Taking a step back a few months to catch up on our missionary activities. (I am attempting to catch up for all these months.)
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| Fatumafuti--a great place to snorkel |
September marked the memorable month in which Jim performed his first spine surgery. It was a cervical laminectomy. Here is how Jim explained it in his own words:
Last Monday a woman came into my clinic with weakness in all her limbs. The shoulders and elbows were particularly weak, especially the left arm, and she could hardly walk. Her CT Scan showed severe Cervical Stenosis. She needed cervical decompression and fusion, but this would be challenging and with risk. She was born in International Samoa, and therefore could not get referred off island for treatment. We admitted her to the hospital and operated the next day. It was more challenging than I had anticipated. She has a high BMI and she carried a lot of adipose tissue in her posterior neck. The exposure was therefore very hard. During the surgery anesthesia reported that she was retaining CO2, was hard to ventilate, and required high ventilation pressures. They tried suction, head repositioning, and checked the tube many times. The CO2 would decrease for a short time, and then climb again.
Because of this I decided that I would just do a laminectomy and not take the additional 90 minutes to instrument and fuse the spine. The laminectomy was done from C3-C5 and the upper part of C6. When all this was finished and the patient was turned onto her back on the ICU bed, anesthesia found a mucous plug in the ET tube, which unfortunately did not come out with their intra-operative suctioning; this explained the anesthesia concerns. Had it been sucked out during the operation, we could have completed the stabilizing fusion in addition to the decompression of the spinal cord. I hope that her neck will remain stable without the fusion, that she will improve her neurologic function, and not get infected.
(Follow-up: As it turned out,the patient did have wound healing problems, and had to return to surgery for secondary wound closure. She was in the hospital about 1 month to receive physical therapy and waiting for her wound to be healed and clear of infection. Her strength has improved, but not completely back to normal)
Spine surgery has proven to be very stressful to do on this island, due to the inadequate facilities, lack of training of the OR personnel, the health of the patients, and the complications that often occur. Another factor that Jim has to deal with is the patients that are unable to leave the island for treatment. If one is native to American Samoa, medical treatment is available in Hawaii or the States. Jim is able to refer patients to leave the island for medical procedures. For those not native to AS it is more difficult as they often have no recourse for better treatment. It becomes a medical dilemma—knowing that one has the skills to treat the condition but also knowing that it can’t be done safely at the LBJ hospital. Most of Jim’s surgeries have been on patients that are unable to get medical treatment elsewhere as was the case with this woman.
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| Brilliant blue starfish |
Other September activities were also “Firsts” for us in American Samoa.
--A diabetes prevention education program “Your Health is in Your Hands” had a Kickoff event. A government agency called the Department of Youth and Women’s Affairs sponsored this 9 week class. The director, Dr. Salote Fanene, is a dynamic, insightful woman who is making things happen in American Samoa. She is particularly concerned about health issues. The Kickoff event included in attendance the wives of the Governor and Lt Governor of the island as well as the heads of numerous government agencies. We then proceeded to begin our class sessions for the next 2 months. Two small classes were taught as a pilot and training program. This took a lot of time, planning, and patience to make this happen. We also continued to teach the Eat Healthy Be Active program that began in August.
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Outstanding community leaders in American Samoa
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| Helen with one of the students in the class. |
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Salote, the director of the Department of Youth and Women Agency, hosted the first "Your Health is in Your Hands" program on the island
--We had an invitation for brunch or toani with a very influential family on the island. He owns a construction company, is a Baptist pastor, and runs a private school. He is doing many good things in the community. The food we ate was exceptional. We took home enough food to feed us for the week. |
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| Fresh fish caught the evening before the dinner--delicious! |
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| Corned beef, bread fruit, taro, and palusami (the green balls which are coconut cream and onions wrapped in taro leaves; then baked in an umu or an oven) |
--Prior to a weekend of special church meetings (Stake Conference as referred to in the church), there was a Sports Night. It was fun to watch Samoans of all ages participate in fun activities together. Another evening was called “Dancing with the Stars.” Numerous couples of all ages performed dance routines. In between the dance routines, the leaders of the congregations were asked to do the traditional Siva Dance. At one point Jim and I and the other missionary couples were motioned to get out on the floor to do the Siva Dance. We did our best under the circumstances.
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| Look for Jim in the bright yellow shirt--step class in the church parking lot in the afternoon--HOT and HUMID!!! |
--A fireworks show at the Pago Pago harbor was a fun event. Apparently, it doesn’t happen very often. We took advantage of it. We walked from our apartment to the harbor and saw a spectacular show. As we walked home, the traffic was quite slow. Numerous times we were honked at, people waving to us—Jim’s patients, people I knew as well, but more often than not, because they knew we were missionaries serving at the hospital.
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| Fireworks in Pago Pago Harbor |
--We were invited to participate in an UMU. This is the traditional way of cooking food either in the ground or on top. This umu was on top of the ground; a square frame formed the fire pit with rocks, leaves, wood used to build the fire so as to get hot coals to cook the food. Coconuts were husked, cracked, opened. The fresh coconut was scraped from the inside. The fresh coconut was then placed in a cheesecloth and squeezed to get fresh coconut milk. Taro leaves put together to form a bowl are filled with fresh coconut milk and onions to make palusami, which is delicious after baked in the umu. Taro, breadfruit, chicken, coconut bread were all placed in the umu to bake for an hour or so. Then we feasted on that food. Taro freshly cooked in an umu has the texture of baked potatoes. We ended the evening with some young women performing a fire dance.
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| Samoan Umu preparation |
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| Food is ready to eat |
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| Grating the fresh coconut to make coconut milk |
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| Squeezing the coconut to get the milk |
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| Pineapple |
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| Face of the coconut |
The bishop of our ward did the umu for a couple who were visiting the island. They had visited all of the National Parks in the US. This was their last one to complete their goal. The husband, a retired doctor, had been diagnosed with brain cancer and had only a few months to live. They had this short window of time to complete this last goal. The bishop truly went out of his way to make this a memorable visit to American Samoa.
--The last of the “Firsts” for the month was to attend the funeral of a baby who had died during a c-section because they couldn’t get the baby out quick enough when complications occurred. The father was an exceptional young man that was one of the first people we met at the hospital. This was his first born son. It was a tragedy due to the lack of adequate facilities and medical skills at the hospital. The service was the most unique I have ever attended. It was indeed a family affair. Thoughts were shared by several of the close relatives as well as the mother and grandparents. The most tender moment was when the young father took the baby out of the casket and sang a sweet song while holding the baby. This is unusual to our western ways, but it seemed to be a very comfortable thing to do. After the service, numerous people held the baby in their arms before he was placed back in the casket for the burial. In American Samoa there are a few cemeteries. I have seen only one. The dead are buried in their front yards so that they can always be remembered and honored by their loved ones.
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| Funeral service for Baby Malone |
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| Intricately woven Samoan mat |
From the stresses of spine surgery to the sadness of a baby passing, life is full of ups and downs; the good and the bad; the happy and sad. We are on this earth as mortals to experience the highs and lows of life. These moments refine our souls; help us develop Christ-like qualities; help us become better, more compassionate and caring people.
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Dr./Elder Gebhard at LBJ Gala for their employees
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| Beautiful and wonderful friend, Leua |
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| Birthday celebration of one of the orthopaedic surgeons |
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One of our YSA friends, Ana, from Grand Junction, CO
Love the dog lying in the hospital waiting area |
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| Sports night with the Pago West Stake |
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| Mat ceremony to welcome a new pastor to the village of Fagasa |
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| Dancers at the mat ceremony |
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| New pastor and his wife |
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| Gifts for the new pastor include money, a case of vienna sausages, case of crackers, a case of tuna or corned beef |
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| Beautiful church in Fagasa |
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| A view of LBJ Tropical Medical Center |
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| Missionaries! |
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LDS youth performance
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| Beautiful view of Fatumafuti! |
