Homeward Bound

Here are a few more photos summing up my time on the Mercy. The last several days we have been travelling between Timor Leste and Guam. The time was well spent taking photos, reading books, cleaning the ship, throwing eggs over board with a few of the mariners, watching the mariners fish from the back of the ship (they caught one!), playing games, making friends etc, etc, etc.

Today was a perfect day to end a perfect adventure. We ported in Guam this morning and got to spend the afternoon on liberty. Brinton, Susanne, Debbie and I rented bikes. Little did we know the weather would be rainy. Um, rainy is an understatement. It poured. Pretty much the whole day it poured--and we LOVED it. Everything I brought with me was soaking wet-passport, change of clothes, book and all.

We road our bikes out to Spanish Steps for a short but beautiful hike down to the a secluded beach for some snorkeling. (see picture #2 for a group photo).

Stay tuned for future highlights of life....but no more crazy trips for a long, long time. Grad school starts again on Wednesday. Hopefully I recover quickly from jet lag and don't sleep through advanced pathophysiology.

sorry if some of these photos are uploaded multiple times...I'm not sure what is going on with the internet at the moment.

MACRODYSTROPHIC LIPOMATOSIS

Finally I remembered to get and post the name of the foot anomaly seen here in Timor in two of our pediatric patients.

MACRODYSTROPHIC LIPOMATOSIS: or focal giantism.

Dr. Provenchar, the orthopedic surgeon, said that only 20 cases are reported around the world at this time....and we just found two more in the same village on one tiny island. (Don't quote me on the statistic...I haven't looked it up to verify that it is accurate. In any case, it is rare.)

Vocabulary Lesson

Did you know that part of the USNS Mercy experience includes lessons in vocabulary?

With sailors, soldiers and volunteers from Australia, Canada and Great Britain there has been a lot to learn.

Australian phrases:

fair dinkem: truth, or "seriously?!?" or "Are you for real?"
example: I just travelled to Timor Leste. Fair dinkem?

Tah: Thank you

Choccers: full

Hoorooy: bye

up the duff: pregnant

dag: uncool

Don't be a mug, mate: Don't do something stupid

Navy phrases

Muster: show up at 6:30 AM to report for duty

Volun-told: no one volunteers, you're assigned as a volunteer

flight quarters: No one allowed on the deck while the helicopters are out flying, no flash photography, no smoking near the helo pad

Stand by to stand by: we have no clue what is going on but be prepared. Something will be soon

Mess Deck: cafeteria

State Room: officer rooming, as opposed to enlisted berthing

Berthing: pronounced birthing but not to be confused. This is the placed where you sleep.

Secured: has multiple definitions. I have obtained something, I have tied something down, you are free to go (secured for liberty), no allowed to go somewhere (secured for flight quarters)

Sweepers: as heard twice daily. "Sweepers, sweepers. Man your brooms." Clean the whole ship now.

BZ: short for bravo zulu or translated means good job.

Rack: bed or bunk

British Vocab

fringe: bangs

chips: french fries

crisps: potato chips

Nappy: diaper for a baby

Plaster: band aid

rubber: pencil eraser

As I was getting on a "band aid" boat the other morning, one of the Australians already on the boat turned and said to the people already sitting down, "if you all shuffle over, we can make room." I realized--it's not their accents that makes me smile. It is the unexpected phrases they use. In my mind I was getting ready to ask one of them to scoot over, but the sweet aussie said it way better, way funnier and way more memorably (if that is a proper english word).
I have a British roommate. I can't help but smile as she throws in terms like heaps, rubbish, bloke, fancy, and "brilliant!" The other day she was reporting on a patient and reported the child had a "nappy rash." It took me a few minutes to determine if she was refering to the type of rash (a diaper rash) or describing the ugliness of the rash.

Photobucket

The internet is much faster this morning loading photos than I had anticipated. So, I will try to upload a few more photos for you to enjoy. These are loaded in no particular order and no particular story behind them.

The LDS charties pediatric day nurses (minus Kristen who had the day off). We are required to be in uniform at all times while away from our berthing areas just like the Navy and other military people. Our baby blue shirts (which you can't see the color by this photo) make us very easy to spot. I was walking down beach street in Dili toward the embassy to drop off a few items for the Crawfords and all of suddent someone is honking at us. Kelly Crawford was driving by and remarked that it is so easy to spot us in our shirts. We ended up getting a ride down the street and able to get out of the humid Dili air.




A few of these photos were taken on Monday when I visited a community health site that USAID is assisting with.





I took this photo thursday at sunset while on Liberty. Katie, MaryAnn and I spent the day with Kelly Crawford seeing some of the sites in Dili--Dili Rock, an Uma Luma (sp?), and hiking the Jesus statue. Sammy, Kelly's 4 year old, joined Mary Ann and I in our hike to the top...he got a pleasant ride on my back and I got an extra good work out while climbing 250 of the 500 plus stairs to the top with him on my back. This photo was taken right after that. The clouds have come in, but I think the only rain we got while in timor Leste was Monday afternoon and it didn't last very long.





This is an after photo of one of the kids who received a cleft lip repair while on the ship. I posted a before photo a few days ago. You canlook and compare the difference. He had a cleft lip and palate repair with dental restoration and tubes placed in his ear. Wow--quite a lot for one little guy to deal with AND for his father to assist with care post surgery. He had one of the worst cleft lips/palate that I saw while here in Timor Leste. He is still pretty young and was such an energetic little guy. He didn't seem ashamed or aware of his deformity prior to surgery as he interacted with all the other children. I can't help but think what a blessing this surgery will be for him. Operation Smile was also doing surgeries on the ship and had some of their pre-op patients in our unit. There were a number of adults who were on board to repair thier lips. Cleft lips/palates seem to be more common in South east Asia than in other parts of the world, according to one of the doctors I spoke with, though they are unable to determine the reason.




Another photo from the USAID trip to a community center. The average age in Timor Leste is under 20 years of age. As I have written in a previous blog, this is because so many were killed during their fight for independence a little over 10 years ago. We didn't see people in the older generation very often and I loved seeing these 3 little ladies. I'm not sure if they were there seeking health education or if this is the place to hang out and get a little shade for the day. Seemed like most of the town had shown up for the event.




Me playing in the pediatrics unit. As a side note--as you can see, the garbages are all labeled. We are required to separate food, paper, plastic, and metal garbage into different bags. The capcity of these bags is obviously huge.





If the baby can cry, why can't I? Gotta love that hat

Final Day in Dili

We have finished our work in Timor Leste and the Mercy ship is now sailing toward Guam. We spent all morning yesterday cleaning up the unit and securing the pediatrics department for sea. We are headed towards a tropical storm and told that the seas have the potential to be very rough. This makes it more important than ever to secure everything in place and tie it down. So far, the waters have been calm. I was able to watch the sun set last evening from the deck, but the winds were definitely blowing. Blowing strong enough that my folder with homework blew open and papers started flying across the deck. Oops, so much for securing my personal belongings. Lesson learned!



My last day in Timor Leste (Monday) was a day off from the pediatric unit. I was forunate to hear about a small group of preventative health representatives meeting up with a USAID employee to visit a district about an hour away from Dili. We visited a community health center with actual buildings/rooms for visits with doctors and pharmacy pick ups. There is also a birthing center. This is a 3 room building for women to come for delivery. I learned that less than 30% of women go to facilities for births and the mortality rate is very high at the time for women and babies during child birth. There are also no Timorese doctors at this time. There was a Cuban doctor at this clinic, otherwise it was run by nurses and midwives. Many of the women who deliver have a neighbor come to assist with the delivery. We met a woman who delivered her 4th child the previous night.

I love the photo below of this sweet elderly gentleman. He saw the photo taken of him on my camera and got such a kick out. Katie snapped this photo of him with a smile on his face. The other pictures I have of him, he has a very serious face. You can't see his teeth, but if you could they would be stained red. Many of the adults chew on a red root called beetle root (not sure if that is how you spell it, but is how it sounds). The first time I saw it, I thought someone mouth/gums/lips were bleeding all over the place. I quickly learned that was not the case.

This is one of our translators. I gave him one of our LDS Charities shirts. He gave me his awesome hat in return. We were grateful for the translators that assisted us. Though there was some misinterpretation that took place, it was impressive to see these young high school age kids assisting us. In 2 years I can only imagine that the language abilities for translation will improve and more of these kids who were introduced to English on this ship will continue to study and get university degrees. There is a huge need in Timor for medical providers and people with innovative business ideas to help get the economy of this new country up and rolling. These kids are well on thier way to being the future leaders of this country.

This Little Piggy Went Wee Wee all the Way.....

This is little Jebanio. Cute little guy, huh? But as my British flat mate/co-worker says in her proper english accent, he's very naughty. Maybe you can see some of the mischeviousness in his eyes. He frequently throws tantrums, doesn't mind his mom, hits her, and wants whatever toy the other kids are playing with. And he will cry and flail his arms until he gets it.




Poor little guy had a surgery that required him to have a catheter for a week. I guess I might cry too if I had to endure that for so long. For the first few days he refused to get out of bed. I was the lucky nurse that took care of him the day the doctor said he must ambulate. Shown below attempt #1 of getting him to walk. My solution: I carried him upstairs to the flight deck to entice him to walk. Instead of using a ball like you would to get a baby to take his first steps, I had something even better--boats and helicopters. It worked. He took about 20 steps up on the flight deck toward the "helo" but every step was a fight. As you can see from the picture, he had a pretty good melt down back on the unit because I tried to make him walk back to bed. He slid across the linoleum floor while mom and I pulled.

I took care of little mr. stubborn for 3 long, consecutive days. On the third day, Dr. Auge took out Jebanio's catheter! Glorious day for the kid. He was out of bed, running circles around the nursing station, kicking a big blue exercise ball, having the time of his life. All until he needed to go PEE (excuse my improper medical terminology for urinate). Once the little guy peed, he could take a bandaid boat back to shore and go home after spending 8 or 9 days on the ship. I thought it would be SO easy. I gave him water to drink, tried giving him bubbles to blow to bear down, etc. No, No, NO. It didn't work. He started screaming around lunch time and doing the potty dance. I put him in a warm shower-3 different times, tried putting him in a bucket of warm water, tried placing a warm rag over his bladder, and pushed on his bladder. The screaming only got worse. I called a different department of nurses-ones who have actually been moms to see if they had other suggestions. It was an international survey as we had suggestions from Americans, Canadaians, Britians, and a nurse born in Trinadad. I had run out of ideas. After 3 hours and attempting to place another catheter in the child while he was screaming/kicking (no luck there), Dr. Auge decided to take him back to sugery.

Pre-op called me 30 mins after I dropped him off.

He peed'd all of their floor and was still standing in the puddle when I came up to get him. Back on the pediatric unit, he continued to go pantless the rest of the shift while he wet the bed, piddled all over the flood and pretty much went wee, wee everywhere.

Sleep tight little Jebanio. Maybe on another day you can go to the market or eat roast beef.....

It really does have a name...

Once again, I forgot to write down the name of this disorder, but I'll post it later today-I promise. Here are the post-op photos of the two teenagers that had their foot anomalies repaired.

Photo #1 was a 16 year old girl. She only had the second toe debulked and shortened. Sorry I don't have any pre-op photos of her foot.

These next two photos are of the 16 year old boy that I posted photos and explained about the other day. His surgery was much more complicated. The orthopedic surgeon removed the second toe, straightened the big toe and debulked the excess fatty tissue from the bottom of his foot.

I'm not sure what you think. As nurses we were debating on whether this really was an improvement from his pre-procedure foot or not. You can be the judge of that. He seemed happy with the outcome and had tossed his crutches aside and was hopping around the unit for the 3 days he stayed.

He and 3 other patients from the unit flew home by helicopter to a remote village called Same (pronounced Saw-May) Monday morning.

We currently have one patient left on the unit. He will be transferred to the national hospital this morning and we will depart for Guam last this afternoon.

3rd World Medicine

Dr. Dorey, while out on a medcap, found two patients who have the medical anomaly shown below. I tried googling the actual name for it, but can't find it.

I did read a site about podamacy, a divination guide used in Persia (Iran) to read feet. It says if you have one toe larger than typical for that toe that the energies of that toe are more abundant and exaggerated. Each toe has a different energy. The little toe has to do with fear and trust. 4th toe to attachment and love, etc. It says if your first toe is large, you tend to be a big talker but not everything you say is based on reality.

According to this site, if you have a big second toe then you tend to have big vision but can be self opinionated and like to be seen in charge.

I hope we didn't distrupt the gods plan for this 16 year old boy and another 16 year old girl who both suffer from this condition.

They both had surgery on Wednesday to correct this medical condition. I took care of him post op, but his foot was wrapped and I couldn't get a good picture of the orthopedics final outcome.

The orthopedic doctor said that this condition is very rare and definitely is not something we would see in America on someone this age because the condition is repaired by the time a child is 6 mo old.

Yesterday, while on liberty, I went and visited Dr. Dan's clinic in Dili. He is an American doctor praciting here in Timor Leste. I didn't get enough information about his history (how long he has been working here or his medical background) but we did talk long enough to hear his thoughts on how to improve health among the Timorese people. His suggestion: educate the women, which goes against many Southeast Asian customs. As women are educated and empowered with knowledge, they can educate their families and villages and then improvements will begin to take place. He said at this time TB and HIV is rampant. Many are dying from malaria, Dengue fever and the mortality rate during child birth his huge. There are only midwives here in Timor to assist with delivering babies and any small complication can have devastating consequences.

In Timor Leste Money Does Equal Happiness

I've never been a parent and never had to deal with the stressful situation of an unruly, cying child. But the Timorese seem to have figured out a solution to making their children stop crying.

$$$$$

I kept seeing little kids in the unit with dollar bills clutched in their hands. One little boy went to surgery with a sinlge dollar in his hand and returned with about $7. Wow, who knew surgery made you rich. I asked one of the translators about it. She said parents give their child money until they have given enough money that the child stops crying.

(this photo is after Rivaldo came back from surgery)

Would this tactic work on american children??

Does this Count as Work?

here are a few more photos of some of the pediatric patients. They are so beautiful and I just wish I could understand more of what they are saying. But the smile on their face and a big hug is enough for the time being. The two cleft lips kids should be going to surgery today.

And should you think that I'm having too much fun playing with the kids, here is a picture of me working in the Timor sun. We painted the school fence tangerine orange. Oh, by the way--it is winter here in Timor. Which means that it is only 90 degrees. Count your many blessings!

MREs: Take 2

In Haiti I tried MREs for the first time. In trying I mean to say that I took one bite of potato soup and decided that I could live off granola bars for breakfast and lunch for the 2 weeks we worked in Haiti.

On Sunday I attended a "comserv" (a community service project) where we spent several hours painting a fence around the perimeter of a school. In true military fashion we ate MREs for lunch. In case you can't tell by the look on my face, I think the second go around was a better experience than the first.

And by trying I mean to say that I gave the main entree of BBQ pork ribs (which included the word imitation in the title of the entree) and clam chowder to another volunteer while I ate the torillas with squeeze cheese and raisins and nuts.

I think that half the joy of eating an MRE is just seeing what side dishes (if you can call them sides) come in your package. The person sitting next to me had a nutella like spread with pound cake while others had peanut butter with a cookie and crackers. Mmmm, delicious.

Photos from Liberty