Monday January 5, 2015

This marks the beginning of my final week in American Samoa.  It has been an incredible experience.  I have been pushed and challenged medically with some very difficult patients, and I have also had the opportunity to travel around the island and experience many new things.

This week, I am scheduled back in the nursery and NICU - meaning I am the only doctor in the NICU and the nursery.  It was a busy day with eight new babies to see, most of whom came from mothers without prenatal care and who have lots of risk factors.  Prenatal care is free for all mothers here, so it is interesting that there is still such a challenge to get mothers into clinic.

Tangra was on call today, so she called me in for a couple of cesarian sections for some more practice with resuscitations.

When I finished with my work, it was around 4 o'clock.  I borrowed Tangra's Explorer and drove up to the trailhead of Mt. Alava.  I was hoping to hike the adventure trail, complete with rope ladders and rock staircases (See more Information on Page 7)

The trailhead was located at the top of another very steep road, with sweeping views on either side of the ridge.  My original plan was to be done with work by 2pm and get a headstart - but it was already 4:30pm, so I decided it was probably not the best idea to start a solo 7 mile hike in the jungle right before the sun goes down.  I got back into the car and headed back into town.

That evening, we went to Tapps to get burgers again.  I had the teriyaki burger again, but this time it had thick sliced bacon and jalapeno.  It was delicious.  I told Tapp I was going to nominate his place for Diners Drive-ins and Dives.

Sunday January 4, 2015 - National Park of American Samoa

 On Sunday, we went to church.  The weather was absolutely amazing.  Sitting in the chair during the service and looking out at the mountains, one cannot help but to be in awe of God's creation.  Several times during the sermon, I saw a trio of white birds flying against the green backdrop of the jungle. Beautiful.

After Church, we grabbed a bite to eat and drove over to the National Park on the other side of the island.  The federal government does not technically own the land the park sits on - they have a 100 year lease from the village that oversees the land.

The road over to the national park was an incredibly steep incline.  We arrived at the top at a shelter.  There were several placards around with information on the surroundings.  I snapped a few pictures for future reading:

 

 

Once again, the view from the top was spectacular.

 

There was a small hiking trail out to the cape that we took through the jungle.

Every 100 yards or so, there were signs with information on Samoan culture and history.

The trail ended at an outcropping overlooking the Pacific Ocean.  The water was deep blue.  I was still in my Sunday Samoan shirt (snazzy, I know). Pola island is seen in the background.

 After hiking back to the car, we drove down into the bay.  Pola island is seen here in the distance.  The village looked almost deserted (probably Sunday prayer time), so we turned around and headed back.

 I stopped and snapped this last photo from the side of the road.  (I will probably be framing some of these photos!)

The drive back down the steep road was an adventure.  I could tell Matt was pretty nervous about the vehicle (Ford Explorer).  He had to ride the brakes pretty much the whole way in low gear to keep from slipping down the insane incline.

It was after getting back down that we stopped for ice cream and saw the bats (see my Pago Pago post).  All in all, it was a great day.

Fatu-ma-futi

On the drive into Pago Pago, there is an iconic set of rock formations out in the ocean.  This is called Fatu ma futi.  Fatu is the rock in the back, and Futi is the rock closer to the shore.

The legend behind the rock formations are varied.

One version of the story goes like this (From Here):

"There was a Samoan couple named Fatu and Futi who sailed from Savaii, an island which is part of Western Samoa, about 300 miles away from Tutuila (American Samoa's biggest island). Fatu and Futi traveled on a canoe many days and nights but could not find Tutuila . As they traveled, strong winds and heavy rain tossed the canoe and caused it to capsize.  Fatu and Futi swam hard for days and nights to find rescue. After two days of fear and misery they finally reached the shore of Tutuila, but Fatu and Futi could not endure the hard time they had faced and both died and changed into big "rocks". The two big rocks are still standing side by side along the shore, Fatu (the man) is the big one and Futi (the women) is the smaller one..."

There are other versions of the story, however I have been unable to verify them.  There is a guy at the hospital who works in HR (Benjamin) who lives in the village of Fatumafuti.  I will ask him for his version of the legend.

Saturday January 3, 2015 - Post Call and Nu'uuli Falls

Saturday morning (post-call), after about three hours of sleep, I met up with Matt, Tangra, and the kids for a hike out to Nu'uuli Falls.  We drove over to a shopping center and met with Dr. Shushunov, who wanted to come with us.

The falls sit about a half mile hike from a local homestead.  As mentioned before, there is no real estate on the island and all land is shared, so the falls are on private grounds.  We drove up a winding road, past a pig farm, to a small house.  A young boy and his grandmother were inside, and we asked permission to park on their property and hike out to the falls, which they granted.

We started out in the backyard of the family's home.  There was a small path worn through the jungle.

It was very hot - about 90 degrees in the shade (though I'm not complaining since it is below zero back home in Minnesota!).  The rainforest was thick and humid.  We ended up crossing a stream (twice) that zigzagged over the trail.

Regardless, it felt nice to be out in the jungle.  (despite the heat and sweat)

All along the path were colorful flowers.

As we approached the falls, you could hear the rumbling of the waters.  It was a small climb up a muddy hill and over some rocks, and then we arrived at Nu'uuli falls.  At the bottom of the falls was a deep swimming hole with cold water.  The mist from the falls acted like a natural air conditioner - with the air temperature a good 15 degrees colder than daily temp.

We spent about 45 minutes swimming around the falls, enjoying the refreshingly cool water.  The best part was swimming directly under the water...

 Eventually we were jointed by some teenage boys.  One guy let me take his photo.  They would climb up the wall and dive into the pool.

On the way back, I snapped a few more photos of the various plant life. It was incredible how thick the foliage was.

Here is a brief video of the falls:

After the hike, we went back to the Broge's house for dinner.  I ended up passing out for about three hours to recover from the call shift.

Friday January 2, 2015

Friday was next 24 hour call shift (now q6 since one of the other doctors returned from off-island).  There were 2-3 c-sections and two admissions (plus multiple phone calls and consults).

The most interesting patient I had admitted was a 13 year old girl coming in with DKA.  I had managed DKA in adults several times on our inpatient service, but this was the first time managing a child. It was also interesting because I needed to physically write out all the protocols (insulin drips, hypoglycemia, etc) by hand - I had gotten so used to simply opening the DKA orderset in EPIC back home and click-click-click... move on.  Looking back, I think having to write out the orders really tests your knowledge of the etiology and management of the disease.  There are also limited computers and no wifi, so you have to rely on *books* and other sources to look up information.  I actually felt like I was doing real medicine.

Another strong learning point was in the interpretation of Xrays.  There is no on-call radiologist to read your films - you are it.  The films are read several days later, but by that time you hopefully have treated whatever the patient had.

New Years Day

New Years day was another holiday, and the clinic was closed (my next 24 hour on call is Friday 1/2/15).

I spent the day at the beach, which was beautiful as always.

New Year's Eve

Monday to Wednesday (Dec 29-31) was business as usual.  AM rounding with your patients, then clinic duties through the afternoon.  I did have a very interesting set of cases -  a couple rheumatic heart disease follow-ups and I also diagnosed a kid with post-strep glomerulonephritis and started her on antihypertensives.  There was a consult from the ED for a kid with ? rheumatic heart disease.  He ended up having a new heart block on EKG, very subtle. Dr. Marrone gave me a few good pointers on interpreting EKGs in kids.

On New Years Eve, Tangra was on call.  Matt and the kids came over to my apartment to hang out for a couple of hours.  We had planned to go either to church or over to a neighbor's home for a bonfire, but by the time 11pm came around, we were all too sleepy.

I had called Carlyn earlier that night to celebrate the Minnesota New Year, so I didn't feel too bad about calling it a night and going to bed early.

Pago Pago

Pago Pago is the capital of American Samoa.  With a population of just under 4,000 people, it is the largest village on the island.  The hospital is right on the outskirts of the city.

Here is the view of the city from the ridge above the harbor. (taken 1/4/15).  The port encompasses a deep bay, which was of strategic importance to the US Navy during WWII.

As you drive into the city, the first thing you notice is how clear and blue the water is.

In the afternoons, you will see families playing in the water.  (Of note, you will see multiple EPA signs around the harbor signifying the mercury content of the waters around various shorelines.  It is not recommended to eat any fish that are caught in the harbor due to toxins and heavy metals.  I decided to avoid swimming in the water, as well).

There are multiple public Fales (Fah-lays), the traditional meeting place of the Samoan people.  They also used to be the homes, as well. 

At the far left of the photo below, is the building which houses the Fautasi, the traditional Samoan longboat.  There is a major race every year around the islands, and the team spends months training for the event.

Below is a [blurry] photo I shot of the Pago Pago harbor entrance.

 

There are many boats and ships coming in and out of the port.

Another view of the port.

 

Next to the Government, the largest employer on the island is Starkist tuna, which operates a major factory on the outskirts of the town.  The smell is absolutely horrendous, but the company is a major economic player in AS.

 

Charlie the Tuna.

 

Back in 2009, there was a Tsunami in American Samoa that killed many people.  There are signs all over the island warning you that standing next to the water is unsafe during a Tsunami.  FEMA was sent to the island for cleanup and you can still find people using the FEMA tents as functional buildings in the villages.

 

This is self-explanatory.  Nothing beats cold ice cream on a hot day (and for $1.00!).  To the right of the sign, you see an example of the water stations that are at most mini marts.  For 50 cents, you can fill a gallon jug with cold water.

 

The government guarantees that at one time (on the sticker) the water is free from bacteria and parasites, however the quality of the water is dependent on the business operating the machine.

Taken on January 4, 2015.  Here is a tree full of bats (the flying fox).  They have up to a three foot wingspan and look like pterodactyls.  At night, you can see them swooping in and out from the trees.

Some of the many colorful buses in Pago Pago.