BY TIM DEPP, MD
No one knows when the first Samoans landed on what is now the Samoan Islands, the destination of our journey. The Samoans have most likely been there for several thousand years, since the Lapita people (ancestors of the Polynesians) migrated there between 1200 and 1000 BC, making Samoan culture, in a word, ancient.
Spaniards, pirates, and missionaries came and went. And "fa'asamoa," the Samoan way, has continued, albeit somewhat changed. Important distinctions are maintained, including the divide between the sovereign nation of Samoa (formerly Western Samoa) and American Samoa (a U.S. protectorate). Its population is now more than 198,000, and the dominant religion of the Samoan Islands is Christianity, with 76 percent identifying as Catholic or Protestant. Despite the island's proximity to New Zealand, which is only a few hours away by plane, the Samoan Islands remain geographically sequestered and receive relatively little traffic from other countries.
It might then come as a surprise that a group of South Carolinians has had ongoing contact with and visits to Samoa for many years. The key player is Vaifanua Pele, a retired resident of Cayce, SC, who was born in Samoa. Pele joined the military after finishing his secondary education and spent the remainder of his career in the army. He became a pastor after retiring and has continued his role as a local leader in leveraging resources for outreach to his fellow Samoans as one of the bloodline leaders of his village in American Samoa. He leads a yearly trip to the Samoan Islands with a team of physicians, pharmacists, and nursing staff from South Carolina.
During our two-week trip, we had six day-long clinics in villages throughout the Samoan Islands. Samoans are naturally a robust people, but the introduction of a western diet high in refined sugar has led to an epidemic of obesity, diabetes, hypertension, and coronary artery disease. A mixture of traditional remedies and poor health literacy often lead to delayed care and poor health outcomes.
Many patients presented to the walk-in clinics with general malaise and blood glucose levels over 500. Many people seem to live in this range (for how long?) and did not feel they needed further care, so we offered them oral antihyperglycemics and strongly encouraged follow-up. Most patients would likely benefit from a combination lipid-glycemic-hypertension pill, which is hopefully on the horizon for the WHO formulary.
Patients were grateful for simple interventions like acetaminophen or refills of their pharmaceutical regimen. Interesting cases included fish handler's disease, Mycobacterium marinum infections, mucocutaneous lesions with chronic nosebleeds, and a high incidence of perforated eardrums from chronic pediatric ear infections.
Logistics for short-term medical clinics are resource-intensive and complex. The trip's visionary is Pele, and Steve is his right-hand man who executes the complex logistical plan. Shortly after arriving home from the trip, preparations for the following year begin almost immediately. Every year several tons of medications and durable medical equipment are shipped in boxes to the islands ahead of the team's arrival. Each day requires an assembly of the supplies, personnel, and advertisement through local communities for exchanges of the medical resources. If any piece falls out of place, through lost supplies or poor advertising or weather, the efforts can be a wash. Our trip was largely successful by historic standards with daily clinic visits in the hundreds.
Short-term trips have a specific set of challenges: Impact barriers such as language, local familiarity, follow-up, and lack of continuity after the trip were significant. Sometimes we succeeded, such as immediate referral of a pediatric incarcerated hernia to a local hospital, but other times we floundered. An 11-year-old girl with severe club feet who was barely able to walk, came to our clinic. She had been seen by well-intentioned medical teams for several years without much benefit. She had been previously evaluated by a Shriners Hospital pediatric orthopedic team and was promised corrective surgery, but that plan had not materialized.
We emailed with Shriners after the trip, and discovered they required legal consent from her parents, who were working in New Zealand and couldn't be reached. Our team offered her pain medication for a week or two, but we had little else to offer. Her crippling deformities seemed to be a visible representation of the chronic medical conditions that our short-term team was unable to treat.
Overall, it was a fun trip. Medically we brought about some good outcomes. The best part was getting to know our Samoan hosts. It is a culture of deep generosity and respect, and I was very grateful to have been able to take part in it.
Dr. Depp is a graduate of the University of Pittsburgh School of Medicine and a member of the Palmetto Health EM Class of 2016.