First few days in a nutshell

We arrived to the town of San Juan del Sur via bus on Saturday. Along the drive the poverty was apparent as was the beauty of this country. We drove along shore for a bit with a picture perfect view of a volcano, I will have to look it up to see which one it was.

Everything has been great so far, truly an experience. Boarding the
ship from a smaller boat in the large swells was a mission in itself, truly hard to accurately describe the experience- adrenaline pumping to say the least. The timing of each persons disembarking the boat is carefully timed by the Civilian Mariners, it is like a choreographed dance with fancy footwork to be able to safely land safely on board the USNS Comfort. Nearly lost some people between the ship and the smaller boat...but we
all survived!! The boarding/check-in process is… a long process. We were met my Faye, a representative from Project Hope who made sure we all were fed and led us to our rooms.

Myself and the other students are in the "overflow" area since we are
here as students, large room, lots of bunks... nice people though. The
ship constantly rocks due to our position in the water, this is
calming at times and other times it feels as if you may roll out of
bed or sustain a head injury in the shower. We are finding our way
around, everywhere we go requires a series of steps, unavoidable diet
plan.

Yesterday we had general orientation and spent some time orienting ourselves to the ship, this continues to be a work in progress, Luz has been the best so far at keeping us from getting lost. Last night we attended the debriefing for the day regarding the activities of the day and the progress so far. Made me appreciate and little bit more the work being done in these countries.

Went off ship to one of the clinics set up on shore, (pictures to follow).Up at 4am, Luz and I were first to arrive to the muster site, unaware that they called for each boat overhead, oh well, lesson learned.
I was paired up with a wonderful pedi NP and we saw about 30 kids, some
with primary care issues others with major medical problems. The
challenge is turning people away with little to no treatment after
they have waited for hours for care. Sometimes they simply do not need
care beyond a kind word and reassurance that all was ok and normal
with their child, other times we don’t have the resources to care for
them at the level they needed. There were a great many who did benefit
from the medications and services we have available.

One child in particular that stood out was seen by a practitioner for double ear infections and discharged with meds, on the way out he began to seize, one of the military personnel came to get the PNP I was working with as they were unsure of what was happening with the child. Together we went to assess the child, when we approached it was clear that he was having a seizure, blank stare, unresponsive to everyone around. Due to our limited supplies the usual suspects, supplemental oxygen, IV start kit, IV or rectal meds… were not available. The pharmacists was quickly at the patients side and offered meds not on the formulary, for use in an emergency, luckily we were able to administer Diazepam, unfortunately with little to no effect. He remained in what seemed to be a postictal state with short intermittent seizures. The local ambulance was called and the patient was taken to the hospital. The sad part is, this patient had a history of this since the age of two (he is 6 now) with seizures that occur frequently, the treatment of choice has been NS bolus and discharge. It was gratifying to be able to diagnosis this child along side such a wonderful medical team, we can just hope that he gets the treatment he needs for further care.

Aside from the scorching heat (96 outside, 116 degrees inside with humidity) and lack of circulating air, today was a good day.