Day 2: Heroes on the Loose!

I've titled today's blog entry as "Heroes on the Loose!" because that is exactly what is happening on USNS COMFORT. Yesterday started before 5:00am for most of the crew. By 6:00am, when reveille sounded, the galley had been serving breakfast for more than 45 minutes, the Casualty Receiving (CASREC) department was fully staffed and ready to receive patients, flight quarters was set, and COMFORT was ready to provide comfort to the injured thousands of Haiti.

It didn't take long for them to get busy. By the time most of our friends back home were climbing out of bed, we had received our first casualties and were taking patients to the OR.

13 hours later, patients were still being processed in CASREC, and as we were being briefed on the plan for today, I took these pictures of the people present to hear the brief. They had been working almost non-stop for 13 hours, and many of them left the brief and returned to spend many more hours continuing the fight. When I gave up and went to bed, there were still seven surgeries that needed to happen to clear the decks for today's arrivals.

This is Dr. Tim Donahue, our Director of Surgical Services. He's a Hero. As I was turning in for the night, he was taking a patient to the OR. I don't know what time he got to bed, or even if he did, but today he was right back at it, prioritizing patients for the OR, coordinating with all of the surgeons, and trying to manage the flow of patients to the ship in a manner that would allow the best use of our resources to save lives.

But Surgeons aren't the only heroes onboard COMFORT. This is a picture of a midnight engineering marvel rigged by some of our Civilian Mariners (CIVMARS) in the middle of the night in an attempt to bring down the temperature in our ICU. The electric motor that powers the air handler that provides cooling air for the ICU burned up. A new one is on order, but it hasn't arrived yet. Last night, the temperature was 104 degrees in the ICU. We had been running portable Air Conditioning units all day in an attempt to cool the space, but this space also contains our negative pressure isolation ward which was drawing hot air into the space faster than the air conditioner could pump it out. So, in the middle of the night, they connected flexible ducting to the discharge of the air conditioning units and ran it up the stairwell and off the ship. It got the temp down to the mid 80's by the morning.

And as the morning broke around us, the patients started coming again. Helicopter after helicopter after helicopter, each bringing three patients at a time. And as they arrived, they were brought down to CASREC by a hard-working team of stretcher bearers where doctors, nurses, and Corpsmen evaluated each one, started IVs, ran lab tests, took X-rays, stabilized them, and made decisions on where they needed to go from there. I heard some of our Corpsmen say that they learned more in one day than they did in months of working at hospitals back in the States.

And still they come. As I write this blog, it is now just before 5:00pm on day two. I'm in my stateroom typing this entry and out the window I see helicopters still bringing more. They will fly until dark, and the CASREC and OR will work till past midnight. The ICU's and Wards will work all night, and tomorrow will come.

I would be remiss as a Medical Service Corps Officer if I didn't highlight the nerve center of CASREC. The Patient Admin Cell who tracks every single patient and escort who comes aboard the ship. They collect identifying information, register them in our computer system, print out addressograph cards, follow them throughout their stay here and will ultimately discharge them and process them off the ship.

Today was a day of firsts: Our first baby was born: Life coming amidst the death that is everywhere in Haiti today. And we had our first death: a young man who was crushed in a building collapse during the earthquake. I would like to think that it is our last, but I know better. Pray for the people of Haiti. Pray for us.

Anchored off Port-au-Prince

At first light this morning we were approaching our anchorage off the city of Port-au-Prince, Haiti. We already had patients aboard from last night, and it didn't take long for more to start coming.

First we received patients that were transferred to us from the USS CARL VINSON and the USS BATON. Some of these men and women had horrible injuries and in short order were on their way to the operating room where our impressive team of surgeons went to work. As the morning progressed, more and more patients came and an awesome team of professionals took great care of them. It takes more than a doctor to care for these patients and our teams of Hospital Corpsmen, Nurses, and Patient Admin personnel combined with our patient transporters, security personnel, air crews and flight deck personnel did a great job.

Well, I have to run to our 1400 planning meeting.

Operation Unified Response, Haiti

Wow! What a difference a week makes! One week ago, my wife and I were still enjoying our RV trip to Florida to visit our Son, Daughter-in-Law, and Grandson. Last Tuesday, we got home from our trip about one hour after the earthquake struck in Haiti. As the first reports started to come in, it quickly became apparent that this was a disaster of epic proportions and that there was no one more capable and ready to respond than the crew of the Mighty USNS COMFORT!!

If you're new to this blog, I encourage you to take a few minutes and look back at the posts that were made during our recent deployment to Haiti and six other Central and South American countries from March to August 2009. We visited Haiti in April.

Three and a half days after the earthquake, two and a half days after our activation, COMFORT was underway enroute to help in the relief effort.

I wish that I had the energy to relate all that took place to make that happen. But quite frankly, I'm too tired, and it was too much to possibly give all the credit to where it was due. The day of the earthquake, our ship was not only in it's reduced operating status (normally ready to deploy in five days), but we had construction going on on the ship with major renovations to our sanitation systems and electrical systems still under way. We had a new CT scanner that had just been installed and an Angio suite that is half installed. Several of our key crew members were on leave and due to the construction, all of our blood had been transferred to Bethesda.

Two and a half days after activation, the ship put to sea with a medical staff of over 500 people, a security detachment, an air detachment, 84 civilian mariners, a Public Affairs shop, imbedded media, representatives from USAID, a logistics specialist, and I can't even think of the rest!

During the three days of our transit to Haiti we have not only pulled together our team, but have developed plans that include the expansion of the Hospital to levels that have never been done before. With an influx of over 450 additional medical and translator persoonel, we will be ready to fill every patient bed on the ship, run every available operating room, fill every one of our 80 intensive care beds, and do everything within our power to ease the suffering of the people of Haiti.

Tonight was our last night to get a good night's sleep before the crush begins. At our 1900 confirmation brief (7:00pm) we told everyone to get to bed early and get a good night's sleep in preparation for our arriving at anchorage off of Port-au-Prince tomorrow morning.

Then the phone rang. It was the aircraft carrier USS CARL VINSON (CVN 70). And at 9:00pm we got word that our first patients were on the way: Two children, one with a head injury and one with a pelvic injury, both needing immediate surgery.

So as I write this first entry, we are waiting for the helicopter to arrive with these first of what will no doubt be thousands of patients. Our team is ready. Our ship is ready. May God grant us the strength to do what needs to be done.

Homecoming!

Well, it's time to wrap up this deployment! We left Baltimore on March 13th and returned to Baltimore on August 4th. Since my last post, we stopped in Panama City for three days of much deserved liberty for the crew, While we were there, most of our NGO partners departed and a handful of our Active Duty staff. We then stopped in Ft. Lauderdale, Florida for two days of "Media Availability" and about 107 of our staff left. After that, we set sail for Norfolk, where we arrived on July 30th. The original plan was for most of our remaining crew to leave then (the whole of the Mission Commander's staff, all the various detachments, and most of the remaining hospital staff) but, before we arrived, we were told that we would be having a special visitor greet us on Friday, the 31st.

There was a lot of back and forth about who needed to stay, but it was finally decided that all we needed to field was a rent-a-crowd of 250 - 300 people. So, we asked all of the people who lived in the Norfolk, Virginia area to come back the next day, as well as the people who would remain with the ship for the trip to Baltimore, and we were able to let the rest leave. So, another 100 or so of our crew left for good in Norfolk.

And on Friday, we were honored to be met by Mrs. Michelle Obama, First Lady of the United States, who came to Norfolk to welcome us home from our mission. While I must admit, that originally I wasn't thrilled about her visit, I am glad to say that it was very nice and I'm glad that I got to participate.

So, to wrap up this blog, how about some numbers: During CONTINUING PROMISE '09 the crew of the USNS COMFORT did some amazing work. We registered and treated 100,049 patients. Performed 1691 surgeries. Provided over 432,000 healthcare services, trained over 39,000 people, treated almost 40,000 animals, repaired over $3 Million in medical equipment, built schools, clinics, and recreation facilities, and probably most importantly, we changed ourselves.

All together nearly 1600 people participated as part of the crew of CONTINUING PROMISE '09. 274 volunteers from Project Hope, Operation Smile, Latter-Day Saints Ministries, University of California at San Diego Pre-Dental Society, and Rotary International. 76 Foreign Partners from the Netherlands, Canada, Brazil, Nicaragua, El Salvador, Dominican Republic, Antigua Barbuda, Panama and Colombia. I actually heard one Project Hope volunteer comment that people wearing camouflage had always seemed so intimidating, but she learned that they were just regular people! We also had some camouflage wearing warriors learn that tree-huggers weren't so bad either! We all learned what great things could be done when we work together, each bringing their strengths to the table, and what a difference we can make in the world.

You may notice that there aren't any pictures in this post. That's because I can't seem to locate my camera since we got home! I'm sure it will show up sometime, but for now anyway, we'll have to do without! Thank you to everyone who participated in this mission. Every one of you made a difference! Thank you for those of you at home who "kept the home fires burning!" You made a difference too because you bore the sacrifice of having your loved ones gone and made it possible for them to do that. Thank you to those who made this mission possible and who invested the thousands of man-hours in planning all the things that had to happen to make this a success. And last, but certainly not least, Thank God for keeping us safe and returning us home to our families. And for the family of our fallen sister, Senior Chief Hospital Corpsman Pamela Branum, I pray that God will give you peace in knowing that she gave her life in the service of others.

Well, it's time to get to work planning the next mission of the Mighty USNS COMFORT! Until then. . .

Nicaragua! Lucky Number 7!

Nicaragua is our seventh and final country for Continuing Promise 2009! That's got to be lucky, right! Wrong! But who needs luck!


First, Nicaragua came literally on the heals of El Salvador. Less than a day after leaving La Union, we arrived at Corinto, Nicaragua. It was only about an 80 mile trip. The bad part was that it gave our people almost no time at all to recharge their batteries. El Salvador was a very difficult country from a logistics perspective. It was a long boat ride every day to and from the shore, the weather was brutally hot, and the Pacific swell made it difficult to get back onto the ship. Nicaragua made El Salvador feel like a walk in the park!

The first couple of days, we sat at anchor outside the harbor of Corinto. Several times we needed to stop surgery because the ship was rocking so hard! Finally, one day, we took 14 degree rolls which made life pretty interesting on the ship: We couldn't operate, we couldn't land helicopters, we couldn't launch or recover boats, and lesser men weaved their way down passageways like they had spent a little too much time at the pub!

So, we put to sea, heading into the swell instead of rolling back and forth in it. We ran a racetrack course taking us 12 miles or so out to sea, and then coming back in toward shore in a perfectly timed ballet to meet our small boats as they braved the waves coming back to the ship. We did that for nearly a week.

Finally, the waves settled a little and we went back to anchor. Well, for a little while at least. Then we were right back to rockin and rollin, so in no time, we were back to the NASCAR circuit!



I usually try to get ashore on the third day of each mission. This time, it wasn't until about 10 days into the mission before I got a chance to go ashore. We were being visited by Dr. Rice, the President of the Uniformed Services University of the Health Sciences in Bethesda, MD. I was on the faculty of that school a few years back, so it was a pleasure to welcome him aboard! CAPT Ware and I took him ashore to show him one of our medical sites before he had to fly off. We flew to shore on one of the Army helicopters that are helping to support our mission while here in Nicaragua. It was a beautiful day!



Our Director for Administration, LCDR Danielle Wooten and our Chief Information Officer, LT Sean Kelley accompanied us.


But now we are reaching the end. During our last day in Nicaragua, we sent 164 of our Shipmates ashore for the last time. We said goodbye to our friends from the Netherlands, and from Project Hope. We also said goodbye to 55 Army reservists, and 45 Navy reservists. Most of our volunteers from the University of California at San Diego went home, and we said goodbye to several of our Host Nation physicians who have been with us for most of this journey:

From the Dominican Republic, we said goodbye to Dr. Salas.


From El Salvador, we said goodbye to Dr. Schonenberg.


From Nicaragua, we said goodbye to Dr. Perez and Dr. Nicaragua. Yes that's right, Dr. Nicaragua from Nicaragua. I guess he's kind of like their Uncle Sam!


Tonight we had our Close-Out Brief for Nicaragua and for the mission as a whole. This was primarily to recap all the work done in all seven of our Host Nations.

As always, the close-out brief was amazing to see and hear some of the stories from what happened in Nicaragua. Our pediatricians treated little children that would have died without their help. Our surgeons did amazing work. Our veterinarians treated thousands of animals and taught veterinary students as well. I wish that there had been a way to capture those stories and to share them with everyone, but maybe that's one of the rewards for being here: to hear first hand and to see with your own eyes the work of these truly great humanitarians.

I started writing this blog post back on July 14th. It is now July 19th and we are anchored in Panama City for three days of liberty. This is our first liberty port in 56 days. That's 56 days of working 16+ hours a day, seven days a week, in often sweltering heat and choking humidity. Because of the limited availability of boats to transport people ashore, it took over seven hours to get the portion of our crew who weren't on duty ashore. I went out last night myself for a couple of hours and had a delicious meal at a place called "Alberto's."

Today, I hope to get ashore again sometime this afternoon, but first, I'm hosting a group of DV's (Distinguished Visitors) onboard for a tour of the ship.

Tomorrow, I'm going diving! That should be a blast!

Follow-Up on Eduardo & Andreas!

If you don't remember Eduardo and Andreas, look back at my Blog entry for Tumaco, Colombia. These were the two boys who were badly burned as infants and had grown up as abandoned children, begging for their existence.

These kids became instant celebrities onboard COMFORT for the 10 days they were with us! They took over the bridge, learnd about the magic of a soda fountain, and for the first time in their lives, knew what it was to be loved.

But now the COMFORT has moved on and we're currently bringing hope to the people of Nicaragua. But the change in the lives of Eduardo and Andreas isn't quite over yet. Today, we received the e-mail that I'll list below. The original was sent to one of our nurses on the ship who had worked with the boys (LT Cely), she in turn translated the essence of the e-mail and forwarded it on to the rest of the team. I'll include both e-mails below:



"From: Cely, Dinorah, LT
Sent: Monday, July 06, 2009 7:57 PM
To: Marino, Mark G., CDR
Subject: FW: SALUDOS

CDR.,

Just got an email from Maria Jesus. The best thing is that someone (the name below) in the US already has contacted her and has expressed her desire to become a godmother to Luis Eduardo and pay for his surgical procedures necessary. Maria Jesus has begun to contact a clinic in Bogota to make appt’s. I have family in Bogota and will contact them for possibly having them stay there. I am so happy!
The boys send their regards to the COMFORT family.

v/r;

LT Cely

From: maria montenegro [mailto:marjm2002@yahoo.es]
Sent: Monday, July 06, 2009 9:33 PM
To: Cely, Dinorah, LT
Cc: MARIA JESUS
Subject: SALUDOS



Ipiales, julio 6 de 2.009

Teniente CELLY
La saludo y le envìo mucho ànimo para continuar en la misiòn humanitaria, le envìo muchos saludos de los niños LUIS EDUARDO Y CAMILO ANDRES, se estàn recuperando favorablemente.
Algo positivo que le comento es que una señora de nombre ANGELICA MARIA HOYOS residente en los Estados Unidos se ha comunicado conmigo con el fin de expresar que desea apadrinar a LUIS EDUARDO y le quiere apoyar economicamente en las cirugias necesarias, por tanto ya hice el contacto con la clinica del quemado en Bogota y solicitarè cita para valoracion en Agosto cuando pienso viajar con los niños y si es necesario tendremos que ubicarlos temporalmente en hogares sustitutos en esa ciudad. Esto que le comento son realmente buenas noticias y se que a traves de Uds se nos abrieron muchas oportunidades de ayudar màs a los niños.
LUIS EDUARDO Y ANDRES CAMILO les envìan muchos saludos, tambien han manifestado que desean que les escriban.
ANDRES CAMILO expreña de sobremanera a KATTY y RICARDO de quienes no han recibido noticias.
Que la distancia no sea un obstàculo para olvidar a tan especiales personas, al contrario que fortalezcamos esos lazos de amistad a travès de la comunicacion.

MUCHOS EXITOS EN TODA SU JORNADA Y QUE DIOS LA BENDIGA"


If anyone else would like to participate in the care of these children, let me know and I'll pass your name along.

Nicaragua has been interesting! The seas, which have been so calm for so much of our trip are now showing just how easy it is for them to throw 69,000 metric tons of steel around! Oh well, I'll write about Nicaragua later!

La Union, El Salvador

We always eat well on COMFORT, but about once a month or so, we have some pretty special grub! Well this month, it was steak and lobster! Two of my very favorites!



That was delicious! Now I have the strength to go on with the blog!

La Union is a small town located in the Southwest portion of El Salvador, about a good stone’s throw from Honduras and Nicaragua. It is a beautiful part of the country with green EVERYWHERE!! We have a very aggressive medical mission here in El Salvador with a total of five medical site locations reaching from La Union up to San Miguel, nearly an hour by bus away.




During our time here in El Salvador, we were visited by Rear Admiral Dullea, the Deputy Commander of the National Naval Medical Center in Bethesda, Maryland. I was able to escort her ashore as we together visited two of our medical sites. CAPT Ware (Hospital CO) and CAPT Negus (Mission Commander) met us when we arrived ashore and together we visited the sites.


This has been a challenging port for us. Due to the geography surrounding La Union and the lack of port services, we are forced to be anchored out with an 11 nautical mile small boat transfer to get ashore. We also have a significant current to deal with depending on the tides, so the trip ashore can take between an hour if the tides are with us, and nearly two hours if they’re not. The waterway is also full of floating debris (trees, logs, etc.) making small boat operations too dangerous to do at night. Typically, we would move about 140 people ashore daily by small boat. That amounts to two trips each for our two “Hospitality” boats. If we were to do that here, it would take us four hours to get those people ashore and another four hours to get them back, only leaving a few hours in the day to see patients. Another confounding factor, has been the sea state. Typically in the afternoon, the sea state rises and makes it dangerous to transfer people by small boat back to the ship. The bottom line is that this has been a very difficult mission site from a logistics perspective.


That hasn’t stopped our people from excelling!! For every problem, there has been a solution. For every difficulty, there have been devoted people who work through the issue and continue to do what we’re here to do: Help the people of La Union. Even though working in dangerous heat (today’s heat index is forecast to reach 130 degrees!), with no Air Conditioning, our medical and dental teams have done amazing work. Averaging over 1,900 patients per day, our hospital staff spends four days and three nights ashore before they are relieved and return to the ship for a brief respite.


So how has this been received by the people of La Union? Well the Mayor of the city presented the Key to the city to our Mission Commander, CAPT Negus. This is the first time (including a visit by President Hoover) that the Key has ever been presented to an American. But of course, we’re not here to collect accolades, we’re here to help people, train ourselves and our partners, and build relationships that hopefully will last a lifetime!