Pacific Partnership 2009 Concludes Its Journey

Mr. Tom Weinz

Special to the Pacific Partnership blog from DipNotes, the official State Department blog

 By Tom Weinz  Foreign Service Liaison Officer (FSLO)

Pacific Partnership has officially come to an end. The final projects were carried out in the Republic of the Marshall Islands (RMI), a group of 29 coral atolls and five single islands with a land area of just 70 square miles spread across 750,000 square miles of ocean. The Marshall Islands have been closely associated with the United States since World War II. A complex Compact of Free Association between RMI and the United States went into effect in 1986, and a renegotiated compact went into force on May 1, 2004. The U.S. Army operates a large missile test range on RMI’s Kwajalein Atoll. Pacific Partnership 2007 also visited the Marshall Islands, so this was the second mission to RMI. There may be many more. By any measurement, PP09 was a praiseworthy achievement. The Navy will publish final figures in the near future, which will clarify in statistics the thousands of hours of medical, dental, veterinarian, engineering and community relations activities that were accomplished since the Richard E. Byrd arrived in Samoa arrived in Samoa at the end of June. For me, the greatest legacy is and will remain the countless interactions among the multi-national providers and recipients of this mission. Friendships were forged that will continue over the years, and that will enhance follow-on missions by Pacific Partnership. Welcome Pacific Partnership 2010. Sustainability has been of primary concern over Pacific Partnership’s relatively short life. Multi-year commitments to a fixed schedule are not currently possible, but a tentative outline of future missions would provide both continuity and encouragement to prospective recipient peoples and governments. In addition to RMI, four countries have benefitted from at least two separate Pacific Partnership missions over the past four years (The Philippines, Viet Nam, Papua New Guinea and Solomon Islands). On September 23 and 24, I have been attending the Initial Planning Conference (IPC) for Pacific Partnership 2010. The list of participants includes an encouraging majority of familiar names from the Navy, NGOs, participating foreign governments and specialized contractors. These individuals, combined with extensive “lessons learned” inputs from PP09 staff still on the USNS Byrd, will contribute measurably to the continuity so crucial to this long-term program. Expect to see a return of Pacific Partnership sites, pictures and blogs about May of 2010, when I expect the USNS Mercy to return to the South Pacific.

Originally posted DipNotes Sept. 24, 2009 at http://blogs.state.gov/index.php/entires/pacific_partnership_end/

The Marshallese and medical care

CAPT Tamara Grigsby

Posted by Navy Capt. Tamara M. Grigsby, Mission Pediatrician

The Marshallese people have tremendous access to medical care, even those living on remote atolls. Corrected cleft lips and palates, surgical scars of the sternum, neck and abdomen are evidence of the PIHCP connecting patients to surgical teams in Hawaii.

Under the Compact of Free Association, the U.S. has the option to establish and use military areas and facilities in RMI, including Kwajalein Atoll, home to the Ronald Reagan Ballistic Missile Defense System Test Site.

Bikini, Enewetak, Rongelap and Utirik Atolls were sites of U.S. nuclear bomb testing during the 1940s and 1950s. Despite the excellent relations between the U.S. and RMI, I was apprehensive that everyday Marshallese men and women would disregard the mission – I could not have been more wrong. They came to see the show and get check ups and tell their stories. Everywhere – Ebeye, Enniburr, Majetto and Ebadon – children were well nourished, full of life and curiosity. Dental caries, insect bites and veils of flies were just a part of growing up in RMI.

Ms. Irene Paul, the Assistant Secretary of Health, who raised six children on Ebeye, all of whom have graduated college, proudly told me “I am so glad I was born Marshallese. Marshallese women are revered and respected; men listen and value the opinion of women.”

CNN covers the debates about Obamacare. PP-09 has revealed to me that the strongest, healthiest people and communities are those who can access healthcare and engage physicians who pay attention to them. In the U.S., universal care is long overdue. But universal care should not be uniform care, and we must safeguard against policies that will undermine and perhaps even bring the intimate doctor-patient relationship to extinction.

Kiribati — Land of contradictions

CAPT Tamara Grigsby

Posted by Navy Capt. Tamara M. Grigsby, Mission Pediatrician

Kiribati weighs heavily on my mind.  It is a land of contradictions.

Infants with infected sores and abscesses, held by mothers who pick their noses as we talk. Public nose picking and nit picking are socially acceptable behavior in Kiribati.

Active toddlers, coughing and sniffling. There noses run and no one bothers to wipe them. They congregate around me as the translator and I explain the concept of “Cover Your Cough.”  Kiribati households consist of 10-15 family members. Most men and an increasing number of women smoke in the home.

Nearly every child I see has an incidental finding of severe dental caries. I talk to the mothers about the increased amount of sugar in the Kiribati diet (candies and ice blocks). Their responses are remarkably consistent – brushing children’s teeth is not traditional in Kiribati.

A well dressed pre-teen presents with recurrent vomiting. Her overweight mother reports that her daughter vomits after almost every meal. The young girl tells me she makes herself vomit because she thinks she has eaten too much.

A fourteen year old overweight male reports daytime fatigue. He and his friends stay awake until midnight, at the village home “fortunate” enough to be furnished with electricity and the latest technology. They snack on coca cola and chips while playing video games.

Why is it that I-Kiribati eagerly adopt Western behaviors that threaten their health, and yet resist measures to prevent disease and illness, arguing that these efforts are not in keeping with their cultural traditions?

There are no Kiribati physicians, only regional nurses. Medical care is provided by transient Cuban doctors, who sign three year contracts to stay on the island. Families tell me they do not seek medical care because they do not trust the physicians.

I-Kiribati people need I-Kiribati doctors.

Pacific Partnership builds bridges in Kiribati

Mr. Tom Weinz

Special to the Pacific Partnership blog from DipNotes, the official State Department blog

 By Tom Weinz  Foreign Service Liaison Officer (FSLO)
From May 4 to 8 of this year the United States and the Republic of the Philippines co-sponsored an ASEAN Regional Forum (ARF) disaster response exercise. Twenty-six ARF countries joined in a civilian-led, military supported activity involving the demonstration and execution of medical, engineering, land, air, and maritime capabilities of ARF’s participants. This exercise, as the Pacific Partnership missions, eventuated from the terrible tragedy of the December 2004 tsunami, which horrified the world. And it demonstrates the strong collective commitment to prepare for such an event in the future. One of the recommendations that emerged following the exercise was that any future ARF exercise “…include MEDCAP, ENCAP or VETCAP projects to bring tangible benefits to the hosting nation’s population.” That, in essence, is the definition of Pacific Partnership.

On September 2, the Pacific Partnership team cut a ribbon to open their most ambitious ENCAP construction project of this mission. For some years a major bridge connecting North Tarawa from the rest of the atoll has been dangerously semi-collapsed, preventing the 5,000 i-Kiribati (pronounced “ee-keer-ah-bhas”) living in the north from full access to most services in South Tarawa, including medical, supply and access to the international airport. During consultations over the past year, I have heard the naval engineers discussing every aspect of this impressive effort: now it is reality. Since arrival of the USNS Byrd on August 23, engineers have dismantled and removed the existing 186-foot/56.7-meter bridge. The new bridge was manufactured in England and shipped to Kiribati (pronounced “keer-ah-bhas”) in eight 20-foot sea containers, along with two 7-ton trucks and two heavy lift telehandler forklifts to move the sections out of and into position across the water. This effort brilliantly meshes a real-world need with an “exercise” in transporting and building in an area that completely lacks local infrastructure — which would be the case in most future disaster scenarios.

When USNS Byrd sailed towards the Republic of the Marshall Islands on September 5, it left thousands of inhabitants of Kiribati with a little better life. The physical bridge has a figurative counterpart, signifying a more compassionate, more involved international community that, in spite of daunting domestic economic challenges, continues to reach out to peoples and countries of the world who need and appreciate benevolent neighbors. Our future needs both types of bridges.

Originally posted DipNotes September 10, 2009 at http://blogs.state.gov/index.php/entries/pacific_partnership_bridges_kiribati/

Water for the world

Mr. Ryan Cronk

By Ryan Cronk, NGO volunteer with Univ. of California San Diego Pre-Dental Society

The lack of adequate access to clean, potable water is a critical issue in many developing nations. The World Health Organization estimates that nearly 1.1 billion people around the world do not have access to an improved water supply, which includes sources such as public standpipes, protected dug wells, and rainwater collection systems. Clean water is essential for disease prevention and overall public and community health.

Pacific Partnership 2009 has taken a comprehensive, collaborative, and multi-pronged approach to help alleviate water-related issues in the South Pacific nations of Samoa, Tonga, Solomon Islands, Kiribati, and Marshall Islands through the various expert disciplines collaborating on the mission including the U.S. Public Health Services (USPHS), Chaplain Delaney’s COMREL outreach projects, and the Seabees.

Of the islands visited thus far, Kiribati has by far the most serious water-related issues. The US Public Health Service partnered with the Kiribati Ministry of Health to test key water sources on Tarawa Atoll, providing critical environmental data to local officials. At the Tungaru Central Hospital in South Tarawa, environmental engineers assessed the facility’s water systems and made recommendations to improve and sustain adequate water quality. Through a series of roundtable SMEE (subject matter expert exchange) gatherings, USPHS officials offered advice on a series of water-related issues, food health safety, and waste management systems (which complements environmental water health) to improve local capacity while the Kiribati Health officials shared insight into regional and culturally significant information.

Chaps’ connection with HyrdAid provides local NGOs and community organizations with much needed slow-sand filtration to provide clean drinking water. For example, at the Tungaru Central Hospital, strategically placed HydrAid filters will help alleviate frustration for the local staff, who must daily complete the labor-intensive process of boiling water for patient consumption, food preparation, and all medical procedures.

From an engineering perspective, the Seabee crew constructed water catchment systems and storage tanks at nearly all outreach locations during PP09. With four islands visited, up through Kiribati, 19 newly completed projects are increasing rainwater-harvesting capacity by nearly 95,000 liters for schools, clinics, and communities.

 In particular, on Kiribati, three additional systems were added at the Tabontemaneaba School to supplement existing rainwater harvesters. Upon investigation into the community adjacent the school, many homes lacked a central water supply. There were even bottles attached to the end of palm fronds, a strategy employed by locals to catch extra water, which illustrates some of the more desperate needs in the remote communities.

Through Pacific Partnership’s humanitarian efforts and focus on one of the most important issues facing the Pacific, island nations will have improved access and larger quantities of clean, safe water.

Pacific Partnership in Kiribati

Mr. Tom Weinz

Special to the Pacific Partnership blog from DipNotes, the official State Department blog

 

 By Tom Weinz  Foreign Service Liaison Officer (FSLO)

Pacific Partnership (PP09) is in Kiribati (pronounced “keer-ah-bhas”), whose principal atoll, Tarawa, is another infamous name from World War II. The Battle of Tarawa in late 1943 was among the bloodiest fighting of the Pacific campaign and a turning point for the war in the Central Pacific.

When I visited Tarawa as part of the site-survey team in March of this year, it was apparent that this location would challenge our mission more than any of the others. Tarawa is comprised of a ribbon of islets joined by simple stone and concrete causeways; the small islet of Betio at the extreme southwest of Tarawa is the focus of much of PP09 local medical outreach. Betio is the densest urban settlement in the Pacific Islands, with 26,000 people living in very basic conditions.

Many I-Kiribati (pronounced “ee-keer-ah-bhas”), as people of the country are known, have already been resettled to other areas and countries. The waters of the Pacific are rising, and gradually turning drinking water brackish and farmland saline. President Anote Tong has been brutally honest about the future of Kiribati. He reflected in 2008, “To plan for the day when you no longer have a country is indeed painful, but I think we have to do that.”

While on USNS Byrd, I was very impressed with the numbers of volunteers taking part in daily community relations projects (COMRELS). I am now looking at the final report for COMRELS in the Solomon Islands, where the USS Mustin was also in port for Guadalcanal Day. COMRELS are staffed entirely by volunteers who have other full-time jobs. In the Solomon Islands, civilian mariners, sailors from the Mustin, Australian Army, Navy and Air Force personnel, Navy SeaBees, PacFleet Band members, NGO volunteers and local citizens banded together to complete 27 different projects over 13 days.

During my experience with very different Pacific Partnership missions over the past three years, one constant has been the ever expanding role of COMRELS, directed by the different Pacific Partnership Chaplains, and developing into a “Come One, Come All” multinational team responsible for significant accomplishments, such as laying pipe for a school water system and other water-improvement or catchment projects. U.S. Peace Corps volunteers have joined these teams in the past; the Peace Corps withdrew from Kiribati in 2008, after forty-one years in the country. The COMRELS planned for Kiribati are as ambitious as those completed in Solomon Islands, thanks to the many volunteers who are serving in them.

Originally posted DipNotes August 31, 2009 at http://blogs.state.gov/index.php/entires/pacific_partnership_in_kiribati/

Culture shock — we’re feeling it now

LCDR Nancy Harrity

By Lt. Cmdr. Nancy Harrity, Pacific Partnership 2009 Public Affairs Officer

Some believe we feel culture shock the strongest after we return for a trip abroad, after we’ve had the adventure of being exposed to something new and different.  Others believe going into a new culture produces the strongest culture shock, because of the sharp contrast to our home culture.   Doesn’t really matter which side you’re on, at some point you’re going to feel it.

To help us prepare for this we are required to sit through a presentation explaining some of the traits of the culture for the country we’re visiting before arrival.

On Pacific Partnership, we’ve been exposed to five different countries now, each with its own unique cultural variation of island life.  It’s been a bit like putting a live frog in a pot and slowly turning up the heat.  We didn’t seem to feel the change in our first country, Samoa.  The adventure was new.  Tonga, our second, it was a slightly more intense variation of the island culture.  New Caledonia is a French colony and was a liberty port for us.  It was more like visiting Europe in many ways.  Solomon Islands was more challenging as the culture there is very different than Western cultures.   Now that we’re in our next to last port, Kiribati, we are feeling the shock. 

We thought we understood “island time.”  Island time is best described as everything starting later than you expected.  We’ve found a new level of this here in Kiribati.  Why is that?  Is it because no one seems to own or use a watch?  Maybe they don’t care?  Are they too focused on the current moment to worry much about the next?

As I’ve thought about this, I’ve remembered a course I took at the State Department’s Foreign Service Institute where I learned that there are a number of dimensions that we can evaluate a culture from.  One is a sense of time.  Some cultures are focused on the past and their people can recite their family tree going back for centuries, as is done in many Middle Eastern cultures.  Some are focused on the future, going to great lengths to plan for tomorrow.  China comes to mind, in particular with the national savings rate and the government’s elaborate five year plans. Some are focused on the current moment, as a Zen-sort of thing or simply because they are just trying to subsist, as appears to be the case in Kiribati.  We’ve found the people here to be easy-going, but are often finding ourselves frustrated because nothing starts on time.

Part of the endemic tardiness stems from another dimension culture can be measured on — the attitude towards family.  In the Pacific, family and relationships are very important – more important than work, more important that food sometimes.  So what we’ve learned here is that as often as not, when someone is late for something, he more than likely was wrapped up in a conversation with a family member or close friend.

Those videos teach us one culture is not any better than any other, they are just different.  Maybe a little bit of our consciousness about time will rub off on the I-Kiribati.  And maybe some of their emphasis on family and relationships will rub off on us.

Pharmacy in the Solomon Islands

By Ms. Alla Marks, Pharmacist with Project HOPE

Steve and I have adapted to the requirements of setting up, working and retrograding a site very quickly.

We have also made an effort to use our skills to enhance patient care. Steve has taken the initiative to discuss patient medications with providers for clarification or substitutions. I have used my certification in administering IM injections to deliver antibiotic injections to patients to enable the nurses to assist providers in seeing more patients.

We had the opportunity to work with Auki pharmacy officers and I donated a Washington Manual to them for reference. I also donated a Lexicomp Drug Handbook to the Navy pharmacy technician who is working with us. The iPod touch Lexicomp program that I am using is an invaluable tool for checking on doses and appropriate therapies.

The phenomenal experience about this mission is the diverse set of personnel-Australian Navy and Air Force, British medical students, Canadian army. On one of the days in Good Samaritan (hospital), we actually did 500 prescriptions!

Thanks for Reading –Alla Marks

This post originally appeared on the Project HOPE int eh Field blog Aug. 20, 2009 at http://projecthopeinthefield.blogspot.com/

Humanity and empathy flourish in Solomons

CAPT Tamara Grigsby

Posted by Navy Capt. Tamara M. Grigsby, Mission Pediatrician

The Solomon Islands are full of history and beauty, but it was the first of the South Pacific islands visited by PP-09, where I encountered malnourished children, malaria and active tuberculosis. A majority of children present with the same maladies seen in Tonga and Samoa, but overall, the pediatric population suffers a higher level of morbidity. Fresh water crocodiles are blamed for many missing persons.

Any febrile individual is presumed to have malaria, until a blood smear is negative. Infants admitted to the Children’s Ward with fever and suspected sepsis, empirically receive chloramphenicol. If the fever does not subside in one week, treatment for tuberculosis is initiated, gastric washings obtained, and malaria tests repeated. Tuberculosis as an etiology for failure to thrive, meningitis and osteomyelitis, is common, with diagnosis confirmed by defervescence after initiation of TB medications.

Scarcity of adequate and affordable nutrition sources causes significant protein and calorie deprivation. Toddlers are weaned from the breast at about 15-18 months of age, with mothers often being pregnant again by that time. Children transition to coconut water (the average green coconut yielding 250mls, with most children averaging 1 or less a day); papaya juice and water (rainwater or river water, not necessarily boiled before drinking.) Locally grown yams and rice are staples. Older children and adults eat biscuits (crackers) and sweetened tea for breakfast. Although fish is abundant, cost is prohibitive, as is true of local chicken and beef. Pigs are raised in piggeries across the island, but pork is expensive and forbidden by Seventh Day Adventists who account for nearly half of the Christian population. There is little candy, which is fortuitous, as most children do not learn to brush their teeth until attending school. As teenagers, they begin chewing the customary beetlenut.  

In spite of, and perhaps because of their hardship, people here treated one another with respect and kindness. On Malaita one morning, when my nurse was delayed by breastfeeding her 3 month old baby, an English speaking father offered to assist me. He politely beckoned patients in line, calling to them reassuringly, “Brother” (or “Sister”), come, and I will help you tell the “pikinini” (pidgin for child) doctor your troubles.”

Humanity and empathy flourish alongside of hunger and disease in the provinces of the Solomons.

Sustainability Key to Success in Solomon Islands

Mr. Tom Weinz

Special to the Pacific Partnership blog from DipNotes, the official State Department blog

 

 By Tom Weinz  Foreign Service Liaison Officer (FSLO)

Early in this series, I reflected on how our best-laid plans often take a detour. My personal detour came in French New Caledonia, when some medical tests prevented my sailing with the USNS Byrd, and I subsequently returned to the Washington, DC area. Although I know both Solomon Islands, and PP09’s specific mission, very well, I am sorry to miss what continues to be an effective and mutually beneficial undertaking.

Guadalcanal Day memorial services were held early on August 7 at the well-kept American Memorial on Skyline Ridge, overlooking Iron Bottom Sound. Americans and Solomon Islanders alike gathered to reflect on the profound events that took place there in 1942-1943.

A few days later, as I was monitoring PP09 activity in Solomon Islands from my home, I read an article in the Solomon Islands “Island Sun” newspaper lauding the Pacific Partnership effort, but pleading for sustainability, an equally important concept to Pacific Partnership planners and participants. These events and emotions resonate with me, what that means, and how it impacts people in their daily lives. Solomon Islands is at a critical juncture. In 2003, the Solomon Islands Parliament requested assistance to stabilize their country, socially and economically. The response came in the guise of the Regional Assistance Mission to Solomon Islands (RAMSI), military, police and civilian personnel from fifteen Pacific countries working to help Solomon Islanders achieve peace and stability. Sustainability is key to their plans also.

Pacific Partnership responded to requests to provide assistance to both Guadalcanal and Malaita, the two key islands responsible for a better future. As I write this, the Byrd is leaving the Solomon Islands, after treating thousands of people and renovating additional schools and hospitals, and constructing teaching facilities for the local Red Cross. Though their stay was not long, PP09 personnel have done much to contribute to sustainability in health care and education for all the people of Solomon Islands.

Originally posted DipNotes August 21, 2009 at http://blogs.state.gov/index.php/entries/pacific_partnership_sustainability/