Day One: 6/9/11
Project Hope volunteers arrived at the US Air Force camp outside of Pekanbaru at sunset, a flurry of action in an otherwise quiet, rural area. Tents were being raised in a field by a group of over 100 Air Force personnel while heavy equipment unloaded pallets as they arrived on flatbed trucks from the airport 45 minutes away. This is the first mission utilizing the HARRT and Operation Pacific Angel units of the Air Force in a joint response, a trial run of their combined resources and potential.
HOPE’s four volunteers didn’t join the C-17s that arrived from Guam with supplies and personnel. We met at LAX and flew commercially through Taipei to Jakarta, a 22-hour journey. After a night in Jakarta, we jumped one more leg to Pekanbaru in central Sumatra, but first managed to spend a few hours downtown visiting national monuments and the largest mosque in Indonesia.
Anticipation for the next week’s activities occupied many of the conversations between this mission’s two medical volunteers.
Noreen Prokuski participated last year with the Project Hope Pacific Angel mission in Vietnam and immediately noticed some differences between the two missions. In the past, participants stayed in hotels and worked out of local clinics and hospitals. Staying onsite in military tents with a portable clinic is a big change and Noreen is excited to be connected closer to the communities she will be working with by living in their community 24/7 and not being sequestered in a hotel.
Susan Opas has been trying for years to fit volunteering with Project Hope into her schedule and is delighted to be on her first mission. She can’t wait to get to work and be involved with pediatric patents and women’s health education.
“Seeing how people live and move in such congestion, taking risks that we in the States would never consider like riding 4+ on a moped, makes me wonder what type of medical conditions we’ll come across in Pekanbaru. What was nicely surprising was that over 99% were wearing helmets”
Tomorrow, the medical tents will be set up and final preparations for camp assembled. There are currently no showers and only two shared squat-toilets in a nearby building. Medical care should begin on Sunday with a minimum of 700 patients a day and everyone is expecting a busy time.
Day Two: 6/10/11
No one expects to be cold in the tropical islands of Indonesia. The temporary clinic for Operation Pacific Angel sits within a degree of the Equator on Sumatra south of Pekanbaru. At high noon the sun bakes down from almost directly overhead and temperatures soar. Nights don’t cool down much, making the air-conditioned barracks tents onsite at the clinic a comfortable sleeping retreat.
Probably because of that unbelievable heat, the thermostats in the 10 tents (with 14 cots each) were set low last night, so cool that conversations at breakfast generally concerned freezing through the night and wearing several layers of the clothing to bed.
Everyone warmed up quickly, though, when they got to work after breakfast.
The five clinic tents went up quickly, their double walls intending to keep the cool inside and the heat away. Fine-tuning their positions took some time, ensuring a tight “H” configuration while making sure floors were tight and doorways connected as designed. With an expected 700+ patients a day coming through the temporary clinic and over a hundred medical staff to attend to them, the facility’s physical organization must ensure a smooth flow of operations.
One of the four wings will be designated for women’s health, the worksite for Project Hope volunteers Noreen Prokuski and Susan Opas. It will be divided into several private bays so that women can seek private medical care, possibly the first time they will have ever been attended by a female doctor.
Noreen will be working with an Air Force FNP, Major Susan Foster, and two local midwives. “Based on previous deployments,” reports Major Foster, “arriving in rural areas with western health care brings along a miraculous component that patients get the most excited about. Seeing an American doctor has healing powers for them.”
“In some cases, this is the first time that some patients will be seeing any health care provider since their last child was delivered,” mentions Noreen.
Susan anticipates that most mothers won’t arrive alone but with families and children in tow.
The other three wings will be utilized for optometry/dental care and general care.
Hope volunteers finished the day helping organize the pharmacy medications. They mostly divided large bottles of vitamins into small bags with Indonesian instructions. Air Force personnel organized supplies and made batches of other pills and medications, preparing for every situation imaginable. Tomorrow the remaining organization will be completed and an opening ceremony will announce the beginning of the clinic’s services. VIP visits and live music will highlight the event.
Day Three: 6/11/11A midnight rain made for a muddy start to day three of Operation Pacific Angel in Pekanbaru, Indonesia. Project Hope’s two medical volunteers got right to work continuing with their help readying the pharmacy for tomorrow’s first patients. Blankets were hung to create private spaces for examinations, shopping lists created for any additional supplies and cots built for a variety of needs. The interior spaces were transformed from large empty tents into a operational HARRT facility ready for a onslaught of visitors.
This year’s joint operation between the US Air Force’s two medical humanitarian units, HARRT and Pacific Angel, includes a multi-national cooperation between medical personnel from Indonesia, Bangladesh, Singapore and Timor Leste. A large staff of local translators and assistants also joins the mission to help in successful operations. These personnel received a morning of orientation detailing the ideas behind the mission and what to expect in the week ahead.
Susan Opas and Noreen Prokuski were active in many of the day’s activities and most involved with a Subject Matter Expert Exchange for approximately 23 local midwives concerning women’s health and the importance of regular exams. It became a comfortable space to learn about maternal care in both countries. Eager questions were asked thorough a translator and everyone walked away with a better understanding of issues facing local women and their pregnancies. “Everyone blossoms when we start talking about babies, no matter what culture
Susan earned a D- at her first attempt assembling military cots. “Hopefully it was done well enough that they won’t collapse tomorrow.”
The afternoon continued with a formal opening ceremony for the Pacific Angel 11-3 attended by local VIPs and everyone involved in the operation. The proceedings attracted hundreds of audience members and took place under an enormous, suspended parachute in a field between the tent city and clinic. They opened with a prayer followed by a traditional dance in local costumes. Speeches continued from every organization involved in this year’s Pacific Angel, all translated from English to Indonesian as required. The VIPs were then given a tour of the tents and their enclosed facilities.
Excitement runs high for the first patients tomorrow morning at 0900, day one of six that the clinic will be open for business.
Day Four: 6/12/11
The Air Force’s HARRT clinic opened this morning outside of Pekanbaru, Indonesia, with a crowd of excited customers. Morning hours were spent seeing the first patients and developing systems to efficiently move people between medical stations.
Noreen Prokuski’s first patient was a healthy pregnant woman excited to have an American doctor tell her that everything was going well. Susan Opas first assisted with an IM injection and spent the remainder of the day moving between areas, evaluating and diagnosing a wide variety of ailments and situations. Both Project Hope volunteers kept plenty busy with the stream of patients coming in the zippered tent doors.
Overall, the clinic saw 492 patients on its first day, the longest lines for dental work and optometry. Several required surgery well beyond anything the HARRT was capable of handling, so local medical providers were consulted with recommendations for nearby hospitals. Because government health care programs only pay for services in a person’s home district, several patients not from this area haven’t sought help because they aren’t eligible in Pekanbaru. One 38 year-old woman initially judged to be pregnant ended up being afflicted with an enormous tumor and has never had surgery for that very reason.
Day Five: 6/13/11
Pacific Angel welcomed a new Project Hope volunteer medical staff member today. Denise Barnes has been a Certified Nurse-Midwife for 8 years and joins the team from her current home in Jakarta, Indonesia. She’s excited to be back on Sumatra after prior work in Banda Aceh on the northern tip of the island.
Activities in the clinic began far smoother on this second day, mainly due to improvements learned from the day before. Three new temporary roofs provided more shade and comfort for the hundreds of waiting patients outside. A group of additional interpreters inside assisted the multi-cultural medical staff in providing care more effectively. The military medical personnel from Singapore, Bangladesh, Timor Leste and the United States rely on their Indonesian counterparts to communicate. A grand total of 473 patients were treated today.
The most active areas of the tent clinic continue to be those dedicated to dental care and optometry. The Air Force’s dental team had another busy day of pulling dozens of teeth and providing oral hygiene advice. The optometrist was in such high demand that her assistant started seeing patients so that they could work together passing out free pairs of glasses for near and far-sighted individuals. By the end of the day, one of the general medicine wings of the clinic was transformed into an optometry ward. Even then, patients were so numerous that about seventy of them were told that they would have to return tomorrow because there wasn’t enough time today to see them all.
The women’s health wing saw less business, partially because school was back in session, but also probably due to reluctance for exams considered invasive. Women of the Muslim faith in Indonesia and elsewhere tend to be very shy and private about exposing any skin to strangers, even in a safe, medical setting. Noreen Prokuski and Denise had the opportunity to work with a few pregnant women and listen for fetal heartbeats. Susan Opas worked all over the clinic assisting with everything from pediatrics to the pharmacy, always smiling and laughing.
“I was delighted to see our group come together, Project Hope with our trusty interpreters, and became an active part of Pacangel,” say Susan.
Everyone is hoping for another busy day tomorrow, day three of the six that the clinic will be open.
Day Six: 6/14/11
The morning started busy and maintained that pace throughout the day for Project Hope volunteers with Operation Pacific Angel in Pekanbaru, Indonesia. An influx of babies and children had pediatrician Susan Opas bouncing from one curtained room to another diagnosing everything from a scabies rash to the cause of some moped-accident pain. “After two days with only a few children, it’s great to have so many kids around. I feel so useful!”
Midwife Denise Barnes worked with a steady stream of pregnant women seeking advice and care. She utilized all opportunities throughout day for training and talking the local midwifes through her thought processes.
Noreen Prokuski spent most of her day working as a pediatrician instead of in her usual midwife capacity because of the unusually high amount of young visitors. Patients had a variety of issues, or sometimes nothing more than a curiosity to see inside the strange US military clinic that magically appeared in a field near their home, but all received her complete attention and kind style.
From Burr Ridge, west of Chicago, Illinois, Noreen has been a Certified Nurse-Midwife for 18 years. When her first child was born using a midwife, “it seemed like the greatest job in the world and I wanted to do the same thing” even though she had no formal medical training. She’s never looked back and still gets a glow in her eyes when talking about babies, even after a long day of work.
In the HARRT clinic today, Noreen saw a 40 year-old-patient who came in with some abdominal pain that seemed like acid reflux. While investigating, she realized that this woman was little more than skin and bones, not something easy to observe through the long, flowing clothing and head coverings that Muslim women wear. The woman revealed that she had lost 40 pounds in the previous year (around a third of her weight) for an unknown reason. It was determined that this patient had intestinal parasites, or worms, a situation curable with a single, easy pill. The simple solution brought Noreen nearly to tears.
“We have so much, they have so little.” She gets undeniable satisfaction from helping people and wants to make working with the less fortunate through organizations like Project Hope a new focus in her life.
Overall, the clinic saw 984 patients today, clearly the most successful day yet. Cheers and applause from the entire staff greeted the announcement at the close-of-day meeting.
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