This morning we had a mass casualty incident at the local elementary school. During a two-hour scenario, Aerie students triaged, moved and cared for 14 elementary school students (most of whom spoke no English) with carbon monoxide poisoning. The past few days we have been down to the local rivers quite often, caring for patients, building shelters to stay the night, and navigating our way to and from the scenes. We also completed our splinting section, with groups of students making improvised femur traction devises and having them evaluated.

February 20

This is our first full weekend of the month, with both Saturday and Sunday off. No interesting pictures to upload, as they would only consist of everyone sitting in hammocks reading. Tomorrow is the beginning of our last week in Costa Rica, and it will be the most rigorous yet. We have a number of extended scenarios to complete, most of which will require the coordination of all of the skills learned thus far. In addition, we will spend two days back in Zapaton, where we held the medical clinic, building rocket stoves for families identified as having a particular need for reducing cooking smoke in their homes.

February 18, post 2

After days of no posts, we're now putting up two in one day! Of the hundreds of images gathered over the past week, here are some highlights of our experiences with actual and simulated patient care. In the top three photos, our intrepid students practice improvising litters and caring for a head injury (simulated blood only!)

The next photograph shows our end-of-clinic table top debrief. For the table top, students present the details of patients they saw during the clinic to staff, including our visiting physician, Dr. Greg Moore. Students were evaluated on their presentations and asked follow up questions by staff and their colleagues. Finally, Dr. Moore elaborated on the patients' histories and gave reasons for his diagnoses. In the final photos, students, instructors, translators, and Dr. Moore all take patient histories, vital signs, and record their findings while visiting patients in their own homes. A good week!

February 18

Yesterday ended with practical examinations covering map and compass, emergency shelter construction (second photo, with Savannah and Jenna at their station), and a "splint-off", with students competing for the best splints, based on criteria like functionality, durability, simplicity, versatility and aesthetics. In the bottom photo, Liam is using a scripted description of his tib/ fib splint to add impact. It helped, and his splint was excellent, but as of this morning his group remained tied for second. At this moment, Andrea and Fernando are teaching UTM (Universal Transverse Mercator) grids and improvised femur traction splint construction. Those pictures are the two at the top of this post. The photo of the trees is this morning's sunrise.

February 17

Sorry for the delay: this has been a very busy week with an amazing group of students. We completed two days of house visits and set up a clinic at a community center in Zapaton, an indigenous community about ten miles from Mastatal. We assessed and provided care to about 40 people, ranging in age from 9 months to 90 years. Since the clinic, we have reviewed head, spinal, chest and musculoskeletal trauma. At the moment, students are completing practical examinations for GPS use, emergency shelter construction, and knot tying. Following the mantra, "Beatings will continue until morale improves", students will take their second written medical tests of the week tomorrow, with instruction in the management of bleeding and shock and long term wound care.

February 9

Yesterday concluded with a full afternoon of practical skill review (Automated External Defibrillator; emergency shelter construction; GPS use) and an extended scenario that used these skills. Groups found patients in the water, safely moved their patients to shore, established a base camp with a fire and shelter, identified their location by map, compass and GPS, and planned for an evacuation and prepared for a night out in the rainforest. This morning we are back in the classroom, debriefing the scenarios, continuing with map and compass instruction, and learning about diabetes and anaphylaxis. In addition, we are adding emergency litter construction with tarps and ropes to the list of wilderness skills.

February 7

Yesterday was our first day off. Most of us went to the soda to watch the Superbowl and relax. Today included about 10 hours of class time, including more map and compass, pharmacology, pathophysiology and respiratory emergencies. Tomorrow includes cardiac emergencies, altered level of consciousness, instruction in emergency shelter construction and introductions to GPS, with the afternoon of scenarios down at the river. Aerie's Medical Director, Dr. Greg Moore, leaves Missoula on the 10th to meet us in Mastatal. He will lead a full day of house calls on the 11th and head up the clinic on the 12th. Students will be visiting houses, talking to and assessing dozens of local residents during Greg's visit. The pictures are of an emerging cicada at night and map and compass review.

February 4

Yesterday, we used our male students as chalkboards for sketching cardiac and pulmonary anatomy and circulation. We headed down to a new river today for scenarios and survival training, which included fire-starting. Getting to and from the river included route-finding with map and compass. Lectures included documentation and communication. Tomorrow, Saturday, will include CPR and practical testing of knots, map and compass, and medical skills.

Day 2

Photos from the waterfall turned out to be too dark to be of much interest for the blog. Our hosts at Rancho Mastatal put on a fairly unexpected but inspired regional variation of Macbeth, titled "Macbetho", last night for dinner-theater. This was a great conclusion to a busy first day.

Today we reviewed knots (bowline and double-overhand stopper- see photo), introduced map and compass use, and had a full afternoon of human anatomy and physiology review. Class ended at 5:30. Dinner is at 6:45. Breakfast tomorrow at 7 am, with class starting at 8.

The area around Mastatal has had a tremendous increase in scarlet macaw populations; we are seeing and hearing these amazing birds throughout each day. It's hot here, but more overcast and a bit rainier than usual, providing a welcome break from the sun.

Day 1

Day 1, our indoor (or, more accurately, under-the-roof) classroom. This afternoon we are heading down to the river and waterfall to learn about the local flora, fauna, weather and terrain. Pictures and updates to follow.