Tuesday, December 8, 2015

Marshaling on through the Marshall Islands

     My arrival in the Marshall Islands was much different than my arrival in Pohnpei, where I had prearranged an airport transfer. Flights to Kwajalein Atoll land on Kwajalein Island, which is controlled by the US military. Security on Kwajalein is tight with measures including prohibiting photos during landing and not allowing onward passengers from deplaning. Immigration and military inspections are carried out immediately on arrival and those without orders to stay on Kwajalein then board a shuttle bus to another building to wait for the ferry to the island of Ebeye. This process is confusing for new arrivals, of which I appeared to be the only one.  It is even more confusing for officials and other persons faced with someone who appears to be obviously going to the military base, but is actually trying to get to Ebeye. The officials repeated asked for my orders. The shuttle bus drive asked "What's your address?", assuming I needed a ride to my house on the military base. A friendly lady, who had been living on Kwajalein for 4 months asked, “Why are you going to Ebeye?” and then tried to answer her own question with the only reasonable answer she could imagine..."are you a missionary?” Eventually I made it to the pier, waited over an hour for the ferry and arrived on Ebeye after dark - happy to find that it was indeed a simple walk from the dock to the only hotel on the island, as I had been reassured by everyone I had asked.

     Ebeye is truly like no other place I have been in the world and the unfortunate nickname of "the slum of the Pacific" is all too appropriate. A few facts may help to explain Ebeye. It is one of the top 10 most densely populated islands in the world, ranked up there with Manhattan and Hong Kong. This is despite the fact that only the rare building has even a second floor. The population of over 15,000 lives on only 0.14 square miles, with a large proportion of families having been relocated from other islands in the 1950-60s due to US nuclear and missile testing. The most shocking aspect of the population is the number of children, as over half of the population is under the age of 16. Children are everywhere – lots and lots of children are everywhere. Rarely did I see children outside with adults. Just hundreds of children, even toddlers, hanging out with other children. To attempt to quantify the number of kids in this town/island, when I walked to the hotel after swimming I counted the children I saw on the first block of the main street. The final tally was 106! I counted the next block and came up with 87. The kids seemed happy - playing, joking and always smiling – only one of the thousands of children I saw was crying. That being said, many of these children are living in poverty and they often greeted me with...“one dollar?”

     During my one full day on Ebeye, I decided to go for a walk…a long walk. My guidebook, that was a dozen years old, mentioned a “poorly maintained causeway” that linked Ebeye to some other islands of the atoll. So I set off with two goals in mind – find the remains of a World War II Japanese armored personnel carrier and reach the end of the causeway. I met the first of these goals, but despite walking for over 2 hours to the north and having the road become just a small trail I never did find the end of the causeway linking the tiny islands to Ebeye. I finally turned back, prevented from going further by sore legs and an emerging sunburn.

     I knew before arriving on Ebeye that my swimming options would likely be two - a public beach or a snorkeling tour. When I inquired at the hotel desk, it was clear that there were no regular snorkeling tours to be had in Ebeye, but "the beach" was apparently quite easy to locate. "Just turn right when you go out the door and follow the street to the end, you can't miss it".  Or in case I did miss it, "you can ask anyone where "the beach" is and they will tell you". As advertised, "the beach" was simple to find and though not nearly as picturesque as many of the other beaches that I had passed on my walk earlier in the day, "the beach" provided easy access to the calm waters of the lagoon and a small audience, of course made up solely of children.

     As I travel and consider the level of Parkinson’s awareness and care in each country, I understand that the money available for healthcare is always limited and there are other competing priorities. In the hotel lobby in Ebeye there was a sign for a diabetes program, which is not surprising given the probable high prevalence of the disease in this population. The town had a small hospital and was in the process of building a Wellness Center, but you can image where Parkinson’s disease would rank as a healthcare priority in a town with so many needs and a generally young population. In Pohnpei, my guide let me know that those who require specialty care in the region travel to places like Manila, Honolulu or Guam. He also told me that hourly jobs often start at $1.75/hour – so most people needing to see a specialist, like those with Parkinson's, cannot even afford the travel expense.

     Air links to Marshall Islands have long been limited to the United Airlines "island hopper" (previously Continental Micronesia). This flight from Guam to Honolulu stops in Kwajalein and Majuro, along with other stops in the islands of the Federated States of Micronesia.  Our stop in Majuro was scheduled to be less than hour, before continuing on to Honolulu. When the time on the ground to address a mechanical issue stretched to two and then three hours, we all became a little ansy. At four hours, we were relieved that we were allowed to reboard the plane. However, our joy was short-lived when the captain informed us that they had run into crew rest issues. Given that there were no other flights and therefore no other planes or pilots arriving in Majuro, we would simple have to wait on the island until the crew had there prescribed time to sleep. This meant the airport staff had to scramble to find hotel rooms on the small island for all of those on the plane. I finally arrived at a hotel room around 1:00 AM, spent the next hour on the internet trying to arranged a new flight from Hawaii back to the mainland and then got about 4 hours of sleep before preparing to return to the airport. My extended stay in the Marshall Islands turned out to have two benefits.  First, I was made aware that not everywhere in the Marshall Islands resembled Ebeye. Majuro, the capital, had well built housing, well maintain roads and plenty of tourism infrastructure. However, my stop also verify the challenges to providing healthcare in this part of the world. I met two individuals who worked in different capacities with an NGO and a public health program and both spoke of difficulties trying to deliver specialty care. An epidemiologist, who worked with diabetes programs throughout the islands of the Pacific happened to have a family member with Parkinson's. Having curiosity about the prevalence of Parkinson's among Pacific Islanders, she had specifically looked for the diagnosis when performing medical records reviews for other projects. She found a number people from her native Samoa who had developed Parkinson's, but noted that ALL had been diagnosed while living in the US. These observations during my travels once again highlight the large gap between the needs and access to care for those impacted by Parkinson's in remote, economically deprived nations, such as the Federated States of Micronesia and the Marshall Islands.

                                      Ebeye                                                     Majuro


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