tag:blogger.com,1999:blog-54738353492251404922024-02-24T20:29:25.523-11:00CorbinMDJustinhttp://www.blogger.com/profile/02756187168565232122noreply@blogger.comBlogger32125tag:blogger.com,1999:blog-5473835349225140492.post-72662086354691083912015-01-09T04:21:00.000-11:002015-01-09T04:21:36.996-11:00Monday January 5, 2015<div dir="ltr" style="text-align: left;" trbidi="on">
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.<br />
<br />
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.<br />
<br />
Tangra was on call today, so she called me in for a couple of cesarian sections for some more practice with resuscitations.<br />
<br />
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 (<a href="http://www.nps.gov/npsa/planyourvisit/upload/NPSA-Trip-Planner_web.pdf">See more Information on Page 7</a>)<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-zyOdaYEQrgo/VK_tk92AkcI/AAAAAAAAORA/8zjrpxHPedQ/s1600/Picture%2B205.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-zyOdaYEQrgo/VK_tk92AkcI/AAAAAAAAORA/8zjrpxHPedQ/s1600/Picture%2B205.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-G-yXK7WlLt0/VK_tvzkeTsI/AAAAAAAAORY/xs9Wrtw26Vg/s1600/Picture%2B204.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-G-yXK7WlLt0/VK_tvzkeTsI/AAAAAAAAORY/xs9Wrtw26Vg/s1600/Picture%2B204.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/--j6PFfegTb0/VK_tuNirXAI/AAAAAAAAORQ/KK8ih3BjjLQ/s1600/Picture%2B203.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/--j6PFfegTb0/VK_tuNirXAI/AAAAAAAAORQ/KK8ih3BjjLQ/s1600/Picture%2B203.jpg" height="225" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-x89bUeJ-BUY/VK_trxk-iAI/AAAAAAAAORI/9mWqanCI0to/s1600/Picture%2B202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-x89bUeJ-BUY/VK_trxk-iAI/AAAAAAAAORI/9mWqanCI0to/s1600/Picture%2B202.jpg" height="225" width="400" /></a></div>
<br />
<br />
<br />
<br />
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.<br />
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-2xS8LbFas3k/VK_tyviXV6I/AAAAAAAAORg/1BAWtaNTwvg/s1600/Picture%2B206.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-2xS8LbFas3k/VK_tyviXV6I/AAAAAAAAORg/1BAWtaNTwvg/s1600/Picture%2B206.jpg" height="225" width="400" /></a></div>
<br />
<br />
<br /></div>
Anonymousnoreply@blogger.com2American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-39913207132157991932015-01-09T01:32:00.001-11:002015-01-09T02:06:03.642-11:00Sunday January 4, 2015 - National Park of American Samoa<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
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.<br />
<br />
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.<br />
<br />
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:<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-vGleKbPu614/VK_E_JuymjI/AAAAAAAAOOQ/RmTVPEClwwM/s1600/Picture%2B153.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-vGleKbPu614/VK_E_JuymjI/AAAAAAAAOOQ/RmTVPEClwwM/s1600/Picture%2B153.jpg" height="225" width="400" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-GAUqkJUy-bA/VK_FEs7zhwI/AAAAAAAAOOg/TfmPMwhAxFA/s1600/Picture%2B158.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-GAUqkJUy-bA/VK_FEs7zhwI/AAAAAAAAOOg/TfmPMwhAxFA/s1600/Picture%2B158.jpg" height="225" width="400" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-_ouFn6NfYBk/VK_FBZkFQBI/AAAAAAAAOOY/LJoDJ7mt9sM/s1600/Picture%2B159.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-_ouFn6NfYBk/VK_FBZkFQBI/AAAAAAAAOOY/LJoDJ7mt9sM/s1600/Picture%2B159.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-vm0t1ks5SoE/VK_FImWFZcI/AAAAAAAAOOo/fl6fMaSBh6A/s1600/Picture%2B160.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-vm0t1ks5SoE/VK_FImWFZcI/AAAAAAAAOOo/fl6fMaSBh6A/s1600/Picture%2B160.jpg" height="225" width="400" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-EkM3Qi6LC8s/VK_FM48nU-I/AAAAAAAAOO4/p7g0bFeCDyg/s1600/Picture%2B163.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-EkM3Qi6LC8s/VK_FM48nU-I/AAAAAAAAOO4/p7g0bFeCDyg/s1600/Picture%2B163.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-0f-otmxkZ3c/VK_FQCFIAEI/AAAAAAAAOPA/uckN9jdazek/s1600/Picture%2B164.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-0f-otmxkZ3c/VK_FQCFIAEI/AAAAAAAAOPA/uckN9jdazek/s1600/Picture%2B164.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Once again, the view from the top was spectacular. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-ZD_dRzjBQrk/VK_FLTQ6wcI/AAAAAAAAOOw/NLe-HcKVTAQ/s1600/Picture%2B162.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-ZD_dRzjBQrk/VK_FLTQ6wcI/AAAAAAAAOOw/NLe-HcKVTAQ/s1600/Picture%2B162.jpg" height="225" width="400" /></a></div>
<br />
There was a small hiking trail out to the cape that we took through the jungle. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-1NORYBPjxZk/VK_FRCfs05I/AAAAAAAAOPE/Hj7ykSV8LQM/s1600/Picture%2B165.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-1NORYBPjxZk/VK_FRCfs05I/AAAAAAAAOPE/Hj7ykSV8LQM/s1600/Picture%2B165.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-U3JRRY0X3jg/VK_FVKvWA7I/AAAAAAAAOPQ/8sv5-w7ptlQ/s1600/Picture%2B166.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-U3JRRY0X3jg/VK_FVKvWA7I/AAAAAAAAOPQ/8sv5-w7ptlQ/s1600/Picture%2B166.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-Kviv2tQYtCg/VK_FYm3jPHI/AAAAAAAAOPY/l57Mzy8HXgY/s1600/Picture%2B167.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Kviv2tQYtCg/VK_FYm3jPHI/AAAAAAAAOPY/l57Mzy8HXgY/s1600/Picture%2B167.jpg" height="400" width="225" /></a></div>
<br />
Every 100 yards or so, there were signs with information on Samoan culture and history. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-3GGijLUpCeM/VK_FbTxSBkI/AAAAAAAAOPg/ncmQV9Q4YLM/s1600/Picture%2B168.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-3GGijLUpCeM/VK_FbTxSBkI/AAAAAAAAOPg/ncmQV9Q4YLM/s1600/Picture%2B168.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-ePnvn8pVhQ0/VK_FdS-9j5I/AAAAAAAAOPo/QvNvDsQ8_VA/s1600/Picture%2B169.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-ePnvn8pVhQ0/VK_FdS-9j5I/AAAAAAAAOPo/QvNvDsQ8_VA/s1600/Picture%2B169.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-N6iPzxGDtWU/VK_FfUWT37I/AAAAAAAAOPw/UB4sTMJcNZ4/s1600/Picture%2B171.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-N6iPzxGDtWU/VK_FfUWT37I/AAAAAAAAOPw/UB4sTMJcNZ4/s1600/Picture%2B171.jpg" height="400" width="225" /></a></div>
<br />
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.<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-amQTG9DoPyk/VK_FimQ1H_I/AAAAAAAAOP4/kEZXsZdx4KE/s1600/Picture%2B174.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-amQTG9DoPyk/VK_FimQ1H_I/AAAAAAAAOP4/kEZXsZdx4KE/s1600/Picture%2B174.jpg" height="225" width="400" /></a></div>
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-_dMVW_jecmc/VK_FkWhCsjI/AAAAAAAAOQA/mTVGSZhdTts/s1600/Picture%2B177.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-_dMVW_jecmc/VK_FkWhCsjI/AAAAAAAAOQA/mTVGSZhdTts/s1600/Picture%2B177.jpg" height="225" width="400" /></a></div>
<br />
I stopped and snapped this last photo from the side of the road. (I will probably be framing some of these photos!)<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-qTxN6W26FrY/VK_FmdQYJlI/AAAAAAAAOQI/vcphpZiQIYE/s1600/Picture%2B181.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-qTxN6W26FrY/VK_FmdQYJlI/AAAAAAAAOQI/vcphpZiQIYE/s1600/Picture%2B181.jpg" height="225" width="400" /></a></div>
<br />
<br />
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. <br />
<br />
It was after getting back down that we stopped for ice cream and saw the bats (see my <a href="http://corbinmd.blogspot.com/2015/01/pago-pago.html">Pago Pago</a> post). All in all, it was a great day. </div>
Anonymousnoreply@blogger.com1American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-2770122122482970252015-01-09T00:51:00.002-11:002015-01-09T00:51:46.723-11:00Fatu-ma-futi<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-FR31DJmYDkw/VK-8VLwbyJI/AAAAAAAAOOA/CxAMiNbLmNA/s1600/Picture%2B054.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-FR31DJmYDkw/VK-8VLwbyJI/AAAAAAAAOOA/CxAMiNbLmNA/s1600/Picture%2B054.jpg" height="225" width="400" /></a></div>
<br />
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.<br />
<br />
The legend behind the rock formations are varied.<br />
<br />
One version of the story goes like this (From <a href="http://www.noah-in-american-samoa.com/blog/fatu-and-futi">Here</a>):<br />
<i><br /></i>
<blockquote class="tr_bq">
<i>"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..." </i></blockquote>
<br />
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. <br />
<br /></div>
Anonymousnoreply@blogger.com3American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-90364063885733206912015-01-09T00:26:00.002-11:002015-01-09T03:47:58.206-11:00Saturday January 3, 2015 - Post Call and Nu'uuli Falls<div dir="ltr" style="text-align: left;" trbidi="on">
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.<br />
<br />
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.<br />
<br />
We started out in the backyard of the family's home. There was a small path worn through the jungle.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-MhfbBbKJ--c/VK-yZ6R4VkI/AAAAAAAAOLo/3Kv_hz5v5M8/s1600/Picture%2B111.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-MhfbBbKJ--c/VK-yZ6R4VkI/AAAAAAAAOLo/3Kv_hz5v5M8/s1600/Picture%2B111.jpg" height="225" width="400" /></a></div>
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-WqacFHDDank/VK-ycyGB5GI/AAAAAAAAOL0/MLow9n-BLkQ/s1600/Picture%2B112.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-WqacFHDDank/VK-ycyGB5GI/AAAAAAAAOL0/MLow9n-BLkQ/s1600/Picture%2B112.jpg" height="225" width="400" /></a></div>
<br />
Regardless, it felt nice to be out in the jungle. (despite the heat and sweat)<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-pAUq7D5jg2Y/VK-yZa5FazI/AAAAAAAAOLk/XGlxX9jw3vc/s1600/Picture%2B113.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-pAUq7D5jg2Y/VK-yZa5FazI/AAAAAAAAOLk/XGlxX9jw3vc/s1600/Picture%2B113.jpg" height="225" width="400" /></a></div>
<br />
All along the path were colorful flowers. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-3qnhIrhj5Hw/VK-yhRet5kI/AAAAAAAAOL8/HuIxHXGoCXY/s1600/Picture%2B114.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-3qnhIrhj5Hw/VK-yhRet5kI/AAAAAAAAOL8/HuIxHXGoCXY/s1600/Picture%2B114.jpg" height="225" width="400" /></a></div>
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-IdoC1h3ssrY/VK-5x7G21iI/AAAAAAAAON0/WvM3BKiS950/s1600/Picture%2B115.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-IdoC1h3ssrY/VK-5x7G21iI/AAAAAAAAON0/WvM3BKiS950/s1600/Picture%2B115.jpg" height="640" width="360" /></a></div>
<br />
<br />
We spent about 45 minutes swimming around the falls, enjoying the refreshingly cool water. The best part was swimming directly under the water...<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-e_XPQ_hRlks/VK-2dfEzZhI/AAAAAAAAONg/3kfpzgbiN0s/s1600/DSCF0138.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-e_XPQ_hRlks/VK-2dfEzZhI/AAAAAAAAONg/3kfpzgbiN0s/s1600/DSCF0138.JPG" height="400" width="300" /></a></div>
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-5ABltIB1-nw/VK-2pGzfzKI/AAAAAAAAONo/fIJq1ykWKhM/s1600/DSCF0141.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-5ABltIB1-nw/VK-2pGzfzKI/AAAAAAAAONo/fIJq1ykWKhM/s1600/DSCF0141.JPG" height="300" width="400" /></a></div>
<br />
On the way back, I snapped a few more photos of the various plant life. It was incredible how thick the foliage was. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-arSzgBwD-K8/VK-ytd-aiMI/AAAAAAAAOMc/HMthYDIE-Ks/s1600/Picture%2B118.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-arSzgBwD-K8/VK-ytd-aiMI/AAAAAAAAOMc/HMthYDIE-Ks/s1600/Picture%2B118.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-u6tQ9Or3anE/VK-y2okPDGI/AAAAAAAAOMs/lJYz7s054bw/s1600/Picture%2B122.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-u6tQ9Or3anE/VK-y2okPDGI/AAAAAAAAOMs/lJYz7s054bw/s1600/Picture%2B122.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-e1ymdNzO3XI/VK-y8zzO-LI/AAAAAAAAOM8/pbpate6hqpk/s1600/Picture%2B124.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-e1ymdNzO3XI/VK-y8zzO-LI/AAAAAAAAOM8/pbpate6hqpk/s1600/Picture%2B124.jpg" height="400" width="225" /></a></div>
<br />
<br />
Here is a brief video of the falls:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxVBFCY8gMSeQdkKqNRJi2dE7c6gPLoXdA_rNHfHcvgt6yHQlg20GVFl1dqlgSUMaOWJxSO0y0z4uEyv8llLw' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
<br />
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. </div>
Anonymousnoreply@blogger.com1American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-39969064671282930692015-01-08T23:34:00.000-11:002015-01-08T23:34:19.162-11:00Friday January 2, 2015<div dir="ltr" style="text-align: left;" trbidi="on">
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).<br />
<br />
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.<br />
<br />
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.</div>
Anonymousnoreply@blogger.com1American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-89087403307138357012015-01-08T23:17:00.000-11:002015-01-08T23:17:18.905-11:00New Years Day<div dir="ltr" style="text-align: left;" trbidi="on">
New Years day was another holiday, and the clinic was closed (my next 24 hour on call is Friday 1/2/15).<br />
<br />
I spent the day at the beach, which was beautiful as always.<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-ylBhgyJcKZM/VK-qN1HXpmI/AAAAAAAAOK0/qpbJZTQi6Bc/s1600/Picture%2B065.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-ylBhgyJcKZM/VK-qN1HXpmI/AAAAAAAAOK0/qpbJZTQi6Bc/s1600/Picture%2B065.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-RWH3e3aOv14/VK-qSeQOEJI/AAAAAAAAOLE/llI8KUqkg5U/s1600/Picture%2B066.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-RWH3e3aOv14/VK-qSeQOEJI/AAAAAAAAOLE/llI8KUqkg5U/s1600/Picture%2B066.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-2pp5q8e7n0Y/VK-qO3NySgI/AAAAAAAAOK8/gFYQO5yT58Q/s1600/Picture%2B129.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-2pp5q8e7n0Y/VK-qO3NySgI/AAAAAAAAOK8/gFYQO5yT58Q/s1600/Picture%2B129.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-sY0knQ3Bg4k/VK-qUDbWtUI/AAAAAAAAOLM/VoNgtX2TEU4/s1600/Picture%2B130.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-sY0knQ3Bg4k/VK-qUDbWtUI/AAAAAAAAOLM/VoNgtX2TEU4/s1600/Picture%2B130.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-D4FKf7sq8lA/VK-qX18Pk2I/AAAAAAAAOLU/GED7KkTV4vY/s1600/Picture%2B131.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-D4FKf7sq8lA/VK-qX18Pk2I/AAAAAAAAOLU/GED7KkTV4vY/s1600/Picture%2B131.jpg" height="225" width="400" /></a></div>
<br /></div>
Anonymousnoreply@blogger.com1American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-27560984304452036712015-01-08T23:09:00.000-11:002015-01-08T23:10:00.595-11:00New Year's Eve<div dir="ltr" style="text-align: left;" trbidi="on">
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.<br />
<br />
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.<br />
<br />
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.</div>
Anonymousnoreply@blogger.com1American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-18488183359808737622015-01-08T22:47:00.000-11:002015-01-08T22:51:00.319-11:00Pago Pago <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
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.<br />
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-xb04ycrzD9I/VK-aXMCLP3I/AAAAAAAAOJI/Q1zD-XFYZ-M/s1600/Picture%2B154.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-xb04ycrzD9I/VK-aXMCLP3I/AAAAAAAAOJI/Q1zD-XFYZ-M/s1600/Picture%2B154.jpg" height="225" width="400" /></a></div>
<br />
As you drive into the city, the first thing you notice is how clear and blue the water is.<br />
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-MNQlq3tACeY/VK-aBiooW1I/AAAAAAAAOII/tlhGWOEm3yY/s1600/Picture%2B139.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-MNQlq3tACeY/VK-aBiooW1I/AAAAAAAAOII/tlhGWOEm3yY/s1600/Picture%2B139.jpg" height="225" width="400" /></a></div>
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
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).<br />
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-kc47yRMgDU4/VK-aJIY2R5I/AAAAAAAAOIY/zf30GQD12LM/s1600/Picture%2B142.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-kc47yRMgDU4/VK-aJIY2R5I/AAAAAAAAOIY/zf30GQD12LM/s1600/Picture%2B142.jpg" height="225" width="400" /></a></div>
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
There are multiple public Fales (Fah-lays), the traditional meeting place of the Samoan people. They also used to be the homes, as well. <br />
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-rG1njl3JmQc/VK-aJp4GscI/AAAAAAAAOIc/tNh3LfJ0IUY/s1600/Picture%2B141.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-rG1njl3JmQc/VK-aJp4GscI/AAAAAAAAOIc/tNh3LfJ0IUY/s1600/Picture%2B141.jpg" height="225" width="400" /></a></div>
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
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.<br />
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-kaWOwcSlpFo/VK-aDmy_YTI/AAAAAAAAOIQ/vSvidp9Kl30/s1600/Picture%2B140.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-kaWOwcSlpFo/VK-aDmy_YTI/AAAAAAAAOIQ/vSvidp9Kl30/s1600/Picture%2B140.jpg" height="225" width="400" /></a></div>
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
Below is a [blurry] photo I shot of the Pago Pago harbor entrance.<br />
<span id="goog_608686045"></span><span id="goog_608686046"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-eN8ctHUY3O0/VK-aQMmPKNI/AAAAAAAAOIw/zEfajTE7mLE/s1600/Picture%2B144.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-eN8ctHUY3O0/VK-aQMmPKNI/AAAAAAAAOIw/zEfajTE7mLE/s1600/Picture%2B144.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
There are many boats and ships coming in and out of the port. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-GTfHXajm9KU/VK-aNdMva-I/AAAAAAAAOIo/M7DohDe0GFc/s1600/Picture%2B143.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-GTfHXajm9KU/VK-aNdMva-I/AAAAAAAAOIo/M7DohDe0GFc/s1600/Picture%2B143.jpg" height="225" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Another view of the port. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-4lhAhfbEV90/VK-Z3NWOTjI/AAAAAAAAOHg/SnXtqNkZRc0/s1600/Picture%2B028.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-4lhAhfbEV90/VK-Z3NWOTjI/AAAAAAAAOHg/SnXtqNkZRc0/s1600/Picture%2B028.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
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. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-a8Ww_vfzWbc/VK-a2olq0AI/AAAAAAAAOJQ/RTwFXKpoGhY/s1600/Picture%2B148.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-a8Ww_vfzWbc/VK-a2olq0AI/AAAAAAAAOJQ/RTwFXKpoGhY/s1600/Picture%2B148.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Charlie the Tuna. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-Jxgyif8UsDI/VK-a5O1TjbI/AAAAAAAAOJY/PQCQoPP5ry0/s1600/Picture%2B149.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-Jxgyif8UsDI/VK-a5O1TjbI/AAAAAAAAOJY/PQCQoPP5ry0/s1600/Picture%2B149.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
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.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-m_Rr-T9g9ak/VK-bCJyoBgI/AAAAAAAAOJw/qvNu9md3X4A/s1600/Picture%2B185.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-m_Rr-T9g9ak/VK-bCJyoBgI/AAAAAAAAOJw/qvNu9md3X4A/s1600/Picture%2B185.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
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. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-yo3hUa1a5J8/VK-a-YIkVSI/AAAAAAAAOJo/Cu-PCpxLTNg/s1600/Picture%2B183.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-yo3hUa1a5J8/VK-a-YIkVSI/AAAAAAAAOJo/Cu-PCpxLTNg/s1600/Picture%2B183.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
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. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-rJ7Jh5QB5Y0/VK-iww-N-cI/AAAAAAAAOKk/817-TOBxcTE/s1600/Picture%2B187.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-rJ7Jh5QB5Y0/VK-iww-N-cI/AAAAAAAAOKk/817-TOBxcTE/s1600/Picture%2B187.jpg" height="320" width="180" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
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.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-plv1lZA3xhk/VK-chdepEkI/AAAAAAAAOJ8/dtPB1HeDIDE/s1600/Picture%2B184.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-plv1lZA3xhk/VK-chdepEkI/AAAAAAAAOJ8/dtPB1HeDIDE/s1600/Picture%2B184.jpg" height="225" width="400" /></a></div>
<br />
Some of the many colorful buses in Pago Pago. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-9S-be70cUhQ/VK-cjrlQiKI/AAAAAAAAOKM/uubXXslCxSU/s1600/Picture%2B186.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-9S-be70cUhQ/VK-cjrlQiKI/AAAAAAAAOKM/uubXXslCxSU/s1600/Picture%2B186.jpg" height="225" width="400" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-Ya7MpAPRrGo/VK-cjLqalKI/AAAAAAAAOKE/VEyKjF31uTE/s1600/Picture%2B188.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Ya7MpAPRrGo/VK-cjLqalKI/AAAAAAAAOKE/VEyKjF31uTE/s1600/Picture%2B188.jpg" height="225" width="400" /></a></div>
<span id="goog_608686045"></span><span id="goog_608686046"></span><br /></div>
Anonymousnoreply@blogger.com16Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-54750539316049789152015-01-08T20:51:00.001-11:002015-01-09T15:10:33.894-11:00LBJ Tropical Medical Center - American Samoa<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: left;">
Here are some various photos taken around the ground of LBJ Tropical Medical Center:</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
This first photo is the main sign at the entrance to the main parking lot. The hospital's main bus stop is situated behind. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-HcpeU2_BC-s/VK9_xjLScWI/AAAAAAAAOEY/DgAk-LjnCuQ/s1600/Picture%2B196.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-HcpeU2_BC-s/VK9_xjLScWI/AAAAAAAAOEY/DgAk-LjnCuQ/s1600/Picture%2B196.jpg" height="225" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The hospital is laid out in wings, with two main hallways joined by cross hallways. The US and American Samoan flag fly out front. It is not uncommon to see dogs sleeping on the sign (see my previous post). </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-IEwzIrOClkA/VK9_cvYcHGI/AAAAAAAAODY/Zfo7mkAWaDE/s1600/Picture%2B099.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-IEwzIrOClkA/VK9_cvYcHGI/AAAAAAAAODY/Zfo7mkAWaDE/s1600/Picture%2B099.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
One of the several open air pavilions at the hospital that acts as a waiting area. Due to the heat, much of the hospital is open-air. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-Cf1TV_iIKXA/VK9_kInhiDI/AAAAAAAAODw/_z_FZRIrog0/s1600/Picture%2B103.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-Cf1TV_iIKXA/VK9_kInhiDI/AAAAAAAAODw/_z_FZRIrog0/s1600/Picture%2B103.jpg" height="225" width="400" /></a></div>
<br />
Another view of the open-air courtyard. There is a picnic area in the middle, to the immediate left of the camera is the women's axillary snack shop, where you can buy egg sandwiches, tuna sandwiches, and various drinks. Tuna is a staple here due to the starkist factory in Pago Pago.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-ryciWvBDSds/VK9_tYv-zfI/AAAAAAAAOEQ/odV8c3FIzkQ/s1600/Picture%2B195.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-ryciWvBDSds/VK9_tYv-zfI/AAAAAAAAOEQ/odV8c3FIzkQ/s1600/Picture%2B195.jpg" height="225" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
There are almost as many chickens running around as there are people. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-WoosaStmfcY/VK9_7h-F0tI/AAAAAAAAOFE/wJ8S2sCf3R0/s1600/Picture%2B201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-WoosaStmfcY/VK9_7h-F0tI/AAAAAAAAOFE/wJ8S2sCf3R0/s1600/Picture%2B201.jpg" height="225" width="400" /></a></div>
<br />
Here is the drive-up to the Emergency department. There are usually 4 physicians or NP/PAs working in the ED per shift. Two trauma bays, around 10 separate bays with curtains. They do not have any advanced imaging - no MRI, CT, or even ultrasound. They have XR and use the PACS system that we use at HCMC to view films - though the monitors are standard definition. The ambulance parking is on the right side of the building in the photo (not pictured), and patients are loaded through a side door that is guarded. Most pediatric procedures are performed by the Peds on call - LP, catheterizations, lines, etc. The staff in the ER are a friendly bunch, and do a great job with the resources they have available.<br />
<br />
(I think this would be an awesome place for HCMC's EM program to rotate - they could really help out with their ultrasound and trauma skills, and the hospital could really use their help)<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-qsaGP8NZD0A/VK-E6ndN3sI/AAAAAAAAOFQ/bsM1h7cYW-k/s1600/Picture%2B096.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-qsaGP8NZD0A/VK-E6ndN3sI/AAAAAAAAOFQ/bsM1h7cYW-k/s1600/Picture%2B096.jpg" height="225" width="400" /></a></div>
<br />
<br />
One of the main hallways of the hospital. The pipes above are exposed, which adds a neat dynamic to the building. In general, the hospital is very clean and well-maintained. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-DyokwzEmX_E/VK9_4tDcRTI/AAAAAAAAOE0/RwO6J0i-tLU/s1600/Picture%2B199.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-DyokwzEmX_E/VK9_4tDcRTI/AAAAAAAAOE0/RwO6J0i-tLU/s1600/Picture%2B199.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
There is a very affordable cafeteria here with good portion sizes. You can usually get a good meal for around $4-$5. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-95xMvAy-IYI/VK9_20FSIeI/AAAAAAAAOEs/R3nXxh7_aBA/s1600/Picture%2B198.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-95xMvAy-IYI/VK9_20FSIeI/AAAAAAAAOEs/R3nXxh7_aBA/s1600/Picture%2B198.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
As you can see, the placement of the wards and departments are fairly random. I got lost for the first two days any time I needed to go somewhere. I especially like the fact that the "spare parts" are located next to the morgue. Hmmm.... </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-QhSe3ePDg3w/VK9_6udbFAI/AAAAAAAAOE8/E1fYcmwW7UM/s1600/Picture%2B200.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-QhSe3ePDg3w/VK9_6udbFAI/AAAAAAAAOE8/E1fYcmwW7UM/s1600/Picture%2B200.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The doorway to the ICU. I did not take a photo inside for patient privacy reasons. It is basically two rows of beds facing each other and separated by curtains. There is one isolation room in the back. The ICU has a reputation on the island as the place nobody leaves alive. (I had to admit a kid for DKA to the ICU and had to talk mom out of hysteria because she thought her kid was going to die simply because she was in the ICU)... again, this reputation is a testament to the struggle that the amazing doctors here face on a daily basis. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-s4uH20JP3pM/VK9_beBKyNI/AAAAAAAAODQ/1xwx3JO4rKY/s1600/Picture%2B101.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-s4uH20JP3pM/VK9_beBKyNI/AAAAAAAAODQ/1xwx3JO4rKY/s1600/Picture%2B101.jpg" height="400" width="225" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The wards were recently renovated (I think using stimulus money). Here is the pediatric ward. Very bright and colorful - well, apart from the seasick pooh bear on the wall. The nurses here are very nice. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-STUV__NSdo0/VK9_edfeAGI/AAAAAAAAODg/-eRj-YQdDWQ/s1600/Picture%2B100.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-STUV__NSdo0/VK9_edfeAGI/AAAAAAAAODg/-eRj-YQdDWQ/s1600/Picture%2B100.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
In the corner of the outside courtyard (across from the ER) lies the Pediatric Clinic, the place where I spend most of my time when I am not on call or in the Nursery/NICU. There are two benches outside and generally it is packed with people waiting to be seen.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-p-m_E0tkH9Q/VK9_gnbq-1I/AAAAAAAAODo/mA9K5T9hv5k/s1600/Picture%2B102.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-p-m_E0tkH9Q/VK9_gnbq-1I/AAAAAAAAODo/mA9K5T9hv5k/s1600/Picture%2B102.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The waiting area of the clinic. This photo was taken at the end of the day. Usually this place is completely packed with patients waiting to be seen. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-ogpBPeWO3XM/VK9_qofuCnI/AAAAAAAAOEI/Yv0HGlY3My0/s1600/Picture%2B194.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-ogpBPeWO3XM/VK9_qofuCnI/AAAAAAAAOEI/Yv0HGlY3My0/s1600/Picture%2B194.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
At the back of the clinic is where bicillin shots, albuterol nebs, and other medications are administered. The nursing staff in the clinic are super friendly. </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-I1isc1qamQs/VK9_nekDhsI/AAAAAAAAOEA/tZkv0XIyUAs/s1600/Picture%2B193.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-I1isc1qamQs/VK9_nekDhsI/AAAAAAAAOEA/tZkv0XIyUAs/s1600/Picture%2B193.jpg" height="225" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Here is one of the patient rooms. It is equipped with pretty much everything you need. The one downside is that there is not enough ear pieces to go around - so we save them for cleaning and reuse at the end of the day. We use CPRS for our Electronic health record (same system as the VA), which is adequate to get the job done, but not as complete or easy to use as the EPIC system we use at Hennepin. There is also a very large written component to the documentation (a fact that I kept forgetting the first few days). </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-vtP548-DZOs/VK9_liQR3bI/AAAAAAAAOD4/LprT_A-oGog/s1600/Picture%2B192.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-vtP548-DZOs/VK9_liQR3bI/AAAAAAAAOD4/LprT_A-oGog/s1600/Picture%2B192.jpg" height="225" width="400" /></a></div>
<br />
For the animal lovers out there, here is my furry companion. She sleeps right outside my door at night and is always there to greet me in the morning. The hospital has "adopted" her, and she is the only dog I have seen around that actually wears a collar. All the other locums and families throw her scraps of meat, so she is fat and happy.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-SRQ2YAVT03Y/VK9_1bMkGOI/AAAAAAAAOEg/KfltSM4C9HY/s1600/Picture%2B197.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-SRQ2YAVT03Y/VK9_1bMkGOI/AAAAAAAAOEg/KfltSM4C9HY/s1600/Picture%2B197.jpg" height="225" width="400" /></a></div>
<br /></div>
Anonymousnoreply@blogger.com8American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-91310735757001586682015-01-08T20:03:00.000-11:002015-01-08T20:06:19.387-11:00A sweet truck...<div dir="ltr" style="text-align: left;" trbidi="on">
There are many unique "island vehicles" on American Samoa. Here is one of the jacked up pickups...<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-BNJY4hIecdA/VK98PhSvexI/AAAAAAAAODE/VnKN5Qt0JbY/s1600/Picture%2B095.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-BNJY4hIecdA/VK98PhSvexI/AAAAAAAAODE/VnKN5Qt0JbY/s1600/Picture%2B095.jpg" height="225" width="400" /></a></div>
<br />
Another fairly common sight around the island are the pickup trucks with 8-10 people in the back - with several sitting in plastic lawn chairs (unsecured, of course) that are propped up against the tailgate. As soon as I get a good photo of one, I will post it.<br />
<br />
I guess when the speed limit is 20mph, you can get away with a lot.<br />
<br />
<br /></div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-25685956654337697912015-01-08T19:52:00.002-11:002015-01-08T19:52:43.539-11:00Sunday December 28, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
Today, I was post call after a 24+ hour shift. I was exhausted and slept pretty much all day. That night, I went to the movies with the Broges and watched the new "Night at the Museum" movie, which happened to be Robin Williams' last film. While I hadn't seen the other ones, I thought the movie was really funny.<br />
<br />
Movies here cost $5.50. The popcorn is "all you can eat", and large sodas have unlimited refills. While an awesome deal, I don't think it helps fight the obesity or diabetic epidemic sweeping the island.</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-43884074716675717192015-01-08T19:46:00.002-11:002015-01-08T19:46:56.858-11:00Saturday December 27, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
Today was my second 24 hour call day. This time, it was on a weekend, which meant that I would need to round and write notes on all the patients in the wards, Nursery, NICU, PICU.<br />
<br />
Tangra was taking care of a very sick kid in the ICU who started out as a fever of unknown origin, which then progressed to decompensation, respiratory failure, upper and lower GI bleed, DIC - presumed to be from a serious infection. He was intubated after coding. Tangra had been on the telemedicine site with doctors from the Tripler Army base in Hawaii discussing his case. <br />
<br />
Without going into great detail about his case, there had been several setbacks - including the hospital running out of his sedation medications and the patient waking up. It was also discovered that the hospital's CT scanner, which was rumored to be "broken", was actually still sitting in a shipment container in the harbor - where it had been for several weeks due to ?the holidays (nobody seemed to really know). This case is a good example of how much the hospital needs resources - both in trained nursing and physician staff, and equipment. It is crazy to think that this actually happens on US soil.<br />
<br />
Throughout the week, the patient improved on the vent and then was extubated. His respiratory status was tenuous, but stable.<br />
<br />
Anyway, my call that day was again very interesting. I ended up sitting in the ICU almost all night watching the patient and adjusting medications, monitoring machine settings... something WAY outside of my comfort zone (since we had literally one month of MICU in residency, and most of the actual management of those patient are not done by residents, but by critical care attendings). I took for granted the excellent nursing staff we have at HCMC - namely that you can trust them to call you when a patient's vitals change, or even trust them to correctly use lines, administer medications, etc. While I don't blame the nurses here (they are wonderful people, but way overworked and the acuity of the patient population is ridiculous), it seems that you have to explicitly double and triple check everything that goes on in the ICU.<br />
<br />
I was also called away to the ER for admissions and consults. There was also a couple of C-sections that Dr. Marrone ended up coming in to help on.<br />
<br />
Throughout the night, the ICU patient's respiratory status and cardiac status remained stable... until about 6am, when he became tachypneic and started desatting... long story short, he ended up getting reintubated, which made me feel absolutely terrible (though, after talking to Tangra and Dr. Marrone, I don't think I made any gross errors in his management... I definitely am not cut out to be an intensivist!). Thankfully, both Dr. Marrone and Dr. Shushunov were in the hospital at the time and took over care of the patient. <br />
<br />
All in all, it was an exhausting call, though an amazing learning experience.</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-31751146441537142422015-01-08T19:17:00.002-11:002015-01-08T19:18:19.294-11:00Friday December 26, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
Went to the hospital for AM rounds with the team, then rounded by myself on my patients. Then it was off to clinic for the day - which was slammed, since the clinic was closed on Christmas. Finished up at clinic around 4pm.</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-15200240049666243022015-01-08T19:06:00.001-11:002015-01-09T02:44:18.550-11:00Christmas Day 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
Christmas morning, we all woke up early. I went out on the back patio and made phone calls to Carlyn and my family from the cell phone (still no access to Skype, but by this time I wasn't really missing it).<br />
<br />
Here is a photo of the Broge family in front of their Island Christmas tree. Pictured from left to right - Matt, Noah, Tangra, Nolan, Linda (Grandma), and Neeli.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-PslIBs478Nw/VK9pXQUv4gI/AAAAAAAAOCg/FBSlm6X5kJg/s1600/Picture%2B078.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-PslIBs478Nw/VK9pXQUv4gI/AAAAAAAAOCg/FBSlm6X5kJg/s1600/Picture%2B078.jpg" height="225" width="400" /></a></div>
<br />
<br />
We watched the kids excitedly open their presents.... <br />
<br />
<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-ujxbnpZhjN0/VK9og7HRAGI/AAAAAAAAOBs/3NqtOA5BRk0/s1600/Picture%2B079.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-ujxbnpZhjN0/VK9og7HRAGI/AAAAAAAAOBs/3NqtOA5BRk0/s1600/Picture%2B079.jpg" height="225" width="400" /></a></div>
<br />
I bought the kids a set of Chinese guns that shoot plastic darts - which was awesome. They had a good time shooting each other (and me)... I'm sure their parents were thrilled.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-hULEhD3gPsI/VK9oicMaUbI/AAAAAAAAOB0/Dq5lODbVWB4/s1600/Picture%2B083.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-hULEhD3gPsI/VK9oicMaUbI/AAAAAAAAOB0/Dq5lODbVWB4/s1600/Picture%2B083.jpg" height="225" width="400" /></a></div>
<br />
<br />
Later that morning, Matt, Tangra, Noah and I decided to go for a swim out beyond the break. The water was at high tide, so you could swim out beyond the ledge without much difficulty. <br />
<br />
It was a bit tricky at first, due to the waves, and there were the occasional cracks in the reef that dropped ?? depth (you couldn't see the bottom). I was a bit concerned about getting my foot caught in one of these holes while walking out to the break (visions of compound fractures danced in my head as the waves crashed over me), so I treaded slowly.<br />
<br />
Once over the break, the reef dropped instantly into the void. There were huge fish. The waves were quite large, and we were lifted up and down 15-20 feet like ragdolls. I attempted to get a video of the waves, but my camera ran out of battery halfway through. You can still notice the power of the ocean. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxXkGFD8qsTj4WizRwieaYkBaRxFRvTRd2ad3W7inzvQkLSTnLAQoJuMaLCQ6Sg0BZG25U51Sb-EbfFzZyYOA' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
<br />
Here is a photo of Matt, Noah and Tangra swimming. Noah and Tangra had life vests on, which was clearly the smart thing to do.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-KPj26lNfVAA/VK9nXlKCgSI/AAAAAAAAOAw/A-tu22mDimw/s1600/DSCF0102.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-KPj26lNfVAA/VK9nXlKCgSI/AAAAAAAAOAw/A-tu22mDimw/s1600/DSCF0102.JPG" height="300" width="400" /></a></div>
<br />
Noah acting cool in the water...<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-FjRF6P0NfdY/VK9noYe5VVI/AAAAAAAAOBI/zsmAE04POfs/s1600/DSCF0105.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-FjRF6P0NfdY/VK9noYe5VVI/AAAAAAAAOBI/zsmAE04POfs/s1600/DSCF0105.JPG" height="300" width="400" /></a></div>
<br />
It was difficult to conceptualize the depth with the camera (was about 50-75 feet deep). Here is a photo of Matt swimming about 10 feet below me. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-F9ijmn5-8ug/VK9niYXA36I/AAAAAAAAOBA/AcarDPn58NI/s1600/DSCF0104.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-F9ijmn5-8ug/VK9niYXA36I/AAAAAAAAOBA/AcarDPn58NI/s1600/DSCF0104.JPG" height="300" width="400" /></a></div>
<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: left;">
After about 30 minutes, the waves began to get rougher & we noticed the tide was going out. This was problematic because without the high tide, there is no way to safely get back onto the break. We swam over to the edge of the wall and literally timed our approach with one of the large waves, which carried us over the wall and crashed us down onto the reef. I ended up getting my snorkel ripped in half (the bottom was still in my mouth), and I cut my hand and arm on the reef. We managed to get back without any broken bones - it was quite the adventure. (I can see now why the Samoans have a healthy fear of swimming... I don't think I will swim out past the break again).</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Back at the house, we all changed and made preparations for dinner. The power went out for about 3 hours. During this time, I decided that I needed to learn how to crack a coconut the "Samoan way". </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Basically, you slam the coconut on top of a sharp, pointed stick. Eventually you make a big enough hole to rip away the husk so that you can drink the coconut water.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
My first attempt was an utter failure... (Matt had a great time poking fun at me. I swore at the time that nobody would ever see these embarrassing photos!)</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-OLgNU99kJLU/VK9olVkR8yI/AAAAAAAAOB8/UbX9i7l6IVQ/s1600/Picture%2B084.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-OLgNU99kJLU/VK9olVkR8yI/AAAAAAAAOB8/UbX9i7l6IVQ/s1600/Picture%2B084.jpg" height="400" width="225" /></a></div>
<br />
Eventually, I got the hang of it... <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-LHywlBvc2v0/VK9ook6h03I/AAAAAAAAOCE/9BiHeVaZOok/s1600/Picture%2B087.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-LHywlBvc2v0/VK9ook6h03I/AAAAAAAAOCE/9BiHeVaZOok/s1600/Picture%2B087.jpg" height="400" width="225" /></a></div>
<br />
This is me with my mangled coconut. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-XTpOfAAKmrk/VK9o2eHL4gI/AAAAAAAAOCU/8ERTxBsUgu4/s1600/Picture%2B093.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-XTpOfAAKmrk/VK9o2eHL4gI/AAAAAAAAOCU/8ERTxBsUgu4/s1600/Picture%2B093.jpg" height="400" width="225" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Which I cracked open and used the coconut scraper to get out the meat. (Much easier than actually cracking the darn thing open)... </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/--_lNtIewGvQ/VK9orjucD-I/AAAAAAAAOCM/pSc_fw9OtkY/s1600/Picture%2B094.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/--_lNtIewGvQ/VK9orjucD-I/AAAAAAAAOCM/pSc_fw9OtkY/s1600/Picture%2B094.jpg" height="400" width="225" /></a></div>
<br />
Later that evening, once the power came back on, we had dinner and relaxed out on the patio. There was another awesome sunset... truly paradise.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-IbF2I6E8a3s/VK9oadDrJLI/AAAAAAAAOBU/Ufuz9f2-uPE/s1600/Picture%2B071.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-IbF2I6E8a3s/VK9oadDrJLI/AAAAAAAAOBU/Ufuz9f2-uPE/s1600/Picture%2B071.jpg" height="86" width="400" /> </a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-VzH8SLVt1_A/VK_aEIs_1wI/AAAAAAAAOQY/HU1I5RvOzck/s1600/Picture%2B098.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-VzH8SLVt1_A/VK_aEIs_1wI/AAAAAAAAOQY/HU1I5RvOzck/s1600/Picture%2B098.jpg" height="225" width="400" /></a><a href="http://4.bp.blogspot.com/-YnJHlCCWYoQ/VK_bF23XMAI/AAAAAAAAOQw/gyEqvXMajW8/s1600/Picture%2B073.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-YnJHlCCWYoQ/VK_bF23XMAI/AAAAAAAAOQw/gyEqvXMajW8/s1600/Picture%2B073.jpg" height="225" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br /></div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-58935602711090544922015-01-08T18:16:00.000-11:002015-01-09T02:25:44.610-11:00Wednesday December 24, 2014 - Amanave and Cape Taputapu<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
Today, we arrived at the wards for rounds. I presented my patients
to the team - very straight and to the point - but very thorough - which
was again a refreshing change from residency (although I do understand
the value of anal-retentive rounding with regards to training and
safety).<br />
<br />
Dr. Marrone was on call the night before, and
he admitted another kid < 1 month with concern for sepsis. He let
me do the lumbar puncture by myself this time, which I was surprised to
say that I got on the first try! (Dr. Marrone is a great teacher).<br />
<br />
After
rounding on my patients, I spent the day in clinic until early
afternoon. Afterwards, I went back out to the Broge house. The
weather was warm, about 87 degrees. The water was absolutely amazing -
the clearest I have ever seen. Even more so than the Caribbean. <br />
<br />
Part of the reason why the water is so clear is that there is very
little sand on the island. It is mostly coral and volcanic rock. The
coral is very colorful, and there were more fish in one spot than I have
seen anywhere else (including Mexico and the Caribbean).<br />
<br />
Prior
to coming to American Samoa, I splurged and purchased an underwater
camera (Fujifilm Finepix XP70). I tested it out in the water, and the
results were incredible. Check out this video that I took just 20 feet
from the shoreline in about four feet of water:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dz3hN5LIeQXhGzFGOxcpWmeIUMWGIHY3ZK6RAsvCogoNT-OVhR2wG64HCvS2zTJ9kfqNO0LN4rAw05gJsqUZA' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
<br />
The water is very shallow for about 50 yards, then it hits the "break", a sharp dropoff of about 50-100 feet that was formed during the volcanic eruptions that formed the island. The coral is almost razor-sharp, and you cannot go into the water without water shoes designed for coral reefs. (Thank you, Andrew, for your Christmas present - the shoes came in handy!)<br />
<br />
Despite my best efforts, I did end up falling and hitting my knee on the coral (hurt like heck).<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-P7YehMzKUa4/VK9lTvQSBDI/AAAAAAAAOAk/xywZBbdYyUE/s1600/DSCF0059.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-P7YehMzKUa4/VK9lTvQSBDI/AAAAAAAAOAk/xywZBbdYyUE/s1600/DSCF0059.JPG" height="300" width="400" /></a></div>
<br />
<br />
<br />
Matt, Nolan, Noah, and I walked out along the rocks to one of the break points - just below an island called "five palms", named after the five palm trees that grow in the top.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-HYtW-HVnez4/VK9g9rDl6KI/AAAAAAAAN_4/lmdwxRQUMjo/s1600/DSCF0023.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-HYtW-HVnez4/VK9g9rDl6KI/AAAAAAAAN_4/lmdwxRQUMjo/s1600/DSCF0023.JPG" height="300" width="400" /></a></div>
<div style="text-align: center;">
Photo I: Matt and Noah just prior to our trek to the rocks </div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-pxOU6MdvIcs/VK9hD5IpKpI/AAAAAAAAOAA/YWrqFCe80-I/s1600/DSCF0032.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-pxOU6MdvIcs/VK9hD5IpKpI/AAAAAAAAOAA/YWrqFCe80-I/s1600/DSCF0032.JPG" height="300" width="400" /></a></div>
<br />
<div style="text-align: center;">
Photo II: The view of the 5 palms</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-GG63ma07Fxs/VK9hKD5bCFI/AAAAAAAAOAI/UAOSawSnE78/s1600/DSCF0029.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-GG63ma07Fxs/VK9hKD5bCFI/AAAAAAAAOAI/UAOSawSnE78/s1600/DSCF0029.JPG" height="300" width="400" /></a></div>
<br />
<div style="text-align: center;">
Photo III: Balto, the family dog (adopted stray from the island) decided to join us! </div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-jY-F8tOv9V0/VK9hiEDKJkI/AAAAAAAAOAQ/S3uo2Oh4AbQ/s1600/DSCF0046.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-jY-F8tOv9V0/VK9hiEDKJkI/AAAAAAAAOAQ/S3uo2Oh4AbQ/s1600/DSCF0046.JPG" height="300" width="400" /></a></div>
<br />
<div style="text-align: center;">
Photo IV: Another view of the five palms </div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-mxSYQSxxGzk/VK9iCRd6IHI/AAAAAAAAOAY/nOEVOE64hbk/s1600/DSCF0028.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-mxSYQSxxGzk/VK9iCRd6IHI/AAAAAAAAOAY/nOEVOE64hbk/s1600/DSCF0028.JPG" height="225" width="400" /></a></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
Photo V: There were numerous crabs and lizards (too many to count) crawling all over the rocks</div>
<div style="text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dyEt_O3UfGReXc1E9HXVP-QqQiLz6HQ5W33gn3zpoB_6-qJKWdh7Vm7mYxRYFErKAKRuP4t1tdIROE_PmWlNw' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
Video II: Here is a view from beyond the rocks (really does not do the size of the waves justice... they were huge!)</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
I spent the night over at their house. The next day was Christmas, and a holiday - so no clinic! I had the whole day off. </div>
</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-72696761327844765002015-01-08T17:40:00.004-11:002015-01-09T00:58:01.530-11:00Tuesday December 23, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
Today I was post-call. I ended up having a little difficulty getting to sleep due to the "high" I was on from the night's excitement.<br />
<br />
As I was finishing up rounds prior to going home, the First Lady of American Samoa paid a surprise visit to the Pediatrics Ward - complete with a Television crew and several AS dignitaries. Being the only peds doc around, I was pulled and interviewed on TV with the First Lady. She had brought large platters of food and gifts for all the children, a very generous gesture.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://imgsrv.talanei.com/image/DbGraphic/201412/3025738.jpg?1420780961" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://imgsrv.talanei.com/image/DbGraphic/201412/3025738.jpg?1420780961" /></a></div>
<br />
Read the story (and see the clip) here: <a href="http://www.talanei.com/news/First-Lady-elves-visit-children-patients/20586317">First Lady & elves visit children patients</a><br />
<br />
<blockquote class="tr_bq">
<i><span id="blurb_body">"First Lady Mrs Cynthia Moliga, members of the
Governor’s Office staff and employees of the Department of Youth and
Women’s Affairs delivered gifts to children hospitalized at various
wards of the LBJ Hospital this morning.<br />
<br />The presentation also included big trays of fruits and yummy treats for the hospital staff.
<br />
</span></i></blockquote>
<blockquote class="tr_bq">
<i><span id="blurb_body">Mrs. Moliga’s first stop was at the Pediatric Ward and she and her group
were welcomed by Family Medicine Resident Dr. Justin Michael Corbin and
Mrs. Tofiga Tufele."</span></i></blockquote>
<br />
The visit was an unexpected surprise, but I thanked her for her kindness on behalf of the hospital. The interview later aired on Samoan television and radio. <br />
<br />
I ended up getting back to my apartment at 11am (so much for duty hours... shhh nobody will know!). I ended up sleeping most of the day.</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-64595954605261425902015-01-08T17:38:00.000-11:002015-01-08T17:42:31.286-11:00Monday December 22, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
This was my first 24 hour call day. The call schedule here was q5. This was a learning experience for sure, as the on-call person covers the Pediatric wards, NICU, PICU, does admissions, and attends Cesarian sections to do infant resuscitations. While I did have current NRP and PALS certifications, my only real experience with either of these in residency was with mannequins. I must have reviewed the PALS and NRP algorithms in my head 50 times that day.<br />
<br />
From 9am - 3pm, I was in the clinic. It was very busy. We see an average of 15-20 patients each during a clinic day. A lot of viral syndromes, crazy strep/staph skin infections, genuinely sick kids. The clinic here does no primary care, as the well child checks are all done at the department of health.<br />
<br />
I was surprised to find that American Samoa also has one of the highest incidence of Rheumatic fever in the world, so a lot of kids coming in for screening and their bicillin shots. Despite what I learned in medical school (strep throat leads to rheumatic heard disease, and strep skin infections lead to glomerulonephritis), most of the physicians believe that the high incidence of Rheumatic Fever/Heart disease is due to a very virulent strep skin infection.<br />
<br />
That evening, I had three admissions, plus a lot of phone calls from the ED with questions about management, drug doses, etc. It was also very refreshing to be in a place where the ER physicians do not admit the patients - I think HCMC has to be one of the only places where ER physicians admit and the team actually taking care of the patient cannot refuse the admission. Of course, with this being my first on-call, I played it safe and admitted most of the kids. After all, many of these kids come from well over an hour away, and their parents may not bring them back if the doctor tells them their kids are "fine".<br />
<br />
My admissions included a two week old with a fever, concern for sepsis. Dr. Marrone came in and taught me how to do a lumbar puncture on a baby. There was also a kid with a bad pneumonia, and a little girl with seizures. I also had a straightforward "emergent" cesarian section that I attended as the NICU pediatrician. The baby required some active resuscitation with PPV, but APGARS were 8 at 5 mins, and the baby did fine.<br />
<br />
All in all, it was a very busy call. I got maybe an hour of sleep, but the learning experience was worth it. The three kids I admitted became "my patients", and I would round on them every day before clinic, write the orders, and discharge them home. It was awesome having the autonomy, but also a little out of my comfort zone - since up to this point, most of the medical decisions in residency are micromanaged by attendings (especially when it comes to kids).<br />
<br />
</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-59756558865132371942015-01-08T17:16:00.002-11:002015-01-09T04:43:21.166-11:00Sunday December 21, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
Today (12/21/14) was another free day. I spent the night
over at Matt and Tangra's, and went to church with them in the morning.
They go to Calvary Chapel, an open-air non-denominational church. The
church location is absolutely stunning, with amazing panoramic views of
the mountains, palm trees, and circling tropical birds. The worship
style is contemporary, with three vocalists, keyboard, and the pastor on
the acoustic guitar. The pastor, Oscar, gave a very good sermon from
the book of Isaiah. Almost everyone came up and introduced themselves
to me - and many gave me hugs. It was very refreshing to be in an
environment with so many wonderful Christian people. <br />
<br />
We
spent the afternoon back at the Broge's house. I had the chance to pick
and drink from one of the many coconuts growing on the palm trees around
their home. Neeli showed me how to scrape out the coconut meat with a
special "coconut scraper".<br />
<br />
That evening, the kids had
a Christmas program back at the church. It was an elaborate event with
songs and choreographed numbers. The songs were in both English and Samoan, and it was incredible to see the talent that these kids have to share.<br />
<div class="separator" style="clear: both; text-align: left;">
<a href="http://1.bp.blogspot.com/-abEtCjd5eMs/VKtDCh5p7SI/AAAAAAAAN_c/2yFKMCnAJyQ/s1600/Picture%2B133.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;">T</a></div>
<div class="separator" style="clear: both; text-align: center;">
<img border="0" src="http://1.bp.blogspot.com/-abEtCjd5eMs/VKtDCh5p7SI/AAAAAAAAN_c/2yFKMCnAJyQ/s1600/Picture%2B133.jpg" height="225" width="400" /> </div>
<div class="separator" style="clear: both; text-align: center;">
Photo I: A view of the outdoor church </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-0NG0TR5dZQY/VKtDE-6o7YI/AAAAAAAAN_k/IZz0XEZlFog/s1600/Picture%2B057.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-0NG0TR5dZQY/VKtDE-6o7YI/AAAAAAAAN_k/IZz0XEZlFog/s1600/Picture%2B057.jpg" height="225" width="400" /></a></div>
<div style="text-align: center;">
Photo II: The banner above the stage during the Christmas program</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-mRl6LFpnuzI/VKtDAG7xeqI/AAAAAAAAN_U/bZqhVE9U41w/s1600/Picture%2B060.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-mRl6LFpnuzI/VKtDAG7xeqI/AAAAAAAAN_U/bZqhVE9U41w/s1600/Picture%2B060.jpg" height="225" width="400" /></a></div>
<div style="text-align: center;">
Photo III: The kids during the finale of the program (Nolan and Noah are on the front left, first and third kid respectively)<br />
<br />
<div style="text-align: left;">
On the way back from the church program, we drove past a very unique house of worship nicknamed the "Santa church" - mainly because it is decorated with dozens of glowing statues of Santa. There is also a big glowing Mickey Mouse out front.</div>
<div style="text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-FC3_ALHAmLY/VK_1rOGn9_I/AAAAAAAAORw/UcpZcKWROm8/s1600/Picture%2B061.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-FC3_ALHAmLY/VK_1rOGn9_I/AAAAAAAAORw/UcpZcKWROm8/s1600/Picture%2B061.jpg" height="225" width="400" /></a></div>
<div style="text-align: left;">
</div>
</div>
</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-34509941888877699612014-12-28T17:56:00.000-11:002014-12-28T17:57:01.910-11:00Photos around the Hospital and the island<div dir="ltr" style="text-align: left;" trbidi="on">
Sorry about the delay - it has been very busy here (will update formally soon). Thought I would update with some photographs from the hospital, the hospital accommodations, and various pictures around the island. More to come!<br />
<br />
Photo 1: The hospital accommodations,<br />
Photo 2: The Main Entrance to LBJ Tropical Medical Center<br />
Photo 3: The view from the main highway into Pago Pago (Capital of American Samoa)<br />
Photo 4: Sunset view from the Broge's backyard<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-cnEIhYbW7OU/VKDcuJR2eEI/AAAAAAAAN9E/suOBRo4dPi4/s1600/20141216_112347%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-cnEIhYbW7OU/VKDcuJR2eEI/AAAAAAAAN9E/suOBRo4dPi4/s1600/20141216_112347%5B1%5D.jpg" height="180" width="320" /></a></div>
<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-G6UxM7GgFc8/VKDdv0nrCFI/AAAAAAAAN9Q/AJNJPGBL3GU/s1600/20141223_081846%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-G6UxM7GgFc8/VKDdv0nrCFI/AAAAAAAAN9Q/AJNJPGBL3GU/s1600/20141223_081846%5B1%5D.jpg" height="320" width="180" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-ZRm9tTAQEs8/VKDd5g5YfUI/AAAAAAAAN9Y/0PhBzVt_tN0/s1600/20141220_162050%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-ZRm9tTAQEs8/VKDd5g5YfUI/AAAAAAAAN9Y/0PhBzVt_tN0/s1600/20141220_162050%5B1%5D.jpg" height="180" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-GrAx8PKM_-w/VKDeAjYl72I/AAAAAAAAN9g/CO_-Tn1vtIw/s1600/20141224_185757_Richtone(HDR)%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-GrAx8PKM_-w/VKDeAjYl72I/AAAAAAAAN9g/CO_-Tn1vtIw/s1600/20141224_185757_Richtone(HDR)%5B1%5D.jpg" height="180" width="320" /></a></div>
</div>
Anonymousnoreply@blogger.com0American Samoa-14.306407 -170.6950175-15.2912465 -171.98591100000002 -13.3215675 -169.404124tag:blogger.com,1999:blog-5473835349225140492.post-4961686616485697512014-12-23T12:24:00.000-11:002015-01-05T13:53:34.687-11:00Saturday December 20, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Today
was a "free day". Tangra was on call and had to stay at the hospital.
Matt and the Broge kids came at 8:45 to drop Tangra off at the
hospital. Matt took us, along with Dr. Cosman and his two sons, over to
the other side of the island for a hike. All the land in American
Samoa is privately owned by various families, and there is no Real
Estate.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
We
decided to hike to a place called "Massacre Bay", a remote bay that was
the site of a French Massacre in the 1780's. The history is very
controversial, but basically the story goes that a French ship stopped
off in the bay to get provisions. Apparently some of the French
accosted the polynesian women, who were naked, and it angered the
villagers, who attacked the French and killed 12 of them. According to
the French account, the villagers then ate some of them - a detail that
the Samoans deny.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
To
get there, we had to drive across this guy's land and park at the top
of a mountain. The owner directed us to the trail, which went into the
jungle and down the ridge for about 3 hours. The bay is very secluded
and is owned by an ex-army man named Tony. He lives by himself and is
rebuilding the site of his ancestor's village in the hope of bringing in
tourists to the site of the massacre. He told us the story and took us
to a monument that was built on the site of the massacre by a French
priest in 1882. We spent about 2 hours on the shore there, and I got
some incredible photos. The water was very blue - much clearer than
anything on St. Maarten - and warm. There were also tons of fish
everywhere. I got very sunburned.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
The
hike back was almost entirely uphill at a steep incline and quite
strenuous. Neeli got tired and had to be carried, but overall the kids did very well. It was unbelievably hot and humid.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
We
got back to the hospital only to find out that one of the kids we
admitted was now in the ICU with septic shock, coughing up blood and
bleeding everywhere. I was going to go spend the night at the Broge's
house tonight and go to Church with them in the AM, but basically when
that kid coded and went to the ICU, all the peds team came in to work
(was only supposed to be Tangra today). I ended up going into the ICU
and helping out for about an hour. <br />
<br />
<br />
<br />
Photos:<br />
1 - a large hermit crab (these are crawling all over the mountainside)<br />
2 - The view from the ridgeline<br />
3 - Matt and Neeli<br />
4 - Nolan<br />
5 - The beach at Massacre Bay<br />
6 - another view of the beach at Massacre bay<br />
7 - The monument to the French sailors who died, erected in the 1800's by a French priest<br />
8 - Tony and his dogs show us around the bay<br />
9-11 - more views from the hike <br />
<br />
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-QT6UmKMZdZU/VKssVkfcDeI/AAAAAAAAN94/8JcBcRS2fp4/s1600/Picture%2B038.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-QT6UmKMZdZU/VKssVkfcDeI/AAAAAAAAN94/8JcBcRS2fp4/s1600/Picture%2B038.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-K9O0zTsaI5o/VKssVT9WvcI/AAAAAAAAN90/wVF8u5grwso/s1600/Picture%2B039.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-K9O0zTsaI5o/VKssVT9WvcI/AAAAAAAAN90/wVF8u5grwso/s1600/Picture%2B039.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-wKA4aV-1xVg/VKssZjcbd3I/AAAAAAAAN-E/7Fcy3lfVhtk/s1600/Picture%2B040.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-wKA4aV-1xVg/VKssZjcbd3I/AAAAAAAAN-E/7Fcy3lfVhtk/s1600/Picture%2B040.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-NXTpz-kJnbk/VKssg3hJUkI/AAAAAAAAN-U/n7eOHNEaewg/s1600/Picture%2B041.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-NXTpz-kJnbk/VKssg3hJUkI/AAAAAAAAN-U/n7eOHNEaewg/s1600/Picture%2B041.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-1jzf4FTosNA/VKssdqllb7I/AAAAAAAAN-M/7L22jjpaR14/s1600/Picture%2B042.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-1jzf4FTosNA/VKssdqllb7I/AAAAAAAAN-M/7L22jjpaR14/s1600/Picture%2B042.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-jQ5BCsPLWkk/VKssjPi3F3I/AAAAAAAAN-c/zycgCEdEQgg/s1600/Picture%2B043.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-jQ5BCsPLWkk/VKssjPi3F3I/AAAAAAAAN-c/zycgCEdEQgg/s1600/Picture%2B043.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-zd6WgVIHJiE/VKssm343LRI/AAAAAAAAN-k/L6lLk2JsgWY/s1600/Picture%2B044.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-zd6WgVIHJiE/VKssm343LRI/AAAAAAAAN-k/L6lLk2JsgWY/s1600/Picture%2B044.jpg" height="400" width="225" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-W3EonkOXd_g/VKssrnXD1wI/AAAAAAAAN-s/h0z1uu40X1E/s1600/Picture%2B045.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-W3EonkOXd_g/VKssrnXD1wI/AAAAAAAAN-s/h0z1uu40X1E/s1600/Picture%2B045.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-avDxt_qvzLs/VKsstSB6kTI/AAAAAAAAN-0/oC8hlf17StI/s1600/Picture%2B049.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-avDxt_qvzLs/VKsstSB6kTI/AAAAAAAAN-0/oC8hlf17StI/s1600/Picture%2B049.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-XQ16B9-2DmY/VKsswO4cxEI/AAAAAAAAN-8/31pzL5j1TmI/s1600/Picture%2B051.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-XQ16B9-2DmY/VKsswO4cxEI/AAAAAAAAN-8/31pzL5j1TmI/s1600/Picture%2B051.jpg" height="225" width="400" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-m70u_tIoqbk/VKssy9t82DI/AAAAAAAAN_E/iXiHVgUMQrs/s1600/Picture%2B052.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-m70u_tIoqbk/VKssy9t82DI/AAAAAAAAN_E/iXiHVgUMQrs/s1600/Picture%2B052.jpg" height="225" width="400" /></a></div>
<b><u></u></b></div>
</div>
Anonymousnoreply@blogger.com0Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-61981426698587673902014-12-23T12:19:00.002-11:002014-12-23T12:19:35.338-11:00Friday December 19, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<b><u></u></b></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Today
was a fairly light day, as this was the day of the yearly LBJ Christmas
Gala, a giant party put on by the hospital for all their employees.
The party takes place in the governor's auditorium. The doctors donated
over $2000 for this party (I think the budget was well over $15k).</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
That
morning we had another CME - this time it was the hospital passing out
CME certificates for the year so that everyone could claim their
credit. They had breakfast for us - scrambled eggs, ham, a pear, and
very strong coffee. It was pretty good. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
We
met up on the wards for rounding. Very informal presentations (though very thorough) - very
refreshing compared with the formal rounding we go through in residency. I
then spent the morning and early afternoon "shadowing" Tangra in clinic
because my license is still not approved due to some political issues.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
That
night, went to the party. It was a Disney Frozen theme, which was
hilarious - although the decorations were amazing. It felt like a
literal ice castle. There was a huge buffet with Samoan food and all
you can drink beer, wine, sodas, water, etc. They had a talent show
from the different departments - mostly ancillary services - Lab,
housekeeping, medical records. Two of the janitors did a hilarious
rendition of "Let it Go", that I recorded. I tried a couple of new
beers from Samoa that were actually very good. My favoirite was one
called "Vailima Natural", which was made with breadfruit. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
There
were over 200 people at the party. All the men wear the traditional
Samoan Lava Lava, a kind of polynesian kilt. The women wear flowered
Samoan dresses. There were a few people, including one of the
hospital's fa'afafines, who were dressed up as Frozen princesses. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Dr.
Maronne and I ran into the CMO of the hospital at the party and got assurances that I would get my license. He approved me to work. Gotta love small town politics. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
All
in all, it was a fun time. We left around 11pm. I rode home with
the Broges and Dr. Marrone, they dropped me off at the apartment.</div>
</div>
Anonymousnoreply@blogger.com1Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-59788067997225212962014-12-23T12:14:00.002-11:002014-12-23T12:15:14.154-11:00Thursday December 18, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Today,
Dr. Marrone was on call and wanted me to be on call with him. I still
did not have my license, though they were working through the channels
to find the right people to sign the paper to allow me to legally work.
Apparently the CMO needed to sign me off, but he was out getting a
haircut and was not around. I went to the nursery again and also the
ICU. The hospital approved funding to pay for a flight to hawaii for
the baby, once he was safe to fly. <a href="http://www.samoanews.com/content/en/lbj-approves-island-referral-baby-mel" target="_blank">LBJ approves off island referral for Baby Mel</a>. Lots of drama and politics here.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
There was another code - a lady who was found unresponsive. Again, did CPR for some minutes and the lady died. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Ate
lunch at the cafeteria with the Broges. Noah and Nolan were there,
along with Neeli and Tangra. Tangra has her own patients and works in
the clinic. Had some lamb chow mein and water for $4. Lots of food.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
That
evening, I walked down to the bottom of the hill. There is a small
supermarket owned by an asian man who speaks very little English. I
bought laundry detergent - a tiny boxy of Gain - for $4.25, dish soap,
sponges, and a $5 calling card to call home from the apartment phone
because I still was not able to use the internet. I found out that day
from one of the PAs who works in the ER that the hospital did not pay
the wifi bill and the account was suspended. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
I
walked back home and tried to use the calling card. The menu asked me
to punch in the pin number, which I did, and there was just silence. I
tried again, no luck. I called the help line and got a very annoyed
lady who told me that the number was wrong and that I needed to call a
different number. Which I did and got a very annoyed lady who told me
to call another number... which I did and the number was disconnected.
Very frustrating and the card is non-refundable.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
On
the way back from the hospital, Dr. Marrone was notified by the janitor of a "party"
up at the nursing headquarters that had some food. We went up and there
was a christmas celebration with the nursing managers - all old ladies
in their 60's. They had tons of food and made each of us three huge
to-go boxes (To-Go boxes are a big thing here). There were several traditional Samoan dishes that I was
able to try - including Taro and breadfruit, both are local fruits that
taste like potatoes. There was also a dish made with coconut cream and
wrapped in bannana leaves that was absolutely amazing... but extremely
rich. One of the boxes contained nothing but meat - chicken, pork, and a
local turkey specialty of "turkey tail", basically the cooked fat pad
from the butt of the turkey... which tastes a lot better than it sounds.
There were also several fruits. Needless to say, I was stocked for
several days.</div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
I
was called in at 2am with Dr. Marrone for a emergency cesarian section
for a cord prolapse. The mom had gestational diabetes and the baby was
very big (over 9lbs). Most babies are born LGA (large for gestational
age) here. Baby did OK and only needed mild stimulation. </div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
<br /></div>
<div class="gmail_default" style="font-family: tahoma,sans-serif; font-size: small;">
Went
home and fell asleep - only to be woken up again at 6am for an
admission. Went to the ED and admitted a baby for pneumonia. Did not
go back to sleep.</div>
</div>
Anonymousnoreply@blogger.com0Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-63821471628657114202014-12-22T16:07:00.000-11:002014-12-23T12:26:47.041-11:00Wednesday December 17, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">I woke up, had some Kix cereal and some instant coffee for breakfast (breakfast of champions). They had CME that morning - a lecture on proctology from Dr. Cosman.</span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">Met with Dr. Marrone in the nursery to go over how to round on the babies and use the electronic health record. After rounding on all the babies in the NICU and the nursery, we also helped out Sergei, one of the russian pediatricians (also a critical care physician back in the US and hilarious sense of humor) who is helping on a high-profile child case that made the local papers - <a href="http://www.samoanews.com/content/en/nuuuli-family-prays-gift-life-christmas-season" style="color: #1155cc;" target="_blank">NU'UULI FAMILY PRAYS FOR THE GIFT OF LIFE THIS CHRISTMAS SEASON</a>. Very sad case.</span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">During lunch, I went back to my apartment and made a sandwich. I was able to connect to the wireless - but it did not connect to the internet. I tried many different things, but all I got was a message saying the router needed to be restarted. I called down to the hospital to ask if they knew anything about it (the welcome packed from the hospital told me to call that number for help with the wifi), but they did not know anything about there being internet in the apartments. They suggested that I call bluesky internet and work it out with them. </span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">You might be wondering why I'm so concerned with internet - the 17th was my wife's birthday, and I had yet been able to contact her.</span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">That afternoon, I was in the nursery again with Dr. Marrone until 6pm. Very tedious, but he is really cool to work with. He is a US trained pediatrician from California. He graduated from residency in the 90's, and has been in American Samoa for over 13 years. He is single, has a very interesting sense of humor, and loves to play poker. He can speak some Samoan language, and has been teaching me various phrases. </span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">There was a "Code blue" cardiac arrest. A man with a history of stroke went into cardiac arrest. There are no heart or stroke specialists on the island, so you are basically screwed if you have a MI or stroke. The code lasted about 20 minutes, and the patient died. </span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">Later that evening, I was invited to watch a breech delivery by Dr. Kareem, a young OB doctor right out of residency. He is from Indiana and is working at LBJ to pay off his loans. The baby was born slightly floppy and had to be resuscitated briefly. Dr. Marrone helped me, but this was technically my first newborn resuscitation thanks to the fact that we no longer do NICU at HCMC with our residency program. </span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><span style="font-size: small;">I went to the cafeteria that night for food, and then went to sleep.</span></span></div>
</div>
Anonymousnoreply@blogger.com0Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-45421379112884776952014-12-22T15:58:00.002-11:002014-12-22T15:59:12.881-11:00Tuesday December 16, 2014<div dir="ltr" style="text-align: left;" trbidi="on">
My first day at the hospital, I basically went around to the various offices and had my "orientation". I had a big piece of paper that had to be signed by all the various people in the hospital - pharmacy, medical records, etc. I had my photo taken and an ID badge made.<br />
<br />
It was Tuesday that I found out that I did not actually have my Samoan license approved - which was also news to the Pediatric team. Apparently, the new Governor of Samoa decided that he wanted to create a new board and changed the process of licensure without telling anyone. Dr. Marrone (head of pediatrics.. more about him later... said this was a political stunt because there is a distrust/dislike of American-trained physicians on the island).<br />
<br />
For lunch, I went with Matt down to a local cafe called "DDW" (Don't Drink the Water). It was located about a half mille from the hospital in Pago Pago, right next to the water. I had teriayki chicken (again), which was delicious. A huge (and I mean HUGE) plate of food with two chicken breasts for $8. I was stuffed.<br />
<br />
I spent the rest of the afternoon in clinic with Dr. Marrone, also going around the hospital. I then went with Matt to KS Mart for some groceries. The hospital had given me $50 for groceries, which paid for cereal, shelf-milk (regular milk is $4 for a half gallon), ramen noodles, bread, ham and cheese, pasta and pasta sauce, and a gallon of water. The gallon can be refilled around the island for 50 cents.<br />
<br />
I also spent a good portion of the day going around and figuring out what the password was to the wireless network up at the locum apartments. I was told be three seperate people that the password was ***, but it never worked.<br />
<br />
That night, I went to a local burger joint with the Broges and Dr. Marrone. It was run by a guy named Tapp, who is a local singer and chef. He imports all his beef from New Zealand. I had the pineapple teriayki burger (Teriayki is a theme here), which was delicious - almost as good as the Kobe burger at Rockit Bar and Grill in Chicago (my current favorite burger).<br />
<br />
Tapp came out and sat with us and had us try some new soup that he had made. He then brought out ice cream and homemade peach cobbler made by his wife, who is [apparently] a famous chef from some 5-star culinary school in the US. It was delicious.</div>
Anonymousnoreply@blogger.com0Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155tag:blogger.com,1999:blog-5473835349225140492.post-49610207611805590032014-12-22T15:52:00.001-11:002014-12-22T15:52:50.393-11:00Monday night (Dec 15 2014)<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><b>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)</b></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<b><u><span style="font-family: inherit;"><br /></span></u></b></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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).</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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)</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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. </span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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. </span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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. </span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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: <a href="http://www.pagopago.com/etv/samoa-america%E2%80%99s-shame-south-seas" style="color: #1155cc;" target="_blank">Samoa: America's Shame in the South Pacific</a>). 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. </span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;"><br /></span></div>
<div class="gmail_default" style="background-color: white; color: #222222;">
<span style="font-family: inherit;">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.</span></div>
</div>
Anonymousnoreply@blogger.com0Pago Pago, Eastern, American Samoa-14.279444 -170.700556-14.3102205 -170.74089650000002 -14.2486675 -170.6602155