PT on the High Sea

PTs aboard the USNS Mercy bring much-needed care to deserving countries around the globe.

Aboard the United States Naval Ship (USNS) Mercy Medical Ship (Mercy), Navy Reservist Lieutenant Commander Mitchel Ideue, PT, looks back at the past five years of his naval career.

From 2007 to 2010, Ideue worked with wounded warriors at Landstuhl Regional Medical Center (LRMC) in Germany. In 2011, he worked at the Quantico Marine Corps Base in Virginia.

"My job was not to cure these officer candidates, but to treat them like elite athletes and help them make it through the program to move on to become Marine Corps officers," said Ideue.

LCDR Ideue recently sailed back home to Hawaii after providing four months of rehabilitative care to deserving people in Indonesia, Philippines, Vietnam and Cambodia, along with a team of PTs and support staff. Here's their story.

On Board the Mercy

"This form of physical therapy is full of excitement and adventure," said Ideue. "It's like an Indiana Jones style of PT. We go to exotic places and see exciting things, and do incredible things in the field, miles from the bounty of Western resources we sometimes take for granted. I thought I saw it all, but this mission opened my eyes to not only the potential of what physical therapy has to offer, but how this profession has expanded. There just isn't enough time in school to learn this stuff."

The work team was comprised of an Officer in Command (OIC), Bradley Wells, and two other physical therapists: Lt. Nathalie Royer and Lt. Anaj Franz. Four PT technicians (PTTs), HM1 Vinson Ilog, HM1 Ceandra Baker, HM2 Osei Tutu, and, HN Hector Hernandez, rounded out the physical therapy team.

The work team hailed from Naval medical and training centers located primarily in the USA and Canada. Reasons for accepting the USNS assignment all were strikingly simple and similar: to contribute to the humanitarian goals of the USNS Mercy.

HM1 Baker, for example, was previously fighting in the war in Sierra Leone and looked forward to the missionary work aspect of this humanitarian mission. Lt. Franz, a Canadian physical therapist, wanted to see how PT outreach was done "stateside" in such missions, since Canada does not have physical therapists on their Canadian ships.

Expectations ran the gamut. Being active duty on the Mercy was new for all crew members and they knew the learning was going to be nonstop. But the rumor mill did set up some now-humorous expectations. Ideue, who hails from Hawaii, confessed his secret anticipation to scoping out surf spots in the various countries. Others heard that the Mercy was like vacationing on the Love Boat -- just one sweet relaxing day after another, with a proverbial fishing line attached to the nearby brass railing.

But they all soon learned the daily work and delicate intricacies of multi-cultural collaboration, as well as unique expectations and a natural curiosity of their diverse patient pool. Often their patients had no idea what the USNS Mercy was, or what it did -- even at their doorstep.

Purpose of the USNS Mercy

The Mercy is a floating hospital ship whose mission is to care for military and non-military wounded during times of war and major disasters. To prepare for the inevitable, the Mercy performs humanitarian/mercy missions or outreach to Southeast Asian countries, such as Indonesia, the Philippines, Vietnam, and Cambodia, to provide care to the host nationals while building and maintaining good will with the United States.

Recently, the Mercy's mettle was tested. In March 2005 an 8.7 magnitude earthquake struck Nias, Sumatra. At that time, Mercy was heading home from a humanitarian mission that provided medical service to Banda Aceh, Sumatra, after a devastating tsunami. In less than 72 hours, Mercy turned around and sailed back to Indonesia.

Mercy spent one month in each country, performing more than 19,000 medical procedures in Banda Aceh and Nias. The Mercy is capable of providing care with its 1000 beds, 12 operating rooms, 30 medical services and well-equipped 1000-square-foot physical therapy department.

Besides the United States Armed Forces, the Mercy was staffed by 14 military foreign partner nations and 17 non-government organizations. Working on ship was a great learning experience because of the various approaches in solving similar problems. Communication was not a significant problem because English aboard ship was the standard but not the rule.

The physical therapy clinic received a physical therapy technician from the Indonesia military that did not speak a word of English. For two weeks the PT staff visually communicated to the Indonesian PT for daily clinic routines.

Background of the PT Team

The physical therapy department was staffed by a diverse group in terms of skill sets and ethnicity. One physical therapist specialized in McKenzie, strength conditioning and neurorehabilitation, a physical therapy technician specialized in hand and wrist splint fabrication, and another three members specialized in inpatient and outpatient rehabilitation. Additionally, one acupuncturist specialized in pain management.

All strived to work together to create synergy. Crew members soon learned that there is nowhere to hide or sulk when things don't go your way. Collaboration, patience and respect are key to achieving daily goals.

The staff's diversity came in handy when dealing with cultural mores, languages, beliefs and values. Ideue, a senior officer, is a Japanese-American from Hawaii, OIC Wells is from Georgia, Royer is French Canadian, and Royal Canadian Navy Lieutenant Anja Franz is German born and raised.

Ilog is Philippine born and raised, Baker is from Florida, HM3 Osei Tutu was born and raised in Ghana, Africa, Hernandez is a first generation Mexican American from New Mexico, and acupuncturist Aaron Cook is from California.

In addition to the natural task of working effectively as a team, they also had to work effectively with host nationals. Working with the people requesting care is rewarding. It's not unheard of for people to spend what little they have to travel or walk long distances to be treated at a land-based Medical Civic Action Program (MEDCAP) facility.

The host national's lack of proper medical care and knowledge resulted in the MEDCAP seeing exotic and/or unfortunate diagnoses. There were several cases of people with cancer left untreated for so long that their tumor had broken through the skin surface. Others came to see physical therapy to cure their cerebral vascular accident (CVA) after walking for miles and then standing in line for hours.

Each person who travelled a long distance had only one day to be seen by us, and then had to return home because there was no place for them to sleep overnight. A translator said that sometimes families have to stay overnight to ensure that all members are seen at the MEDCAP.

When families chose to stay overnight, they often slept in the forest or nearby temple, putting them at risk of contracting Dengue fever and malaria from mosquito bites.

Many of those treated had never received medical care, and many had never met an American. The team did what they could -- whether it was speaking in simple terms, showing them the exercise, or gesturing directionally. Hernandez came up with the idea of creating a simple exercise sheet for the work team and translators to use to help convey information.

Many of those seen had very little in their life, yet they were appreciative and grateful to the USNS staff for their attention and care. Such gratitude from farmers, mothers, children, and the elderly -- all with aching backs, knees, or missing limbs or severe ailments -- often came in the form of air-kissing the hands, as if the staff were royalty, and smiling no matter how desperate the situation, as well as giving notes of thanks and drawings. All these gestures made the work team feel that their efforts as individuals and as representatives of the U.S. Navy made a difference, and a reciprocity of kindness ensued.

A person being seen by a physical therapist never left empty handed. After a patient made the effort to get to a MEDCAP, the treating therapist felt obligated to give them something in addition to advice such as home exercise programs and equipment such as crutches. These gifts were accepted gratefully, no matter what the culture.

Cultural Challenges

Cultural challenges were a daily event. Instructing and advising the locals on proper body mechanics was a challenge because many, if not all, patients squat to sit, and carry heavy items on their back or head.

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Communication was such a challenge that gestures seemed the only way for people to convey their aches and pains. When asked, "where do you hurt?" the patient would point to their right shoulder, then left shoulder, then left hip, then right hip, then knees. The PT staff good-naturedly termed this response MPS, or the "Macarena (dance) Pain Syndrome."

Another challenge was dealing with translators and their cultural differences. The PTs were not always able to communicate questions or instructions in a way that was clearly understood by the translator and patient. The translator would have difficulty taking what the patient said and putting it into English words.

At other times, communication was clear but uncomfortable to give. A distressed translator clearly explained to a mother that her child had a hole in the heart, and that her child would likely die before becoming a teenager. While Westerners often want doctors to "give it to me straight," the Southeast Asian way of giving bad news was a major challenge. Ironically, this mother and all other patients were always thankful for the accurate information, no matter how devastating the news.

The four countries -- Cambodia, Vietnam, Philippines and Indonesia -- presented the same work-related injuries due to the common occupations of farming, manual labor to build roads and buildings, and fishing. Out of the 9000+ host nationals seen at a MEDCAP, approximately 45% presented with low back pain, 15% with knee pain, 10% with cervical pain, and another 10% with shoulder pain. The other 20% presented with complaints such CVA, foot, ankle, hip, hand, wrist or elbow pain. Of course, the Mercy had its own share of work-related injuries as well.

PT on the High Sea

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Brilliant article and fantastic work! I'm becoming a champion for public health (of which global health is a huge component). I'm pleased to see other PTs encouraging a paradigm shift and recognizing a wider variety of roles we can play in global health. Keep up the good work!

Dean MetzDecember 17, 2012


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