Things you can't see

This week, I've had a rollercoaster of experiences over things you cant see. Some my own, some of other people. In my job, often I am a listener. I think its important in a job where you provide a service, to be a good listener.  So I have been listening alot to people that have been suffering, but they suffer from things you can't see. Funnily enough, Ive been experiencing this a little myself. I have found myself the unfortunate victim of a symptom called "Tinnitus" which is basically a ringing sound in your ears. Like, all the time. Its kinda really annoying when trying to appreciate the stillness of the night, the quiet, the full moon, the stretch of black water...and then this darned ringing like someone has a high pitched radio stuck on no station just going EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE.
 You get my drift.

So, this week Ive listened to people who have things in their eyes (blurred vision aching eyes), their heads (pulsing headaches and migraines) , some depression and even morning sickness! And its made me feel a whole lot of empathy for these people who have these things that you can't see. You look at this person and they look absolutely fine, a picture of good health really! And then, apparently, they are sick. And the most dissappointing part  about what they are feeling is that no one else understands what they are going through, and are even getting annoyed with them. Basically if you can't see something, its hard to understand the nature of whats there. Its also hard to empathise at the right time, and support people who have (ringing in their heads and nausea left right and centre) ....I can see why someone with a not so obvious symptom, could easily fall into depression. Unless you have a really caring on to it support person who ASKS you how you are ...its easy to feel ignored and left to suffer in your own silence.

I try to encourage these sorts of people to bring their support people, their other halves, or a sibling in with them. Someone who you can reiterate the nature of the problem and the severity of their ailment. That does not always happen and this is not always an ideal world. heck, even I feel like that many a time, but sometimes I think my other half is too mechanical with his way of thinking about life. You have a problem, whats the solution, right you're on that tablet huh..the end.And I don't think he is alone in this mannerism. I think alot of people (men) are like this.... and sometimes it is our job to (knock some sense into them ) tell them about whats going on and what you need from them (eh) I am also sure alot of medical people fall into the trap of everyone expecting them to 'treat' themselves as it is our profession- and that includes, nurse oneself and ask oneself how one is. (!)no need for anyone else to ?interfere.  
Not trying to go all Dr Phil on you but in a way I am so too.

Anyways, so just a word to my friends, if you know someone that has something, that isnt like a broken leg in a cast, make the effort to remember and ask- hey hows that _______(insert symptom you heard about in the past but can not see) Because I think human nature makes us look at our friends and family and partners for empathy/sympathy as a way to help get us all through any sort of suffering. And many types of suffering are unfortunately silent.

Adios people:)

My top 4

Top 4 meds that Samoans will sell their souls for.

Having to constantly try to win an uphill battle with an enourmous number of patients, has left me a little flabbergasted to say the least. It seems for every 1 person I try to educate, 3 more don't have the time to listen. And so, in lack of any other brain destressing excercises to deal with this little everyday frustration, I have devised a list of top 4s. For all ye future medicine seeking bradas (and sisters) yet to experience the wrath of BMIs >35, old age, smoking and drinking too much !lol

Sitting at number 4 is- Fualaau Sela, aka- Ventolin tabs.
 I dont really know what it is with our people and this aversion to using an inhaler. A patient will happily sit in front of me and debate that -: they dont have sela (asthma) but uhm...why are they requesting ventolin tabs?? (i.e 20yrs of shortness of breadth and wheeze but they feel that if they admit to the diagnosis the inhaler is automatic) so they will sit there and describe symptoms of cough at night and shortness of breath but deny the obvious diagnosis. Then we go through the whole dilly dally of trying to dispel their beliefs that- the inhalers make it worse....trying to convice them that- the tablet and the inhaler have the same basic drug in it.... that it is better to deliver the drug straight to the diseased organ rather then your whole body... bla bla bla. Often after this whole excercise, I get some ooohhhhs and aaahhhhs and then a smile and a, "well can i try to the inhaler next time but now I will just take the tablet thanks"...like I even gave them a choice (tired much??) Not that there is any harm in giving a ventolin tab...its just in times of emergency you can give yourself multiple puffs of your inhaler whereas you can't do that with a tab...so yea, I kind of worry about those times...being so far away from the hospital...and having something on hand for those times of emergencies...anyways I can only advice thats all...

Number 3 is antibiotics...namely amoxycillin and flucloxacillin
Pneumoniaes and boils. Maybe one out of 3 times, you might have the mentioned, but many a time, people just have simple viral infections or wounds /cuts that could do with a little cleaning and care , and  do not yet need  an antibiotic. But my frequent flyer customers will often pull out all the whole dramatic fiasco of why they need antibiotic "oh my cold started this morning- and my nose just wont stop dripping!- and I know every time I take amoxy my nose turns off right away please really  this is all I ask of you, its a simple request- the pharmacist usually just gives it to me everytime I ask, even they know my nose well "
 Really ? man I want to know where you get your amoxy from because even though it has absolutely no nasal drip stopping properties, any med that can do it that quick whatever it may be should be made known to all !   I am constantly fighting  an in-my-head save the world battle with the overuse of unneccesary antibiotics.  Sure I dont want to miss anything but at the same time dont want to add to the ongoing plight of antibiotic resistance ever growing in Samoa- most people will now know the name of the antibiotic they think they need, most wont know about MRSA and other organism resistance which is brewing in Samoa ( note to readers- in Auckland they have isolated a strain of resistant bacteria known as  the "Samoa varient of  multi resistant....bla bla bla"- otherwise known as the resistant bug that came from us...hmmmm think a minute next time you offer that friend your 'leftover antibiotics in your fridge' )  When I dont perscribe antibiotics, I am often made to feel like I did not give patients their moneys worth...that being said- I always tell my patients to come back if things dont get better or get worse in a few days. Most of the time , they never come back- so I think they either got better without needing anything just as I had said , or they  just doctor shopped along to the next place that gave into what  they wanted haha:)

Number 2 is gonna be Voltaren.
Fuala'au ponaivi aka fualaau gugu. Ive spoken about this craze before. I dont know who decided and came up with the samoan terms for medications, but I wish "fualaau Gugu:" translated to a drug called Allopurinol and not Voltaren (or Naproxen for that matter). Unfortunately, for  a population of patients who learn very little about the human body and disease, Voltaern surely must 'feel' better then Allopurinol and so one goes on how they feel. Take the former and the pain goes away instantly  the latter is meant to decrease uric acid which helps improve gout slowly over the future months  after taking it religiousloy (ie it is meant to be preventative) ..unfortunatley the latter process can still be littered with episodes of excrutiating gout attacks  and so people who do not understand wholy what this drug was for, get disillusioned and give up. I am constantly being approached by people asking me if I have Voltaren at hand. Most of the time, they are not even seeing me as a patient but just asking me over the counter and out right...as if I would just dish it out if I had. What they don't realise is I have a recurring night mare of all the people I have seen with Gastric bleeds from Ulcers. Ulcers that were caused by years of Voltaren abuse (and no sign of Allopurinol anywhere!!) ....What people dont know is how difficult it is to treat an active GI bleed without having gastroscopes available in Samoa. What people dont palpitate over (like me) is the vast open sea that seperates where I live from where the main hospital and surgeons and more intense help is available. People dont realise my nightmares because they dont know any better. I wish I could given them a snippet of the movies going on in my head, rather then try to convince them about the risks of their risky pill popping behaviour. The Facts are- Voltaren increases your risk of GI bleed from 1 to 4. A Voltaren addict is 4 times more likely to develop (and maybe die) of an ulcer then your average Joe. Other interesting facts??- Brufen increases risk by 2 only (all NSAID class meds have a risk but there is a ladder) Naproxen is even worse coming in at 9.2 X more likley (!! Yikes!!) Yes folks...lets go easy on the orange and white tablets...and lets all start to befriend Allopurinol.

And to top my list at number one, its Voltarens best Friend- Dexamethasone.
I had never really heard of Dexa apart froma  few mentions in pharmacy lectures until I got back home.  Where I trained and previously worked, everyone was always so conscious about the use of steroids (Dexa is a steroid) . Steroids are a potent anti inflammatory and if you look up the uses of Dexa you will quickly find literature on it being used for "Rheumatoid Arthritis ( a life long and sometimes severely debilitating illness) Bad asthma, Crhons and cancer"...all of which some form of severe suffering warrants its use. For everything else, there are less potent steroids which should be used spppooorrraadddiicaly throught out ones life. In Samoa, Dexa is popped like candy. Seems like any little thing and its - Dexa to the rescue. So much so that patients now counsel other patients and the word in the village spreads like wildfire about this wonderful little white magic pill. People have bottles of their own supply from goodness knows where...and they all seem to have the same moon facies, humped backs and stretch marked stomachs...hmmmmmm I wonder why. The problem with this drug, is it is 26 X stronger then the naturally occuring equivalent in the human body it is meant to replicate. It is 7 x stronger then its much more friendly and smaller counterpart- Prednsione. Being stronger although will make one feel better in the short term, in the long term has terrible side effects. Such as  the most obvious being- an immunosuppressant or "suppresses your immune system" in layman's terms so- makes you more susceptible to other diseases/infections- next on the list is  osteoporosis (brittle bones) - kinda ironic given people with gouty arthritis are the ones popping these....High blood pressure, fragile skin and Cushings syndrome (which is what the whole moon faced, back humped combination describes) Unfortunately we are not really good at testing for this as we dont test for hormones in Samoa.... so alot of the side effects and bad effects just fly under the radar  and people just then end up living with all these other things. My issue really with such a strong drug is how relaxed people are with using it. Something like Dexa should only be used by a doctor for a short time and with monitoring and ongoing advice. Unfortunately my fellow Samoan has discovered and enjoyed the relieving short term effects of what I like to call - the "superman pill" that cures all ailments (with a price to pay) . For some, I guess the relief of pain is worth the side effects.  For others, they simply do not realise there are less side effect induing ways to treat their ailments- many patients would have jumped 4 or 5 rungs on the ladder to land at Dexa. My point is to know all the rungs and start from the bottom up...one step at a time.

Okidoki...so thats my little rant for today. My top 4 headaches that I have shared with you to educate yourselves your bradas and sistas , your fathers and mothers and uncles.Happy reading!

25 days in China..Part 1

So I am  writing this blog from my room in the Hainan University exchange hotel, Haikou City China. I never would have guessed a month ago, this is where I’d be at this moment in time. In fact, on a Thursday morning I would be at my clinic going crazy trying to juggle patients and getting the payroll for the hotel done and hoping our bank would process it on time.  To cut a long story short, 4 invitees from Samoa where brought over  by the Chinese Embassy to attend a 3 week tourism seminar/conference. Unusually, Samoa has the largest number of participants (4) whereas other countries have either one or at the most two invitees- makes you think a bit doesn’t it.

Anyways, it has taken 2 whole days of traveling to get here. An overnight in Auckland, a 12 hour flight to Shanghai- 4 hours killing time in their aiport and a 3 hour flight to Haikou, which is on an island South of China ( had no idea it was on another island!lol) 

The flight to China was Long to say the least…we got dinner and breaky and I got maybe 4-5hours sleep. Arriving in Shanghai the first thing I noticed was ?fog. Then I remembered my mother in law telling me how polluted the air was in parts of China and if this indeed is the extent of that its pretty scary. Surrounding the airport was what appeared to be a thick fog blurring even the nearest airport hotel across the road from the airport.  We didn’t do much exploring in what I am sure is a huge airport, only because we suddenly felt so miniscule in the big pot of China 20 something million people in this city alone…, were a little scared we’d get lost so went straight to locate our departure gate and then parked up at a coffee shop charging our cellphones and calling home.  A young Chinese lad came and asked to take photos with us which was kind of funny…

So my first taste of Chinese I guess would be the meal  on Southern China Domestic  airline which was a noodles and mince concoction. My hopes for enjoying some traditional Chinese cuisine were not satisfied by this option but I put it down to maybe just bland airport food?? There were like 3 other small packet things , one of which I opened and looked to be some sort of fermented cabbage?? Like cabbage in a sauce which smelt terrible…..hmmmm

Arrive in Haikou and its bloomin 34degrees Celsius. Even for an Island girl getting above 30 is really not to my liking and I felt like a sweltering pig in my wooly top picked to keep me warm on a long plane ride! The two young ladies from the university who collected us were friendly and looked dressed to be at a beach with very short ripped jean  shorts and airy cotton topsJ I immediately regret not bringing a pair of shorts L

The drive to the university had me and a friend joking about the road rage our driver appeared to have but also secretly ensuring our seat belts were fastened and clinging to our doors! The roads were narrow and lots of bikes and carts and in some places the rules and lines seemed to blur and we, more then once appeared to be heading straight towards an oncoming vehicle one of which was an ambulance lol!! Our driver honked her horn practically the whole way to our hotel and by the time we reached here I was truly relieved and almost wanted to yell something along the lines of “Hallelujah!”…

Our room is on the 4^th floor of a building whose elevator is out of order. We are now all joking about how much weight we will lose  while we are here! Dinner last night was broccoli and some other vege?? Sliced beef, ?duck…chicken wings, deep fried chips, fried rice and fruits….Im still waiting to be awed by Chinese food. Im sure it will be any day yetJ

2) it’s the morning of day 3 in china and I am awake at 5am. I’ve woken at 5am every morning since arriving and struggle to go back to sleep.  You can hear the echo of birds bouncing off the hundreds of  large brick buildings that make up the apparently 9 universities housed in this complex we are staying in. Ive never seen so many 7 story buildings lined up uniformly in the same area before. I counted 22 X 7 story buildings  this morning on an attempt at some exercise and this is only in the one small block we are located in…. It is kind of weird but in a way- very Chinese. Its reassuring to hear the sound of birds because sometimes when I stand on the hot balcony of this hotel room, the thickness of the air and heat  make me wonder if this is just Hainans climate or if the air is thick with pollution.  At least the birds are not dropping dead midflight which is almost what I expect with what I see,  so perhaps that is a good sign lol

Yesterday was our first day of lectures. Our first lecture was in introduction to China and its history. It was interesting to learn about how ancient the Chinese civilization is  and the struggles they have faced. But it was kinda amusing to hear so many ancient proverbs being used to justify things being done in such a modern era lol. They’d talk about bigger neighboring countries and use expressions such as “we will not be bullied”  and “when going up the mountain, be prepared for vicious tigers” ….there was also particular reference to a particular neighbor (se malo uncle Sam) and one could easily read between the lines that their emotions towards this country were not happy ones lol.

The lectures are really tiring because they are done in Chinese and translated by a young lady whose English is not very good either. We’ve had about 5 questions being asked so far in class and not a single one was answered, I am sure it is because of the language barrier but it’s a bit frustrating at times. One question asked was whether the Panda is a protected species and the answer was to describe to us that Pandas are a symbol of peace to the Chinese. We have given up on asking questions now….learn quick. We’ve had a right jolly time trying to communicate basic things with hotel staff where we are staying using our phone translator apps. We spent a good afternoon trying to find an iron from reception and would enter the text into the translator to write into Chinese “I need an iron please” and the response we got was “iron is your translation”…we couldn’t figure out what the hell the receptionist was going on about as this was always his answer but it later worked out that he had given the iron previously to our “translator”  and was trying to say  it was with her!lol…

We are grateful to know that our meals are all provided. But its been a bit of an underwhelming experience so far. We have to walk through a local cafeteria to get to our meal room and when its busy there are people with really interesting looking things on their plates…but our table always has fried rice, steamed veges and Fries. Two basic meat plates like fried chicken and beef stir fry…and watermelon for desert. I kid you not with the fries, we get fries for breakfast (yes breakfast!) lunch and dinner. Served with Coke and Orange juice!lol….its amusing but we think that perhaps they see us as foreigners and think this s what we want!lol…Ive made a subtle request for dumplings and local delicacies to our host so fingers crossed that we might get to sample something exciting soon!

We went to the night markets last night. There are several shops mostly a mixture of clothing, jewellery and accessories and food. It was hard to find a shop with my size though and took me the whole night to find a t-shirt that looked to fit me. Everything else you could see appeared to be fit for size 6 size 8 stick think figures!lol. The ladies at the clothes shops kept laughing when trying to sign out the size of my ass (ie for pants)  and I have since learned that in China, Im a XXXL...dang it!

Day 4.

Today we get to go sightseeing in  the countryside. Apparently we will be going to the beach. In one of our lectures earlier, a lecturer described Hainan as being equivalent to Chinas “Hawaii”.  Having never been to Hawaii before I cant help but at this moment in time think the only thing they have in common is the weather …although I am not entirely sure even Hawaii has weather this hot. The tour guide was eager to tell us there was a beautiful Beach but then went on to add “but you must remember that China is a very Pollution..so don’t go far into the water”!!!....this seems to be a common tone in a lot of their lectures and descriptions- owning up and reminding everyone that “China is a lot of Pollution” …whats sad to see is I don’t really see any effort to majorly tackle this issue. They say they are developing Hainan to be Chinas Hawaii…but the streets are full of rubbish, the air is polluted an so far every river I have seen is a thick dirty brown….there are just too many people and I don’t know if they will ever be able to deal with this problem!!

Yesterday we went to the big city and very quickly one was swallowed in the enormity of Chinas Population. We had asked our tour guide if he could stop by a shop where we could buy a simple phone to call home, and the place they took us, along the way, was some 4 or 5 story building (shopping mall with 4- 5 levels) with I am sure over a million products, all electronics . Phones cameras laptops wires. It seemed like every store sold the same thing and was crammed from the floor to the ceiling with shelves full of electronics. There were so many stores the isles were small and crammed too…  I couldn’t help but start feeling a bit claustrophobic and just absolutely flabbergasted…what started as an itch to see if I could buy a nice phone ended in a tarpit of indecisiveness and uncertainty over what was real and what was fake.

The Samoan lot soon found ourselves outside by a food cart trialing some Chinese Hotdog (savoury sausage on a stick…who knows what kind of meat it was haha) and some Chinese round puff pancake things. The other thing about Chinese is that probably 99.9 percent of them are thin. And you can see the whole place is geared so that people are not encouraged to be lazy…so many buildings with NO elevators….everyone just takes the stairs- that’s just normal… when I bought 1 hotdog and a small bag of 8 pancake things (just a little bigger then the size of a marble) the shopkeeper exclaimed that I was “eating a lot!”..lol…as we stood outside the electronics mall I watched all the stall vendors, one guy quite close by was eating his lunch which consisted of 3 small round metal containers which had lovely steam fuming off it. In these 3 he was  scooping into a small bowl in front of him,  Rice, what appeared to be seaweed and boiled watercress. That’s it. I couldn’t help buy envy him. If I tried to introduce such a diet in my homeland of Samoa I am sure I would be shot!lol….

Funnily enough, our sponsors took us to Mac Donalds for Lunch. As my sister in Law did warn, even McDees tasted a bit Chinese with the chicken burger having two options of mild spicey or very spicey…and it certainly was more of a Chinese spice J Was rally thankful to  be there though as they had a Mc Café (YAY) And I had my first decent coffee on the trip which immediately killed a lingering headache Ive had the entire time in China (Coffee addict!) I was not impressed with the toilets however, the ladies had 4 toilets and they were all SQUAT toilets (OMG) our group had a good laugh describing each persons attempt at trying to figure it out, didn’t know which way we were meant to face and having to take all our bottom half clothes off in fear of accidents OMG…like I will NOT miss this ever. Funnily our chinese hosts claim to prefer these!

  Heading into town was an experience. From seeing fields of Taro planted in swampy land, to the several sky rising buildings…and not just several like a handful…several like rows and rows and rows, old ones new ones half complete ones… I felt like I was watching something from star wars where the drone army surely must be kept….on this day I really felt the enormity of the population of China…so many people they have to live on top of each other….we are so fortunate in SamoaJ  What I thought about though while watching all the skyrising buildings was another statement our Chinese History lecture said which was that they are not afraid of being bullied by the big powerful countries because one of their weapons was a huge mobile human workforce…hmmmm….they moral of the story is- don’t mess with the Chinese.

Another Day in Paradise

 If there is one thing I have always been weary of in my job/role. Its unneccessary praise. I am not sure if its just me  or its from years of very subtle low key celebrations of our achievements as kids (!LOL ) but when someone starts ooing and aaing about something that is related to me... I kind of shrivel up and feel like Im being set up for a fall. I'd rather not people praise me just incase one day I dissappoint them. I dont know...sometimes I think maybe I think Im just a big fake and one day someones going to point it out lol. Other times I have all this energy fueling me to do something complete a project throw my energy at something- with my mums whispering in my head telling me I could do it, I can do anything if I just put me head to it. Talk about split personality lol.

So today was one of those days. PAtient after patient...I think its a cultural thing too...a whole lot of new patients today and all the conversations start off with praise- they had heard from who and who that this was the place to come...etc/ Sometimes I worry because their relative came in with a straightforward infection which required a simple antibiotic and bazzaamm...they were better (not really any magic in that but thats what people see here....) sometimes I think people are so used to all simple illnesses being lengthy and drawn out because when they see fofos with the same thing, I think the fofos just help ail their symptoms while their bodies go through a natural fight and recovery phase (that sometimes results in a loss!!) but to have the same illness resolved within days with a pill is nothing short of a miracle!  So I worry that now this man with terrible arthritis thinks I am gonna cure him...crap....so save your breadth buddy all the showers of blessings is not going to sugar coat the hard and fast truth I am going to have to tell you...and unfortunately only serves to make me squirm in my seat.  Anyways, now you know how I feel about the subject ha ha. I dont mind a thankyou after Ive done something, but i dont need the whole ula-lole type ordeal. Especially before Ive done anything!!

Penis-es. (if there is such a word) Man why are guys so obsessed with their willys. Even in the big ol Island, there is a constant murmur in the male grapevines on this subject.  Fortunately being a woman, I've not had to deal with these enquiries directly myself, but my poor husband, and brother in law. They are constantly being pulled to the side and asked I have in in my clinic "fualaau faaku ai le mea" and also "fualaau faa-kele" and "fualaau faaumi".....no jokes. OMG. Ok so the first one at least exists, but the other enquiries??OMG>>. One day my husband was sat in a delivery truck (his brothers') surrounded by other people and some random person he doesn't even know called him (who knows how he got his number!!) and was asking  pe maua gi fualaau e faalapoa ai le mea. What was even more hilarious is my husband actually had a hard time trying to convince this guy that no such pill existed. He ended his phone call with a "well ok if you find such pills in your search please let me know about it as well" :)   Fair to say his audience to the phone call were cracking up in fits of laughter after overhearing this.

Kids. So my eldest daughter is going to a pretty good school for the big island. Sometimes Im a little over impressed with some of the things they do (like make yr 1 students sit exams that require them reading an exam booklet and following instructions printed on it  etc when they can barely even read) etc etc etc....lately though. Ive been a tad egg-ed with them. Don't get me wrong I do believe that alot of your childs education starts at home and when I can I do try to read and do math and do writing etc with her at home. Sometimes she is a little short -attention-spanned but I figure what 5 yr old kid spending the afternoon inside doing this as opposed to climbing trees isn't? Anyways, when I do do work with her she is pretty good, she completes full pages of letters when working on her writing etc. However, lately her report card (and she gets this progress report card every week) actually, all of her comments on the report card have been along the lines of- "your daughter looks tired sometimes in class, you should put her to sleep earlier" and " she hates writing and reading, we pray that soon she will be able to write and read" and the last one " your daughter talks too much, but when it comes to writing she is hopeless and fiapepe...we hope and pray she can read and write soon" WTF is that?? honestly what about some constructive criticism mate...like could you point out what she is struggling with? which words vowels what?? the last parent teacher meet I went to all I got told was "yea she'll get there, shes a good girl" I would actually appreciate if I were told she is behind in a certain area she needs to work on some sounds or pronunciation.  Where is she lagging compared to other kids with writing??Honestly give me something I CAN USE. She seems ok when I do writing skills with her. Honestly "we hope and pray " like lets just all SLEEP and pray  on it and see if it will happen?? for goodness sake.errr... it just bothers me that I have no other options of anywhere else to take her on this island.....hmmmmmm eh

Anyways, just thought I would update you on the happenings in Paradise.:) Just another day in Paradise