A Night Out in Town – Finally!

28-May-2011, 1715

Memorial Day Weekend is here, at least for you guys over there in mainland US that is!  It’s that time again, the time that will soon herald the coming of hot summer months, with heat and humidity, cooler beach waters of Misquamicut and Rocky Neck, warm, blue and chlorinated swimming pools, swimsuits, barbecues, potato salads, watermelons (yes Preston, red, ripe, and juicy watermelons!!!), ICE CREAM, and…well at least during the last two years in our family, Orlando Florida!  Though, I must say that it is still undecided whether vacation in the Sunshine State will have to be re-scheduled sometime in November when I get back or not.  It is also time to memorialize and commemorate all those who gave for the freedom of the country.  I salute all of the veterans, wherever they may be at this time!  I must say it is rather fitting for this weekend indeed because Pearl Harbor, starring Ben Affleck, Josh Hartnett, and Kate Beckinsale, is going to be on in one of the HBO channels this Sunday. 

Last night, Friday, Tom decided to take me out for dinner at The Pallazzo, a rather modern, upper class, Westernized restaurant inside the La Mana Hotel in Waigani, NCD.  The restaurant also happened to be situated beside The Gold Club – a club and bar that, just like The Palazzo, has been designed to capture the essence of night life in the West, and of course the destined place that expatriates frequent very often.  The refreshing difference though is its open roof design.  One can dance the night away under the glinting shine and sparkle of the moon and the stars.  The common sights inside a bar—billiards, smoking area, ashtrays, and a generous dance floor space—are found inside its perimeter.  There’s even a small section where slot machines are located, imagine that!  It was also nice to see the familiar lights and sounds of a bar and club, with tunes in the likes of Pit Bull, Jennifer Lopez, and Beyonce, bellowing out of the loud speakers.  At least now I realized that there is a little bit of nightlife found in Port Moresby, with local Papuans and expatriates as patrons.  I just don’t think that I will be frequenting this place alone as much as I would like to.  I remember the “Be Safe” mandate from Global Security when I attended the weeklong orientation in New York City.  In addition, I also have some mandates from my brothers to just stay at home during the off-shifts and weekends for safety and security’s sakes.  I guess I will heed the mandates, eh?  So, as Tom and I watched the very physically demanding Australian Rugby (and I mean physical, worse than American football!) in the two large and wide screen TVs, I just thought that by the time I come back home in late October, it will be time again to cheer for Tom Brady and Wes Welker of The New England Patriots at Chili’s in East Haven Frontage Road.  I say, “C’mon October already!!!”

It is really uncommon for me to order Indian food.  I remember one Indian dish that a co-worker ordered and it smelled quite alright, but judging by the looks of it—pieces of meat, chicken, pork, or otherwise, mixed with green and red bell peppers and smothered in a very rich, flowing sauce that was somewhat pink in color—I was immediately turned off.  But, last night was unprecedented since for the very first time, I stepped outside of my comfort and zone of normalcy.  I figured I am in a foreign land so I might as well be bold, daring, different, and exotic.  Well, OK, probably not the very last one as I just got carried away here, you see?  I ordered a curried fish dish called Barramundi Fish Goanese Curry over white Jasmine rice, figuring that it will not turn out to be pink since it is curry.  It really wasn’t that bad, as a matter of fact, it was very good!  It actually reminded me of a Thai dish called Massaman Curry (choice of your own meat of course).  In comparing and contrasting the cuisine style, the Thai dish that I know from the carts outside of Yale New Haven Hospital and Siam Orchid at Branford, are only mildly spicy.  The Indian dish that I had last night however, was all-out spicy and hot!  I mean I really could have become Eragon the fire-spitting and breathing dragon!  Some of these little slivers of red, hot, chili peppers, hot enough to cause vasodilation, induce hyperhidrosis, and what I expected to be a very bad case of acid reflux, were sliced thinly and diagonally, almost Julienne like, sprinkled ever generously over the bowl, in addition to the whole ones, which I remember were two or three medium sized peppers!  But, even though it was really spicy, I was still able to savor the decadent taste of the fish, curry, sauce, and the other spices.  For those of you who know me very well, just imagine table napkins on my head as I wipe my hair and forehead with sweat!  Tom was laughing!  It did helped to have a glass of ice cold SP, the local beer in town.  Overall, the dish was great, Grade A!  And, I think I will order this again!  We’ll see…  In the interim, in the spirit of summer, please enjoy a bottle or two of Bud Light Lime for me!

Getting My Hands Dirty at Work

21-May-2011, 1616

It’s Saturday!  It is a bit warm and humid today, probably mid-70’s to early 80’s right now.  I am thinking if I would have been in US right now, I probably will most likely be working at the CRU until late this afternoon, go home and take a nap, and plan something nice and be out for the evening.  Alas, I am in East Boroko, Port Moresby, PNG, and guess what?  I am at home!  It was nice to just wake up in the weekend morning and not rush to do errands.  But then again, there weren’t many errands to do today anyway.  Listing some of the activities to eat up the hours of today helped—breakfast, shower, read, lunch, laundry, ironing, blog, dinner, blog, and more reading.  Tomorrow is still up for grabs. 

Everyday at work, the hours pass by rather quickly and before I know it, it’s time to go back home again.  Thankfully, work colleagues are there to interact with since boredom and isolation are always creeping up on me like a parasite.  Desperately in need of company and mental stimulation, I am bordering on selfishly needing my co-workers to challenge, talk, ask, make me think, or just say jokes, laugh, and have fun.  I don’t have this at home being isolated and alone.  When Thomas (my housemate) does his errands on the weekend, I am left at home with absolutely no one.  My living situation in New Haven is physically the same, and yet different!  In New Haven, I am at least mobile, able to drive, and go around!  My family in Groton is 45 minutes away.  There is internet, TV, radio, movies, restaurants, bars, and gym (not that I go often, he he he!).  The mere absence of these things, often taken for granted, humanizes me, making me long for and wait until the day comes to go back home!  Please understand that I am by no means whining or complaining, rather, just exposing the pragmatic feeling of being lonely and homesick.  So, pardon’e moi, sil vous plait, eh?  Hopefully, the burden of work during the next five months will temporarily make me forget about home.  Just thinking that it will be five more months from now literally excites me—one down, five more to go!!!

Reading novels is slowly becoming an enjoyable past-time and hobby.  I already finished two murder, suspense/thriller, CSI-esque type of novel from Michael Connely (Chasing the Dime) and Stephen King (Cell).  Both were not bad! As a matter of fact, I am looking forward to reading another novel, my third one that is, from Andrew Klavan, not only because I have something now to consume my time, but also because the novel’s prologue alone describes a very sexy, daring, and thrilling hide-and-seek kind of action.  Thankfully, there are books on the bookcase shelf at the house that the guests are welcome to read.  I probably will start Uncanny tonight since the laundry and ironing were done this afternoon while watching and getting amused with watching The Hangover, which was on HBO.  Doing the laundry and ironing reminded me of my Mom  and how I could never ever match up on her abilities in ironing my own clothes.  The movie reminded me of my younger brothers, brother-in-law, sister, and sisters-in-law because we watched this movie together one weekend. 

In the interim, writing a blog this afternoon, so as to update all on my recent underpinnings at work, provided a cerebral way of releasing inner thoughts all the while listening to the lighter mood and tunes of neo-classically trained Josh Groban’s vibrato and falsetto.  The USAID and CDC group left PNG yesterday after the morning debriefing meeting.  Even though I met the Asia Regional Monitoring and Evaluation Group for only a very short time (2 weeks), all of us bonded and became acquaintances rather quickly.  Since yours truly will be the only one going to be left behind while the others travel back to Washington, DC, Manila, and Bangkok, they wished me well and asked for me to go forth and continue the legacy of their work, make positive and sustainable changes despite being the smallest donor, and reinforce previous and most recent implementation items.  Business cards, phone numbers, and e-mail addresses were exchanged, promises of keeping in touch were made, especially if anyone is around town, so as to meet and catch up again.  Hopefully, I will be able to keep in touch and connect with USAID in Manila Philippines next year when I go back home.  We’ll see…

OK, so work stuff.  Believe it or not, I will be here for almost three weeks now, and I am still somewhat unclear as to what exactly my role is going to be.  I know that somehow, technical advisement and expert consultancy will be my areas, to help out in building and strengthening capacity in the health clinics that FHI oversees.  I spent two days last week at one of them—Lawes Road Clinic—and had a good concept of how the clinic operates.  However, clinic staff thinks that I, an expatriate hailing from US, am there to actually see patients, do physical exams, and prescribe treatments and recommendations using and following American guidelines.  I made sure to be perfectly transparent and clear with all of them that I will be observing, keeping notes, and recommending practice enhancements, but NOT to actually and physically see patients.  I mean, I would love to really, but the NGO at least made it clear, that I will not be providing hands-on-care, at least not yet.  I might get the chance to do it in Id Inad clinic in Madang, but that is not going to take place at least until September.  I still have to sit down with the technical advisors like me next week, and discuss in great detail what my Scope of Work is going to be.  I already had a draft, but I saw numerous changes and amendments to it, leading me to believe that what I had in mind as far as what I will be doing is not necessarily accurate and correct.  During the two days that I went to the clinic, my plans of attack were to get to know the key personnel and their scopes of responsibilities and practice, become familiar with the patient flow, identify areas of strength and weakness, and qualitatively inquire about the accomplishments and perceived deficiencies of the clinic.  I got an earful from the Clinical Project Manager, nurses, physician, lab staff, reception/registry, counselors, and administrative staff, working on these items.  I responsibly jotted and wrote down all of the comments, questions, suggestions, and answers that everyone told me, from much needed equipments and clinic materials, to suggestions on how to better service the patient population that come.  During the observation and tour, I also listed numerous items and practices that needed urgent focus and action.  I suppose I will be using these pieces of information when the technical advisors and I sit down and talk about my Scope of Work next week.  The issue is, almost all of the items I wrote down demand urgent attention, and picking out which ones are the top priority will be somehow hard to decide. 

Some Pictures from PNG

 Cartoon impression of my trip courtesy of Mr. Gary Draper (aka "Uncle Gary").  I remember him telling and reminding me to not let this happen!!!  :-)

Green Tree Frog - unsure whether its supposed to be poisonous or not but I dont think now is the right time to find out, dont you think? 

   Star Fruit - supposed to be very citrusy and sour.  Eaten with salt.  The power of imagery, as I am salivating right now that I am thinking about it!!!

   Guava, or bayabas in the Philippine common tongue.  High in ascorbic acid.  The leaves can also be boiled and make a tea out of, supposedly possessin some powerful wound healing abilities.  I just remember the day when I was 13, the leaves and its tea and I had some "quality time" together with wound healing. 

   Bananas - too bad it is not ripe yet.  I need something with my peanut butter and bread.

                                             Paw - paw (poh-poh) or papayas

                                            Pineapple and Alex (security)

  I was so surprised to see this tree here.  In the Philippines, it is called aratilis.  Small, sweet, totally harmless.  But according to folks here, it is not eaten here at all. 

 In the Philippines, this is atis.  Many seeds, fibrous fruit, milky white inside.  I dare not get one from the tree here though. 

In memory of one good colleague and friend - Scott Ingraham, aka as "Scooter".  The shirt I am wearing was mass produced and printed for him and his family.  I hope Rose Zambrano Ingraham gets to see this picture.  RIP Buddy! 

The Habit of Betel Nut Chewing – Part II

14-May-2011, 2316

Betel nut is chewed regularly by at least 10% of the world population, imported by immigrant users wherever they settle, and is the fourth most widely used addictive substance (Sahelian, n.d.)  It turns out that Papuans chew betel nut for three reasons: stress reduction, feelings of well-being, and heightened awareness.  Sound familiar?  It is almost akin to coffee drinking and/or cigarette smoking, eh?  Folks chew first thing in the morning in order to become fully awake.  “It is an eye opener” says Alex, one of the security guards at the house, who is frequently found with a lump in his cheek full of buai fibers.  Chewing the nut for the very first time will be a turn off for anyone as I was told, since the taste can range from being very sour to somewhat bitter.  But, according to folks, one can also easily acclimate to the taste, just like smoking a cigarette can feel asphyxiating at first, then gradually become something that one grows to like.  Then, folks chew one betel nut at a time intermittently throughout the day.  Some chew more than others throughout the day.  And then there are some who chew more than one betel nut at a time!  In the documentary Betel Nut Bisnis that I watched last week, a native without teeth (forget about false teeth) from the Goroka Province used a wooden mortar and pestle in order to make the concoction, and eventually place the mixture in his mouth to extract the juice and taste.  Talk about ingenuity, eh? 

Chewing betel nut intermittently throughout the day, aside from increasing salivation, supposedly suppresses hunger sensation as well.  This theory, if proven true, has a profound implication here in Papua New Guinea.  With the rising prices of commodities in the country, including food, natives are reduced to eating cheap and locally grown produce like peanuts (raw!), kaw-kaw (Asian sweet potato, and not the kind that we cook during Thanksgiving either!), po-po (papaya), and bananas.  Some also eat crackers that are locally manufactured and therefore cheap.  Forget about the “Dollar Value Menu” from McDonald’s, Burger King, or Wendy’s as these are non-existent here.  Even the so-called “cheap” kai bars (local food establishments) are not so cheap.  In addition, Dr. Sahelian warns that “excessive use leads to palpitations, warm sensation, increased pulse rate, and sweating”.   Betel contains three major alkaloids: arecoline, pilocarpine, and muscarine.  I am not sure as to which chemical is it that makes it somewhat mildly addictive, but you can imagine its innate power to make its victim want more, and more, and more.  Dr. Sahelian (n.d) adds:

Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut, and pancreas.  Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumors throughout the upper gut and foregut derivatives in animals, are also associated with increased tumor risks in man.  Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage.  The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health. 

It is also relatively cheap, with price of one betel nut ranging from 20 to 50 toeas (cents), depending on season and availability.  So the common Papuan will buy maybe 6 nuts and put them in their bilum bag (like a pocket book).  The purchase will include the nut, mustard stick, and lime powder.  The mustard stick is another produce with seeds, coming from some vegetation that are also locally grown.  The lime powder comes from corals.  The corals are first harvested from the sea, dried in the sun, collectively burned, until the corals are reduced to the white powdery material.  It will be sieved by the locals using cheesecloth or some other form of sieve material in order to get the purified powder form.  It will eventually be sold in the market, also for a cheap price.  Interestingly, the paraphernalia to do betel nut chewing (betel nut, lime, mustard) is really cheap compared to any other useful commodity, like food!

                                    Sea stag-horn coral harvesting, then off to dry in the sun...

                                     Stag-horn coral collective burning after drying in the sun...

                         Corals reduced to white powdery lime that are sieved for extra purification.

Then off to the stock market...

So, what is the process like?  The folks will get the fruit and crack it open using their teeth since it is somewhat soft.  The inside is very husky and fibrous and the actual nut is found inside the center.  The nut is obtained and put in the mouth and the folks will just start chewing it until it breaks.  Folks will keep on chewing until the juices inside the nut are released.  Then, folks will moisten the tip of the mustard stick in their mouth and dip it in the lime powder.  Understand that one mustard stick will probably last about three to four dips in the lime powder, and I was told that it really should not be a big portion of the stick and a big wad of lime in any given time because it will really burn inside the mouth.  After the mustard stick is moistened and dipped in the lime powder, the folks will place this portion on top of the chewed betel nut, bite the portion off, and continue on chewing.  Again, I was instructed to not put the mustard stick with the lime powder directly on the oral mucosal surface because it will burn, supposedly.  The mixture of the three ingredients produces a chemical reaction that produces the flagrantly maroon clay red color.  Salivation is also increased at this time.  This explains the red spit all over town because what the folks do is spit the excess red saliva from chewing.  It is very disheartening to see the town tainted in maroon red spit all over because almost everyone are chewers, and this is despite the poster and billboards all over the town that mandates to not do: “Respect the town.  Do not chew and spit betel nut”.  Some people swallow the whole concoction over time.  Some people just chew, then spit, then chew again until the whole residue has been completely swallowed slowly.  This brings my interest in finding out whether the urine or excrement turns out red as well.  So that is what betel nut chewing is all about. 

 Betel Nut Chewing Paraphernalia (betel nut, lime powder, and mustard stick)...

(Pictures, except the last one, are obtained online, courtesy of Stella Chiu-Freund.  Last one is mine)

Have I tried it?  You bet I DIDN’t!!!

The Habit of Betel Nut Chewing – Part I

14-May-2011, 2017

Almost two weeks ago, when I first came to Papua New Guinea, I hitched a ride with a taxi cab from Crowne Plaza Hotel since the person from FHI who was supposed to pick me up was late.  Imagine the panic and anxiety that overwhelmed me intensely that morning!  One of the first eye-opener I immediately noticed was the red stained teeth and lips of the driver.  In an instant, the thought of many differential diagnoses involving this clinical feature came to mind, from Vitamin B₁₂ deficiency, Vincent’s angina, severe gingivitis with resulting hyperplasia, oral cancer, to dengue hemorrhagic fever.  Ok, so these might all be the worst case scenario, but I really could not help myself but to notice the deep maroon clay red color of this guy’s teeth, gums, and lips.  As he drove, I also noticed that the sidewalks, roads, and light posts (basically everywhere), were festooned with spit of the same color.  In addition, I also noted the ubiquitous little sidewalk vendors with their items for sale, as well as the people clamoring around as if some item really went on major clearance sale and everyone was after it.  I immediately thought that Papua New Guinea must be a major exporter of limes (the citrus kind, cousin to the lemon) because ALL of the sidewalk vendors were selling these fruits.  Alas, the driver pointed out that these vendors are selling betel nut or buai’ (boo-ayeh) in the common tongue.  I did not dare ask any further than what he was offering to tell me.  In my mind, I just remembered that this person was a total stranger and it might provoke him if I asked something that was rather unconsciously offensive!  I didn’t want to get dropped off in the ghettos and slums of PNG on my very first day!  Instead, I figured that obtaining more information through therapeutic communication strategy would be best.  I thought that short, succinct, yet exploratory in nature kind of replies, such as “Hmmmmm, interesting”, “What do you think of this?”, and “Tell me more about that”, could be construed as harmless, even though there were at least twenty different glaring questions I wanted to ask already formulated in my head at that time. 

I could not even remember his name because I was that nervous!  But, in his words, the chewing of betel nut has been part of daily life for every Papua New Guineans and it has been used extensively since antiquity.  Natives chew the nut as early as 4 or 5 years old and continue until the rest of their lives.  Betel nut (Areca catechu) is of the palm tree family palmeacea and is cultivated and grown in warm and tropical climates of Southeast Asia and Melanesia.  People from Vietnam, Cambodia, Thailand, Laos, Pakistan, Bangladesh, Indonesia, Malaysia, Papua New Guinea, Vanuatu, and the Philippines are known to chew betel nuts.  I am actually surprised that some Filipinos, at least according to literature, are supposed to have chewed betel nut because I have never seen one person chew, let alone have red stained teeth and gums in the early 15 years that I have lived in the country.  Maybe folks from the deep provinces of the central and southern parts of the country are known to do this, but I don’t think the practice is ever founded in Metro Manila.  I am not sure if this is somewhat similar to the nga-nga that the very old Filipino folks in the deep provinces chew.  I remember it had a very distinctive (and gross!) smell to it as well as a dark green color, but not red!  Betel nut is also chewed in New Zealand and Australia by immigrants from India and Papua New Guinea who are now dwelling in these countries.

                                              Betel Nuts ("nut" = misnomer) still on the palm tree...

Most, if not all, of you are probably asking the same exact question that I have been asking all along, and that is ‘why in human reasoning do they chew betel nut’?  What is it about chewing that Papuans start early and continue for the rest of their lives?  Is there a strong tendency for it to be habit forming and addictive?  What are the similarities and differences of betel nut chewing to cigarettes, marijuana, or alcohol?  Is it an expensive habit?  What are the desired effects?  Are there any undesired and untoward physiological effects, other than the red stained teeth, gums, and spit?  What is with the white, cocaine like powder that they use it with?  What about that green mustard sticks, what is it for?  What makes it red?  Do they swallow the fibrous concoction?  Are there systemic effects?  Will it make the urine, bowel movement, and the alimentary canal also red?  And most importantly, are there health implications at all? 

 

Friday the 13th—Not too Bad!!!

13-May-2011, 2115

A week and a half now at PNG, slowly adapting to the PNG life, so far so good though I really didn’t sleep that well last night as I tossed and turned in bed for a good amount of time before finally getting some zzzz’s.  The notion of bad omen and unfortunate events that is associated with Friday the 13^th was discredited since today was basically unremarkable.  Ironically, PNG, with its many myths, beliefs, and traditions, presumably do not believe in the folklore of Friday the 13^th either because it was not even mentioned in the office.  I asked a few staff about it and one of the response was “Why, what’s today supposed to be?”.  Need I say more…

There is a restaurant inside the compound where I am working—The Point International Cuisine—and I tried it twice this week.  From what everyone has been telling me, the place caters to Japanese, Malaysian, Chinese, Korean, and Filipino patrons so they all say that I ought to try it.  So I did with the USAID and CDC group!  The place really should have been called “Asian Cuisine” since it’s really not international, eh?  But, somehow, I can say this place brings a little bit of home, and since the menu even listed the food items in Tagalog, the group basically asked me which items were good to eat.  Since I knew all of the Filipino food items in the menu, I told the group all were good, palatable, and I have had before:  sinigang – a brothy pork or fish dish with vegetables and lots of stock made sour by tamarind base, served over white Jasmine rice (Dana, you’re favorite!!!); adobo – pork or chicken dish sautéed in garlic and onions then generously glazed with soy sauce and vinegar, then served over white Jasmine rice, truly full of salt and sodium but nevertheless so good; pansit bihon, canton,  or sotanghon – all three are variations of noodles that is sprinkled with calamansi, lemon, or lime juice on the top for extra added flavor, can be consumed by itself, or with choice of bread or white Jasmine rice; and tortang talong – eggplant omelet, somewhat akin to the American Chinese food Egg Foo Young.  So, we all ORDERED these and had a very good lunch!  Having these food items just made me feel good because it reminded me of home. 

Papua New Guinea is a country that lies in the midst of Melanesia and Oceania, just north of Australia and east of Indonesia.  Yet, here I am watching American Idol tonight!  Actually, Thomas and I were watching it last night as well and both of us were so sure that it will wind down to just the two guys—country singing sensation Scotty McCreery and hard-rocker James Durbin.  Thomas and I are still largely baffled over Haley’s continued presence in the show and yet singing powerhouse in the likes of Pia, Jakob, and Stefano were already voted off early on.  Tonight, we were both in disbelief when James was voted off!  I probably share the same sentiment amongst many Americans in asking why it is so.  Oh well, life goes on.  Though, with Haley, Scotty, and the other girl as the last three contestants on the show, I must say this year has been the worst year ever for American Idol, the second worst was the “Battle of the Davids” year, when David Archuleta lost to David Cook.

Happy Nurses’ Week!

11-May-2011, 1755

This is a tribute to all the nurses around the globe to celebrate Florence Nightingale as the foundation of the nursing profession – Happy Nurses’ Week to all of you!  Cherish and provide for the patients whom you are taking care of, whatever capacity or setting it might be—the 30 patients of the sub-acute/skilled nursing facility; the 60 geriatric, long-term patients at the Alzheimer’s Unit; the 8 medical-surgical patients at the local community hospital; or the 3 intubated and vented patients at the ICU/CCU.  I share with all of you the joy and pride in all of the accomplishments of Nursing as a profession, yesterday, today, tomorrow, and the days beyond...

I have had the opportunity to sit with the Provincial AIDS Committee at the National Capital District of Port Moresby this afternoon, together with USAID and FHI PNG, as guest of honor.  The PAC group systematically presented the triumphs and challenges of the group in promoting the model of Continuum of Prevention-to Care-to-Treatment (CoPCT) as the primary vehicle in addressing HIV/AIDS infection and epidemic in PNG.  Highlighting the achievements of the group just within the metropolis makes for a strong statement for the major funders, such as USAID, to continue, and perhaps increase funding so as to preserve and further enhance capacity and thus greatly improve access to healthcare and reporting.  One of the striking highlights of this committee is having HIV+ people called “friends” join the citywide campaign against HIV epidemic.  I really do believe that the voluntary work of the “friends”—to raise awareness, campaign, and educate about HIV spread and condom use—is a strong and forceful statement that the PNG government supports not only the program but also the patients afflicted with the virus.  Truth be told, negative and ill feelings are flagrantly abundant towards HIV+ individuals.  Therefore, tremendous amount of work still need to be done to build tolerance and acceptance of people living with HIV here.  This is where the NGOs like Family Health International come in since their areas of expertise, aside from strategically building the foundation of HIV awareness and education, is to formulate curriculum for sensitivity training and empowerment.  I am already making plans to help out with education and training but not sure yet as to what areas—sensitivity, change theory, empowerment, therapeutic communications (listen up nursing students and nurses, Nursing theory really does pay off!!!), or maybe basic A&P, lab, or basic physical assessment skills and techniques.

BUSY BEE – Global Funders’ Visit to PNG (USAID & AusAID)

10-May-2011, 1825

The internal humor now at the FHI office is about me and how I picked just the right time to come and work with FHI, when almost all things could potentially go haywire since the major sources of support and funding—USAID & AusAID, in addition to CDC—are all coming and staying for the next two weeks to review strategic partnerships and alliances, past and present statistical data, potential pitfalls, and current issues and dilemmas.  I really do not mind at all that I am put at the back burner at this time because the Country Director, Deputy Country Director, and the rest of the staff are shuffling to get all materials and data together for professional presentations, of course with the primary objective of securing more funding and continuing the present, working relationships.  In the interim, I am proactively and strategically inviting myself to most, if not all, of the meetings that have something to do with the clinics that I will be working with, and rightfully so because I really do need to know the issues and trends within these health centers.   I am also delightfully stamping the brand of “Pfizer Global Health Fellows Program” whenever I can and have everyone be aware of what Pfizer, a global Fortune 500 company and the largest in the pharmaceutical industry worldwide, is doing to advance and promote global health and positive health outcomes.  I wanted them to know that Pfizer will most probably welcome another invitation to have a Global Health Fellow work alongside an NGO in Papua New Guinea, not just Family Health International (FHI), but also PSI, WaterAid, HOPE Foundation, Save the Children, maybe even USAID.  The visitors bearing gifts came from all directions around the globe, some from Washington, DC; Manila, Philippines; Bangkok, Thailand; and Beijing, China.  Somehow, I felt really important today to be sitting with global health professionals in this roundtable and providing input in addressing simple, and yet complicated issues within the clinics.  And to my surprise, ALL of them were aware of my impending arrival to PNG as Global Health Fellow and Ambassador from Pfizer, and were delighted that someone in my capacity actually did agreed and accepted the Fellowship position for six months!  FHI and the rest of the team supposedly anticipated that none will apply for the position at PNG, mainly because of the negative reputation of the country in terms of high rates of violence and crime, let alone the ridiculously inflated sets of prices and costs of living.  I was most welcome, I suppose!  But I also told them it is both a privilege and a wonderful opportunity indeed in my part as a nurse practitioner to be working alongside an international NGO such as FHI and provisioning primary care and clinic management as well as advancing sexual health, minimizing STD/STI, and providing counsel and health directives to Papua New Guineans.  So it will be a very busy two weeks for FHI and staff while I sit and observe interactions, attend meetings, and go along with FHI and the visitors to do site visitations.  It is not my time yet to actually get my hands dirty and work, but I already have some working opinions and drafts in my head that I want to put on the table, soon after the visitors are gone and FHI have had some time to breathe and relax. 

On a personal level, I feel that I accomplished something big this week.  I actually hired a native Papua New Guinean with a car living in the settlement as my personal driver.  Gary (the newly hired) was strongly referred to me by Gideon (the FHI driver who comes and picks me up every morning).  Both are good mutual friends living on the same settlement around town.  I drafted a document this afternoon that details the employment terms, duties, requirements, and payment schedule.  In my previous blog, I believe I mentioned that transportation in here is a big issue since taxi rides can be very expensive.  It can go as high as 30 to 40 Kina one way, and not roundtrip, way above the allocated budget that I have.  If I do this on a daily basis, it will not be very cost effective.  I am also strongly advised against using the PMV (Public Motor Vehicle, or bus) even though they are relatively cheap.  One ride costs about 50 to 80 toea (to-yah), which is equivalent to that of 50 to 80 cents.  However, safety and security will be of utmost concern since the bus is overcrowded and I will be a primary target of robbery and who knows what else by raskols (rascals).  PMV rides I believe is one of the only two things that are found to be cheap here in PNG, the other is the betel nut.  On a side note, I will be writing a paper regarding betel nut and the habit of chewing this so stay tune on this.  So with Gary, we agreed that I will pay him 125 kina a week, and salary will be every two weeks.  He will pick me up at the house at 0730 and drop me off at FHI; then pick me up again at 1700 at FHI and drop me off at the house, Monday through Friday.   Ad-hoc drives on the weekend on a PRN (as needed) basis for shopping, errands, and leisure will be an additional 30 Kina roundtrip.  He promised me that he is trustworthy, reliable, honest, punctual, and generally a good man, with a valid driver’s license, insurance, and registration.  He actually told me that once a Don Bosconian himself, he used to work and drive for Don Bosco Seminary School in the Philippines and that he is fond of the Filipinos because he knows them well having worked and lived there for quite some time.  He assured me that not only will he be my driver; he will also be my security person.  I like this man a lot—an honest man, a father to 4 biological daughters and 1 adopted son, and a husband—so I hired him, we shook hands, and signed both copies of the Employment Agreement. 

The Budua Haus - Where I Am Staying

Simple Bedroom, thank goodness with a bed & pillows.  I am not using the blanket that is found folded at the bottom of the bed, otherwise, I will roast and get fried in my own fat and sweat...  he he he...

                                           

This is quite a luxury - to have a sink, standing shower with hot water, working/flushing toilet, and rolls of toilet paper in the bathroom.  Papuans living in the settlements and tenements have a communal latrine for families to use.   

                                              Closet space and windows with glass jalousies. 

Again, luxuriously living here with a TV, fridge, hot plate stove, and a microwave!  That is a Citronella candle in the middle of the dining table, guard against the Anopheles and Aedes egypti...

The washer and dryer are communal.  Tom and I share this.  I yet have to use it.  The space to the right is used for ironing. 

The view of the house from the outside.  It is gated and with security.  The lawn garden is heavily manicured to attract expatriates like me. For the most part, the house and security staff are liking me a lot (thankfully).  They say I am rather very friendly and cheery.  I gave them M&M peanuts and they went ga-ga!!!

 The water is treated so thankfully enough, I dont have to buy bottled water, because it is so expensive here!  And just in case, I still have my fluoroquinolones and macrolides to use...

Power goes out everyday.  Back-up generators are in place.  Unlike in the US, electricity in PNG are bought at the store, the numbers are crunched in the meters, and that is how power is supplied.  For starters, my power amount initially was purchased at 100 Kina (roughly about $40) and may last me about two weeks. 

My First Weekend

08-May-2011, 1017

Happy Mother’s Day to all the mothers at home and work, especially of course to my Mom Sarah, and Grandma Raymunda, Tita Grace, Tita Susan, Tita Bona, Tita Lynn, Tita Helen, cousins Dang and Alma, and my sister Karl-Anne!  I still do not have Internet connection at home so I cannot update my FB status and send greetings to all as much as I would love to.  For now, I am celebrating all the love and maternal influences rendered to me by my Mom, Aunts, grandmother, and all relatives who are also mothers, in spirit.  Long live all of you!

With cost of living already high and currently still sky-rocketing in PNG, it is a bit hard to think about what to do this weekend.  I figured I will catch up on policies, guidelines, security briefings, and other work-related stuff at home to kill time.  I understand it is unorthodox to be doing work while not working and within the comforts and boundaries of home.  I know I should be living life and live it fully.    At this point, I am still giving myself some time to really acclimate to my surroundings.  It is not so easy to just take a cab ride and go downtown here in PNG due to safety/security reasons knowing that I will really standout as an expatriate, despite having many Filipinos around supposedly.  So far, I have only seen two Filipinos at the market.

Tom, my housemate, was kind enough to let me hop along with him when he went to the store and did some grocery shopping.  This time, I finally saw the mall and the supermarket.  Prices were still crudely high but were better compared to the prices at the store down the street where I live.  Tom advised that prices at the supermarket are still gauged higher because of the newness of the place.  I only bought selected few items as he advised me to do.  He took me down to where he generally buys household items and this place is a little bit smaller scale than the supermarket but big enough to have all of the things that I will be needing at home, including laundry detergent. 

Tom also bought a few vegetable items as he was going to have few guests for a lunch party.  Apparently, one of his colleagues from AUSAID (Australia’s version of USAID) was awarded a complete scholarship to attend and study for two years in University of Melbourne for a Master of Science in Organizational Development degree.  So this party is going to be not just a lunch party but a gathering of special significance since a colleague of theirs is leaving and to also celebrate her award achievement.  I offered Tom my culinary services and told him how I love cooking.  As it turns out, two nice young ladies who were also colleagues like to do the same.  Tom invited me to the party so I joined and told his co-workers stories of US life, work, school, home, my flight, Florida, Washington DC, New York City, nightlife, politics, Barak Obama/Hillary Clinton, and it seemed to delight them of all the things that I’ve done and places that I’ve visited (not that there were really many).  I also told them about Pfizer, the New Haven Clinical Research Unit, what we do, and the Global Health Fellows program and its connection with FHI.  I met Suzanne, as well as 9 of her colleagues.  When they found out that I have only been here for 3 days, they just swarmed and welcomed me with their open hearts and hospitality.  It turned out to be Suzanne’s and Mark’s party—goodbye/congrats and welcome party that is!  I had a great time; the dishes that they prepared were all so delectable and good!  We had ice cream and cake in the end.  It turns out that Papuans also like music and singing.  I really should’ve brought my karaoke system with me, oh well.   I really had a great time in the end and thanked Tom for being inclusive and overall a really nice gentleman.

When everyone left, Tom and I watched movies about the history of PNG and the early Australian colonial settlers looking for gold.  It was totally informative.  Papua New Guinea is a very new and young country, ideologically that is.  Australia awarded its independence only in 1975, but the colonial influences are still somewhat palpable.  It is almost like the country went from the time of the Australopithecus to the time of cellphones and internet without having to pass by anything or anytime in between.  Infrastructures are booming and yet there are no regulations, policies, and plans.  Government is weak, and from what I hear, corruption is also rampant.  The country can greatly benefit from its tourism industry because it is a very beautiful country.  But not a lot of visitors and tourists are flocking to the country because of the prices and its well-known crimes and violence.  Natural resources such as copra, gold, and oil are also abundant, and yet oil prices, just as in the UNS, are also skyrocketing.  Many Papuans from different provinces are cramped and settled in Port Moresby illegally in tenements and settlements because at the rate and price of realty right now, no one, will be able to afford to rent a house, let alone build or buy it.  Primary and secondary educations, as well as healthcare are also problematic.  Only a few are able to continue to university settings and afford a college education through government subsidy.  This is the one of the key reasons why the strong presence of FHI is needed as far as healthcare is concerned, often funded by outside governments and donors such as USAID and AUSAID.  I now have a working plan on how to tackle my clinic visits at least when I go to Lawes Road Clinic and 9-Mile Clinic sometime in the future. 

At this point, I can say that I survived my very first weekend.  I am missing home, especially my family!  I am not sure what will be in store for the next coming weekend though, we’ll see.

FHI (me) meets AUSAID (everyone else).  Only Tom (green shirt), Ahmed (last on the right standing), and I are expatriates (US, Kenya, & Pakistan). 

My First Work Week

07-May-2011, 0747

When I planned for this assignment, I thought when I arrive on a Wednesday, I would at least use the Thursday and Friday to settle in, get used to, and know my immediate neighborhood and surroundings.  Or so I thought because not only did it not happen, but I also went to work immediately that afternoon to meet the country director and deputy country director of FHI PNG.  On Thursday, I had the new employee introduction to policies, guidelines, security briefings, and a more formal trip to the US Embassy.  On Friday, we discussed in great length my scope of work and job description, briefings on the 2 health centers I will be working with initially, allocated budgeting, and first office staff meeting.   Welcome to work Mark, PNG style that is!

I am still getting used to the hours of sleep in here.  At the present moment, it is about 1700 in CT, so I should be napping at this time.  The past days I have been going to bed around 2000 and getting up between 0300 or 0500, way before my cell phone alarm clock set at 0700.  I have another set of alarm clock in here, a more natural one that is – roosters!  It has been a very long time since I have seen or heard roosters crowing, so it is nice to be one with nature again and wake up to these birds exercising their vocal cords. 

FHI purchased a mobile phone and some air time for business use.  I will be travelling to remote sites of the country and visit community healthcare centers from this point forward so it was impressed to me the importance of having a mobile phone at all time for security purposes.  They also purchased an internet modem and some “user time” for me.  But because the internet bandwidth is not robust at all as I had expected, net surfing is very slow.  Currently, I am checking work and home e-mail, FB status updates, GHF communications, and other home business during my break time at the office.  Even connections at the office can be challenging at times.  Slowly, I am internalizing the differences between work in US versus work here, on the basis of the internet alone.  For instance, I tried to research online for the incidence and prevalence of HIV and AIDS in different areas of PNG.  Some of the .edu, .gov, or.png sites took a very long time to download, and then the power went off.  There is a back-up generator, but because there was a brief electricity cut-off, the internet line was also disconnected, and then I had to start all over again.  Also, before leaving US, I made sure I fully understood and knew how to do video teleconferencing via Skype.  As it turns out, I am NOT going to be able to do it here at all anyway – again, internet infrastructure is not that robust, especially at home; and, if I am actually able to, it will be a very expensive effort for only a short amount of time – airtime, megabyte use, and since Skype is a constant streaming of megabytes…you get the idea.  For now, I try to update all of you through Pfizer work e-mail, home e-mail, and FB status.  Heck, I have not been actually able to update my Twitter feed at all since May 1^st!  But for now, rest assure I will research on other ways to do Skype, hmmm, maybe when I go to Cairns, Australia for a weekend getaway, hopefully I will be able to do it.  I will have to leave the country, technically on or before 60 days after arrival because of the visa type I have: “Short Term, Multiple Entry, Business Visa”.  FHI PNG will consult with an Immigration Consultancy Agency to ask if the 60 days can be extended to 90 so that I will only have to leave the country and come back once.  If that is the case, I am anticipating traveling to Cairns, Australia at/or around the last week of July or first week of August. 

Currently, my mode of transportation is still an issue.  For now, Gideon or Alois, FHI PNG’s formal driver, comes by every morning to pick me up using the company’s truck or SUV.  One or the other also drives me home in the afternoon after work.  My allocated budget for transportation is $15 daily, M – F.  $1 is equivalent to about PNGK2.25 (PNG Kina), so transportation budget is 33.75 Kina per day, or 168.75 Kina per week.  Taxi rides from where I am staying to where the office is can cost between 20 to 30 Kina one way!  Clearly, this is not going to cover transportation expenses for work M-F, let alone going anywhere on the weekends.  There are plenty of PMVs (public motor vehicle, PNGs version of bus) and fare is about 50 toya (half of a kina).  The glaring issue is safety, the bus can probably accommodate 20 people, but there are times when 30 or more individuals are cramped inside the vehicle.  FHI PNG at least is adamant about me NOT using the PMVs at all.  It is also not of walking distance, so scratch that.  And I cannot have my Mustang shipped here either because the steering wheel is on the left side, while the whole country drives on the right.  Besides, one of the cardinal rules of Pfizer GHF is for all fellows NOT to drive on host country locations.  I am not sure of our fellows right now in TX, NY, or SC…  Next week, we are interviewing a young gentleman who has a vehicle and is looking for a job.  We can give him a job so I am hoping that we can negotiate for 100 Kina a week, M-F, AM and PM ride, and occasional weekend rides for personal errands with an additional “subsidized” payment.  From my understanding, this amount of money per week is considered a good paying job, AND a constant source of income.  So we can have a win-win situation in both sides, I just hope that he is reputable, honest, trustworthy, and time conscious. 

PNG Arrival

04-May-2011, 0245AM

The soft glow of the morning sunlight shining on my face was very welcoming as I walked through the Exit pod at the airport.  I immediately felt the tropical heat from the environment that I longed for, especially as I remembered shoveling the 1 foot or so of snow that fell twice a week between December and February.  Immigration and customs at PNG were unremarkable and my entire luggage made it through to destination as I did. 

As I went outside and looked for the placard that said “Mark Gregorio” or “FHI”, anxiety started to creep in because there was no person holding a placard with my name or the company logo in it!  I thought that I should call the office but the phone number was in my work e-mail (so much for being organized, eh?).  So I turned my laptop on with about 5% power (OMG!!!) but Wi-Fi cost about 20 Kina and signing up at this point will prove to be another long process to do.  The airport security personnel tried their best to assist me by looking for the person with the placard to no avail.  Finally, I asked how long of a ride it is from the airport to the US Embassy.  It turns out it is only about 3 km away.  They were kind enough to put my luggage in a taxi operated by Crowne Plaza Hotel and told the driver to drop me off at the US Embassy.  As the driver drove through, then I thought this person is a total stranger and every worst case scenario just kept on popping through my head.  But it turns out this person had a good heart and soul.  He told me that PNG is just like any place in the world, with its shares of negative influences and crimes, but for the most part, Papuans as they are called, like to show off their country to visitors and let them know it is not as bad as it is portrayed in media.  I somehow felt relieved when he said that, so I encouraged him to tell me more about the place, at least until I get dropped off. 

Thankfully, I knew Mr. Paul Berg, the US Ambassador to PNG, because we had exchanged few e-mails when I was applying for the visa.  Shiv Nair, the country director for FHI at PNG mentioned my name to him so Mr. Berg was expecting my arrival since February!  He was not there at the time though so his assistants came down and welcomed me happily.  In the wall of the Embassy, three prominent and very familiar pictures were displayed: POTUS Barack Obama, VPOTUS Joe Biden, and of course Secretary of State Hillary Rodham Clinton!  I was so relieved to be inside this building!  Stacy and Elizabeth told me more about the country, the do’s and don’ts, currency exchange, traveling, nightlife, entertainment, driving, and safety issues.  Then they asked me what I was in the country for.  So, I put on the Pfizer Ambassador hat and explained to both of them what the Global Health Fellows was all about, that I am a nurse practitioner by trade, and that I will be volunteering for Family Health International NGO (non-governmental organization).  They were pleased with the philanthropic mission statement, vision, and philosophy of the program and immediately told me that the Papuans are in dire need of assistance in health counseling, screening, and primary care.  Then Paul arrived and was very pleased to meet me, but told me he had about 10,000 things in his plate for today, but he will be happy to meet with me the next day for some security briefing.  I was also happy to have met him because I can now attach a friendly, smiling face on the e-mails that he sent. 

Elysse, one of the drivers for FHI finally picked me up at the Embassy and drove through downtown to the FHI office.  Finally, a sense of relief rushed through because I now know I am “home” with my new comrades at FHI.  I met almost everyone, including Shiv Nair, the country director, and Rita Pala, the person who was mainly in-charge of handling my work papers through immigration.  I spent about a good hour at the office and was shown at where my desk was going to be.  I used the opportune time to log online and let Stella Carolan (my Pfizer manager) and Oonagh Puglisi (GHF Program Manager) know through e-mail that I arrived safely at Port Moresby.  I also logged in at Facebook, do a status update, and e-mailed my brother Mark C-zar my safe arrival. 

Shiv drove me from FHI to where I will be staying, roughly about 15 minutes ride, but Papuans drive on the right side, there is a lot of traffic, and road structures are not that great, so I thought this probably will be a 30 minute ride if I am going to be one driving myself but thankfully I am not.   The living space is a shared apartment, indeed an apartment within an apartment.   I have my own bathroom and kitchen in my quarters, and then the outside living room and kitchen are shared space.  I am sharing the house with a Kenyan native named Thomas Gowa.  Tom, as he likes to be called, is a nice young man who is also doing similar duty as I am with AUSAID.  Previously, he was working for UNICEF.  I met the two security officers of the compound, the housekeeper, and the gardener.  The apartment has a working shower and hot water, working (flushing) toilet, microwave, TV, refrigerator, sink, washer, dryer, bed with 2 pillows, sheet sets, and towels.  Princess (the housekeeper) will be keeping my quarter every Monday and Wednesday.  For additional fee, she can also tend to my laundry and ironing.  The only items I thought of not present at the Unit just yet are internet connection and a mobile phone.  I am sure Shiv and I will talk about securing this at some point.   I’m thinking, goodness gracious; I am living in luxury here, compared to the REAL Papua New Guinea.  I saw dilapidated houses, latrines on the backyard, simply opposite differences from the provisions that I have now.  And with these, like I mentioned, are security around the clock, with a big, ominously looking black German Shepherd named Kola, I deemed the place to be safe and sound.  I was taken aback with the dog at first but as soon as I became familiar, he was no longer barking and eyeing me with suspicion.  He had another sibling named Pepsi, who died early a couple months ago.  All of the service personnel at the apartment are related to one another at some level, and all were very pleased to have met me today.  Like everyone else, they were also expecting me at some point since February or March.

I tended to my luggage and things, shoot pictures of the apartment for all of you, took a shower, and had a power nap.  I was so tired but I really could not sleep and I attributed this to the fact that I am in a new place (dx: new place anxiety!)  They told me the tap water is treated and safe for drinking, showering, and cooking.  It was so hot, I was parched, and had really no time to go shopping just yet, so I bravely drank water from the tap, but I also made sure that the Ciprofloxacin and the toilet paper were handy, just in case.  My thoughts of Microbiology flashed through me as I pictured my little, tiny, microscopic friends, probably also doing a warm welcoming wave as I drank through the glass—coliform bacteria, E. coli, Vibrio cholerae, Enterobacteriacea, shigella, amoeba,  etc…  BUT, guess what?  NOTHING happened, I am safe and unremarkably well, thank goodness.  So, I made iced tea and ice cubes! (To be continued…)