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.

Flights:

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 wotif.com 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.

Banking:

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.

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!

The Lighter Side

By the sounds of my posts you would think its all serious and intense here. I think that is just what inspires me to write. The first week here, the peace corp had brought all the volunteers from the outer islands to give them some flu shots and do some training. I met tons of lovely people from all over the US doing really interesting projects in villages across Vanuatu. Living in the villages they had many wonderful insights into the culture that have helped in my work in the hospital. They happened to be here during the superbowl. There is a bar / microbrewery here called the Wild Horse Saloon owned by a couple from Colorado. They have a big projection screen and we had a Monday morning (I am living in the future) USA style super bowl party. Followed by guitar hero sillyness. My mom was wonderful company cooking and doing laundry here, she eased me into the culture shock and helped get through the intense few weeks. We went on tour called the Caloonga cruise. Where we took this 80 foot old sailboat out to a deserted beach accompanied by dolphins. At the beach we did some amazing snorkeling with insanely bright coral and marine fish in a marine sanctuary and then had a barbeque. And yes I ate the beef. After 10 years of being a vegetarian. Adventures in traveling I guess. I also met this lovely Australian fellow who invited me along to a tour in Tanna, the island with the Volcano. We flew over in a Cessna one afternoon and then took this amazing four wheel drive road across the island passing villages of grass huts with kids screaming and waving and women in brightly colored dresses and huge old Banyan trees. We got up there in the late afternoon, it was a bit rainy and foggy, which made it more dangerous cause it is harder to see if the lava rocks are coming at you if it goes big, so we stayed back from the rim at first. As night fell we went over to the rim a bit closer and you could here it go off the smoke coming up would glow red and then lava would shoot out. We sat and watched for a good while and as we were all saying we were over it and ready to go this one dude said one more, lets stay for one more. Well the next one was huge lava came shooting right out of the volcano in our direction. The guide yells for everyone to stand still and only move away if it comes close. Once all the lava hit the ground, the guide tells us its TIME TO GO! As we walked past where we were sitting before there were these two huge glowing hunks of lava rocks. Then as we were driving back home, just 15 minutes later as we came around the back side of the volcano there were two HUGE eruptions that shot lava rocks half way down the backside of the volcano. The back side had a higher rim so they had to be pretty huge eruptions to send lava that far. The guide said we were lucky we weren't still up there. Kinda sketchy. Definitely got the heart racing, but it was amazing to see. You could hear the Volcano rumble all night from the spot where we stayed which was pretty incredible because we were on the opposite side of the island with big mountain range in between.

The Mundane: I get up every morning and have a breakfast of tropical fruit, check my email, then I either head for the hospital to do the day shift or go out for a day adventure to swim and snorkel at some white sand beach and come back to do the evening shift. Somewhere in there I cook some food, stop by the hotel bar to chat with the fun people I meet and have a Richard special. Richard is the bartender here and he makes this amazing cocktail with rum, mint, lime and lychee. When I get back from the hospital I always go for a dip in the pool whether it is 3 in the afternoon or 2 in the morning. Life is not so bad.

2/19/10 Stillbirth

I see why everyone told me to stay for 6 weeks. I have been here for nearly 3 weeks and I am just getting fully competent in the procedures of the hospital. Now I can really be useful. If I had stayed a month then they would only get a week of that. Yesterday I was the admissions girl. Doing the initial evaluation of the multitude of women coming in to the hospital. A young 18 year old woman with gorgeous skin and an infectious smile came to me and handed me a card, I got her chart and brought her into the admission room. I felt her belly determined which side I thought the back was on and asked her then normal run of questions. Had her water broke, has she seen any blood, has baby been moving, when did her contractions start? I put the the Doppler on her belly to check the fetal heart rate, nothing. I tried the other side of her belly nothing. I slathered her with gel and glid the Doppler across her lower abdomen, occasionally a rate of 50 something would flash but no beat. I went to get the midwife and inform I couldn’t find a heartbeat. She came and repeated my steps, still nothing. And in fact she hadn’t felt the baby move since yesterday. She went and got a doctor so that we could send her for a scan or ultrasound. He found nothing, she was four cm, plenty of time for a scan. About twenty minutes later I saw her walk past the admission room, tears streaming down her face. They hadn’t found a heart beat. For the rest of the morning I saw her walking gracefully, moaning through her contractions all with sad eyes brimming with tears. She delivered that afternoon, a small quite blue baby. We wrapped it blankets and the family passed it around rocking it and wailing. I sat behind the curtain just listening to it the melodic wailing. Some peace corp workers told me this time is important. It is essentially the only time they are allowed to express their grief. When someone dies they wail initially and until the funeral and after that it becomes inappropriate. I will always remember the father. He came into the delivery room with his sunglasses on and tears streamed out from underneath, covering his cheeks. I was surprised at the amount of emotion displayed. He did not wail, he just cryed. He watched as I weighed and bathed the baby. The room was silent except for his sniffling. Its true, they are still born. Several babies were born after that, and I often caught him standing at the door, watching me as I weighed and bathed the other babies. These little ones screamed in discontent and being uncovered and I would try and soothe them with my silly little cooing noises. I wonder what was going through his mind.

2/16/10 The Night Shift

Everyone once in awhile there is this mark on the board: BBA. It stands for born before arrival. Baby is born at home and then they come in or it is born on the bus on their way to the hospital. For whatever reason baby doesn’t wait until the delivery room. Even though most of the time I am clueless that it is coming I know when its happening because a wheelchair heads into the delivery room instead of out of it (most women walk into the delivery room when they are in labor). Last night there was such a wheelchair so I followed it into the room to see if I could help with something. This woman could not even get up out of the chair. The boyfriend, the student nurse and the midwife lifted her out of the wheelchair and set her on the delivery bed. As she settled on the bed I noticed that her arms and legs were covered in bruises. I gasped. I thought DIC a disorder where the body clots and bleeds and nearly always causes death. Then I noticed her hands were huge and swollen. Lissie pointed out the bruises to me, as if I hadn’t already noticed. She had the umbilical cord hanging out of her, so we grabbed a clamp delivered the placenta. I heard them inquiring about the whereabouts of the baby. I gathered that the baby had not lived and had been left with the grandparents at home. The boyfriend was sent out of the room as we delivered the placenta and after it was determined she had no tears, the energy of the room settled and Lissie asked what had happened. He eyes were white and glazed over and she had barely spoken a word since she arrived. Just whispering her name and address as I filled out her intake. There was a woman with her from her villiage, she stroked her head and told her to tell the doctors the truth to tell us what happened. First it came in small bits and slowly she got comfortable and the story unfolded from the beginning. On Sunday, her boyfriend had become suspicious that she was having relations with another man, so he began to beat her (7 months pregnant) with a stick to try and get her to admit it. This went on all day and all night, she was not allowed to sleep. He told her if she would just tell him the truth he would stop, so she told him that it was true so that he would stop. He continued to hit her wanting her to divulge details, which she was unable to provide since nothing had happened. This went on through Monday and into Tuesday morning. He pushed her and she landed with her belly on a table. Her water broke. She tried to tell him she was going to deliver and to get help but he thought she was lying so instead he kept hitting her with the stick. The word for hit or strike in Bislama is killim. I sat there listening to the story thinking of the irony of that. She was describing it, “he was killim mi, killim me.” Which sounds like he was killing me, killing me. And in fact he had, only he killed his daughter. She was born dead in his home and only then did he go and get someone to get his girlfriend to the hospital. Lissie suggested that she file a police report and press charges but I think she was too scared. She made me promise noone would see the history I had taken. Then he stayed there in the hospital most of the night, caring for her in this very sweet way. For her protection I had to force myself to look down each time I saw him so that he wouldn’t see my rage, that I knew the truth.