Now that I’ve been in American Samoa for a couple of weeks I have an idea of how things are here at the hospital. Many of you reading aren’t health care providers but for those of you that are I just have to include all those details that make practicing here so very different. Hopefully this won’t bore the others of you out there to tears.
The facility itself is very old. It is your typical 1960s cinderblock tropical facility. It’s not what you would think of as looking like your typical “hospital”. The building really needs to be taken down and rebuilt. Apparently during one hurricane there was two feet of standing water through out the wards. Though the buildings are ancient and over used, the equipment is good.
There is a big brand new ultrasound in the clinic, some of the beds in clinic are hydraulic (and there is also one that has rusted so bad the stirrups won’t come out), and there is electronic fetal monitoring. One of the best things about the hospital, unbelievably, is the cafeteria! I never thought I’d say that I look forward everyday to eating in the cafeteria. Ribs, Cornish game hens, fresh salad, stuffed chicken, plantains . . . .thank god Samoans know how to cook!
The outpatient clinics are on the same property as the hospital. Clinic is a rotating schedule (Wed-Postpartum, Thurs-New Patients, Fridays-Return patients). Patients don’t have appointments but come in first thing in the morning and wait: first come, first served. This can be a problem if doctors have to cancel clinic, because there’s no way to know who is coming in and notify them.
On New Patient day the women are all undressed in the hall wrapped in lava-lavas (bath sheets wrapped around them sarong style). Privacy seems to be of little concern here the exam rooms have curtains instead of doors. Labs are minimal, really, minimal. All patients though get a level two ultrasound. Pregnancy dating is really important here because patients usually come into care ½ through their pregnancy around 20 weeks and few remember exactly when their last period was. (One of my first deliveries I thought the patient was 32 weeks by dating and measurement-thank god it came out looking 36 weeks). Apparently postdates issues are huge so induction at term if favorable is strongly recommended.
Diabetes is also a big problem here and all patients get an early glucose screen. (One uncontrolled diabetic came in with a capillary blood sugar of over 314!) There are four OB docs in the call rotation. There will be another CNM here in June. She has worked for years in Samoa and had taken some time off and is now returning. There is a also a licensed midwife, Sati, who is great. She is a Samoan and was trained in Fiji as a midwife.
The labor and delivery staff is skeletal in my opinion. Just like everywhere there is a nursing shortage. There are 4 RNs, 2 LPNs, and 4 CNAs. These women work long 12 hour shifts and keep in mind there are on average 140 births a month! The patient rooms are shared with only curtains for privacy.
Patients go to the delivery room to deliver—no delivering in the room here. However, since there is no privacy and the beds don’t break apart and with the very real threat of shoulder dystocia with these big babies, I can see the rationale for that. Most patients are grandmultips (more than five deliveries) so hemorrhage is a huge fear here so active management of third stage (something I didn’t do before) is now my practice. Vaginal birth after cesarean is standard practice here and isn’t given a second thought as an option. I haven’t heard of one case of uterine rupture or fetal demise from a VBAC delivery. Though there have been demises due to postdates and shoulder dystocia.There are no epidurals for pain management. IV pain meds are the only option, however I have yet to have a patient ask for anything. Actually, most patients want to go home if they are in early labor (sometimes even if they are in active labor and have to be convinced to stay). Patients beg to walk the halls so intermittent monitoring is standard.
I love the patients and their approach to birth and pregnancy. There is very little complaining of common discomforts of pregnancy and are open to suggestions and very gracious in their attitudes towards care providers. I do wish that the patients had more interest in prenatal care in general. The government has worked to encourage early prenatal care by offering free care if patients start visits by 12 weeks of pregnancy.
There are many non-Resident patients here from Western Samoa (i.e. Independent Samoa). Though many patients speak and understand English, Samoan is the language of choice (especially of Western Samoans) and I will definitely need to learn Samoan. My first words have been pepe-baby, su-su-breastfeeding, ‘oono-push.
The overall mood is relaxed and I love only working a 40 hour work week. When I leave the hospital I can leave my worrying there and enjoy the day. I work clinics Wed-Friday and 12am-8am Saturday and Sunday night. It’s a great schedule. I have most of the day off on the weekend and Sundays here most everything is closed (including most restaurants) so I’m not missing out on much if I have to sleep. I think I will be very happy in this position and have already adapted to the have-nots (though I miss my rapide suture and unexpired 6 ½ gloves).Next week: A new home for Markus and Me (and Einstein, of course)!!!!!
12 comments:
Talofa!
I am contemplating coming down to LBJ for 4-6 months as INt med /pulm/sleep doc; I enjoyed your blog and pics. It gives me an idea of the place.
would be coming with wife(peds) and 2,3 yo boys; the paper work process has been>6 months
do the patients/staff make up for the outdated equip/facility?
Jack email me at my personal email account and we can chat: esballering@gmail.com
hello everybody! i work in LBJ medical ward for one year.. it was 1 of my greatest experience in my nursing carreer.. happy new year to all... Mabuhay kayong lahat!!
hello everybody! i work in LBJ medical ward for one year.. it was 1 of my greatest experience in my nursing carreer.. happy new year to all... Mabuhay kayong lahat!!
I was at LBJ for a couple of months as a student midwife. 10 years into my midwifery career I think fondly of the stoic Samoan women, walking down the hall to the delivery room at 9 cm dilation. I do not think fondly of the lack of supplies, but it is an island and not a rich country.
Hi!
My friend and I are considering working at LBJ this winter. What's the rest of the hospital like, specifically the ICU/ER?
I volunteered at LBJ for about a year and lived in American Samoa for over 2 years. Yes, the place is very relaxed. I got negative responses from the medical staff when I took my son for surgery, such as "take yourself to x-ray" and they need to smile more. Women there give birth to 10+ children. They don't need more $ for dialysis they need to get rid of McDonalds.
Hi Elizabeth, I am a student nurse-midwife and I am about to graduate in December. I saw the job at the LBJ Medical Center listed on the NHSC website and then I found your website when I did a google search for the clinic. I am wondering if you wouldn't mind telling me how you like working there and any advice you may have at this point. Also, do you know the best way to go about applying for a job there? I am hoping I would qualify as an NHSC loan repayor as well. Thanks for your time, Rachel.
Rachel feel free to contact me directly. You can find my email above.
I shall say, there were so many horror stories that I heard about LBJ and people dying needlessly there. As for me, the great docs at LBJ saved my life on July 8, 2007. As a mom of 7, for that I am forever THANKFUL~
Hello there:
Came across the site by chance, very interesting. I worked at LBJ between 1985 and 1990 as an OBGYN.
Evidently things have not changed much since then. The locals continue to be as overweight as ever and vaginal deliveries of 10 pounders are nothing special. When you leave self-sealing envelopes in a drawer, they will seal themselves because of the constant moisture due to the daily rain showers. When it comes to running the hospital it always seemed of overriding importance to the Samoans that the key posts be occupied by one of their RACE (he could be a WESTERN Samoan, that is to say, technically a foreigner), even when no suitable cantidates were at hand, rathern than have a palagi do an efficient job.
Don't expect to learn Samoan, the locals are not very interested in you acquiring much lingual knowledge beyond "talofa" and "fa'afafine". so they can talk about you without having to lower their voices.
Don't be misled by smiles and gestures of hospitality; it's a show... as you walk away, their kids, who know very well how their parents feel, are likely to throw stones at you. They accept the palagi only as long as they can get something out of him.
Naturally, you cannot know that after 2 weeks on th island, yet sooner or later you can't help but find out that this is so.
Still, your experience is bound to be an interesting one.
Good luck.
Paul H Gamig, MD
Boynton Beach, Florida
I worked at LBJ Tropical Medical Center, Emergency Dept for five months in 2007, on a traveling RN assignment. I loved working in the ER dept, the staff and patients were very kind and accepting of me. I would recommend America Samoa as a traveling nursing assignment to any RN who may be fortunate enough to be offered a job at LBJ. I loved the culture and the people of America Samoa.
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