6-11-13: Last Day at the Hospital

Today was the last day in the hospital, which was good. I think I’ve seen just about as much of that place as I can handle. For now, anyway.

                

There was some initial confusion about which doctors the three physicians were going to work with, with Dr. Patrick being in surgery and nobody really that trilled about working with the triage physician. Finally, Dr. Lesho bit the bullet and went with the triage doctor, and both Dr. Mann and I worked with the pediatrician. Since there weren’t any patients waiting to be seen, we went upstairs for rounds and saw the kids on the inpatient wards.

                

After rounds, I worked with my translator on my presentation about HIV in the US Military, and then it was time for a tour of the nursing school. It’s a military nursing school, with most of the students in the military, and a few civilians who pay tuition. We actually interrupted their finals, which I felt a little bad about.

The group outside the nursing school

The school itself wasn’t too bad, although outdated. They actually still have an iron lung in the clinical simulation center, which has got to be the oldest one still around. I don’t know if it’s still operational or not; somehow, I wouldn’t be surprised.

Iron Lung

After the tour of the nursing school was lunch, and then we had the last day of academics. We had two lectures on blood security and blood transfusions, one about the program and stats at Kitona, and one from LTC Cannon about WHO standards. I was actually surprised at how robust the program is here—they don’t pay anyone for donations, which is good, and test every unit of blood for HIV, syphilis, hepatitis B, and hepatitis C. It’s not nearly as many as we test in the States, but it meets WHO recommendations, which is always good. They do have a strange policy where they only transfuse matched blood—an A patient will only get A blood, etc. I feel sorry for their AB patients. There aren’t many of us out there.

                

The third lecture was about sexually transmitted diseases at Kitona, and then I wrapped up academics with my presentation about HIV in our military. It actually started an argument between the hospital commander and the deputy commander of Kitona Base, who was there to present the completion ceremonies. The hospital commander asked why all the recruits at Kitona didn’t get tested when they joined, the way our recruits do (and according to DRC policy, as we learned yesterday during academics), and the general said that it’s the hospital commander’s responsibility to do it. There were angry words flying around in French all over the place, but hopefully they’ll figure something out to get the testing done.

My presentation on HIV in the US Military

After the awards ceremony (read: speeches and certificates), we headed back to the hotel, and then down to New Cliffs restaurant (our usual dinner place) for a final Muanda dinner. We invited our translators and the hospital commander, and hired a music/dance group. It was a lot of fun to hear and see traditional music and dances from Bas Congo, and everyone got up on the dance floor at least once. Yes, even me, but I really hope there are no pictures of this out there.

Dancing

I gave Lt. Olivier, my translator, a gift at the end of the night: my Army Medical Department regimental crest. I brought it with the intention of giving it to the doctor I worked with, but I didn’t end up forming any sort of bond with any of the doctors, and Olivier and I got to know each other fairly well. I told him that it was what American Army doctors wore on their uniforms, and after translating for me all week, he was practically a doctor and should have it. I think he appreciated it.

Tomorrow we fly back to Kinshasa, and then there’s a couple of days of stuff that we have to do for the embassy before we head home on Friday night.

Final group picture in front of the hospital

6-10-13: Back to the Hospital

We were back at the hospital today for our second to last day of clinical and academics at Kitona. Like Saturday, we physicians rotated physicians to work with. I took the pediatrician, Dr. Lesho worked with the triage doctor who doesn’t like anyone, and Dr. Mann (the pediatrician) went to internal medicine.

                

Pediatrics clinic was slow today, so we ended up going up to the pediatrics ward for rounds. Most of the cases were simple malaria (well, simple for them), but there was one boy who’s pretty sick. He’s had swollen lymph nodes, a cough, lack of appetite, and swollen legs for about a month. I’m thinking it might be TB, but with three primary sites (lymph nodes, lungs, and possibly kidneys), which would be unusual, unless he has HIV, and the mother won’t consent to an HIV test. Dr. Mann thinks it might be Burkitt’s lymphoma, a cancer caused by EBV, the same virus that causes mono.

                

The issue about HIV testing came up in academics this afternoon as well. In DRC, you have to “opt in” for testing, which means that a doctor can recommend that you go for counseling and testing, but can’t order the test for you. This is the system that the US used to have, before we went to “opt out”, which means that a doctor can order an HIV test for you, unless you specifically state that you don’t want it done. The problem (especially in Africa), is that if you have an opt in program, people can chose not to opt in (and usually they chose this because they’re afraid it will be positive), and then continue living life as if they’re negative, continuing to spread HIV. You’re not going to be able to fight HIV until you have the ability to get people who are HIV+ the education and treatment they need.

                

We also had a lecture on antibiotic stewardship by Dr. Lesho, who works in the wound infection division at WRAIR. The lecture was a bit too technical, especially when working through a translator who doesn’t know medical terminology, but the point was sound. Since they can’t do culture and test for which antibiotics a bacteria is susceptible to, the doctors in Kitona tend to prescribe anything and everything for any complaint, and often for longer treatment courses than necessary. For example, every patient (outpatient, inpatient, etc) gets a urinalysis, even if they don’t have any urinary symptoms (which they usually don’t). Because hygiene is an issue, and I doubt they know how to do clean-catch urine collections, there’s a lot of background bacteria. In the U.S., you don’t treat bacteria in the urine if there are no symptoms, unless it’s in a pregnant woman. Here, however, if they find evidence of bacteria, they’ll treat with 7 days of ciprofloxacin (an antibiotic). In the States, that would be a 3 day course of antibiotics. This kind of over treatment and over-lengthened treatment increases antibiotic resistant bacteria, which is a huge problem everywhere.

                

Tomorrow is going to be our last day of clinicals and academics. It’s also a surgery day, so there probably won’t be much going on clinically. I might watch a surgery or two. The academics will be long; we’ll finish up the HIV lectures, and then we have a presentation of certificates to the DRC participants, and then we have an after-action report. It should be interesting.

Random picture of the group from cultural day

6-8-13: Change of Pace

Today was much better than yesterday. We actually got to rotate physicians today, so I was working with Dr. Patrick (no idea on his last name), the deputy commander of the hospital, in the internal medicine consult room. Meanwhile, Dr. Mann, our infectious disease pediatrician, worked with the doctor I had been working with. She said that he tried the same stuff with her as with me, the “this is how we see a patient…”, “this is how you do a physical exam…” stuff, but she put an end to it by repeatedly insisting that she had been a doctor for ten years, she knew that stuff, etc, etc. So because she was being aggressive, he finally started to treat her like an equal, and at the end he said, “I guess one of the American doctors knows something.”

                

Thanks, guy.

                

Meanwhile, I was over in internal medicine consults, where Dr. Patrick was going through patients at a much quicker (and more reasonable) pace, and for each, asking me about my differential diagnosis and how we would make the diagnosis in the States. It was so nice to be treated as somebody who actually knows something about medicine. I discovered in the course of conversation that they use the word “malaria” the way we use the word “flu”. It’s not so much a medical word to describe a particular diagnosis, but a general word to describe any illness. They call real malaria Paludisme (for Plasmodium), like we would call the real flu Influenza.

Yellow Fever and Malaria signs

Now that that has been explained to me, things make a lot more sense.

                

We finished the day with academics, which was to finish the malaria lectures (there was one we didn’t get to) and then onto TB. The DRC physicians explained their programs, program objectives, and their numbers, and I’m actually really impressed with how robust the program is. Kitona was apparently the pilot health zone for the new program, and comparing numbers to historical numbers, it’s looking like it’s making a difference.

                

Their goal is make TB “not a problem” by 2050. Guess we’ll have to wait and see.

TB treatment regiments (yes, I needed a translator for this, too). 

Tomorrow is Cultural Day, since there’s nothing going on at the hospital. Should be fun. 

6-7-13: Malaria Day

Today was actually a pretty frustrating day… Well, at least the morning was.

                

The plan from yesterday was that we would try to switch off to different departments, to see different parts of the hospital and get a more rounded experience. To be honest, for as much as I hate rounding, I was hoping to do internal medicine rounds, because I feel like there’s more opportunity for teaching during rounds than while seeing clinic with the same triage doctor, who doesn’t seem to understand that he’s doing things wrong. Unfortunately, they weren’t prepared for that, so we decided to continue with the plan for today, and our logistics support would talk to the hospital commander about us seeing different things tomorrow.

                

We shall see.

                

So I went to triage with the same doctor, and the first thing we did was see a patient on the wards who came in the night before. Her eyes were very yellow (from jaundice) and her belly was very extended (from ascites). However, the doctor said that it was from a perforation in the intestines, and the air from the intestines was making her belly big. I tried to explain that we see that finding in patients with liver failure, and that the yellow eyes and extended belly are both probably from the liver. I was about to suggest that they look for different causes of liver failure—viral hepatitis, yellow fever, liver parasites—but he remained sure that the belly extension was from a perforated intestine.

                

Sigh.

                

We went back down to triage and continued seeing patients. One had a very swollen neck, which started about five days ago as an earache. If it had been slower than that, I would have thought it was TB in the lymph nodes (more common in the Pacific Islands than Africa, but still happens in Africa), but with such a quick onset, I narrowed my differential to mumps, an ear infection that infected the bones, or a dental abscess. I had my otoscope (to look in the ears), and there was no sign of an ear infection, but when I looked in his mouth, the back teeth looked a bit suspect. This led me toward dental abscess, which apparently the doctor agreed with, because we walked the patient to dental. The dentist decided that he should be put on antibiotics until the swelling went down, and then he would remove the tooth. That made sense, because I don’t think the dental clinic has general anesthesia, and it would have been too painful for him to open his mouth all the way for the surgery under local anesthesia. However, what I don’t agree with was that the doctor discharged him home with oral antibiotics. With his mouth so swollen, I don’t know that he can swallow pills, and his throat was swollen that he was struggling to breath. When you have to work so hard to breath, you can’t always keep it up forever, and eventually you’ll stop. I hope that doesn’t happen.

                

There was another patient with fever and a negative malaria blood smear, so I tried using that as a teaching point about infections that aren’t malaria, but also cause fever. I might as well have been talking to a brick wall. Both the military doctor and the junior doctor in the room insisted that fever is always malaria. When I tried pointing out that mild dengue looks like malaria, they said that dengue looks like ebola. I agreed that severe dengue looks like ebola, but mild dengue looks like malaria, and they said that dengue is not nearby. I informed them that Cabinda (the piece of Angola north of the Congo River) has dengue, and that that’s very close to Bas-Congo (the region of DRC we’re in), but they said no, that dengue was in Sudan and malaria was in DRC.

                

Clearly I wasn’t going to get through to them.

                

Lunch break was at noon, and then we had academics in the afternoon. The topic today was malaria, so I wanted the DRC physicians from Kinshasa to give their presentations on malaria, followed by COL Lesho, one of our teammembers, to present infections other than malaria (dengue, chikungunya, typhoid) last. However, they’re so eager to have us talk that they had him go first, and he was a bit awkward with the translator, taking almost an hour. That only left an hour for the DRC physicians to talk about their malaria programs, which wasn’t enough time. We’ll have to finish that tomorrow.

COL Lesho's lecture

What we did learn about malaria in DRC was interesting, though. There are no parts in DRC that are not endemic for malaria, and everywhere accepts it as a fact of life. DRC accounts for 11% of all malaria infections in the world, and is one of five countries that makes up more than 50% of all world-wide infections. Forty percent of childhood (<5 50="" all="" and="" are="" big="" doctor="" during="" for="" malaria.="" malaria="" numbers.="" of="" old="" p="" pregnancy="" so="" those="" visits="" years="">

                

Nationally, the country has programs for treatment and prevention; sadly, I can tell you from working in clinic that the treatment programs are not followed. All clinical malaria (fever + any other symptom) is supposed to be confirmed by blood smear before treatment, but all “clinical malaria” (any fever) is treated as malaria, regardless of what the blood smear says. So everyone is getting medication that they probably don’t need, and everyone is ignoring other causes of fever. I also asked what percentage of the population is using bed nets (one of their interventions), and was told “everyone”. Everyone in DRC gets free bed nets—insecticide-treated bed nets are distributed free of charge—but as far as usage? Nobody knows, because nobody asks.

                

Mosquito net sign

It’s very frustrating for me, a physician who was trained in evidence-based medicine and in tropical medicine, to go to a place where evidence is disregarded, where national and WHO guidelines are ignored, and where the physicians on the ground aren’t interested in learning from outside physicians. It makes me wonder why we’re here at all, working side-by-side with physicians who ignore our “helpful hints” and are only giving lectures to the upper-level policy makers, all of whom already know what we’re teaching.

                

I’m probably not going to give this experience a high rating.

6-6-13: Day 2 of Clinicals, Day 1 of Academics

Today was day two in the hospital, and things went pretty similar to day one. I talked to the DRC physician I’m working with before the first patient this morning, and said that I’m okay doing physical exams, but what I wanted to do was discuss what he thought the diagnosis would be and differences between symptoms in DRC and the US. However, what ended up happening was pretty much the same as yesterday. He would pretty much do a full history, full lab work, and physical exam on every patient, which is not standard operating procedures in my clinic. If I do a physical exam (which our veterinarian will tell you is hit or miss), I only examine the areas in question—if you’re complaining of shoulder pain, I’ll look at your shoulder, but don’t expect me to press on your abdomen. If you’re complaining of shoulder pain, I’ll ask you about your shoulder, what the pain is like, and how long it has been hurting. And I’ll only order labs if you look like you have an infection or if you need your cholesterol checked.

                

I did have some opportunity for teaching, or training, or whatever you want to call it: there was a man around 70 years old who came in for difficulty rising from a chair and inability to see out of one eye, and I pulled out my ophthalmoscope (to look in the eyes) and showed the DRC physician and the doctor-in-training (graduated medical school and here for additional training before he goes out into independent practice) how to use an ophthalmoscope to look into the eye. Anyway, he was completely blind out of that eye, and the pupil didn’t even change with light, which is a bad sign. I’m pretty sure he had a stroke, and possibly has Parkinson’s, but neither of which is treatable in DRC, so there really wasn’t much to do.

The second case where I got to be an expert was the last case of the morning, an obese women (yes, they do exist in Africa) with abdominal pain. I’m pretty sure she has gallbladder problems, and talked the doctor into sending her for an abdominal ultrasound to look at her liver and gallbladder. I also identified that her skin was darker in her skin folds (neck, armpits, stomach rolls) and pointed out that that is usually a sign of diabetes in the States, and maybe we should check her blood sugar. So they did. I don’t know the results yet.

Over lunch, our team conferred about things we had seen over the morning and what we wanted to do for academics. We have a pediatrics infectious disease physician, adult ID physician, me, a public health nurse, and a lab officer. The peds ID doc saw clinic and then rounded in the pediatrics ward, but both the adult ID doc and I just saw clinic, and would both be interested in seeing rounds. Hopefully tomorrow. Honestly, I think the public health nurse is having the best time and seeing the most things. Yesterday she went over the tuberculosis surveillance program and other surveillance programs, and today she rounded with the nurses on the internal medicine wards. The lab officer, who was requested to help them with the blood bank program and with SOPs in the lab, today tried to talk to them about quality control and calibrating equipment, but didn’t really get far. The idea of having quality control is fairly foreign to them.

                

After lunch was academics, and today was the first real day of academics. We got an overview of the hospital, which I had heard in March but the rest of the team hadn’t. The hospital commander ended up giving more of an explanation of the health zone and the six included health areas, which was good, because that was stuff that I hadn’t heard before. After that, I gave an overview of prevention of cholera, and then the academics concluded with the hospital commander with discussing the cholera epidemic that happened from January 2012-February 2013. In the 12 months of the outbreak, there were 226 cholera patients in the Kitona Health Zone area, with 4 deaths, and no cases among health care workers. Everything they had done was textbook; in the lecture I gave about preventing cholera during an outbreak, there were ten points that I had mentioned, and they did all ten of them during that outbreak. There were questions from both the DRC physicians and our team asking if we had coordinated the lectures, but we hadn’t. They had done everything that well.

Setting up for academics

COL Amisi Okito, the hospital commander, speaking about the 2012 cholera outbreak

I’m hoping to round with the internal medicine team tomorrow, which I think will be more interesting than clinic, and possibly have more opportunities for teaching. We shall see how things develop.  

6-5-13: Getting Started

Today was our first day working at Kitona Referral Hospital, which was nerve-wracking in its own right. It means that the MEDRETE has officially started, and there’s nothing we can do about it now.

For the mornings, we’re paired up with DRC military physicians, to see patients with them. My physician partner is the equivalent to a first lieutenant (one rank behind me), but he’s older. He also has a wife and five kids in Kinshasa, which came up in conversation before our first patient arrived.

                

We spent more time on the first patient than we should have, given how many patients we had to go through. I think maybe the physician I’m partnered with was unsure about my level of education or what my role is, because he explained things in much more detail than necessary, instructing me on listening to heart and lung sounds (medical student-level instruction). I didn’t say anything, but I should have, because it made things drag on much more than necessary and didn’t really accomplish anything. Tomorrow, I’m going to tell him that I’m okay on physical exam, and what I really want to do while we’re working together is talk about what he thinks the diagnosis is and why, and from there, to discuss the differences (or similarities) between those symptoms in the States and in DRC. I guess we’ll see if I have enough of a backbone to do that tomorrow.

                

The first case was interesting, though. It was a young man, maybe 23, a college student with pain with urination. My immediate thought was chlamydia or gonorrhea, both sexually transmitted diseases. However, the physician I was working with didn’t ask anything about sexual history (beyond “are you married?”), and definitely didn’t ask the “men, women, or both?” question that I was taught in medical school. He was leaning much more toward a urinary tract infection, which is fairly rare in grown men in the US, outside of some other medical problem (HIV, cancer, etc) or men who have sex with men. However, he said that UTIs are common in men in DRC, due to poor hygiene, poor sanitation, and relative dehydration.

                

The rest of the morning was fairly routine cases, and then it was time to break for lunch (me, not the DRC physician… they don’t eat as many meals as we do and don’t mind working through the day). In the afternoon, we were supposed to have didactics, but there was such an influx of patients from the community that none of the DRC military physicians were able to get away. We found out afterwards that that was because there was a message that went out on the radio saying that the Americans would be here and would be giving out free medical care.

In other words, the exact opposite message that we wanted to go out, which was that we would be training in public health and infectious disease along with the DRC military physicians.

                

Instead of doing academics, we hammered out a schedule for the week we’ll be here, with what we’re going to talk about on any given day, and then it was time to go back to the hotel. This morning, the hotel manager told our logistics people that they don’t have enough money to keep taking care of us (electricity, food, etc) for eight days, especially with the list of needed repairs that we gave them (showers not working, AC out, etc). We gave them one night pay each ($100 x 10 people) to help out before we checked out. When we got back from the hotel, we found that they had repaired all the plumbing issues we brought to their attention (for example, the switch deciding shower or bath in my shower was broken, causing there to be a slight trickle of water from both) had been repaired, and they had moved everyone who’s AC was broken into new rooms.

Landscaping at the Prosper, new since March

Apparently, when you give money to a business in the developing world, they reinvest it in their business, instead of just lining somebody’s pocket, as usually happens in the State. It was nice to see a hotel operating to provide hotel services, and not just a profit.

                

Well, it was a long day, and after waiting far too long for our food at the restaurant (as usual), I’m ready for bed. I hope tomorrow goes smoothly.

Dinner tonight: lobster :)

6-4-13: Back in Muanda

After getting into the hotel in Kinshasa late(ish) last night (around 9), I had a late dinner and then went to bed in preparation for getting up early to go running before we had to head to Muanda in the morning to begin the MEDRETE. As it turned out, I didn’t go running (the alarm went off and I disregarded it), but I was ready for the flight to Muanda.

View from the Fleuve in the morning

The flight was the same as last time—small prop plane, a little warm, stops in Matadi and Boma—before we landed in Muanda around noon. We loaded up the rental cars (and by cars, I mean Toyota Highlanders), dealt with the usual drama associated with traveling in developing countries, and made our way to the hotel. Fortunately, the advance team was already on site and had ordered our lunches ahead of time, so we only had to wait about 30 minutes before we got to eat.

View of Kitona Base, from above.

Around 2 pm, we headed back to Kitona Base, to meet with the hospital commander and a few representatives of the medical department of the Ministry of Health, who had traveled from Kinshasa. We hammered out the final details in preparation for tomorrow (which I still think will be a disaster) and then called it a day and headed back to the hotel.

We’re staying at the Hotel Prosper this time, which is different from my hotel when we were here in March (I was staying at the Eunice). The rooms aren’t as nice, the air conditioning doesn’t work as well, and as of yet, I still don’t have running water. This will make returning from my run tomorrow interesting, I’m sure.

My room in the Prosper, complete with sequined pillowcases

We had a meeting of the medical personnel right after we got back from the hotel, to hammer out who’s giving what presentations during the academic portions of the mission. We’re going to be working closely with the physicians in the morning, seeing patients while paired one on one with the DRC military physicians, and then the afternoons will be spent in academics, some of which will be given by us, and some by DRC physicians. I still don’t know exactly what I’ll be talking about, but a couple of the other physicians came with canned presentations that will work nicely.

               

It’ll be interesting, let’s just put it that way.

                

The day wrapped up with dinner at New Cliffs, which we ate at before (as it’s one of three restaurants in the whole town), and like before, it was a 2.5-3 hour wait before we got food. We did get to see the sun set over the Atlantic Ocean, so that was kinda neat, but really, we were hungry.

Watching the sun set from the beach by the New Cliffs

Tomorrow, after a short run in the morning with a few of my teammates, it’ll be the first day of the mission. Should be interesting.

Stranded in Brussels

Well, the inevitable has finally happened. After years of traveling to remote and exotic locations, I finally had a missed connection on a flight that happens once a day, stranding me in a foreign city.

Fortunately, it was a foreign city I've never been to, so once I calmed myself down, it was actually a win.

Yesterday started pretty much the same as any traveling Saturday. I had done most of my packing Friday night (translation: I grumbled about packing and procrastinated until I finally got around to putting some clothes in a duffle bag hours after I should have), so after my run in the morning, all I had left was my carry-on stuff and then I was good to go to the airport.

I was flying United from Savannah to Chicago, and again from Chicago to Brussels, but then I switching to Brussels Airlines. It's still a Star Alliance partner (yay for frequent flier miles... I'm going for gold), but I wasn't able to print off my boarding pass in Savannah due to the airline change. I didn't think much of it, figuring I would have plenty of time when I got to Brussels.

Wrong.

The weather in Chicago was pretty terrible, which delayed us about two hours. We made up some of the time in flight, but in all, my comfortable two hour lay-over was reduced to 25 minutes, which is never comfortable, especially when 1) flying internationally; 2) connecting in an airport I'm not familiar with; 3) in a country where I don't speak the language; and 4) I don't have a boarding pass yet. So nope. Didn't make the connection.

And there's one flight a day down to Kinshasa.

Fortunately, United/Brussels Air/Star Alliance/some unknown benefactor put me up in the Sheraton (on airport grounds) and gave me meal vouchers for lunch, dinner, and breakfast tomorrow. After having to forcibly calm myself down (because honestly, what good does getting angry/frustrated get? They're not going to create more flights out of thin air), I got a shower and free lunch and decided that there's no point in spending my free day in Belgium cooped up in the hotel. So I got on the train and headed down into the city and walked around a bit, taking some pictures.

Playing with the panoramic feature on my iPhone while standing in the middle of Grand Place

It's a chocolate museum. Because, well, it's Belgium and they do that here

I saw the chocolate museum, which was actually pretty interesting. It went into the history of chocolate and how it's made, and then there was a demonstration (and treats). The demonstrator gave one line in French and then repeated the line in English. After a couple of trips to Africa, I've forgotten how well people in Europe speak English.

Belgian waffle with chocolate and banana

 And, of course, when in Belgium, you have to have a Belgian waffle. At least, that's what I told myself. It was very tasty... Much better than Belgian waffles I've had in the States.

So that was my day in Brussels. It's now 6 pm local time and I'm fading fast, so I'll probably be getting dinner soon and then going to bed, keeping my fingers crossed that the plane leaving for Kinshasa tomorrow is on-time (even though, realistically, I'll settle for it landing at any time, as long as it lands).

Getting Ready to Leave Again

Tomorrow I'm taking off for Democratic Republic of Congo again, so why I even bothered to go to work is beyond me. Especially because I was on the only one there.

It didn't take me long to finish the few things I needed to do for travel before I went (printing off my official orders, attempting to check-in for my flight only to be told that I have to check-in in person because I'm flying internationally), and then I moved onto the things I knew I needed to do before heading out for two weeks (putting in medication refills, making sure orders were in the computer, etc). All in all, most of the work day was pretty boring, but at least it was quiet, since I had the office to myself.

The one point I had today where I actually got to feel productive was when one of the medics for A Co came in to ask me to look over his medical threat brief for Lesotho. He's not going to Lesotho, but two of his team members are, and it's always the responsibility of the medic to put together a "okay, here's what this country has and here's how you can avoid getting sick" brief. We have a template of the brief that they should give on the medical section website, so they just fill in/delete as needed for the country (for example, Lesotho doesn't have yellow fever or malaria, so you don't need slides for either of those). Unfortunately, he didn't remember that we had a template, so he tried to reinvent the wheel.

For the most part, it wasn't too bad. There were a few things he went into too much detail about--he had a slide about the symptoms and treatment of hepatitis A, when all he really needed to say is 'hepatitis A is transmitted by food and water, and you're vaccinated against it--and a few things he didn't go into enough detail about--what to do about jet lag, how to be safe while traveling, etc. So we went through the template presentation and filled it out for Lesotho, discussing things along the way, such as which vaccines they needed and which they didn't. The medics are all pretty sharp, and this one was no exemption, so he picked up on the stuff pretty quickly. It's still hard for me to remember that they don't have the same training in travel medicine as I do, however, so sometimes I have to stop myself in midst of technical explanations about proper dosing of malaria medications and remind myself to stick to the things they need to know.

Anyway, so that was my bit of excitement for the day. Once we were done discussing Lesotho (and discussing his future career plans), I called it a day (because there was nobody around to tell me I couldn't), put a message on my white board saying that I'm out until 17 June, and headed home to pack/procrastinate about packing. Because honestly, I hate packing and I wish I could pay someone to do it for me.

Out in the Field

Despite my best intentions, I've been neglecting the blog world. Sorry about that. I can't decide if it's that I've been too busy or that things are too routine. Let's just go with that I'm too lazy.

A few weeks ago, though, we did something out of the routine--we went out the field! Kinda. Alpha Company had their Culminating Exercise, which is when they go to a simulated village, in this case in Mali, and demonstrate that they learned something in all of their training.

In theory, anyway.

The week started with the firing range and mass casualty situations, which were to assess how well the medics could triage and determine who to treat first. Overall, they didn't do too well. One medic spent all of her time on a head casualty that should have been triaged as "expectant" (as in, expectant to die). Another went straight to the first casualty and didn't look any further. In other words, we have some work to do.

On days 2-4, they were out in the simulated village in "Mali" (really a remote corner of Ft. Stewart). I got to play a doctor with MSF (Medecines Sans Frontieres, or Doctors Without Borders), which has a very strict "we don't work with the military--any military" policy, so I played that to the best of my abilities. This is me yelling at one of the team leaders (my friend Dan) for their actions throughout the village and how we just wanted them to leave.

The other two officers in my office, MAJ Greifenstein, the environmental science officer (in red) and CPT Avriette, the veterinarian (the girl) also got to play parts, both as USAID scientists (he a soil science, she a vet... we were really imaginative). In the course of playing a soil scientist, Griff was digging holes, and instead of the teams asking him what he was doing (which they were supposed to do), they reported him for burying land mines and declared entire roads off-limits. Not quite the reaction we were going for.

In all, it was a fun week in the field (because, well, we weren't in the office), but the teams have a lot to learn about operating in Africa. Maybe I have an advantage, because I've only been on "peacetime missions" and no deployments to Iraq or Afghanistan. I don't really have a combat mindset, but all the team members have been deployed in combat situations, and that's what they revert to when they think of going overseas. As I've said in multiple conversations to multiple people, Africa is not Iraq or Afghanistan. Not only that, but civil affairs shouldn't be about combat. It's not about going into a village with weapons, ready to shoot the bad guys. It's about getting to know people and winning trust, and not assuming that there's a bad guy behind every door.

It's a work in progress, I guess.