January 2021

Like Angina,

I find it hard to breathe...

thinking of whats to come...

the loves I have to leave.

 

Paua shells and pohutakawas

...cafes and malls

if home is where the heart is...

Why cant I have it all?

 

the daughter I cry over..

growing up way to fast.

my chest is tight.

how long will this last.

 

Quarantine

Isolation

4^th time round

for the good of the nation.

 

Baby Pele,

she grew up behind the glass

smiling at strangers...

behind shields and masks...

 

Hospitals, healthcare

investigations and diagnosis

Not available in the islands,

poor prognosis

 

Like anxiety, my chest hurts

my heart thuds like its trying to escape

Trying to think of right from wrong

the decisions we have to make.

 

Covid, pandemic

new and virulent strain

sacrifice and scanning in

hopefully not all in vein...

 

my daughters eyes

 they are so big

I see the fear in them

I want to curl her into my arms,

and tell her she'll never have to leave them

 

but life's been good, at never giving me

a straight path to choose

 its always been a windy one

something always has to lose

 

God protect them,

please be at our sides

I don't know how else we will

survive ....

 

my heart beats

I will leave you

I will be oceans away

and in that time we must be strong

we will see each other again ,

one day

 

My home for 14 days

That 1 month of my life.



For unfortunate reasons, I found myself having to make arrangements to travel to NZ smack in the middle of the Covid Pandemic. Being a dual citizen this was possible thank goodness but so surreal the whole experience. I couldn’t help feeling like an actor in a Netflix series of the new world where germs and viruses dictate the way we live…I still cant shake that feeling off yet and worry that there may be some truth in that. So, needing to travel to NZ urgently, the hubby I made the difficult decision for me to go and take our infant daughter. He would stay behind with the older two still in school.



Packing for the  trip. How stressful. Knowing we were going into mandatory isolation we were told, bring everything you need for 2 weeks. For a baby that means  diapers rash cream, baby Panadol and baby food for 2 weeks! I wanted to ask if we could have a package dropped off or online shopping but there wasn’t really anyone to ask . We took what we could. Leaving Samoa the airport staff and experience was pleasant. The ladies at checkin however took my pram off me despite me asking to keep in inflight as usually the planes from samoa park a loooooonnnggg way away from baggage (why is that?) and I didn’t want to have to carry heavy baby and 2 bags the whole way. “don’t worry” they assured me. “we’ll make sure its outside the gate when you disembark the plane” we always do that they said.



Arrive on the other side. No pram in sight. Disembarking the plane takes an hour as we have to be offloaded in small groups of 5. Everyone is a walking virus until proven otherwise. Even though samoa has no covid. Im frantically trying to hold baby grab my backpack and my bags…and trying to ask an airhostess or person outside about my pram. NO-ONE-CARES….usher me along, don’t know anything about a pram, pick it up at luggage surely. F*@!K. exactly whaa worried about. No one tries to help with my juggling act. I must be conora saturated lol. Anyways, get to baggage HUFFING AND PUFFING> the whole getting out from there was pretty painful just cos I had a baby in tow and the whole hands off thing with this pandemic meant that I was kind of on my own. The aiport is ghost town. We are ushered into a bus, It feels surreal to be ushered into a bus not knowing where we are going. Thankfully its only down the road to sudima hotel (literally 10minutes from hotel ) getting off the bus however is more painful then getting of the plane. Each person has to be offloaded infdividually and an official moh person has to run through all the rules one by one. OMG I can think of so many ways to do that better but I guess it makes sure no one can play dumb after. Far out. We landed at like 7 I think and don’t get into room until after midnight ☹



The next 14 days are summarised by

-too much food

-baby safing a room

-watching sunsets

Watching sunrises

Watching the DHL and postie trucks go by (a lot of trucks go by, we must be in some industrial area)

Watching people in the smoko area of the carpark

Watching that ?tongan family do Tabata everyday

Watching people try to burn off energy going round and round in the carpark

Going round and round in the carpark ourselves

Watching security watch us…

-not allowed to sit in lobby everything is hazard taped off (bar restaurant pool gym etc) basically you must move through the lobby but don’t stop (less you drop off or pick up a germ I guess) there is a small carpark with 3 trees you are allowed to go walk around in. its fenced with security everywhere. There are army people wondering in and out from time to time kinda intimidating but they are nice eye candy so its ok.

We get to register to go for a walk down to a park. I go with baby. By park it was just some grass behind a big shed but no swings or slides or anything I thought might be nice for baby. I sit under a tree and we eat yogurt until some teenagers have done with their game of rugby and we all walk back to the hotel in line formation.

My saving grace is being able to order coffee to the room (barrista coffee) yay.

Baby has fallen so many times in the room. Thank god its carpet but, she has bumped her head (big eggish lump) split her lip (tub in bathroom) and bit her tongue (OMG if cyfs were around lord forbid they take her off me!!) Ive moved all the beds to cover any edges from tables and chairs but it’s a small space for the little one to wonder. Shes only just started standing in the last few days so her exploring skills are on the rise. It breaks her dads heart to hear and see her little steps and advances when we call on messanger. Everyday she  seems to learn something new. I till can't believe the year we are in.



We are allowed to order online shopping so I go a bit crazy with fresh.co.nz groceries. I end up taking 90% of the stuff out with me when I leave cos we didn’t really need rice crackers and extra tea coffee milk powder/cereal /twisties/chocolates etc….!



Despite free wifi I don’t really do much Netflix or movie watching. Its hard to look away when theres a baby around. The 2 naps she has (or 3) I use trying to catch up with emails and check on things back home. Never enough time.

We are allowed washing twice a week. Despite it being included (free) we get the bill in the bag when clothes are returned  I guess so to feel lucky that we don't have to pay ? (thankyou NZ  government pays) WOW $143 NZD for what I would consider half a load. Gosh they mustve had some goddesses of Rome handwash my knickers !!



D-day comes and we couldn’t be more eager to GET OUT OF THERE. Some formalities though.. wait for nurse…fill out form…take to designated official at reception. There isn’t a special person at reception when I leave…see a nurse getting into elevator- “ask reception” see reception – hmm, give it to guard…see guard---uhm leave it at reception. OK guys, seems checkin you’ve got down but check out ?? different story ANYWAY…hip hip horray- poppa has come to get us. THANKYOU LORD for keeping us healthy and sane . no corona virus here faafetai  looking forward to seeing mum and having our first KFC!

saying goodbye to dad at airport.

He doesnt want to let go 

Carpark shenanigans

our room 

We need new toys..empty bottles wont do!

the one tree at the "park" 

She doesnt like socks

She learnt to stand in Sudima!

Too much shopping we didnt need

HI POPPA

HI NANA

WE OUT YAY!

The "we'll call you back " phenomena

My journey and time working in our health system back home has been a bucketful of mixed emotions and experiences. Alot of challenges and alot of lessons learned.  It definetly took me a few years to adjust to working in our "lots to be desired"  health system. Ive had to  become more resourceful, lower some of my expectations while raising the bar on what I could do for patients with what was available. A whole lot of embracing rural health and rural people and removing my preconceived/naive " how could they do this to themselves" way of  thinking to understanding why our health is the way it is.

If theres one thing I did not see coming, it was the development of  a passion for rural medicine. Practicing medicine in a rural area has  been one  of the toughest most nerve wracking things I have done but at the same time truly  rewarding . I certainly now appreciate that people who live  in some of the furthest corners of our country are some of the happiest  and healthiest too, and they want to stay in their homes. Their villages, their land...they want to reap and sow the plantations handed down by their forefathers and we all could learn alot from their humility and outlook on life. However it has been my most burdensome grievance, that when these people need something from our health system, that it is often placed so far out of their reach, so many difficulties, challenges, costs, human error and human slackness resulting in negligence and  eventual distrust. One honestly can not blame the people sometimes. I do realise that our health has had advances and things to be celebrated - certainly we have acquired new skills and thus new services over the last 10 years, more technology and more human man power. However our health system still falls flat on some basics. Its like  teaching someone how to speak spanish (or french or latin or whatever) when your english is still poor to begin with ....

I often come across this phenomena in health, that I have to warn people about. It rears its ugly head in various situations and torments the lives of poor patients. I dont think the bearers of this phenomena actually realise the anxeity and grief this causes, and if only one could audit and measure the amount of emotional stress associated with it. This phenomena I call the "call you back " phenomena.

In this day and age of technology, of Microsoft work and excel, of phone text messages, to group chats viber messanger whatsap, to online organisers google calender, cloud, dropbox, trello, etc etc etc. Surely there must be a way our health can be held accountable for the promises it makes its patients. Time and time again I have patients who come in to see me , often very unwell after a ridiculously prolonged period since last seeing a health professional who say "I saw them (specialist/doctor/nurse/ whoever) and they said- sei faakali bla ba bla(some reason person/investigation/team from overseas/test to go overseas/lab reagent to be back in stock/radiology machine to be fixed etc etc)...and they will call me back " and then they wait. They wait and they wait. They wonder how long they are meant to wait and whether their ongoing weightloss is meant to be of concern?. They go back to the hospital but when telling the new face young and freshly rotated Dr there that they had the "call me back phenomena" they are promptly told to go and wait again. That the first issuance of the "call you back " ticket surely means youve made it past round one (which is where the new dr now sees himself/herself) and you need to go wait as youre currently suspended in round two of this phenomena. And surely Drs/health professionals are good people, theyll follow up on their promises.  A year goes by and they are far worse. finally they decide this is ridiculous and come back to see someone else. (me) to be fair, on the odd occasion, people have changed phone numbers/lost their phones. Which isn't unusual in Samoa. Thanks to ridiculous rivalry between the two giant phone companies constantly trying to outdo each other, customers are constantly being lured to come in exchange their sim cards and get a free amount of X credit etc etc etc....annoys the crap out of me because this is what happens. Everything registered to their life with that number, does not cross the minds or cares of the phone company and often the customer is ignorant to the fact that youd need to go change all those registrations (and often wont do anyways) and so...that call back phenomena gets worse.

Anyways. Then, even overseas visiting teams have the same effect . Although they come from health systems which are highly refined and scheduled and manned and held legally accountable ie someone could go to jail should it fail, not a single hair out of place on that head .When they come to our shores, they suffer the same sloppiness. I dont know if they see us do it (issue the call you back cards) and think thats what they should do, or they just dont realise the effect they will have or how much work this action actually entails, and dont realise the slim chances of this even happening,  but we even have visiting teams of specialists who go around and see people, and then lo and behold give them the same phenomena...they tell them things like ...something is wrong, but we/or someone " will call you back" sei lipoki aku le falemai and then they will call you back, they promise.Once their findings are handed back to the Samoan health system, even if its Bob Smith the data entry clerk at office/building 102 miles and miles away from the acutal hospital, who'll just file their forms...surely, theres someone sitting somewhere who will ring these people back when I return to zimbabwe.

My problem is, 1) the hospital landlines cant even call a mobile phone so how are people meant to be called back on their mobiles (ie this leaves the caller with no credit phenomena to ensue) then 2) who is doing the calling? if the actual health care people are operating/working in clinic/ resuscitating people - who sits down and calls everyone up?Although I really hope and root that my fellow brothers are...I often find the patient who did not have this luxury. Unlike other fancy overseas health systems where all specialists and departments in hospital have receptionists and secretaries who are responsible for spending a good amount of their days organising these, in Hamo-land we dont.  3) what are they using to remind themselves to call people up? often the call back phenomena is seen accompanied by 'scribbled my number on a piece of paper' phenomena...surely there must be a more robust system of capturing these lifesaving details and prioritizing /remind the caller? We must all remember that we are only human and our brains are not endless gigs of data...we too will reach a point of maxing up...and surely there is some software we can invest in to do the reminding? some people we can invest in to do the calling?

 I think this terrible phenomena is not solutionless. It really just needs smarter solutions and I really feel it boils down to 2 things -Technology and manpower. Better systems, that are smarter then us, that wont fail or forget or lose details or that piece of paper.   Some sort of technology (and surely you can pick from hundreds of free tools available on the internet/computers) to capture peoples details and plot dates and reminders for follow ups, and a dedicated person ot do the calling. Full stop. In other countries, this is called a secretary (or medical receptionist) or ward clark or personal assistant, and the other is called a computer and a phone.  The two need to go hand in hand and weak points identified. Ie what happens when a follow up date goes by and the person doesnt show? then the human power looking at this must have the dedication and belief in their purpose to ensure the person is hunted down by all other means (thats why you normally should always provide 2 numbers, a next of kin, next contact, your wife husband father mother, faifeaus number along with your own) to ensure the person is indeed located and not left  behind to become one of those " lost to follow up " statistics

Unfortunately, my brothers and sisters in the rural areas suffer most from this glitch in our health system as travelling often to the main hospitals to try to get answers is financially burdensome as well as time costly as well. things they dont have lots to spare. Samoan Fofos are far more accessible and often people will resort to seeking fofos in the interim for prolonged periods , sometimes to their own demise. 

My heart is broken today

This morning I learnt of the passing of the son of a staff member of ours whom we have had for years. This little man was only 4 yrs old. His father has pictures of him on his phone/facebook showing a wide grinned little boy with a spark in his eye. Someone you can just hear people in the village say "o le ulavale ia" referring mostly to his overabundance of energy and knack for life.

2 weeks ago, our staff member  brought this little man to me with his wife. It only took a first glance to see that he was pretty sick, looking very thin, gaunt and breathing very rapidly.   He was admitted to hospital that day and after a prolonged admission finally was deemed better enough  by the drs there at the time to go home. In that time, we had discovered that the little guy had acquired an illness that had caused his heart to swell significantly. I had done a bedside scan on him trying to find answers to our questions  and could tell right away that his condition was quite bad. I refrained from leaping straight into giving him a terrible prognosis as I don't feel I have enough experience to know with his illness, whether he was past the point of no return or whether there was a chance things could be improved. When it comes to kids, my heart is fragile and I only ever want to give good news. The bad news is so enormous when its a little person who hasn't had the chance at  life. Actually I think Im like this with all my patients. Just never rushed to give bad news unless Im sure we have exhausted all possible help, drugs, meds, investigations, expertise.  In this little guys case. His heart was very sick. Meanwhile, we don't have a heart dr to consult on at the hospital, and in particular a paeds heart  dr was who we really needed help from  (or childrens heart dr) so everything was going to be a 3 step process of trying to contact overseas specialist, send them reports/images and await a reply.

We did this. But the replies were not good. My heart always sinks when I get a reply which starts with. "this is very sad" because I feel like this summarises the whole outlook right there. What I didn't expect though was that this kid would go so soon. I had thought he would have more time, at least a year or two of back and forthing to the mainland , to see visiting specialists, even if he were deemed unfit for surgery I thought there would be a palliative pathway he would go down. But no. Literally within 2 weeks of his illness coming to light, his heart gave out and he has taken his last sleep. Im not sure if this was better or worse. I think either way is pretty sad but perhaps more time ?although always the question of quality of life :(

His father rang me to tell me he couldn't work this morning . I asked first if they were being transferred to the main hospital in Upolu  for his sons treatments - knowing he was pretty sick? When he told me what had happened, I could hear him choking back tears in his breadth and so did I . I had to run away to the privacy of our bathroom to escape the morning rush of people in our house and have a little cry . Kids getting ready for school, sitter just arrived,  manager from hotel coming to update tasks of the day, housekeeper from hotel wanting to know how to use her timecard...my heart is breaking just a little bit and I want you all to go away :(

I thought about this kid a lot today. What a gorgeous little man he was. How his parents loved him so. How much my kids mean to me. How terrible it is to see your children suffer. How parents are meant to cope with this. The fairness of it all. Our staff member came over later, and sat at the foot of our door. He looked like he did not have the strength to even breath.  His eyes blood shot from obviously being up all night and for the river of tears he must of shed. His English is not very good, my samoan aint that flash either. The hubby is in Pago for a faa'lavelave. Where are his wise Samoan words when I need him. I'm no good at providing comfort or counselling in Samoan, and I doubt me doing it in English would be very good either. So I stumbled through some "I cant think of anything that will ease the pain you are going through now" (in my broken Samoan ) and some "be strong for your wife and kids, so you can get through the next two weeks" I didn't feel it was enough but all I could muster while trying not to be a ridiculous bag of tears.

Of all  thing things in life I am grateful for. My childrens health is  one of the most important . Despite all the challenges and hardships we face, that is the one hardship I am glad to not have. The pain of suffering and health issues.  Today I will hug my kids a little harder and pray for this families pain.