GOUT and morphing peoples personality.

Gout. Ever since I arrived in Samoa, more so in Savaii, it has amazed me how little people understand about GOUT and its management. It doesn't surprise me that from their own childhood education they may have never heard of it (ie health education in schools is minimal..down to the basics only ie. the birds and the bees and stds and thats it) But the fact that they GOT an attack, got seen by a doctor and got started on painkillers - kinda blows me that at no point did someone NOT tell them about uric acid, and Allopuriol. 

For those of you who have not heard of or know anyone with- gout is a type of arthritis caused by a build up of an acid called URIC ACID.Many meats and foods are high in this acid so heavy consumption of certain foods brings on an attack. These attacks can be severe and debilitating. It may not look so bad (ie a red joint of big toe) but don't be fooled, this baby will make grown men cry...What baffles me is the number of people on rescue remedy only. Wait for gout attack (which may be as often as every week- ie imagine 2 or 3 days of every week being incapacitated by a sore foot which can not even touch the floor for fear of excruciating mind blowing pain resulting in 2 or 3 days of absolute dysfunction (ie in bed all day) ) and then Voltaren Voltaren Voltaren. To make matters worse, along the way  someone may have slipped them some "Superman" pill..also known as steroids ...also known as Dexamethesone resulting  in a quick but FAKE improvement of pain due to its powerful anti inflammatory effect. Anyways, my point is these remedies treat the PAIN only. And not the culprit- uric acid. Which means that these individuals just run these vicous circles of not treating the cause but treating the symptom of  pain only, at the same time  abusing Voltaren and Dexa...which later results in CUSHINGS SYNDROME (another illness) Hypertension , Ulcer (from Voltaren abuse) and kidneys that are SHOT.

What I am battling now- is explaining this to patients who have done 10 yrs of this. And now look at me funny like Im lying to them- Allopurinol?? (the treatment remedy which over time can rid excess uric acid from the body and thus improve and hold off gout attacks forever if you are compliant ) what is that?? Are you sure? no ones ever mentioned that to me before?Oh wait a minute, thats that tablet you take once a day?yea it doesnt work I took it for 2 days and it did nothing to the pain (Where I then explain it does not treat pain and still get funny looks)  Why do you want to stop my Voltaren addiction?? and worse yet- WHY are you not giving me DEXA??arrhhhh.... where I worked overseas..we were forbidden to prescribe dexamethasone..this was reserved for specialist consultant only in clinic or for admitted patients in hospital. IF you were bad enough you'd get Prednisone (hospitalised  patients get- Pred is a weaker Steroid) but never Dexa. In Samoa , there is a dexa craze. Every time I see someone on it, they almost always have the Cushings Side effect , and when you decline giving it to them again, they mutate into these angry stubborn begging beings- ie. "Please please please give me dexa, I can not live a normal life without it!", I promise I wont take it until absolutely necessary (which when out of my site is like, everyday according to the patient)  bla bla bla. Sometimes, the husbands send the wives in to get it...and they do the exact same thing, whine, complain, beg, lie....from - but this is my husbands standing order, and who and who said he needed to take it everyday, to please my husband will beat me if I dont come back with it...and then I find out, that he initially got it from a friend of a friend who shared some of his- ….OMG , but that is a norm in Samoa.

Honestly, the sweet little old lady in a muumuu suddenly gets all huff and puffy and angry when I don't prescribe these things, and the men just go bezerk...they pull out every excuse in the book like its a life and death matter and then give me the "I'm a Matai" look and just do as I say line..sorry bro..not gonna work- my policy is FIRST DO NO HARM....it is  most certainly not  a life and death matter...you walked in here without as much as a hobble...you don't need Dexa!!

Seriously, getting people off these terrible rescue remedies that lead to a continued vicious circle of attacks (and not to mention terrible side effects)  and onto the needed Allopurinol is just a mission. You'd think I was dealing with a drug addict trying to come off morphine or something. 

Thats not to say there aren't people who Allopurinol does not work for- like any drug, there are some who it doesn't work for, for whatever reason, as well as those who get bad side effects. But for a lot of people, this drug would really do them so much good if they only gave it a good go. 

I've made a pamphlet now, that explains it all. Prevention, treatment, etc....seems like when you give someone a piece of paper it seems a little more truthful then when it comes out of my mouth. I tell myself not to take it personally as I think many people think I am younger then I actually am (thanks for being vertically challenged! )  and so I guess are a little less trusting of a young doctor maybe?? Anyways...I've also had patients come in Absolutely gobsmacked at the improvement since starting Allopurinol. Like seriously these people did not think they could ever live normal lives again, and now can...so that is pretty satisfying. I just hope that more and more people learn about this and realise there is actually a treatment for this debilitating illness:) Thats all for now have a great week everyone!!

Things that have made me go hmmmmm....

As I write this , I am thinking to myself, hmmm...have I gotten over my hangover or not yet?? I can't really tell because I am a tad fuzzy and lightheaded and not really nauseas or migrain-ey...but maybe kicking my ass into gear and getting up this morning really helped:) We went to a small little get together with some good friends in Savaii last night. We almost didnt because we were both so tired from a hell-a busy week but told ourselves- how often do we really do anything in Savaii these days??  But it went on much later then we had oringally planned to let it go on til, and was an hours drive away from home so we got home well into 2am which for these two 30 yr olds who do 90 hour weeks...this was way past our bedtime:)

ANYWAY. So I woke up this morning and its my hospital day and thought- I am going to call in sick.BUT Ive been so slack in the last month and had so many days off my inner goodytwoshoes -always-wanting-to-help-others told me to get out of bed, wash my somos off have a coffee and a panadol and go to work. So I did. an hour into it, the other 2 collegues helping me in ED got called away and I got left doing OPD all by me weeself..me and the masses of grumpy impatient mingled with genuinely sick and dying but mostly all needy masses...just what I need to cure a hangover!

So in the last week- my daughter finished school. She had a prizegiving. She didn't get any prizes but she passed all her subjects- with 36/40 sort of marks:).  She actually sat an exam, actually  3 or 4 exams...with real exam papers with instruction sheets...she passed those...As much as a year 1 student  can. She is halfway there with her reading and can add  and multiply and knows all her shapes and colours. What more can one ask for right? Well, I could not help but feel like a tad of a failure. Seeing alot of relies and freinds FB pics of "first in year 1"...did actually make me look at myself and wonder if perhaps I had not done enough for my kids this year? Didnt spend enough time reading or doing work with them?too much work and not enough family time ? To be completely honest though what I think of more is that  I was a straight A student my entire life. From year 1 up. What I remember about myself is being rather introverted. I had a handful (and only a handful) of friends and did everything the teacher said. I never spoke back nor broke a rule nor perhaps even had a opinion of my own until I was in year 6 maybe?? I dont know  cant really remember , what I do remember is feeling like all my mum ever asked me was "how was school" and "what did you learn" and then we would go through this repetative monotomous routine of "fine"  and "stuff" and I remember thinking I couldnt hold any other sort of conversation with my mum  other then this sort. Then I remember the "do your homework" "you can do better" "listen /ask questions/ask for your books "etc etc like a drill sargent constantly pushing..it was a little suffocating ....

When my daughter started school I said I was not going to do the same. I would not be drilling her to do everything perfectly outstandingly all the time. I would have conversations other then about school and let her enjoy friends and the learning environment- the most important thing was to be wth other kids in a classroom because we have no other cousins  etc where we live while at the same time learning something. And that it was only year 1.....we'd get serious a little later. Now I am wondering if that was all an excuse to be lazy about it? perhaps I should have pushed harder. My daughter I think is surely the complete opposite of me. She is talkative and has a million friends including many of our guests at the hotel who have left. We've been told she is a bit effervescent in class and talks too much and runs outside alot and doesn't always do what the teacher says. Everytime I look at this girl she is giggling or laughing, she always has a sparkle in her eye and ...funnily enough, her hair even glistens coz she has some mean english-blood red/blonde streaks int here (all natural) which makes her look like this child of the earth and sun full of life and love. Im debating with myself now over whether this translates to - comepltely wreckless free willy type child evolving who I should be drill sargent-ing a little bit more...or wether this is fine..she is only in year one for goodness sake.

My siblings and I are a testament I think that success especially in school does not follow any one path. I was always in the top 3 places of classes right throughout my entire primary and secondary. Then went on to do well in uni and graduated and got an ok job. My brother on the other hand struggled in primary, he was always a 'concern' of my parents  and teachers a like in that he was 'behind' the others etc...when he got to secondary, it was like he blossomed. He started exceling in his subjects, went on to land top positions nearing the end of secondary then got a scholarship to NZ graduated on time and now has a pretty awesome job....so I tell myself that each is to his own path but I am sure there is a little more steering I will need to look at. Ok, just stroke your ego that way mmmhmmm:)

All the talk on rape and incest. Thank you Lani for your courageous letter and blog. I for one was in complete agreeance of everything  you said. What baffled me was all the idiots people who did not get that you were being sarcastic- and actually wrote to the paper saying they were insulted that you said to bite hard etc etc....like OMG. Annoyed the heck out of me but this is a real problem that needs real solutions. I can not imagine how many young girls lives are tainted by this sort of behaviour. If it were my choice, it would be a lifetime sentence ...for anyone with any degree of this sort of stuff. lock em up, make em work on maumagas for the rest of their lives  and never let them out. Ive seen these girls at the hospital, the ones who are subsequently left with an unwanted pregnancy, whose families dress them up to bring them to hosp for antenatal checks and will quickly tell you of some loving family that the baby will be given away too...they dont say anything about the uncle you see in the medical report int he file who did this to the 15yr old...and the 15yr old looks like  a walking zombie whos parents are trying to pass off as strawberry shortcake,...or mary poppins..or whose someone very happy and all fluffed up in a dress??thats what they try to do. It breaks my heart.  This makes me go hmmmmmm....

I went to my first Title Faamasinoga this week. If anything it was to learn a little more about where my children should know they came from. I wanted to listen and learn as I hadnt actually heard through any other means of the nitty gritty of our family.. Well I got a lot more then I bargained for because if anything it was bewildering. What Ive seen in the court is it sometimes mimics confession. Some of these people who greet you on the road everyday and share small talk with  who are all nice to your face...then get into the court room and suddenly its all emotions spilling like one sat in a confession booth- except that it is for all to hear!!- that person is faamaualuga and that one is fiapoto- you and you and you...these people are right there! staring at their family or their neighbour they had grown their whole lives up with...and now feel it appropriate to describe such bitterness that was never before seen??? Its Krazy stuff and I hope I will never have to participate as anything other then a keen listener trying to learn something about herself....I take my hat off to those that can stand there and take it with such poise and grace...that is something that surely comes with years of experience and patience.....something I am lacking at the moment!lol-mmmmhmmm

OK thats all for now cause I need to go home and spend time with the kids- til next time
ciao!

a long day at work..

I am pooped. And over the course of the afternoon, have realised that this uncomfortable-ness I have been suffering with, was a brewing urinary tract infection..shoiiiit...just my luck. As it was, I saw a patient with one and really wanted to say "me too!!" to her symptoms...but alas..I am sure that would have just been weird...right.

my rant for the day is-

The trouble with my job, is that sometimes I see people who I don't like. Some people just rub me off the wrong way, have eccentric personalities that I would not necessarily warm up to in a public setting (ie, you would not be my friend..sorry) some people are just plain rude, arrogant , and ignorant that I find myself squirming in my seat trying to hold back all my fiapotz moral teachings I want to slay this person with....instead , I am restrained to a "so what has brought you in now??"...SOME people are truly enemy-title worthy i.e took my parents to court -type enemy(!lol) who continue to bewilder me with even chosing to come see me...eh. Anyways, thats my trouble, my door is open to all and any. I am here to treat and help you get better and it would just be morally unjust for me to decline someone I did not like (even though I REAALLLLY want to sometimes hehe) , unfortunately I can not treat your manners, or your personality. Too bad for you.

The hubby seems to think I should or I could. Ie when someone really unacceptably rude sees me and I tell him about it- he always said "sa kakau ga e fai sa'o i iai" and goes all hype about them but the fact of the matter is- it would not be very nice for someone outside to overhear a verbal catfight in the office would it? Especially having a catfight with someone who is supposedly ill....now that is just not professional..so for professionalisms sake, I keep my peace and hold my tongue. But I always say, if you could hear me speak my mind (like truly and honeslty what I was thinking in my head) for a day  sometoooiiimes..(not all the time) seriously, it'd be pretty shocking.

You may be interested to know that my number 1) type of client...is..without saying names directly, a profession that would be profuse in Savaii. ie, every village has one, or two, or maybe three. They come in all sizes but mostly XL or XXL. You may be insterested to know that there are actually some size L and medium, but they are hard to find. I won't say exactly WHAT profession for fear of being struck down dead by lightening(!) but I am sure you get my drift.

So some of the rip-my-hair-out comments I have had to deal with in the last week with this certain kind of clientelle  are along these lines
"I went to see the specialist in Apia and they said I was all fine, but I'm sure there's something they are hiding from me, I'm sure I should be going overseas to NZ for treatment".....yea ok, why don't you just say you want a free holiday sponsored by Samoas medical budget
" I have no idea why I should have Hypertension and Diabetes, I know I am big but I feel healthy...I just don't get it and don't want to accept it" ok buddy, when you weigh 200kg, these diseases were invited, its called a disease  of lifestyle...just try to cut down the paelo loads of food...and exercise a little....if you start this trend, you are the key to 100 followers going in the same right direction.....

 Today  someone just barged in while I was just seeing someone out the door demanding to be seen cause he was in a rush...there's a sign on the door (which was the direct result of people like him!!) that says PLEASE DO NOT ENTER UNTIL YOUR NAME IS CALLED. This is because I need 5minutes to enter your name (provided to me a minute ago) into my computer and get myself organized maybe take a breather after back to back consults also I might need to nip out for a wee and don't like strangers in my office (which is an extension of my home sometimes) without me being in there....people just don't get it sometimes...apparently, I should work more like a machine/computer and just slug it until the power goes out....

Another earlier questions everything I did...ie "I'm going to start you on this blood pressure pill because your BP is too high, called XXX"- ARE YOU SURE THATS A BLOOD PRESSURE PILL?
then after my explanations BUT I TOOK A PILL BEFORE FOR CHOLESTEROL AND IT SOUNDED SIMILAR< ARE YOU SURE YOU KNOW WHAT YOU'RE DOING?- mate, Im not 5, I went to school got a degree worked for almost 10yrs before opening this office, you with your cholesterol laden eyes and tattood arms looks like you were a paugaka before you did what you do now and could use some of my health attention but if you think you know it all, please...don't waste my tired breadth..I don't mind keeping my suggestions for your health, to myself if they are not wanted...sometimes I don't know why people come at all(!)

Other times, some patients have really shocking backgrounds. Most of the time, it is not necessary to delve too much into what someone does, what they did etc we just need to know whats going on now and what other medical interventions they may have had in the past...but one time, I admitted a guy whos social history was a bit dodgey - could'nt really get a resident  village out of him etc...later on I found out he was a child molester in Apia who the village had banished back to his birth village (here in Savaii) even though he left at 2yrs of age  and doesn't have a house or family  here anyway...put him on the boat and he'd been hanging out at the wharf til a cut on his foot got infected....ae poo le a le mea e le o e ave i le ofisa leo leo ae just banish him to another dont-want-him-here poor island...for goodness sake...pe faavelvalea ea kagaka se..

So anyways, I've had a few days of this particular kind of clientelle day after day and what I have figured is that- it is immensly energy draining to put up with people you don't like , especially when you don't have a choice. Some of these people seem to really like seeing me and they come ALOT. Either they like seeing me or they think if they see me more often they will live longer...?? don't know so maybe what I need to be doing is- be less nice...especially about telling people they have an over-eating problem - who knows, ae ke'i lava le writer lea ua fula le maka mai se sensitive patient!!choohoo....

My "eh" story for the day!

So, for the last 9 yrs of my life, I have always exclaimed I have a love hate relationship with my job:)  My profession or my career as some would say ( I always find that an odd expression for me as I envision "career" as this thing that you are working at , and striving torwards some big aim (i.e to be the boss!) ) whereas for me, in many ways I feel like its just this thing I do, and I try to do well. I am not sure what the big aim is, I guess maybe the aim is for it to serve its purpose in my life and make my some tralla to make me comfortable?...But perhaps I  should have picked a different career path to get to that end point sooner and maybe lived on another island, located in a different part of the world -ANYWAYS. So for me, the last 7 yrs have seen me and the job, evolve to say the least. The work and the lifestyle has been a rollercoaster of on call, no breaks, having kids, part time, full time , overtime, and now - my own time. (or dreaming of it!) lol....

For now, things seem to have evolved to being more in my control with the clinic. I set my hours, I chose my days off...that is kind of cool..except when it doesn't quite workout  that way. Take for instance yesterday. Yesterday the sign on the door says 5PM CLOSED. I have been there since 8am and I am tired. I want to go see my kids, my sitter is waiting to go home, I am hungry because in actual fact I had people to be seen right through lunch and beyond, so now I am hypoglycaemic and grumpy. I stay behind another 30mins to try to catch up on some paperwork. Almost an hour after the office is closed I leave, laptop bag, and an extra kagapepa of books I hope to read in hand weighing like a tonne. As I am walking down the path awwwaay from my clinic. A car rushes up..this car symbolises every other person in Savaii as of late. A couple get out and eyeball me..the conversation is along the lines of "uhm, where are you going? we are here to see you!"..the answer is- oh? really..so sorry the clinic is closed, ga kapugi i le lima, le ua ka le ogo. - reply- total disregard of what I said- hop out of the car and hobble over, husband and wife hand in hand- awaiting me with a look on their face that say "well? open up" I explain again- I am closed now- so now they play for excuses, "oh, really, ok well can you just explain bla and bla...we saw you last week..bla bla bla..e vave ah..bla bla bla"...ok lady, I have like 500 people registered here now and frankly..cant remember what I gave you and what bla and bla was for. In the end, had to open up look for their file to sort their misunderstandings out and then come all the questions about why they are sweating and why they have a headache etcits a consultation by force... all the while,me-  very grumpy, cos the receptionist has completely miffed the filing system I showed her to carry on and can not for the life of me locate this persons file number, and in the end just go commando and try to guess all the things done from last week.

The couple , obviously seeing my disappointment with the hour of their arrival, shove a $10 at me with apologetic nods.. and gestures to 'take'the $10 awaiting some sort of thanks....to be honest, I could not give a flies arse for another $10 now, my sitter is pissed cos she has kids and a family she is late to get to, and by the time I get home everything planned is delayed an hour so I might as well forget about any reading..cranky cranky pants alternate personality coming out is not winning me any brownie points as now I am sure they are gonna go spread how sour I was looking the whole time and how unprofessional I was  ...eh, faiaku a foi.  To make matters worse..the man had a nose that was dripping on my floor, so I offered him a tissue having not seen one on him (which of course he blew his nose profusely on) and after they left I found it, scrunched up on the floor, 2 feet away from a very visible red rubbish bin....r u serious??Last week - it was SAME scenario with another couple except they called my other half and played the Matai card and I was 'obliged' almost to open for them...only to honestly pull my hair out about the nature of their visit (I had thought it was some urgent emergency or something) ae leai, faimai ga fai le kalagoaga ma le lakou aiga, kau ia a'u and they didn't know I had a clinic here, omai ai lea e fai se siaki...ARE YOU FREAKEN SERIOUS! It was open all day but still..the lemafaufau or sorry, grand treatment ..for- who are you again?? laga ua kupu uma kagaka gei aso

This is the mindset of alot of people lateley and  it will stop. Because lord help me but the time for being oncall around the clock for all ye patients for me has freaken ended. That is why I have gone out of me own and ended my time a the 24hour centre called "the hospital".... Sometimes, I don't mind if its a genuine emergency/worry/concern from a patient I am well affiliated with/related too/good friends with ...and people ask nicely...word to remember is -nicely. Because the saying stands true that you treat others like they treat you..and not treat me like I am your servant- Open Se-sa-me type shop..nope not da way it works....whenever you want, whenever you please.

Don't get me wrong, its not that I am uncaring and unkind, its because I have a family and I have a life. And I only have 2 arms and 2 legs and I have to decide how much I can constantly be giving out, when I am being given (whether by choice or by force) constantly to patients patients patients...something else misses out and more often then not its my family. I've already lost some of the most important family in my life and regret deeply some extra time that was spent on the job just prior...so now its called priorities.  Unfortunately sometimes drawing those lines and those boundaries can feel like a slap in the face to others, but honestly, there are other choices for places to go, and those places and set up to receive round the clock calls. 

Anyways- take home message for me is- get a back door so I can run away without being spotted and stopped:)


ok, rant and rave for the day...now I need to go take a chill pill ke'i ua stoke se faiai a seisi!!

one day Visa

So I got a one day visa to visit the mainland last Friday. An unavoidable fono I had committed myself too and some empty shelves dying for stock in my clinic meant that I had to go. And leave the kids and hubby behind much to their dismay! 

So, in the usual Savaii style manner, my Friday was the expected  panic stricken crazy hectic rushed sorta Friday.  Down to literally 10 minutes before the boat was due to depart, I am still in Lalomalava trying in my most polite and non rude way to break a conversation between the hubby (who was meant to drive me to wharf) and some diginitories..... Sat in the boat and realised had not organised a ride into town and debated whether I would dare try a bus (after all the commition lately with buses and accidents, and an already sceptic views of drivers anyway..this was sort of not really even an option!) Luckily, I found a seat in a hospital car (yay) and made it safely home.
Had to rush off to my meeting at a hotel in town only to arrive any hour early...( I thought it was at 5...but no, it was at 6) which meant I got to go and kill time at Amanaki (!yay) Which meant I got to enjoy a cold beverage some Poke and limu yum!!

Literally 24hours later from that moment, I am back in Savaii and I look back at the 24hours passed and it cracks me up what a contrast of lifestyles I just blitzed through!

One moment, I'm haggling vendors for cheaper fruit and the Salelologa market, debating with salu lima makers over the prices of salus going up when the number of kuagius in the broom are going down  and scouring for Limu that I used to hate, and now I love!. Not to mention, chipped in my senes for the collection of da mafutaga o tina for whatever it is we are fundraising for (financial member only!) lol...then next I am sat in an air-conditioned bar which has been sealed off for our conference, we are being served wine and cheese with a room full of highly educated and motivated personal and of course my current lifestyle in the bush is even discussed as a topic!lol... fly forward to the next day and I'm rushing around Apia town trying to get all my shopping for da big island done. And the only vehicle available to use is my little brother's homey G done up skyline.

 Now let me explain this car to you. All my shopping to my disgust, has to be squeezed into the passenger seat because although the car has a sizeable boot, 95% of this space is occupied with a speaker. The very high tech sound system that compliments that has a list of MP3 music which I do not recognize (techno?RnB? I can barely make out the words being sung all you hear are base and treble tweaks the whole time! is this what the youth of today are into!! I feel very old...) The drivers seat is purposefully about a foot lower then a normal car should have, so that I feel like I am sitting on the floor , honestly with my legs lying flat on the ground (without a bend in the knee) to reach the peddles.Its awkward, who drives like that?? The car itself is only about half a foot off the ground so I feel like I am literally sitting on the road, Im sure it was higher then that when I first saw it, but I think lowering your car until you hit all the speed bumps you go over in town is the in thing now !lol

 Only about half my head can be seen outside my side window which means alot of people I dont know wave at me, I think my brother and I share the same shaped forehead so I do him a favour and wave back enthusiastically to all wavers which I know would be strange as my brother is more of a furrowed hermit!  The music when only on volume 2, is shaking the vehicle. I can not tell whether this deafness by the minute is a result of the music or the muffler which can still be heard when the music is switched off!! I can not help but feel like everyone is staring at me and its a tad amusing but mostly embarrassing and Im just glad I can not be recognised! .Coz I am really not this homey-G-ish! lol! And in my rush to get home when I realise I really needed to be halfway to the wharf, I cringe the whole way because the muffler explodes (not in a broken way, but in a purposefully amplified way!) and now the whole damned town and oncoming traffic is staring at me!! errhhh

Such a contrast to the horseback riding in the bush! (not!)  but you get what I mean. It was nice, the change of scenary, change of people. change of ware...makes me appreciate the little things in life all the more.

So anyways, back now in Savaii ....back to the grind back to da bush. Until my next visa
ciao

6 month mark

It is now June and I have just realised that I am averaging about one post every 3 months! Pretty slack of me aye! But I guess life has gotten in the way (!) so many things to do , so little time! Sometimes I wish we could have 7 day weeks (yikes!) But then 5 day weekends (wuhoo!)  Unlikely but one can always dream!! At this 6 month mark of the year, I look back and eyeball what I have done with my life. Having re-read my December (sour) post I think I can say I am not wallowing in that boat at this minute! I think December is always a semi-somber time for me because its always low season and crunch time at the hotel where we make all our losses, (!) haha.

This June, My sister is at the forefront of my mind because 4 yrs ago almost exactly, my 24 yr old sister passed away in a tragic car accident. I can not speak or even write about her without getting all choked up because the experience of losing her is still so raw, I can remember it like it was yesterday. The worst of the many snippets of the long memory are remembering that she had asked me to stay behind in Apia, but I decided to come back to Savaii anyways because I had to work the following days and did'nt want to rush back on an early ferry. Then remembering the call I got in Savaii at night from my mum wanting me to pull some strings and find out what had happened (they were in the waiting area of the hosp) And then being told her pupils were fixed and dilated. I don't think these memories will ever fade or become any less painful.  When they pop into my head they are like someone had just whacked my chest with a baseball bat, and when they are not there then they are not there.

This June I am 3 months into opening my clinic. This was something I have wanted to do ever since I got to Savaii. GPs are practically non existent (there is only 1 on the island) and the hospital is always busy with long waits and you just cant do any preventative medicine or educating because there is always a brood of patients staring over the back wanting you to hurry up and get to their number. I can happily say things are completely different at my clinic. I spend alot more time with my patients and it is almost an everyday occasion when at the end of my consult, someone thanks my for explaining their chronic illness to them. For years they had just had repeated medications given and they had no idea what their illness was. Its always nice to empower people with the knowledge of their health and I do find that people take care of themselves better when they understand whats going on and why they are being treated.
It has still been a bit slow and there are still days where I see no one (!) so there is still no trallas coming in just yet! Whoever said that doing medicine would make you money?hehe!  I know I didn't help myself by not having a sign up for the first month and a half!!

It has been interesting none the less. One GP said it very well when he said the concept of a private dr/GP in Savaii is still very new and alot of people seem timid and shy when they come and are confused about payment- some offer me their pensions and ask if I can charge the hospital because the hospital sees pensioners for free!!lol

Some classic ones were -

Mr M from a nearby village comes along. He says his wife saw me and I "fixed" her , she had troubles with her tummy and is over the moon that I had sorted it out. She was so impressed she insisted her husband came to see me . So I question - Are you ok? is there anything wrong?
answer- No I am fine, I am fit and well have a plantation that I work on everyday , Ive never been to hospital before
me- So do you want to general check up ? or was there another reason your wife sent you?
answer- no I dont need a check up because I know I am fine, Ive already had my blood pressure and sugar done and they are normal I am well
me??
him- well actually there was a bit of diaorhea, it was profuse and went on for a few days
me- When was this?recently? has it resolved or are you still suffereing from it?
him- No its gone, it was about 2010 that that happened, for about 2 days, I think it was something I ate...
me- Oh ok, thats good that it has resolved (!) was there anything else that you are worried about regarding your health?
him- sometimes, I get headaches, they usually last about an hour and its always in the morning
me- oh ok, have these been occuring more often do you think ? are they associated with any other symptoms and what helps it to go away?
him- 2 panadol do the trick, but yea, I dont know why I would get one, this was about lotu tamaiti time last year....
him- also I get an itchy heel sometimes, theres no rash on anything , its just an odd place to get an itch, if I scratch it goes away, it was January I got it a bit more often when I was doing work in the wet grass...but I dont get it anymore, but now  thinking about it, funny place to get an itch aye?
....the conversation went on and on like this before I pronounced him fit and well and healthy and gave him some panadol incase his headache ever came back again.

The next week, I saw his wife again "You know my husaband came last week, and those pills you gave him were magic, they have made him feel so much better thank you for seeing him"

Se makua kaufaasee kele tagata se!! :)

I've had a few Matais come in who spend the first 10 minutes rolling out the formal Samoan greeting (to which I am a lousy reply-er!!) I've had a few people rush in with minor emergencies because the Sapapalii river ford had burst and they could'nt get to the hospital (I hope the man above helps me out and doesn't send me anything like that , that I would not be able to help because I am not set up for emergencies!!) People that have brought their elderly on their mattresses because they can't walk and don't have wheel chairs and lay them on the floor in the front where the  store area is...and Ive had to examine them like that (!) ...
I can not say it has not been interesting because it has:) I finally got my car after 4 months of waiting and shes a beauty, nothing flash but drives so comfy and well...I love her...I just hope she doesn't become the bum car running the hotels errands...(!)

So thats all I have for now, until my next 3 monthly update (LOL) take care and ciao!

Patience

Patience

I must admit, I have never been a very patient person. I didn’t realise I was such an “impatient” person until not very long ago when someone pointed out that I have a tendency to ‘interrupt’ people in conversation(!)  I don’t do so on purpose at all and infact was horrified when I watched myself on a family film once!! I think if I look at myself now, its more like “finishing off what people say” because I already know what they are talking about and they are taking ‘too long’ to get to the end point(!!lol- what a fiapoko  and impatient one aye!) Its mostly my own close friends and relies I do this too though, unconsciously and not so much random acquaintances.(so I know they forgive me because I LOVE them!!thankyou!! hehe) Yes I can be very polite and courteous, I think its when I am too much in my comfort zones that ms impatient dr jekyl my hyde comes outJ

Since getting married and living with the hubby and having kids, I have really had to learn to dig deep and work on my ‘patience’ skills. Its hard to know looking at myself whether I have managed to improve on that front but the hubby says I have. At work thought it’s a whole different story! In my line of work, at the public hospital, sometimes I simply don’t have time to be patient. When you  have 10 people breathing down your neck waiting for their “turn” sometimes I need to cut through to nitty gritty and stop people from exclaiming a million times how they have an itchy armpit in so many ways (at night after a shower when the wind blows etc etc) I just need to look at it, I get that it itches. I do try to do so in the most polite fashion possible but I have been known to literally put my hand out, and stop people midsentence (talk to the hand! Jks..nah when they just wont stop after I have asked) However , I swear some days my limits are tested to the MAX. I swear to the man above if another mum brings in her teenage daughter to complain that she is lazy  in a million different sentences while she (ms princess) sits there chewing gum and texting her friends (couldn’t care less) I might just have to fukislam someone…as a treatmentJ  Sometimes I waste 20 minutes of my breadth trying to find out if by lazy then mean sickly, unwell, is lethargic  etc only to discover that no, she  or he is just plain lazy and doesn’t ‘want ‘ to do fe’aus etc… but she is certainly “NOT SICK”  they are healthy, I might just have to prescribe get the h#*ck out of hereL OMG…people please don’t expect the Dr (or the teacher for that matter) to sort out your hormonal kids ahhhhhhhhhhhhh. I have no skillz for that except a look that says WTF

Other things that test my patience….. crying kids who are very sick whos mum sent them in with a neighbour/housegirl because she is busy at work/shopping/at a faalavelave…are you serious…I wish we had cyfs here in Samoa…arrest them all I say (!)

 People who come and exclaim they just need a prescription but they don’t need me to check them over because they already know what they have , the fofo said it’s a “toalamumumatesilailugamuli”

Fofos who rush patients to the hospital literally dying or recently deceased (giving us next to 0 chance of helping them) and then proclaim loudly outside with the gathering of mourning family that it was the hospitals fault (uhm can we pass a law please to prosecute these people??)

OK..need to stop there because I can feel my blood pressure rising.  Lately I think Ive been impatient because I have felt helpless a lot. I thought once that I cried a lot because I was hormonal, hello my youngest is turning 3 soon so I think I am way out of the pregnancy post preganancy hormonal excuses. Now its just too much emotion. You came too late = cant help you. You chose not to return before = cant help you. You couldn’t be bothered and threw away your medicines= cant help you. Your child was low on your priority listas you had too many faalavelaves and got sick= cant help you.  People, the first step to the new improved you or your kid, is to take accept that you must first help yourself (or your kid) . And not help yourself last . A family rushed in with a kid today with a football of a boil on his tiny little thigh.Obviously he is was in a lot of pain. He had written across his thigh  with a marker “IESU”…(ie this was the treatment he was getting the last few days ) last time I checked, the man above was not giving out miracles. He was also not at our beck and call and we can not command him to ‘fix’ something.  I do believe, that it was with his help that Medical people do what they do. I know I would not have survived medical school without him and goes the same for many many other medics out there. They do what they do with his help because of  a passion to serve. To help other people (or at least most do or should do!!) I do believe that through us his work is done, and people should start realising that.  We are not Aliens or Atheists…

Ok, I should stop now pei ia ua off on a tangent le mea le ua ou alu I ai!!Ok, ive got my fingers crossed I get the mothers weekend off away somewhere nice!!Til then CIAO(myrantandravefortheweekJ )

I love this..

Came across this on a friends page-- sometimes, I cry when I'm stressed or frustrated, I feel a little silly after and tell myself its all due to hormones and over reacting...but after reading this, I feel a little better about myself and my 'reactions'lol - i.e I must not be ablone, and look at the awesome reason women cry. Screw men who dont get it haha!! xoxo


A little boy asked his mother, "Why are you crying?" "Because I'm a woman," she told him.

"I don't understand," he said. His Mom just hugged him and said, "And you never will."

Later the little boy asked his father, "Why does mother seem to cry for no reason?"

"All women cry for no reason," was all his dad could say.

The little boy grew up and became a man, still wondering why women cry.

Finally he put in a call to God. When God got on the phone, he asked,

"God, why do women cry so easily?"

God said, "When I made the woman she had to be special.

I made her shoulders strong enough to carry the weight of the world, yet gentle enough to give comfort.

I gave her an inner strength to endure childbirth and the rejection that many times comes from her children.

I gave her a hardness that allows her to keep going when everyone else gives up, and take care of her family through sickness and fatigue without complaining.

I gave her the sensitivity to love her children under any and all circumstances, even when her child has hurt her very badly.

I gave her strength to carry her husband through his faults and fashioned her from his rib to protect his heart.

I gave her wisdom to know that a good husband never hurts his wife, but sometimes tests her strengths and her resolve to stand beside him And finally, I gave her a tear to shed. This is hers exclusively to use whenever it is needed."

"You see my son," said God, "the beauty of a woman is not in the clothes she wears, the figure that she carries, or the way she combs her hair.

The beauty of a woman must be seen in her eyes, because that is the doorway to her heart the
place where love resides."

my 10 sene

Its been a crazy (is it not always!) last few weeks- been trying to  finish a hug project but now down to the last few things that I have no control over...and going nuts at the lack of progress. note to self- remember where you live, yes, you are in Samoa and snails pace is = Samoan pace...awe shux.

anyways, I have decided, that I am a Guru in how men should speak/act- if they just acted the way we women wanted life would be all bees and honey wouldn't it?? But Ive discovered that men really are from mars at times (well a large part of the time) and women from venus.... After years of being married to one and courting one (!) I have compiled my notes and now- since I cannot bestow advice upon my one, who is set in his ways bless his soul, I am going to give advice out (for free!!)lol  to all other possible future ones out there, who may just happen to need extra tips on being da bombest man eva.

1) when a woman asks you to do something, don't ever just nod your head and say yes, and then not do it, or proceed to forget you said you would do it. This will result in the boy who cried wolf syndrome, and you will lose trust wit yo woman. If you say yes, put a date on it, say when you actually will have time to do it, and if you need a reminder, ask your woman to remind you at a precise time (i.e the morning of, or the day before) so that when she happens to remind you, she does not have to suffer the complex of feeling like a nag especially when you huff and puff about not having the time bla bla bla...we can say "well you did ask me to remind you" and not have to feel bad...

2) Be courteous and conscience of 'time' ...for women but mostly for mums and especially working mums - time  is all mapped out. What we are gonna do in the morning, when we will have time to wash our hair, when the kids  need to be put to sleep how much time is put aside for work, family, washing,chores, etc. So if you just happen to be the driver on an errand with your woman and you happen to see 15 people you would like to say hi, stop and chat, catch up with local goss ( cause admit it, men are worse then women at that!!)  do keep in mind that your 'not enough time' woman, is really holding her tongue back from lashing out and yelling "hurry the $#&*~! up"....we really are, and we swear alot..in our heads only! Learn to end the conversation, two men talking sometimes is like a dog chasing its tail, neither has the heart or knows how to just end the convo...especially with a "look Im a bit pushed for time right now"...just do it. Women do, we even almost have secret nods of understanding- quick catch up then a "oh hun Ive got to go pick up the kids now" type nod which will usually be responded with a "awe girl, you hurry along I completely understand!! hope you have time to have a decent shower tonite!!" type nod...comprende

3) if you decide you would like to take your woman out on a date. Be it a cheap lunch or drink somewhere. Your woman will interpret that as you would like some you and me time with her. What that means to her is all focus  on her. Do not go on to discuss genealogy with the waiter, discuss business with an the bartender..discuss weather or sport or anything for the matter with anyone other then her. That 10 minute conversation you just had all effervescently  with the waiter will remind your woman how long its been since you had an effervescent conversation (like ages ago ) and she will also feel like everyone else is more exciting then her (or you are so bored with her) that you had to spend half your date talking to someone else.You just lost all your good points with that right there.

4) women are very conscience of the word 'nag' so at all costs save yourself and don't ever bring the word up. Try to realize that all our gentle reminders, help to get things done..around the house, in our lives, in the business (if you happen to have the luxury (not) of working alongside your hunnybun!)  And we don't exactly have very many other people to turn to, unless you would not mind your ego being trod on when we hire some handy man to reinsert a screw or two around the house...yea not gonna happen aye? So be patient, and sometimes, just sometimes, say "oh hunny thanks for reminding me about that"...trust me..I don't want to remind you anymore then you want to hear me remind you...but that leak aint gonna fix itself !!

5). Sometimes, ask us how our days were, and how we are feeling, just to break the monotonous routines we all sometimes get into. Especially when work is on the grind. And when you are asking questions, be prepared to listen, and then throw in a sympathetic comment, or two. i.e "awe that sounds terrible" "shux your day sounded disastrous poor you",... a nod and a silent "mmm hmmm" is a crap  response- just listening is not key, showing that you realised what we went through is key.   We will just feel like we spilt our souls out and you just mm hmmd it...sometimes, all we want is a pat on the back or a squeeze of the shoulder... you can do it in words and in gestures (that does not include sexual activities)

6) Learn fast, that women are talkers. We are expressers. We like to share our feelings with our other halves, and be understood.  The key for you, is knowing how to understand your woman. Sometimes, we will rant for hours because we had crap days...sometimes we will go on about all our problems...do not attempt to offer your solutions....they are not needed. Most times, we know what the problem is, and we even know the solution, its just the shit in getting there that we are ranting about and what we want from you- is support and understanding of what we are going through. as per before- squeeze her shoulder , express your understanding - tell her she is doing a good job or agree with her that so and so are shit(even if they are not) - ranting is sometimes us just calling for your shoulder to lean on...your "well  you should have just closed it" or "why didn't you just tell them to shut up" matter of fact replies were not what we were after, in fact, they are miles from it and you will deflate your ranting women into a small pile of palapala when you speak to her like that.  you are soul mates not business partners...

7)Say sorry when you know you are in the wrong. Apparently experts have said the two most difficult phrases to be said  amongst humans are  " I'm sorry" and " I need help"...sometimes, a small little I'm sorry makes all the difference. The "ok I see I was wrong" is not really an I'm sorry..and saying you are sorry DOES NOT mean you are giving up your manliness or giving in to some unspoken demand that you have fabricated women have...it is not accepting defeat in world war three...its a minor complication in the huge spectrum of life..that a little sorry would make all the difference to a lovely rest of the evening, or a shit rest of the week. Decide and bite the bullet...we have no problem saying it- lets be visa versa when it comes to sorry.

8) Don't speak to your loved one in the same tone you would speak to your employees with. It is belittling, and unloving. We take ages to recover from it, and we have given up trying to tell you how it results in avalanches of miserable thoughts and feelings in our head. Don't do it, respect each other and hold on to that respect. If you go down that pathway, there is one exit and its miserable...keep the peace and keep the respect. you are meant to nurture your love and make it grow. Not beat it and see how resilient it is....

9) all that cliche stuff about surprising her with flowers and bringing her gifts...do it. Even if we say we don't mind (that you forgot a birthday or anniversary) or we claim that we are not high maintenance and don't need gifts...women are in need of loving nourishment and this is one of many ways you can do it. No we know we dont need it..and to be honest, I could make myself forget about it, BUT  at the end of the day, we are the estrogen and you the testosterone. One is all muscles and the other is fluff. Fluff likes to be fluffed...fluff her up with a present a flower when she least expects it. You will make her day and her week. Keep it simple  it doesn't need to be shiny and glamorous...it just needs to have your loving stamp of thoughtfulness on it..we love it, sap it all up:) And brownie points to you

and 10...
Hmm..what is 10. Remember, that at the end of the day. We all married our best friends (well we think we did, and maybe some of us didn't woops!) friends have fun together. Laugh, enjoy each others company. Go out, have a coffee together, watch a movie..watch a sunrise or a sunset. Steal those 1hours without the kids to just sit in each others presence and arms and enjoy each others company. Make each other laugh, joke, smile, be dumb together!! If you cant do that, that what sort of future do you have in store for yourselves?? We need to be happy, and sometimes, that takes a bit of work, a bit of understanding. Its not all fireworks and sparkles forever like that first kiss...no, it changes, but it grows and you grow with it. Nurture the love between the two of you and don't take it for granted.

ok...das ALL on da advice for the week:) til next time- love Dr signing off right thur...

Note- non of the above advice is specifically directed at any one or particular man. Mines in particular is awesome awesome and this is most certainly not directed at him. We may have been through a few of the above humps but we got over it, grew learned adapted and loved:)