by Navy Medicine | 12 June 2019 By: LCDR John Roman, MC (FMF), USN LCDR Roman is a Staff Dermatologist at Navy Medical Center Portsmouth I had been on bilateral exercises before ? missions with the Korean and Indonesian Marine Corps, respectively, and spent time with the Thai Medical System. Lessons learned from these experiences emphasized the importance of building rapport with our partners and attentively working to further develop our relationship. As a member of the 2019 Brazilian Riverine Mission, I quickly realized this operation was going to be different from previous exercises and had the chance to be special. We immersed ourselves immediately into their culture by living on their ship, eating every meal together and socializing every day. They were our friends and colleagues. We worked side by side, practicing medicine with their medications and their equipment, and we learned a great deal from each other. While there were no translators, most Brazilian doctors spoke English. Prior to leaving I knew none of that, but I did know that small social gestures are key to building lasting relationships. So before the mission, I wanted to make sure that I could speak basic Portuguese. At the very least, I wanted to have a few phrases to use in the clinic to make patients more comfortable and a few phrases to use socially. When we first met with our Brazilian partners and their spouses, I decided to test my elementary language skills. ?Boa tarde! Me chamo John. Prazer em conhecer voc?? ?Good morning! My name is John. It is a pleasure to meet you.? I fumbled the words, but I could tell from the Brazilians that it didn?t really matter. Engaging in their native language was enough and the act of trying is what registered. Over the course of a meal punctuated with laughter, we traded Portuguese comments and remarks for English ones. These interactions began to lay the foundation of a successful mission. While Portuguese might not have been my forte, we found another avenue to build understanding by leveraging our diverse medical backgrounds. Our team was comprised of doctors with specialties including pediatrics, infectious disease, family practice, dermatology, gynecology and general surgery ? we all had unique perspectives that we brought to the mission. In tandem with the Brazilians who had experience with populations in the Amazon, our team began to speak a common language that would benefit our patients and bring us closer together. Our clinics were set up in large rooms, allowing different specialties to work together in real time. We were each paired with a Brazilian doctor and together would see around 30 patients a day, learning from each other?s medical acumen. Before becoming a Dermatologist I was a General Medical Officer for two years, but my skills were rusty. When seeing general medical concerns, I was comfortable turning to help from our Brazilian colleagues or other specialists and vice versa. This culture of collaboration and trust was crucial and led to joint ventures between the two nations in ultrasound diagnostics, telemedicine and informatics with the potential to impact much greater numbers of underserved people. These efforts laid the groundwork for meaningful change for long after we left. The relationships we built between treating patients drove the lasting impact beyond the scope of our mission. In between clinics, there was downtime moving from village to village. Many of our team members brought their favorite board games while the Brazilians shared their favorite video games. The games allowed the team to relax, take our minds off patient care and continue getting to know and trust each other. As the mission concluded, we decided to leave one of the board games with the Brazilians as a gift and token of our appreciation for a successful mission, each of the Americans signing the box. When I was a younger officer, bilateral missions were opportunities to immerse myself in my professional duties and responsibilities while getting to see the world. As I?ve continued in my career, I?ve started to understand that the most impactful engagements are born out of the moments between the tasks at hand. The time spent with our partners, exchanging everything from best practices to board games, are what strengthen and reinforce the alliances that ensure a readier Force and a safer world.