Post from Beverly

July 23, 2011
Lori and I flew together from Miami to San Salvador having no idea what to expect from our adventure. We arrived at the airport and were greeted by a Project Hope veteran named Earl. Earl is a pharmacist who went on Hope’s first expedition in 1958. He now brings pharmacy students who compete for the privilege of traveling on the mission. He is retired military and so soft spoken you have to lean in close to hear him. Incidentally, Earl met his wife on his first Hope mission.
At the hotel we met several people who would be traveling along with us. Some had traveled on Hope before and had many stories to tell. All were interesting, some were sad, most were funny. The next morning we were all excited to be heading for the ship. The bus was supposed to arrive at 10:45 AM which turned into 1:00 PM. We then drove around the city three or four times picking up various other people who would be joining us. We took another trip back to the airport and then finally headed towards the port. The 1 hour ride to the port took nearly five hours!
As we drove around San Salvador the first thing I noticed was a McDonald’s. As we continued to drive we saw Subway, Pizza Hut, Burger King, KFC, Wendy’s along with Sears, Nine West, and even Wal Mart. Everything was so Americanized. Except for the housing; corrugated aluminum houses in various stages of disrepair were crammed together on hillsides and in valleys. There were forty or fifty crowded almost on top of each other and surrounded by large piles of trash and garbage. Amongst all the American retailers and impoverished citizens was the most beautiful foliage and flora I have ever seen. They have the same hibiscus flowers we have, but the colors are more brilliant and the blooms are twice as big. I really wanted to spend a few days getting to know the people of the city and find out what their lives were like; but we moved on to the ship.
The Comfort is physically much larger in person than you expect from the pictures. Brilliant white with a giant red cross on the side, it stands out more than any other in the port. Once on board, the first thing that you notice is that this is a collaborative effort much greater than the United States Navy and Project Hope. There are military personnel from the U.S. Army, Air Force and Coast Guard as well. Additionally, there are military from Canada, Holland, Brazil, Columbia, and a variety of other countries. Several private and religious organizations are also prominent.
It is an extraordinary experience to encounter such a variety of people. Surprisingly, with so many people in such tight quarters everyone remains amiable. Manners are displayed by all and impeccable. Those who have been on board longer help the newcomers find their way around (which by the way is a lot more difficult than one would expect). This is my first close encounter with military personnel. The maturity and professionalism displayed at all times is refreshing; especially when you recognize that most of them are late teens and early twenties.
We arrive too late the first night to do much but eat, find our bunk, and go to bed. Our second day is orientation to the project and the ship; which is like orientation everywhere. The third day we at last get to go out to our first medical site.
We see nearly 1000 people the first day. There are medical experts from every field working together to offer as much help as possible in such a short period of time. As a student, I am not only welcomed, but sought after. Physicians and practitioners with unusual and text book cases seek me out to show me the nuances of assessment that we don’t always get to see in the United States. Detailed history and physical assessment are the key to diagnoses in our outdoor makeshift clinics. Simple procedures are performed on the spot. Family Practice from crib to crypt is flourishing here. I have seen and learned more here in four days then I learned in nearly two years of training.
The people of El Salvador are happy, extremely clean, and grateful for all things we offer; big and small. The difficult encounters are those that could be easily fixed in the U.S. but ruin lives in Central America. A 14 year old boy who has what his mother calls “a hole in his heart” and has heart sounds suggestive of a VSD is thin, gaunt, and low on energy. Back home, we could fix his heart in less than one hour. A 72 year old woman arrives our last day in El Salvador blind in her left eye and no peripheral vision in her right. Her blindness is caused by simple cataracts; had she arrived the day before we could have fixed it. We referred her to the host nation, but in El Salvador she may be too old to have the surgery. Fortunately, there are only a few of these cases that stand out. Most of the patients present with complaints of headache, dizziness, stomachache; usually symptoms of not drinking enough water or malnutrition from parasites. We give out vitamins and acetaminophen; along with education, education, and more education. And we get back a lot more than we give.
July 26, 2011
We have not been able to post anything as of yet. The internet and telephones have been down for several days. You never realize how dependent you have become on these electronics until you have to do without them. I well remember the days when long distance calling was rare due to cost and mailed letters were the only form of communication. We have been out of touch for less than a week and all of us are feeling a strain.
We left El Salvador the evening of July 24. It was a really a great experience in many ways. The people of El Salvador are warm and friendly. They have a system of socialized healthcare and have many services available to them. The problem, as was explained to me by one of the many translators, is that the services are not close to home for most people. A trip to San Salvador costs money and most of the people do not have automobiles. Additionally, once they make the trip there are no guarantees that the procedure will be performed when the patient arrives or scheduled for another day. We met a young 23 year old mother of a 7 month old who had a PAP smear result which showed CIN 2 (moderate dysplasia). She had a letter which described the necessary cryosurgery and where she would have to go to get it. She did not have the resources to travel to the city and stay in a hotel while she awaited her appointment. In some ways, the citizens have access to many services that United States citizens do not, but there are other difficult conditions that prevent access.
Speaking with the discharge planner about this same young woman she told me that many of the postsurgical patients from the USNS Comfort are discharged to a central location or taken to the port exit to await a ride. In this country people are used to a long and difficult road home. Some of them call for a taxi, some wait outside for a family member, and others have no idea how they will get home safely. In the U.S. this would be unheard of for somebody one or two days post op waiting for a ride in the street.
Today has been a very exciting day. It is the day where the ship is refueled and restocked with supplies. One would think that boxes would be loaded at the dock and fuel would be dispensed at the port. Not so. We travel out to sea and meet a ship called the Lewis & Clark. The two ships travel side by side while gas and supply lines are thrown from one ship to the other. Fuel is dispensed through these lines and palettes of packages are pushed across ropes to the other ship. The Navy’s helicopter picks up supplies from the Lewis & Clark and drops them onto the deck of the Comfort. It is a process which the military makes look easy, but it is quite difficult. The ships have to travel exactly the same route without any deviation in rough seas for close to twelve hours.
We are expected to arrive in Costa Rica on July 28. Hopefully, at that time I can post some of this info.
July 30, 2011
Well, we have been in Costa Rica for two days. The ship is on “Liberty” which is similar to vacation only you still have to get up ridiculously early and be checked in by 7 AM. We have been exploring Costa Rica a little during the down time and have seen some beautiful landscapes and beaches. I took some pictures but forgot my USB cord so will have to upload when I get home.
During our exploration of the area, we were stopped at a check point and were asked for our passports. I was not carrying mine with me, but I did have my US drivers license and my USNS Comfort pass. However, this was not enough. The police then decided to search my purse, the vehicle we were in, and were telling us we could be in big trouble. Out Civil Rights were totally irrelevant in Costa Rica. Memories of old movies where people are hauled off to jail and left indefinitely raced through my head. My cell phone does not work here and I did not have the ship’s phone numbers with me. My American sense of justice and freedom for all was causing me to feel angry, but I knew it was best to hold it back. Fortunately, someone thought to show them a picture of the ship. Their attitude changed immediately. They shook our hands, thanked us for being there, gave us all our stuff back and let us go. I am really not sure what they wanted. I hope they are trying to stop the drug trade and not blackmailing American tourists. I now have a much greater appreciation for justice system in the U.S. Even though it often makes mistakes, at least out officers are forced to respect individual rights.
Tomorrow we will all go back to the ship and begin surgical screenings. I am looking forward to getting back to work. It is such a great opportunity to fine tune my assessment skills. Hopefully, the internet and phones will be working on the ship and I can post more frequently.

Beverly Griffis