and how it is the best in the world. I mentioned (in passing) that I would love to try some, not thinking anything of it. Well, guess who showed up this afternoon on his bicycle with a big green pot of coffee and a matching green coffee cup- Jose! He had gone home and brewed some up fresh for me and the docs. With a bit of trepidation I accepted Jose’s cup of Nicaraguan Joe. It was awesome! Hit the spot. In return I scrambled to find a “regalo” (gift) to give in return and luckily in the MRE container there was a leftover Lemon Pound Cake safety sealed in the brown plastic. I gave it to Jose with pride and told him that this is what we eat with coffee in the U.S. He opened the package and smiled after taking a bite of the pastry. Whew…..

The day ended with us seeing a bit less than the day before – about 1500. Since the town had only a few thousand people, we began to realize that those people we thought looked the same as yesterday, probably were the same people from yesterday…….
Oh well, it’s all good. We’re providing a stockpile of medication for them. The longer it lasts the better. Just so long as they know the proper usage. And it’s not like we are doling out Diprivan or Propofol or something like that (MJ).

I am trained as a medical doctor of the Allopathic discipline. Many other docs are trained additionally in the Osteopathic discipline, learning to do “adjustments” and chiropractic treatments. I have never been much of a fan of these but tonight I changed my tune. After several days of seeing hundreds of patients I felt like dog doo, and my back was stiff as a board and my neck jacked up. Barretti is a D.O. (Osteopath) and so I gave in and asked him to crack my back and my neck. I am now a believer. Thanks Mike. See, I knew under that insolent hard shell with your jaded view of the world, there really is a nice guy who can crack peoples joints and allow them to feel better.

Nicaragua- Woman with 20 Children

“Baldwin, Holy S%#* it’s 6:15!” screamed Mike Barretti. “Bus leaves in 15 minutes!” We had both slept through our alarms and we scrambled to get ready on Friday morning for the trek back out to the medical site in Somotillo. Mike elected to forgo the cold shower and shave in order to get some breakfast, as I chose to face the frigid water in hopes that the bus would be late and I could still snare some biscuits and coffee on the run. Dang that was cold! I exited the shower and tried to slide the door back the entire apparatus came unhinged and crashing downward. Shaving my my beard and at the sink navigating around the broken plastic/glass was a chore. The morning was indeed off to an interesting start! And as anticipated the bus was bit late, so I inhaled some eggs and beans and threw some coffee down the hatch and then boarded the bus to Somotillo. I took a moment to reflect that although we were in the second poorest country in this hemisphere (behind Haiti) the beauty of this land was worth a million. The view out to the San Cristobel volcano looked gorgeous in the morning light and many of us leaned over each other to try to get a moving photo through the bus windows (note to reader- this never results in a quality photo). During the drive I embarked upon a new book by Michael Creighton called NEXT and then sadly was told that he had passed away last year. The Harvard medical school grad wrote many novels and also was the force behind the TV show ER.

We reached the health clinic in Somotillo at 8 am and the line of patients was enormous. I tried to take a picture that captured its enormity- the crowds of a few thousand stretching down the street and around the curve. It reminded me of the start of a large marathon race. The majority of the patients were mothers with their children. Most of the fathers away in the fields working. I went over to the food stand that I had spotted yesterday run by a few ladies named Erika and Cristina and they yelled out, “Hey Andres!” Wow, they remembered. “Me falta un café (I need a coffee)”, I said. This was no STARBUCKS. The water heated up in pot over fire, a chicken ran by, and Erika’s premature little girl was crying at top volume. The instant NESCAFE coffee was not nearly as good either, but it woke me up and got me through the morning. Cristina begged me to get her baby some more vitamins, and also some cream for the rash. I saw a stash of medication that they had collected already (no doubt in barter) and began to see the way that things work around here.

My translator today was an extremely knowledgeable woman named Karen who currently lives in Managua but grew up in the United States in Los Angeles. Her English was better than many Americans I know. She had done quite a bit of medical translator work before, and with these skills we set a rapid pace of seeing patients. It was a good thing considering the line outside. In the examination room with us were Dr. Barretti, Dr. Ed Taylor (Family Practice doc), CAPT Sheehan (Nurse Practitioner in Public Health Service). We were flying. By mid-morning we had already seen about 800 patients, and the line outside still kept going and going… Most patients here in Somotillo were the same- country farmworkers and housewives – the overwhelming majority of whom had headache, gastritis, and dizziness. So much so that we were already filling out the forms by the time they presented to us. Some unique patients that I saw were a woman who had no teeth, but wanted to show me her smile anyhow ☺, a man sporting a Nautica (one of my sponsors) cap and having no idea what Nautica meant, and an 80 year old woman who had twenty children over her lifetime. At eighty years of age she told us that her youngest was 30 years old, and that only eleven of her children remained alive today. Many of them were killed in the Contra-Sandinista conflict during the 1980s she said. I had to take a moment and regard the uteral courage of this woman. Upon further questioning I found out that she has over 100 grandchildren all throughout Nicaragua. What a life force!

The crowds were so large that we ate a working lunch, having some MRE crackers and cold beef stew while answering questions about headaches, gripe (flu) and cough (toz). Early in the afternoon Karen and I went through the typical patient visit and wrote out the prescriptions for a nice mumbling young lady and thought we were through, but at the end she opens her mouth and showed us something. She had a frenulum (that piece of tissue that connects your toungue to the bottom of your mouth) that held her entire tongue down. She had extremely limited movement ability for her tongue and she was able to tell us it prevented her from rolling her R’s and speaking effectively. I thought how nice it would be to get it cut back, and ventured with the woman over to Dentistry to see if we could do some minor surgery. No more surgery room aboard the USNS COMFORT, but with some urging and serious courage on this girl’s part we decided to do it right then and there. We numbed up the underside of the tongue, and got out some sharp scissors, and Dr. Sanchez dissected away avoiding the large bleeding vessels and carefully giving this girl the ability to move her tongue around (something that we take for granted every day). Afterwards she could roll her R’s (I still can’t for some reason and am considering a frenulumectomy, but others tell me that is not the problem).

The afternoon wore on and we began to see our first patients from Honduras. CDR Ed Taylor, who is from Honduras originally, jumped up and told the room when he encountered a nice woman from his home country. She had heard of the USNS COMFORT team being close by and had crossed the border to be seen. Several more followed and many more would come over the next few days I am sure. Outside the crowds became unruly outside the pharmacy, and the pediatrics waiting areas were overflowing us adult providers agreed to see some kids as well. The pediatric bail out was fun and gave a change of pace to see some different issues- lots of scabies, diarrhea, parasites, and parents stating that their children were not eating (no appetite). Most of these children were normal weight and their mothers were the opposite. But have to put it gently. Health education and reassurance I think is ofen times the most valuable in this type of setting and population.

By the time 5pm came it had been 9 hours of seeing patients, and in all the site had seen close to 2000 patients. I must have seen close to 150 and Barretti, Taylor, and Sheehan was up there as well. As we so often joke on this mission that it is “Not about the numbers” CAPT Sheehan pushed the joke even farther as he grabbed the stacks of hundreds of patient encounter forms and flipped through them all. It was a record setting day out there today, and the most prescriptions given out by far for the entire mission thus far. Great job to the Medical Military Strike Team led by Dr. Cole!

Thoroughly spent we retreated to our hotel in Chinandega, and found one hundred of our fellow humanitarians there as well. The boats and helicopters were grounded due to bad weather and they all would be staying over crashing on our floors, or on cots if available. I joined the table with CDR Santa (UNC grad and Navy NP), Jefferson Medical Student Majit Gupta, and several others including Dr. Richard Soetens, a Dutch physician. Soetens claimed a cot in our room. I’m not sure if either of us got any sleep that night with Barretti’s drunken snore. Well, until tomorrow from Nicaragua. Buenas noches.

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!).

Nightlife on USNS COMFORT / July 4 with the Surgeon General

What does the crew do at night aboard the USNS COMFORT you may wonder? Well last night may illustrate a few of the options. There are only so many places to go and things to do onboard a ship. After dinner, I ventured towards the operating room. Inside I saw a group of folks watching the movie “Don’t Mess with the Zohan” (relatively funny Adam Sandler movie). Two of my friends, LCDR Vic Diaz (my Nurse Anesthetist roommate) and Lieutenant Junior Grade Marcela Zelaya were part of the group. Those two could be brother and sister.

Zelaya, whose family is from El Salvador, is extremely smart, speaking six languages, getting her PhD in astrophysics, and a former Olympic Trials qualifier in swimming. If they made a female version of the Zohan who was from Central America it would be Marcela. She’s Wonder Woman. After a while I grew tired of the movie and moved along to see what else I could find going on aboard the ship.

I ventured back to the galley to get some more water because I was already dehydrated (hot ship). People are stil getting soft serve ice cream, but I decide against having another. In line is LT Matt Gill, public affairs officer extraordinaire for the mission. I’ve been corresponding with Matt for months now, working on several strategic communication initiatives to get the word out about Continuing Promise 2009. He is a levelheaded Naval Officer with Explosive Ordnance Disposal and Navy Diving background.

Gill is steady, does not overreact, stays on point and gets the message across- just what you need in a Public Affairs Officer. You wouldn’t know he has such a dry sense of humor until you got to know him better. He has a great family back home in Norfolk and soon they will be headed to their new port station in Naples, Italy. I snap a photo of him and move along.

I hear my name (or something close to it) called from across the room. It is Warrant Officer Tuparan- a gregarious Navy Officer of Filipino decent who works in Patient Administration. “How you doing Alec?Need anything?” He’s the guy who knows how to get something if you need it. Kind of like “Red” in the Shawshank Redemption.

So when the paperwork needed to be straightened out, Warrant was the guy who knew someone who knew someone. “Nah, I’m good Warrant. Thanks, though!” I filled up another glass of Gatorade and picked up some more saltine crackers (that’s all they have to eat on the mess decks after dinner is over). I like the crackers. Warrant Tuperon always has jokes, and smile on his face. I hope his kids will go into Navy Medicine as well.

There is someone singing/rapping “In Da Club” by 50 Cent from across the room (fairly well I must say). The ship is having their COMFORT IDOL finals tonight – Karaoke style. I just watch for a bit, and see that the guys and gals are having fun. The “Fun Boss,” Jeremy (recent Penn State grad, not in the military) has things under control and is doing his job. The Fun Boss’s sole job that he is highered for on the deployment is to come up with events each night and at liberty ports for entertainment.

He hosts Bingo nights, Video game competitions, Athletic bouts, Karaoke, Movie Screenings, etc., etc. I went up to him and asked if he had a business card. I just want to see if his card reads “Fun Boss”. One of my good friends worked for the Sheraton in Hawaii and his job was the “Director of Fun” for the hotel and that’s what his business card said. No kidding

I ventured downstairs to the Officers Lounge and found CDR Bill Graf. Dr. Graf is an interventional radiologist and a fellow Navy Deep Sea Diver. He is a steadfast athlete, and we always seem to find ourselves PTing (physical training) next to each other.

I just found out a few days ago that Graf and I both grew up in Lancaster. A cool thing about the Navy is that you can be halfway around the world, and meet someone that grew up down the street from you. Two days ago while running with Graf on the treadmills I noticed the yellow LIVESTRONG bracelet on his wrist. “You lose someone to cancer, Sir?” I asked him. He told me the story of how his wife had lost someone and was very active with fundraising for cancer research and supporting the LIVESTRONG movement created by cancer survivor Lance Armstrong. I told Graf the story of my uncle who had rapidly and painfully lost his life to pancreatic cancer and the work I do with PANCAN.org. Tonight Graf handed me a cap and a yellow LIVESTONG band. I put is on and we got a photo. “PA Pride” (Pennyslvania Pride) we both said and pounded fists to our chests.

Time to head back to the other end of the ship and see if anything is happening back there. I stop quickly to check the computer and see if the outside communication is working. As usual the answer is no. Only email we are receiving is from intranet (within the ship). The one message I did receive internally from the supply office informs me that I have a letter and package waiting at the post office. Wow! Things were looking up. I go up there and ask the postal clerk (it’s after hours but they are still up watching movies) what he’s got. He hands me a bag and a letter.

In the bag is a white T-shirt with El Salvador proudly painted on the front with adjectives and things that make the country special. It was a gift from one of the El Salvadorian patients I had seen and the note expressed her thanks to all on this mission. Even though the T-shirt was three sizes too small, and had colorful writing that would not last long in these washers, it was the best token of graciousness that I could have received and it made my night. Thumbs up to you!

In a jovial mood, and feeling even more joyful because it was the eve before Independence Day, I decided to return to my favorite chair in my room and put in the HBO TV series John Adams. Very fitting to watch the signing of the Declaration of Independence that occurred 233 years ago on a DVD video player on my Mac on my lap in the underbelly of a floating converted Oil Tanker off the coast of Nicaragua. If you have not seen this Series based off of David McCullough’s book chronicling the life of our 2^nd President John Adams, I highly recommend it. Paul Giametti does a fantastic job playing Adams and clearly shows the courage and fortitude our founding fathers displayed time and time again so that we could live with life, liberty and the pursuit of happiness. I have not felt very homesick up until this point, but everyone wants to be on American soil for July 4^th. So any of you reading this, please give a salute, a howdy! and a thank you to any military personnel you know serving around the world today. With these thoughts in mind, I dozed off to sleep in the chair, woke up at 1am, and my first thought was Happy 4^th of July! Next thought was “Hey Baldwin, get in your rack for Pete’s sake! You fell asleep in this chair for the past three hours!”

Happy Independence Day! I am still shipboard since I’ll be working the back half of our Nicaragua stay ashore (my friend Karen Jacobson and others have been out there the past few days). Today is another good opportunity to work out a lot and read medical textbooks. This morning was the ritual Dave Bacon spin class, followed by a reading session on Bioterrorism agents. When I was falling asleep from the material, I decided it was time to work out once again. Sick of running and falling off the treadmill, I asked a recent Newbie, LCDR Lynn Sterni if she wanted to run the ramps of the ship with me. She nodded yes in a manner that said “yes, get me out of here!”

The ramps are switchbacks used for loading and unloading large cargo, and also the entry point for mass casualty receiving. The walls of the ramps are lined with stretchers and the floor painted red to conceal the blood. Pray we do not have to use them. From bottom to top at a gentle incline is .16 miles. So going up and down three times completes a mile. Sterni is a pediatric anesthesiologist in the Navy. She has red hair, practices in St. Louis, is super nice, and I always see her working out. I come to find out while running the ramps that she is an outstanding runner and triathlete. I was winded trying to keep up with her. Turns out that she was at the TAPS Good Grief Camp in D.C. that my foundation Got Your Back Network (www.gotyourbacknetwork.org) helped out with in May for families of the fallen. Very nice thing for her to do. She is quality people. After 9 times up and down on those ramps (3 miles) in the stifling heat with calisthenics in between, we were drenched with sweat and spent. Two solid workouts on the 4^th and we were ready for the Ice Cream Social that evening.

July 4 was extra special this year on USNS COMFORT. The Acting U.S. Surgeon General, Admiral Galson, came aboard with his staff (my friends Julie and Tomas) to visit the ship and to celebrate the anniversary of the U.S. Public Health Service.

We have just shy of 100 Public Health Service Officers onboard from all throughout the country. They serve in numerous roles from Environmental Health Officers, to Epidemiologists, Physicians, and Veterinarians. Over the past few months while in Washington, D.C. it is been an honor to help Admiral Galson with his “Healthy Youth for a Healthy Future” initiative combating childhood overweight and obesity throughout the United States. For more info see: www.surgeongeneral.gov and pledge your support today.

For the Surgeon General’s visit we had a very nice dinner in the Wardroom with distinguished staff. They brought out the best china and silverware for the occasion and everyone in attendance had a personalized nametag at their table setting, as well as a colorful Independence Day menu.

Given the choice of ribs or chicken, I went for the poultry. I sat next to a very nice Veterinarian LCDR who I found out attended Cornell University for Veterinary School (the same undergrad school that my parents and sister attended), and it was fun to talk about the beauty of Ithaca, NY and Cayuga Lake. I have been there many times. Across the table from me was CAPT Beadle who has led the Medical Operations and planning for this mission from the start. She is the brains and the powerhouse behind the medical planning and execution. I told her good job- “Bravo Zulu ma’am!” Bravo Zulu (BZ for short) means good job in Navy lingo. “We’re not quite there yet! Almost,” she said. With all the moving parts that this mission has, the amount of time she has put in is remarkable. I hope CAPT Beadle feels proud and people give her a pat on the back for the great job she has done. Dinner was excellent (best food I’ve had on board yet) and I thanked the Petty Officers who served us and asked them where they were from and what their goals were. Solid kids. The Surgeon General made some remarks in addition to the Commodore (Captain Negus), Captain Ware (Medical Commanding Officer), and Captain Finger (Ship’s Master). They call this trio of Captains the “Three Amigos.”

After dinner we had the usual 7pm Confirmation Brief, and the packed mess decks as always felt like a sauna. The Three Amigos name a “Person of the Day” every evening and tonight it was a truly special person- the lead vocalist for the Air Force Band. As if on cue she took the microphone and started singing right in front of the American Flag- “God Bless America.” The entire crew came together singing in unison to finish out the hymn and you could feel the pride. The only thing missing was fireworks. But we did have Ice cream! Tonight it was the real stuff- fresh with several flavors from the scoop- no soft serve. As they turned on the movie Flags of our Fathers, enjoying the dessert, smiles abounded and we (at least for a little while) forgot we were off the coast of Nicaragua. In our minds and in our hearts we were home, proud to be Americans, celebrating the day that 233 years ago fifty six patriots pledged their lives so that we could live in freedom. God Bless America.