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Jan. 20, 2010

Plenty of boats, no pier

Helicopters bearing patients began arriving on the USNS Comfort in earnest around 8 a.m. Wednesday, with only about two minutes between landings and take-offs.

Large guns have been mounted on the bridge deck area and on the stern, port and starboard, with Naval security forces in close proximity. Out in the harbor, a US Coast Guard vessel steamed around the stern of the Comfort. Small Navy boats also surrounded the Comfort, providing security.

The air traffic is heavy with helicopters. A commercial jet flew overhead just after 8 a.m.

There is also at least one ferry, and several small sailboats and other harborcraft buzzing around the big white haven that is the Comfort.

At 6:05 a.m. today, a large aftershock hit, although it felt like the engine shuttering to a stop or the anchor dropping.

The pier in Port-au-Prince that the Navy had planned to use to get supplies to triage units on land has collapsed, according to the ship's Master Chief Charles Collins.

"It is now a ramp, not a pier," said Collins, based at the Naval Health Clinic in Annapolis.

Aftershock

The USNS Comfort is preparing to anchor in Port-au-Prince harbor after a magnitude 6 aftershock hit the Haitian capital this morning.

The Comfort received its first two patients by helicopter around 10:55 p.m. Tuesday. One was a 20-year-old man with a head injury and skull fracture. The other was a young boy, 6, with a pelvic fracture and bladder injury who did not know the fate of his parents. Both were stable Tuesday night, according to officials on the Comfort.

"It's a good way to start," said Capt. Daniel Shmorhun, of Kensington. "Everyone's done a wonderful job."

Jan. 19, 2010

As the Comfort neared Haiti, the first two patients were expected to arrive on board — ferried by helicopter — tonight.

Patients expected Wednesday

The USNS Comfort is expected to receive its first patients via helicopter early Wednesday. The patients are coming from the USS Vincent.

Just to put this whole mission in perspective: The hospital on the Comfort is the operational equivalent of Suburban Hospital in Bethesda, according to Cmdr. Tim Donahue, director of surgical services.

On its last mission to Haiti in 2009, the ship had 1,180 people on board, Donahue said. This operation is likely to exceed that, with as many as 1,250 people on board. With eight operating rooms, the ship could do 30 to 40 operations per day, although that number may increase with staffing.

Some of the escorts coming with the acute or moderate medical patients, Donahue said, will "have a medical component as well," stressing the ships resources even more. So the patients you see in the beds aren't necessarily the only ones who will need or will get some kind of medical treatment.

In general, the more you descend into the bowels of the ship the lower intensity of care the patients receive. In fact, as I type this, Navy corpsmen are setting up 16 beds for low-need patients in the office where the reporters and photographers work. There were four general surgeons, one pediatric surgeon, five orthopedic surgeons, two obstetric surgeons, two ophthalmologists, and a vascular surgeon, among others, aboard the ship as of Monday.

Navy corpsman Michael Ponn said it took him and a group of other corpsmen about two and a half hours to get the beds ready in some of the lower intensity care wards toward the bottom of the vessel.

"The entire world is watching what we're about to do," Donahue told an assembled team of medical personnel Tuesday night.

Jan. 18, 2010

Patience for patients

Late Monday, the Comfort was south of Florida and speculation began that the ship could receive its first patients sometime Tuesday afternoon.

The helicopters on the ship have a range of 100 miles.

The Comfort is expected to arrive in Port-au-Prince late Wednesday or early Thursday.

Teddy bears that care

Over the past year, there's been a fair bit of tension between the Stone Ridge school in Bethesda and its next-door neighbor on Rockville Pike, the National Naval Medical Center. Navy Capt. Daniel Shmorhun hopes a big gift of stuffed animals can help the relationship a bit.

The tension arises from the Walter Reed Army Medical Center's relocation to Navy Med and associated traffic and property issues.

Shmorhun, a Kensington resident and a pediatrician at Navy Med on board the Comfort, guessed pretty early after the earthquake in Haiti that he might be going to the country to assist. What he wasn't expecting was that his daughter Katya, 9, a third-grader at Stone Ridge's lower school, quickly came up with a proposal to help out.

"After the initial crying, her wheels started spinning, wondering what she and her friends could do," Shmorhun said.

Katya brought her idea to the school, and Stone Ridge sent a letter home with students Thursday night asking students to bring stuffed animals to the school Friday morning.

Given the short notice, the response exceeded Shmorhun's expectations. The stuffed creatures flooded the hall of the lower school's foyer by the hundreds, according to Shmorhun, and it took several car trips for the toys to be put on buses at Navy Med that were headed to the Comfort on Friday in Baltimore.

The animals will be distributed to children on shore.

"We're hopeful that this kind of activity spurs other kinds of things that are going to be needed in Haiti over the next several months," Shmorhun said.

10,000 nurses and 10,000 doctors

On his previous visit to Haiti aboard the Comfort, Cmdr. Mark Marino saw it all, and it wasn't at all good. He saw a woman complaining of stomach pains who had not eaten in five days. There were children with fluid on the brain, their heads the size of watermelons. He saw an autistic child who had burns on his back from when a car he was sleeping under backed over him.

This time, things will be even more difficult. But Sunday night in his office, Marino, the ship's director of nursing services, made a bold and happy declaration.

"If we got there today, I could take patients today," said Marino, a 28-year veteran of the Navy who is one of the few people on board permanently assigned to the ship, even when it is docked.

A lively, energetic leader, Marino repeated that message to a meeting of the ship's crew, only with fist pumps added.

Although he has to obsess over so many details, as of Sunday night Marino couldn't put his finger on exactly how many nurses he has on board, although the numbers game didn't worry him as much as other things.

Any organization, he said, would be taxed by having to put together the kind of mission the Comfort is undertaking with under 72 hours notice.

"I could take 10,000 nurses and 10,000 doctors down to Haiti and it still wouldn't be enough," Marino said.

Jan. 17, 2010

Arrival time

As of 7 a.m. Sunday, the Comfort is expected to arrive in Port-au-Prince Thursday morning, according to the ship's Public Affairs Office.

The seas for most of Sunday were fairly rough, and by the afternoon the ship began a steady but gentle roll.

It feels as though every few hours, we are either informed officially or overhear from crewmembers that there will be an abandon-ship drill at such-and-such a time. We haven't had one yet. Perhaps we're just being kept on our toes, not by being prepared, but by preparing to be prepared.

There was a small electrical fire near the radio room that was quickly extinguished. No major damage was reported.

Do not operate

During an interview I was conducting with Alayna Schwartz, an OR nurse based in Bethesda and living in Germantown, a medical officer slipped behind us and began to walk into the OR, which is currently off limits.

Out of nowhere, the Comfort's Director of Surgical Services Tim Donahue, one of the busiest men on the ship, came into view.

He barked out, "No, no!"

The medical officer about to go into the OR froze.

Donahue explained that the OR was off limits and the officer turned around and left.

Schwartz laughed briefly at Donahue, her superior, and said, "He's got eyes in the back of his head."

There will be blood

There are 50 units of fresh blood and 215 units of frozen blood on board the Comfort. The ship has room for 1,000 units of fresh blood and 2,000 units of frozen blood. Each unit of blood represents a pint.

Commander Christine Howe, the Director of Ancillary Services, who oversees the blood bank, said generally the blood is O positive or O negative. Haitians, she said, do not have a predominant blood type. The ship's command has no way of knowing how much blood will be needed or how long the current blood supply will last.

"It's really hard to predict that," she said.

Very little blood was needed on the ship's mission to Haiti in 2009, according to Howe. In fact, some of the blood that was on board that summer is still stored in the blood bank.

Federal guidelines, she said, dictate that frozen blood can be stored for up to 10 years.

Jan. 16, 2010

The Plan for Haiti

Addressing the crew on the USNS Comfort on Friday night, Navy Capt. Andy Johnson, director of medical operations, gave the audience a laugh with the following: "The plan we have is incredible. … The problem right now is that I have no idea what it is."

But the massive ship's capabilities are clear.

The floating hospital can treat about 1,000 patients at any one time. Fifty patients at once can be handled in its main casualty receiving area. At full strength, there are 12 operating rooms with space for 24 simultaneous surgeries. Approximately 560 medical personnel are on board and there are 900 people total on the ship. A large portion of the medical personnel are based out of National Naval Medical Center in Bethesda, others are from Portsmouth, Va., and San Diego.

Among other medical specialties, the ship can deal with neurosurgery, pediatric medicine, maxillofacial reconstruction, dental needs, urology, OB/GYN, pathology, optometry and infectious diseases. There are three decontamination areas.

Casualty reception, near the bow, is on the same main deck as the intensive care unit, which is close to stern. This allows medical teams to move critical patients to critical services without using stairs or elevators.

There is a helipad for transport of patients, along with a "dock" that the ship can lower to help receive patients being brought to the ship. There is at least one helicopter on board.

Ware's House

The first phase of the Comfort's mission is expected to last 45 days, treat 40,000 patients, and could require up to 100 French and Creole translators, according to commanding officer, Capt. Jim Ware.

The ship can normally accommodate 250 patients over 30 days, according to Ware, who visited Haiti last year on the Comfort as part of the ship's humanitarian mission that also included a stop in the neighboring Dominican Republic. Up to 1,000 operations could take place in the ship's four functioning operating rooms, over the first 45 days.

When the ship gets to Haiti, hundreds of medical personnel will board to accommodate the vast relief needs in the Port-au-Prince area.

"Right now we think we're going to be surgically-intensive," Ware said. There are 13 surgeons on board.

Ware said the goal is for Comfort personnel to connect with nurses, NGOs and Doctors Without Borders, who are already in Haiti. Ware called these people "medical nodes" and "Mother Teresas of the world."

"Every three hours, there's some huge change that I just didn't see coming," Ware said.

Comfort Zone

On the emblem of the USNS Comfort, is a demi-sun, symbolizing the World War II kamikaze attack on the previous US Navy boat, named the Comfort. Although Haiti is described as a "war zone" it seems unlikely that the ship will add more solar bodies to its emblem after this mission.

Here are some more structural facts about the Comfort, from the freeboard and the fantail, to the draft to the forecastle.

The ship rises to the equivalent of 10 stories high. It is 164.5 feet wide, just svelte enough to slip through the Panama Canal, with a few scratches on the hull, and almost three football fields long. No reports of Mike Shanahan scouting the ship as a future Redskins' practice facility, however.

At full engine, the ship can split the waves at 17.5 knots, or about 15 miles per hour. In other words, world class Olympic sprinters can outrun the comfort – at least on land, and for a few hundred feet.

One of the boat's most important abilities is desalinization, which sounds like a mundane chore typically reserved for municipal bureaucrats, until you learn that the ship can take 300,000 gallons of salty seawater and convert it into freshwater daily. It's a crucial service when you consider the responsibilities of a hospital ship docked at a ruined city.

The current Comfort was once an oil tanker, named (presumably in a slight of romantic fancy) the Rose City. The Navy commissioned the Comfort in 1987. As one officer described it, the old tanker was "hollowed out like a canoe" and a working hospital "dropped" inside. That's simple enough.

For those who saw the movie "Titanic" as a horror flick, the ship has 84 life rafts, each of which can hold 25 people. There are 10 life boats with room for 112 people each, including 16 hospital patients per life boat.

Finally, the Navy calls a water-tight opening a "scuttle." I had previously reserved that word to describe how crustaceans move. If there are any crabs scuttling through a scuttle on the boat, this probably means that the Comfort is underwater.

Shower shoes and ‘Chutes and Ladders'

There are two decks that run continuously along the ship, with other decks and levels broken up by bulkheads. This makes getting around feel like an enormous game of Chutes and Ladders. You may need to walk up several flights of stairs, along one of the main decks, and back down several more flights of stairs before you reach a destination that is only a few linear feet from your starting point.

Some other thoughts:

Right in front of my berth is an open hatch, leading to a set of ladders that appears to lead down to the hall above the keel. It's a nice journalist's-eye view. Fortunately, the Navy has put a series of raised chains around the hatch to protect us, although it still gives the experience a bit of "The Poseidon Adventure" flavor.

Initially, I was put into an officer's cabin with eight bunks. But I and two other reporters were relocated Friday night to a bigger berth with dozens of bunks. The berths are three-bunks high, and acting on a tip, I chose the middle bunk. During my first night, no one figured out how to turn off the overhead light in my part of the berth, so I slept with the curtains tightly drawn.

One of the Navy guys in the public affairs office is a very friendly man called Dave Shark.

At peak times, the line for chow snakes back from the kitchen for what looks like the same length as the Comfort's weight.

My cousin is a lieutenant commander in the Navy. When I asked him Thursday night how to deal with life on a Navy boat, one of his first responses was "shower shoes." Sure enough, I have been told that the Navy store on board the Comfort sold out of shower shoes Saturday morning, before the ship left port. Fortunately, I listened to my cousin.

Correction: The USNS Comfort can treat about 1,000 patients at any one time.