Sorry it has been so long -- I will update you on what has been happening (pictures will be added later once I figure out how to get them uploaded)
I took off from Honolulu on Hawaiian airlines. The plane was a Boeing 767, and was packed completely full - mostly Samoan passengers on their way back home for the holidays. There are only two flights per week - Monday and Friday, and Hawaiian airlines is the only carrier that flies direct to Pago Pago. There are other flights that come from Western Samoa (the independent nation approx 30 mins flight from American Samoa).
On the plane, I sat next to a Samoan lady who was probably late 30's, early 40's and pregnant. She lives in Hawaii, but she and her husband are both from American Samoa - she also has like 6 or 7 other children. She was flying home for the holidays because she found out her baby was breech, and there is a traditional ceremony/massage that her mother performs in her village that supposedly helps flip the baby into the right position - not really sure what it is, but it did not sound like the ECV (external cephalic version) that we and the OBGYN doctors do back home for similar situations.
The plane ride was fairly smooth. I had a window seat and was able to see an amazing sunset out the window. I tried taking a picture of it, but my phone wouldn't focus correctly. The seats were comfortable - bigger than usual, probably because American Samoa is technically the world's most obese nation (more fat people per capita than any other territory or country). Had a dinner on the plan of teriayki chicken, salad, hawaiian dinner rolls, and a piece of chocolate with coffee beans (Kona, I think) in them. It was very good for airplane food. The entertainment consisted of music (mostly hawaiian music) and a Christian football movie that played over the main TV screens. I was actually very surprised, but come to find out that AS is very Christian and they always play family/Christian movies on that route.
We landed in Pago Pago, the captial city of American Samoa around 9:30pm. We flew through some clouds and the ride was very bumpy without any visibility until we literally bounced on the runway and came to halt. The plane stopped outside the terminal, which basically is a metal and concrete building from the 1960's. We exited the plane from the rear exit, and went down some stairs directly onto the runway. Security and immigration were lining the route to the terminal, however they would randomly hug certain passengers that happened to be in their family. It was very informal.
We were herded through to a big open room with several lines for immigration. It was a VERY hot room with minimal ventilation. No air conditioning, just a couple of old rickety ceiling fans. There were probably 250 people in line, and everyone was dripping with sweat. There were probably 5 non-Samoan people on the flight. Come to find out, one of the white men and his two boys were also here for medical work (though I didn't find out until later). The dad is named Dr. Cosman, and is a colorectal surgeon from San Diego. His older son, Raphael, is a 22 year old Computer Science major from Stanford, and his little brother is 12 year old Elon. Anyway, Raphael had a ukelele and was playing random songs while in line, so at least we had music.
I got through immigration without difficulty, though there were several forms I had to fill out. American Samoa is an independent territory of the United States, though is only loosely American. They have their own independent government, and I still needed my passport to enter. I now have an AS stamp in my passport :). Once through immigration, there was a very crude luggage conveyor belt that looked like a giant, rusty grocery store checkout belt. I found my luggage and left the terminal.
Outside, there were literally hundreds of people (it is a big deal when the flights come in). Matt and Tangra were there, with their daughter, Neeli. They gave me the traditional Samoan beaded necklace made from one of the local nuts (the traditional way to greet new arrivals etc). They were driving an old ford explorer - that harkened back to the days of St. Maarten. (awesome car)
Cars are ridiculously expensive there (probably double what you would pay in the US), and electricity/AC/hot water is probably double what you'd pay in the US, as well. Gas is about $3.50/gallon, so very reasonable for an island.
The roads are very well maintained, but the houses and stores are very run down. Most of the islanders live in tiny homes, usually one large room with all family members sleeping on mats in the floor. Many homes are in the style of the "Fale Samoa", which are basically concrete versions of the huts they used to live in 50 years ago.
The island is very Christain. Each village has one or two churches, and the pastors are viewed as very important members of the community. Most of the Churches are either some form of evangelical (pentecostal, baptist, etc), or Roman Catholic. The mormon church is also very active on the island. Probably half of the people working at the hospital are LDS. Many of the churches also operate as bingo halls, which is a huge money-maker for the churches (and seems a little unethical to get people hooked on gambling). Many of the island's poor waste their money playing bingo.
Some intersting tidbits about the island culture - swimming in swimsuits or bikinis is not allowed. All females swim in shorts and tee shirts, if they swim at all. Most locals do not swim - many do not know how. They have a cultural fear of the water, probably from years of both tsunamis and also attacks from the sea. There are almost no houses next to the water, and most of the homes have their doors and windows facing away from the sea - probably to allow people to exit up the mountainside in the case of an emergency.
Each village has a chief, and there is a council of chiefs that meets to discuss important matters. There is also a governor and a senate. The territory also has a non-voting representative in the US congress that helps to represent their interests in Washington DC. The chiefs are selected by the families, most are educated or wealthy, and there is a lot of corruption. The largest employer on the island is the government, and most of the budget comes from US Federal funding that is then distributed around the island. All residents are classified as "US nationals", not US citizens, but they are all covered by medicaid and can get this when they travel to the US.
The largest private employer is Sunkist Tuna, which owns and operates a large cannery in Pago Pago. It employs a few thousand workers, and pays about $5/hour, which is one of the better paying jobs on the island. The cannery processes thousands of tons of fish per year, and the stench is horrendous when they are actively boiling/cooking the fish.
Tattoos are a huge part of Samoan culture. Many of the men go through elaborate ceremonies where they have literally their entire upper body tattooed manually using a mallot and various ink blades. It is very painful, and it often takes 2-3 weeks for people to recover. There might be the possibility of seeing a ceremony while I am here.
There is also an interesting group of people in Samoan culture - a "third gender" called "fa'afafine". Despite the conservative culture, they are openly embraced and celebrated, and not particularly looked down upon. The fa'afafine are men who are raised "in the way of the woman", and there are usually a few in each village. They dress and act like women from a young age. Many of the cheerleaders at the local football games are fa'afafine. These people will date straight men in the community, and those who date them are not considered to be homosexual. There is also a female version of the fa'afafine, but less common.
Anyway, it was great to get the chance to meet up again with the Broges. Their daughter is adorable, very outspoken. I did not meet Noah and Nolan that night because both boys were home with Matt's mother, who is also currently living in American Samoa.
I was taken to the locum apartments on the hospital grounds. They are located just up the hill behind the hospital. My apartment is a ground floor - 2b - actually the "handicapped apartment". It consists of a living room with a table, three chairs, two couches, a small TV with cable, kitchen with stove and refrigerator, a bedroom with a closet, and bathroom. The bedroom and living room have AC (similar to the ones we had in St. Maarten). There are also two dogs that hang around my apartment (and multiple other + chickens which populate the hospital grounds). The accommodations are far more luxurious than I was expecting, and are very comfortable.
The hospital itself is very old. Built in the 1960's under the LBJ administration. Basically there was an old reader's digest story in the 1960's that was written by someone from Minnesota that sparked an outrage against the conditions on the island (read the story here: Samoa: America's Shame in the South Pacific). This prompted LBJ to travel to the island and build a hospital - now LBJ Tropical Medical Center. It reminds me of a slightly larger, airconditioned version of the hospital I volunteered at in Migori, Kenya. There are two main hallways, with open-air causeways connecting them. They have an emergency room, Operating room, OBGYN delivery suite, a small nursery, a medical ward, pediatric ward, also clinics for surgery, pediatrics, dentistry, and surgery. They have an Xray machine and a CT scanner. The CT scanner is currently broken.
There is basically no primary care to speak of. The clinics are reserved for people who are sick, and they do not do immunizations there at the clinic - this is done a the department of health. The government pays for healthcare with medicaid - basically the US government gives AS a lump sum to use for the year. The AS government charges $10 for a clinic visit, with an additional $10 for ALL additional labs, imaging etc combined - so maximum cost per person for a clinic visit is $20. An overnight stay in the hospital costs $50. This does a pretty good job of keeping people away from the hospital who do not need to be there. I think that they should institute this in the US, because it would keep people out of the ER.
The hospital is staffed by a mix of US and foreign trained physicians - many from the pacific islands of Fiji, Solomon islands, Tonga, etc. Most of the doctors only come for 2-3 years at a time, and then leave. There are very few Samoan doctors.
There are virtually no specialists. If someone needs specialist care (cancer, severe illness, etc), they have to get to Hawaii. Because of EMTALA (US law which forbids "patient dumping" from one hospital to the next), the hospital cannot transfer a patient unless they find a hospital which is willing to accept the patient, usually on charity. This very rarely happens - even charity hospitals like St. Jude very rarely accept even kids with cancer because of the expense of transport and the lack of funding. Usually what happens is the hospital meets and agrees to pay for a passenger ticket aboard Hawaiian airlines. The patient then flies to Hawaii and "chooses" the hospital of their choice, and then walks into the ER. There have been several patients who have died en route to Hawaii on the airlines. It is pretty sad.
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