Thursday, March 11, 2010

Tips for those planning trips

Elias here. There are a few folks planning their trips for next year, and I've been holding onto this tip post, but I figure now is the time to share it! Hopefully Hillary will add her own tips to people planning to go.


ITA Software has some of the best searching capabilities, including their monthly or beta "Matrix 2" feature that lets you find the cheapest days to fly, if you're flexible, which we usually are. Some of the flight combinations are complicated and it's helpful to book using a travel agent, but travel agents can't book some of the airlines (like the discount Australian airlines or Air Vanuatu). I found my flights on ITA and brought them to a travel agent at STA in the University District (hi Dave!) and he managed to get me an even cheaper itinerary. It cost $50 to book the itinerary with him, which was definitely worth it, though I had to book some of my flights on my own. He also booked my tours in Australia, and I was pretty happy with that service (I emailed him from Vanuatu asking him to book me).

For internal Vanuatu flights, Air Vanuatu offers a baby doc discount, and you can search for flights on their web site. You can book those flights pretty close to when you want to leave and can walk into their office downtown. Tanna and Santo are popular internal destinations.

Where to stay:

Many baby docs stay at Coconut Palms. Booking through or FlightCentre is cheaper than booking directly (though you don't always get breakfast included). They don't advertise it, but they have a baby doc lounge with a kitchen, fridge, and free internet access. This is important because only the most expensive Coconut Palms rooms have cooking facilities. Some even have shared bathroom facilities. You can get a discount for staying an extended period of time, and some have gotten discounts for being medical students. The manager is extremely sociable and often looks after the baby docs. There's a pool, a pool table, restaurant, bar, and laundry (250 vatu to wash).

If you're not coming alone, or you don't need the social aspect of Coconut Palms, Tradewinds is closer to the hospital (marginally), can be cheaper, and even the studio apartment has en suite bathroom and full kitchen. We're paying 4500 vatu per night over the course of our extended stay ($45/night for 2 of us). This is a much smaller facility than Coconut Palms, but it still has a small saltwater swimming pool, ping pong table, gas BBQ, and kayaks available to be hauled down to the lagoon. The housekeeping staff will do your laundry for you for 1000 vatu, or you can use the machine yourself for 500. We hand wash. There's a clothesline setup alongside each apartment (which are each stand-alone).

Hillary probably has something to add on this count -- she stayed at another resort (Mangoes) and got an even better deal, but she was there during the wet season. Mangoes, Tradewinds, Coconut Palms are closest, then Poppy's on the Lagoon (where some folks stayed a few years ago) and then other resorts further out. If you're going in a big group you can rent a house.


Beware the following:

  • Your bank will probably charge you to use someone else's ATM (or if they're evil enough, like ANZ, their own ATM)
  • Your bank will probably charge you a foreign transaction fee for the currency conversion when pulling out cash
  • Your credit card will probably charge you a foreign transaction fee for the currency conversion
  • Local businesses are charged for their credit card transactions, so they charge you to use a credit card

Bank of America has a partnership with Westpac, which has ATMs easily available in town. I'm a BoA customer and have yet to pay an ATM fee (though I do pay a 3% foreign currency transaction fee, I think, although in retrospect I see no evidence of that).

Speaking of fees, almost everyone in town charges an extra fee to use your credit card. This can be as high as 5% on top of your bill, so most of us use cash most of the time. If you're going to use cash to pay your hotel bill though, you need to work around your bank's ATM daily withdrawal limit and also deal with the ATM fees (if you have them), so in our case, the hotel's 3.75% credit card surchage was close enough to the ATM foreign transaction fee, and I was sufficiently disinclined to pull out that much cash, so I just used the card. Capitol One is one of the only credit cards that doesn't charge a foreign transaction fee -- I got a Capitol One card just for this trip.

Bank of America also has a foreign currency order service. Before I left I ordered currency online, both Vatus and Australian dollars. They were delivered to the branch of my choice for a $7 delivery fee and took around 2 days. (They can deliver it to your house, too, but you have to be there to sign for it.) I got a pretty decent exchange rate, and I had the comfort of knowing I'd be set for money for a little while, and the pleasure of showing off the pretty money to folks before I left. The huge foreign currency service in the States didn't carry Vatus, so I'm pretty impressed with Bank of America.

Au Bon Marche (the big supermarket) doesn't charge extra to use a credit card. Everywhere else I use cash.

The hospital:

I had the intention of wearing scrubs. I bought good quality scrubs, knowing I'd be washing them a lot, and wanting the pockets all down the side. It's like wearing jeans in the tropics. Within a week and a half I'd switched to wearing my cargo shorts and a scrubs top. Nobody wears pants at the hospital. The midwives and nurses wear uniform dresses, the doctors wear shorts and t-shirts or island shirts. Actually, the nursing students wear white pants and tops, but they're the only ones. Nobody wears closed-toe shoes. Everyone wears sandals, closed cell polyethylene clogs (aka Crocs), or flip flops. I got closed-toe Nothinz-brand clogs (which are cushier than Crocs), but the closed-toe nature means I sweat hugely in them, so I wear them with socks, which I powder liberally in the morning. If you go into the operating theatre they have clean scrubs there to change into.

Bring a tote bag for your hospital stuff. I bring a supply of gloves (sterile and non), food, water bottle, headlamp, and reference material.

I sweat profusely, especially when I have to suture, so I've acquired a couple bandanas/headcoverings from the operating theatre. My sister also sent me a Croakies to keep my glasses on, since they just slide down my nose. Thanks, sister!

Travel insurance:

I got it through STA. It was only a few hundred bucks for my 3-month trip (it's priced based on length of trip), and covered medical and electronics, and since I got it within 2 weeks of booking my flights, covered terrorism and the airlines going out of business. You can get a rider for sports, too. Some diving outfits offer their own travel insurance.

Wednesday, March 10, 2010

Last Days

I am relaxing listening to the sound of rain and wind. Contemplating going for a surf in this weather. Its my last few days here. Savoring it. I worked with Lissie last night, I hate to pick favorites but she is my favorite. She has such a warm heart and makes me feel appreciated. She always gives a little clap and a smile when I walk in to her shift. She pulled me aside and gave me a little purse with that says Vanuatu. Made me cry, it was sooo sweet. I will miss her. Nothing of particular interest has happened on the maternity ward, I have just been developing my skills, gaining muscle memory and learning a few new things. I had one of the interns to teach me to put an IV catheter into an infant, I have done one short straight forward neonatal resuscitation and I have done enough suturing now that I feel like I can effectively use the instruments. I am a little worried about what it will be like to go back and do births in the US where women don’t just slide up onto a table when their fully dilated and push their babies out. I am used to looking at my watch and feeling like 30 minutes is a long time to push. Back in the states I think an hour is closer to average. My perception of certain things is skewed. I used to get squeamish at giving babies shots, I hate to hurt them when their brand new. But I have put so many needles into baby thighs here, I barely think twice. It will be interesting to go back and feel what it is like to do homebirths and practice as midwife in the US again. There are few things I wish I had the opportunity to experience… a breech birth, a shoulder dystocia, but all in all I have learned so much. Last weekend one of the chief pilot’s brother came into town. I was taken along for the ride of showing his brother a good time. Wined and dined, gambled, drank kava, stayed up late laughing and raiding the pool at their resort. Then I would wake up tired, and they would pick me up to go for a surf, I’d do several hours at the hospital and meet them for dinner to do it all over again. It felt like an episode of entourage or something. I ‘reckon’ I will never experience anything quite like this again. Loving my work, picking my schedule, learning, playing hard, enjoying the sun, honing my intuition as I am free from structure and schedule. There is a reason I haven’t been on the blog in a few weeks. I have been too busy living life to the fullest to spend time writing about it on the computer. I will miss the beautiful smiles on the mammas on the maternity ward, the sweet moments bathing the babies after the birth, the giggles of the midwives, the warm waves, the Australians that seem to speak a foreign language that makes me laugh with every conversation, the relaxed sense about life in island culture. To all who have followed my adventures: thanks for listening, this was an important part of my process here

3/3/09 Surf and Sky

The maternity ward has been slow. Lots of scrubbing the beds, making cotton balls and folding gauze. I have really grown fond of the midwives. They are such kind souls, we make faces at eachother, discuss their culture and laugh. We laugh a lot, now. Always something to giggle about, its so much fun to be in on the ward and feel like I am really helping and I am so glad I have a few more weeks here. Outside of the maternity ward, I have taken up surfing. I go out to the point every chance I get rent a board and head into the crystal blue water. It is reef break so I can only surf at high tide. I have stopped working regular shifts at the hospital and go into work based on the hours I can surf. The water is warm and the waves are small and perfect for learning. The kids all chatter, scream and call out and cheer me on. Its such a joyful place. I love being out there, its been a while since I have taken up a new sport its great to get my body to learn something new. I also have made friends with a gang of pilots. The one airline over here, Air Vanuatu has about 30 young guys from Australia and NZ that work for them and they are all tight group of friends. It a click that reminds me of capoeira a little bit and I have good time hanging out with them. Its nice to have a crew of people to do things with. This trip has been perfect, time with my mom for a couple of weeks, lots of alone time for a couple of weeks and now it looks like lots of going out with new friends for the last couple of weeks. I love Vanuatu!

2/23/10 For Autumn

Today I am missing my friend. She was killed in an accident 3 years ago today. Its nice to have time a space to contemplate her. Woke up did sun salutations, one for every year of life and one for each of the years of her life I have now missed out on. She was golden. I wasn’t sure if I wanted to go into the hospital or just sit with my memories but intuition drew me into the maternity ward. It was busy! Two women were being prepared for ceasar (c-sections), which never happens (two at once) and there were several antenatal women getting close to delivery. The midwives and nurses were all busy. I took one women back to the delivery room, she was saying that she wanted to sit sit (push). No one was around to help me so I prepped everything, hemorrhage meds, IV ready to insert if need be and layed out all the supplies. I did an exam and she still had a bit of cervix there, we tried to push it back but it didn’t work. I had her do some sidelying contractions, still there. I could tell that the baby was a little asynclitic or crooked coming down by the sutures on the babies skull. This mamma had been up all night, she was exhausted and kept begging me to help her. Much to her dislike I made her get up out of the bed and put one foot up on the stool and do some lunges while I helped support her through a contractions. She cried while we swayed and then switched feet for the next contraction. Suddenly she started to grown so I had her get back onto the bed and slipped on my gloves. With the next contraction the babies head was crowning, it worked!!!! After the head I felt and there was cord around the babies neck. I told the mom to stop pushing so that I could try and slip it over the baby’s head… it was too tight. Another strong contraction came and told the mamma to pullum wind (breathe) through the contraction so I could cut the cord but she couldn’t stop it and the baby was coming. We learn this technique to sommersault the baby out in school but I had never actually done it. I held my breath and pinned the head to the inside of the mom’s thigh and the baby flopped out of her in a forward roll. Future acrobat maybe. The baby was quite blue and for about 30 seconds didn’t take a breath. My heart raced as rubbed the baby, trying to get it to cry. It let out a cough and then strong scream, and its skin started to get pink. Phew!!!! I gave the mamma her shots, delivered the placenta, examined her perineum and she had a small tear. I set up a sterile field, gave her 5 stitches, one of the best I have done and then took the baby out be weighed and given its shots. No other person came into the delivery room the entire time. I knew they were just out in the hallway and only a shout away if I needed help but it felt like such a sense of accomplishment and competence to be able to do it all on my own. Through a cervical lip, a nuchal cord and a tear. I starting to really trust my skills and feel proficient in my craft. Thank you Autumn, you are always giving me beautiful gifts…. I miss you!