On the Ground of 'Operation Lone Star'

Below are primary accounts from our own Commissioned Corps officers on the ground of ‘Operation Lone Star’ in South Texas. Texas Health and Human Services employees, Texas Military Forces, the U.S. Public Health Service Commissioned Corps, local health departments and community volunteers worked to bring health services to thousands of underserved South Texans. This operation also served as emergency preparedness training to state and military personnel. In this one-week operation’s 14 year history, this year marked the first time that the Remote Area Medical Foundation (RAM) joined forces with the Commissioned Corps in providing invaluable dental and vision services. (http://bit.ly/QdhbWx).

Read on to hear the voices from the frontline:

PHS officers assigned to the Mission site at Palmview HS visited by RADM Epifanio Elizondo, RHA Region VI and CAPT Dean Coppola, 2012 OLS OIC.

PHS officers assigned to the Mission site at Palmview HS visited by RADM Epifanio Elizondo, RHA Region VI and CAPT Dean Coppola, 2012 OLS OIC.

Left to Right: LT Michelle Krayer, Nurse Practitioner - BOP; RADM Elizondo, Kerry Hearod, Social Worker-IHS; CDR Elizabeth Escalera, Nurse Practitioner-IHSC; 2nd row from left to Right: CAPT Dean Coppola, LCDR Brooke Wallace, Social Worker-DoD; and LT Marjorie

Impressive Numbers
July 24, 2012

I have the pleasure and honor to discuss the second day in the life of the oral health mission at the Brownsville site of Operation Lone Star (OLS) 2012. July 24, 2012 began very early with arrival time at 0600 hours and departure time at 0630. Our goal for each day was that 200 slots would be available for dental services each day. The team arrived in the clinic area of the Manzano Middle School very early, formation and official daily notifications were presented then our “daily dental adventure” began. As a dentist, I was a member of a team providing oral services to the population presenting to the Manzano Middle School in Brownsville, TX (the only site to provide comprehensive oral health services).

One might ask why the Rio Grande Valley? Why free services? Why involve so many agencies? The answer is simple, but has 2 distinct motives. The first is to provide much needed care to a population that is under-served, under/un-insured, and desperately in need of health care services without regard to citizenship status, income, race or creed. I certainly see this part of the OLS mission dovetailing with the mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety of the United States.

The second motive is to prepare agencies to work together as a unit in times of national disaster and crisis. Medical readiness innovative training was an essential part of the operation, utilizing the Incident Command Structure, various skills from the myriad of different agencies all to achieve one mission.

After just the first two days I can tell you that the OLS oral health mission is going to be extremely rewarding. Seeing all these different organizations arriving as separate entities, but gelling together to form a Team is inspiring. The facility/school I am working at is set up as one would imagine for a natural disaster. Communications and a logistics network are established, chain of command is clearly defined, and this week we will be testing our medical readiness.

It is the 2040 hours, the end of the first day and I am totally exhausted. Yet, I feel an overwhelming sense of camaraderie and I am absolutely enjoying my very first deployment as part of Operation Lone Star. I cannot wait for the rest of the week to occur but first I need to get some chow and hit the rack.

CDR Gloria Jean King, DDS
Lawton Indian Health Service Unit
Oklahoma City Area
Indian Health Service

The Power of a Smile
July 25, 2012

The dental clinic that was set up in Manzano Middle School in Brownsville. Photo Courtesy of the Texas Department of Health and Human Services System.

The dental clinic that was set up in Manzano Middle School in Brownsville. Photo Courtesy of the Texas Department of Health and Human Services System.

Operation Lone Star sported a new partnership this year at the Brownsville site. The U.S. Public Health Service (USPHS), back for a second time, was joined by Remote Area Medical Volunteer Corps (RAM). On a hot, sunny summer day in the Rio Grande Valley, I opened the doors of a would-be shelter. Still early, dental patients lined the hallways of Manzano Middle School. Operation Lone Star’s (OLS) dental component has always been a high point of interest. In previous years some OLS attendees walked away once they learned there were no dental services offered. That is not the case this year thanks to RAM and USPHS.

I walked away from the school with the sun beaming against my face. But I was in some way changed. It was comforting to know that I had been a very small part of an operation that touched the lives of so many people. I know that Cody and Amber’s stories were multiplied by thousands of similar ones. Because of Operation Lone Star, RAM and USPHS many new, more confident smiles will be shared in this corner of the globe. And, there will also be a lot more people enjoying crisper, clearer rainbows and sunsets in the Rio Grande Valley this year.

John Villarreal
Specialist, Texas State Guard
Operation Lone Star 2012 Public Affairs Office

My time in the Commissioned Corps has made me a better person
July 25, 2012

My participation in Operation Loan Star (OLS) 2012 was very rewarding and I am so grateful I had the opportunity. I was impressed with the focus of integrating the two services, PHS and Texas State Guard, on mission goals one of which was that we would know each other’s capabilities if needed for future responses. The support of the Texas State Guard and Rural Area Medical personnel was unbelievable. We could not have achieved the numbers we did without the Baylor dental students, the local dental hygiene/assisting school students, all who helped keep the work flow moving as well as translating. I really appreciated my fellow PHS dentists, who provided encouragement and consultation. I must say that the most rewarding part of OLS 12 was the patients. They were so grateful the hugs and "God Bless You's" were awesome. As a fellow officer said, his time in the PHS has made him a better clinician and a better person. I couldn't agree more.

CAPT Ross Silver, DDS
Indian Health Service
Takopid Health Center
Tacoma, WA

We have a 911
July 25, 2012

I heard a knock on the door of the wellness center and it opened slowly. A case worker states, “we have a 911”, and I see a tearful older woman in front of me.

This is a day in the life of LT Lorener Brayboy while deployed to Operation Lone Star 2012, and assigned to the community of Brownsville, TX. I had the opportunity to deploy to OLS, a humanitarian training mission lead by the Texas’ State Guard (TXSG) and Department of Health Services serving the Rio Grande Valley. As a mental health provider, I have been working within the Wellness Center in Manzano Middle School in Brownsville. This day was very busy, just like every day I have been here; many patients lined up awaiting dental, optometry, and medical services. TXSG walking swiftly down the halls with their held hand radios. Yet I would soon find out today would be different for me as I was about to be confronted with a crisis situation. I knock on the office door where I was stationed revealed a TXSG officer with a frail elderly woman who appeared very distraught. I invited the woman into the room; I introduced myself and asked what was making her tearful. She stated, “The girl asked me a question and I just couldn’t help it. She asked if I had thoughts of hurting myself.” The elderly woman began to sob, covering her face with her hands. During this encounter, it was unveiled she was preparing for her death. She had written letters to many of her children and were experiencing auditory hallucinations telling her, God was ready for her arrival.

It was the first time, this woman was able to express her thoughts and feelings freely. She had admitted a sense of calmness afterwards. Due to the severity of her condition, my fellow team member and I made the necessary community referrals for further evaluation and hospitalization. Although, it was a difficult situation, it was rewarding to know we helped to keep her safe.

LT Lorener Brayboy, LICSW
Federal Bureau of Prisons

Providing critical dental services to those in need
July 25, 2012

Today we were excused from the morning formation, as our superiors showed us some sympathy since we worked until past 1900 and did not get to our hotel until after 2000 last night. This gave us an extra hour to sleep in, hooray!

Regional Health Administrator, Region VI, RADM Epifanio Elizondo stands with Ruben Villarreal, the Mayor of Rio Grande City, one of the six sites for Operation Lonestar 2012.

Regional Health Administrator, Region VI, RADM Epifanio Elizondo stands with Ruben Villarreal, the Mayor of Rio Grande City, one of the six sites for Operation Lonestar 2012.

Patients started coming in to the waiting area soon after 0900. I started this morning performing dental cleanings (prophylaxis), since there was a huge line for it each day. Cleaning involved using an ultrasonic scaler along with hand instruments; because the patients had a lot of tartar (calculus) build-up both were necessary. Most of the time a third or fourth year dental student from Baylor University assisted me. They were very helpful, and it was encouraging to see their enthusiasm for this dental mission.

In the afternoon I performed fillings and extractions. My first extraction case for the day involved some remaining roots of an upper (maxillary) third molar. My guess was that only the roots were present because they were fractured during a previous attempt to remove the tooth. Each challenge I faced made me appreciate grow for the many different organizations that served as our support/back-up. Thanks to Remote Area Medical (RAM), we had a good supply of instruments and equipment. There was never time for lunch but since we were working such long hours it was necessary to have some sustenance, so we enjoyed our Luby’s box lunches. We took turns eating, so the chairs remained full.

The Dental providers alternated our procedures based on the longest line to increase access to care. Today Operation Lone Stare saw 43 children and 140 adults. The following procedures were performed on these 43 children: 16 extractions, 8 fillings, 29 cleanings. Adults had 98 extractions, 48 fillings, and 41 cleanings. Although we again felt sore at the end of the day, it felt good to be able to be a part of this team that is providing such critical services to people in need.

LCDR Joseph Collins
Dental Officer
Oklahoma Area
Indian Health Service

Today I became a ‘Millionaire’
July 26, 2012

Today was another rewarding day here at Palmview High School in Mission, Texas as we support Operation Lone Star 2012. We have been able to link numerous clients up with much needed resources and as the day comes to an end, I reflect back on one family in particular.

When I volunteered for this deployment to south Texas I feared that my not being a fluent Spanish speaker would inhibit my ability to have the needed impact. I was so happy to discover that was not the case, as we had great volunteer interpreters to assist us though out when the need arose. In this particular case the fact I didn't speak this mother’s language very well didn't present a barrier. We were able to help her get durable medical equipment and some home health care to assist with her severely disabled child and this left her feeling as if we were a part of her family. She thanked me profusely before leaving, for something I felt was so minimal. But to a mother with a special needs child, hesitant to ask for help, our services are anything but minimal.

Through the interpreter, she told me she felt like a millionaire today and that this had been one of the best days of her life. Her eyes tear up as she hugged me and then spoke, "I love you" to me as she tightened her embrace around me. She kissed my cheek and said, "Thank you" once more before letting me go. Tears streamed down her face and I saw her sincere appreciation reflected through her eyes. Today I've become the millionaire, as she has filled my soul with riches that will last a lifetime.

LCDR Brooke Wallace
Department of Defense – U.S. Army
Brook Army Medical Center

Appreciating my role as a Commissioned Corps Dentist
July 27, 2012

PHSCDR Angie Roach assisting a patient during OLS 2012.

CDR Angie Roach assisting a patient during OLS 2012.

Operation Lone Star 2012 was an annual joint exercise involving several military and civilian agencies working together to offer many different health services to an underserved population in the Rio Grande Valley. I was assigned to the Manzano Middle School site in Brownsville, Texas. This was one of six locations that offered free medical services to the community as part of a disaster preparedness and emergency exercise. Brownsville was the only one that provided comprehensive oral health services.

As a Commander in the United States Public Health Service (USPHS) Dental Category, I was part of a team of 8 USPHS Dentists and 1 Dental Hygienist that provided over $120,000.00 in free dental services to underserved to the Rio Grande Valley communities during this week long operation.

We provided a wide range of dental services which included dental exams, cleanings, fillings, extractions and referrals. Our patients overwhelmed us with gratitude and thanks.

My take home message from this mission is that in realizing how during this week I have helped those that were in great need of oral health services yet could not access them, I can better appreciate what my role is as a United Stated Public Health Service Dental Officer.

CDRAngie Roach, DDS
Commander, USPHS
Department of Homeland Security
ICE Health Service Corps
Port Isabel Detention Facility

Prevention is vital to Commissioned Corps’ success
July 27, 2012

I was deployed as a U.S. Public Health Service advanced practice nurse officer to the San Juan Texas site for Operation Lone Star 2012. Our site was the PSJ Middle school and had a myriad of health services to provide. I was in charge of the Diabetic screening for this site. Along with performing the screening and providing patient education and refers to community resources I also was teaching for the nursing students who were volunteering to assist the mission. While the glucometer screenings (measures current blood sugar levels) were sufficient, my experience told me that my patients would be better served if I could obtain the A1c levels for the high risk patients. A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been over a period of 3-5 months, versus a glucometer testing which simply tells me what the blood glucose level is at that moment. The A1c test would allow me to much more confident in my diagnosis of Diabetes.

That more definitive diagnosis would allow me to be much more aggressive in assisting the patient in securing the appropriate medications; medical supplies and support organizations as a newly confirmed Diabetic. I began discussions with the site’s State Department of Health Services lead in the hopes of securing an A1c machine. Before noon on the first day of the mission we identified a local Physician who not only allowed us to use his testing device for the week but also provided us with enough supplies to perform twenty tests. Additionally, we contacted his pharmaceutical representative who supplies him and she agreed to assist us in securing more supplies, if needed. The result, I saw about ten patients today with blood sugar levels of greater than 300 and due to the my ability to perform A1c tests on those ten high risk patients, two of them were definitively diagnosed as new Diabetics.

LCDR Jenny Mohon
Indian Health Service
IndianLawton, OK

ImpressiveThe Importance of Mental Health
July 27, 2012

I was seeing a young married couple at one point. The husband chose to be examined first. As we were discussing his weight condition and potential complications associated with weight, including medical, mental health, etc., he became tearful. Without his wife noticing, he looked at me and pointed to his medical history, where the paper read “Yes,” next to the line for depression. I gently noted and felt his pain. As I completed his wife’s medical evaluation, we discussed life style modifications and strengthening his mental health component. Her husband pointed out that, “I eat everything I can find if I get stressed out or depressed and then I cannot move for a while.” I asked them if they would be willing to be seen by the Mental Health Team for bio-feedback, which I believed would work for them. I suggested that it might help them learn to deal with stress/depression. They were so pleased with this decision that they immediately agreed, and will let us know what is the outcome of our visits in 2013 OLS visit for follow up feedback.

CDRCDR Hyosim Seon-Spada MSN, FNP, U. S. Public Health Service
Regional Quality Improvement Coordinator – NER
Devens, MA