July 2nd – July 4th Sataua Clinic

We opened the clinic at 0800 and it became immediately apparent that we have some rather large holes in our formulary. We're missing some key antibiotics, we have almost no GI meds, and our selection of antifungals is painfully limited. But on the plus side, we do have enough 100 count bottles of pseudoephedrine to start several meth labs and enough bisacodyl to keep the entire island on the porcelain for several days. Joking aside, I find that I rather enjoy these oddities. It gives me the opportunity to work directly with the physicians and challenges me to find creative alternatives for therapy.

Most of our patients speak very little English, but it's clear they are grateful for our help. The lines, in every part of the clinic, are long, but I have yet to hear one person complain or see anyone get upset. In the pharmacy, we are hand writing all of our prescription labels on small stickers or plastic bags. This takes time, but the people here are nothing but understanding. If it wasn't for the 90% humidity and the lack of internet access I might just open a pharmacy here.

Our medical clinic is busy, but dental and optometry are at capacity. Access to healthcare is limited on Savaii, but it is still possible to get care. The hospital is staffed by nurses and a doctor visits the hospital once a week. The same is not true for dental and eye care. These services are virtually nonexistent on the island and travel to Apia, the capital city, is too expensive for much of the population.

As the days progress, the clinic gets more and more interesting. We had a patient with a severe abscess requiring IV cefazolin. Under normal conditions, this would be prepared in a sterile environment. Under our conditions, it was prepared on an old weathered desk sterilized with Purell. Later we had a patient with elephantiasis resulting from lymphatic filariasis. He had been suffering from the condition for over three years. The origin of the name, elephantiasis, was clear. His legs were massive, at least 8 inches in diameter at the ankle. And his skin had become thick with callus and hyperpigmented. It was an amazing sight; one that evoked both fascination and sympathy.