In the faint beam of someone’s helpful flashlight, I lifted my backpack from the truck bed and carried it the eight flat feet to the mound of luggage, prescription pills, and medical supplies that would sustain the next four nights of our joint Ha’apai Healthy Eating and Oral Health Peace Corps Partnership Program (PCPP) and Tonga Ministry of Health outer island tour. While our team waited for the driver to bring his boat to shore, I made an ass-first controlled fall into a groove in the sand next to a leave-less tree. I formed my hands into a pillow and gazed at the stars and branches above.
I was exhausted both physically and mentally. This was our third consecutive rise before 5am. My Tongan counterpart had bailed, the dental therapist spent most of our trip upset with me, and so far each of the six villages had low turnouts for our health presentations. The trip was not going well.
Half of the USD $3500 donated by generous donors went to hire this boat for a seven day tour to the thirteen inhabited outer islands of Ha’apai excluding Lifuka and Foa. My goal was to have both the dental therapist and the new health promotion officer, who had been jointly running our project’s health presentations on the main Lifuka and Foa islands, conduct similar presentations on each outer island. Rather than spend all that money to send just three of us around Ha’apai, we joined with the Ministry of Health to form a 10-person hospital team: a doctor, a clinical nurse, a dispenser (of prescription drugs), a family planning nurse, a secretary, a health and sanitation inspector, and an assistant/heavy lifter, in addition to our dental therapist and health promotion officer and me. It was great to share costs – I paid for the boat and the Ministry paid each team member a substantial per diem for the tour.
Minus our health presentations, these health tours are nothing new. In the 1990s, they happened four times a year, according to the health inspector, who has been stationed in Ha’apai for more than twenty years. By the end of the decade, budgets cuts dropped the number of outer island tours to only twice a year. The last few years have seen only one such tour each year, and if it wasn’t for our PCPP, there would not have been none in 2011. For the majority of the population of Ha’apai, then, this tour was the only chance this year to see a doctor or a dental therapist, or receive medication or family planning advice. This PCPP, then, allowed invaluable secondary benefits.
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Kauvai
The problems began in our first village, Fakakakai, on Kauvai Island, as the project’s primary and secondary goals were flipped. We arrived at our base at the small village clinic not long after 6am. Over two long hours, a meager fifteen villagers came and went, each meeting only with the health specialist they needed, a format called a talatala. It was no venue to conduct a presentation. The health promotion officer and the dental therapist met with a few people, but it was not the village congregation I had hoped for. Most frustrating was that none of my other team members seemed to care. It didn’t surprise me, as they were only continuing the talatala routine that every outer island trip has followed for at least the last twenty years. I was trying to drastically change the program.
I made my concerns known to the group, and they kindly offered hope that maybe the next town would be better. I wasn’t so sanguine; if this was the program for the remaining 6 days, then my project would be a disaster.
By late morning our team arrived by pickup-up truck in Ha’ano. While the hospital team arranged the Wesleyan hall for another talatala, I ambled to the primary school to see Blair, Ha’apai’s outer island PCV. Dejected and sleep-deprived, I found charged and motivating friend. Instead of “oh, that sounds terrible, I’m sorry, Too bad,” she offered, “Well what can you do about it? Can you talk to the doctor in Pangai? Can you call ahead to the different villages to gather more people?” Still sleep deprived, but less dejected, I returned to the hall to get fix my project.
What I found there surprised me. About fifteen village adults had congregated on the floor and were waiting for the health presentation to begin. With a better venue, the health promotion officer told the attendees to wait to see their health specialists until after they listened to a presentation about healthy eating, exercise, diabetes prevention, family planning, and oral health. I was elated.
The health promotion officer, the clinical nurse, the doctor, and the health inspector all spoke over a fifteen minute-long presentation before continuing with their talatala. The dental therapist, however, refused to speak. Her petulance confounded me, though I was able to convince her to visit the primary school give a short talk there. Following the model of our malimali routine (she and I often visit Lifuka and Foa primary schools to lead tooth brushing sessions), she gave a short tooth brushing lecture and I lead them in song. Blair was key in getting obtaining the student’s students’ attention and pushing the dental therapist into giving a bruising demonstration.
While the dental therapist inspected juvenile mouths, I brought Blair to see our team’s health inspector, whose job was to inspect village stores and water supplies. Something rang false when I overheard earlier the town officer of Pukotala (where all water for the island is pumped out of the ground) insist to him that the water was always running. Blair’s water had been off for weeks and only turned on the night before, we suspect because the town officer knew the health inspector was coming.
In an unusually direct and persistent exchange, Blair pressed the health inspector for information about the rules for sanitation and store maintenance, and what sorts of consequences are brought by violations. She teased out that violators are allowed seven days to comply with regulations, except that since outer island tours happen so infrequently, it may be more than a year before he returns to re-inspect for compliance.
Mo’onga’one
I emerged from below the low ceiling of our boat’s compartment slightly sea sick. The sea had turned angry as we approached the beach of our tour’s second island. Our driver’s helper and the hospital heavy lifting assistant tried stabilizing the back of the boat as we each jumped off into three feet of water. I tripped on the landing and nearly summer-saulted forwards. My front was soaked but I had saved my backpack.
Mo’onga’one is a small, lonely island in the north of Ha’apai. If I recall the town officer’s conversation correctly, they have no electricity and only a few dozen families. They do have a primary school.
Again we used the Wesleyan hall as a base. Too few people came to engage in a concerted health presentation, however, so the health promotion officer engaged a small group of only five women. The dental therapist visited the primary school without me, perhaps to avoid having to conduct the talk. I was once again dejected. This wasn’t what I had paid for.
Lifuka
And so, at 10:00 that night, I found myself at the home of the island group’s chief doctor, Tevita, who had been helping me plan this project all along (who was not the same doctor joining the outer island tour). I should have been in my bed, utilizing my last chance to sleep comfortably before we continued the rest of the island tour the next morning, but I had many concerns about the trip, the worst of which being that the health promotion officer had just backed out of the tour and would not be joining us in the morning. At the last minute, her husband, a Wesleyan minister, was called to attend a low-level meeting in the capital. It didn’t matter that our outer island trip had been planned for weeks, religion takes priority.
Tevita invited me and his friend Jack Daniels to his living room table. For an hour, the three of us discussed my multitude of concerns until they were mostly alleviated and I was too tired to continue.
Lofanga
Tevita said something to the outer island team that next morning before we all met at the wharf at 5am, because the team was much more supportive at the next island. The health inspector became a charged organizer and emcee. The family planning nurse took over the absent health promotion officer’s job, which was appropriate because she had been to many of our presentations on Foa island and knew the program. There were still, however, only about 15 village attendees.
The dental therapist also spoke, our relationship having improved over a healthy exchange of feelings after I had learned from Tevita the reason for her previous negativity. She was displeased with her picture being printed in the dental health pamphlets my PCPP had paid for and that we were distributing on the tour. She had helped me design the pamphlet, had seen it many times before approving the final draft, and had never mentioned anything about not wanting her picture in it. But Tongans, Tevita said, are shy and don’t like sticking out. It’s not humble to advertize your face like that.
After the health talk, the dental therapist and I moved on to the primary schools, where about twenty students listened to me read our PCPP sponsored children’s book, Fakaveve a Miutani (the translation doesn’t quite work, but means “the poop of Miutani,” Miutani being plaque and his poop being the acid he leaves on teeth). Following the story, the dental therapist checked their comprehension with questions, gave a short lecture, and then inspected their teeth. Lofanga kids have good teeth.
While the hospital team engaged their individual patients, I meandered through town snapping photos and interviewing the town officer. They have three churches, no electricity, and 236 people.
‘Uiha
Everyone except for the dental therapist and I leapt off the boat at Felemea village on the southern end of ‘Uiha island; the boat dropped the two of us off at the primary school located on the beach halfway between Felemea and ‘Uiha village to the north. We did our dental presentation, I read the book to the kids, and we waited to catch the rest of the team on their walk from Felemea to ‘Uiha. They told me they gave the health presentation to 25 people in Felemea.
‘Uiha village was a complete bust. The town gave us a house that was inappropriately small for conducting a health presentation, and then barely ten people arrived over the course of three hours to see us. The only solace came from the doctor, “I’m sorry Sione, tomorrow we’ll try very hard to gather villagers for your health talk.”
The next morning, the clinical nurse awoke me from a poor-quality slumber sometime around 4am with the question, “Sione, what are you doing our here?” I sat up in my thin fleece sleeping bag and took a few seconds to remember why I was on the concrete floor of a veranda and not inside the house next door where everyone else slept.
“I don’t know who invited the horse to sleep with us last night, but it was very loud,” I said.
The snoring was worse than any I had ever experienced before, so I moved outside in the middle of the night. It was perhaps the best Tongan joke I’ve ever told, inducing side-splitting laughter in most of the group. I heard about it for days and someone repeated it every night before we slept.
We packed our bags, waited half an hour for a truck to transport us to the beach. There we unloaded and waited for the boat to come in from its nearby anchorage. I soon found myself on my back in the comfortable sand groove under the leave-less tree looking up at the early morning sky.
As the branches parted to show the entirety of Orion, a shooting star sped past his right shoulder, and I smiled – not because of the serene sky, nor for the shooting star, but because I suddenly remembered the comforting words of our doctor the evening before. Something in what he said made me think day three would go very well.
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