Outreach in Peleliu

This week I had the opportunity to visit one of the outer islands, Peleliu, for work. The purpose of the trip was to assist with health screening and provide nutrition support where required. My ulterior motive was to broaden my nutrition assessment to include some of the less populated places. 

Welcome to Peleliu! Where the fishing is good and the life is simple.

Peleliu is a small island south of Koror. The population is about 700 people, making it the 4^th largest population in Palau. If you are interested in diving or WWII history then it is definitely a place for you to visit. I am not a war buff but my understanding is that Peleliu was a strategic site heavily fought over in WWII. It was a Japanese strong hold that reportedly many people lost their lives over. The Japanese reportedly placed themselves in thousands of well hidden caves, forcing the US soldiers to change their combat strategy so they had to do ground patrols in very dangerous areas. Unlike most places in the world, many of these sites are still accessible to tourist. Asides from war history Peleliu also has free standing monoliths (stone faces) which are apparently very cool to visit.

At the dock in Koror waiting for the boat to leave.

Nice day to be out on the water

Not a bad way to get to work

The Ministry of Health boat left around 8.30 am. It was a crowded ride for a small boat but luckily it was a bright sunny day and not too windy. Every Wednesday on pay week the doctors and hospital staff go to Peleliu to do outreach in the community centre/hospital. On this trip there was a few members from my team, Non-Communicable Disease (NCD) unit, a paediatrician, outreach doctor, Medical technician, nursing staff and the new Doctor and Nurse Fijian couple who have taken up the post to live and work in Peleliu. The Peleliu clinic services not only Peleliu but also the outer islands. Prior to the appointment of the Fijian Doctor and Nurse couple, Peleliu hospital employed a hospital administrator and a maintenance man (who I also think drives the ambulance). Needless to say the arrival of the Doctor and Nurse to the island is an absolute god send.

It took us just under an hour to get to Peleliu via the smaller boat. On the way we got to take in the scenery of crystal clear waters, blue skies and some very beautiful and isolated beaches and Rock Islands. Just as we were leaving Koror a largish sea turtle poked his head out of the water. I think he was wishing us well. I just absolutely love sea turtles. They are by far my favourite marine creature and I knew I was going to have a good day.

Island View Motel- more like sea view. Our digs for the night.

Beached as boat!

Who you gonna call!?! Our wheels in Peleliu!

Peleliu- tide going out

Cats of Peleliu- I wanted to take this one home with me sooo bad!

It was all systems go when we arrived. We dropped our bags at the Island View Motel, hopped a ride in the local ambulance and headed to the hospital.  We were anticipating a maximum of 20 women over 2 days at both day and night clinics.  However, we were smashed the first day, seeing 30 women. We didn’t finish seeing ladies until 11:30 pm and I was absolutely exhausted by the end of the day. 

Needless to say, I got in very little sightseeing and downtime. I managed to check out the local supermarket which was the size of a small bedroom. Food items consisted only of canned and packaged goods and not a fresh food in sight. There were 6 large coolers full of ice, beer and soda though. That's a type of food right?!?!

Cats of Peleliu- Siamese twins

 It was a worthwhile experience. I think I am starting to scratch the surface of the nutrition issues faced in Palau. As far as health issues are concerned, the stats show high rates of overweight and obesity, diabetes and high blood pressure.








Like most Pacific Island and Micronesian communities, diets have shifted away from traditional and local foods to ones that are energy dense, nutrient poor and low in fibre,  high in salt, fat and sugar; a chronic disease cocktail. Having spent a bit of time with people here I think tastes are skewed to a salty/sweet balance and they consume packaged foods at most meals.  For example canned beef, like spam, and ramen cup noodles are commonly consumed for breakfast (and most other meals). On a sweet note, sugar sweetened beverages such as iced tea, vitamin waters, sodas etc. are drunk by most people by the gallon every day.  

The Nutritionist in me really wants to get into it and work towards increasing awareness and changing behaviours but I keep needing to remind myself that my role here is to build the capacity of the people around me to do the work; once that’s done then the fun stuff can begin!

 

Main Road into Peleliu

Peleliu Community Health centre & hospital

  

Our Palauan Home

Nathan & I moved into our apartment on Thursday. We were both keen to move from the hotel to our dwellings so we could have some space, cook our own food & get out of the air conditioned rooms & get used to the environment- seriously my skin & hair had been so dry from moving in & out of so many air conditioned spaces!!

The area we have moved to is called Ngermid. The apartments are called Sechedui (pronounced se-e-dui, the ch is a gap in the word). The locals believe this area to be very far out of town & keep offering to find us closer accommodation.  Quite frankly, I'm happy to be a little out of town, plus I'm only a 15min drive to work. We live a 3 min drive from a beautiful snorkelling sight called Nikko Bay. The water is so warm & calm that we have been snorkelling almost everyday.

Nikko Bay

View from our bedroom balcony

There is also a basketball & volleyball court down there as well. I can see us spending some time down there. The water is so clear & it drops off really fast so I've been reinforcing my confidence in open water swimming. Speaking of which, each year they have an open water swimming competition & I have decided to add this to my goal list. With the confidence I feel now I think I'd be able to easily do the 500 m comp. 

We have had a number of invites to diving & other activities but need to wait for our social security numbers so that we can get the local rate. So that will come eventually. For the meantime snorkelling is pretty good. Yesterday I actually saw a sea turtle & some school of large fish (I need to swot up on their names). That was very cool!

The rental places here come mostly furnished but we have had to provide linen, kitchen stuff, tv & stereo, so we kind of feel like really poor uni students at the moment. Nathan & I have assessed everything we need & are currently living on what we consider the bare minimum. As a nutritionist who works around food security space this has been an interesting exercise. So far we have 4 plastic dinner plates, cutlery set, 1 mug, 2x glasses, 4 bowls, wok, med pot, 2 chopping boards plus a couple of different cooking utensils. So we have to be creative with how we cook.  The can opener broke first use, so it was lucky I packed my pocket knife. 

Food here is hit & miss. With the US & Japanese influence you can get plenty of package & jarred foods- at a cost. Fresh fruit is pretty much non-existent & the tinned stuff is expensive. Veggies are ok & I've been opting for the local varieties as they are more reliable. We did go to the fish market today & bought a whole red snapper for $6.75- caught fresh today! So we will have an entree of sashimi & then fish & veggies for dinner. 

We don't have the Internet, tv or a stereo so I think Nathan is feeling a little sensory deprivation. I've been trying to fill my time with different things & am thinking about teaching myself the guitar (tips anyone??). But I've discovered that I'm a potterer! Who knew?!? I think living here it's essential that one has a hammock as well. It's so warm & chilled out that read & napping the afternoon away whilst laying in a hammock is the only sensible thing to do! 

So in Palau there seems to be loads of chickens, dogs & roosters all living in harmony. The roosters generally start calling from 4am, although last night one started at 12.30! After a very rough first night in our new place I have taken to wearing earplugs. I think I am getting a little used to them now. The locals tie the roosters to trees in their yards & we had one situated under our window on the first night. Apparently it's got something to do with cock fighting. Roosters are territorial & will fight each other. I've seen a few size each other up but nothing more than you would see on a wildlife special on them.