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.

To the capital!

This blog won't be long as I am not on my laptop writing this entry (no pictures either, sorry)

Today we left Kosrae and flew to the capital of FSM, Pohnpei (pronounced pawn-pay). Though the climate did not differ, the culture and the people have drastically changed. For starters, air conditioning in the airport was a nice touch. Also, the airport bathrooms are not that dissimilar from those back home! Automatic air dryers, ventilation, and most importantly, CLEAN bathrooms surpassed any expectations I had (which were low, sorry).

The people were definitely more professional. There was law and order and everyone was in uniform. As we stepped out of immigration and into the terminal, you can see traffic in the parking lot. The expression shoulder to shoulder crowds colds be used, except it was more like shoulder to elbow from my perspective. Nevertheless, it was crowded.

We were received by the hospital staff members we were going to be working closely with over the next week. They gave us flower headbands, assisted us with the car rental and arranged for our hotel to pick us up. After we parted ways, they went back to the hospital to work while we drove to our lodging.

I'll stop here and my next entry will include pictures of the hotel. To sum it up in one word: legit. :)

Kosrae's beauty

I have to say today was Kosrae at it’s best. The morning started off B.E.A.U.tiful. No humidity, hot sun, blue skies, it was an awesome sight to wake up to. We went to work as usual and it started raining. When we finished work, we came outside to a nice breeze with no rain. We had plans to see Kosrae’s mangrove and then head to the happy hour over at the next hotel to join the other couple and locals for a few drinks. Then while at work, we were invited to the governor’s place to have dinner. We opted to miss the happy hour and still embark on the mangrove.

The mangrove is essentially the habitat Kosrae resides in and environment it thrives in.We were picked up by a local and his daughter to begin our journey. They were extremely nice and were great tour guides. He told many tales and legends of the island and his knowledge of the land cannot be captured by any picture or blog. That boat you see is hand carved and crafted. He took us into hidden river beds and bends that were so uniquely scenic. They say a picture says a thousand words, but no picture can do this sight any justice. So I decided to video record it instead. I can’t post videos on here and since bandwidth is an issue, I will show you all when I get home.

The clouds were rolling in but the sights were so breathtaking, I didn’t even care. As we proceeded out of the marina, I noticed something interesting: the water was shallow, regardless of how further out we went. There were times when we were barely floating above the bed of sand that our boat captain had to pull up the motor and use an oar to row is through the area. Luckily, I had my head on a swivel and captured this picture you see on the right. It’s so majestic to see the clouds through the jungle terrain that is close to you. It’s so mysterious and can’t help but feel like it evokes my imagination to think of the possibilities beyond my visibility. Perhaps this island of the sleeping lady is now awake and is covering up what she is doing. Or better yet it’s an alien invasion like in that memorable scene from “ID4.” Or even cooler would be if the smoke came from a dragon like in “How to train a dragon” (go nightfury!). At any rate, too cool.

I am doing a lot of things on this trip that I would never do at home. I’m not the first person to volunteer to eat fish yet the sashimi here is so amazing. Last night, I had dinner and the waiter had informed me he, literally, just caught the sashimi I was eating right before he began his shift. To describe it: best sashimi ever. This picture is a young coconut. I’m not a big coconut fan but the juice from this one was so sweet and didn’t taste like a gross coconut. This was a good coconut. I want more of this good coconut.

One of the tales our tour guide told us included one of this flower. We were at the mouth of a river bed that had dried out (we were in low tide). He said about 19 years ago, there was a Kosraean man who had asked his girlfriend to be his wife and move with him into the Kosraean Mountains. She said she would after she helped her family take care of an ill family member. The man went first to the mountain to settle in and found this unique flower. If you look closely, the flower is only half a one. Intrigued, he picked the flower to show his future bride who loved studying flowers. Tragically his fiancé had died because the tide had come in and drowned the entire village. Where her family house used to be, the very same plant was found by the man. He took his half of the flower, her half of the flower, joined them and spawned one flower that shows the union they were supposed to share. Also in the picture you see the plant’s fruits. Kosraean’s squeezed the extract into their eyes to see clearly. It is also said that the plant provides relief to those with trouble breathing. Our guide ends the story by saying the girl in the story was caring for her family member who had dyspnea.

Our trip ended when it started to rain. The entire mangrove was only 90 minutes or so but the climate change was so sudden. We went back to the hotel to change and got ready to attend the governor’s dinner. I wasn’t going to bring anything formal but luckily someone helped me pack and said I should bring jeans and a nice shirt (thank you to that person ;D).

The governor’s dinner was so cool. We, along with the team from Salinas, were honored guest to the governor, state assemblymen, and the other legislative officials. They had speeches and traditional food lined up for us. As you can see from my plate, it was a very traditional dinner. Also presented at the dinner, we received plaques! Mike and Lori both received one and even I got one. So cool, totally going up on the wall and bypassing the fridge. The other team’s leader gave a very heartwarming speech. I have it on video and my summary would not suffice or even reflect her emotion, passion or genuine care for her native Kosraean people (she works as an RN in Salinas). Shout outs to Betsy, James, Ryan, Nick, Sue, Nancy, and Melanie. Great job and congratulations on fulfilling your dream!

After the dinner, we actually made it out to the happy hour at the other hotel. Problem was there was no happy hour. That’s ok, we still had a good time. We ran into the people we saw yesterday and met a few new faces. The attorney general also came out to party with the locals. His English was perfect. So perfect, we had to ask where his education was. Turns out, he’s not even Kosraean. He’s from Oakland, California. Talk about a dub tee eff. He was a very bright, down to earth person who wanted to make a difference to Micronesia and was offered a position on Kosrae though he is from Chuuk (the third island we are going to visit). I wish we found out about this place sooner because the company totally made the place more awesome than our current hotel (though our hotel has VERY FEW bugs which is all the features I need to hear when picking a hotel). The place is called Bully’s and the owner is from Tennessee. His wife is Italian and they actually serve Italian food (tomorrow’s special is lasagna, fried eggplant and Italian soda if you were curious). No picture here because I left my camera in the car as it was getting late at night.

This is a purse. Shame on of all you who want those LV, Coach, Gucci bags or what not.

Tomorrow, we head out Pohnpei. This is the island where we sleep in those treehouse/bungalows. If you’re still unsure, please visit our hotel’s website www.thevillagehotel.com . That being said, I may or may not be able to blog. They do have wifi though so maybe I will be OK. Til the next update…