Jailolo - Epilogue

Jailolo – Epilogue
I’ve been back on the ship for a few days now and we are in a new location – Ambon. While I still have some day visits ashore remaining, Jailolo will be for me the defining week of the entire mission. It is one thing to go ashore in the morning, see patients, then return to the ship, and quite another to remain in the environment for an extended period of time. The latter situation intensifies the experience and makes it more intimate and real. Your experience is a more subjective one as you are a participant in the drama rather than the more objective experience of an outside observer. While the week was intense I do know that it doesn’t come close to what those who have gone to Haiti have experienced post earthquake. Conditions are far worse in places such as Darfur where the population is enormous and mostly displaced and where attacks on the innocent by the warring factions have been as deadly as disease and starvation. You don’t see people here lying around because they are so weak from lack of food as in some places in Africa where there is famine from crop failures or conflict. Still, it is difficult to see so many people with diseases that could be easily prevented with some basic public health measures or that could easily be treated in early stages before serious consequences develop. One of the recurring themes in my postings was my frustration in not being able to do more for the patients, especially those with chronic diseases or complicated issues. I wasn’t prepared for the limitations of what one can do when you pop into a location for a few days with the minimal supplies and personnel that can be readily flown in and flown out from a ship anchored out in the ocean miles away. I wasn’t prepared for the notion that seeing 100 patients in a day would be not only desirable, but encouraged. I wasn’t prepared for the ethical dilemma raised (in myself) by the conflict between the utilitarian goals of the mission, which is really to promote relationships to pave the way for more involved missions in the future and which translates into seeing as many people as possible, and the more individualistic goals of hands on patient care where each patient you see you feel a responsibility towards. I found it somewhat ironic that I had a hard time with the utilitarian goals of this mission as I have thought in the past, from a detached theoretical standpoint, that in our own system it doesn’t make sense we will spend so much time and resources to save a person, especially a child, in situations where the chances of success are extremely slim yet so many more people would be saved if that money were spent on basic prevention and early treatment interventions. Funny how having personal involvement can affect your thinking. I still think I did what for me was correct in spending the extra time with the woman with very high blood sugar or seeking admittance for the young man with TB but I do see and respect the counter argument that my approach meant others were not seen at all. Guess I will have to ponder this issue some more. Perhaps it is my own selfish desire to see that “I” have done something concrete that is getting in the way. We humans have trouble with those gray areas in life. I should point out that there were many other aspects to our mission that had readily identifiable concrete results. We did a large number of surgeries on board that had life altering results for a number of individuals (cleft palate repairs, etc.). There were teams on engineers in the fields redoing clinics and schools to make them safe and more effective, and digging wells to improve access to safe drinking water. There were veterinarians who went in the field to vaccinate animals and educate. I saw one picture of a baby deer that had been caught in a trap and the vets created a splint made of bamboo for it. There were teams of health educators who provided education and training on various topics. There were dentists pulling teeth (a widely needed treatment here). There were optometrists doing basic eye exams and dispensing donated glasses. There were people spreading good will and cooperation.

Medcap in Peleaw

Went on a medcap yesterday in this small remote area of Peleaw. How remote was it? Well, so remote that we had to be "inserted" via a helo. It was my first helicopter ride in my life. I thought it was very exciting!I looked so funny with the helmet,goggles and vest on.Again, I will try to send a picture when I can. One of the doctors joked about how the locals view these helos. When they land, all the people come running out to the field(looks like some sort of soccer field) and all the chickens, cows and goats run in the opposite direction. It is quite comical to watch!

I was at this location on the 3rd day of the medcap, so the locals were accustomed to seeing us, they were also sad to see us leave. The site was set up in a clinic, and the local officials were there to coordinate the care given.Their nurses set everything up for us and coordinated the patient administrative stuff.Also, the medication formulary was approved by them prior to our arrival. There was a real feeling of cooperation amongst the several nations present, in the care that was delivered. I saw people from 3 months to 82 years old. Not sure how many patients I saw, but they kept coming and I just kept seeing them! There were all sorts of skin rashes, old injuries, respiratory illnesses, etc... Some of the illnesses were specifiic to this area and many were sort of generic, same as we see back home. Yes, they have many people with metabolic syndrome, hypertension, diabetes..etc. Did I mention the KFC in the mall at Ambon? Can't blame it all on America's influence though. Their diet is high fat and high carb as well. They seem to fry many things here(fish, banana, eggs etc...).Of course they also eats lots of white rice... morning noon and night. I also noticed that most of the men smoke cigarettes and many men and women chew betel nut. The betel nut stains their teeth an ugly reddish-brown, most of the adults show evidence of this. I hear it is addictive and somewhat of a stimulant. If it weren't for the staining of the teeth, I may have tried it. But no way would I want my teeth looking like that!
It was a productive day and also a tiring one. I have one more medcap tomorrow and am looking forward to it. Vanessa will also be going, this is the first one we will be on together. We will write more after returning. After that, things will be starting to "wrap-up" and we will be on our way to Australia! We are already planning our itinerary. All for now!

Jailolo - Days 6 and 7

Days 6 & 7 – Today was the last clinical day and probably a good thing as I was spent. Started earlier and worked through lunch so we could finish early. The hospital staff had a party for us at the local beach. Seemed like many of the patient today were coming in just to come in and get meds. Actually that is okay and not discouraged because a major part of our mission is to spread goodwill and develop relationships. Just seeing and meeting the people helps develop relationships in the long term and will help allow future missions that can do more medically. That has been hard for me to understand as a provider as I feel so focused on the individual patient and as I have written about, those cases where I felt helpless because of not being able to do much medically. The bigger picture is also quite important, and many would say more important. Of course, there was at least one heartbreaking case for the day. A young man and his wife came in from a village 2 hours away. He looked like he was on death’s door. Wasted, ashen, sweating, barely able to walk, having much difficulty breathing, and coughing. After some questioning is was apparent he had known TB, had begun treatment in his village, but because of misunderstanding had only completed 2 months of the 6 month treatment regimen for it. I had previously seen active TB cases, but nothing like this. True consumption you read about from the age before antibiotics. He would be an ICU admit in the US but that wasn’t available here unless he could afford the hospital in Ternate, a 2 hour boat ride away (which he of course couldn’t). Because he was so weak, my only thought was to try and get him into the hospital here and hope he somehow got proper medications. You can get them for free at the health clinic which is not nearby but it was totally unclear if he could get them at the hospital (ironic don’t you think). Anyway, I had the interpreter ask the staff if admission was possible and at first I was assured that it was and that nursing would come and get him. After some time someone came and took him away (they didn’t bring the wheelchair). It was the ER doc from Tuesday. All I could do is cross my fingers and hope he would be taken care of and continue on seeing other patients (long line waiting). We ended up going later than expected in order to see everyone and at the end, one of our own went down with heat exhaustion. Had to be helo’d back to the ship after stabilized. We all were certainly ready for the beach after that. The beach was beautiful, or I should say the views were incredible. Unfortunately, trash is dumped everywhere here, including on the beach. There was a pier however and we were able to jump off it into the ocean. The water felt wonderful and for the first time in a nearly a week I didn’t feel sweaty, sticky, and dirty and I did feel relaxed. So relaxed I missed the dinner that had been prepared. The next day was a day to get packed up then back to the ship. One helo was down so our departure time was delayed until early afternoon. Our commander arranged for a tour of the island which was great. These are the Spice Islands and it is season so as we drove we saw blankets stretched out everywhere with cloves drying on them and the scent was ever present. The last stop was a sacred place on an isolated beach where the Sultan’s birth home was located. It was quite nice and because it was isolated, no trash on it. An elderly lady, her daughter and grandson were sitting out and she waved me over. She said in Enlgish “My name is…..” so I thought she spoke English. I asked her something and she again repeated “My name is….”. She was very cute and invited me in for coffee. I so wanted to say yes but we had to leave. I do have a picture with her I hope to post soon when I have better internet service. By early afternoon I was on the helicopter back to the ship and our mission was over. Although I couldn’t wait to have a hot shower and sleep in a relatively comfortable bed and cooler air, it was sad to leave the team I had been with all week and the people we had tried to help all week. I do want to say that our team was really fantastic, from our commander on down. If I had more time and space I would have written about them. Many very interesting and dedicated professionals whom I had the privilege of working with.

Jailolo - Days 4 and 5

Day 4& 5 – Both Wednesday and Thursday were very busy days and I picked up the pace (somewhat) seeing patients, partially because there weren’t as many tough or dramatic cases as in the first two days. Still there were certainly some including more patients with active TB, patients with partial paralysis from strokes looking for a cure to make them like they were before the stroke, hernias in need of surgical repair, inability to get pregnant, and others. For some reason on Thursday I had 3 women who all came in with signs and symptoms of Grave’s disease including anxiety and tachycardia. All I could offer was a small supply of metoprolol and a rec for them to go to the public health clinic. Even if we could treat their hyperthyroidism, it would be a major issue trying to treat their subsequent hypothyroidism. Even giving metoprolol for symptoms was a dilemma because as was the case for all chronic diseases, we could only give a short supply of medications and it was very uncertain what would happen when that supply ran out. Also, I knew that propranolol is preferred for symptomatic hyperthyroidism, but we didn’t have it and our formulary was Indonesian so probably wasn’t available locally anyway. I took the path of treat then firmly explain the need to take the meds every day, to never miss a day, to get more before ever running out, and to never stop taking the meds even if they felt well. Others took the path of referring them to the local clinic and give no meds on the sound rationale that short term treatment was worse than no treatment and those motivated to be treated correctly would go to the clinic. Wish I could do a study to see which led to better longterm outcomes. The most memorable patient was a women who was very shy and obviously scared who spoke in a whisper. She said she had suffered from hoarseness for over a year and it had started soon after she found a lump on her left throat area. She said she went to have it checked and was told it was nothing to worry about but that her hoarseness had just kept getting worse, the lump kept increasing in size, and now she was tired all the time and was losing weight. She had a large firm discrete palpable mass that was not goiter as I had seen in a number of previous patients. My interpreter, a medical student here in Indonesia, let her know that we were both very concerned about this and that she needed to be seen right away but I think we all knew what was likely happening and what the outcome would be. Both the interpreter and I had to fight back some tears as she quietly left. Certainly we saw many, many patients whom we were able to do something positive for and I do need to point that out. There were many people with acute infections of varying types that we were able to effectively treat especially since we had alternatives to the amoxicillin which is so often used (and misued) here. We had treatments for worms, malaria relapses, pneumonia, cellulitis, sinusitis, middle ear infections, and on and on. There were many, many more such cases than the difficult cases I have described but I think medical professionals expect to be able to help everyone so we most often remember those patients we couldn’t help much medically (although hopefully we helped them in other ways). I was exhausted by the end of the day Thursday but the good news was we were going out for a night on the town. Okay, so there wasn’t really a town but there was a restaurant with karaoke. Wasn’t sure what to expect but the place was very clean and comfortable and the food was amazing. Fresh local fish grilled, lotus leaves (I think) sautéed (think greens), the best chicken sauté I have ever had, a hot pepper salsa, rice, and beer. The karaoke was fun, and no, I didn’t sing.

Jailolo - Day 3

Day 3 – We stayed on site at the hospital for the second day of clinical. Unfortunately it was hotter at this site and there was absolutely no air circulation in our exam rooms. Also, some of the local workers smoke in some of the rooms (in the hospital). There was a long line of people waiting early in the morning. One of my early cases was a woman who came in stating she was diabetic, had run out of medication two weeks ago, and wasn’t feeling well the past few days (and she didn’t look well either). Luckily we had a glucometer so we checked her blood glucose (fasting since she hadn’t eaten since the previous evening). The result was above 500, beyond the detection level of the machine and was the same when repeated. For those non-med folks, normal would be less than 100! I wanted her to get insulin, fluids, etc. but we only had glyburide in our formulary (again, our formulary was what the government here would allow us to get from them) so I asked if there was a possibility of admitting her to the hospital and them giving her insulin. Well, they didn’t have insulin either and if they did, she would have had to buy it. I was feeling pressure to see more patients but I couldn’t just give her some tablets and send her on her way so I had her take two tablets and had her sit outside and told her to drink plenty of water and that we would recheck her blood sugar in an hour. After an hours of seeing other patients we rechecked it and it was still in the high 400s. I asked to remain for another check in an hour and then went back to more patients. The local “ER” doc came over for another reason and I thought maybe he could take her and have her observed for awhile and check her blood sugar. After explaining the situation I showed him the patient and he smiled and said”Oh, that’s one of my patients.” He then waved at her then promptly left, not to be seen again. I was dumbfounded but now think it was probably a matter of him not really understanding what I was saying. Like many cultures, people say yes they understand when they really do not. So I kept her there until her blood sugar was in the low 300s then sent her off with meds and a promise to get more before running out and to never run out. Then I crossed my fingers. Next was the patient with partial paralysis from a recent stroke who had run out of blood pressure meds. So I checked the BP and it was 215/110, another stroke waiting to happen. I gave him a combo of BP meds and had him promise to take it now then also to never miss a dose or run out of meds (again I crossed my fingers). Another woman with apparent metastatic breast cancer. Not as dramatic as yesterday but just another sad situation. Then a man covered in dirt came in emanating a rather foul smell. He lifted his foot to show me a gaping, smelly hole that went to the bone (this wasn’t apparent until after it was cleaned). He said he had the wound for 20 years but that it got worse lately. Not sure how that could be but anyway I had him with high doses of oral antibiotics, topical antibiotics, and a good cleaning with a dressing by the wonderful med techs. They showed him how to do it himself but again, crossed my fingers. Of course, most cases were not like these four. Again, many vague complaints. However, this is actually fine as major goal of our mission is to build relationships and establish goodwill in this country so despite the limited ability medically, this latter mission was achievable.

Jailolo- Day 2

Day 2 – We awoke, or I should say got up as I never really went to sleep, at 6 am to prepare for our first day of work. Despite my bird bath I was already feeling pretty grimy and we hadn’t started working yet. Breakfast came (arrgh! No coffee. I don’t drink soda but Coke became my morning beverage this week). We mustered early (roll call) and packed up our medical gear as our first medical day was offsite at a rural school. Anytime we went somewhere it was a caravan of SUVs with a police escort. You would have thought we were important dignitaries. I was glad though that we were doing this today as I wanted to get some idea of what the local area was like. I’m not sure what I expected to see but I think I was surprised somewhat by what it is like here. I expected poor but in a different way (the more romantic poor with huts, and little gardens, etc). It turns out that much of poor today is filth mingled with modern touches. By filth I mean open waste, trash everywhere, smoke from burning things, etc. Such a weird contrast between the tropical beauty when you look at things from a distance. The modern was the abundance of satellite dishes. If nothing else, many people have TVs. Other than our SUVs, there are almost no automobiles. However, lots of scooters. I saw a family of five (mother, father, 3 small children) all on one scooter. I saw both mosques and churches on the way but they were not in the same locations. It was indicated that Christians and Muslims here don’t mix and further discussion of this issue was discretely ended. We arrived at the school and there were already many people waiting in line. Okay, now the medical part begins. I already knew that we would be seeing 60, 70, or even more patients each, each day, (something I have never come close to experiencing) and we would see all sorts of things whereas my NP experience was almost exclusively in cardiology so I was a little anxious about this. Vanessa and I set up in a large room with two tables and we each had an interpreter and a few instruments and some bags of vitamins and Tylenol. Then the day began. We saw people with active TB, relapsed malaria, interesting derm issues, allergies to fish, or meat, or eggs (I soon learned to be skeptical about such allergies), COPD (smoking is epidemic here, shame on the tobacco companies), diabetes, hypertension, asthma, things I had no idea what the problem was (between lack of education and different dialects the translator’s had difficulty with it was often hard to get a good history), and many other things. Also, no vital signs were taken at intake so we only took those if we really thought they were necessary. So in 5 minutes and with basically just a stethoscope (otoscope if indicated) had to diagnose and treat. We had a limited formulary based on meds the Indonesiam government allowed us to obtain here as they wouldn’t let us use our own. Oh, have to stop here to give a high 5 to our military med techs Lisa and Jessica. They were fantastic as were all the other personnel on our team. The defining moment of the day is when Vanessa and I at the same time were seeing dramatic cases. She had a woman with by far the largest goiter I have ever seen. One of those textbook pictures (we have pictures so hope to post it and we did get patient’s okay before taking them). I was seeing a woman who stated that just over a year ago she developed a lump in her right breast. Now it was this huge, seeping tumor jutting out and her lymph nodes were huge and she had weight loss, etc. Think you can guess what that meant. Both very sad situations for us. For the goiter (we saw a number of other cases over the days) surgery and then thyroid hormone replacement would be the treatment but our surgical schedule was already full and we didn’t take such cases anyway as there would unlikely be followup to provide synthroid postop. Chronic diseases were a really tough issue for me over the days as while there are meds available, almost everyone who has a chronic disease only takes them sporadically, mostly because of cost, but also, like at home, the mistaken notion that you don’t need to take the meds if you feel well. As for the breast cancer patient, about all we could do was clean and dress the tumor, give some pain meds, provide some comforting words, and refer her to the local clinic. I would say that there were at least one or two patients each day that caused me to tear up. The other such case that day was a woman who had severely burned her left hand 4 years ago. It was badly scarred and deformed. Her wedding ring was still imbedded in the scar tissue and she just wanted the ring taken out and her hand straightened. Many people came in with M/S complaints such as low back pain and when I found out what they did for work (e.g. an elderly woman who chops wood everyday) it was no wonder they had such issues. Taking time off to rest isn’t really an option so depending on the patient, it was either Tylenol or ibuprofen. There were many, many patients who had pretty vague complaints or who outright stated their purpose for coming was to see us and get meds. One medicine that is readily available and everyone seems to take for everything is amoxicillin. Apparently it cures low back pain among other things. Tried to do teaching on the misuse of antibiotics but as we know, even at home, people want antibiotics for viral infections even though they are told it won’t help. So in about 7 real clinical hours I saw 60 patients. Turns out I was one of the ‘slower’ providers. Overall though I really liked being in the clinical setting and was happy to really be working. After dinner that night I sat out back where it was quiet. The evening call to prayer began. So beautiful and exotic. I thought how truly lucky I was to get the chance to experience this. That night I slept like a log despite the heat (and my roommate’s amazingly loud snoring). Okay, I confess, I had earplugs in and on top of that my noise canceling earphones. I like my sleep.

Jailolo Day 1 Pictures

Our boxed meals which we received twice a day (this was the fried chicken with the fixin's)
and yes, we drank coke for breakfast also

Randy and I with the Jailolo Hospital nursing assistants

My roommate Liz (an FIU alum) cleaning our bathroom

this is what our cots looked like once they were set up

Jailolo - Day 1

Jailolo – Day 1
Wow, what an amazing week in Jailolo. First, I will start with how it ended. This morning, before the helicopters came to pick us up to go back to the ship, I was sitting in front of where we were staying when I was jolted out of my chair. A big earthquake! Much more intense than I ever felt in all my years in California. Later an aftershock that seemed just as big. We were on flat land near the ocean so couldn’t help but think about a tsunami. Well I did read this was a highly seismically active area. Weird thing was that I didn’t scare me. Okay, so instead of writing one really long blog I will post a recount of each day over the next week, internet permitting. At some point I will add pictures which is not likely until Darwin. The week began last Sunday when we awoke anchored off Ternate. It is a cone-shaped island, basically an active volcano sloping down to the ocean with a city built on one side. There is a huge mosque right at the shoreline. The city was evacuated in the 90’s when the volcano erupted. Really quite a view but then there are so many such amazing views here in Indonesia. In the early afternoon we helo’d to the village of Jailolo which is on a larger island nearby. I was definitely as excited as any kid to get geared up and take a Navy helicopter to our site. Hopefully Vanessa can get a picture on showing us in our gear. When we arrived, SUV’s were waiting to whisk us away to the local hospital. Our driver sped off and immediately began honking his horn and then about 15 seconds later (and approximately 150 yards, a short walk) we were there. The hospital is a complex of one story buildings but you could immediately tell there was no ac and there were no screens in the windows (the mosquitoes here carry malaria, Japanese encephalitis, and Dengue fever). More about the hospital in later blogs. There some local men out front and I noticed all were smoking and it smelled like cloves. This is the Spice Islands after all. The locals were all smiles and throughout the stay they were very friendly and always smiling and laughing. Initially I wondered if we looked funny our something as they always laughed we went by but soon came to realize just a cultural norm. Made me think of back home where some people will stare and scowl when strangers come around and I decided I prefer the laughing. We went to our building and my roommate and I got a tiny little room with two small cots and mosquito nets. Our first task was to put up the nets (there were no poles or anything). We went out back where a local man macheted some bamboo for us. Different people used different methods but I put 4 bamboo poles of equal height at each corner of the bed, secured them with twine, and put up my net. It was high enough to sit up in bed and looked pretty good. Not bad for never having been a boy scout. There were no showers, no ac of course, and no flush toilets. You must see our bathroom and I will post that picture when I can. There was running water but we couldn’t use it for brushing teeth, etc. There also were no screens on the windows. Oh, and we started sweating the moment we got off the helicopter. The rest of the crew arrived and we unloaded the cargo and set things up and then our local dinner arrived. Originally we were going to have the prepackaged MRE’s 3 times a day (the packaged rations that last 20 years) but they were able to arrange delivery of local food for breakfast and dinner. Every meal we got consisted of rice, fried chicken or fish (small whole fish), some type of egg, tofu or noodles, hot sauce or salsa, and fresh bananas or papaya. Pretty good although I couldn’t eat it for breakfast every day (had a stash of poptarts as an alternative). After dinner we saw some young women in white outfits and asked some interpreters if they were nurses. Of, first about the interpreters. We picked them up in Jakarta. Almost all were nursing or medical students or were working nurses or doctors. They are all extremely nice and so, so helpful. Think I already told you about out interpreter in Tebelo who insisted on buying us some local treats. Anyway, both the interpreters turned out to be working nurses in Jakarta. I asked about their education and working conditions and sounds pretty similar to nursing in the US. However, that is Jakarta (the majority of the population lives on the island where Jakarta is located). Out here there it is a different story. Both resource and education-wise much less advanced (perhaps analogous to New York City versus Appalachia). It turns out the young women in white were nurse’s aides who were also in nursing school. They were 16 and 17 years of age. I was impressed with how their uniforms were so white and pressed and how professional they looked despite the tropical heat and humidity. Think Miami in August. We had an early morning the next am so I went to bed but didn’t sleep a wink that night (but I did sweat a great deal). Well finally the adventure I came for had begun.

Liberty in Ternate

Spent yesterday on the Island of Ternate... had a great time! We took a tour of the interesting and historic parts of the Island. We stopped at 2 different forts that were built by the Portugese back in the 1500's-1600's. The views from the forts were nothing short of spectacular, hope I was able to capture it on camera(will download pics when I can). We also visited the Sultans Palace. Yes, there is a Sultan but he does not live in Ternate... I was told he lives in Jakarta. The palace is beautiful, spacious and filled with interesting artifacts(swords, clothing, china, pictures, furniture and such). Tropical flowers, trees and shrubs are lush and found just about everywhere. I was able to identify many plants that are found in Florida as well. I have a feeling that many are probably native in these areas, most seem to grow wild here. Funny, the plants that I recognize and have in my own front yard look puny and pathetic in comparison! After touring the forts and palace, we stopped at the beach. We went to a small swimming area(a small inlet or cove) and donned a mask and snorkle. I was amazed at the abundance of coral reef formation in such shallow water. You simply stick your face in the water and there it is! I saw angelfish, bright blue neon fish, sea anemone, all kinds of coral formations and more. Don't know the names of what I saw but it was beautiful and the highlight of the trip for me. Afterwards, we stopped off to eat at a local restaurant that was recommended to us. This, I must say, was not the highlight of my trip as the food was strange in taste and texture. I guess I am not too adventurous when it comes to food!I ordered a clear green pea soup, or so I thought. They brought me a huge bowl of soup with all kinds of strange and unknown things floating in it. I tried it but couldn't get past the fishy taste and was unable to identify little bits of meat floating in the soup. Not my "cup of tea"...or soup! So far, today, my stomach is fine, so I am guessing that the little bit I did eat didn't do any damage.
After the "yummy" dinner we went shopping for souvenirs. We shopped at their traditional market which were rows of dirty shacks that sell all kinds of things(fruits, vegetables, cell phones?, clothes etc...an interesting and cultural experience. The people were all happy to see us, probably have never seen anyone like us before. Could hardly get much shopping done, the local people all want a picture with us. It felt good to be so welcomed! After the traditional market, went shopping at their "new mall". Apparently, the locals are very excited about this mall. I have to admit, I was somewhat disappointed by the "westernization" that I observed. I really wanted to buy things that were Indonesian, but found myself surrounded by all kinds of American looking things ( electronic devices, clothes such as Rolling Stones Tee-shirts etc...) all to the beat of the background music in the stores...American Rap! I'm not so sure they knew what the lyrics of the songs were about(I heard a few choice words while shopping). This is a very religious, predominately Muslim country. I have a sneaking suspicion they don't know what those lyrics mean. I have a hard time trying to distinguish the words in rap songs myself. All in all, it was a great day and one I will always remember.

Today is a day aboard the ship, don't have much going on today. Catching up on laundry, reading, studying and some R&R. Tomorrow I leave for a day medcap and Vanessa and Randy will be returning from their weeklong medcap. I'm sure they will have lots of stories to tell. We will be leaving this area tomorrow after the medcaps are completed, and then off to Ambon, our last stop before Australia.
All for now
All is "Bagus"(good)

Sick Call Duty

Well, Randy and Vanessa are still on their medcap,they still have another 4 days to go. I am sure they are working hard and seeing many patients. Meanwhile, back at the ranch, I am rattling around the ship without them. Yesterday, I spent the day studying tropical diseases. It is unbelievable learning about all the weird things people can contract! I am doing my best to avoid contracting any of them! I have been taking my malaria prophylaxis religiously(methloquin) and we all got immunized for Japanese encephalitis(contracted from "day biting" mosquitoes).

Today I had sick call duty. I spent the day in the ship's clinic(set up for the crew). I had the privilege to work amongst some of the finest physicians, NP's and PA's and they were all more than happy to share their knowledge with me. It was a great learning experience for me! When we were not busy seeing patients, we sat around and chatted about all kinds of medical things. Just a great day for me! Tomorrow is a day off but I plan on spending the day "shadowing" a physician that has agreed to let me tag along. I also plan on reading more of the medical books in the clinic(with all the exotic tropical pathology).

On Thursday (today is Tuesday), I will get "liberty" and have already signed up for a tour of Ternate. I am really excited about going. Oh, I forgot to mention the most amazing thing about who my "liberty" buddy is. Last week on my overnight medcap, one of the people on my team was an old friend from the NICU where I work in Fort Lauderdale! We worked together over 25 years ago! Her name is Regina and she is a captain in the United States Public Health Service. She has really done a lot of amazing things since we last saw one another. We have been reminiscing about old times ever since. Talk about a small world! Anyway, we look forward to having an interesting and fun 'liberty day".

I also have a day medcap scheduled for this Saturday and really look forward to getting more hands-on experience. So life is good!!

All for now!

Mission to Morotai

Hi all! I returned from my 5 day mission to Morotai. What an incredible experience! Our group consisted of several(probably 40 or more) Doctors, dentists, nurses, dental hygienists, medics etc..We left via a "band-aid" boat and transferred to 2 identical Austrailian Navy ships, which was our "home " for the length of our stay. The ships stayed anchored over night just off the coast. Early in the morning we were awoken by a "wakey- wakey" call by the Austrailians. We would wake up to a wonderful breakfast prepared by the Austrailian chef"Cappy". Man, can he cook! Huge amounts of delicious gourmet foods! All made in a teeny,tiny galley! For example, our first night we had a choice of Malaysian chicken or prawns in a cream sauce, both to die for!! Also fresh veggies, salads, breads and desserts, all prepared by "Cappy". The men slept in tents outside on the deck while the girls slept in a portable modular unit(resembling a deep freezer). A bit claustrophobic for me, but it kept us dry and cool. Each day we were taken to shore and we set up our "clinics" in area schools. The landscape is lush with coconut trees and banana trees growing wild everywhere. I was told that many of the people in Morotai are farmers. They produce rice ,coconut oils and other coconut products. The people here were all very nice and seemed happy to have us about. You can tell by their appearances that they have rough lives. It is a very poor island and the people seem to have extremely limited health care. Many have what appears to be non-existent health care. I kind of got the impression that the limited healthcare is available for only the wealthiest. We have all seen this, even at home, but this is much worse! Many of these people have never seen a doctor. Most of them look older than their chronological ages. They were all very nice and appreciative for anything that we were able to do for them. The kids were adorable and all wanted to talk with us, even if all we can say is hello back and forth. They all wanted their pictures taken with us. I will be sending some as soon as I can. For all the FIU nursing students that are reading this blog, I want to mention the most common illness we have seen so far. These are the top 10 in order. Respiratory illness(common cold), acute resp. illness(pneumonia), muscle complaints, malaria,skin infections,hypertension, gastitis, diarrhea, allergies and upper resp. infections. We have a formulary that we used, with various drugs and treated hundreds of people. I saw over 150 patients myself! We worked from about 8am to 5pm (non-stop) each day, until every patient was seen. There were many people controlling the crowds, playing with the kids and also Army, Navy United States Public Health Department, Airforce etc.. all patrolling the area for our safety. While this was going on, there are also several other medcaps and surgcaps occurring in other areas at the same time. Back on the Mercy, surgeries are scheduled each day, so everyone has been busy! I am now back on the ship. Today is a day off. I am currently writing this blog(I finally got internet access today!), and doing my laudry. Vanessa and Randy both left awhile ago for a 7 day medcap, similar to what I did, only longer and on a different island. I will be rattling around the ship without them this week. I have sick call duty a few days this week and have already booked a tour for my "liberty day" on thursday. I am excited and can't wait. I will be going with a small group to tour interesting places on the island and may also get to snorkle! I am also hoping to get some shopping in. I will be going on a day medcap on saturday, not sure after that point as the schedules are not made yet. All is great and will be blogging again soon!

Ternate

I checked the manifest and Vanessa and I muster in the CASREC at 1330 for helo transport to our MEDCAPS site for our 7 day tour of duty. In civilian talk that means we take the helicopter to the site where we will be staying and seeing patients for the next week. Very excited about this although we will have no showers or flush toilets, will be eating MREs (food in foil packs that have more than a 10 year shelf life), and will be sleeping in small popups that they call the ‘easy bake ovens’. That’s what I came here for so now I am going to get it.
First though the snorkeling trip on Friday was awesome. Fantastic coral, much better than the Keys. Also just nice to be off the ship. We got fried bananas, fresh coconut milk, and fresh roasted peanuts. The bananas were better than any plantains I’ve had in Miami and that is something. We also got a local to take his boat back to the main town and get us some local food. I got a fish (head still on), rice, and hot sauce. It was great despite my aversion to fish eyes.
Arrived Ternate this am and just looked out as the sun is now up. Fantastic cone shaped island. Very dramatic. Maybe pictures next week when I am back on the ship.

North Halmahera Island Tour

Mercy in all her glory (with a helo about to land)
view from the Bandaid boat

Tobelo

Taxi anyone?

first church on halmahera Island

Japanese bunker where the bombs were stored during a conflict

the local kids loved taking their pictures with us

At the local hotsprings were the women were washing their clothes and the water was really hot

We enjoyed some time on the beach which was absolutely beautiful

Delicious fried banana, chillies and coconut milk

Trying the coconut juice..the coconut was cut from the tree while we were at the beach

Galley duty...

Every Thursday Project Hope volunteers in the galley of Mercy in order to give the Food Service personnel a break from their duties. It is hard work but we are more than happy to help out. These guys work from 4am to 8pm every day, so they really appreciate any help that is given and also the chance to sit and eat dinner with their friends

Impromptu Celebrities?

Some Indonesian officials toured the ship and they decided they wanted pictures of Calin (the Canadian EMT) and I while we were on duty in sick bay. Their outfits are traditional Batik and the print represents their island of Halmahera

Morotai Sunset

Morotai

Wednesday July 14, 2010 - Morotai
We arrived in Morotai yesterday. From the ship it looks sort of like a miniature Maui with a valley between two volcanoes. The harbor isn’t deep enough for us to dock so we are circling it during our mission here. It looks beautiful and I can see a smaller island nearby that looks like it has a large,white sand beach. Now if it just had a Mai Tai…
The energy has changed dramatically the last two days. Patients have been arriving from shore for onboard surgeries. Medical teams have been deploying ashore via helicopter and various types of boats. It has been really hard to be here doing sick call. I have to keep telling myself it is important to take care of the caregivers and that my turn will soon come. Sick bay has actually been busy and I am enjoying the clinical work. Tonight I carry the pager so may not get much sleep.
Friday I get to go on a tour. We are going to see what are supposed to be pristine coral reefs and do some snorkeling. Really looking forward to that although not sure I have worked enough yet to get liberty. However, Sunday we will be in Ternate and I will be out in the field for 7 days so there is a balance. Actually really looking forward to it even if I won’t shower for a week.
Thursday July 15, 2010
Heard about what to expect ashore from those who went ashore yesterday. Lots of TB, malaria, derm issues, worms, and then general aches and pains. Also, the volcano is spewing smoke but hear that is a regular occurrence. People are really friendly.
Vanessa and I were busy yesterday afternoon in sick call. She is doing great and basically on her own. Just has to quickly run her patients by someone and have a cosign. Only had 1 page last night but still tired. Ready for snorkeling tomorrow. Just got my haircut in the Navy barbershop. Never thought I would say that! Thinking about my father who was in the Navy in the South Pacific. Wished I had asked him more about it while he was alive. He developed polio during his tour and think that is why he didn’t talk much about it. Sorry, this is sort of a free association blog today.
Will try to write Saturday to tell about the snorkeling trip. If can’t get online then won’t be anything until the 26th at the earliest.

Morotai Mission Begins with Dawn on the go...

The boat Dawn will call "home" for the next 5 nights

Dawn disembarking from Mercy onto the dingy to board the Australian Ship

waiting for her turn to get onto the dingy

On their way to the other side of Mercy to board the Aussie Ship

Loading the supplies onto the Aussie deck

Picture Post...

Sorry, the pictures are not in order...(just some events of the past few days)

preparing for the mission to Morotai

Enjoying the Indonesian sunset

Our interpreters put on a Cultural show for us...there is not much entertainment on board Mercy, so we were all very appreciative

Casting the fuel line from for refueling from the Robert(or Richard) E Byrd

watching the helo ops doing their transfer of supplies

the water between the two ships looked like white water rapids. Sometimes, apparently dolphins try to race the ships in these waters.

Watching the Robert E Byrd approach Mercy from the Weather Deck

Department on Medical Services (our dept) on board Mercy

Project Hope on board Mercy

Yes, we are getting a workout even if we don't go to the gym!

one of the first patients aboard Mercy

Language lesson fun

Galley duty

We made new friends. These are the Cambodian dentists on board Mercy

Enjoying an evening on the deck after a full day of classes

Refueling and Replenishing....

On Sunday July 11 we got to watch something that very few will have the chance to (unless of course they are on a mission of this kind).
We are out in the middle of the ocean in between the Archipelago that is Indonesia. We will not anchor at any port during our time in these islands. But we still need replenishing. The best way for the Mercy to do this is to receive fuel and replenishment from another ship.
Basically we watched as the Robert E Byrd (or maybe it was the Richard E Byrd), another US naval ship pulled up besides us on the open ocean. Both ships were at full speed steaming parallel to each other. A line was thrown across from the Byrd to the Mercy and refueling began.
At the same time, the Mercy helicopter picked up supplies( read food!) for us from the Byrd and dropped off unnecessary items (read trash!) onto the Byrd.
The whole operation took about 4 1/2 hrs whilst both ships maintained speed alongside each other with just about 190feet of ocean between us.
It was quite an interesting experience to be witness of and I have some video that I will post when time (and bandwidth) cooperates.
In the meantime, it is on with the mission....
Until later
blessings....

Selamat Siang(good afternoon)

Apa kabar (how are you) everyone? Saya Baaik(I'm good). No I am not fluent in Indonesian yet .This is about as good as it gets!
I worked in Sick Call today, got to examine a few patients(military personnel). The rest of the day was spent learning more about the tropical diseases that I hope not to contract! Lots of weird diseases in the world!
Tomorrow I go on a 5 day mission. I won't be able to make any phone calls for a few days as we will be in a remote area. Sounds very adventurous and I can hardly wait!! I will write more when I return!
Sampai Jumpa!(see you again!)

Shellback and New Haiti Experience

I’m a Shellback now!

It is Sunday July 11. Last 36 hours have been a combo of fun and work. Friday not us former Pollywogs had to entertain the Shellbacks with a talent show. The crowd was pretty rough, much worse that Simon Cowell. Our group got booed off before we were able to start our song. Luckily we were one of the first groups so I got to sneak a peek at the other groups. Lets just say there is much medical talent here and they should stick to that. We lost an hour of sleep that night with a time change then were woken up very early for our ‘initiation’. Can’t tell you specifics other than it was a long, grueling morning. Dawn, Vanessa, and I all toughed it out and now are shellbacks. However, afterwards, while most of the ship played and had a cookout on the flight deck, I was on call in sick bay. Many people have URI’s now and they spread quickly in this environment.
We got our assignments for the first two stops of the mission. In Morotai, Dawn get to go on a 5 day overnight. Now usually that means really roughing it but her group will be based on an Australian ship. They will get Australian cooking, etc although some will have to sleep on the deck on cots, but that sounds fun. Each day they will shuttle to their clinic. Vanessa and I are on call in sick bay much of the time and hopefully will be able to go ashore for at least one visit. However, at the next stop in Ternate, Vanessa and I go on a 7 day overnight and we will be roughing it. No showers, toilets, beds, etc for a week. Food comes prepackaged in foil. Saw an example last night and was thinking I am so glad I brought a box of protein bars. The longest mission is Ambon, but no schedule for it yet.

Another former student of mine from Samuel Merritt U., Karen Cory-Mejia just got back from Haiti. I can’t open attachments so I am sending her link where she reports on her mission in Haiti. I haven’t seen it yet but knowing Karen it will definitely be worth checking out.
http://cid-18f68b9f1343f0cd.spaces.live.com/default.aspx

Crossing the Equator

Yes, today is the day! We will be partaking in a traditional ceremony that will transform our "slimy pollywog" selves into "Shellbacks". Not sure what is in store for us but I do know that we are going to get wet, dirty and probably very embarrassed by what we will be doing. Whatever it is, it should be a memorable experience! Everyone participating(it is optional!) has fashioned their own t-shirts and we are to wear our clothes backwards and inside out. What happens next is anyones guess. We will let you know. Lets just say, the military likes to have a good time! After the ceremony, there is a big feast on deck (steel-beach picnic). So today will be an unusual day. Hopefully, today will be all fun because tomorrow will be devoted to classes, classes and more classes. Mostly on tropical diseases that we are trying to hone up on. Well, all for now! Next time I talk to you, I should be an official "Shellback". Now that's something you don't do everyday!

Education

Yes, I really did work in the galley (doing dishes) last night. There are rumored to be pictures to prove it.

Well we are here for educational purposes and there are many educational opportunities in addition to the clinical work (which we have started as Vanessa, Dawn, and I have all had duty in sick call. In fact Dawn gave me an injection of JEV vaccine. Multiple educational presentations by different experts have begun. So far we have learned about cleft lip and palate repair and care, worms and flukes (I'm not sure I can eat sushi again), and ECGs. Next is tropical derm, tropical diseases, and rabies. Dawn and Vanessa are preparing a presentation in conjunction with Brian and Julie, Pharm D students from Shenendoah U. on malaria that they will present in a few days. We have also had language training with the Indonesian interpreters, Indonesian history and cultural training, training on the field devices for our charting, and more to come. Great prep so we are ready when we go into the field.

Another day on ship....in Indonesia somewhere

I have had difficulty with the internet on ship. It seems the chances of success are greater early in the morning or very late at night. It is now very early(0430) and here I am!

I think I have somewhat adjusted to the time changes, routine on the ship and the sleeping arrangements. Since my rack(bed) assignment was changed, life has been much easier. I was originally assigned to a top rack....it requires climbing without a ladder(funny that the shortest person here gets the highest rack and coinciding highest locker).The military does not care if you are shorter or... ahem... little older than the rest,all are supposed to be in 'tip-top' shape therefore it should not be an issue(and along comes me!) I never did sleep up there.Found an empty rack and stayed there until I was not to. Had to go to the supply Officer to get it officially changed. It was difficult to get the assignment changed, not even sure why it was allowed,many others were unable to change it. Anyway, I am relieved and feel much safer on the bottom rack. Sounds like a little thing, but it caused undo stress for me.

Still meeting fascinating people each day from all over the world. This experience,so far, has been eye-opening for me, and we haven't even begun our mission yet. In a few short days, we will arrive at our first destination and our work will begin. They are still trying to prepare us with many classes on the language, culture and specific medical needs of the population we will be serving. It is all great and saya senang(means I am happy in Indonesian).
All for now, gotta run!
Selamat Tinggal(good bye)

CHIMES and Bahasa

This morning we had our introduction to the CHIMES documenting system which is the Civil and Humanitarian Information Management Expeditionary System. This is what we will use to document on our patients when we are out on the MEDCAPS, and also helps them tally the total number of patients that we have seen at that particular site.
Since we took on our translators yesterday, we also had our first Bahasa Language lesson today. We were split into small groups with one translator who talked us through a cheat sheet of common words and phrases that we will be using. I found the lesson very interesting especially since our translators are so eager for us to learn their language and so excited that we are there to help in their country.
Dawn and I took a walk on the flight deck last night, where we met 4 Cambodians (3 dentists and 1 dental assistant). They are all so eager to speak English. Today we saw them a few times in the hallways, so they are hitting high fives with us now. We most likely wont be working alongside them since they will be doing DENCAPS, but it was pretty neat to meet people from a part of the world that I had never met before.
We just got out of Tropical medicine lecture. This one was on the different types worms we would probably be seeing. I don't know if we really ought to know the difference between each, because the treatment seemed to be the same for all...Albendazole...I think that's what I know I need to remember.
Anyways, tomorrow is more language lessons, more tropical medicine and we have to come up with an outfit for the crossing the line ceremony on Saturday.
By the way, I have pretty neat picture of Dr Roark helping out in the galley during dinner hour. We have galley duty on Thursdays....next week Dawn and I will probably be in there.
I will try to post some pictures next time....and write more if possible
Until then....
Blessings

Update

The post is a few days old. Just now getting online. In transit to Ternate after picking up patients,supplies, and interpreters in Jakarta. Getting much education in prep for Ternate. Still no seasickness. Beautiful on deck at night with stars and this am passing many small islands. Wish I could take a quick trip to each to see what they are like. Certainly a romantic aspect to being out here especially since at time seems like I am the only one on the deck. Vanessa and Dawn are preparing a presentation on Malaria they will give with Pharmacy students who already have prepared a presentation on prevention and treatment.

Life on board

Life on board –
This may be a long post as connecting to the internet is very sporadic so I will write in Word and cut and paste whenever I get connected.
July 6 – This is our second day out to sea. So far no seasickness for me, although others have succumbed. I am now a believer in the acupressure bands. I have found that standing on deck and looking out over the ocean to be very calming and liberating. I think I now get why some people become sailors.
So, life on board… The food is much better than I ever expected. Plenty of fresh fruit, salad, veges, good coffee. Sleeping quarters, well, that is taking some getting used to. First night I kept hitting the bunk above me. Imagine your bed is like a 3 sided coffin. Also,surrounded by snorers. Luckily got some great ear plugs last night and slept. I’ve been getting up at 430 to run on the treadmill. Also get much exercise going up and down the stairwells on the ship. Our days have been busy getting oriented to both the ship and our mission. So many fantastic people on board – naval personnel, civilian personnel, and all the various volunteers. It would take pages to describe just of a few of them and it is humbling to hear what many of them have done.
I was worried about the military atmosphere but turns out there are many great aspects to it. Military personnel are very polite and well mannered and respect for others is highly valued, not matter what your position or standing. Being here you understand the need for discipline and protocol. Gives me a totally new perspective and glad about that.
We arrive in Jakarta tomorrow to pick up interpreters, supplies, and a few patients. Don’t think we will be able to go ashore though. It will take another 6 days to get to Ternate so plenty of time to plan and get briefs on the different locales, etc. One interesting thing is when we cross back over the equator on the 10th. If you dare go through the initiation, you go from being a “pollywog” to being a “shellback”, a tradition among sailors. You will have to look that one up to see what it involves but I do plan on doing it.
I actually had to work today. Got sick call duty and saw patients. I felt a little rusty but it was good to be back doing clinical work. The real work though is when we go ashore. Will see 80-90 patients per day. Yep, you read that correctly. On those days you get up at 5 so you can take a transport boat to shore then catch transport to the clinical site. Days for them are long but sound really rewarding. Then there are the long haul trips where you can go to a site for 3-6 days and basically rough it in tents and port o pots. Hot, sweaty, hard work with no showers Hopefully will also get some liberty time but these locales are remote and very underdeveloped..

Some Pictures Finally!

Some of our group with the Chief Engineer of Mercy. We Took a tour this morning and learned all the neat facts about Mercy that no one really knows. We also felt privileged because the Chief only does the tours for PH himself

On the Flight deck

Waiting to set sail from Singapore

Don't we look spiffy! All set for the Abandon Ship Drill yesterday

Sorry these pictures are in no particular order. It has been a difficult and frustrating process. I will try another time to upload more. These will have to for now
Until next time...
Blessings....

Hate to Blog and run....

I finally got internet access and it is now time for yet another meeting! Since being on board, it has been one meeting after the next... all day long. Just for the record, each meeting usually requires going from one side of the ship to the other...not to mention countless stairs to climb each time. Who needs a stairmaster when you are on the Mercy! Since I don't have much time, just want everyone to know that we are having a great time, learning a lot and meeting many interesting and talented people on the Mercy. We have been attending classes to learn about the culture of the people of Indonesia and what we need to be careful about too, as our commander stated today,"we are no longer in Oz". Gotta run, I think I am late!! Just so you all know, you can post comments! Will try to write more soon!

The Straits of Mallacca?

Hey Everybody,

So we are full steam ahead to Jakarta now. We set sail yesterday and it was quite an interesting experience. I have set sail on a few ships in my lifetime so far, but this was very ceremonial and quite a moving experience. We are on the Straits of Malacca (?) right now. We should be in our first clinic port on July 13th. In the meantime we have meetings upon meetings all day long. It's lots of education on the culture of Indonesia, the do and don'ts of the ship and the medical info we need for our clinics.

When we set sail from Singapore, the armed service members perfomed the "manning the rails" when we passed the Japanese ship the Kazamuki(?). It was beautiful to watch the respect and honour given to each of the groups of sailors across the mass of water that separated them from each of their ships. We were allowed to watch from afar after initially being told that we could not.

We met the Commodore of the Mercy yesterday also. Our Commodore is a female and she definitely runs a tight ship!

We got told all the rules about a million times yesterday, but I guess they really have to protect Mercy (and it's plumbing!).

We also met our department leader yesterday, another female officer, and she is very eager to ensure that we have an amazing learning experience here whilst at the same time helping our host nations. It is stressed continuously that we are to give the host nations the praise for anything that is accomplished.

The most interesting thing that is in the planning stage right now is the "crossing the equator" ceremony. I am right now a "pollywaag" and the plan is to be a "shellback" when we are done with this ceremony. If we dont participate, we cannot watch! We are told to be prepared to get wet and it is supposed to be very physical. I am excited! i just hope we dont have to eat something crazy!

I was asked about the 4th of July celebrations. It was actually on the 3rd of July in Singapore on the Navy base (not on Mercy). they had a huge cookout and fireworks...only it rained. And they had the Navy band perform...they were pretty good also...just imagine a bunch of sailors in uniform singing "it's gonna be a good, good day!" Pretty funny experience.

So, we are actually working here too. We started today., We have to take call in the sick bay. luckily I am not on rotation today. We have a man overboard and fire drill also in the 100deg heat this afternoon. we will be out there in the heat till everyone is accoounted for and has found their life raft. Hopefully it will go smoothly.

Dawn and I also have to do a powerpoint presentation on a topic not yet decided to present to the department of medical services. this is going to be tough since the internet connection is sketchy and resources extremely limited.

Anyways, I have to head out to get my clothes sprayed with permethrin and for an engineering tour before trying to start on that project.

By the way, not sure if I mentioned it before, but we also have veterinarians on board...

So the Navy word of the day is "be may my last" which we hear on the overhead speakers at some time or the other...it means, disregard what you just heard....

next time, hopefully some pictures.

Till next time.....

Blessings,

Vanessa

Singapore and Project Hope

Hey everyone,
Just thought I'd give you a quick synopsis about my time in Singapore. After check-in on Friday, which took quite some time, (it was definitely organised chaos!), we met some of the other PH volunteers in the group and we learned about our berthing assignments. It's really not that bad because in all honestly we don't spend much time there (except to sleep and shower).
We were placed on liberty until 0200 July 5th. This gave us time (which we had not initially anticipated) to explore Singapore, and that we did. We took full advantage of the Metro system (which is amazing here) and the bus system and the tram system, and of the kindness of the locals! Singapore is a pretty easy city to navigate and we hit all the major spots that everyone in our little group wanted to see as well as enjoyed a great variety of their culinary delights. Though I must add, we did not always know what we were ordering! They almost always were amazing dishes.
We even took a ride on the Singapore Flyer which allowed us to enjoy and amazing view of the city.
One thing we are learning about ship life is that when the mess hall is open, you better go eat! Even if not hungry!
When we leave the ship we have to sign in and out and wait for permission to leave the ship. Sometimes we get saluted (that's pretty neat) and otherwise we just get told "permission granted".
Anyways, we should have internet access on the ship tomorrow. So I will write more and add more pictures once I organise the ones I have taken already.

The picture above is of some of the PH Volunteers as we set off to explore the city on Saturday morning

These are our sleeping arrangements. there are 100 to a roomSingapore is a very CLEAN city and the fines are pretty steep for any offense committed.
We had to be conscious of not chewing gum and of not keeping our hands in our pockets!

Dawn and I at check-in. We were really tired here (note only 3-4hrs of sleep)

Our first glimpse of the USNS Mercy!

Tomorrow morning we set sail for Indonesia. And we muster (meet with our departments) at 0630. That means we really have to get some sleep
until later....