Mother Drives Her Son Across Two Countries to Get Care

Another awesome story is this little boy, Oscar. He and his mother are actually Salvadoran. He’s got strabismus (wandering eye), and his mother brought him to one of the sites in El Salvador late in the stay last week. Late enough that we were able to do a work up for him, but not able to get him into one of the ORs—they had all been booked for some time.

So she asked, “Where are you going next?” We told her, and with a simple, “Ok,” she left...Only to show up at the site in Chinandega, Nicaragua, on the first day it was open, paperwork in hand. She’d driven him across two countries just to see us. The ORs were wide open. With that drive, she’d changed the course of her son’s life. He was operated on today, and as the muscles in his eyes get used to their new positions, they will line up as they should.

Thanks for reading-Jacob

Volunteers Help Restore Health and Lives

The best part of today was checking in on all of the patients from the last two days. I’ve been following the case of Sixto Lopez since he came to the screening site three days ago. A 61-year-old man, his job is “working with the machete” –a field worker, but he was very specific that he didn’t cut cane. Maize and sorghum (I believe I got my plant terminology correct) are his specialty.

His son and grandson are also fieldworkers in the same line of work. Sixto has not been able to work for several months, however, because the scar from an old gallbladder removal has herniated, forcing him out of the fields. His family has been suffering without the extra income—so much so that neither his son nor grandson could afford the time off from work, so his granddaughter-in-law, his grandson’s wife, came with him on escort duty.

I saw him again last night in the Hotel, where Project HOPE volunteer Doctor Bob gave a final exam just to make sure of the morning’s work (see photo). His granddaughter, Nicoleta, is just as shy as the rest of the Nicaraguan women I’ve met—but very friendly once they smile and open up to a conversation.

Today was Sixto’s surgery, and everything went “swimmingly,” as Doctor Bob would say in his best faux-Monty Python. I gather that that means, “very good.”

I caught back up with Sixto and Nicoleta in the Post-op ward after the surgery, but Sixto was indisposed to the photo op. I took this of Nicoleta and me instead. That’s a huge smile for the photo, for a stoic Nicaraguan.

Check back tomorrow for another heartwarming patient story. And as always, thanks for reading-Jacob

Volunteer Surgeon, Dr. Bob Coleman Helps Provide Hope

Two residents crowd around the operating table as the surgeon gives instructions. His voice is low and calm, but carries the force of experience. The whole surgical team moves as one orchestra, with his voice conducting.

The woman on the table has had this procedure done four other times, each ending in disappointment. This time, she hopes, will be different. This surgeon has more equipment, more knowledge and experience than the others she’s seen. Yet he’s giving her this care for free—as is the entire surgical team. In fact, the whole operating room and the entire hospital she’s in come at no cost to her.

The Nicaraguan woman on the table, is under the care of general surgeon Dr. Bob Coleman and his team here on the U.S. Navy’s floating hospital ship, the USNS Comfort. The care they provide is part of a joint effort on the part of the Navy, international militaries, and NGO’s to provide free health care to underserved and developing nations in Latin America and the Caribbean. The mission is called Continuing Promise, and Doctor Bob, a volunteer through Project HOPE, has been onboard for three weeks.

“Being in private practice, it’s tough to get the time away to come and do these missions,” says Dr. Coleman. “But if it’s important enough, you’ll find a way.”

Part of a three-man surgical team based in Champagne, Illinois, Doctor Bob is finding more and more time to come to places like Corinto, Nicaragua, La Union, El Salvador, and others throughout Latin America to provide his services where they are needed most.

Project HOPE will bring over a hundred surgeons, doctors, nurses and midwives aboard the Comfort this year in this collaborative effort with the Navy.

“Using the Navy’s hardware along with the manpower and expertise of the NGOs is really brilliant,” says Dr. Coleman. “We’re really becoming more than the sum of our parts out here. There are frustrations, of course, but the bottom line is that this is happening, and care is getting to places where before there was no hope.”

“I personally feel—and you can see this in everyone who works here—I feel a deep calling to this type of work in the world,” he adds. “And when there are this many people who care this deeply about a problem, things are ultimately going to come together.”

Thanks for reading-Jacob

HOPE Volunteers Begin Work in Nicaragua

Project HOPE hit the ground running in Corinto, Nicaragua after a one-day transit from El Salvador. Elie Malloy and Diane Speranza headed to the most remote site Continuing Promise has set up so far—far enough from the ship that they’ll remain there tonight and the next two days in order to make the logistics feasible. (To be honest, I’m a bit glad I can’t reasonably make it all the way out there—it is hot enough in the town of Somotillo, away from the coast, that the locals say its “where the Devil takes vacation.”)

At the closer of the two remote sites, in the nearby village of Chinandega, Dr. Ken Iserson and HOPE’s pediatric nurse practitioner, Faye Pyles, charged in to begin administering primary care to the Corinteños and Chinandeganos—people of Corinto and Chinandega. Amy Bream and Marley Gevanthor’s triage skills kept the first day—always the hairiest—running smoothly and efficiently toward the primary care providers.

Meanwhile, HOPE volunteer Elise Chamberlain was leading a training day on pain management in one of the classrooms at the hospital. She and other volunteers covered four topics—Pain, Pain Management, Acupuncture, and Physical Therapy—to interested doctors and nurses from the Chinandega hospital.

The first two days of Continuing Promise’s presence in a country are also unique because we run a surgery screening clinic in addition to the primary care facilities. Here, volunteer general surgeon Bob Coleman saw as many patients as he could possibly see today (and will again tomorrow) to fill up his OR schedule for the next 9 days. He’s got several tough cases coming up for himself, including a woman with an incisional hernia that has been operated on four times, unsuccessfully.

“After the last time, the doctor looked at me and said, ‘I won’t touch it again,’” she told Dr. Coleman.

The injury is pretty large, and after his examination, Bob told her the risks of further operation, and the risks of leaving the injury as it is. He believes he’s found the reason why the previous surgeries failed, and that he has the equipment onboard to evade the same problem. She’s chosen to come onboard with us and go under Doctor Bob’s knife—we’ll see her in the hotel tomorrow.

Dr. Coleman was also asked for a special favor today, something somewhat unusual in Continuing Promise—the two-man general surgeon team showed him into the ICU where a young girl (she looks much older here than her 10 or 12 years) was in recovery after having had severe inflammation and infection in the abdominal area, tachycardia up to 120 beats a minute, and a very high fever. The surgeons had performed an appendectomy and opened several pockets of severe infection—now she is stable, but with a large surgery wound in her abdomen. They believed that she was on her way to recovery, but simply wanted his opinion on the case.

She was eating, talking, and fever was lower, which along with some other indications led Dr. Coleman to agree with their assessment. But the biggest thing was that when she saw our HOPE shirts, she sat up in bed and began excitedly pointing into her mouth—hardly the behavior of a fatally sick child. It turned out that she was just more excited to tell us about how she had come aboard the Comfort on its last visit, in ’07, for a cleft lip/palate surgery, which looked good enough now as to be almost undetectable. Abdominal wound, fever, whatever—this was important!

Thanks for reading-Jacob



PS—also, the US Surgeon General toured the Comfort and the worksites today. Nothing but kudos from him to the sailors, soldiers, and civilian volunteers that are keeping this mission afloat.

PPS—Happy Fourth of July!

Underway on the USNS Comfort

The Project HOPE team set sail today for our final stop this year on operation Continuing Promise—Corinto, Nicaragua. On most Navy ships, underway is when things really crank up, but here, away from the port, the patients, and the work sites, the doctors, RN’s, nurses, midwives, sailors, soldiers (and yes, cameramen) get to take a little breather.

Which isn’t to say that it was a complete day off. The HOPE volunteers took over galley duty today, serving lunch and dinner, and cleaning the tables and dishes afterwards. The Culinary Specialists (CS’s) take such great care of us day in and day out, it was the least we could do to take the pressure off of them for a couple meals.

The volunteers also took a tour of the bridge, the brain of the ship. Joe, the Third Mate, had the deck, and graciously answered every question the girls posed to him, from turning radius and radio operation…to marital life and time spent at sea.

And, of course, there was the mandatory abandon ship drill. Each of us donned a blaze orange life jacket and, when the fire bell sounded, rushed for the flight deck. There, chaos somehow became order, and each sailor and volunteer were accounted for…

Tomorrow, we set the anchor again and begin the process of setting up for the final round of surgical screening, patient triage, education, vet assistance, surgery, prescriptions, and all the rest. Sleep well!

Thanks for reading-Jacob

Fair Winds and Good After-care, El Salvador

It’s the last day of services in Pasaquina, El Salvador. The same crews that transformed the Pasaquina Elementary School classrooms into the biggest hospital in the area are now converting them back into 1st Grade Math, 3rd Grade Reading, and 4th Grade English rooms. Meanwhile, the last of the waiting patients are being seen, final prescriptions written, and last health education pamphlets handed out for this country.

Which is not to say that the doctors and nurses didn’t go full steam ahead to the very end. In fact, some of the cases most in need of attention came yesterday and today. Doctor Ken Iserson, Project HOPE’s senior medical officer, saw the only case of Rickett’s, a rarer form of malnutrition caused by vitamin D deficiency, in a toddler yesterday. The boy’s mother brought him in with the complaint that “His feet are funny.” Not just his feet, though—his legs are obviously bowed outward, and under x-ray the ends of his bones significantly mushroom up, a signature of Rickett’s.

Fortunately, he got care just in time. His condition is not irreversible, and the Ministry of Health here has been in campaign against all forms of malnutrition for several years. His case got immediate attention from them, which is very good, as it’s usually not as simple as just adding more D to his diet. Most likely, he’s getting a normal amount of vitamin D, but not absorbing properly. Now, its in the Ministry of Health’s hands to find out why.

Project HOPE volunteers were also on the scene doing some non-medical assistance today. Diane Speranza and Elizabeth Roughead both participated with about 10 sailors in what the Navy calls a “COMREL” Project—military shorthand for “Community Relations,” their way of reaching out to the local communities where they harbor to lend a helping hand. Diane and Elizabeth both “got their lumberjack on” by clearing low-hanging limbs from trees that were directly over the Leones Special-Needs School. The trees were threatening the corrugated tin-roofed building, so the Navy/HOPE team cleaned them up, cleared the gutters, and even trimmed the hedges. (All this, of course, after due time was spent playing with the kids.)

That’s just two snapshots of all the activity today, though. Our Ops boss, Tracey Kunkel, represented HOPE at the El Salvador closing ceremonies today, and volunteer nurses Jane Bower, Ann Russell, Elise Chamberlain, Tina Weitcamp, and Meg Candage all were at the Subject Matter Expert Exchange with Salvadoran Ministry of Health educators, discussing El Salvador’s public health education program, rabies and dengue control, atraumatic dental practices, and El Salvador’s public contraceptives and sex education push. And on top of that, all the rest of the HOPE nurses were trying to get the remaining patients packed, together, and ready for their helo ride home.

Thanks for reading-Jacob

HOPE Volunteer Charity Braden Caring for Post-Op Patients in El Salvador

In rural El Salvador, the local elementary school has been turned into a bustling hub of medical activity. Thousands of potential patients wait at the gates. Scores more are in the initial screening process, and dozens are seeing health care providers in what were, until two days ago, children’s classrooms. As patients see the specialist doctors here, those who require surgery are forwarded to one of the 6 OR’s operating just a few miles away.

Crossing those few miles, however, will require what will most likely be the ride of the patient’s life. A Navy SH-60 helicopter will pick up the pre-op patients later that day, and hustle them aboard the white-hulled Navy hospital ship, USNS Comfort, anchored 10 miles off the coast. They’ll spend the night aboard, with volunteer nurses managing their pre-operation medication and diet, before being operated on the next day. From the OR, they’ll go briefly to ICU, then to the post-op ward to spend the night before the helo ride home the following day.

Here, in on the post-op floor, Charity Braden, a Project HOPE volunteer nurse, listens to the heart, lungs, and abdomen of her six patients as she comes on shift. Her bright spirit and enthusiasm are infectious, and soon all her patients are smiling with her. Like nearly all of the nurses here, Charity is volunteering a month of her time to deliver humanitarian aid to the places it is most needed in the Americas. Her presence in post-op allows more patients to be sent through the OR’s more rapidly, upping the “operation tempo” of the entire ship.

“Its great to be in a place where I can come do some real good in the world,” says Charity. “I’ve been trying to get out on a mission like this for three years, and both my husband and I are beginning doctorate studies later this year, so its awesome that I could do it this time. This is my first humanitarian mission, but my goal is to volunteer around the world with my nursing skills.”

A North Carolina native who now lives in D.C. and works in the ICU at George Washington Hospital, Charity is looking forward to beginning her studies as a Nurse Practitioner and to getting out on more volunteer work.

“Project HOPE is one of the few NGO’s that do volunteerism as well as they do, and its been really powerful to be part of the cooperation going on between the military and humanitarian NGO’s. They really have huge logistical capability, and we bring the extra manpower and expertise to make this mission happen. I’m really glad to be a part of it.”

Thanks for reading-Jacob

Patients and Public Relations

I spent a few moments with HOPE volunteer RN Carrie Reichert in the ICU this afternoon, while she was looking after Juan Jose, an 8-year-old boy who had just come up from anesthesia after a successful tonsillectomy, and his cheerful, hovering mother, Sandra. There were only two other patients in the ICU today, patients that for whatever reason were at higher risk for bleeding or other complications. In fact, in a “normal” hospital, they probably wouldn’t need to be in Intensive Care; but, we have the equipment, we have the space, and we have the staff, so it is no problem to give them an elevated level of care.

Getting the word out in the States about the daily struggles and triumphs of the volunteers and Navy personnel working here is a big deal, but the real heavy lifting comes in letting the rest of Latin America—and the world—know about what we’re doing here. Working through the embassy, Navy public affairs lead Matt Gill arranged for 5 different media outlets (television, radio, and print) to come aboard USNS Comfort today to tour the ship, meet the patients, surgeons, and nurses, and get a better picture of what we do here, how we’re helping.

I stayed with them for the entire tour, translating where necessary and doing a few interviews. Our first stop, of course, was the mess decks, where they got a taste of some good Navy chow. We then stepped through the patients’ process—Casualty Receiving, Pre-op ward (the Hotel), where we met Project HOPE volunteer RN Addy Wakeman, post-op wards. The cameras will get to see the OR and some surgeries tomorrow before they head home.

In the Hotel, one of the patients called out to a video crew (in Spanish):

“Hey, what channel are you guys?”“Channel four, my friend.”
“Oh, that’s the Salvadoran channel.”“…Well, yeah.”“We get Honduran television better here. Too bad.”

We’re anchored a mere 37 mile from the Honduran border, and due to the mountainous terrain, many of these Salvadorans get better reception from Honduras than from San Salvador, a three hour bus ride away.

After showing the media crews to their bunks, I stopped back by the ICU to see Juan Jose again. The night nursing staff was on, and he was now in the capable hands of HOPE volunteer RN Sarah Angelo. Both the boy and his mom were sleeping soundly—mom most likely because of exhaustion, the boy because of his hectic day.

On the post-op floor, HOPE night nurses Kelly Magee and Susan Troll were keeping things wrapped up as well. Kelly, who has been here since Miami, was in charge of the starboard wing, and Susan had six patients for the night in the port wing. Besides a few infants waking up now and again, only to be calmed by their mothers -- on the night shift, all was calm and quiet.


Thanks for reading-Jacob

Project HOPE Volunteers Help Yasmina and Other Salvadoran Girls

Three years ago, Yasmina, a 14-year-old Salvadoran girl, had received a penicillin shot to treat tonsillitis. The penicillin worked, but the very next day she displayed symptoms of “drop-foot”—she could no longer flex her foot upward to walk or run normally. The condition hadn’t improved in the intervening three years, and now her lower leg and foot were significantly atrophied and she walked with a limp.

Yasmina was now at a new Continuing Promise temporary worksite that had just opened today at the elementary school in rural Pasaquina, El Salvador. Project HOPE volunteer nurse practitioner Faye Pyles, one of two care providers in the pediatrics ward, thought she knew what Yasmina was suffering from. She referred her to the Navy physical therapist in the 4th grade science room down the hall. The physical therapist worked with her for almost 20 minutes, and seconded the diagnosis Faye had suspected—the tech who had given her the shot, either through poor training or negligence, had brushed her sciatic nerve in the process.

Even in the States, nerve damage is untreatable.

We put her in an ankle brace to keep her from a severe sprain and give some support to the leg the way her foot would if she were walking normally. She had just been referred to the pediatric neurologist, a Navy doc, when I was called away to translate another case—a woman with plantar fasciitis to whom the physical therapists were trying to explain how to use shoe inserts and do some stretching exercises to help the pain.

Meanwhile, Ann Russell, HOPE’s volunteer nurse midwife who is heading the OB/GYN ward on the ground, was having an interesting day of her own. She was seeing a lot of unwed young women, say, under 20, with severe dysmenorrhea. Back home, the most common treatment for irregular or very difficult periods is actually hormonal birth control—the scrip just says “hormone therapy” instead of “contraception.”

Continuing Promise doesn’t stock contraceptives, but even if it did, these young women probably wouldn’t take them. There is a huge cultural stigma against an unwed woman being on any form of contraception here. In fact, when Ann asked her patients the routine question of whether or not they were sexually active, they were uniformly taken aback that she thought such a thing might be possible.

She spent most of the day, then, educating these girls, and convinced them that, if they found some “hormonal therapy” medication, they wouldn’t have to miss school for an entire week every month, wouldn’t have to miss work, miss life…and that they could remain sexually inactive at the same time.

Faye and Ann were at the elementary school with Project HOPE senior medical officer, Dr. Ken Iserson, and a whole handful of HOPE volunteer triage nurses—Amy Bream, Meg Candage, and Marley Gevanthor—who upon arrival dove right into the crowd of patients awaiting screening. Even the HOPE Ops Officer, Tracey Kunkel, found herself employed in the pharmacy, working on totaling the hundreds of prescriptions HOPE, the Navy, and the other NGO’s onboard have given out so far in El Salvador.

I caught up with the Navy pediatric neurologist just before our helo flight back to the ship this evening. He had seen Yasmina just before he had to pack up for the day. If she were in his own practice, he said, he would have an orthotic device made to fit her foot, one that would place the joint at a safe angle and offer support in the way a normal foot would.

This is exactly what he did for Yasmina. He worked with the Salvadoran Ministry of Health on the site, and they have her mother’s telephone number, and vice versa. She is scheduled for an initial fitting for the device at La Union hospital on July 6th.

Thanks for reading-Jacob

On Shore, On Board and Behind the Scenes, Volunteers Continue Critical Work

The moving parts onboard Comfort never seem to stop moving. While the Project HOPE care providers were getting things done ashore and our team of nurses held down the fort aboard ship, the management team was engaged in their own work.

Dr. Ken Iserson, HOPE’s chief medical officer onboard, has spent the last two days as one of six docs on a board in charge of credentialing each and every volunteer doctor and surgeon that comes onboard. It’s a job that sounds fairly simple—yet considering that it requires reading English, Dutch, Spanish, and sometimes Portuguese, plus the sheer number of doctors and surgeons that rotate through Comfort’s OR’s, the task becomes quite formidable, especially given how critical the job is.

Meanwhile, Project HOPE’s operations officer for the mission, Tracey Kunkel, was officially handing over HOPE’s donated medical supplies--nearly $150,000 of medical and first aid supplies—to the El Salvadorian Ministry of Health for use in the nation’s clinics and hospitals.

While that was all going on, the Chief of Naval Operations (number one admiral) of the El Salvadorian Navy paid a visit to the Comfort and toured the ship and the hospital. Captain Ware, Commanding Officer of the hospital, gave him and his entourage the tour, and I ended up in front of the group of El Salvadorian top brass, (briefly, as the Captain had a lot of ship to show off) explaining HOPE’s mission, size, and makeup in Spanish.

Still, I managed to sneak into Casualty Receiving (CASREC) for a short time to see Project HOPE volunteer ER nurse Carleen Qualantone with her incoming patients. CASREC is equivalent to the ER in a land-based hospital--the first place that any patient bound for surgery goes when they come aboard Comfort. Carleen and the other CASREC nurses take whatever X-Rays, CT scans, blood work, or labs that a pre-op patient needs, then sends them to stay with HOPE volunteer nurse Addy Wakeman to stay the night before their surgery.

While I was with Carleen, HOPE volunteer nurse Peggy Goebel (who I shadowed on my first day ashore) walked by with three El Salvadorian nursing students in tow, showing them the ship, their berthing spaces, and…where they would be working. One of the major pieces of this mission isn’t about seeing patients at all, but liaising with our partner nations’ medical corps—the doctors, nurses, midwives, interns, and residents who will be in the medical work force for the next 20 to 40 years. Ken Iserson and Faye Pyles, when they were ashore, were especially good at this. They were both assigned El Salvadorian med students to help with translation (Ken speaks Spanish, but kept the med student there with him for this purpose). For most cases, both Faye and Ken would make the med student make the diagnosis.

Most of the time, Faye says, the student would be correct, but not sure of his answer, so she kept training—it was awesome for the med students, awesome for the HOPE volunteer docs to get to train, and awesome even for the El Salvadorian patients to see their own med corps growing. This same thing will be happening with these three nursing students who, out of the 400 students in their school, were selected to come aboard the Comfort for a week to help out wherever they’re needed.

And, as a final treat, I got to wave goodbye to Luciana Portello, the hysterectomy patient Elie Malloy was caring for in the ICU yesterday. I shook her husband’s hand and wished them well after her successful fibroid surgery before they left the discharge area. They say, “A smile will go a mile.” In this case, it’ll go a lot farther than that.

Thanks for reading-Jacob