From Here to There

You would think that an island with approximately 40 miles of roadway would have few cars. However, the island is jam packed with big, brand new SUVs and pickups. There are multiple new car dealerships on island. Markus and I marvel at how the population with a median annual salary of $18,000 (61% of the population lives at poverty level) can afford these expensive new cars. I think part of the ability is that house payments are virtually non-existent.



Even locals say (as they are driving around in their SUVs) that there are too many cars. It's not unusual for some families to own 3 cars. After paying my customs duty ($800 on my car with 190,000 miles!) I think there is an alternative motive behind the AS Government allowing all these expensive high-end vehicles to rattle around the island-the duties alone must be phenomenal on all these new vehicles! Above is a picture of your Samoan car dealership.

Since most of the vehicles here are pickups a popular way of traveling is piling into the back with your sister, cousin and newborn baby. If it’s Sunday and you don’t want to ruin your white church dress, sitting on the tailgate is preferred. An add campaign is running on the radio pretty much non-stop: Click-It or Ticket-threatening enforcement of this new seatbelt law. So far I think this is all talk and little action, plus I have no idea if this applies to passengers as well. There is no infant car seat law that I can tell either. I saw a group driving with a stroller in the back of the pickup truck. I would have put money on there being a baby in that stroller. I was surprised to find there wasn’t one when we passed by; however, Markus and I both thought that someone was probably in the truck bed holding the baby, you know, “to be safe.”



There is a large and highly utilized independent commercial bus system here. The ‘aiga (buses) are contraptions built from small pickup trucks taken down to the frame and built back up with wooden seats. The driver sits below the platform area of the bus, his head on the knee level of the passengers. The buses are named, brightly painted and usually have some airbrushed tablo painted on the tailgate. They boom out Samoan rap and reggae. They are usually jam packed too because the driver won't leave the stop until the bus is full.










Around town bus fair usually costs 50 cents and to the outlying villages $4.00. The favorite carrying method for one’s bus fair? The ear. You will often see people with quarters in their ears and know they are on the way to or from the bus. I guess this is because lava-lavas don’t have any pockets for change. One pays for the ride after the trip, throwing quarters onto the dashboard and making one’s own change. The bus trips are really slow and spine jarring but riding the bus at least once is an experience. Buses don’t run on Sunday or at night, except to the cannery where Starkist has some arrangement with certain bus drivers.

There is one major two-lane road that hugs the coastline. There are only a few stop signs where the small intersecting roads meet and there are no stoplights. The speed limit is 25 mph! Some days you are lucky if it gets up to that speed. Too many cars on island leads to major traffic jams. Or if there has been heavy rain you can drive through two feet deep rivers crossing the road. One crosses these tentatively, fearful that there is a hidden pothole underneath that is about to swallow your vehicle. And there are horrible potholes. The potholes get blamed for ruining cars, but I think the cars (in combination with the rain) are to blame for the potholes. It’s been raining heavily and for a while lately, so the potholes are getting out of control.

Some of the newer stretches of road have bike lanes and I’ve been working up my nerve to try to ride my bike to work. There are few bikes here and of course no one wears a helmet. The road is all curves which makes me worried that one of these big SUVs is going to smash me. I’m still set to do it though I am going to be prepared to arrive completely drenched with the rains the way they are here. Luckily, there’s a shower at work.




The day before Markus arrived I finally got my car and despite my dislike for everybody else’s cars—I was so happy to see mine! It’s all decked out now with the American Samoa license plate which matches my car beautifully and is so cool with it’s palm tree. My license plate has gone from the Oregon pine tree to the American Samoa palm tree. I got my driver’s license too!











PHOTO OF MY LICENSE REMOVED AS PEOPLE SMARTER THAN MYSELF NOTED THAT MY ID NUMBER WAS MY SS# AND POSTING IT ONLINE WAS A TERRIBLY STUPID THING TO DO. In an apparent attempt to one-up the U.S. chaos of the DMV, the American Samoa OMV ("Office" of Motor Vehicles ) does not take numbers. The system is to walk up to the counter with 20 other people and stand there until someone deigns to wait on you. Then you get told that you need some crazy paper from some other agency and to come back. Oh and they close at 3:30pm. So, next time you are at the DMV just tell yourself that yes, it can be worse. Markus thinks the AS could be easily forged. However, we came to the conclusion it would do no minor any good because wherever they would try to pass themselves off as of age the salesperson would know them, their mother and grandfather and probably be related in some fashion.



When Markus got his license, he said, “Now I’m Samoan.” I thought that was funny.
Oh and walking? Very rarely done here. Even by myself. Why? “It’s hot!” And not only is it hot, it’s so humid you are soaked by the time you get a hundred yards. Yeah I know, hardly an excuse, but you gotta live this humidity to understand completely.

And gas? Well it's about what we're used to in the states these days$3.00/gallon. But my how much longer a tank of gas lasts at <25mph!

Straying in American Samoa

One of the first things I noticed about American Samoa was the horrible stray dog problem. The island is shamefully over run with strays. They aren’t aggressive and in fact are so abused they shy away from strangers to the point where they won’t let you help them if they are injured.

The first week I was here I was caught in a rainstorm and had to take shelter in a museum. When I came out the fale in front of the building was filled with dogs. There wasn’t one square inch that wasn’t covered by canine. The strays are starving, injured and often have infections and cancers.

The pet dogs are often not treated much better. They are usually underfed and watered; forcing the dogs to wander and become strays. There are some well cared for animals but they are in the minority.

The island does not have any private veterinarians. I think it would be fiscally impossible to have a private practice on the island. There is a veterinarian that is hired by the Department of Agriculture who’s job it is to oversee agricultural animals (pigs). Apparently in an emergency he will see pets and I think he will do some spay and neuter surgeries.


There is a government task force for strays, this seems to take the form of mass euthanasia. I think a periodic round up is done, especially before large tourist events. The dogs in downtown Pago that I saw when I first got here, magically disappeared when a giant ocean liner was due in town.
There is a Humane Society run by an amazing group of dedicated individuals. The organization, headed by Director Cheryl Morales, has brought in a group out of (yes our very own) Portland, Oregon (with vets from all over the U.S.). The group is Vet Ventures. It is a free clinic that for the past two years has come for three weeks to spay/neuter and give medical consults.





These guys are awesome. Anywhere from 40-70 animals are seen a day! They have a traveling group that goes to the outlying villages and a stationary clinic in central Pago. They aren’t charging a penny, they brought all their own supplies; and are providing flea, tick, and deworming for all the animals they see.












I have been volunteering with them on my days off in the recovery Dog Pile (I even have a mention in one of their blogs for taking down a ferocious feline named "Pretty", mmm, "Pretty Crazy" was my impression). They are here for such a short time I feel like I have to do whatever I can to help them while the opportunity presents itself.












The business community is in full support of this cause. Sadies by the Sea donated free rooms to all the vets! Their food is being supplied free from different restaurants. It’s nice to see the support. I think if the means to care for pets existed on the island the people and community would take advantage of it.

Vet Ventures has it’s own website and the vets are blogging about their time here if you are interested. Adventures in Pago Pago Blog and PAWS Saipan Blog1 and PAWS Saipan Blog2.







Unfortunately, this is the last year that Vet Ventures will come here. They will go to other Polynesian islands in the following years. What the island will do in the future is unknown. The hope is to find a vet that would come for a working vacation and would volunteer time here in exchange for free accommodations. Apparently, this model has worked in the Cook Islands.

If ever there is a cause to support it’s Vet Ventures and the Humane Society (especially the HS of American Samoa that can make such a huge impact, for so little money).







Here is a dog’s prayer shared by my new friend Shannon up in Canada:

Treat me kindly, my beloved master for no heart in the world is more grateful for kindness than the loving heart of me. Do not break my spirit with a stick, for though I lick your hand between the blows, your patience and understanding will more quickly teach me the things you would have me do.

Speak to me often, for your voice is the world's sweetest music, as you must know by the fierce wagging of my tail when your footstep falls upon my waiting ear. When it is cold and wet, please take me inside, for I am now a domesticated animal, no longer used to bitter elements.

And I ask no greater glory than the privilege of sitting at your feet beside the hearth. Though had you no home, I would rather follow you through ice and snow than rest upon the softest pillow in the warmest home in all the land, for you are my god, and I am your devoted worshiper.

Keep my pan filled with fresh water, for although I should not reproach you were it dry, I cannot tell you when I suffer thirst. Feed me clean food, that I may be well, to romp and play and do your bidding, to walk by your side, and stand ready, willing and able to protect you with my life should your life be in danger.

And, beloved master, should the Great Master see fit to deprive me of my health or sight, do not turn me away from you. Rather hold me gently in your arms as skilled hands grant me the merciful boon of eternal rest... and I will leave you knowing with the last breath I drew, my fate was ever safest in your hands.

This was found in a special supplement to Dr. Julian Whitaker's Health & Healing newsletter

Next Week: Hop on The Bus, Gus!

Home Sweet Fale or How I Learned To Love New Concrete Block Construction

Traditionally, Samoans lived seaside in fales, large flat platform huts, with helmet shaped palm leaf roofs supported around the perimeter with large tree trunks. The breeze from the ocean would flow through at night; blinds would be rolled down for privacy. I’ve read in Western Samoa many families still live in these structures.






Here in American Samoa, fales exist still but their platforms are concrete. They aren’t used as much for living and sleeping but largely for family gatherings. The fale usually sits directly in front of the concrete family house. Many family members will have houses on the same family property. Multiple generations will live in the same house and some will occupy the property that is officially another family member’s: “I am living in my Auntie’s house, she’s in Hawaii.”



For the most part, property is owned communally by the family. Owning and living in a house of your own is very, very rare. From what I understand, if family owned property is to be sold all family members must sign off and agree to the sale.








Part of the communal nature of the property is the tradition of burying family members directly in front of the house. Large above ground concrete mausoleums abound. And with the rain the way it is burying people above ground in this way is probably wise. One of my friends described being terrified of driving by the cemetery (a strange concept here to begin with) when it is raining torrentially in the middle of the night. She said that she was terrified that the crunching under her tires was that of old bones. “I don’t mind having dead people in my front yard, those are my ancestors. These people I don’t know!”


Somewhere I remember reading that the concept of burying ones ancestors directly in front of the family house presents a fairly permanent claim on property, it’s hard to argue that someone doesn’t have rights to land that has their family buried on it. In island life, where land is so valuable and can be a point of dispute, this seems brilliant. The burial in public view is also a show of strong Samoan familial ties and respect.




Moving over here I was told that the hospital would be responsible for finding and furnishing a house for me. However, policy seemed to change without my contacts being aware. Two weeks after arriving I hadn’t heard from the housing coordinator. I made a call and was told that new employees would have temporary housing for 60 days and then would be on their own, and that LBJ wasn’t holding leases with property owners nor helping them find a home. They would still be providing a housing stipend but after that employees were on their own.

AAAAAHHHHH!

Property can only be bought and sold by resident American Samoans. This has allowed the Samoans to retain their culture. Combined with the communal property situation this means there are few rentals and obviously no houses for sale.








My first venture in the rental housing market from the “for rent” section of the newspaper was distressing to say the least. I quickly learned that “furnished” meant has refrigerator and oven, “unfurnished” didn’t. When I asked if a house had A/C I was universally laughed at-most houses have A/C because the concrete structures are stifling otherwise, but apparently this is supplied by the renter. As the A/C units here are semi-permenent this is head scratching. I saw houses with slime mold; pigs corralled nearby, and barely running appliances. Houses advertised as being by “McDonald’s and KFC” as a selling point. I got horribly lost trying to find one rental. The palangi surfer guys at the lodge I ended up at, laughed and scratching their heads asked, “How did you get lost out here?” Oh, maybe because of the Samoan driving directions? “Turn right at the coconut tree and then go towards the ocean . . .”


I finally found a house through word of mouth, which is apparently the way most things work out here. A man in finance dept had a cousin who had built a house for his sister on the family property and as she was in Hawaii for a while he was looking to rent it. The Samoan driving directions are evidenced by the following to the house that I rented on sight when I finally found it. “Go around the bend in Pago, past the cricket field, past the Korea House, past the new soccer field they are building, it’s right across from the Banyan tree.” Or simply “The Foster Family’s House” as most places are known by ownership. There are no street names or numbers. The roads have numbers but I’ve only seen a few signs and no one refers to them when giving directions. Mostly if I tell people I’m renting from the Foster Family in Pago people will know immediately where the house is.

The house is great. Brand new construction. On a hill with a view of the harbor (without the sewer plant). It has two bedrooms. A giant “Samoan style” bathroom-which means a shower area that’s half the bathroom and open like a gym. I’ve yet to see a bathtub. A major luxury I’ll be missing. The kitchen and living room are huge. And there is hot water. This is apparently something most people do without and don’t miss. It’s so hot here the hot shower is not a necessity. Cleaning is mostly done with cold water. There is a large yard that I am excited to start planting with avocado, papaya, mango and flowers.







The house isn’t furnished and now I am so glad I brought my bed. Something I was vacillating about since my house was supposed to be “furnished”. As long as I have a place to sleep I’ll be happy.

Markus and Einstein arrived safe and sound though a little frazzled from the long flight and all the paperwork hoops to jump through. Of course money had to exchange hands in the form of paying Customs and Agriculture “overtime” at the airport. This is humorous to me, as these civil servants have to be at the airport anyway when a flight arrives and if no one needs their service, who pays their overtime? Puzzling.





The cargo ship with the container of car and household goods didn’t arrive until the Tuesday before Markus got here and the goods weren’t delivered until this Monday. We are now settling in. Our A/C should be up tomorrow in the bedroom (Hallelujah). We will have to piece together furniture as we go but we have what we need for now. And most importantly our kayaks and fun gear are all here. Hopefully, we will get a bed for the guest room so all you out there planning on visiting will have comfy accommodations.



Markus' Home Sweet Fale Likes

• Plenty of Room
• Air Conditioning
• View

Dislikes

• Too Close to Cannery (the winds blowin’ from Charlie The Tuna’s House Today!!!)
• Tile Too Painful on Tender Tootsies
• Thin Shower Head
  

Liz’s Likes

• View!!!!
• Garden Space
• Lots of room

Dislikes

• Roosters everywhere crowing all day long (mmm freerange poultry . . . )
• Ants (Dead Ant, Dead Ant, Dead Ant, Dead Ant . . . )
• No shade trees

LBJ Tropical Medical Center

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)!!!!!

First Week in American Samoa

As expected things here are so different. I can't wait to share everything with all of you out there. I’ll be posting something new every week until I start repeating myself (at which point someone should mail me a plane ticket home).

There are so few non-Samoans here. I find this really refreshing. American Samoa receives a lot of U.S. assistance (take me for example) but most probably because non-residents can’t purchase land this small little island remains the sole property of the Samoans. Where else can we say that natives in the U.S. still own their own land? Sure I stand out---a white, young(ish), female, so of course, everyone stares and at first this intimidated the heck out of me!

Living in Portland so long one becomes used to blending into the background, people don’t look at you directly unless they want something or you make an effort to get their attention. It’s not considered rude. I think it’s a way of maintaining privacy in a city. In Portland people even wear clothing that camouflages them: dull black, green, and brown that blends nicely into the landscape and cityscape. In Southern Oregon it was somewhat different a mixture of small town, “hey we know you” with still the ability to maintain some anonymity.

Here it is really the small town feel. Having grown up in Mt. Shasta, I know what it’s like and how things work in a small town. I’m not sure if everyone really knows everyone else here, but there is definitely that sense. Walking the streets when I first got here before the hospital rented me a car, I got more male attention than I was comfortable with. I’ve never been any place where that’s happened to such an extent. It’s not something I’ve had to consider so thoroughly. I don’t think I would ever be in true danger and no one makes lewd remarks or approaches me, but it’s overwhelming, unwelcome attention. And of course, I don't want to avoid interacting with people in public because that makes me feel unwelcome. I find if I don’t make eye contact and ignore the younger males (which seems rude to me, but I think is the proper way to interact) and only smile and greet women and older adults I feel much more welcome and get a warm response.

There is A LOT of gossip. Those of you that work in the health care field know about gossip, well it is 100 fold here. I am a stranger and already I know more about people than I am comfortable with. Word travels fast on what is called the Coconut Telegraph. I’m going to do my best to stay out of the main headlines on this particular version of Samoa CNN.

Ana in Human Resources, a gracious hostess and superb representative of the hospital, let me in on my new title here on the island over a meal at a local Chinese Restaurant. She insisted I order and not knowing what she would enjoy and too fatigued after my second day in Samoa to think to hard about food, I simply chose the dinner for two that all Chinese places have. What followed was sooooooo much food a family of six could have eaten well and come away satisfied. I was embarrassed by the volume and sent Ana home with the majority. I quickly learned to assume that all food orders would come “Samoan”-meaning large, large, large! But I digress.

My new title was palangi. As she described it, when Caucasians first showed up, the Samoans thought they came from Heaven and the name palangi meant, “fell from Heaven.” When she first told me this I couldn’t help but guffaw. “Yeah, right,” I said. “I am sure Samoans today really think we are heaven-sent.”

Later reading Paul Theroux’s novel that Polynesian’s love to hate, The Happy Isles of Oceania: Paddling the Pacific (I think I’ll post my own review once I’ve finished reading it), I enjoyed his explanation of the concept of the palangi:
“It meant ‘sky-burster.’ In the seventeenth century, Tongans and Samoans believed that their islands lay in a great and uncrossable ocean. The story of a long overseas migratory journey was conjectural in Tonga and absent in Samoa, where the local creation myth described how they had risen from a knot of twitching worms in the soil of their islands. So when the first Europeans appeared in this part of western Polynesia . . . the only possible way for them to have arrived was from the sky, exploding from the heavens.”

In truth, I do feel as if I have exploded out of the sky and landed in this beautiful and unknown place. And so, my blog from American Samoa will be entitled Palangi Post, where I get to tell all of you what it’s like living here from my palangi point of view. Hopefully, this will help me to connect to all my loved ones so very far away as I get to know new friends here in American Samoa.


Next Week: LBJ Tropical Medical Center (ladies in the hall in lava-lavas (sarongs-instead of hospital gowns), roosters in the courtyard (or being carried away by boys for dinner), expired gloves in the drawers (only size 8s seem fresh), but where at least 5 lovely Samoan babies are born a day . . . ).