The Challenges of Micronesia

Updated: Nov 23, 2020

My week in the Palau hospital clinic started by working with a Doctor named Jonathan who I found out was actually a Pathologist. He was functioning as a Family Physician helping out in clinic for the day. He informed me that he usually works in the clinic for a couple of hours every day and has been for the last 9 years. I asked him about the path lab before we started seeing patients, he told me they ran out of stains and the only thing he can look at are gross specimens.

To my surprise this pathologist was heads and tails the best clinician I have yet worked with in Palau. He was able to take his knowledge in pathology and apply it clinically. Everything he diagnosed he was able to go through the mechanism of how the disease worked and how the patients present. It made me wonder that although pathologists never interact with patients I wonder if most could work a clinic if they really had to, granted they remember which side to listen out of a stethoscope.

That afternoon I was planning on going back to clinic, but was informed that there was an anesthesia conference going on in the library that might be worth checking out, Vanessa was already there. The conference was actually a week long event, it was actually pretty cool. These two Anesthesiologists from Australia were running the thing. The concept was to bring other Anesthesiologists and Nurse anesthetists from other islands for the week and run through a training seminar.

There were about 10 others there from places like Yap, Chuuk, and as far as the Marshall Islands. They represented all of Micronesia. This conference is actually held every other year on different islands. One of the Australian doctors Arthur said he had been doing it for several years, and the faces are usually the same. The main concept of the week was more about establishing a system of professional support for these people rather than truly trying to educate them. Most of them work in these rather remote islands in rather awful medical conditions in complete isolation.

The outer island providers are under equipped for the jobs they are doing, this became apparent very quickly. Islands like Yap and Chuuk can’t do simple things like blood gases, nor do they have anything outside the most basic of drugs and gases. Often times the doctors from these first world countries would start talking about a tube or drug that is basically considered standard of care in many other places, they realized that no one in the room had access to what they were referring. They couldn’t really do anything else besides look at each other and move on to another topic. Palau is no exception, and they lack just about as much as the rest.

I learned that conditions in Chuuk are the worst; they don’t even have running water in the hospital most of the time. But, I was shocked to find out that Chuuk has 60,000 people, which is three times more than Palau. While Palau is a fairly safe place where you can walk around at night with no issues, the same night time walk in Chuuk and you might find yourself with what they called a “phillipinni” through your chest. It’s basically a tire iron straightened out and sharpened and then they launch them at each other with these sling shot like contraptions.

The World Health Organization is well aware of the health care disaster is this area, and like most areas of the world the problem revolves around corruption and money. The WHO and Federated States of Micronesia pour money into places like Chuuk but the local government is so corrupt that hardly a dime gets to where it’s intended.

I was actually impressed with how the Australians had organized the week. Every modern well proven method of learning module was somehow in play. We did review questions, had problem based learning sessions with fake scenarios, watched DVDs, and of course death by powerpoint. At one point they asked Vanessa and I to act out scenarios and the participants would each take turns working us up like a trauma patient and running through the basic ABCs of trauma (airway, breathing, circulation). It was fun, the Aussies hammed it up and all had a good laugh with some of the scenarios. Although it was a bit scary at times when some of these Anesthesiologists who were MDs did not understand the simple concept of how to access the Airway, Breathing, and Circulation in that order. Arthur told me later that he teaches basically the same course every other year to what is basically the same group of people and little is retained. So these guys do what they can to teach the trade. If nothing gets through at the end of the week they have at least helped the group establish some kind of professional comradely, and at a very minimum give an email address or two so they can ask questions later. But I think Vanessa and I have enjoyed it because we actually are learning a good deal about anesthesia and getting a lot of review at the same time. We are also getting another lesion about the challenges in this region.

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