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Tuesday, July 6, 2010

Cambodian fortnight (third in a series)

Read part 5 ...

Read part 4 ...

Read part 2 ...

Read part 1 ...

As the skyline of Singapore fades into the hazy gray of the equatorial summer and Malaysia passes by to the port (left) and Indonesia to the starboard (right), I am again writing from USNS Mercy (the ship at the top of the photo) to update you on the progress of Pacific Partnership 2010. I will apologize at the outset—it’s a long one, but worth it.

Another few weeks have gone by, and at the time of my last message we were just getting ready to pull into Sihanoukville, Cambodia. Right on schedule, the anchor was let go and we sprung into action. Our 60-person surgical screening team tromped down the three decks of noisy steel ramps and took a fairly smooth and mercifully dry boat ride to the pier.

During the 20-minute trip we passed an island with a solitary Buddhist temple and then looked over the bow toward the lush green landscape giving ample credence that it was wet season in Cambodia. I am still amazed that it is dry season in Vietnam and just around the peninsula in the Gulf of Thailand; it is full-blown rainy season.

After passing our Partner Nation vessel, the Japanese Self Defense Force ship Kunasaki (above, center), we caught our first glance of the breasting dock through which we would make our way to shore. It is a sight that I will not soon forget.

The fact that this rusty contraption stayed afloat was a testament to applied physics, some good old-fashioned twine and a few empty 55-gallon drums. Getting off the band-aid boat and onto the flat portion of the dock was easy enough—it was the next series of maneuvers that bear mentioning.

First you have to climb a very narrow and very vertical ladder to reach a small platform that was still about three feet below the edge of the pier due to the low tide. Hanging on both sides and overhead was a tangled mess of wires leading to a few naked low-wattage bulbs. The lower loops of wire bobbed up and down in the water as small waves lapped at the side of the barnacle-covered concrete pilings. The entire inner core was covered with some ill-defined layer of marine slime. By the time I negotiated this maze without being electrocuted, I dusted off my rust-covered hands and was pretty sure that I needed both a tetanus booster and a strong dose of antibiotics.

Being the first group ashore at each new mission site has its challenges. Asking myself, “What could possibly go wrong?” I walked up to the pier boss and made sure that our group had transportation to the screening site. He pointed down the length of the pier, made a series of contorted hand gestures and said something about Cambodian border patrol.

The 60 of us then gathered our gear and trudged through the early morning humidity with a glowing sheen of sweat across our brows. As we dropped our bags at the container boxes that held our precious bottled water (also sitting in the morning heat), we were greeted by RADM Nora Tyson, the Navy one-star who is in charge of these parts.

The first pleasant surprise of the day came when I saw that we had large air-conditioned tourist buses rather than open-window, painted-over school buses that probably drove Beaver and Wally to school in the 1950s. (Score one for the Advance Party guys).

Comfortably seated in the buses, we proceeded with a police escort to Sihanoukville General Hospital. It did not give me great comfort, however, to be sitting right in front of the preventive medicine guy who kept saying "Neat, I caught another one, and look, it's full of blood." He of course was referring to the mosquitoes that had joined us for the trip to the hospital. Head in hands, I cracked open my first bottle of pre-heated water for the day.

Fifteen minutes, a few ignored red lights, and dozens of narrowly avoided mopeds later, the buses turned off the relatively well-paved road and onto a winding and deeply rutted dirt path that led to a faded yellow, one-story building—Sihanoukville General Hospital. About 200 patients already were waiting in line and were very glad to see us drive up.

We jumped off the buses, covered ourselves with bug spray and set about our work. About mid-morning, my big boss, RADM Christine Bruzek-Kohler paid a visit. Fortunately, everything was running smoothly and she leapt at my offer to join the action. With full credit due, she rolled up her sleeves and worked at the anesthesia screening table for about two hours before her aide insisted that she leave to attend a lunch function. She was having a good time and was reluctant to depart.

I spoke with her later that evening back on the ship and she conveyed great appreciation for the opportunity to take part in the mission. All told, we saw 247 patients that day and scheduled 132 for surgery. As we were packing up in the late afternoon, we were treated to another site that you don't get to see back in the states—a couple of very scrawny cows wandering right through the middle of our screening site.

Monkeys and cows are all over the place here. We treated the veterinarians for two monkey bites and one laceration that was delivered by the horns of a water buffalo who opposed getting vaccinated. Feral monkeys are nasty little creatures and bear close watching.

The day ended favorably; we got back to the ship without difficulty and we had a very productive visit. We were joined by our Operation Smile colleagues for five of the 12 days and had a great time. They brought a multinational team with individuals from nine different countries. The common language was English (or some variation thereof). They were gracious partners and treated us to an end-of-mission dinner at a nice resort hotel—The Sokha.
The local seafood was delicious and for dessert we had fresh dragonfruit and pineapple. At the end of our two weeks in Cambodia, we had performed 272 surgeries and were all thoroughly exhausted.

Cambodia is a very interesting place, filled with interesting people, and I had the good fortune of making the acquaintance of one Mr. Lim. I was seated next to him at a luncheon to honor CAPT Sasaki who is the commanding officer of the aforementioned Kunasaki. Mr. Lim is a master brewer who studied for years at the Guinness brewery. He now runs Cambrew and makes the very tasty Angkor beer.

A few toasts to CAPT Sasaki later, and I was invited to join Mr. Lim and a few others from the ship at the Cambrew tasting room. In my wildest dreams, I could never imagine myself sitting in a lavishly decorated tasting room in Cambodia, sipping a wide variety of beers with an accomplished Malaysian brewmaster. The Angkor lager was exceptional, but the stout came up just short of Guinness, something about the water, Mr. Lim explained.

On a more somber note, on the second to last day, we were involved in the initial treatment and medical evacuation of a U.S. Embassy employee who was severely injured in a car crash; the Australian ER nurse and the Army medic who were the first responders are directly responsible for her being alive today.

The helicopter pilots made a heroic effort to find her in the midst of a downpour with only a few sketchy landmarks for navigation and an underpowered flashlight to guide them down to the makeshift landing zone. A few blown over fruit vending stands were a small price to pay to save a life. Within 30 minutes of picking up our patient, she was aboard MERCY.

We don't have a neurosurgeon aboard during the humanitarian assistance missions, so the duties of performing a craniotomy fell to the plastic surgeons. Alan Lim (no relation to my brewer friend) is another Navy plastic surgeon aboard, with advanced craniofacial training. As Alan was getting the OR set up, I was dialing my neurosurgeon buddy back in San Diego.

To his credit, he didn't mind being awoken at 2:00 a.m. to field this particular call. A few jpeg images emailed rapidly to his home, and both Alan and I were relieved to hear him confirm our own diagnosis - no burr holes or craniotomy necessary, just a lot of close ICU monitoring.
Her husband and two small children were flown to MERCY via helo and I had to have one of those very difficult conversations with the husband. I keep two small stuffed animals in my office that my own kids gave me for the trip. I looked into the eyes of this poor little 4-year-old girl who was just whisked aboard this giant ship knowing that her mom was very sick.

I gave her Laurel-the-Lamb in some small hope that it would comfort her a bit. She clung to that scruffy old stuffed lamb for the entire time she was aboard the ship and never let go, even as she climbed aboard the helo to go back to Phnom Penh to meet up with her aunt who was flying in from the States.

The next day, the trauma surgeon, a nurse anesthetist, and a respiratory tech escorted her safely from MERCY all the way to Singapore where she was admitted, is getting state-of-the-art care, and is doing well. We even remembered to leave them the wrench to take the external fixators off later (the medical people will understand).

After leaving Cambodia we sailed straight for Singapore and a well deserved four days off. More on that next time....

As I conclude this lengthy message, we are preparing for three stops in Indonesia during July before pulling into our next resupply port in Darwin, Australia. My experiences in Cambodia, especially dealing with the critically injured embassy employee, have left me with a much greater appreciation for all of the good that we are able to do out here.

We are touching many lives in a great ways, and have saved at least one that I can count. Through our multinational partnerships and great teamwork, our mission is proving to be a huge success and we are all better doctors and better people for the small part that each of us play.

Happy belated 4th of July!

-- CDR Trent Douglas 95M, director, surgical services, USNS Mercy


  1. Kudos to the helicopter crew; Lt Clark, and Ltjg Johnson, Rahall, and Wells for some outstanding flying in zero visibility!

  2. Hi Trent--it is great fun reading your blog! I know I loved being on the Mercy and interacting with all of you. I think of it several times a day and always have something interesting to tell my friends. Hope we meet again one day! Say hi to everyone.
    Helen Walton, CRNA

  3. Hi Trent, I hear that you met my son and I have seen a photo of you and him together in Indonesia. My son's last name is also Douglas and he is an MA on the USNS Mercy.