Go play outside now

Innate fears are funny.  Some people are scared of the ocean, some of snakes.  I'm scared of spiders.  Not the jump on the couch shrieking scared, but more like the paralyzed fight-or-flight scared.  Honestly, the only reason I make my bed everyday is to prevent spider surprises. 

Here in Pohnpei there are several different species of terrifying spiders.  There are the kind that build webs up high in corners splayed into an X and then there is this kind.  Unfortunately, googling "scary micronesia spider" didn't yield the correct taxonomy.  I call it the sand-dollar spider. 

So, I'm talking to my dad last Friday morning and spot this sand-dollar spider sitting silently on the corner of the couch (upper left hand corner).  We tried to troubleshoot the situation over the phone but to no avail, I'd have to deal with it. 

This is the third one I've seen in  the house.  They stay relatively still until they move very very fast.  I cut the first 2 minutes of this video where I was practicing deep breathing techniques while mustering the courage to help Mr. Spider back outside to play with his friends.


 

The May Adventures

Prom

I’m gonna go ahead and classify menwai prom as an adventure activity.  “What is this?  Oh all the foreigners get dressed up in ridiculous outfits and have a dance party?  And Boris was prom king last year?  Ok I’m in.”  I keep getting confused trying to balance my serious epidemiological investigation with the regular shenanigans of the menwai community.  I’m here to conduct serious research.  I’m here to consume soursop daiquiris at the village hotel?  I’m here to educate the local community on local disease prevention.  I’m here to sing karaoke every weekend?  

prom queen

The dress code for prom is island formal.  This means going down to the local secondhand Supersaver shop and conducting an archeological dig through the discarded items imported from Hawaii.  Sadly, I must admit I have yet to venture to the Supersaver, but there’s plenty of evidence of its impressive stock.  For example, at last year’s prom, Mollie located purchased and wore a child’s size Cinderella princess dress.  Whenever you inquire about an outfit that’s both horrible and amazing, rest assured that it came from the Supersaver and cost less than $3.   

 

I wore a pretty maxi dress that came from my suitcase only to spend the evening in Supersavor dress envy.  The boys dig out three-piece suits and costumes that are far too warm for the tropics, but everyone looks amazing in their shimmery sweaty glory.  We dance our little hearts out.

  

Sightseeing

We’re on a small island.  It’s the size of Newport and Jamestown combined, but shaped in a circle with huge volcanic mountains in the middle and only inhabited along the outer ring edge.  (See map link at top of page.)  Man, I love that the interior is mostly still undisturbed, allowing thick, unforgiving tropical rain forest.  And that means pristine waterfalls usually found in calendars and screensavers.  Remember that scene in Jurassic Park when the helicopter is flying in over this massive waterfall through crazy mountainous terrain?  Yes, like that.  That scene was actually filmed in Kawai, but you get the idea.

So every weekend we take the ‘Pohnpei Ecotourism Travel Guide’ and select a destination to tick off.  Pick a spot, figure out roughly where it is, drive there, find its white and red sign, pay $1-3 to the children hanging out near your car, ask the children to serve as your guide, watch the children shrug and motion in one general direction and walk off in the other direction.  The added challenge is determining which of these spots is safe for swimming.  Since I’m the Pohnpei leptospirosis researcher, I make a general effort not to get lepto.  If there is potential for animal/pig effluent to drain into a river or swimming hole, then it can be classified as unsafe for swimming.  There’re actually signboards around town identifying safe from unsafe.  

The Pahn Takai [pon-chi-KAI] waterfall is also appropriately called the Bat Cave.  The trail brings you to this giant cave with bats behind the waterfall.  We followed the treacherous steep and slippery rocks down the river and almost swam if not for the eels.  I mean, the eels probably weren’t going to bother us but they were just too slithery.  

waterfall and bat

 

In addition to natural spots of interest, there are also the manmade kinds.  As an anthropologist, I particularly enjoyed our venture to the petroglyphs.  These are pre-historic rock carvings.  Well I enjoyed it until it became clear that some carvings were archaic and some were quite recent, but made to look ancestral.  So by the hundredth sword-like carving, we gave up on trying to identify the legit glyphs.

 

The best part about the sightseeing is that you never see other people.  No tourists, no locals, no children guides.  Yes, may I please travel to a tropical pacific island in which the natural rain forests are mostly undeveloped, and where everyone speaks English and American goods are consumable, but where I can sightsee and surf without ever running into other people?  Ok thanks.  Incredible.  

Houston, we have lift-off

To conduct research on humans you have to gain approval by an ethics committee or internal review board that reviews your project and says: We do not think you intend to harm people while researching them.  It’s a precaution to prevent situations of intentional harm in the name of scientific advancement.  Like the numerous tales of deliberate infection of prisoners or mental institution patients to test drug treatments.  Or the 1960s New Zealand incident, when the infamous Dr. Herb Green observed patients in pre-cancerous stages of cervical cancer, but neither told them nor treated them to see what would happen.  Well many of them died of cervical cancer, that’s what happened.

And my study is no different.  I intend to enroll human subjects, therefore my study must be subject to a review board who can rest assured that the risks do not outweigh the benefits, etc, etc.  My study application was reviewed by the University of Auckland Human Subjects Committee on April 27 and, well, was not approved.  This is annoying for me but conscientious for ethics committees.  They provided a laundry list of issues with my application, some completely bogus, but their main concerns were that they needed further assurance of my ability to conduct research with an indigenous population in a culturally sensitive context (ok fine), they wanted to see approval from a local Micronesia ethical committee (check), and they wanted further explanation of why I proposed to test for a disease that I did not intend to treat (fair enough).  Within 2 days I had addressed all their concerns, revised all the study documents accordingly, and submitted the study approval letter from the FSM Department of Health.  The Auckland ethics committee agreed to re-review my application in one month’s time.

So what do you do for 6 weeks in Pohnpei when you’re not enrolling participants? 
You go to meetings. 

I met the chiefs of the health department, I met the US ambassador, I gave a presentation to the physicians of the state hospital, I gave a presentation to the physicians of the Genesis hospital, I met with the laboratory coordinator, I met with the Environmental Protection Agency, I met with representatives of every other health-related Non-Governmental Organization, I met with the state hospital chief of staff, and I tried to give a forum lecture to the local college but its summer break.  (Imagine a movie montage here.)  This ethics purgatory was actually quite useful as I had a chance to build relationships with the physicians, laboratory, and support staff.

meeting of the health partners group at island foods

The Auckland ethics committee re-reviewed my application to conduct research involving human subjects on May 25 and I was given approval on Monday May 30.  Thundercats are go!  I spent Tuesday reformatting the study documents for printing and collating.  I was able to track down the directors of both hospitals and have them sign the Head of Hospital Consent Forms.  I also made a flyer for all the physicians reinforcing eligibility criteria.  I found Dr. Jim to coordinate translation of study documents into Pohnpeian.  Wednesday I went around to see each physician at the State Hospital and distribute my flyer.  I visited the Chief of Staff Dr. Hedson to let him know that I'd begin combing the hospital wards.  He sent out an official memo to all the hospital staff and posted the announcement on the Pohnpei Health Services website.  I met the outpatient nurse team, and they agreed to let me sit with them at the triage desk to screen any walk-in patients.  I also checked all the patient charts on the medical ward for fever and symptoms.  No participants.  Thursday I accompanied Dr. Almeda on morning rounds in the medical ward (MW) and went through every patient chart.  

state hospital on a rainy day

The MW is full: diabetes, COPD, and oral cancer.  These are the direct result of a diet high in fat, salt, and sugar; lifelong smoking; and chewing betel nut.  One boy has leukemia.  One man has nine lives.  I like the old style of the wards: one long room with rows of beds lined up on each side, separated by a curtain if it pleases you.  The other thing I like is how Pohnpeians bring their life to the hospital.  They don't like for family members to be alone, so there is always one or five family members sitting beside the patient bed, or napping, or preparing food.  They bring mats for sleeping and the entire contents of their kitchen.

So at this time, no participants have been enrolled but I’d say the study is moving along smoothly.  Well, at least my ethnography is underway.