ASTMH: Day 3 (I think)

If today is Tuesday, than it's the official third day of the ASTMH conference (and yes, it's all run together that much that I no longer know). The day started with the first session at 8, just like yesterday. I attended the session on non-malaria fever in Africa, thinking it might be applicable to my job, but that might have been a mistake. I don't know if it was that I was so tired from the night before or if the speakers were just that non-engaging, but I found myself falling asleep during the presentations. I actually stood up during the last presentation, which was on a new algorithm for treating pediatric fever, because I actually wanted to stay awake to hear what she had to say. It was a really good presentation; her group had gone through and tested a lot of children (I forget the number) who came into the hospital with either fever, cough, or diarrhea, and then went back and correlated the signs and symptoms at presentation to what they actually had (malaria, pneumonia, dysentery, etc). They came up with a new algorithm for evaluating children that, when used properly, reduced the number of kids given antimalarials or antibiotics who didn't really need them. Pretty powerful stuff, if they can get wide-spread use of the new algorithm.

The second session I went to was also on global health, and wasn't really that great. Each session had multiple speakers, and the one I wanted to hear was about training community health workers on proper diagnosis and treatment of kids (a lot of the same stuff as the session before). However, the presenter didn't really discuss what the teaching was, just that it didn't work very well. Oh, well. At least I get continuing education credit for being there.

The best session all day was the lunch session on tropical medicine in temperate climates. It's a session given every year by the people at the London School of Tropical Medicine, because they have an entire ward of the hospital for tropical medicine. This year's cases were loa loa (African eye worm), West African trypanosomiasis (African Sleeping Sickness), and adverse reactions to malaria medications. Just for something to gross you out, here's a picture of loa loa:

Yes, that is a worm in a person's eye. It's gross (all pictures of eyes are gross), but the patient was properly diagnosed and treated and is now doing well (at least, that's what the doctors making the presentation tell me).

Tomorrow is my poster presentation on my dengue project, so I hope that goes well. After I'm done standing by my poster, I'm packing up my stuff and then heading for the airport, because it'll be time for me to go back to Savannah and work for a couple of days before I leave for Tanzania to climb Mt. Kilimanjaro (should be a good time).

Exploring Atlanta and Beginning ASTMH

Yesterday we didn't have any obligations at the conference until the opening plenary session in the evening, so I decided to explore. I have been to Atlanta before, but the most recent time was in 2004, when I was at Emory doing research for the summer. That was obviously a long time ago, so I had a lot of exploring to do. I started the day by sleeping in (it was, after all, Sunday, and I had taken a pretty big exam the morning before), and then headed down to the Underground Atlanta area (less than a mile from my hotel) to take an electric car tour. It was pretty similar to the trolley tours in Savannah, only without the on-and-off that the Savannah trolleys offer (to allow you to explore on your own between stories from the tour guides). I did learn a lot about the downtown Atlanta area, though, including some of the history of the King family as we drove by the house where MLK, Jr was born and the church where he would occasionally preach. I also learned what this is. Any guesses?

It's actually a holding cell (I know, right?). Back in the day (before 1905 or so), this part of Atlanta (Inman Park) was pretty far away from the city proper, so when someone had committed a crime, they would lock him into this tiny little cell and turn on the light on the top, so the paddywagon knew to come pick him up and take him to jail. Well, Atlanta gets hot in the summer, and after enough people died in these, they decided that maybe it wasn't the best way to hold prisoners until they could be taken to jail.

After the tour, one of my classmates from last year and I explored World of Coke, because it's free with a military ID. I wouldn't recommend it to anyone who has to pay. Completely not worth it. We did like this picture of a WWII Army nurse, though:

Last night was the opening plenary, by the CEO of Save the Children, Carolyn Miles, pictured below (pic from the internet):

It actually wasn't the best speech ever, but it wasn't bad. I think the problem was that she's a business-type person, speaking to an entire room of people who study tropical diseases about why children are important and why studying the diseases that kill them is important. I think we got that message already.

Today I started the day with clinical updates from the last year in malaria, dengue, yellow fever, and TB. The malaria updates were very well done and very helpful, but the other presenters of the other three diseases spent too much time going over the history of their respective diseases and not enough time talking about updates. After that session was a talk on tropical dermatology, which made me feel good about myself and my ability to recognize pictures of rashes. Of course, it's the same 100 pictures used for the same diseases, so whether I'm just recognizing the pictures or if I understand the rashes or not is another issue entirely. Here's one of the pictures I saw a lot of in my tropical medicine studying:

This is chromoblastomycosis, and if I didn't know better, I'd swear it was the only picture of this disease, for how often it's used. Anyway, after tropical derm was lunch/clinical cases, which was about echinococcus and given by a completely uninteresting speaker, so my friend and I left early for our midday break, which I spent going on a short run (3ish miles). Then we returned for more clinical updates from the CDC, and then it was time to break for the evening for drinks and pizza. I forget the name of the restaurant, but it was delicious. And I got to do a lot of networking, which is always helpful.

Tomorrow will be more of the same (as far as the lectures, not the exploring of Atlanta). Hopefully I learn something applicable to my new job.

CTropMed Exam

Well, this morning was the moment of truth: the last test of the foreseeable future (assuming I passed both the Preventive Medicine boards and this one), the ASTMH Certification of Knowledge in Tropical Medicine exam. Here's what I was using to study:

Yes, this is a very large stack of flashcards. I went through all of the lectures from Principles and Practice of Tropical Medicine (the most intense course I had during my MTM&H coursework) and turned every bacteria, virus, fungus, parasite, and miscellaneous disease into a flashcard. It's pretty much all I've been doing for the last month, but I think it paid off, because I was feeling pretty confident during the exam. From the conversations of my classmates who went through it with me, that wasn't a universal feeling.

The exam was 200 multiple-choice questions in 4 hours (I didn't take the whole time), paper and pencil (which was also strange, since I hadn't had a non-computerized exam since the MCAT). Most of the questions were infectious disease, but there were also some on travel medicine and I think five questions on epidemiology/biostats (which were all ridiculously easy). There were a few that were "guess what I'm thinking" type questions, and a few that I could swear had a few right answers to chose from, but it all, wasn't too bad. I would give an example if I could remember any verbatim (and if it weren't against the rules to post such things on the internet).

After the exam, those of us who did the course together all went out for lunch, and then some had to leave to catch flights back to their respective locations (since the conference isn't funded for DoD, most people decided not to stay; I'm paying for it out of pocket). Those of us who are staying went back to the hotel to crash before we went out for dinner. It was a pretty fun group, and aside from that inconvenient little test, was a pretty fun day.

And here's a random picture of looking up in my hotel from the lobby. Yes, it's very tall.

APFT and Preparing for Yet Another Exam

Even though the rest of the Army does the APFT (Army Physical Fitness Test) in April and October, we just got around to doing ours on Wednesday (November 6). Better late than never. Now, this brings up a fun fact about coastal Georgia: it gets cold in the mornings in November. Not the kind of bone-piercing, dry cold that I grew up with. No, this is wet cold that you breathe into your lungs and it just kinda stays there, all cold. So even though the thermometer said 42, I was bundled up like it was far below freezing (or maybe the South has just made me weak).

Despite the cold (and a fair amount of whining by yours truly), I managed to do this on the APFT:

That's a 308/300, or better than what the Army considers to be prime fitness (it'll be recorded as a 300 in my records; just like there's no such thing as an A+, there's no such thing as better than the maximum score). Since our brigade command sergeant major (highest enlisted Soldier in the brigade) was here from Ft. Hood, my perfect score got me one of these:

This is our brigade coin, which I was supposed to be awarded during morning formation yesterday. Unfortunately, when they called my name, I wasn't there, because I was at the hospital seeing one of our Soldiers. He had an ACL repair last week and ended up developing a clot (DVT, or deep vein thrombosis) in his leg, which traveled to his lung (forming a pulmonary embolus, or PE). He's doing fine now, but he's been in and out of the ER since the day after his surgery. He first went in with shortness of breath and a CT (cat scan) was negative for PE. So he was sent home; four days later, he was again short of breath, and this time, they did find a clot in his lungs. It wasn't large, but they did admit him for observation and to teach him how to take the medications to treat it (one week of a blood-thinner shot and six months of a blood-thinner pill). Unfortunately, the day after he was discharged from the hospital, he was back in the ER. He followed up with the orthopedic surgeon who did his ACL repair and ended up coughing up a little blood, which freaked out the surgeon and he called for an ambulance. Again, he's fine. I explained to him that while he's on these blood thinners, he might cough up a little blood every once in a while, or he might get nosebleeds, or might bruise easily, and unless he's actively bleeding, there's no need for alarm.

The biggest learning experience of this (for me) was learning how to be an intermediate between the doctors at the hospital and the Soldiers and officers of my battalion. I obviously speak 'doctor', but this Soldier doesn't, and neither does his company commander or first sergeant. They're understandably protective of their Soldier and were very upset about all of this back-and-forth to the ER, thinking that it meant that he wasn't getting adequate care from the hospital. So I talked to his doctors, found out the whole story, and explained things to the Soldier, his commander, and his first sergeant in a way that (I hope) calmed everyone down.

Of course, after all of this, I hopped on a plane for Atlanta (okay, there was some time between; I finished up the workday yesterday, went home, studied, got up this morning, went running, gave blood, and then hopped on a plane for Atlanta), because I have my Certification of Knowledge in Tropical Medicine exam tomorrow, the first activity of American Society of Tropical Medicine and Hygiene. Since arriving at the hotel, all I've done is sit and go through my flashcards (I'll put up a picture of the stack of flashcards tomorrow, if I remember). I did have a nice view, though:

I'm on the 23rd floor of the Atlanta Marriott Marquis, which is downtown (and only a couple of blocks from a MARTA station, so I didn't have to spring for a cab from the airport). After my exam tomorrow (if I have any energy) and all day Sunday, I'm going to explore Atlanta, since I haven't been here (airport doesn't count) since my summer at Emory in college (2004... Man, time flies). And then I'll be spending my time conferencing and preparing for my presentation. More about that later.

Activation, Triathlons, Medical Evaluation Boards, and Everything In Between

Yes, it's been a while since I've updated. A very long while. I could say I've been busy, but really, I think I've just been lazy. Here are some of the things that have happened since my last post:

1) The 82nd Civil Affairs Battalion was activated on 27 September 2012. The week leading up to the activation, we had rehearsals almost every day, which was tedious, but there were still some good times:

This was one of the rehearsals, obviously. I don't know what led to this; I just walked up as they were doing pushups, so I figured it was as good a time as any to take pictures.

And this is 2LT Alex Sasseman, the Adjuvant General (officer in charge of personnel). She had the delightful job of running in front of formation at the sound of the Adjuvant's Call, so that was actually quite a bit of running in the course of all of those rehearsals.

This was after the activation, when LTC Gardner (in the middle) cut the cake with his Zulu sword.

2) Triathlons. I ended up doing two triathlons this summer, one on the beach on Hilton Head Island and one in Florida at Amelia Island. The one on Hilton Head was actually pretty difficult, because not only was everything on the beach (including the bike), but it was August and very hot and sunny. The one at Amelia Island ended up not being a triathlon (they cancelled the swim due to riptides), but was still a good race. I ended up winning the military division for the sprint distance (16 mile bike and 3 mile run). I also did a 2.5 mile ocean swim in Jacksonville, FL and a few runs, the most recent of which was the Rock n Roll Half Marathon through downtown Savannah yesterday (I started too fast in efforts of finishing under 2 hours and ended up dying around mile 8, coming in at 2:21. I'll try not to repeat that mistake at my next half in December).

This was at the costume run the Friday before Halloween. I had to buy the red running shoes special for the costume.

3) Medical Evaluation Boards (MEB). This is not fun. As part of the "post tax", as LTC Gardner calls it, once a week I see soldiers from the Military Police in clinic to determine if they need to go to the MEB. These are soldiers who have been on limited duty profiles for an extended period of time and aren't making any recovery (or not enough). For some, it's just a matter of writing a referral to see a specialist (orthopedics, neurology, etc). For others, it's time for a long conversation about not being fit for the Army any more. It's not as simple as writing the referral for the MEB, unfortunately. The entire process takes anywhere from 6-12 months and involves many meetings and evaluations from people from the Army and the VA and likely more that I'm forgetting. I have no idea how many of the people I refer will actually be found to be not fit for duty, but this is what I do.

4) Parents came to visit. We explored Savannah, went hiking in a state park, Jekyll Island, and went up to Charleston, SC and Ft. Sumter. It was good to have them here (even though my guest bed didn't arrive until after they left).

5) Disney World. It's the most magical place on Earth. Need I say more?

6) Firing range. For three days last month, I got to hang out with the team leaders and senior NCOs from Alpha Company at the firing range. It wasn't much fun, but I did qualify on both the M4 (rifle) and M9 (pistol).

And I got a little burned by some ejected brass. Like I said, not much fun.

I think that's about it. I'll try not to let it be another three-ish months before I update next.

Slowly Settling In

Progress is being made in getting me settled into my new job (yay, progress!). I have an office now. It's nothing exciting yet:

We're supposed to get some fresh paint in the next couple of days, and it's still undetermined if anything will be done about the flooring (rumor is, the tiles have asbestos, so they might have to stay put). We have some furniture waiting to be moved in, once the painting is done, and then really, all I'll need is a computer. There will be an "after" picture, at some point.

I do finally have access to AHLTA, the DoD's electronic medical record. That just came through today, so I was pretty excited about that. Even though I won't be able to get it installed on my office computer (you have to be on the medical department's network, and my new job isn't), I will be able to access it remotely from my office, once my application to do so is approved. Again, with any luck, that won't be too long.

I also swung by the division surgeon's office today. The division surgeon is the top medical person in the 3rd Infantry Division (the division at Ft. Stewart). My battalion isn't technically part of 3ID, but since we're located on the same base, we fall under them in some respects. One of those is an agreement that all medical providers in the division put in some time at the Troop Medical Clinic (TMC). This is kinda a hairy point, as I'm not technically part of the division, but common belief (not held by me) is that this applies to me as well. So I talked to the division surgeon and explained that patient care is actually a very small part of my job, and the number of hours they were asking was not in alignment with how much time I should be spending on care. She then asked for my full job description, so now I'm roped into giving a presentation to her on Thursday about my roles and responsibilities as the physician in a civil affairs battalion. Much fun. I'm hoping I do a good enough job that I can convince her to let me out of time spent at the TMC, without having to involve higher-ups to pull any influence. Fingers crossed.

Getting Work Done, and Taking a Break

I've been a bit lax about updates, but to catch you up, I finished in-processing, both for Ft. Stewart and the battalion (yes, there was a separate in-processing for the battalion, but it was easy and only took about an hour).

Friday was my first full day, and since then, I've been working(ish). The unit does PT together every morning, which is a completely foreign concept to me (I'm used to working out by myself). So Friday morning, I joined in for PT with some of the other officers. We ran about three miles in a park not far from where I live, which was nice, because it meant I got to go home and shower and change, instead of sharing a locker room with about 100 other girls.

I still don't have full computer access, either at the battalion or at the hospital. I don't mind so much at the battalion; as long as I can get on a computer, I'm happy. The hospital, on the other hand, controls whether or not I can do work. So I've been spending a lot of time going back and forth between my battalion headquarters and the hospital (where I'm using a computer in the preventive medicine department). It's a couple of miles across post, so all I've really been doing since Friday is going between office and car and office and so on and so forth. I think I made the round trip three times today.

I tried to do PT with the battalion on Monday morning as well (after doing a whole lot of nothing all weekend), but got caught in traffic and ended up arriving 45 minutes late. And I thought I left the traffic behind in DC (I found out later yesterday that there was an accident, which tends to slow things down on a two-lane highway). So I went running on a treadmill at the gym yesterday morning instead (and then dealt with the whole shower/locker room situation) before spending the morning at the hospital working on getting computer access. Great fun.

The day started early this morning, when I drove to Hunter Army Air Field (subordinate base in Savannah) to do PT with the junior medics. They're taking a paramedic course in Savannah, so it's easier for them to work out at Hunter instead of Ft. Stewart. After that was back to Ft. Stewart, to continue trying to get stuff down without a computer (seriously, how did people do it?!?). People are starting to come to me with medical questions, which I can't really do anything about. I can't practice medicine, because I don't have a clinic, computer access, or credentials; and because I don't have computer access, I can't write referrals for them to see anyone else. With any luck, this will all be over soon and I'll be doing real work.

Until then, I have ten days of vacation, because that's what the Army does when you move somewhere and haven't figured out your job yet. Immediately gives you a vacation.

Days 3 and 4 of In-processing: Almost Done

I realized this morning that I forgot to write a post about yesterday. Sorry about that. I'll try to combine the experience with today's experience.

Yesterday I did not go in for PT at 0600, choosing to go running at home instead. I was going to go running outside, but ultimately, unfamiliar neighborhood, lack of sidewalks, prior to sunrise, and lack of streetlights lead me to believe that that not be the best idea ever. I found a place on base today where I'm going to try running tomorrow, but I digress.

The day really started at 0845, when I arrived at the room where we would spend the morning. Even though they told us 0845, nothing really started until 0915, and that wasn't much. We turned in our dental records (exciting), our medical records (I didn't turn mine in, because I don't see the point), and then finance came to have us fill in forms to get our housing pay changed to Ft. Stewart (good-bye, getting paid to live around DC) and fill out our travel forms to get reimbursed for moving. Sounds simple enough, but you would think it was rocket science for all the questions it generated.

After lunch was when the VIPs (me and a few others) were separated from the normal people. We were given four tasks to go through: dental for an exam and x-rays, even though I just had an exam and x-rays at Walter Reed last month; medical, to confirm that I am up-to-date on vaccinations (which I am; that's kinda my job); behavioral health, to confirm that I'm not [too] crazy to be in the Army; and personnel, where I changed my address and made sure my life insurance when somewhere (have fun, parents). Then I was given four more tasks to complete in the next five days. I knocked out two of them yesterday (the museum of the 3rd Infantry Division and the Education Center). The other two will take the next two days, because they both happen at the same time daily.

This morning, I opted for the Central Issue Facility, where I was given almost $5000 worth of Army gear (not to keep for myself) that I will probably never use. At every step, they seemed really surprised that I hadn't been issued any gear before. That's what happens when you spend your time at a base that only has a hospital (and no troops). Nobody gives you anything. So now I have a trunk full of cold weather gear, Kevlar helmet, sleeping bag, rucksack, etc, etc. Tomorrow morning will be the safety brief, and then I'll be done in-processing on post.


Since I finished at CIF around 1100, I headed over to the battalion office to check in and see if there's anything they could do for me (or I for them, even though I can't really do anything yet). While I was there I took a lovely picture of the sign:

They're getting me set up on getting email and whatnot, which is about all they can do until I actually get an office. I also stopped by the hospital to see about getting computer access, because I can't really be a doctor until I have access to the DoD's EMR. With any luck, that'll happen soon.

Day 2 of In-Processing: Continuing to Make Progress

Today was my second day of in-processing, which is actually my official "day zero". It didn't make much sense to me, either.

After getting up early to make it to PT on time, I was again stuck in the "no decals" lane at the main gate, because I still don't have decals on my car (I now have a temporary pass, which is the best I can do until I have my Washington registration and plates, but that's another story). What nobody bothered to tell me, however, is that it takes about 45 minutes to get through the "no decals" lane around 0600. I didn't make it on base until 0630, half an hour after when I thought PT was supposed to start. Turns out, 0600 is the time for formation; PT itself doesn't start until 0645. So I didn't miss anything (except a good workout, because you can't get that at group PT 95% of the time).

I finished PT, showered, got dressed, and returned to the Marne Reception Center to find one of my classmates from my MPH sitting there. After the initial "What are you doing here?!?" greetings, I noticed he had the patch for the 85th CA Battalion on his arm (see Friday's post), and was able to put two and two together and realized that he's the environmental science officer for the battalion. So I do know someone at Ft. Stewart (and even in my battalion!) after all.

Since he was just signing in today, his "day one" is Wednesday, and since he's a major, he doesn't have to work at getting on the VIP list, so he's not even coming in tomorrow. For today, though, we stuck together to get our cars registered (which is where I got my temporary pass) and go to finance, where I turned in my paperwork to get paid for my partial do-it-yourself move (meaning I put a bunch of stuff in my car and drove it south). Then we grabbed lunch and he headed back home, I got official word that I'm a VIP (yay for no group PT tomorrow!), and then headed over to the hospital to do the in-processing that's not a part of the overall in-processing.

I won't be working at the hospital, since I'll be working in the battalion, but the hospital has to keep my credentials and give me access to the computer systems and whatnot. Turns out, though, that while we were able to get my credentials file started, Walter Reed still hasn't send over my residency file (let me put on my surprised face...). We got that going, but I won't be able to request access to the electronic medical records or my work email until I'm done in-processing to Ft. Stewart.

That taken care of, I headed home and got my paperwork ready for tomorrow, my "day one" of in-processing (only three work days into the process). What do I have to look forward to tomorrow? Endless lectures. Including one on preventive medicine. I wonder if they'll let me give that one.

In-processing to Ft. Stewart, Day 1

Today was my first day of in-processing at Ft. Stewart in anticipation of starting my new job as the battalion surgeon with the 82nd Civil Affairs Battalion. In true in-processing fashion, it was not all smooth sailing. Let's start from the top:

I arrived at the gate at around 0745 this morning, only to be told that, while the DC area no longer used military decals on the cars, Ft. Stewart still does. Since DC doesn't have decals, I don't have any on my new car, which meant that I had to go to the main gate to go through a full inspection before I could get on base.

Even with that, I still arrived at Marne Reception Center, where all new arrivals sign in, around 0800, only to discover that I forgot my leave form. I thought it was still in a folder in the trunk of my car, but it wasn't. So I tried calling WRAIR to see if they could fax a copy over; unfortunately, the sergeant seemed to be incapable of operating a fax machine, because despite multiple claims of faxing it over, no copies ever arrived. So I drove home (about a 35 minute drive), found the pile of papers that included my leave form, and drove back to sign in. Success.

I was supposed to go to a safety brief at 1530, but instead, I was rescued by MAJ Ellis, the chief of preventive medicine at Ft. Stewart (everyone in PM knows everyone else, it seems). He took me to find my battalion, which after a few wrong turns, we did. There's a pretty sign in front of the building and everything (I didn't get a picture of it, but I will). The battalion commander is at a training course, so he wasn't available, but a few of the senior non-commissioned officers were there. They welcomed me to the battalion, which included giving me the proper left shoulder patch for my uniform:

So I am now officially part of civil affairs, and no longer part of MEDCOM (Medical Command). The fifteen minutes I spent with the two NCOs were probably the only useful fifteen minutes in my entire day. They explained who has arrived thus far (the battalion won't be officially stood up until September), what my job will be (I'll be in charge of the medical shop for the battalion, which includes me, a vet, an environmental science officer, medical logistician, and a slew of medics of various ranks and training), and where my office will probably be. I didn't see my office, but I am excited about the idea of having an office. Of course, as one of the NCOs pointed out, having an office means people know how to find you.

In all, a long and trying day, with a rewarding few minutes at the end. Compared to most in-processing activities, the rewarding few minutes at the end made it almost worthwhile.

Next step... PT at 0600 on Monday. Fun.