Full Pledged Immersion at Work

12-June-2011, 0917 AM

It has been a little more than two weeks since my last blog entry.  Throughout this time, there had been quite a few noteworthy events, some of which even caused a stir and mild anxiety.  Really, the nervous person that I am worries just a tad bit too much I admit, but considering the most recent events and the status quo in PNG concerning personal security and safety, I do strongly believe that my perceived need for a mild anxiolytic, albeit low-dose, is really warranted.  Somehow, I feel that Dr. Dabdoub will readily agree to prescribe a short-acting benzodiazepine should I present my case to him right now. 

Raw and descriptive statistics from previous Global Health Fellows indicate that isolation, loneliness, and homesickness rise and peak through the entire first month of the assignment.  Anecdotal accounts also dictate that it should gradually dissipate from partial to complete situational adjustment and internalization of the normalcy of these emotions and feelings during the second and subsequent months.   Colleagues, and most especially family members, will agree that this was the case for me during the entire first month (May).  At the onset of the second month (June), my full pledged immersion at work, now that the final version of the Scope of Work (SOW) has been created, revised, and submitted multiple times for quite some time, caused a bit of distraction in my mind and helped to temporarily forget about home and family.  I’m not completely out of the woods yet, but it seems that I am slowly adjusting somehow.  My daily work routine generally goes like this: 

1. Wake up at 0630, snooze alarm clock twice.
2. Coffee, eat breakfast, and prepare work lunch, which is usually egg and cheese sandwich on a buttered hoagie roll.  Hopefully, there will be no need for me to re-start a cholesterol and lipid lowering agent and the Fish Oil I am taking currently will be good enough. 
3. Shower and everything else that goes on with morning hygiene, get dressed, and take AM meds. 
4. Wait for my hired driver who picks me up usually between 0745 – 0815 (notice the long variability on wait time). 
1. On Mondays and Tuesdays, he drops me off at Lawes Road Clinic. 
2. On Wednesdays and Thursday, he drops me off at Nine Mile Urban Clinic. 
5. FHI driver picks me up at the clinic around 1300 then lunch at the office from 1315 to 1415, though last Friday, I did not get picked up until 2pm.  I had lunch at 230 pm due to road traffic.  Back at the office, I also use the extra minutes of lunch time to check my personal e-mail, Pfizer e-mail, update blog, check and update FB status, and respond to queries and tweets at Twitter. 
6. I summarize the day’s events and make plans for the next day from 1430 until 1700.  My hired driver then picks me up at FHI country office late in the afternoon and brings me back home around 1715. 
7. Fridays are my personal administrative time.  This is my planned time to develop in-service trainings and powerpoint presentations for clinic staff.  At the moment, I am planning on doing the following in-service and training:
1. Pharmacology of Anti-retroviral Therapy and Newer Classes of drugs
2. Occupational Health and Safety
3. Standard Precautions and Transmission Based Precautions
4. Bloodborne Pathogens
5. Personal Protective Equipments
6. History of Present Illness, Medical History, Art of Interviewing, and the 7 Dimensions of a Chief Complaint

The first full week of being at the clinic was initially nerve racking because I did not know what to expect.  Talks and reminders were given for me to be fully alert at all times, knowing where my belongings are, especially my wallet and laptop computer.  I just remember the mantra to “kill them with kindness”.  So I waved, smiled, and greeted everyone I met and thanked them for their time in their language – “Tenkyu Tru!” (Thank You Very Much!) like I am some kind of a politician running for government office.  At the same time, the clinic staff inadvertently introduced me to clients by saying that I am an “English doctor from America”.  Time and again, I find myself gently correcting these folks and saying that I am actually a nurse.  It made no difference either way, as I later find out that both nurses and doctors are authoritative figures who are equally regarded and treated with high degree of respect.  This is all the more magnified when the clients find out that I am from America as they wanted me to be in during the consultation and sometimes cast a quick glance to see if I have some input regarding their conditions.  Outward appearance definitely plays a role, even though my daily work attire are a little less than business casual, but they can see that I am well cleaned and properly groomed, from head to toe, with shirt, shoes, and socks.  Needless to say, as soon as my patient interactions began, I felt a little bit better knowing that they genuinely want me to be at the clinics all the time.  Therefore, applying myself to work and keeping busy is what I have been doing in order to get distracted and not feel homesick.  It goes without saying that at work, I feel good because I am in the company of my new colleagues, knowing that the small inputs and recommendations I make can provide small changes, if not potential profound improvements.  The loneliness and homesickness still haunts me though as soon as I get home, most especially during the weekends, like today.  Sometimes, I walk around inside the house compound and see if I can find any critters, insects, animals, flowers, or fruits that I have never seen yet, but even that I have not done because it’s been raining like the dickens today. 

Last week, I was caught in a bit of surprise and excitement when the Country Director asked if I applied for an Australian Visa and made arrangements for flight and accommodation yet.  I realize that the full 1/3 of the assignment is going to be completed soon, July 4^th to be exact.  The two month finish is heralded by a short weekend trip to Cairns since a one-time stay at PNG for a short-term multiple entry business visa is 60 days, which I have to get out of the country on or before the day, and then come back again.  It brought sheer excitement and inspiration because the short trip is scheduled to leave early morning on July 1^st and returning in the afternoon of July 3^rd.  A complete change in scenery will do me well I suppose, and I put myself on a mission to find a good burger house and pub.  What’s profoundly even better is the easy process to apply for an Australian Visa.  I did it online and got approved within a matter of 1 minute!  Remembering in retrospect the bureaucratic red tape I had to go through to apply for a PNG visa, I was ecstatic afterwards because it took me a total of only 10 minutes to get the whole process done for Australian ETA (Electronic Travel Authority, no passport stamp though).  Then I booked a hotel accommodation in the heart of the Esplanade in Cairns, where the touristy attractions are located. 

It’s not all gravy these past few weeks though.  One of FHI staff, (For privacy and confidentiality purposes, I am not going to say who or what this person does), was punched in the face, shirt ripped, and assaulted while inside the truck last week.  The FHI staff supposedly hit another parked vehicle inside our lot at the compound.  The FHI staff stopped the vehicle, was going to get out to assess damage and arrange for plans to repair, and apologize to an incoming Papua New Guinean who saw the incident, who was eventually surmised to be the owner of the vehicle.  Without any forewarning, the Papuan provocatively assaulted and punched the FHI staff in the right cheek.  I did not saw any of these but later found out something bad was happening because I saw and heard escalating voices from the FHI staff outside the truck, my driver, and the Papuan trying to talk as to what happened.  My driver was the one who later told me the whole incident because he was there waiting for me when the incident took place.  I was a bit edgy and nervous at the time knowing that the perpetrator is inside our very own lot!  But my driver assured my safety and advised me to call him at anytime I feel I am in grave or perceived danger. 

Want more?  On Friday, my driver picked me up in the morning as usual and I saw his car without the right side view mirror and the right side of his face was obviously hurt.  He had scattered bruises and his right eye was red.  He then tells me that the night before (Thursday) he was involved in a not-at-fault car accident.  The driver from the opposite oncoming traffic was going to hit him head on.  He swerved to the left; the other driver hit the right side view mirror, which then hit my driver in the eye and in the face.  I immediately asked him if he had an x-ray done, eye exam, fluorescin stain maybe, and a quick doctor’s visit, and also to press charges.  But because it involves money, he deferred going.  There is no system in place like collision coverage or insurance.  Every expense is out of pocket.  The worse thing is that my driver cannot go after the other party either because he did not stop.  So as far as the incident goes, it was a done deal already and nothing that my driver can do.  He then tells me that this is how it is usually done in PNG.  All that I kept thinking at the time was how sorry I was for him AND how thankful I was that I was not with him during the time of the accident.

Thomas, my housemate who works for AUSAID, is gone and out of the country for two weeks.  He went to Ottawa Canada for some business meetings and trainings.  There is no one in the house but me so I am just trying to keep my mind occupied and busy to help pass the time.  I did laundry and ironing yesterday.  I read two chapters in the current novel I am reading by Bryce Courtenay.  I am now making and entering this blog currently.  The TV is also one of my saving grace as far as distraction goes.  I mean thank goodness and thank heavens for this and the cable; otherwise, I probably would have gone crazy bananas without anything to do.  I discovered the timeslot for the Filipino News program called BANDILA hosted by Julius Babao, Karen Davila, and Ces OrenaDrilon.  I also now remember that today is the actual Philippine Independence Day when the flag was first hoisted and put on the pole in Kawit Cavite by the first President Emilio Aguinaldo.  I usually flip the channels between HBO and Star Cinema for some movies.  Tonight, Titanic and Avatar is going to be on.  It’s good to hear “I’ll never let go” and “I see you” (the two prominent one-liner of these movies) again after sometime. 

October is still a long far ways to go and up until right now, I still do not feel nor observe the saying that “time will go by fast and it will be soon over before you know it”.  At this point, I am only looking forward to the end of the month when Thomas comes back home and I will be going to Cairns Australia. 

PNG - Lifeforms and Snapshots

This is red-hot chili pepper!  In the Philippines, it is called labuyo.  Very powerful and potent spice, it may actually bring tears to your eyes. 

The two security guards at the house - Paul and Matt!  Both really enjoy the M&M peanuts I just gave them.

 Common house lizard that scared the bejezzuss out of me when it crawled on the ground.  Lizards have the innate biological ability to grow their tails back when it's cut off, a process called autotomy. 

 This is a picture of the flower called sampaguita in the Philippines.  It is as a matter of fact Philippine's national flower.  Very aromatic and sweet smelling...

 I forgot what the natives call this fruit here, but, yet again, in the Philippines, it is called guyabano.  This is actually the neighbor's tree and fruit, but it is crossing over to our side, so the guards tell me they will get pick it up for me as soon as it is ripe.  Juicy, succulent, and sweet white meat, but be careful of the seeds. 

 My Filipino friends will probably laugh and remember Mask Rider Black because that was what came to my mind when I came across this green grasshopper. 

This picture was taken when I attended the company's launch of a study program that they piloted.  Dr. Graham Low is the Medical Director of one of the clinics I am working with.  Elizabeth Gande is an Australian taught and licensed nurse but a native of PNG, and is one of the company's Program Officers.  Currently, her work involves community based health care and clinic based program care.  I am helping her out with the latter one. 

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?