Statistics

Team 1: 138

Team 2: 190

Total: 328 patients with 23 requiring surgery

beetle juice, Beetle Juice, BEETLE JUICE!

This entry may or may not be the last entry for my Micronesian excursion. Yesterday was our first day of work in Yap. On every island we have had a liaison meet us at the airport to inform us of the plan and work schedule (including an idea of work load). We flew into Yap rather late and expectedly met with no one other than our hotel personnel to drive us to the hotel. Monday morning came, and like the other islands, we planned to begin work at 0900. We got a call at 0845 from the hospital wondering if we were still coming. Apparently, there were already 30 patients screened and ready to go. We worked diligently throughout the day and had a mini 15 minute break to call lunch. After lunch, we were told there were still 28 people waiting to be seen. We asked about the possibility of having some people be seen tomorrow (today) or possibly the new, incoming people be moved to the next day. The staff said they would oblige and would ask incoming patients to defer to the next day. 19 patients after lunch, we asked for the new total number of patients and it was a staggering 22. Unfortunately, we had to defer 12 of these patients until the next day. On day 1 in Yap, we evaluated 58 patients.

I was really surprised on how compliant the patients were. Most were really good about taking their medicines every day (or month) and had not deterred from their regiment. There were a couple of patients who did not take their medicines as scheduled but when presented with the option to either restart prophylaxis versus no meds and seeking immediate medical attention if sick, all patients chose to take the prophylaxis. I feel this is the reason why most of the physical examinations/echocardiogram studies yielded normal or mild abnormalities. Kudos to compliancy!

As the day progressed, the patients were starting to blend into one big blur. When reviewing the notes, I couldn’t remember who was who. There were a few patients that did stick out. For example, there was a 5 year old boy who needed an echo. He was seen by our good doctor, then had to wait in line for his echo. When he returned for his echo, he had something in his mouth that was clearly visible (not to mention he was a chatterbox when examined by Gira and now he was quiet). Any who, Lyndsay asked that he spit out whatever was in his mouth so that she could start the study. He looked at his mom and she walked across the room and simply stuck her hand out, palm side up. He spit into her a hand what looked like candy but upon closer examination, it was a beetle nut!

Beetle nut chewing is not allowed on hospital grounds as per the numerous signs that have been posted all over the campus. Yet, I see nursing staff, patients, and even the doctors all with beetle nut in their mouths. According to our guidebook, the Yapese are quick to shower foreigners how to properly chew beetle nut and indeed they were as they showed Lyndsay exactly how to make a “good” beetle nut concoction. The trashcan is a constant red because of all the spitting that happens. I guess it’s a good thing the trashcan is red and not the walls or ground. Nevertheless, it’s still a gross habit that rivals conventional cigarette smoking.

Of the four islands we visited, Yap is by far the most untouched as far as westerners. There is obvious western influence (mini-mall, tourism, etc.) but the culture of the indigenous are still very traditional. You are not supposed to pat children on the head here (not that I do, but it’s something you have to be conscious of). It is considered rude to walk over someone’s outstretched legs or between two people who are talking. Locals also dislike having their pictures taken (hence my lack of photographs). The weather has been hot, humid, and rainy so most pictures did not turn out well.

What's the hap in Yap?

We left Chuuk to visit our last destination Yap (pronounced yap). But before we could get there, we had a layover in Guam. It’s probably better known as the Japanese Hawaiian islands. The territory is US owned and there is no visa required to visit this area. I would highly recommend anyone visiting Hawaii to take that extra flight and also include Guam on your travels. I saw American chain restaurants including TGIF, Outback Steakhouse, McDonalds, Taco Bell, Pizza Hut, CPK and many others.

Guam is definitely geared toward the shoppers in all of us. I saw a lot of brand name stores and their store sizes were huge. Everyone was fluent in English and then there were those who also spoke Japanese. There were many tourists from both USA and Japan and everyone was really polite. The food was really good, too.

We ate at a Japanese restaurant. The food was made from scratch and the seafood was extremely fresh, as depicted in this image. This is a lobster of some variant. The sushi was really good, too. As was the sukiyaki. As was the teppanyaki. As was the shabu. Everything was really good. The table next to us ordered this little guy here.

We’re staying at the Manta Ray Bay Hotel. The rooms were very comfortable and though electricity isn’t a problem as it was at Chuuk, internet is not reliable. My ability to blog may/will be impeded, sorry! Apparently, our hotel has the best food on this island and has yet to disappoint us thus far. The hotel also holds a very strong reputation as the island’s premiere provider for divers.

The main town is located 500 feet from our hotel. It spans a half mile stretch and that’s pretty much it. The building you see here is the “mini-mall” of Yap. The hospital is located about 2 minutes from where we are staying. Though there is obvious western influence, Yap is very traditional. Many women are bare breasted. Men dominant the decision making process.

This is a “men’s house” where the local men gather to hold political, social, or any other discussion. If you look closely, you can see stone money around the house. Yap is where stone money was invented. The monetary stones range in size and value. To my understanding, the Yapese have a currency system like our own in America. Instead of literally moving the stone money, the two bartering patrons would agree that who “owns” the stone money and it will be physically left at that location with new ownership (think of our Fort Knox).

Gira spotted this plant and it was one of the strangest things I have witnessed. Once the leaf is agitated (physically touched) it closes. It was raining when we saw the plant and the water droplets made the leaves close. The best way for me to describe this phenomenon is imagine the leaf shaped like your hand. Once you become agitated, you would make a fist. I have the video so come see me and I’ll show you.  ;)

Team two pow wow!

I’m pretty tired so my imagination is not very rampant. Hopefully a good night’s rest will fix my creativity. Good night!

Download cover orange if you haven’t done so already!

Jimmy gone rogue

We had a full day yesterday. In the morning, we went snorkeling and it was pretty cool to see the wrecks that were down there. I wish my camera was water proof so that I could have taken pictures of these amazing sights. The ones we saw included a sunken oil tanker (huge torpedo hole on the side), a downed Japanese air fighter with machine guns still intact, and a bunch of others. Nature has adapted to these metal remains and it was interesting to see how life is now very much a part of these man made ruins. It was my second time ever snorkeling and I had a lot of fun. It's intimidating how fast the pressure builds up when you dive. I thought my head was going to explode, and I wasnt more than 10 feet below the surface!

We were told that a new patient had showed up at the emergency room yesterday exhibiting heart failure symptoms. After our snorkeling trip, we made our way back to the hospital to see the patient. Again, I cannot express how happy I am to have the opportunity to receive medical attention, if needed, at one of our hospitals. For instance, I saw so many people walk by and even stand in the doorway to watch us work. I wouldn't want a stranger in my room while a procedure was being performed on me (patient was undergoing an echocardiogram at the time). Another problem I saw was lack of sanitary supplies. No sani-wipes, very limited number of gloves, even septic hand sanitizer was scarce. I say these not to discredit the hospital employee capabilities, I admire them for still striving for quality of care with the few limited resources they have.

At night time, the hospital staff, namely a surgeon and his staff, wanted to come and hang out before we left the island. We sang karaoke and everyone had a good time. The title of the blog, "Jimmy gone rogue" stems from my lack of decision making on this trip (meaning I haven't had a preference on when or where we eat, havent had a preference on going out versus staying in, havent had a preference to stay at this hotel versus that hotel, etc). I usually "defer" to my attending physicians leadership and make Gira make all the decisions. Then, karaoke was mentioned and I opted NOT to sing. Alas, Gira deemed me traitorous and had informed everyone that I've gone rogue!

Today we leave for Yap with a long layover in Guam. Hopefully everything follows through and we make it without any hitches. I also hope the Internet is more reliable there as well so I can update my blog more often. I may not have mentioned it, but Chuuk isn't the richest island in Micronesia. With money being an issue, resources naturally are harder to come by. One in particular, electricity, is a very nice perk our hotel has. To maximize electrical usage with the allotted budget, the state only supplies power to half the island at a time. I was originally told power alternates sides every 4-6 hours, but I notice power cuts more frequently. Our hotel has it's own generator when this side of the island is out of power. The hospital also has a generator, but to my understanding it doesn't last very long. Good thing there aren't a lot of mechanical dependence in the hospital else they would be doomed once the generator runs out of juice and there is no electricity available.

Enjoy your day!

It's not bad, just... different

There were no patients scheduled for today or Friday (tomorrow) so we thought it would be best if we skipped town a little earlier than originally planned. Not that Chuuk is so horrible that we were running away, but with all the violent stories it was just intimadating to be here. When we had first arrived, it was night time and dark out. We didn’t go out at night either so we really couldn’t see much of the island. The only path we were accustomed to seeing was the one to and from the hospital. As mentioned in my previous blogs, roads are bad the buildings are tagged with graffiti. It’s like I’m back home! Gira made a good point about the graffiti though. Yes it’s unsightly and downright rude to property owners but at least it demonstrates at least there is some literacy present. Any who, this building is the epitome of buildings you see in Chuuk and one of many we saw on the way to the airport.

The road conditions are horrendous. Imagine driving in an unfamiliar country and seeing roads like this. Keep in mind you are in a rent-a-dent and there was NO insurance offered to you when you rented the car as there is no one on the island that will insure anyone (our hotel is a very professional and business orientated yet they can’t offer us insurance, either). You can’t help but think how deep is this trench? Are there potholes within this trench? What about huge rocks we can’t see? What about other hazards we can’t see? So what did we do? Just trekked forward and hoped for the best.

This stand was easily one of the biggest ones present throughout the island. We have passed this lady on numerous occasions and she is very nice. She always smiling at us and waving as we pass by. She usually has people buying stuff from her stand and she keeps it well cleaned, weather permitting. Honestly, I’d totally buy stuff from her to eat.

We met a couple that works for United (the company that bought out Continental Airlines) who were also trying to fly out of Chuuk. We were told the flight was full and the couple used their work privileges and checked online last night confirming the full flight. They suggested to try and wait it out anyways because it’s never full until they take off. We checked our bags in and waited. Hours later, the flight was still full. In fact, they overbooked and made several announcements to have any confirmed passenger give up their seat for $400 dollars in airfares as compensation. Being that there were four of us, the chances of all 4 of us getting on the plane was slim so we left.

We wanted to go to the Blue Lagoon Resort yesterday but were faced with a very serious obstacle. I had posted a picture of our right sided Toyota RAV4 and how it was pretty cool to drive on the right side. What I didn’t comment was that it probably isn’t the typical RAV4 we are used to seeing back home (I feel it may be smaller, which makes sense considering we are in a country that doesn’t have many resources). That being said, I came to this freaking lake and wasn’t sure if I could make it through. It was a very rainy day yesterday and though we could have made it going through the lake going to the resort, we were worried about the troubles of coming back. The road before this was extremely muddy and I wont lie: I was worried I could have easily been stuck. (Though I reference this as a lake, it was a really really bad road)

So today, we asked our hotel to escort us to the Blue Lagoon Resort. They happily obliged and the means of transportation: the car we had rented, the very same RAV4. At first, I was thinking to myself if would we make it across that humongous lake? But I didn’t question our local driver. As soon as we got to the river, she simply drive right in and over. I looked out the window and I swear the water level was level with the bottom of the door. If I opened the door, I think the water would have came rushing in. But, as you can see from the picture, we made it =)

We wanted a different change of scenery from what we saw every day. Don’t get me wrong, The Truk Stop has been super friendly and extremely cordial. They are gracious hosts and have been nothing but splendid to us. As soon as we found out we could not fly out today, we went straight to the Truk Stop to check back in. It’s just we needed something different. Alas, Blue Lagoon Resort. This is part of the water front that BLR has. Many people swim/snorkel right here, so we did too. Though the sea life is not comparable to a coral reef, there still was an abundant amount. Chuuk is world renowned for its diving though, something I am not certified to do. I understand it does come highly recommended so I will pass that recommendation on to you. Especially since there are so many ship and plane wrecks that you can explore.

Let me tell you some pretty cool Chuukanese lore. Before there was heavy westerner influence, Chuuk used to be a place of very traditional place. One of the cool stories I heard takes place when the locals used to reside in huts. Now, in the states, males coerce females to begin the courtship. In traditional Chuuk, men used to create these uniquely shaped sticks so that females can identify who they are. What they would do with these sticks was place them inside the hut while holding on to a handle. The female would feel the stick and know who is on the other side based on the texture/shape of the unique "lovestick." If she rejected the patron, he would simply take his love stick and find another hut. If she wanted him, she would pull the stick and the male may enter. The significance of these flowers? Nothing, I thought they looked nice =)

Yay team two pow wow connection! Though the sunsets are very brief, they are still an astonishing sight. I’m pretty tired, its 11pm over here and it’s been a really long day. We have an early day tomorrow, even though we’re not even working! I think I will conclude this entry with some pretty cool pictures.

What the Chuuk?

Sorry to leave you all in suspense! I know the last big blog I had included our trip from Pohnpei to… well Pohnpei. We are now in Chuuk (formerly called Truk). Our flight was at 0130 on Monday, 10/3/11. By the time we landed and got to the hotel room with our luggage, I was in bed by 0300 or so (that’s including the time zone change when we landed). No one from the hospital met with us when we landed. I wouldn’t want to get up at 145am either but fortunately we were able to get people from the hotel pick us up. We’re staying at the Truk Stop, a place run by a former chief of police (I think that’s what he did but not quite certain. I do know he was a high ranking law enforcer who brought order to Chuuk). But yeah, that's why I was unable to update the blog, I was catching up on some sleep =)

Chuuk definitely has some rough edges. There is a dramatic difference in culture, society, and the people when compared to the other two islands. The first noticeable difference is the state’s current economic condition. There are very few paved roads. The dirt road is constantly wet from locals dumping their dirty water into the street or from the rain. The mud forms and it’s not uncommon to see cars have spinning wheels as they press the accelerator without physically moving. These create holes and divots which dry and become wet. Over time, these smaller divots have created huge bumps and very unsteady roads for driving. I was driving today and we came upon a section of the road that had collapsed. Clearly on the sides of the road were broken remnants of the concreate pavement that once existed. Now it was a 4-5 foot deep trench with 2-3 feet of water in it. I wasn’t able to see if within the trench had huge rocks or pot holes or anything dangerous like that. We promptly turned around and found a different route to take. The walls and buildings are littered with graffiti. I was unable to assess if it was due to gang affiliation or simply names but nonetheless the buildings were tagged full of random writing.

There is a lot more beetle nut chewing here compared to the other islands. Beetle nut can be compared to as tobacco chewing. Creates some buzz of some sort and it’s not meant to be swallowed. Thus, beetle nut chewers spit and the saliva that comes out is a very dirty dark red. It’s very easy to spot the beetle nut chewers as their teeth are either red as clay, missing, or they have enamel fillings (is it called fillings when it’s on the outside of the tooth?). It’s a nasty habit that both males and females are addicted to. I guess to create an even stronger kick, kids have been wrapping up crushed beetle nut with tobacco from a cigarette and then squeezing lime on it to chew. The walls are stained red and it seems everywhere you look you see someone chewing, ranging from teenagers to adults.

If you could steal $100 bucks with absolutely NO consequences, would you? Knowing that there will be absolutely no punishment should you get caught because no one is looking to catch you, would you still perform the act? Well for a long time, that was what was going on in Chuuk. This may look like art but really it was a tool used by many indigenous to hurt other people. On the bottom is a homemade slingshot; on top, wooden darts with rhubarb (think of the metal wires in concrete) tips that have been sharpened. There are many variations of the dart but the idea is essentially identical: to hurt, maim or even kill other people. One of the island doctors informed us that people would come in with numerous darts impaled into them, many of which whom died. The most he has ever pulled out of one victim was seven darts. The scariest part: the local police would not go after these murderers. That is until Bill (Truk Stop owner) came along and finally deemed this tool of violence “dangerous” (don’t ask me why it wasn’t done sooner). Bill made it illegal to have these items in your possession and anyone caught with it went to jail. Those who put up a fight were “assisted to the floor” and they had “talks to discourage resistance.” Though these rhubarb darts are outlawed, there are still cases of their use.

Sad story: Bill’s nephew (Bill is married a local Chuukanese woman) and his friend were playing with a loaded gun. You already know where I’m going with this. Long story short, Bill’s nephew was shot through the heart and died instantly. The friend never got in trouble. No jail sentence, no fine, no anything. Bill told the boy’s father to have him arrested simply so he can feel some punishment for the deed, especially since it won’t be serious as there is no real consequence. The boy’s father refused. Over the years the friend gained a lot of weight and got hooked on to drugs and alcohol. The friend died at age 29 from a myocardial infarction (heart attack). It is believed that the friend felt so much resentment after the death of his friend that he was eaten by his guilt, especially since he was never punished. Unfortunately it took two lives before the friend’s father understood what Bill was trying to say.

This is our rental car. What’s really sweet about this car is that it’s the first rental car we got that has the driver on the right side. This was the first time I have ever driven on the right side in a car and it’s actually pretty intimidating to do so. I mean, to pass someone up, I feel like 3/4 of my car is in the other lane. I guess the poor road conditions aren’t helpful either. True story on the car’s band aid: it happened the night before we got it. The car was parked in front of the hotel and someone threw a rock at the window and broke it. When we have rented a car on the other islands, the first question we asked is insurance. There is no insurance available on Chuuk. Not just specific to our car rental agency, but the island overall. I asked what if this window incident happened while the car was under someone’s name. They said they would eat half and the renter would have to pay the other half. Totally not cool, especially since the rock was thrown in THE MIDDLE OF THE NIGHT when the car was PARKED AT THE HOTEL as the renter was SLEEPING IN THEIR BED.

The hospital is capable of having 110 or so beds for inpatient services. Whether or not they really have this many is to be determined. Their emergency room has 4 beds, all within an arm’s reach of each other with no curtain or barrier for privacy or any type of segregation. You could be seen in the ED for a mild headache and the person next to you could easily be a victim of the rhubarb darts who is bleeding to death. All while there is family members in the same room while doctors and nurses work on patients. This picture is a patient’s room. Though there is only 1 visible patient (the baby in the lady’s arms), clearly you can see there are 5 other people in the room with the patient. Family visiting is not the significance of this picture. What is significant is the fact that this patient is considered “isolated” due to some communicable disease, yet family members are touching/playing with the patient though they are supposed to be isolated! I would bet my top dollar they don’t wash their hands or clothes right when they leave or get home so it’s quite feasible to state these people expose others to diseases.

Technology available at the hospital is also a concern. This picture shows the electrodes of an EKG machine. This is a much Much MUCH older machine that uses suction bulbs in lieu of electrode clips and stickers. To my understanding, the machine does work just as well when compared to its electrode clip successor. In fact, it makes sense to employ this type of EKG machine because the maintenance of disposable stickers would be too costly. This is my first exposure to this type of EKG machine so I found it pretty neat to see it in action. The only downside to using suction bulbs opposed to stickers is that it doesn’t stick well most of the time thus being quite impossible to obtain pediatric EKGs. Also hairy patients (includes both men and women) are hard to have EKGs performed on using this suction bulb.

This little man has the coolest hair. He had to travel from one of the many remote islands of Chuuk to the main island (Weno, where we currently work from) in order to be evaluated. There is an issue with many “no shows” but hearing stories like his where it is a very difficult task to come to Weno, it’s quite understandable. Chuuk hospital also utilizes Pohnpei State Hospital’s strategy of announcing patient appointments over the radio (how many people own radios?).

Food on the island can’t be compared to many other places. We are staying at the hotel with the best food on the entire island and it includes burgers, pizza and even pasta. The dessert look absolutely decadent but upon closer inspection, I think I’ll pass.

Honestly, once you take a step back (somewhere safe) and take a look at Chuuk, it really is a nice place. If you are a diver, this is the specific island in all the FSM to be. I guess during World War 2, there were a lot of Japanese ships that were sunk here. The remains of these vessels are still here and divers love to explore these man-made underwater ship ruins. The diving is what makes the island so legendary but the scenic views atop the water aren’t too shabby either. I am very comfortable with our hotel and the staff is super friendly. Hospital staff have been extremely nice. Patients and their families have all displayed great character. A lot of people stare and if I recall correctly, I am NOT supposed to stare back unless I wanted a confrontation.

I was told not to go out at night. With all these stories I’ve heard, I won’t. But they didn’t say anything about sunsets =)



Retro update

Thanks to team 2, I have a laptop that now works! I just wanted to share a couple of pictures that I have taken with this entry.

Even though we had to stay another night, I guess the view isn't so bad. This is a typical morning I wake up to. Being that we are close to the equator, sunrises and sunsets are rather short. Nonetheless the view, simply put, is mesmerizing. The sun shines between 610 and 620 in the morning. It’s my alarm and has yet to fail me. The sun sets around 630 and usually queues our dinner time.

With entrees like this, how could you pass up sashimi? As mentioned on my previous blogs, I am not a seafood kinda person. I don't take well to fish or those heavy with the "ocean" taste. Funny how I can't seem to stop ordering this dish. Usually served with a side of steamed or fried rice, I don't think anyone could go wrong getting the tuna sashimi. Especially for the price (this dish was 5 bucks)!

Pohnpei state hospital was definitely a step up from Kosrae but still had some issues to work out. I know most of us in the health care field are very conscious of the HIPAA law and tread carefully not to violate them (for those of you who are not in health care, the HIPAA law requires health care workers to be sensitive to the privacy of patient information). Over here, the story does not hold true. I hear patient names over the PA intercom informing them which room to meet which physician. Also, our patients were informed of their appointments over the local radio! Though we did have a fair number of "no-shows," the radio was fairly effective in mass communication. Another method the hospital staff used was to tell neighbors to tell neighbors to tell neighbors so and so has an appointment. Most families don't have telephones so a call isn't feasible. (anyone try to visit the hospital website yet?)

Here is a shot of the room we were assigned. You can see Lori setting up in the distal part of the room while we saw patients on the left side by the metal stools. We tried to keep patient confidentiality but they often were about the room socializing with one another. There was no air conditioning but towards the end of our campaign we did have fans circulating which made a world of difference.

This is a shot of Genesis, a for profit hospital across the street from the Pohnpei State Hospital. This hospital only accepts patients with insurance. To my understanding, they do not favor pediatric patients (for reasons unclear to me) however they did refer a lot to the cardiology clinic. I wasn't able to see the inside of Genesis but as you can see from the picture, the building is fairly new. I understand some patients "game" the system in Pohnpei by acquiring medical attention at Genesis (with the idea that the quality of care is higher) and filling their prescription at the state hospital (free of charge for the patient).

This is group photo after Gira's lecture on rheumatic heart disease. Beginning from the left: Dr. Morchi (CARD), Dr. Morchi (ED), Lyndsay, Dr. Santiago, me, Carmen (RN), Dr. Lumuel, I dont know, and Princess (RN). We worked closely with Dr. Lumuel, Carmen, and Princess. Again, the room was filled and people were sitting outside the door to hear Gira's talk. Congratulations!

Our only team picture. Team two came 1 night before team one had to leave. This is a breakfast shot the day team one left the FSM. Great job team one! You guys changed the lives of 138 patients and their families!

 This gentleman prepared our bananas foster. This is my first time having it and it was very tasty! The show reminded me of Beni Hana's but better (not to mention I didn't smell like their food afterwards). I tried to catch an action shot and this was the best I could do.

The following pictures were added for scenic value =)