Mid Study Review

Participants Enrolled	31
Surf Missions	3
Marriage Proposals	2
Infectious Diseases Contracted	0

The study is going great!  Let me begin by saying, I love the State Hospital.  It gets a bad rep but the physicians are well-trained, and they make do with the resources available.  I’ve worked in several hospitals in varying degrees of developing/ed countries, and what impresses me is the cohesion of all the hospital departments.  The services are efficient and affordable.  The operation is nearly flawless, and the staff works together well with a tone that is calm, competent, and comedic.  Before morning rounds, the nurses and doctors joke and tease in a combination of English, Pohnpeian, and Filipino.  There’s an absence in haste and stress and irritability that I remember from many US hospitals.  Sadly, my menwai compatriots give the impression that the State Hospital isn’t safe or trustworthy.  That any injury or illness should bring you to the private Filipino hospital or med-evac’d out to Honolulu.  I disagree.  I know the staff and I know the physicians and I trust their care and judgment. 

I also love my job.  It's a pretty sweet routine.  Mornings, I head to the medical ward to check for new patients to enroll.  New participants are interviewed with my growing Pohnpeian vocabulary.  The patients are receptive to the study, and I think they appreciate that someone is taking the time to understand more about their illness.  If participants are returning for their scheduled follow-up blood draw, I head down to the markets to buy local fruits and assemble their compensation fruit bowl.  I pop into the emergency department to ask if anyone has fever, including the physicians.  Haha, I asked one nurse this morning if he had fever, and he replied that he had a fever of the heart.  I peruse the medical records department to search for missing patient info.  I check into the laboratory for test results and to see if I missed any patients who were ordered rapid lepto tests.  In the afternoons I schedule follow-ups and manage data in my gorgeous database.

Then there’s the fun detective part of my job.  If I find rapid tests run on patients who are no longer at the hospital, then I have to track them down.   From the lab records book, I have a name.  With the name, I can ask the ladies in the coding department to look up the hospital number.  With the hospital number, I can look into the medical records to confirm eligibility, and then I have to locate a phone number to contact the person.  Not everyone has a phone, so sometimes it’s locating a relative who has a phone number.  This expertise is best left to the ladies at the check-in desk.  They must know everyone on island and every relative and all the most recent family gossip.  I bring them a list of unknowns and some home-baked muffins, and they provide the family phone numbers.  Perfect.  This study would never be as successful if not for the amazing supportive hospital staff, which is precisely why I bring baked goods to each department regularly. 

The study works.  But what makes me even more delighted is how this project combines my fascination with infectious diseases and my love for indigenous cultures.  Medicine meets Anthropology.  No one loves their job as much as I do.

Lois and Elise, Outpatient Dept Triage Nurses. 
In the first photo Lois was slouching and Elise teased her into hysterical laughter

Monique and Elnora, Medical Ward

Dr Khristain and Dr Franklin, Medical Ward

One of my fantastic lab techs Johnny

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.

Mangrove Monsters

So I've never cooked crab before. 
They were a little muddy, so I thought I might soak them first.
Kinda like how you'd soak steamers?  I dunno. 

[Two mangrove crabs were harmed in the filming of this video]

The Rush Hour

Imagine dense, wet, tropical rain forest.  All the sounds, smells, and animals are new and exotic.  The shapes and variations of the creatures remind me of Darwin’s Origin of Species and his painstaking observations on generations of Galapagos finches.  This island is smack dab in the middle of the Pacific and so far from other land masses that genetic isolation has worked its magic, yielding unique and endemic species.  So without further ado, let me introduce the Pohnpei Lory.  

I’m not an ornithologist, so from my scientific observations, it’s a dark red parrot looking bird.  Here at my home/wildlife sanctuary, the lories travel in small groups very quickly from treetop to treetop.  Every morning between 6-7:00, they quickly swoop in and stop off for a quick break.  Squawking loudly like, well, parrots, they seem to have the following high-decibel conversations.

 

“HEY, HURRY UP WE’RE LATE”

“DID YOU SEE THE GAME ON LAST NIGHT?”

“NO BUT I DID SEE YOUR WIFE OUT AT THE BAR”

“DON’T BE A JERK, HURRY UP WE’RE LATE”

“MAN I’VE GOT A TON OF STUFF ON TODAY AND THEN HAVE TO WORK ON THE KITCHEN RENOVATIONS”

Everyday.  At least 50, loud, beautiful birds swarm in from the east, stay a couple minutes and then move on heading west.  It’s like they’re clocking in.  And then, around 5pm, the same but in the opposite direction.   

“WHAT A DAY”

“QUICK HURRY UP I WANNA GET TO THE GYM BEFORE DINNER”

“DID YOU REMEMBER TO STOP AT THE BANK?”

“SHIT.  YOU WERE SUPPOSED TO REMIND ME”

“DON’T FORGET TOMORROW IS LITTLE JIMMY’S RECITAL”

“NO THAT’S TODAY, HURRY UP WE’RE LATE”

What Kevin and I couldn’t figure out is if they actually have a daily destination, or if they just make laps around the entire island checking into their various airports and hubs.  Strangely, they are they only lorikeets on the island.  No other parrot type birds at all.  Just these little maroon ones.  

Genus Species: Trichoglossus rubiginosus
Pohnpei Name: Serehd
Claim to fame: State bird of Pohnpei

Exists only on Pohnpei and Ant Atoll

Off The Verandah

Malinowski, the ‘father of social anthropology,’ studied cultures through participant observation.  His field work led him through Melanesia including Papua New Guinea and the Trobriand Islands.  He emphasized the concept of coming down 'off the verandah,' departing from the Western comforts to join indigenous peoples.  To live with them and live like them in order to learn about them.  This ethnographic approach stresses the importance of observation, limiting one’s influence onto the local peoples.  In college we watched beautiful black-and-white documentaries of Malinowski in the field, and I wanted badly to immerse myself in such a raw culture and create brilliant ethnographies.

When I was little, Mummie used to tell me stories of her childhood in Ethiopia and Kenya.  Her father was a professor of law at The University of Virginia and also worked in the Foreign Service writing legal codes for new and developing countries in Africa and Eastern Europe.  She and her siblings spent their formative years in these countries.  In the stories, they lived in the Embassy compound and had local servants (which today would be called landscapers and chefs and handymen).  Against her parents’ wishes, Mummie befriended the help and spent her playtime with them and they taught her Swahili.  She remembered all their names and spoke about them fondly.  She had, in fact, come down off the verandah.  In some deep subconscious place, these stories brought me to where I am, in a way I didn’t even realize until now.

So here I am.  In my country.  Excited to contribute useful public health information, not to impart Western medicine, and to soak up all the local cultural information available.  Yet I am increasingly aware of how my experience here is confused; somehow straddling two worlds.  In my role as epidemiology researcher, essentially contracted by the World Health Organization, I live alone in a beautiful house, with a gorgeous view, with modern appliances, with a car, with an office, with a purpose.  This is all wonderful until I stand on my deck, cooking fresh fish on the grill, drinking an ice cold beer, bathing in the ocean view, when I realize…that I am On The Verandah!  Looking down.  Not interacting with the local indigenous peoples, but separated by a manicured landscape.

I try to eat local fresh foods, but I’m not eating local dishes.  I’m not experiencing the culture.  I’m not immersed in the language.  I’m not compromising any of my Western comforts.  This is made even more apparent by my friend Mollie.

Mollie is a Peace Corps Volunteer (PCV) from California who went to Harvard and studied English Literature but fears that she got the wrong Harvard degree.  “So, is being pretentious, white, and wearing turtlenecks, and walking around with really good posture a New England thing or just an English Lit thing?”  I laugh and tell her that I was too busy buried in science labs and too stressed-out over-achieving to notice what anyone else was up to. 

So Mollie and I are fast friends.  She lives with a host family on the other side of the island in Medolemnihnw [med-doe-lem-EEN].  After almost two years, her Pohnpeian is fluent and she is well adjusted to local Pohnpeian life.  She teaches me how to dress and how to make sukasuka a piyaya (pounded coconut food).  I visit Mollie’s home and her host family and her church.  And I am pleasantly culture shocked.  Life outside of town is beautiful and simple and foreign.  Our friendship works because we both indulge in the other’s lifestyle.  Mollie comes and stays the weekends in my guest room and takes hot showers and eats my best Southern California cooking and does her laundry in my washing machine and dryer.  I make fish tacos.  I make fajitas and margaritas for Cinco de Mayo.  Last Saturday morning we sat on my deck eating breakfast burritos and sipping mimosas.  I go to her host family to see the home, to pet the pigs, to join a Pohnpeian church service, to drink fresh coconut, to sit with the family in the open Nas, and to smile as I realize that I’m the only one who doesn’t speak/understand Pohnpeian.

I’m disappointed in my own situation that lacks cultural integrity.  At the same time I feel ashamed that I don’t appreciate the fortunate situation that I’ve adopted.  It’s a struggle between worlds.  I feel guilty because I can choose to access the local Pohnpeian way when it’s convenient for me.  Mollie doesn’t have that choice.  She’s immersed/stuck.  We both want what the other has. 

Yesterday was FSM Constitution Day.  I asked Boris what that meant and he said to take the day off.  He invited me for board games and beers at his neighbor’s house in the embassy compound.  We play Civilization on polished furniture and eat foods prepared from ingredients that simply aren’t available here.  Everyone is American and under the age of 35.  In fact, the guy who is issued the house is from Jamestown, Rhode Island and is only a year older.  We all joke and laugh and check facebook on game breaks.  From the house and the furniture and the Pacific Ocean view, you could easily confuse your surroundings with Malibu or Santa Cruz.  Through the kitchen window I watch a dark-skinned Micronesian tend the garden.  He looks so out of place in the Caucasian compound.  In an instant I am brought back to Mummie’s stories unexpectedly, and she is playing with the gardener outside.  I imagine the garden in Kenya while I stand inside the kitchen with ice cubes clanging in my drink in my air-conditioned comfort. 

Luckily, I’m losing badly at the board game and bow out early.  Thankfully, I can leave the other players to squabble over territory, population expansion, and hostile takeovers. Another rough day in Pohnpei.

"Where’d you learn to surf, in a bathtub?"

I met Boris a year ago at a conference in Auckland.  It was a 2-day meeting of the World Health Organization Western Pacific Regional Office (WPRO) and the Secretariat for the Pacific Community (SPC) to discuss the Pacific Public Health Surveillance Network (PPHSN) implementation of communicable disease syndromic surveillance program.  My fabulous supervisor Jude suggested that I accompany her to the conference knowing my interest for infectious disease research in the Pacific region.  At the time, Boris was the infectious disease surveillance officer for the WPRO based in Pohnpei, FSM.  During a coffee break, I talked with Boris and expressed my interest in a Pacific project for my Master’s.  “Well we’ve got lots of work to be done in FSM.”

This explains why I’m in Pohnpei.  It’s only by coincidence that this teeny little Pacific island happens to harbor one of the most remote and sought after perfect right hand reef breaks in the world.  The Palikir Pass or P-Pass break was first featured on the cover of Surfer Magazine in 2000 {see link} .  In 2004, Allois Malfitani, a Brazilian living in Hawaii, moved to Pohnpei to capitalize on the break.  He purchased a waterfront hotel and renamed it the Pohnpei Surf Club.  Due to costly airfares and a nonexistent tourism industry, access to P-Pass is exclusively reserved for wealthy wave hunters and professional surfers.

Fortunately, for me, we are just entering the non-surf season.  From May-September you won’t find 6-8 foot stand up barrels but rather calm 2-3 foot Suze size swell.  You can imagine my relief after watching these videos of Taj Burrow’s recent visit to the surf club in March.   Day 3 in Pohnpei is my first surf session.  It’s a 20 minute boat ride out to the pass and I have equal anxiety about proving my worth as I do for eating coral and raking myself across the reef.  [I like to call this “parking lot anxiety” which I coined as a kid when I was learning to snowboard.  We’d arrive to a ski area parking lot and I’d feel a sudden fear from the daunting height of the mountain, completely questioning my ability to do the sport.  After 15 snowboard seasons, I still wonder if I’ll get off the chairlift alright.] 

Because there aren’t any guests at the surf club, Allois and I were the only ones in the lineup.  Yup, a perfect head-high peeling right and no one out.  People pay big money for this kinda thing.  I take 3 waves, and they go!  They don’t close out, they don’t fizzle to mush and better yet, I don’t fall off.  It breaks like Maria’s in Puerto Rico, and the water is warm like a heated swimming pool.  I keep expecting heavy unforgiving Piha waves, but they are easy to catch and I am so appreciative to the Piha girls who helped me train all summer.  But like Allois said, these are small and it only gets bigger and heavier.  I’m psyched about my first session and then accidentally reel in this dog-fish tuna on the boat ride back in.

Saturday was a PSC boat tour out to Manta Road and a few other spots for swimming and snorkeling.  I met some of the Peace Corps and World Teach volunteers who are all great fun.  Found out why they call it Manta Road.  Sunday (Easter), there was no surf but Allois was heading to Ant Atoll to pick up some friends who had been camping for the weekend.  According to my Micronesian guide book, an atoll is formed when a volcanic island with a barrier reef recedes back into the ocean after a bazillion years and leaves only the circular reef ring behind.  There are no inhabitants on Ant other than the coconut trees and the coconut crabs, both of which we tasted.  Every few minutes I’d proclaim profound things like “I’m on a tropical island!”

Tuesday was my second surf attempt.  Still held a healthy amount of fear for the waves and reef.  Still blissfully surprised at how mellow the waves break.  Still in one piece.