the concept of Falling

Doc I have fallen….

In my 10 years of practicing medicine and certainly in the last 8 yrs in Samoa, I have had a mixed relationship with our peoples ideas if sickness and disease. Especially when it comes to , local superstitions and on some occasion local healers. At the moment, I do feel there is a big gap between traditional and western medicine. The two do not always work hand in hand and perhaps there is a road there to improve this in our health system. I think us western drs tend to see much more of the  dire scale of things when it comes unwell patients who were previously treated by local healers. But not being able to actually quantify the possible help that these traditional healers give is perhaps what leaves us ?ignorant.

Anyways, back to my topic. Since I began practicing in Samoa, I have often been dumbfounded by the things our people put weight on when it comes to a person being sick.  A classic example which is at the top of my ‘leaves me bewildered’ list is this concept of falls- leading to all sorts of disease. Even a simple skipped a step, landed on his bottom, type fall is often etched in the memories of mums, or children of elderly people. A common scenario in my clinic is a young person being brought in, who sits there breathless, and when he coughs his chest rattles away like the v8 engine of an elcamino ( and later on is found to have double pneumonia) , and the parents are spending 15minutes explaining, that a month ago he fell. On the ground. He hit his left arm and chest. There was no bruising, or scratches sustained. He cried and got up. Since then he was fine. But NOW…now hes feverish and is not eating and is tired…and of most importance is that I take into consideration the fact that a month ago he fell.

They completely ignore the fact that…his nose became runny a week ago, he developed fevers, a cough followed and now he is breathless. No, that information was not readily provided until dragged out of them…instead most of their focus and concern is the fall and fevers and how the two are absolutely intertwined. 

I spend a lot of time trying to teach people some really basic rules. Like pay attention to symptoms…signs from certain parts of the body that may indicate something is wrong with that part (ie if you are coughing you may have an infection of the throat/chest if you are spewing from both ends maybe a tummy bug  etc ). Unfortunately there are so many common scenarios amongst Samoan kids that a general immunity to those symptoms can sometimes result in a complete dissociation of what is actually wrong with the person. An example is…in a big family…there are often..snotty nosed kids running around. From time to time  those snotty nosed kids may ‘cough’…but generally…these symptoms are ignored as just normal things for kids. Luckily, kids here are pretty robust and Im sure are exposed to all the elements from a young age..often most viral colds and coughs resolve without actually needing much intervention anyways. But when they do deteriorate, it bewilders me how parents continue to ignore these worsening symptoms and instead are focused on age old myths and beliefs … I can understand how if you fell off the roof of your house or the back of a moving car and broke a few bones  or even developed some  internal bleeding -you'd be pretty beat up and sick. But to not even have a scratch and still believe this could riddle one so ill…and so long ago?? Baffles me….

I even heard of a family, whos young child (2 yrs old) had died mysteriously. When I asked a relative what had happened (ie had he been unwell etc) the answer was…well, we don’t know but when he was a young baby, he fell out of his cot and so we think it was from that time that he must have started to get sick and resulted in his death ( a year and a half later?) …..

So, my point is- people , please help me spread the word..... If you fall, you can physically do harm to yourself AT THAT TIME. And it will be visible and physical (most of the time- unless you are unlucky enough to be a tiny percent of people who donk their heads and have a small internal bleed- which will manifest usually within the next few days/weeks at most!) ….it will not kill you a year later…or make you cough a week later…or give you this fever 3 months later. Lets stop the cycle of this belief right here now so that people can start WAKING UP…and paying attention to what their kids/loved ones/relatives might ACTUALLY have.

Uma loa iga. Have a great weekend guys

the sucky part of life...

 I wish had cable TV and I wish if it were here, that it aired Dr Phil. I love that guy. As cheesy as he may be sometimes, I always have so many "epiphany" "Aha!" moments were suddenly..the challenges in life start making sense...

this is one of my challenges living in the bush. Not having my people...mah girls who I usually rant and rave and talk about life and its dealt hand. I know the poor hubby has probably had enough of my rants. And to be honest...men and women talk about such things differently  :(

Lately....Ive been balancing a lot of pretty lousy news. Im trying pretty hard to get my head around it all. Process and figure out what I am meant to be doing. One of those lemons that life has thrown at me is illness. I jinxed things by mentioning good health in my last post....and then in the last few months a couple of people very dear to me have been challenged with poorly health. The problem is both live so very far away and it'd cost an arm and a leg to go over...not a trip I /we could be making often so .....now staring at the wall trying to figure out what to do......

Then, I dont know how...but lately Ive become the recipient of news of men who have cheated on their women. I hate this. I hate being the bearer of such news. If  I had known the conversation where it had come out was headed that way I would've excused myself politely and gone to the toilet. I don't know what to do with news like that. Suddenly...the boyses it involves are now appearing to me in a whole new light.  A red light.  A "wtf" light....because I simply cant explain it.These are people I respect and admired and enjoyed company with occassionally.  Why would you marry someone...vow to honor them and spend the rest of your lives with them.... and then cheat on them?I mean..to me...excuses that go round are just pathetic.... sometimes its a poorly sexual life...or a setting in of a boring routine....whatever.... to me... you commit and you honor that commitment. Its called through sickness and in health, through good times AND bad....You can chose to push on through your frustrations ...marriage is a rollercoaster and its not always high....if you love someone you respect them by knowing how to do just that...honor and respect your marriage. if you honestly have fallen out of love then get a divorce and make it clean...dont dribble drabble in infedelity because thats like dragging your partners face through shit before splitting up.   Dumb things like that affect peoples mental health and outlook on life. And its just dumb and stupid. Eh...ka fefe e ia Dr Phil.lol.


ok, thats all for now. Love your wives and your husbands. Love your family. Because you dont know when one day they may no longer be a part of your life, and you are crying a river on your lonesome because it hurts.
Tofa soifua . uuma ii na

living life and learning:)

There is nothing more humbling in life, then experience. This  is something that 10 yrs ago, fresh out of medschool..ready to ‘take on the world’  -- I cast little thought to. I think there is something about hormones, puberty, going through adolescence that sometimes overarms us as human beings. Makes us think that we know it all and can do it all ( yes , actually I can Remember being that fiapoko little 16yr old lol) . That the world was indeed our oyster and we were one of the best fisherman ready to indulge!!lol…10 yrs ago- “old people” or “older people” were just that. Older people. Apparently they were ‘wiser’ then me and us at the time, and maybe that was so. Maybe they had learnt more etc…but I did not think I was ‘that’ different then a ‘me in 10 yrs time’ or a collegue at the hospital who was 10 yrs my senior (!!)  I thought I was fresh, well studied...had had 6 yrs of medical school experience under my belt (which was quite long or so I thought!)  and  with a bit of practice would be ready to take on anything!

In the last 10 yrs since stepping onto the soil of my homeland, having completed my medicine, I have never been so whipped before in my life. The things that I have seen, dealt with, cried for, yelled at, laughed with, encouraged, sympathized, lost my temper with, I can now honestly say I was vastly unprepared for - and having gone through each and every one of those moments, I can now vouch that I am indeed ,a whole nother person. A more "experienced''  wiser more worldly - older me. And although at many times in the last century I have felt way out of my league and undertrained, under-knowledged, underskilled and abandoned in the bush, there is a great lesson in life to be learnt from experience.

 Every time I realise that life has yet again, revealed the truth about something I thought I already knew but obviously  had not…I am always astonished. At how vastly inexperienced and naïve, I had just been about something and not too long ago. It is almost scary to think of how immature I actually was ...and immature more in the sense of approach/understanding/ability to exude confidence with and not the cheeky little shit sense lol:) And how humbled I am to now truly be able to appreciate that experience , that condition, illness, event, emotion,occassion…with a new set of eyes.

Then my own personal  experiences like having gone through childbirth, and medical investigations…and others experiences - surgeries, watched people die of terrible things like incurable illnesses, and heart attacks, and heart failure, sepsis. Things like having to have some procedure done on myself, like an IV, a  lumber puncture, a caesarean section- and then realising all those times I counselled others on what to expect, was completely inept  for what I actually went through and felt- and therefore felt like I had been a fraudster in all those previous years!OMG useless!! Now instead, I  just hold peoples hands and layout the reality of what they will endure and there is  a sense of calm now that I know a little bit more about something to be able to counsel someone with ease…. Having gone through it myself  Is truly, the best way to truly make you a decent counsellor of what to expectJ

Experience has opened my eyes out to far beyond the horizon. I have seen things that have crept out of all corners of our community that I had no idea about before. That no one had prepared me for and certainly had never been exposed to in  my upbringing. I have seen the ugly side of poverty, of people not afforded the same opportunities to health, people with mislaid beliefs of health problems and how to treat them, and then watched them watch their loved ones, children die as a result. The experiences one has no option but to choke down at times in practicing medicine in Samoa are challenging, humbling, frustrating all rolled up into one. 

The worst of all  experiences of course , is seeing  a person die on me, whom I did not expect to die. And then the wrath of the following days guilt, that I might have missed something, not done more, or even contributed to somehow ….the death of a patient.  There have been days I have prayed for comfort, for people I have cared for…and for myself too. There have been days I have thought “THAT’S IT..i can’t do this anymore’…the challenge is too big…there’s not enough of us- its ridiculous to expect people to work like this!…not enough resources not enough support not enough anything to make this job easier, ideal or even safe  for me…but then I think…well, that goes for everyone doesn’t it? All my collegues…young and old…fresh out of school or here 100 yrs…they are all trudging on in this environment.And its not that no ones trying to change it. Its just htat change in Samoa for some reason is like pushing an elephant. Its not impossible its just ridiculously hard and slow.  And here I am crying about it not being easier. Nothing is easy in life. And maybe my perceived hardships suck…but at the end of the day. There is just not enough drs  here. And if I remove myself that’s one less then the whole lot of ‘little’ that there was before. Right now there’s 6. 6 drs ( and that’s no 6 GPs, that’s 2 gps and 4 hosp staff)  looking after tens of thousands of Savaiians. So  who is ever going to help make it easier for the next person if not me?

 Then,this whole concept of maintaining ones distance and keeping yourself separate from your patients and their issues, problems, health concerns  is something I have never been able to do. I don’t think it is really possible in Samoa due to the small size of our country and everyone knowing everyone. Even if I try to keep my distance it always comes back to me through- my family telling me ( I had seen their aunties best friend and they have put all their faith in me to sort out their health issues) or a collegue at work,  a neighbours aunt, the gardeners dad….at the end of the day the connection somehow is always presented to me …that there is some closeness of this person and therefore I must work extra hard because not just the patient has expectations…but now everyone else is awaiting news too !!  

 I try very hard to keep my sanity by asking that people see me in clinic and not, on the road, at the restaurant, parked on the road at frankies or at some formal event I have attended. That’s where I do draw the line and get a bit titchy much to the disappointment of my hubby sometimes. But Im pretty feisty when it comes to seeing people “properly” and examining them properly  in a formal setting, with all my tools etc and notes  and can ask the sensitive questions etc. And not just guessing and pissing in the wind, outside of the carpark at frankies, because they aren’t going to pull their pants down to show me the rash (obviously) but instead want to just describe it and me give them the magic cream lol. No, when it comes to examining people its always gonna be in my examination room please.  Unfortunately me trying to educate people about that always ends up looking more like Im being unhelpful and stubborn L but oh well. Im sure there are worse names to be called.

Anyways, I am ever grateful that to date, the good man above has blessed me and my own immediate family good health. Im pretty bad with stressing about people I know when they get sick (only because of all the worst case scenarios that play through my head and the lack of resources to be able to rule half of those scenarios out confidently!!)  and if my kids had the misfortune of getting sick…I might just pack up house and move to NZ for the most trivial symptom. Yes, hubby be warned lol. Anyways…its tough times in Samunda but I /we do try our best. 

One of the funniest (well, not funny but maybe slightly hysteria inducing) things about some people I come across here is their lack of knowledge of what IS NOT available in Samoa from a  medical perspective. Like people that rock on up and are like…so I have this symptom bla bla and so I saw on TV  in America  this test and had a talk to my family and am here coz I want that done now…yup …something really expensive and specialist requiring and probably wont be available in Samoa for another 20 yrs…is not available here friend…much to the shock horror of this patient. Then they are like ‘can I see the specialist then’…which again, is no because Samoa does not have one of those specialists…shock horror. 

Specialists do not fall from the sky nor are easy to find. It takes years and years to train to become a specialist (and that’s like exams and stuff and not just years of work experience!) not to mention is really freaken hard…there is an infinite amount of material to learn about the human body and disease, current treatments, drugs, investigations etc....its changing all the time..and mostly you have to be a little bit of a genius to complete …and when I say years and years…like 12 yrs or more…many people give up  or fail before completing. If it’s a woman often life gets in the way and they have babies and a family before completing…sometimes the ones that do complete,  get an epiphany at the end and realise they’ve slugged half their lives away at this degree working night shifts and crap hours, missing out on society  friends and family  to get there that the pot of gold more lucrative careers offered in developed countries  at the end of it all- becomes more important then returning to a peanut pay packet and challenged work environment at home (esp if you’ve started a family during the process) etc… anyways…my point is…its freaken hard. At to be honest, Samoa at present only has a handful of actually fully qualified and practising in hospital specialists.   Everything else we don’t have we  depend on a visiting volunteer to come help with. That’s the truth on that issue right thur (I have just remembered an article in the paper on Sunday that got my knickers in a twist because a general member of the public was complaining about not having access to a specialist after a visit to  ED) 

 Anyways. That’s were life is at , at the moment. Thats the truth right thur. If you didnt know - now you do lol:) and a bit of a rant and rave from me as usual! I hope everyone's been having an awesome day week month. Its almost up so live it up. Til the next blog.

ciao

And like THAT...1/2 the year was gone!!

 So I met this palagi traveler the other day, and in our conversation he said he was going to go hike to this certain monument/thing in the bush here in Savaii that has long 'not' been operating as a tourist site for some time now. In an effort to just prewarn him I told him ins and outs of this- there is no proper access at the moment, it is likely to be overgrown and you can not find it without a guide. Point being...find a guide. Oga sau ai lea ma laga fiapoko ma faimai..e le maga'omia e gaia se guide...ogaia o se kama "hunt i le bush" i giusila bla bla bla. Strike 1. When a local gives you advice about something in the bush/environment etc...you really should listen. After a bit of to and fro-ing. Sau fo'i ma leisi aga fia'poko..."dont the samoans know of how special this place/thing is bla bla. Why isn't there a tar sealed road (with golde rails)leading right up to it....they should do this and this and this" iiii..sa'o...laga ga'o oe lava le kagaka muamua ua intrigued i legei mea. Leai faamolemole, matou te iloa uma lava le significance o legei mea i le makou atunuu faamolemole.  Putting a path and rails and parking and a loo etc that you speak of  is not as easy at it seems. Not to mention lets just trash right round this sacred place to make it more about pleasing tourists than keeping the wonder that it is left as untouched as possible. NEWAYS

So, the next day, alu si kama i le bush ma laga fagu vai, insect spray ma laga samoa jasons guide...kau leiloa ma koeaikiki a oki i le bush. Oga ma koe meet lea after. WTF. Did you know that there is practically no raod to that thing?? Eventually I had too find a local villager...and when we got there I couldnt even see it!! ( ma legei eyebrows ua maualuga i luga le lagi ma frown pei  ua kaufaavalea gaia e seisi) ...yes Indiana Jones...I did tell you so.

Oga koe fa'aauau lea le ma conversation faimai..."you are not Samoan huh?"....hum..yes I am "no u can't be!!!.....hum ok apparently I don't know what I am....hmmmmm...because...apparently..my Igilisi is too good. Ia ...strike 2. Sorry a sole...but some of us speak good english too mate...e le gao  kagaka  Mai England e Iloa  speak English.  E ke Iloa foi  speak Maori...???



Anyways. The hubby and kids have been away overseas attending a wedding that unfortunately I had
 to remain home from, and hold the fort. It has been a little stressful but am so glad to be on the last

stretch ( last week) ...o le mea ouke fiu ai. As much as I do enjoy running our place and trying to give people good holidays...e iai lava isi kagaka e ke fiu ai. Someone wise said...you cant please everyone and thats the truth. The liner that bites me is what a mentor said to me about the type of business we run. He said...look you need to put yourself out there...you are selling yourself..not just a place a bed a room a tour a meal...put your touch your story your point of difference...be brave and wear it...
 Which is like the complete opposite of me as I am rather a hermit and hate 'putting myself out there' I guess the fear is if you come across someone that is not impressed and you are out there...how do you not take dissappointment personally ??

So ga iai le kusi  ga aumai se kagaka ga gofo i sheraton...uma lea koe sau gofo ia makou , i makou poku  piko kaugofie lava ..( ie kai kukusa ma le kau e ke ai iai i macdonalds lol).ae fai mai laga tala...after having come from (sheraton) I was not impressed with your place....bla bla bla....ka fia fai
iai...uhm...like of course. gae ua e sau compare le sevae kosokoso ma le sevae high heel Prada....e
makua ese ese mamaoooooo lava...sa kakau ga e alu e faakai kai seisi place kukusa ma lou prada ga ga e fiafia  Iai  i upolu...ma fai gi ou conclusions...eh se kailo ia se.
 Its hard not to take things personally when you are constantly trying and you think you are giving your best. But peoples expectations vary so much I guess and that is something I am trying to learn not to take personally.:)

...ANYWAYS.
 In another world where I perform a different Job...something I have learnt about our people is that the power of GOSSIP is immense here...i guess without a written language - word of mouth is everything. even more important then what a professional might have to say which is freaken frustrating...

 For Example-Today started with my first headache inducing patient) a man...who came in with his wife...to spend 30minutes explaining how his whole life, he had this thing - which did not debilitate him,..but he thought hed better come check out..that hed seen all the fofos in the world for..but had not cured....though he was actually absolutely fine..he could plant his taro, carry his popo..go to church..go to town..in actual fact there was nothing to worry about because he was as fit as a fiddle....but he just thought hed double check (they story went round like that for a while - and as you can see...15 minutes into it and I still dont know WTF  the actual complaint is) and in the usual Im the king of the village manner..me trying to interject to ask for a symptom, was quickly spoken over with further explanations of failed cures. In the end. A swollen testicle. Actually, a chronically on/.off swollen testicle that got bigger sometimes and smaller other times...long story short...a thing called a hydrocele (which is where a man accumulates fluid in his testicle and is NOT the result of an infection) ...anyways...Going on to trying to explain the cause (ie..its just poor plumbing and sorry mate..you were probably born with it) was interjected many times with - I dont need an operation but You must give me that "fualaa'au" for fula-polos that everyone takes. I just need the tablets doc. So using diagrams I tried to explain how this was not curable with any sort of fualaaus but is a result of plumbing mishaps which eventually if gets worse (ie swelling gets worse) you need repaired surgically...but still...furrowed eyebrows and more "why dont you want to give me the fualaau fula polos that everyone else takes....who the F* is everyone ??? I tried to explain other things that can cause fula polos like STDs might be amenable to antibiotic fualaaus but this is not a general 'for all fula polos" just for pus discharging penus'es, and  his non discharging polos were perfectly fine...that he may not need an operation even,  if it never got much bigger,  but if it did- that would be what needed to be done. Ends with....so you're saying.....you're not gonna give me the fualaau polos that people in the village said I need?...far the farg out man...who are these people in the village that seem to know everything and would they be willing to stand in a court of law if their treatments failed???I want to swipe someone...anyways...thankyou "word of mouth" in the village..for making my job more about persuasion and not about fact, and for making my job ever so difficult.  In the end I had to talk to the wife....if it gets bigger and painful..please take him to the surgical clinic. Thanks. Uma loa iiga.