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 =)

Steeeeeriiiiiiiiiike!

So some further updates on our trip to Chuuk. Apparently, there is a newly appointed supervisor of the international airport on Chuuk. This was person was selected by the governor of the state. Staff members (not necessarily continental team members) did not appreciate the change and went on strike. That said, there may or may not be a chance we will be able to fly (more specifically land on) to Chuuk.

It's unfortunate because Chuuk is one of the islands that have the bigger patient list, hence our stay there being a week long. We will see what unfolds as time goes on. Until the next update!

Just kidding!

Today is Saturday and we're still on Pohnpei. I say still because we were scheduled to fly out to Chuuk (pronounced chook) this afternoon. Our flight was scheduled at 135pm and set to land in Chuuk at 145pm. 10 min flight doesn't sound bad but it was actually a 70 min flight. Chuuk is one time zone away from Pohnpei. But let me start from the beginning.

There was another storm last night. Thunder and lightning filled the skies and the rain felt great in our humid rooms. I slept so soundly but I can't figure out if it was due to the cooler temperatures brought by the storm or the ambien I took just prior to bed. At any rate, my sleep was also pleasant with the fact that it was my last night I had to deal with the "night terrors" thanks in part to the bugs and creatures. I woke up before my alarm and took a nice long shower. I was so excited to leave, I packed my belongings in the car prior to walking up to the restaurant.

We made our way to the airport a little earlier than we had originally planned. The car rental had 1/4 tank left but we opted to not fill it up because it is cumbersome to get gas here in the FSM. We informed the car rental guy and he acknowledged we did not fill up our tank by first spitting his beetle nut (think tobacco chew but red) then informing us we owed him $35.00. I said not a problem and was about to hand him my credit card and while we were talking about receipts, he said he would be unable to process my credit card and would only deal in cash. He said if I wanted to use my credit card,he would have to take it and run it back at his office which is 15 mins away. Dub tee eff, right? I told him that would be fine so long as it's documented we paid. He hesitated and then wrote 35 on my invoice. I had asked him to put cash right next to it and he put what looks like "c/s" I am not sure if it's because of illiterate or frustration from a failed scam attempt but I had what I wanted which was documentation of us paying in cash including a "paid" on the document and he got his 35 he was asking for.

It was a good thing we had arrived earlier than expected. The airport was full! We were behind a group of people who volunteer their time and go to other countries and build schools for them. I didn't catch where they originated from but they appeared (and sounded like) they were from the Austrailian/New Zealand area. After that group finished, two locals cut in line in front of us and then it was our turn. After we checked in, it was time to go through the scanner. On Kosrae, there was no X-ray machine so continental had personnel go through our bags manually. Pohnpei not only had xray machines, they had A/C in their airports! I even got to watch part of the BYU/Utah St. Game. (for the record, the RB Turin on Utah St. Is a freaking beast).

As we were waiting for the airplane to come, it started pouring rain. When I say pouring, I mean there was about 3 inches of rain a 20 min span. I couldn't even see the pavement it was so high with water. Once the plane landed, the rain coincidently let up. By the time we were walking to the plane (we have to walk outside to the plane as opposed to the entrance being connected to the terminal), the pavement was obviously still wet but not as deep as I had expected. I guess having the landing strip surrounded by water is a quick way to get rid of the run off.

We boarded the airplane and found our seats quickly. Just as we sat down the rain started to pour again. The take off wasn't bad but as soon as we got airborne, turbulence was immediately encountered. It was scary because there were sections where it felt like we would drop a few feet. We welcomed the blue skies and radiant sun as we cleared the clouds. After a few more bumps, the trip wasn't bad at all. We got closer to Chuuk and the pilot began to descend. We were instructed by flight attendants to raise our chairs to their upright position and put away our tray tables. I was a middle seat so I was still able to look outside the window. I saw the atoll, outer remote islands, and even the main island of Weno (the island we were staying at and working from).

Then, I heard the engines get a little fast and felt the thrust from the acceleration of the plane. I knew I wasn't alone as the rest of my cabin mates had a confused look on their faced as well. Than, we began to bank left and again, the thrusters fired up. Even more confused looks on patrons became evident. I still recall the speech.

"This is your captain speaking. We are not cleared for landing on Chuuk as the fire department is not available. We will return to Pohnpei and those of you who were supposed to deplane at Chuuk will get off and stay in Pohnpei. Sorry for the inconvenience."

I guess no airplane is allowed to land without the fire department ready to go. And like that, we lost our afternoon and were back to where we began the day, Pohnpei. We got the first available flight out of Pohnpei to Chuuk, 130am 2 days from today (technically, it's tomorrow night but really it's Monday morning). With that said, we now needed to find a place to stay for (two) night (s). So, back to The Village Hotel for us. The chauffeur immediately greeted us at the airport. Apparently, he already knew the plane turned around and was already at the airport before we even arrived.

I'm sitting in their bar/restaurant writing this blog and both owners came up to us to say how sorry they are to see our business again so soon. They are so nice and I would definitely recommend this place to anyone and everyone. Just not for 8 nights like what I am going through. Tomorrow, team two will embark on the Nan Madol (I think I may have spelt it wrong previously) journey. Since I have already taken the trip (and it's expensive), I have opted to sit this one out and try to catch some NCAA football games. Worst case, I'll just watch a movie on my iPad.

Also, congratulations to Gira for her educational talk on rheumatic heart disease yesterday. She had people lined up outside the door wanting to hear her talk. Some have commented that it was their first time exposed to a real live echocardiogram (they have only seen them through textbooks and other literature).

Until next time folks, good night!

We're half way there (queue the music JBJ)

Today, team two comes in. There are only two airplanes that come through Pohnpei. One connecting flight from Hawaii and the other connecting from Guam. Though I don't know team two's specific itinerary, I know they will arrive here in Pohnpei around 1pm (as do all the other Flights from Hawaii arrive every week). With the arrival of team two comes another pediatric cardiologist, her husband whom is an emergency medicine doctor, and another ultrasonographer. Mike and Lori will be heading home soon and I will stay with team two to finish out the trip.

Last night at dinner, we were talking about our hotel room. Yes, it's nice and very unique. Yes, it has won awards for Eco-tourism. Yes you will never find anything like it back home in the states. But man, is it stressful. If the constant jungle noise of shrieks and shrills don't get you, the rustling of the branches and the darkness will. I hear noises throughout the night but I can't see anything because foe the dim light. Naturally, my imagination runs wild and just conjure the most bizarre things. Any who, I try really hard not to think, or look, for anything and just go about my business.

I had an especially hard time sleeping last night. And then ambien came to save my day :)

Ok, well time to go eat breakfast! Will update later tonight. Cya!

SaO2 = 74%

There was a storm last night here on Pohnpei (my mistake, pronounced pawn-a-pey) and it freaked me out a little bit. I woke up at 245 am (local time) to change positions in my waterbed. I tried really hard not to kick my feet too far out because I had the bug net around me. I had ear plugs in but could still hear the strong winds. I felt the cool mist from the rain and instantly felt 10 degrees cooler. As I laid my head back down I saw the lightning crack though I did not hear thunder.

In the morning, I bear witness the storm laid in it's wake. As I walked over the tree branches that were on the ground and hopped over puddles of water toward the hotel's restaurant, I overheard the owner's son talking to another patron. They were discussing how that storm was one of the strongest systems that has passed through in a long time. Funny how the best sleep I've acquired while on this island was through during that beast. Later I find out there was a typhoon affecting the Philippine area and moving it's way toward Southeast Asia. Is it the same system? I am not certain but prayers to the ones who have endured or will endure nature's fury.

I understand the nature of my business is to help the indigenous population and everything I have blogged about has been pleasure. Please don't let this blog set a precedence to our working habits.

Today is only Tuesday (day 2 on Pohnpei) and we have already evaluated, screened, and consulted on 43 patients. We are expecting 2.5 more full clinics before we move islands. There are many interesting cases here in the FSM. One of the more interesting ones was presented by a female native.

I remember this patient encounter so vividly. Since we started work here in FSM, I find myself frequently behind a desk as Mike does his physical exams. For some reason, I was up and about as this specific patient came in with her mother and younger sister. At first, I thought nothing of it as I see mom shaking hands with our good doctor and the younger sister full of energy and smiles. I walked passed the family to shut the door for privacy. The patient was young (an older teenager) but seemed tired from her walk (from outside in the waiting room onto the examination bed). The patient was playful with her kid sister and you can see the bond they share. As I prepare the patients medical record, one of the first items that is reviewed is vital signs. I looked at her chart as I was walking back toward my desk and saw her oxygen saturation level: 74%. For those of you who are not in the medical field, an acceptable and normal oxygen saturation level is anything above 95%.

As Mike was interviewing the patient to obtain her history of present illness, I was looking through her chart. Then I heard our translator say "inoperable." I stopped what I was doing and looked up to listen more intently. Apparently, this congenital heart condition that our patient has been suffering from was seen when she was two years old. She was referred and actually transferred off the island for surgical intervention. It was then when mother was told her condition was "inoperable." Though this may have been the best and logical choice at the time it was made, it certainly was not an everlasting decision. As our patient became older, she was evaluated and even admitted numerous times (for a variety of problems) as reflected in her medical records. Not once did anyone address her chronic cardiac issues (one major one being pulmonary hypertension secondary to a hole between the two ventricles of the heart) though it was listed as one of her diagnoses.

Medicine has seen advances by leaps and bounds in the last several years. Albeit the tools doctors use or the medicines they prescribed, medicine has been improving however you look at it. One treatment of pulmonary hypertension is the administration of pulmonary vasodilators. Of course, the patient was not on it, why would they? When inquired about the medication, the attending physician had informed us that it has been ordered on several occasions (there is one other documented case of pulmonary hypertension on the island), and when the medication arrives, the get 1/10 of what is required (here is where I am not sure if it was due to financial issues or other problems). The other patient has only been getting, at most, half of what he is supposed to receive. This patient unfortunately has been receiving nothing.

When Mike was doing his exam, I could literally see her heart beating. It wasn't just in her chest where the heart is located, I saw the pulsation near her neck and through her back. I saw severe clubbing, a condition that makes your fingers and toes bulky and blue (a condition you only get when you are hypoxic, or have oxygen saturation <95 for a long long time). She appeared tired in nature and rightfully so, she doesn't have enough "red" blood in her body. Her heart murmur sounded like a sloshing liquid that even my untrained ears could tell sounded wrong.

What makes this case stand out to me is how tragic it is. Yes, when she was two years old, it may have been too early to operate on her (not big enough anatomy to operate on). It may be due to not having the right medicine developed yet. Whatever the case may be, she has been seen numerous times in the interim and inevitably nothing was done. Now it's too late. Her condition may and probably is permanent.

She left our clinic today with a diagnosis of Eisenmenger syndrome, a condition where one would have more "blue blood" in the body than "red blood." This could lead to organ damage and even organ failure. Prognosis: 15? 20? 25? or so years. She may not have the ability to become pregnant and have kids of her own. Was she a candidate for surgery? Not right now. Can she start the pulmonary vasodilator medications? She could but how much will will it help now? It just makes me sad because all of this could have been prevented. Unfortunately, this happens frequently here in FSM, some states more often than others.

Oh and here's a fun fact: FSM has cut all costs for dialysis. If you have a kidney problems, either plan to move or plan a funeral. The donated blood is only partially screened. Little is known of the donor other than type, rH, and HIV status. If you're lucky, they will screen for hepatitis and other blood borne illnesses. So don't be anemic. I know our healthcare system has it's faults, but be happy you have something to complain about. I'm not trying to say the FSM healthcare system is careless and inhumane. I am simply stating the fact that they are stuck with what they have and must make the most of what they got.

Tomorrow brings a new day. Hopefully our team can catch other cases and intervene before they start down the wrong path.

Bad news

Sorry folks. The laptop I was working on won't power up anymore :( though I can blog through other means, I will NOT be able to upload photos which sucks. My camera was also running low on memory so I placed all my photos on the laptop, which now won't boot up. Any ideas are helpful. I've tried to charging at different plugs, examined the wires, removed the battery with the ac adapter in, no ac adapter and batter then ac adapter in, I mean everything I could possibly think of. Help? For all of our sakes :(

The Village Hotel

Deepest apoligies. I totally forgot to update my blog on my room!

The other side of the window is actually ocean view. For more details, http://www.thevillagehotel.com/ . The best part, FREE WIFI! and it's so much faster than that of Kosrae.

Pyramids of the Pacific

Kosrae was beautiful, but Pohnpei is even more breathtaking. If you haven’t clicked on the link from the last blog, you wouldn’t know that my hotel here on Pohnpei is essentially a tree house; a bungalow in the jungle with wide open windows to nature. Obviously, the first thing anyone would think of is the bugs. It’s not that bad. If you ever seen that Expedia commercial where a couple stays in a hotel room and in the middle of the night turns on the light and sees the wall come alive, that’s what I was thinking I was getting myself into. I actually slept pretty descent throughout the night. The hot humid weather wasn’t bad as there are a lot of night showers and the mist keeps us cool as well as the bugs at bay. I was greeted by this friend in the morning. I think it’s a termite. Nevertheless, when I showered and left my room it was gone so it’s all good.

Today we went on a boat ride. I have never snorkeled before in my life and being that this was my first experience, I fear that it may have ruined it. It sounds bad, but really I’m just saying how this set the bar for snorkeling so high, I may not have the same exhilarating thrill as I did today. First off, we were on this boat and it was POURING. I mean the rain freaking hurt as it hit us and sitting in wet clothes while traveling fast made it a very cold trip. We stopped and anchored onto a buoy and started to gear up to jump into the water. Coincidently, the rain stopped as we were putting on our fins and masks. When I jumped in, I was pleasantly surprised how warm the water was. I just wish I could have taken pictures of what I saw. The reef was so full of life and colors. I never realized how much life there is underwater. We saw countless number of fishes and our guide was even able to sniff out a couple manta rays (not literally). There was also a really friendly shark (a white tip?) that was casually swimming through. The school of fish was one of the best choreographed sites I have ever seen. Once one fish turned, the entire school moved. Again, I am sorry I couldn’t take these underwater pictures!

I read in this a traveler’s guide to Micronesia that if you’re even remotely close to Pohnpei, you must stop by and visit Namadol, an ancient ruin site that dates to pre-civilization on the island that no one understood how it got there. You can even say it’s the “Pyramids of the Pacific.” This monstrous site is constructed of extremely heavy stone. We’re talking 50-60 tons each brick. As you can see from the picture, each brick isn’t exactly small. It’s believed that men from unknown origins built this place as a palace for worship. On this island, there were three different tomb sites, a meditation chamber (arguably a prison, but the guide pointed out that no place of worship would house detainment areas), and walls that surround the campus to protect the “palace” from incoming waves.

The steps you see lead to one of the three tombs. The guide sits us down in this pathway and tells us everything he has heard of the Namadol islands. He opens by admitting to not knowing much about the ruins. It is believed that the palace was built for worship, but how it was built is unknown. There are stories that it took 18 locals to pick up 1 brick and took half a day to transport it from steps of the palace to the shore line. They constructed an “oversized” raft, one never seen before due to its sheer size, and it immediately sank to the bottom once the brick was placed into the raft. That’s just one brick. This palace fortress utilizes countless number of rocks and bricks. I am still dumbfounded and can’t figure out how the fortress was built (notice I use fortress and palace interchangeably. I understand it was a palace but man, it looks like a stronghold!).  It’s just like the Egyptian Pyramids or the Mayan Temples or even like that huge rock from Indiana Jones. If only someone had a whip I could say “Dock-tah Junes! Dock-tah Junes!” Anywho, place is freaking SWEET.

This wall you see here is from the entry way. Whoever constructed the place was obviously experienced. In between each brick is broken down coral. It acts like cement in a way and binds the adjacent two bricks while sealing it off and preventing any leaks in between the layers. The guide states there is a unique, indigenous word that describes how the rocks got to the island. Though there is no direct translation from Pohnpeian to English, it sounds like it’s not too far from the definition of levitation. Archeological teams have surveyed the sight in the past and our guide states the stone have some type of “magic” because compasses were not functioning correctly (the needle didn’t sit still, something you would expect from a magnetic field).

This is the biggest tomb of the three and is located dead center of the island. When I mean dead center, I mean past teams have measured the tomb and it’s equal distance from every which direction in regards to the island (by the way, the island was pretty small. The wall in the previous picture was almost the border of the island. There is a small walkway around the perimeter directly in front of that wall and beyond the walkway was the water. We’re talking you can walk the perimeter of the island in 5 minutes).

The three tombs incased held 16 skeletons, as discovered by a German archeologist. This archeologist had the skeletons shipped back to Germany on a freight boat. Unfortunately the boat never reached its destination nor did anyone figure out where it sank. Sadly, the same German archeologist who opened the tomb succumbed to a grave illness and soon passed away not too long after the graves were overturned. Based on that story, the locals further believed the existence of a magical aura that radiates from the island. Our guide admits he does perform this tour often and there was a $3 dollar “entrance fee” to attend this tour, so whatever ambiance that was present may or may not still be there. Nevertheless, I don’t want to disrespect any spirits so I will kindly take his words for it.

This is one the mediation hole the guide was talking about. It is 4ft x 4ft and is 6 feet deep. One of the other tourists (another MD from Austria who is here doing work on Diabetes and the obesity challenge the islands present) posed the question what if it were a prison. As I previously touched upon, the guide said they understand this was a place of worship ergo a place for detainment against your will would not be a reasonable explanation for the hole. Nevertheless, he answered her question by stating that it could possibly easily have been a prison because they still do not know the origins/purpose/use of these Namadol ruins. After I saw the hole, the first thing that popped into my head was “Are there any spiders down there? That alone would be enough to make sure I don’t go to prison!”

After our adventure on the land, we went kayaking, another activity I have never participated in. I was paired with Lori and Mike with our guide. The others on the trip had single kayaks and were roaming about. Now, past experience has taught me this was going to be grueling and extremely hard (tandem bicycle riding at the beach was the most exhausting thing ever mainly because my partner didn’t pedal, THANKS!). Lori was a champ and rowed the entire way. In fact, there were parts where she would row and I didn’t because I was too busy taking pictures (thanks/sorry Lori!). It was a lot of fun and we saw extensions of the ruin walls as we kayaked far in between the numerous small islands.

After our Namadol trip, we moseyed on over to another part of Pohnpei, Kepirohi Waterfalls.  It was a boat ride away and once we reached our destination (another island but still a part of Pohnpei), we had to walk this extremely narrow, rock trail. The trail was outlined with exotic plants and bushes of a variety of color. You could hear the water roar but couldn’t see any water or wet spots.

You turn the corner and BAM! This is what you see. Talk about WOW factor. The waterfall was easily 30 feet high. The water was 26 degrees (according to one traveler’s watch thermometer) but being that it was a hot and humid day, it felt refreshing. There was an area in front of the waterfall but before the rocks where we could swim. Our guide showed us a specific spot where you could sit behind the waterfall. I attempted to get into that space but he made it look a lot easier than it was. As I tried to get up into the space, I actually slipped and fell onto the rocks before I landed in the water. I think I’m ok but I believe sympathy points are in order.

There is no narration needed for this picture.