WHO?

U.S. Navy Cmdr. Dr. Trent Douglas is a plastic surgeon and lives with his family in San Diego, Calif.

U.S. Navy Cmdr. Dr. Trent Douglas (Col ’91) recently completed a humanitarian and civic assistance mission aboard the USNS Mercy hospital ship. The mission brought together an international group of physicians, medical students and other health care, security and administrative professionals from various military and civilian backgrounds to provide medical care in cooperation with host nations throughout the Western Pacific and Southeast Asia. In this letter, he describes his visit to Cambodia from June 14 to June 30, 2010.

The USNS Mercy hospital ship under the dark sky of the rainy season.

In Sihanoukville, Cambodia, we weighed anchor and 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.

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. Fortunately, my stomach reminded me that I had remembered to take my antimalarial pill that morning, but my hopes of avoiding racking fevers and chills were dimmed when the same doctor then said, “Cool, these are the day-biters that can give you dengue fever.”

About 200 patients were already waiting in line at the hospital and were very glad to see us drive up. We jumped off the buses, covered ourselves with bug repellent and set about our work. Although the dark skies threatened rain all day, we got only a few drops of the massive thunderstorm that passed just north of our location. About mid-morning, my big boss, Rear Adm. Christine Bruzek-Kohler, paid a visit to our site. Fortunately, everything was running smoothly and she leapt at my offer to get in on 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 think that she got a taste for humanitarian assistance, and she liked it. 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.

The Sihanouk General Hospital during the visit from Mercy volunteers.

During our time in two weeks in Cambodia, we would perform 272 surgeries and thoroughly exhaust ourselves. Monkeys and cows were all over the place and we had the opportunity to treat the veterinarians for two monkey bites and one laceration that was delivered by the horns of a water buffalo that did not want to get vaccinated. Feral monkeys are nasty little creatures and bear close watching.

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 crash occurred about 30 miles north of Mercy’s location, and we serendipitously happened to have a medical team about 5 miles away seeing patients in a nearby village. Dispatched with a paucity of information and a Blackhawk Bag—an advanced first-aid kit—an Australian emergency room nurse and the Army medic were the first responders and they are directly responsible for the embassy worker’s survival.

Helipad aboard the USNS Mercy.

The helicopter pilots made a heroic effort to find our patient in the midst of a downpour with only a few sketchy landmarks by which to navigate and an underpowered flashlight to guide them down to the makeshift landing zone in the middle of a local road. Within 30 minutes of picking up our patient, she was aboard Mercy, through the Advance Trauma Life Support protocol and in the CT scanner. Our two radiologists worked seamlessly with the trauma team to assess the multitude of injuries and help us make some big decisions. We don’t have a neurosurgeon aboard the ship during the humanitarian assistance missions, so the duties of performing a craniotomy fell to … you guessed it, the plastic surgeons. Alan Lim is a Navy plastic surgeon aboard with advanced craniofacial training. As Alan was getting the operating room set up, I was dialing my neurosurgeon buddy back in San Diego. To his credit, he didn’t mind being awakened at 2 in the morning to field this particular call. After we e-mailed a few images of our patient to him, 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.

Our patient’s husband and two small children were flown to Mercy via helicopter and I had to have one of those difficult conversations with the husband. After doing one of the things that most doctors dread—delivering bad news—I looked at the patient’s daughter and felt a maelstrom of emotion that melted the steely resolve with which one must tackle these complex situations. She was the same age as my own daughter and a helpless feeling of inadequacy came over me. I tried grasp this family’s conflict and relate it to how I would feel if it were my wife who had just been critically injured in a foreign country and I was alone with two young children. 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 and very disorienting ship only knowing that her mom was very sick. I gave her Laurel-the-Lamb in some small hope that it would comfort her. She clung to that scruffy old stuffed lamb for the entire time she was aboard the ship.

The next 12 hours involved a lot of phone calls, not much sleep, some help from the U.S. ambassador to Cambodia and a lot of good luck. We were able to wait out the following morning’s rainstorms, get the patient via helicopter to Phnom Penh and from there transfer her to a waiting fixed-wing medical evacuation jet straight to Singapore.

With our patient receiving the care she needed, we set sail for the next port of the Mercy’s four-and-a-half month deployment.

Dr. Trent Douglas and the rest of the team who participated in Pacific Partnership 2010 saw 102,000 patients, performed 817 surgeries, completed 11 major engineering projects and participated in 59 community service events while serving host nation populations in Vietnam, Cambodia, Indonesia and Timor-Leste.

The USNS Mercy accompanied by the JDS Kunisaki.

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