The 2 nights at sea provided welcome relief and an opportunity to catch up on sleep. For me the highlight was my last night on the ward when my patients, sitting in a circle, spoke through 2 active duty personnel (born in Vietnam and like my "adopted" son, Tuan, arrived in the USA as teens).
My patients repeatedly described their experience aboard as "paradise, paradise" and told me about the hours they waited in the hot sun to get evaluated by a doctor in order to be seen on the ship. They said that without access to medical care death comes so frequently and unexpectedly that they just try to work hard every day and hope to make it to the next day. Not a single one of my patients had ever had a vacation day or left their village.
When I told the patients I would be meeting with the Commodore and have an opportunity to relay messages they became very quiet then started to whisper. The sailors explained the patients were stunned at being invited to address a person of such high import and were unable to respond other than with gratitude. We talked for about an hour; an older man described his experiences during the Vietnam war with the South Vietnamese military.
A few of my impressions include my older patients' agility (remarkable), including a 93-year old woman who walked without assistance. The "younger" 80-year old patients woke daily to exercise next to their bunks. Several women had terrible acid burns on their faces from husbands. Several men described more than one wife.
The Commodore told us we treated over 19,000 patients in less than 2 weeks. Four major construction projects were completed, including a medical clinic and school. Hundreds of surgeries, evaluations, and community service projects were completed. Again, I am humbled by the honor to serve and astonished by the lack of access to medical care. The historic nature of the mission was explained to us as this is an attempt to reestablish a relationship with Vietnam (particularly salient as it is being courted assiduously by China).
A quick word about computer use. I do not have access to a computer at work on the wards. Those computers are exclusively for military personnel and solely for the hospital-military intra-net. Because email is not deemed priority, I succeed in gaining online access either around 11:30 at night or 4:30 in the morning. These are my work hours so I am able to get online only during time off. Because accessing my individual email requires a minimum of an hour or two, time constraints dictate I only open the "summary" email David prepares. Posting this blog does not entail email machinations but can be equally frustrating - thus the sporadic posts.
Now underway, the undulations of the ship at sea are calming. The best description is that they are like gentle aftershocks after a small earthquake. I can feel the floor rolling but it is constant and, as I wrote, somewhat calming. Helicopters land periodically and the 800 foot ship travels at 18 knots (about 20 mph). Small flying fish that look like hummingbirds hover next to the ship. The water is a deep cerulean blue and the air is spectacularly clean and salty.
All of us are on malaria prophylaxis (some of our group a little ill from its side effects) and the State Department briefing I attended warned about parasites, dengue fever, hepatitis, and the largest HIV/AIDs rates in Asia. We were told that Cambodia will not restrict movement the way Vietnam did and we will be treating people in 3 provinces, rural places where homes are built on stilts, and in places whose populace has never seen Americans.
Yesterday was our day off and mine looked like this: I ate breakfast from 7 until 7:15 a.m. and then went to my work station (Med-Surg Wards 1 & 2) to muster. Attendance, taken at muster, is to ensure no one is overboard and disseminate information. Afterward I went to the "Cas-Rec" (Casualty Reception) to attend a wound care lecture given by a medical officer from Australia (we are 8 partnering nations trying to standardize emergency preparations for natural disasters such as the 2005 tsunami, Katrina in New Orleans, and most recently, the earthquake in Haiti). Then I went up to the mess deck to attend several briefings by ship personnel and an American dentist living in Cambodia.
The Commodore also briefed us. She is a charismatic married mom who usually leads 6 ships in the Destroyer Squadron based in San Diego, California. In the Navy over 25 years, she provided an informational briefing and a security briefing. I found it interesting to learn our arrival and departure dates are intentionally vague related to security concerns. Thus we do not know our future arrival dates, neither to Cambodia, nor Singapore.
After the briefing I attended a frocking (promotions) ceremony from 11-noon on the flight deck. About 20 active duty Navy personnel were congratulated by superiors and cheered by hundreds of their peers. We were all invited to the mess deck for celebratory cake and a "steel beach" party which occurs on a steel deck in lieu of a sandy beach. Heat concerns drove the party inside but it remained festive and everyone appreciated the hot dogs, hamburgers, and ribs. The steel beach, combining lunch and dinner, was followed by an ice cream social.
After lunch I went on a tour of the engines graciously given by the Chief Engineer of the ship, who leads a crew of 28 civil servants. We were provided with ear plugs and warned that the temperatures would exceed 100. The equipment was awesome and stretched the equivalent of several stories high. Small, air-conditioned rooms were used for fascinating explanations.
Still going strong, I stopped in the library to exchange my book (I can't fall asleep without reading) and after opting out of yet another meeting I spent several hours top side (out on the deck) watching the magnificent scenery and reflecting on things heard and seen. After I showered I retired to my rack (bunk) to read and had my real first night of sleep (I work nights). It was heavenly!
This morning after mustering I got a haircut. At first they were reticent to cut my hair (usually there are only 2 choices: hair trim or head shave) but I persuaded them that regardless of the outcome I would be fine. The young woman who cut my hair did a fine job and I was pleased to learn I was allowed to give her a tip. The barber shop looks similar to a civilian shop but neither a shampoo nor a blow dry are provided and everyone must sign in and out.
Unfortunately, I missed the malaria briefing because I attended the State Department briefing. We were warned about medical risks to us (I have already cared for TB-positive patients) and that lack of maps prevent adequate land mine clearance. The USA saved its maps but neither China nor Russia did and casual walks result in a limb loss that makes amputatees a common sight in Cambodia. Additionally, crime and robbery are common in this area (we are on a strict "buddy" system) and the Department of State instructed not to resist attackers, that crimes are not investigated by local police, and to avoid cyclos (rickshaws).
I also learned about the pervasive sex slavery of children in Cambodia, that men become monks to learn to read, Cambodians use chopsticks in conjunction with spoons and fingers, and that wells and rivers are primary sources of domestic water. Many of us old enough to remember Pol Pot know that up to 50% of the populace was executed by its leaders and all educated city dwellers, if not executed, were dispersed rurally. The result of the indigenous genocide is a serious brain drain and lack of educated citizenry (doctors and dentists, inter alia).
And so we prepare to arrive at this largely Buddhist country the size of Oklahoma, where according to the State Department, military weaponry is readily available and constitutional protections are extended only to the local Khmer people.
Should be interesting!
