Ramblings of a dr in the bush:)

A long time ago, a list on a piece of paper presented to me, dictated what I would be able to do with my future. To be completely honest, I hadn't given too much thought to what I wanted to be "when I grew up". I think, I was raised by rather conservative hard working parents who focused so much on ensuring (drilling) we passed exams and were good girls as they were so busy trying to make ends meet...that there were few conversations ..or any..of what I would like to do when I 'grew up'. For the longest time the focus was on 'a scholarship' I now realise it amusing that little thought was given to 'what scholarship'. And so form 7 came to an end, and a list lay in my hands. As a full science student ...my options were based on- I was a good math student , good in chemistry and physics. On the list I was guided towards, Dentist, doctor, architect, engineer, pharmacy.....I think there were a few more options but to be honest I don't think I even recognized what they were for (food technology etc) so those 5 were there....I had had it narrowed down to Architecture or medicine. Why ? I actually was a bit interested in Architecture,,...the idea of design and being involved in 'building stuff' seemed interesting to me. But as I was from a family of several health personal .....the idea of medicine became the choice that was celebrated by all. I come from a humble background, my mum is a self taught baker who never had the opportunity to do tertiary education, and my dad ws similar, left school at form 6 to run the family business (back then a large exporting farm) but later on when the family business shut down,worked managing a company that made soap and shoes.And when I say manage, I mean oversee a few staff and fix broken machines (a skill I was always impressed with my dad over...he was no engineer but could fix anything that was metal and had an engine ) I have 3 aunties who are nurses and a grandmother who was a matron of the hospital so the idea of medicine was one encouraged to me by family. A safe, steady and noble job:)

And so my journey with medicine began. I've never regretted doing medicine. I really enjoyed all my years down south of NZ and worked hard in my clinical and preclinical years and although I thought medicine was frustratingly hard (there is just a ginormous amount of knowledge out there!!) I really did enjoy practicing it. I enjoyed my hard work as a house surgeon in Wellington and also travelling throughout NZ working as a locum. And then we returned home, the hubby and I , and landed in Savaii. This is where lifes challenges really started.

Working as a dr on rural island, where day in day out..people depend on you. And I mean know you , know your husband see you all the time, remind you that you saw them...and those people, end up being almost 40,000 people on the entire island, means not a day goes past where I have not been tired. Ive tried to adjust to make my life more sane by limiting my hours...I moved away from full time at the main hospital after a few years of full time and realizing, that the shortage of staff is never ending. The cries the pleas the hopes and the disappointment that things will improve, just go round and round and round. What changes is your tolerance, your patience, your enthusiasm to change the world and save the world. Ive tried really hard not to get to disillusioned and continue to remind myself that there is a greater purpose to my life and it is a life of serving. But at times, I cant help but get angry and frustrated and the worst guilt is when I feel like I'm not meeting that higher purpose but getting selfish. On some days, I feel like I want to scream from a mountain, well what is wrong with me wanting to be selfish. Selfish is more time for my kids, selfish is time with my husband and family ..selfish is not going insane on this remote island...if I need some me time its to protect my ability to continue to slug at work in an environment that changes at a snails pace...and not quit altogether.
But you can not help but twinge when you hear people comment, that this never ending grind is what is expected and just the nature of the job..being tired is really just a haphazard of this  job description  and well that's just how things work here (slugging it til your knuckles bleed) ...I often think ..well actually I didn't know it'd be like this. In a premature earlier life...I worked as a young dr as part of a really awesome 'team' in big hospitals in NZ. IN the team there'd be me and 3 or 4 more senior staff smarter then me who could answer my questions when I was stuck...when you needed technical info on imaging etc you had a seminar with the radiology staff and went through xrays and lab results with the pathologist...it really was an awesome environment to work in.You continued to learn on the job and were encouraged and nurtured to do so.

 Then you come to Savaii...where there is me , me and maybe one or two similarly qualified drs to me..and when you (or we) are stuck, we look at each other ..and blink, try to find help from a book or something online( on our own phones because we don't have access to internet resources at the hosp)  or we call APia if the crap hits the fan and move people out via boat if we are so lucky and its not past 4pm yet .Sometimes this process (actually..often) is skewed by - the other dr meant to be with me has been instructed to go do an outreach clinic and its actually only me, no one is answering their phones in Apia or the phone numbers given are dead/outofreach/going to a mail box.... We see 100 people a day in an ED/OPD and often ive done that on my lonesome. And by the end of it all its just a bit ridiculous how tired and hungry one can get....and not to mention, ED is the shittiest place to work in when it comes to patient "patience" which has only added to the colourful atmosphere of this workplace (not) ....In ED, few people have patience. Everyone thinks they should have been seen sooner and you could of done your job faster, everyone has an opinion and sick people are not generally happy people.THeir relatives are even worse. IF there is one thing we Samoans are known for its being brutally direct at times  such as " e ua e lapoa" or "eh, ua e paee o e Ma'i?" direct comments that you wouldn't hear a Palagi outright comment to another palagi lol..but here , its "se ua ou fiu e faakalai koe a se ulu a se fomai ou ke kuia"  Usually, the less distressed patients can be the most annoying (ie woman rushes her 18 yr old son into ED pushing and shoving, screaming he is dying and makes you clear a bed to examine him n the critical area (not to mention drop everything you are doing including talking to another patient about a dire prognosis) and it turns out her son has simple sinusitis..and a headache...and they haven't even taken Panadol because they thought it was more important to see the dr first...humph)So the stress even of just having to put up with personalities is enough to want to bang your head on a wall sometimes. I long for the days of WEllington ED where the door between waiting area for patients, and examining area for cliicians, is separated by an electronic lock and only emergency cases are tended to urgently by a highly skilled nurse while everyone else has to "wait yo moment" sorry but the definition of an emergency really should be the job and responsibility of the clinical staff...and not the patient.. for most of the time anyway.

.In medicine, the expectation is always to be selfless...and for the most part I think I am. But there are occasions where the expectations of people are just mismatched with the severity of what they have...and yet still everyone expects that a dr will always drop everything they are doing...open the clinic and inspect that really itchy rash on your groin that you've had for the last 6 months, at 7pm on a Saturday  night...just-because-you-felt-like-it. Again. Headbanging moment.

It took me 10 yrs of asking, for the main hospital in Apia to try to beam their weekly lectures for continued education of Drs via teleconference to Savaii. Prior to that as I felt my brain turn to mush as I tried hard to recap everything taught to me in medschool again and again and improve it somehow by reading (a little) on line and practicing a lot ...the 'staff ' in Apia said...get together with your team there and do your own continued learning. your team there are 2 overworked tired, and just as stagnant with their medical knowledge as I dying to be taught something new...because on a daily basis we share our knowledge...what we know we continue to share and rely on each others strengths and experiences so to formalize an hour to do this again??why bother ....not really my idea of learning. regurgitating my own unsure medical knowledge was not what I had in mind for continued medical education.

I am not sure all the people surrounding me actually understand my grief when my eyebrows furrow when I overhear a phone conversation with a loved one, who is reassuring a (stranger to me) friend of theirs, that sure, shell come and see you now, where are you. Half the time people have asked me to see them outside of a normal clinical context (ie in hospital during times I actually work) its for really , nothing much kind of symptoms, which tells me...that peoples lives and errands have come first and this medical annoying thing with their kid is bottom of their list during the normal working day but suddenly realized once all their shopping is done and the convenience of being friends with my hubby then becomes abused ...and yes , I know people are really grateful and cant stop thanking me when I do...but all I can think is that really could have waited til tomorrow morning. OR...they are on their death bed...taking their last breadth, 2 yrs ago were kind of murmured they had a tumor in their abdomen but they refused to go see the surgeons, have been going round to different fofos for 6 months and now they want me to "save"them...

Hierachy. I have never been one to seek out status. It was never really a prominent part of my upbrining. Both my parents raised us on a , head down bum up , work hard for what you want kind of concept, and you will be blessed. The only hierarchy I have been taught is respect your elders..you came from their flesh and blood and they have had you at the forefront of their sweat from the day you entered this earth, respect yourself and strive to be the best that you can  and respect your boss...he who employs you. And I have stood by that concept. Ive worked hard to be self sufficient and be afforded the things in life I want. I am not wanting, I travel from time to time, I have a roof over my head that I am happy with and a car I adore. I value and love my family to death (though never nearly spend enough time with them) I am happy with my life. I have a great group of friends and great kids and husband.

In my own surroundings, I am happy. In medicine, I am not. I have worked the majority of my medical life in a challenging and under resourced environment and feel like i am always wanting, asking pleading and for the most part responses to aid development  will mean that i will be 150yrs old before some of the things I enjoyed in NZ will be available on this island.  Frsutration number 1. 2. I understand completely the urge to specialize and become particular in one area of medicine that you can be great at, but man...if someone told me in 1997 that that would take 12 yrs...I think I would have thought twice. 6 yrs of medicine and you graduate as a turd ...in the medical world you cant help but read between the lines that "all they ever did was that one medical degree" ...and nothing else. Like this qualification means nothing if you do not have another prefix suffix attached to it. Like all the hard work and tireless nights sweat tears , trials fights, mean nothing if you are "just" that basic degree. If tertiary degrees of such nature were available online , Id have two or three by now...but as they are not  or at least the ones i have seen require a month or two in freaken Egypt, and I am the furtherst of places from anywhere where I can find one of those, I feel like I suffer the often unspoken label of 'just' being a underqualified dr. So when I hear of the heirachy of medicine belittling the smaller tirelessly committed unsuperpecialised drs... I want to ask whether people understand that there is due recognition in the work everyone does regardless of the suffixes and prefixes to your name. And when you die, I'm not sure it will matter in your last days to the people around you what extra bits you have added to your name more then how you treated people when they were in need.

In real day to day life, I couldn't care less really because I know I give this island and my patients my all- 150% or more. And I don't see many other people stepping up to fill these gaps...so I feel I am making a difference. And I am not after any acknowledgement or thanks. I am satisfied knowing that people are greatful and there is someone looking out for them.
 A few years ago, when I had left the hospital (due to my sister passing away) and then decided to go back...I wrote to the hospital about locum rates (locummin is a reknown type ot employment worldwide where drs work part time to fill positions in hospitals or clinics) which were being practiced in Samoa, and I was told by a senior hospital management person that I was "too young" and needed to go get another qualification to qualify as a locum. Ive locumend all over NZ previously at much higher rates, and know from the pool of currently (at the time) locumming drs , I could offer just as much or more as a locum as this was work Ive already been doing in Savaii  but in the context of no one else to refer patients to- so I would really be doing what would be expected in a normal hospital setting of 2 or 3 drs.... but this reply was really a slap in the face type of reminder that in medicine, hierarchy is huge. I get it. I really do, and I have much respect for those who have been afforded the opportunity to excel, but please don't turn around and say there is no place for me.  I am believer in the quality of work you do...and I often feel like this is the immeasurable aspect of our work especially in Samoa where our practices are monitored very minimally. There are some tragedies happening out there that just get spilled down the drain...meanwhile some of us are constantly pushing for higher ceilings and better practices...much to the yawn of people sitting in at a desk somewhere (to generalize it lol) I feel like one day , some created watchdog executive group is gonna say...sorry but your degree is now out of date...and because you have done nothing else..you must retire lol.

Anyways, so if my kids were to ask me whats glorious about medicine, I would dish out the reality. Its a selfless job, its 24/7- 365days a week  no matter what you think, the hours are long and you will get tired. The expectations of how you work and how you deal with stress will always be yours and everyone elses around you.Everyone will always have an opinion because being sick can be an emotional rollercoaster for human beings and sometimes it is easy to lash out at the dr  and people will not always realise that what you are working with is really far less then what you see on scrubs or greys anatomy-ie people will not always understand your frustrations or woes or even acknowledge that you have any or should have any lol....don't get me wrong it is a needed profession and you have to have a certain kind of selflessness and passion to do it well which will always be a glorious thing...but honestly...go get a business degree or a skill .. something that will allow you to take holidays  or work from home. Celebrate all the public holidays and special occasions in yours and your families lives...have lots of babies and still be able to balance work and home life...save your sanity and your premature greying seriously ...statistics are  now coming out regarding high suicide rates in young doctors and the mental aspect of all of the stressors above contributing to this   reinforce my idea that for my kids sake- Id rather they not be exposed to this Luckily...I asked my younger daughter what she wants to be when she grows up ae faimai..hairdresser or policewoman..or a fairy ballerina- hallelujah !

Dearest Dad

My earliest memories of you are the best.
You used to walk me around the garden,
In the evening as the sun was setting,
And pointed out spider webs.
All busy spinning, preparing for the night,
You taught us that these tiny creatures, created something beautiful and need no fright.
I watched you prune our roses, and airlayer our tempermental trees.
You loved to talk about ,plants the birds and the bees.
You loved to read books –your favorite science fiction.
you also watched cartoons ...an inherited addiction

You enjoyed the company of ur friends...love and laughter you never lacked...people of all walks of life ...u never were siu to shout a beer and pat their backs
Long after you left Samoa...people would still ask if Kevin was my dad
The random taxi driver or shop keepr
Would eagerly tell stories of outings you and them had had
You loved your motorcycles...
And have had a few accidents as well.
We brought ur bike back from nz...Anton beefed ut up and you were very proud.

Somewhere in our childhood.
You and mum could no longer exist,
You went separate ways, and there were some hard days…but we new it was for the best.
Dad you were aways so hard to figure out. There was so much history of you and your family
we felt a bit left out,
because you could never speak, of you father or your childhood.
Like it was such a painful memory..that could never be understood.
You were a slave to your drink. You would never admit it. But we could always see it
Alcohol use disorder –you met all the criteria…
Dad, You had all the signs- you did. But You did not want to hear it. And you would never admit it.
It did not make you an evil person, it did not mean you loved us less….it just meant that you had terrible mood swings like 10 women with PMS.
I used to describe you jokingly, as dr jekyl mr hyde
There was a before alcohol you, who was decent and withstanding
And there was the after…a complete extreme makeover..who was sarcastic and moody and overly emotional…like I said PMS…. I always wished you'd be less, of hyde and more of Jekyll

Having you as a father has been a roller coaster. Of trying to understand and accept.
That not all families are picture perfect .
That we all , are only human. That everyone has strengths and weaknesses.
That despite everything, what was important, was that you loved us all so much and never ever failed telling us…to the point where it could be an earsore…
but how lucky were we, to have a parent who unconditionally, showered us with praise and love- … never discouraged us from the man above,
Told us to do all that we wanted and all that we could.
All that was important and all that we should
Always told us you were proud… you boasted we were your kids aloud
For not always being a present parent you were always saying you were sorry,
But we only ever wanted you to be happy and not to worry.


Your last few months have not been easy…you’ve always been so tough
Watching your decline in health, has been heartbreaking for all of us
But you battled your illness like a solder. Most drs and nurses would often say.
How little you seemed to suffer, in all the usual ways.
You didn’t lose your hair after chemo…you trimmed down to a younger looking weight,
you got a tan…new teeth…you looked really great
IT was just this last month, when things were quite rough. You tried you best to hold on,
To the you that was you, determined and headstrong.

Your pain threshold was very high, and you were always concerned about imposing on others,
even when it was at your own cost of suffering.you didn’t want to be a bother
That was always been you dad…a beacon of strength no matter what.
You never cried, you never lied, you always made up your own mind,
You were always fearless, you looked after your family, you were tireless
, you lived life,, you gave it your all..up until mother nature took its toll

And even that…you battled ,headstrong, eyes closed, fists clenched…..determined not to let her take the best of you
Dad…you may not know it…you may not think it…but there is so much of you in me, in us…
From you we got our confidence, you were always our walking encyclopedia
You corrected our English and our grammar, and sometimes our teachers
from you I am fearless. From that day you dropped me off at school,
on the back of your motorcycle- looking Pretty cool
much to the astonishment of my teachers who had thought my parents were some bookworms
and not part of a motorcycle gang. and you told me that if any teacher dare hit me…
to come straight away and tell you and you would make them regret it ….
I was an 8 yr old silently fearless…because you were our hero…and nothing scared us.

As you leave us dad for your final malaga , I want you to know, that your life was well lived, you celebrated it in your journey, you loved you laughed, you shouted you cried . you were lucky enough to get married twice and have a handful of children and friends and acquaintances who all love you. You leave behind pieces of you in us. I want to thank you dad, for everything you have taught us, instilled in us, imparted for us…for without you…we would not be, the people we are today.

Manuia lou malaga Dad, and as I have always said to those who have left us before, this is not goodbye…it is just a see you later.

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