Mission to Comfort

In 2009, the Navy Hospital Ship USNS COMFORT brought medical, dental, and humanitarian assistance to seven Caribbean, Central, and South American nations.

Lieutenant Commander Andrew Baldwin in Tumaco, Colombia. Photo courtesy of Lieutenant Commander Andrew Baldwin, M.D.

Called "Continuing Promise 2009," U.S. military personnel and host nations Antigua, Colombia, the Dominican Republic, El Salvador, Haiti, Nicaragua, and Panama conducted the fourth humanitarian Naval deployment to the region in the past three years.

The COMFORT and her sister ship, the USNS MERCY, provide humanitarian medical services around the world and also strive to promote partnerships and goodwill. The COMFORT, now back in her homeport of Baltimore, treated more than 98,000 patients during her four-month deployment.

Lieutenant Commander Andrew Baldwin, M.D., a U.S. Navy physician, embarked upon the COMFORT for the second half of the mission visiting Colombia, El Salvador, and Nicaragua. In a sampling of his journal entries from Tumaco, Colombia, Dr. Baldwin shares how a mission like this can be both rewarding and also heartbreaking.

★★★

This is the story of my journey, a deployment that would change my life - a journey of joy, sadness, hope, reflection, and revelation.

I saw the COMFORT for the first time, sporting its big red cross on its port bow, in Colón, Panama. The converted oil tanker embodies what the Navy prides itself on - responding rapidly to a crisis, whether it be conflict or disaster, anywhere in the world. The floating medical treatment facility, which served in the Persian Gulf during Operation Iraqi Freedom, and provided relief to victims after September 11 and Hurricane Katrina, has a 1,000 patient-bed capacity, 16 operating rooms, an Intensive Care Unit, and full medical support services. The ship, its crew, and this mission are a beacon of hope and humanitarian aid throughout the Americas and the world.

As the other health care professionals and I walk the distance up to the quarterdeck, we salute the American flag (Ensign), and are welcomed by nearly 800 crewmembers already aboard the ship. We unpack, get situated, and begin what would become our daily routine for the next seven weeks: sleep, eat, travel, treat, travel, debrief, eat.

El Salvador. U.S. Navy photo by Mass Communication Specialist Second Class Marcus Suorez

Tumaco, Colombia, was the port of my first treatment site. Colombia is a stunningly beautiful country and yet incredibly poor in some areas. Perhaps because it was my first stop, two of the people I encountered in Tumaco would stay vividly in my memory to exemplify all the patients that I would eventually treat. We stayed in Tumaco for ten days, and saw patients whose ailments required everything from the dispensing of simple medications such as Tylenol and Motrin, to ointments for rashes, and pills for eradication of intestinal worms. Some patients required surgery and were brought aboard the COMFORT by helicopter. We also saw patients whose diseases, unfortunately, were beyond our ability to help.

At our makeshift exam room, a chiseled, 75-year-old, hearty and proud Colombian man named Jose walked in wincing in pain, while attempting the best smile he could. He would quickly become my favorite patient. His daughter accompanied him and supported her father's arm. She explained in frantic Spanish that he had traveled over four days from the distant countryside (much of it by boat) to get to Tumaco for medical attention. He had been working on a farm and to avoid colliding with a tree had put his arm out, caught a branch, and yanked his shoulder out of its socket. I removed his shirt and saw that his left shoulder was dislocated. When a joint is dislocated, the muscles contract around it. Unless it is put back into place immediately, it becomes increasingly difficult to get the joint back into place. Four days had already passed. Jose was extremely strong, but the procedure would be challenging without any anesthesia to relax the joint.

I asked his permission to yank on his arm to see if I could force his shoulder back into place, and he replied, "Yes, whatever it takes! I have traveled long and far in a lot of pain. What is a little bit more?" I used all of my strength to attempt to force the head of the humerus bone back into the normal shoulder socket, but it would not budge. In order to get more leverage I improvised a pulley system to use his weight against mine and hopefully push the arm back into the socket. A stretcher had been set up as a physical therapy table in the next room and we laid Jose on it. Enlisting the assistance of the physical therapist and a nearby fellow Navy doctor, dermatologist Carrie Hall, we used a sheet to put Jose's arm in traction. While I pulled his arm downward, Carrie pushed the humeral head upward. The man winced in pain, but yelled, "Siga! Siga!" ("Continue! Continue!"). On the count of three we tried once more. As I released the last pull, the humeral head slid back into normal position. The old man rolled over with a huge smile on his face. He shook out his arms and shoulders, looking like a Colombian Michael Phelps shaking out his muscles on the blocks before a race. His daughter and the man said "thank you" repeatedly, and all we could do was smile back. Without our usual medical equipment that would be standard in the U.S., a team effort made all the difference.

Colombia. Photo by Lieutenant Commander Andrew Baldwin, M.D.

The following day, a frail and deathly skinny woman named Maria walked into the clinic. At just 30 years of age, she would be one of my saddest cases. Upon examining Maria closely, I noticed her bulging eyes, and almost transfixed expression. This type of cachexia (muscle wasting and anorexia) could have been due to several etiologies such as parasitic worms, severe malnutrition, or cancer, but the protruding eyes gave it away. I knew immediately that she suffered from Graves Disease. Graves results in an increase in thyroid levels and subsequent uncontrollable weight loss, osteoporosis, and eye muscle hypertrophy. The usual standard of care is to treat this condition with anti-thyroid medications propylthiouracil and methimazole (Tapazole). Another option is radioactive iodine therapy. We didn't have these types of drugs with us, and we didn't have the ability to do specialized radioactive treatments: I reached for the pharmacy sheet to see if there was anything that could offer her some relief. There was nothing. I realized this woman was going to suffer a gradual demise of brittle bones, bodily wasting, and there was nothing I could do about it.

I was frustrated being unable to help. I pleaded with her to go to see a doctor in Colombia to obtain the medication that would surely treat her condition. Maria said she couldn't afford it and didn't have health insurance. I asked her if her husband had insurance, but she wasn't married. I asked about whether her job provided insurance but she told me she was unemployed. As I looked into this woman's protruding eyes, I was hit by the harsh reality of her situation.

The USNS COMFORT medical team and I would meet many more Joses and Marias over the next two months as we made our way through El Salvador and Nicaragua witnessing a primitive lifecycle where the old who were strong would live and the young who were weak would die. It is the harsh reality of the Third World. For some patients, a little bit went a long way, and for others, it may have provided a temporary stay from their suffering. I will forever carry with me the smiles, the joy, and heartfelt appreciation of all the people we met, in spite of the hardships they endure.

As the crew of the COMFORT headed for home - a group of talented, dedicated, incredibly compassionate people - we knew we had not only saved lives, but we had changed lives. The people we met had a spirit and a will to live, even when sometimes hope had passed. Through the US. military's humanitarian efforts, person by person, country by country, we will continue our promise to provide medical assistance and strengthen partnerships with countries throughout the world.

U.S. Navy Lieutenant Commander Andrew Baldwin, M.D., a physician and Navy diver, is stationed at the Navy's Bureau of Medicine and Surgery in Washington, D.C. He also serves as a spokesman and advocate for Navy medicine. To read about the mission of the USNS COMFORT, please visit www.comfort.navy.mil.

USNS COMFORT. Photo courtesy of Lieutenant Commander Andrew Baldwin, M.D.