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which apparently are the mainstay of transportation in this area. There are 2-person teams to drive each boat. One sits in back steering and managing the twin Yamaha outboard motors. The other stands in the bow area holding a rope. I could never get an answer as to why they had a guy standing up front, but it did make for quite an interesting scene. For some reason it totally reminded me of all those old paintings of George Washington crossing the Delaware. And so we set out in a way that only America could. 
We pass several islands on the way out. You can see small seaside huts or shacks dotting the otherwise undisturbed tropical landscape of beach and palm trees and steep volcanic hills. We pass some seaside caves where the Japanese hid during WWII. There are at least a few totally uninhabited islands, that would taken about 10 minutes to walk around on foot.
We pull up to a small concrete dock with a rotted out building frame that looks kind of like a greenhouse without the plastic. The water is ankle-deep and there is coral, rock, and seaweed everywhere. We unload the boats, passing the gear along a chain of people, and we are here. America is here. On shore there are perhaps a dozen 10x10 shacks made of tin nailed to a wood frame. There is a small graveyard with just 5 prominent mausoleums. Except for clothes hanging out to dry on one of the shacks this area doesn’t seem to be inhabited. 50 yards inland and we are in a grassy clearing half the size of a football field with an L-shape of simple concrete buildings forming 2 of the sides. This is a school and a schoolyard. There are about 6 or so classrooms, of about the same size one would expect in the US. There are large windows with wire mesh instead of glass, a decent amount of desks, and some rather filthy chalkboards. The only books to be found are a shabby looking pile in one of the rooms. We setup our various medical services in each of the rooms and it’s game time.
The weather today is hot. I tend to sweat a lot and it’s just outright embarrassing
now. My shirt is soaked and I am just dripping all over everything. My body would adapt to these conditions if I kept living in this climate, but that doesn’t do me any good today. I unzip my REI convertible pants revealing my khaki dress socks and black shoes underneath. It’s a look that only really cool, yuppie white guys can pull off, and that’s definitely me. That’s the “doctor” these people get to see when they come to my table. My most interesting patient of the day is my first. His complaint is “neck mass”. One glace at him reveals that it is a thyroid tumor. I plead his case to the commanding officer and several iridium cell phone calls later he is scheduled to go to the boat for an ultrasound and possibly surgery. As a footnote he eventually had the surgery and so was likely “cured” of his ailment.
I’m trying to keep the cynicism out of my posts, but I can’t help myself here. Clearly this guy was “sick”. Anyone off the street could look at him from 20 feet away and know that he needed medical care, and it’s awesome that we could provide that to him. However, I saw lots of other “sick” people that day who would look fine at 20 feet, or even at 2 feet. How about the lady who has been having heavy, painful menstrual periods for the last 2 years? I couldn’t check her for anemia (the weather was so hot our lab kits stopped working) but I bet $1000 it was probably pretty bad. She looked and acted fine, except for a little weakness and being rather fed up with the excessive bleeding. She did not get a trip to the boat. It would have been hard to convince people that she was “sick”.
So I guess my point is that we probably overlook the more subtle things in people when we decide who gets more extensive medical care. I bet we do this in the states as well but probably to a lesser degree because healthcare providers are educated about those subtle signs of disease and they are supposed to have an idea of what is sick and not sick.
The other interesting thing on this island is that the people don’t get along so well. I saw several patients with scars from stab wounds. I guess there are eight or so “clans” who don’t like each other and they are constantly getting in little scuffles. That’s really not so different than my family at a holiday get together, except none of us has stab wounds to show for it… well at least not yet anyways.
During lunch I realize there is really no signs of dwellings here. I know there are no roads. There is no electricity save for the occasional private generator. Apparently the island’s 2000 residents live scattered all over, mostly concentrated on the coastline because they “like to fish” as one local told me. Realizing the implications of this I am struck with another thought. Most of the patients I have seen are well-dressed and groomed. They literally walked through the jungle to get here but they managed to look very presentable after doing so.
The only other interesting medical stuff is how common infectious diseases are here. Lots of families complain of “worms in stool”. This is
probably pinworms. These are 1 cm in length. They live in the intestine, not doing much else except eating some of the nutrients that would otherwise go to their host. It is estimated that over 1 billion people worldwide have pinworms. They are also common in the US. I give out the treatment, which is mebendazole. It will kill 95% of the worms in the body with a single dose. The problem is the eggs which may have been deposited in the skin around the anus can survive for 2 weeks so you are supposed to get a second dose in two weeks. --pete
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