I've been putting off the writing of this post for some time now. We left Tonga on a Sunday and spent three days sailing to New Caledonia, PP09's only liberty port. We were working while we were underway, preparing medications for the Solomon Islands, but I had time to write. I guess that, subconsciously, I associate the writing of this blog entry with the end to what has been a truly remarkable experience. Even now, as I stare out over tarmac, it hasn't fully hit me that my time with PP09 is done.
My last week in Tonga was probably the most memorable. In addition to the adventure that was Tuesday, on Wednesday I was called upon to prepare some IV medications for a trauma patient. I had prepared sterile medications under far worse conditions while in Samoa, so doing sterile work in the Tongan hospital was a walk in the park. The fun began after I delivered the medication. The local nursing staff had not used this particular medication before and was unfamiliar with its administration. After our surgical tech tried several times to convince the nurses of the proper technique, I was called in to defuse the situation. I would like to say that I was my calm, authoritative demeanor, my natural leadership ability, or my irrefutable charm that made them believe me, but I suspect the flashy drug reference I showed them on my touchscreen iPod may have played a role.
On Thursday, things got interesting when we had a patient present with typhoid. Technically she didn't list that as her chief complaint, but the bloody diarrhea in Dr. Ho's office gave it away. True to form, Dr. Ho wanted to give chloramphenicol, a drug rarely used in the US due to its toxic side effects. Thankfully Dr. Newman, our fearless cardiologist, was there to suggest something a little less toxic.
Friday was our last day of clinic in Tonga and my last day of clinic for PP09. We were only open for a few hours in the morning with the rest of the day being allocated to packing up our clinic (the Navy calls this process "retrograde", but I refuse to use retrograde as a verb). When we had seen our last few patients (I'm happy to report that the lady with typhoid was responding well to treatment) and finished packing, the hospital staff held a closing ceremony for us. In Tonga, the traditional way to say goodbye is by sharing kava. Kava is a plant whose roots contain a chemical known for its anesthetic and anxiolytic properties. It is brewed into a tea and served in a coconut shell. You don't savor kava, you chug it…a feat that is difficult to do gracefully.
Sitting on the floor in an elongated circle, they served us one at a time. Using a half of a coconut shell, a large Tongan nurse scooped up the kava from a vat and walked over to me. She towered over me as I sat cross-legged on the ground. Given the inherent elevation differences of our positions, the coconut shell was presented directly to my face. She gazed down upon me impatiently as I hesitated, but for an instant, to inspect this mysterious concoction. It was a watery, light brown mixture with no apparent odor. Without a moment to lose, I grabbed the shell and slurped it down. Now coconut shells are not like bowls; their edges are rough and inconsistent, so a certain amount of spillage is unavoidable. Handing the shell back and trying to slyly wipe my chin at the same time, I began to wonder why they drink this stuff. It does not taste bad, but it's not good either. It is a little earthy, but ultimately it is quite flavorless. Then it hit me…I couldn't feel my lips…or my tongue! I even had a slightly numb spot on my chin where it dripped. It was quite fascinating really…something akin to drinking lidocaine. I'm not sure I'd like to adopt this custom, as I found the lack of sensation more unsettling than relaxing. Nevertheless, I felt honored to be included in the ceremony.
After the kava ceremony we exchanged gifts. We presented each of the hospital staff with certificates of appreciation and they gave us each a trinket or souvenir of some sort. I was given a lali (pronounced La-Lee) a sort of percussion instrument. It is hand carved from piece of wood and really quite beautiful. Apparently these were used in place of church bells. When the gifts were all given the dancing started….and everyone knows I love dancing. Like a fish to the frying pan…or an Irishman to a tanning bed…you just can't keep me away…
The ceremony officially over, everyone was standing around, talking, and taking photos. A bunch of local children where there and soon became the life of the party. At the sight of a camera, they'd cluster together for the shot then swarm you to see how it turned out. The remarkable thing about Tongan children is that they are all tough. At the pharmacy we had several 3 year old children that could swallow pills. Even during dental extractions, very few of the kids would cry…and our dentists were scary ;) After the ceremony, the kids were literally climbing all over us. Dr. Farwell and I decided to have a race, each with a kid sitting on our foot. Farwell is huge…a sort of Arnold SchwarzenDoctor…so he won by a mile, but the kids had fun.
The kava finished, the gifts given, and the goodbyes said it was time to leave. For most of the medical team, Tonga was just a stop on their journey. For me, it was the end. I rode to the pier on the back of an old flatbed truck with the last of our supplies; trying to soak up as much of the experience as possible. My time with PP09 has been amazing from the start and is an experience I won't soon forget. I am saddened that it is over, but moreover I'm grateful for the opportunity and forever humbled by the experience.
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