Random Palau Statistics
Number of Babies Saved: 0
Number of Times I Have Been Encouraged to Sleep With a Hooker: 1
Number of Times I Have Been Within 10 Feet of a Shark: 4
Number of Times Said Shark Was Currently Feeding: 1
I realize, now, I’ve made a grave strategic error. By opening with a 13-page diatribe, I’ve set expectations unreasonably high. I shall simply have to hope I can approach the double-digit limit this time. Perhaps with the liberal utility of polysyllabic utterances I can extend this particular installment’s duration to suitable lengths.
I typically ‘work’ at the hospital from 8am-4pm on weekdays (for our viewers at home, that’s 4pm-12am, one day behind – I’m writing from the future). This is a nice schedule because it is the only time I can reliably get online at a time when friends back in the States are still awake. I only put ‘work’ in quotations because I’m not being paid and there is not, necessarily, a set task I am to work on in a given day. The atmosphere, as everywhere else in Palau, is extremely laid back. My presence is neither required nor (I would presume) wanted on an hourly basis, as I don’t actually work for anyone in the cubicle forest which surrounds me, and I take up valuable space in their designated storage cubicle.
Hypothetically, I am working either on the various IHOP assignments given me (readings, journal entries, the like), my project (which I have not begun in concrete terms yet, more on that later), or any odd-jobs which Kristen wants me to do (a task for which Jodie has shown far greater propensity than myself, though once I’ve finished my project, that will, undoubtedly, be the focus of my time). In reality, I spend anywhere from 30-70% of my time working on these things (depending on how productive I am feeling, whether or not friends back home are online, the tides, the phase of the moon, and the particular alignment between Jupiter and Saturn) – and the rest amusing myself by seeing how long it takes to load some of my favorite US-based websites (such as the ineffable iddxblog.blogspot.com). I’m actually way ahead of schedule on my written assignments and the organization of my project, so this is of no great detriment.
There is an odd dynamic between what IHOP – and thus, UWSOM – and Kristen want. Last year, we did a research-based epidemiology project. Being an epidemiologist, Kristen was an ideal contact and supervisor. This year, with the switch to a community health-based intervention, we are less directly involved in anything Kristen actually wants done – so it’s a bit difficult to make my project something that is also useful to her, which was the initial intention of the program. As such, she’s not really my ‘boss’ per se, but she is a great resource in terms of getting in touch with hospital staff and negotiating the bureaucratic quagmire which could sink any well-intentioned project. Technically, my project needn’t be completed until the very end of my 10 weeks here – but she would like it done by mid-July, at the latest. This really shouldn’t be a problem – I may be able to have a draft of the presentation done by next week, and the week after that at the latest, to be modified and developed as I receive feedback from Peleliu and various other contacts.
She also knows all the best restaurants in the area, and our two-hour lunches are a welcome diversion from various degrees of productivity. These alone make her invaluable. The rest is just gravy.
In terms of my project, I’m doing well in the gathering of other peoples’ work that I can potentially adapt for my purposes. Kristen has helped get me in touch with the local nutritionist/dietician, who provided me with a book of tables on Micronesian dietary habits which is far too dense for me to actually read – I plan to go back to him once I’ve narrowed down my food choices to a more select few, to have him help me put together a healthy meal plan. I also got some useful brochures/postures from the Non-Communicable Diseases division (Kristen maneuvered that one brilliantly, waiting for the reticent head of the division to go off-island so we could deal with her assistants, who are apparently much friendlier) and some pamphlets from the various dispensaries. Kristen had actually attempted to introduce me to the apparently-skittish head of NCD – I only overheard the conversation from my storage cubicle:
“Hey, can I introduce you to a couple of students we have with us?”
“No.”
Needless to say, I’m glad we avoided having to deal directly with her.
The nutritionist suggested I get in touch with the Governor of Peleliu – Jackson(!) Ngiraingas (I have NO idea how to pronounce that – I have been told, and have failed miserably in my attempts). I have taken, thusly, to calling him Governor Jackson (or, in my mind alone, as Jacko). It just so happens that the patient whose blood pressure I took, and who, along with her husband, gave me the idea for this project (a very well-spoken and friendly woman) is the Governor’s main assistant on Peleliu, and is Montoya and James’ main contact on Peleliu. So, I went to her, and presented her with my project idea (which she loved – thus far it has been received well by everyone, locals and otherwise), and she gave me his number and told me to run it by him so she could help me. She also very emphatically requested (I assumed the subtext was in the spirit of ‘tit for tat’) I fetch a poster entitled “What’s In A Walk?” from Dr. Yano (the Minister of Health, and a very polite and friendly gentleman) – a task which took a week and a lot of hassle to complete, but I finally managed to find, copy, laminate, and prepare to deliver to her tomorrow. I got ahold of Governor Jackson yesterday, and he’s going off-island for a week, so we’re planning to meet next Thursday or Friday to discuss my project idea and get his input on it (which, from the brief overview I gave him over the phone, he also really liked). So, with the Governor and his assistant helping me out, I’m hoping to begin organizing something in earnest over the next week – as well as take a three-day trip to Peleliu to bike around the island, go to the various shops, etc, and get an idea of what is available on Peleliu to be eaten, and what a good exercise suggestion might be for the inhabitants. Then I’ll be able to begin pulling things together into a PowerPoint, pamphlets, etcetera – perhaps even arrange, with the help of her and The Guv, some sort of group session. We’ll see.
The other aspect of my time at the hospital is clinical – most(all) of the other IHOP sites seem to be inherently more clinical than ours. Students are matched with preceptors and get a fair deal of clinical experience. Palau was the lone site who had an epidemiology focus, and thus, in a year of change, this sort of matching was not achieved – and it has been mostly up to us to make time and contacts for clinical experience. I have (or, rather, will) benefit from the time Jodie had taken prior to my arrival to make contact with the two general surgeons at PN – I’ve followed them on rounds once, though with most of my written assignments taken care of, I intend to start doing so with greater frequency. I also got to watch an adult circumcision (more on that later), and hopefully will be able to split time with Jodie in terms of observing surgeries.
I also made contact with an orthopedic surgeon who I hope to observe in the near future – his surgeries usually take place on Wednesdays, which overlaps with Montoya’s clinic on the mainland (which I had hoped to observe at one day), but I haven’t yet been able to speak with him at length about observing him, so we’ll see how that works out. Hopefully, Jodie can then observe his surgeries as well (and thus benefit from my work as I will from hers) – either alternating weeks between general and orthopedic surgery or, potentially, with both of us observing both surgeons simultaneously (provided the OR is not too crowded). There is also a psychiatrist at the hospital I may get in touch with, but I have the feeling my schedule will be crowded enough as it is.
My favorite two parts of the hospital thus far remain a sign which proudly proclaims that “visiting hours is over” and the multiple “wash your hands with soap and water!” signs which litter a hospital whose bathrooms, with few exceptions, lack soap. People bring their own private soap dispensers (as normal hand-soap dispensers seem to get stolen) or hand sanitizer, as well as bathroom tissue (ironically-termed, in honor of the late George Carlin) to compensate, but nothing beats a hospital with an ironic sense of humor. Jodie is actually considering changing her project from her current zoonoses focus to some sort of hand-washing crusade – a change which will likely relieve her of quite a bit of work. I had actually been thinking that, had I not already embarked on this nutritional journey, I would have done the same.
On Thursdays, as I have already mentioned, I go to the dispensary on Peleliu, where I shadow James and Montoya. They basically let me do whatever I feel comfortable doing – be it interviewing patients (I haven’t done so yet, since the language barrier, however slight, is a bit intimidating), taking blood pressures, applying ointment to rashes, etcetera. It’s the most direct clinical experience I’m likely to get during this trip, so I’ve made it a point to go every week. This Friday, we’re also going out to Kayangel, one of the smallest inhabited islands in Palau – with a population between 30 and 40 people (Anguar, by comparison, has about 80, and Peleliu 500-600) to run their once-monthly dispensary. In my quest to visit all of the inhabited islands of Palau, I am well on pace, save for the extremely distant ‘Southwestern Islands’ (I am told they are about 300-400 miles away, and closer to Indonesia than to Palau itself, and it is a multi-day boat ride just to get there). James and Montoya are trying to plan an excursion to visit them and provide some medical care – apparently, doctors only get down there maybe once a year. I’m not sure what they do for the rest of the year – perhaps the Navy gets out there more frequently, but I somewhat doubt it.
I’m going to forego any attempt to sort through what happened on a day-by-day basis, since, to be quite frank, they all seem to run together. In my old age, my memory for the temporal sequence of events has faded – replaced by the ripened wisdom of many years, I’m certain.
While nothing significant happened clinically (other than taking a blood pressure and chatting with a few patients on Peleliu) the first week, the second week was slightly more eventful.
In PN, I went on rounds, and saw a case of severe generalized abdominal pain, combined with liver masses and an enlarged spleen whose etiology seemed to elude the general surgeons (every test they were capable of doing was negative, and her medical history didn’t really adequately explain her symptoms – which included a slow but persistent internal bleed, the origin of which they couldn’t determine without exploratory surgery). Since PN does not have laproscopic equipment, exploratory surgery is a hugely invasive procedure, and they elected against it when the bleed seemed to stabilize – but the case provided Jodie and I about an hour and a half’s worth of entertainment in the form of playing doctor.
Playing doctor is a lot more complicated than I remember it being as a kid – it was like some sort of remedial episode of House. The patient seemed to be much improved in the morning, and the surgeons have decided to wait and see for now – though I desperately want to know the final diagnosis.
I also observed an adult circumcision – the first real surgical procedure I’d ever seen. Other than the natural comfort pain, I thought I did all right with it (there was certainly the physiological stress reaction, but I’m hoping that’s pretty normal when you’re first around these sorts of things) – the blood didn’t really bother me so much as the cutting… and especially because of the region involved. The patient seemed to be a pleasant combination of drunk and anesthetized (I only guess drunk because he was really, really unresponsive to the doctors’ attempts to make sure he couldn’t feel anything), so he wasn’t in any pain.
***DETAILS OF THE CIRCUMCISION – SKIP AS NEEDED (Mom)***
It was done a bit differently than I remember it being done. Apparently, the procedure was being done for medical reasons – for some reason I wasn’t sure of, the foreskin had constricted so much that the urethral opening had become extremely narrow and the patient was having difficulty urinating. What I’ve always expected, from popular media and my own vivid recollection as a newborn, was a rather simple “stretch and snip” technique. Oddly, they actually left the foreskin attached – they slit it along the top to open it up and peeled it back and away from the glans, leaving it attached on the underside (for those of you not well-versed in native penile anatomy, it’s attached by a thin bit of elastic tissue not unlike that on the bottom of your tongue – the name escapes me). They then rolled the foreskin back and under the glans, before suturing it down against the shaft – and leaving it otherwise attached. As far as I’m aware, that’s not the typical procedure (though admittedly I’m not a surgeon), and I’m not sure if it was done that way because he was an adult, because he requested it be done that way, because it was considered less invasive, or what have you. Whatever the reason, it served the function of easing the medical problem, so I suppose there’s no problem with it. I even had the honor of cutting the final stitch, as if I were christening the bow (that’s the front, right?) of a newly-crafted ship.
Okay, that was a bit more Freudian than I’d intended. Pounding the golden spike into the Transcontinental Railroad is little better. Let’s just pretend that didn’t happen. I didn’t write it, you didn’t read it, we all go home happy.
***END CIRCUMCISION DETAILS AND VAGUELY-EROTIC ANALOGIES***
On a random tangent, we’ve been eating Montoya’s MREs for lunch on Peleliu. He won’t touch them, having been forced to live off them for months, but they’re actually decent, as far as pre-prepared and packaged food is concerned. There was some intense bargaining going on, with a blockbuster 3-way trade bringing James’ M&Ms to my meal, sending my Picante sauce to Jodie’s beef, peas and rice, and Jodie’s cheese spread to James’ wheat snack bread (which tastes suspiciously like cardboard, with the texture of Styrofoam) – a trade I clearly came out atop. I felt comfortable dealing from a position of strength, as my backup spread – a cheese-spread with jalapenos had proven strong in limited playing time on my vegetable crackers, and would have languished without regular use.
On the subject of Peleliu, during my second trip there a couple of interesting things happened. I got to help dole out prescriptions and explain how to take the medicines and their potential side-effects (for prescriptions like benadryl, ibuprofen, etc), I got to help treat and bandage a little girl’s rampant jellyfish sting (cute kid – with a stronger handshake than many adult women I’ve met), I learned how to do a finger-stick to draw blood for on-the-spot glucose testing (which I quickly filed away under ‘Clinical Skills Which I Want to Practice but In Reality Will Never Use Because Nurses Will Do Them For Me,’ right alongside ‘taking a blood pressure,’ ‘taking a temperature,’ and ‘bedside manner.’ We also got to see that girl with impetigo (you remember? She was the one who didn’t have diabetes?) return completely healed on follow-up, which was kind of cool. Lastly, a guy came in with a pretty bad infection which had spread down to the connective tissue underneath the skin and had caused a lot of edema in his right foot – since we didn’t have the equipment to set him up with IV antibiotics, and he needed to go to the hospital, we took him to Koror with us on the speedboat and James drove him to the hospital personally to get care. He’s doing fine, but I’ll never forget the first question he asked me after James had left to go discuss the case wit Montoya (and after he’d had me explain to him, again, what was going on – which I was just thrilled to do):
“So… it’s not a boil?”
Other than Frisbee, the highlight of my days spent in Koror during the week was watching Aladdin with Jodie Tuesday night. There may or may not have been singing involved. For those of you who know my love of this movie, you’ll understand. For those who don’t understand, you’re probably David, and your judgment means less to me than your continued well-being. Since most weekday nights are filled with either working or reading, a movie here and there is a welcome change, and we’ve decided to make the first few Disney movies – we started with my (current) favorite, then will move to her (current) favorite, The Lion King (also a classic), and then go from there. The movie store here actually has a really surprising selection of titles for $2/night – expensive if you keep it for a 5-day rental, but cheaper than the States if you just watch it that night and return it the next day. They even have Dude, Where’s My Car? Not that I know why anyone in Palau cares where that dude’s car is.
PPR has proven to be an entertaining diversion. We’ve been three times so far, each with varying degrees of success, but you really can’t beat the quality to price ratio of the food there (with the 30% discount, so long as we stay in the ‘cheap’ section). The first day was the day we finalized our membership – specifically for a dinner party (with an open bar! – apparently an EXTREME rarity in Palau) for members only that James had invited us to. After paying our fee, we were told that, regretfully, we’d have to wait for the next dinner party (which was going to happen after we left) – and, after consulting with the manager, it didn’t apply to one month memberships either. A bit bummed out, and about to put my silver tongue to work in order to get us inside (since James, being one of only a few health-care providers in Palau, is relatively well-known), the manager suddenly glanced down at our names and back up at us:
“You work at the hospital, right?” He had asked, over the phone while reviewing our application, what Jodie and I were doing in Palau – I had told him we were medical students, visiting and doing some public health projects. Technically, we do work while we are present at the hospital (and shadowing physicians counts, in my mind, and we are doing health-care related work, which would have been far too lengthy to explain in detail), so the proper answer was clearly:
“Yes?”
“Why don’t you go ahead and join us?”
Feeling rather like the hotshots we’d always fancied ourselves to be, Jodie and I glanced at each other in surprise and gratefully accepted – I was impressed he even remembered talking to me a few days before, let alone that working at the hospital apparently carries with it unseen benefits. It really seems to impress the locals, at least. Save for that checkout girl at Surangel’s:
“So do you go to school here?”
“No, I’m a medical student, I’m just here for the summer working at the hospital.”
“Why,” she began, with a rather incredulous look, “would you come all the way out here from the States to study medicine?”
Anyhow, the food at the party was fantastic, and they actually had salad (another rarity in Palau, though I haven’t been here long enough to appreciate it) – but the spread was outstanding, and as James introduced me around to his and Carmen’s friends, it was odd how I began to realize I recognized a lot of them – had seen them on dive boats, hanging out at restaurants, in the supermarkets, etcetera. It’s really kind of insane the way you see the same people all over the place. And everyone, for the most part, remembers seeing you, is glad to see you again. It’s like one giant episode of Cheers, I swear to God. My personal favorite was the guy who, after I introduced myself, said “Didn’t I see you at the supermarket?”
I blinked, a bit taken aback, before I recalled that on my first or second day here, I’d gone to Surangel’s and, pleased to see another American (or, at least, foreigner), we’d exchanged definite “oh, look, we’re both white” nods – finding this amusing, I’d actually related that story to a couple of people, though I never would’ve recognized him again. I can’t believe he remembered me, frankly – it must be my disarming smile or my sea-green eyes. There was also a guy there who looked eerily like the main character’s best friend from Office Space. You know, ‘watch your cornhole’ guy? Hell, maybe it was him.
After that party, we went to another party hosted by some friends of James’ – which consisted primarily of beer and karaoke. In honor of Dan and Gary, I did a few songs – and came away with the second highest scores of the night – 84 and 88 – doing Billy Joel’s ‘Piano Man’ and ‘Honesty.’ Someone beat me with a 94 on ‘Can’t Buy Me Love,’ a song, I maintain, which was much easier to sing than ‘Honesty.’ Jodie and I together had a much less respectable showing on ‘Eye of the Tiger.’ They didn’t have ‘Don’t Stop Believin’,’ – can you believe it?
The highlight of karaoke was definitely the old and (extremely) intoxicated man who owned the karaoke machine, knew all of the songs, and sang loudly and boisterously along with everyone. Oh, Bob – how I miss your dulcet and nigh-incomprehensible intonations.
There’s been a lot of talk down here about ‘trochas’ – some sort of snail-like critter that people go out and catch in the sea every 4-5 years. Market price on them seems to be pretty sure, so I can’t tell if they’re a big deal because it’s cheap food, because they’re good, or because people make a lot of money selling them. They had a plate of trochas sashimi at the party (my first hint should’ve been that no one seemed to be eating them) that they offered us – curious and polite, I took one and popped it in my mouth. For those of you who don’t know what sashimi is (Mom) – I ate raw snail. It had been pickled in… something… was faintly spicy… extremely rubbery… and really not very good. So, naturally, I encouraged Jodie to try one too. Given all the hullabaloo (I’m just glad I got to use that word, honestly) surrounding them, we’re convinced that maybe these just weren’t very good trochas. Who knows?
I ended up taking the state ferry up to Peleliu on Friday and coming back on Sunday, rather than going to Kayangel, so that I could go around to the various stores and get an idea of what food is available on Peleliu. It’s kind of a bleak picture – there are some decent items available – mostly canned fish, fruits, vegetables, and chicken – but the vast majority of it is extremely salty, extremely fattening, or (usually) both. And most of the stores have the same items, with only a few exceptions, so there’s not much in the way of choices to be made. Something as simple as wheat bread, brown rice, or skim milk simply isn’t present, making a ‘healthy’ menu on Peleliu rather sparse. Apparently, a favorite snack here is taking chips (usually Pringles) and dipping them in a mixture of Kool-Aid, soy sauce, salt, and pepper.
I know.
Peleliu itself is rather small – all 500 or so of the island’s inhabitants (and their chickens) live in and around its one village at the northern tip of the island, and it only takes 15 minutes or so to bike around this portion. Other than bike around, explore the island, and play basketball, there’s not overly much to do. It’s interesting to note that Peleliu was the site of some extremely bloody fighting towards the end of World War 2 – and there’s a WW2 museum (and many scattered WW2 relics to be found on the island) that Jodie and I plan on exploring and taking a look at sometime in the future. For now, though, I’m just trying to stay out of the heat – it’s over 100 degrees outside and extremely humid around mid-day here, much more tolerable towards evening and early morning. The governor’s main assistant set me up with a sparse apartment so I could avoid paying for a hotel for two days, and with a fan it’s cool enough. The first thing she told me upon arriving was not to tell anyone where I’m staying – so this is real cloak-and-dagger shit we’ve got going on up in here.
In the interest of maintaining this entry at a reasonable length, I’ll shut up now. I’ve got a couple more snorkeling/dive stories to go on for pages about, so I’ll save those for padding the next file.
People keep staring at me like they’ve never seen a white person before. I should just start telling people I live here to confuse them.
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