Go Local!

Panfried Parrotfish topped with Mango Chutney

Ingredients:

• Parrotfish
• Mangoes 
• Love

Cooking delicious food with local ingredients is possible and only takes a little creativity.  I remain amazed at how there are different seasons for produce here even though we are on the equator and have only the slightest variations in annual climate (rainy and rainier).  Yet somehow local mangoes and avocados are only available in small windows in extreme abundance.  I have yet to see the mango tree in my yard fruit.

Okay go down to Simon's Market and get 2 bright blue parrotfish and politely ask the guy to fillet.  Get there early before 9am.  Pick out 4-5 lemon-sized mangoes that are medium ripe.  Try to resist buying donuts.  Once home, remove remaining bones and pretty blue skin from fillets.  Feed the fish carcass to the dogs.  Panfry fish fillets in a little olive oil.  How long?  Until they are done.  (That's the precise amount of time that Dad tells me to cook meat and fish.)  Gently remove fish from pan.

In the same oily pan, add some chopped garlic and diced onion.  Cube the mango flesh.  Add and saute the mango with a little white vinegar and some white wine.  Pour yourself a glass at the same time.  Let the liquid cook off and the sugar from the fruit caramelize.  After the sauce reduces, spoon on top of fish.  If you are fortunate enough to grow that amazing long leaf herb that tastes exactly like cilantro (I managed to kill all of mine), chop and sprinkle on top of dish with some local Pohnpei black pepper.  Oh, and the entire dish costs less than $10.

The Delayed June Adventures

Boating mishap

Surftrip success.  The ride home, not so much.  Captain Marko’s engine wouldn’t start which left us stuck on the mooring at Palikir Pass.  And with a busted phone, he can’t call up his backup boat men who are only a mile away.  This is the point where we start sharing survival man techniques, tales of local drifters lost at sea, and the sea turtle story from Life of Pi.  I mean, we were still anchored, but the stories are fun.  Oh and it also starts downpouring and blowing a gale which makes the temperature drop like 20 degrees.  So we’re freezing cold and the rain hits us sideways so hard that it hurts.  Mollie and I jump overboard not to abandon ship but to gain sanctuary in the warm waters below.  

Then the unlikely rescuer arrives.  A salty and weathered fishing man pulls up in his saving skiff.  Looking not quite Pohnpeian, he could have come straight from the Bedouin nomadic tribes of Africa with his head wrap and beard.  He could have been a mirage.  He tows our boat to safety?  He tows our boat to Marko’s larger long-line fishing vessel which is attached to an even larger mother ship, like a sea lamprey attached to whale.  Here is where we find Marko’s henchmen who can fix the engine.  While we wait attached to the lamprey and the whale, thousands of (ok maybe 50) fishing men peer down on us like prey, crawling out of every last crevasse and hole that both ships can hold.  The men all smile and invite us to come aboard in all of their varying broken English languages.  While it was still freezing cold on the skiff, I politely decline “no, no thank you, no kidnap.”  The engine ignites and we speed off back to the pier, crawling out like drowned frozen rats.

Flat tire fiasco

So that same night we drag our sorry selves to Michael J Coleman’s house at Nihco Marine Park for dinner.  One of the World Teach volunteers, Will, is celebrating his last night in Pohnpei, so we rally and regroup.  After a fun night at MJC’s, we head out to join Will and gang for karaoke.  Oh I have a flat tire.  This is Boris’ Opel Tigra that I’ve been driving.  We all know that I can change my own tire, but it’s midnight and MJC is an eagle scout and would be more than happy to assist a couple damsels in distress.  Sooooo the jack is broken.  And the full spare tire is also flat.  Awesome.    

We abandon ship yet again and join the caravan to karaoke.  Tires can’t get patched in Pohnpei until Mondays, so little Tigra slept soundly for the weekend at Nihco.

Pohnpei Cinema

Definitely counts as a weekend adventure.  Honestly, I can’t believe there’s a working cinema in a small remote pacific island playing quite current movies.  Three at a time with one rotating out every Friday.  For real??  Too good to be true.  While I’m usually pretty particular about films, I am so thrilled that I will watch anything that comes to the Pohnpei Cinema.  Thor, Pirates of the Carribean 4, The Hangover 2 (twice), and Super 8.  I mean, The Hangover 2 wasn’t that good, it was just that I wouldn’t turn down another opportunity to go to the movies.  You can’t even find movies this recent in New Zealand.  It’s incredible.  Oh, and the best movie theater popcorn I’ve ever had except for that IMAX in Munich with the sugary salty popcorn.

Sokehs Ridge (Pohndollap)
“Mt. Sokehs is located just behind Sokehs Rock and is quite accessible.  The old Japanese Army built various facilities here and the ruins have been quietly sitting deep in the jungle ever since.  15 minutes by car from Kolonia.  2 hours from the beginning of the mountain path to the peak (even after wandering around the battlefields).  About 1 hour to get down if you walk slowly.  Firm soled shoes such as hiking boots are recommended.  Be sure to bring rainwear and enough drinking water.”   -Pohnpei Ecotourism Travel Guide, 2010

In February 1944, WWII allied forces began air attacks against the occupying Japanese.  120 tons of bombs, over 6000 in number, were dropped on Pohnpei.  Where did all those bombs go?  Oh, they’re still here.  Live.  Living.  Here, let me describe some of the protocols for ammunitions recovery.  (I don’t know the difference between munitions and ammunitions.)  So when local Pohnpeians find old bombs in the ground they find utility in the metal.  A long grenade may become the base for an outdoor firepit or even the base on which to pound sakau (local kava).  If such artifacts are reported to local authorities, they are carefully moved to a bunker underneath the state legislature building in the middle of town for routine detonation.  I can’t make this stuff up.  Also, these bunker holes are open, allowing a fun hiding/playing area for local kids.  I know.

Misko Beach

A fun beach day activity, until it rained upwards.  There are no naturally occurring sand beaches on the island of Pohnpei.

Pahnaker

Directly across from my house, there is the old dredging site which has become a swimming lagoon.  It only took me 2 months to discover this recreation paradise.  Despite the fact that we live on a small tropical island, there is little in the way of water access.  Almost the whole island is surrounded in a buffer of thick mangrove, and almost all of the land is privately owned so these public access spots are appreciated.  Imagine living on a very small island but hardly ever swimming.  So the girls and I finally investigate this lagoon spot.  Mollie and Cori Jo play with sea cucumbers and I pry live oysters off the rocks.  We swim in local swimming attire which means covering knees, thighs, and torso.  We don’t want to offend the neighbors or draw any unwanted menwai attention.  

Cash Power

There are approximately 34,000 people living on Pohnpei.  I would have said like 2,000 but let's not split hairs.  All the electricity on the island is powered by four giant rotting diesel generators.  Two of them are dead.  One of the working generators works sometimes.  As a result we get to participate in these really fun rolling brown-outs everyday.  My village scheduled outage is 9-12 which might actually be 8-2:30.

The Pohnpei Utility Corporation (PUC) controls the electricity, not unlike holding the Electric Company property in Monopoly.  All electricity is purchased on a pre-pay basis in a currency called "cash power."  You go to the little PUC building in town and walk in and buy cash power in whatever denomination you want.  Electricity costs $2.43 per kilowatt hour.  Local families often run a house on less than 10 kWh.  Menwai houses have thousands of kWh. I use about 8 kWh/day.

Running out of cash power does happen and is kinda like running out of gas.  Today when I stopped by Public Health to talk to Dr EJ he was examining a patient outside because the power was out.  I laughed so hard when I learned that the building had run out of cash power.

So when you buy cash power they give you a receipt with a 20 digit code to punch into your cash power box, and then it does a little song and dance.  The whole operation is very user friendly as demonstrated in the clip below. 

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]