Monday, 24 September 2018

August 2018 - Micronesia

So, somehow, I ended up in Pohnpei, one of the 4 states of Micronesia, for 3 weeks in August. In the last year of medical school, my school gave us 12 weeks to plan our local and overseas electives. I wanted to do a posting in a rural, developing island for the scenic views and to experience a very different healthcare system. Originally, I wanted to go to the Cook Islands, but they were full for the period I requested, so my friend and I emailed many many other hospitals in similar places and the doctor from Pohnpei responded so that's how we ended up here, in a place most would not even have heard of before.

Our route there was long and complicated. We took Qantas to Brisbane, then Air Niugini to Papua New Guinea for a stopover of 6h then Air Niugini to Pohnpei via Chuuk. 3 flights over 24h. There is a shorter route to PNG from Singapore directly but the timings meant that we'd have to spend a night in PNG, which I didn't want to.

Our accommodation was arranged through the doctor, and we stayed at one of the other doctor's old apartments. It was spacious with 2 bedrooms and a large hall, though it had many problems. The ventilation was pretty poor so we had to get air fresheners lol. There was no hot water nor a working shower head so we bathed in cold water through a pail - which is something I've experienced before in Cambodia. There was no stove but the owner did kindly buy a portable stove for us. The beds were a little suspicious so I had to buy sheets, but still got bitten by possibly bed bugs. Oh well, all part of the experience haha.
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We spent most of our time in the hospitals, on weekdays from 8-5. We rotated mainly through the emergency department, medical wards and public health, though we did get exposed to the other departments as well since the whole place is so small and everyone was friendly and willing to let us join. We joined a couple of outpatient clinics and saw stuff that are hardly seen in Singapore like scabies and parasitosis. We also went to the OTs to watch a range of ops. There was an ophthalmology missionary team visiting from the US, so we watched several cataract operations. The doctors were very kind and more than willing to explain every step that they were doing. I've actually seen quite a few cataract operations in Singapore done through the same method of phacoemulsification so this wasn't new, but they were still so kind. We saw a C-section for a breech baby, and it's amazing that it's just the doctor and the scrub nurse! The obstetrician was also very nice to allow us to watch and teach us. On the surgical side, we saw a couple of debridements and I&Ds for diabetic wounds, as well as a fixation of a patella fracture. It's amazing cos the surgeon isn't even an ortho surgeon.
The ER is small with just 4 beds and 1 resus bay - it was meant to be for real emergencies or patients that required IV drips or urgent care. Everyone else goes to the outpatient clinic. Which is good, cos Singapore gets too many P3 cases in our EDs. They have basic supplies like cannulas, sterile suturing sets, drips and medications but not more sophisticated stuff, so the doctors are very adaptable and innovative. I saw the doctor use the wrapper for the sterile gloves as a drape and thought it was ingenious haha. The doctor we followed (there's just 1 in the ER at any time) is a Filipino and was very nice to let us examine patients and take us through any interesting cases. I got to set many cannulas and suture a patient too.
In the medical ward, the doctor (another Filipino) was also very kind and explained every single case to us. Basically, everyone is just EXTREMELY nice and friendly. When we walk down the hallway, people would just randomly say good morning to us, and the nurses were always very eager to offer me a seat. Even the PATIENT in a clinic offered me his seat which I found hilarious.
The Public Health department is on the opposite side of the road and they have several programmes - non-communicable diseases (mainly diabetes), STI screening, family planning, antenatal care, immunisations, TB & leprosy screening and treatment and RHD screening and prevention.
This is the entrance to the hospital that we grew so familiar with.
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For sightseeing, we went to Ant Atoll with the Pohnpei Surf Club on one of the Saturdays. It cost $130USD for the whole trip which includes the boat ride there and back, rental of snorkelling gear and some banana bread and fruits. The weather while we went there was really amazing, and Ant Atoll is like the beaches you find on postcards - absolutely picturesque. We snorkelled abit here, though there wasn't much. Mostly just walked along the beach and chilled in the sea. There was one point it rained though so we had to seek shelter in the hut. The island is really deserted though and there's nothing to buy at all! We went to a pass to snorkel and this place had much more corals and fish and reminded me of the Great Barrier Reef a little. Really pretty! The weather back though, was a disaster. It rained so heavily - I was freezing and getting rained on and it was pretty miserable, but all part of the experience!
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On another Saturday, we visited the Nan Madol ruins, also arranged via Pohnpei Surf Club. We went with 2 other people, so a very reasonable group size of 4 people + the guide-cum-driver. It's about a 1.5h drive from Kolonia to the place where we had to start 'hiking'. We wore slippers anticipating that we would get wet - which we did - but man it was terrible for getting through that perilous path full of rocks and stones. I came back with a foot bruise lol. There's actually a lot of ruins but most are already swamped by mangroves so the few tourists just end up going to that one place. There's honestly nothing much left, and of what's left, even the locals don't really know what was what. They can only postulate that this hole was for burials and that hole was the prison haha. Oh, there's a really really nice place for an ocean view from here.
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The tour also includes a stop at the Kepirohi waterfalls
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We got invited to a picnic at Long Island by the ER nurses. We thought it wasn't going to happen because no one told us any details other than that 1 nurse would be driving us. And then that morning we heard her honking and shouting my name LOL. I was still sleeping! So we rushed out and off we went on a boat to Long Island, which is GORGEOUS. Oh, and it's indeed very long hahah. The snorkelling here was surprisingly good as well. I saw swordfish! Had a great time watching the nurses just let loose and dance to the music haha. I also came back extremely roasted, as noted by many people in the hospital the next day lol. 
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There was also a Friday where Vocal Trash, a band using recycled materials as instruments from USA, came to perform.
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We also rented a car and drove around the island on the last day. There's essentially 1 main road that goes around the island. We stopped by Sokehs Rock, went to find the Japanese anti-aircraft guns (amidst bushes), went past Palikir (which is the capital of FSM but has nothing) and went to Nett Point. Also suffered a punctured tyre along the way lol.
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We also tried most of the restaurants, at least in Kolonia - there aren't that many, and most are attached to hotels. Most places serve breakfast, lunch and dinner.

We ate many many meals at Blacksands because it's the closest to the hospital. The food is good, but man the ventilation is terrible and I smelled like a stove each time I went there.
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Kasehlelie Diner, which is near the hospital and serves a buffet for $10.
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Breakfast at Ocean View Hotel.
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7 star hotel - their idea of spaghetti and mine is abit different lol.
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Arnold's Pizza.
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Cliff Rainbow Hotel.
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Joy Hotel - serves only Japanese food. Though their idea of teriyaki chicken is very different from mine lol.
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South Park breakfast. That view!
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One of the standouts was the PCR hotel's restaurant, which serves a buffet lunch for $9. The view is really nice and the food was great and very worth it for the price! Plus there was dessert!
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Kia's restaurant at Yvonne's Hotel
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Nett Ramen and crepe with ice cream! Dessert is RARE. and that view!
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Fusion restaurant. Oh I really really liked this place. Great views and nice food. But somehow we were the only customers that night, and it was a Saturday!
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Seaside. Finally tried fried ice cream cos all the places that previously served it no longer do. Though they somehow served it before the main course, and when it came back out again after dinner, the ice cream was all melted.
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Coco Marina. The architecture of the building is really interesting - essentially a thatched house.
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And Deja Brew, the one and only cafe in Pohnpei.
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And just to end off with a couple of pretty pictures from Pohnpei. Such a beautiful country
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