Things are finally in a routine here in Fiji and I feel like I’ve hit my stride. Last week I started consistently working at the hospital, and my yoga programs at the school are running on a regular schedule. Quite the change from my last post! There’s no debating the challenge of my first two weeks in Fiji, but with much persistence, things are happening. A big change that happened for Justin and I is we moved into a home with a family of 6. Our former living arrangements fell through, which was added stress to the former chaos. Justin and I were at a loss of what to do initially given we didn’t know anyone in our small, rural town. We went around the neighborhood asking around about room rentals, and to our surprise, multiple families eagerly offered us a place to stay. Can you imagine such a thing in the United States – two foreigners scoping the neighborhood, knocking on doors, asking around for an extra sleeping space? Small community support is strong here in Fiji. We are in tight living quarters for the next few months, all 8 of us sharing one bathroom with paper-thin walls, but it’s amazing how comfort can be found simply by the fact that we are around loving and hospitable people. The kids are nonstop energy (age 2, 6, 6, and 12) and the mom is a total rockstar. She insists on doing all our laundry (by hand) and cooks all the meals over kerosene and open fire. We feel lucky and well cared for in our new living space. I am very much an introvert in how I recharge, so I have to find quiet spaces to myself during the workday, which is impossible most of the time.
I am in my second week of my pediatric yoga program, focusing on executive function skills development for one of the middle school classrooms with moderate learning disabilities. My data set is small thus far, but it has been fun to see how the kids change their focus and divert their energy over the course of each session. I have also had lots of positive feedback from the teachers from my chair-yoga class for stress-management. Yoga is my primary avenue for delivering services, but all of my interventions still remain in the realm of occupational therapy.
The hospital has been an eye-opening experience. I have been given high respect and responsibility since my first day, which I wasn’t expecting given I am an outsider with a physical disability. I feel very trusted, which is empowering, but also stressful at times given we see a wide range of diagnoses in the hospital. The physio staff has been a delight to work with. There are four physiotherapists and one student, all rotating through the inpatient ward, outpatient unit, and home visits. Every Friday there is a Diabetic clinic that I got to be a part of last week, which involves an influx of patients from all over the island. We provide education regarding foot care, exercise, and other relevant topics to their diagnosis. Wednesdays are my favorite day since there is a hand surgeon on staff and I get to see all his post-surgical patients. My first Fieldwork rotation in Arizona was in hand therapy and happens to be my preferred work setting, so I was over the moon to learn I would be working with this population in Fiji. When a patient with a hand injury walks in our door, the staff looks to me to take charge. I’ve had to act fast and be creative with very few resources. All my free time outside of work is spent reviewing my school notes, calling mentors to problem-solve, and digging through the literature.
The surgeon on staff does not have a traditional MD. I learned from a staff member that medical doctors in Fiji usually obtain a Masters in Allied Health. I was slightly horrified upon learning this, but this is how things work logistically in developing countries like Fiji. Sanitation measures in surgery are nil compared the U.S., leaving the risk for infection unnervingly high. Amputation is common, especially given the rate of Diabetes in Fiji. Rehabilitation protocols are not always effective or evidence-based, even when written by the surgeon. Standard patient evaluations are not done with patients on their first visit, which has forced me to be creative and quick with my assessments. When time is available and there is no line for therapy, I spend much longer with patients, asking evaluation-based questions and developing therapeutic exercises and routines they can use as a home program. My impression why evaluations are not completed is that many patients travel from far away and do not always return for a follow-up to the hospital, so formal evaluations are thought to be excessive. I think you get the picture by now that things are different here! And I expected them to be, which has been invaluable to my learning regarding global health. Fiji won’t be the end of my international endeavors, and it is important to me and my own learning to see through the lens of other cultures in how healthcare is delivered. When a protocol is not evidence-based, it does not necessarily mean it is wrong. Most developing countries don’t have the resources to conduct research in the first place, and when basic resources aren’t available, treatment unfolds in a way that is distinct from the process in another country. It’s easy to be on the outside and say ‘that’s the wrong way to do it’ but keeping in mind the environmental, financial, and remote factors influencing the system, I can understand that protocols taking place are the next best option. I am slowly learning the complexities and hardships of healthcare in Fiji.
As a way to share ideas and openly discuss the layers of health services, I am writing an education series for the staff that involves weekly presentations of evidence-based practice. To lay down the foundation, I started with a lecture on the basic practice of OT, our role in rehabilitation, our value to global health, and why OT is of benefit to Fiji. At the end of the presentation I left time for discussion to share ideas and problem-solve ways we can merge our backgrounds in therapeutic intervention. It was fascinating hearing the staff bounce ideas on how to simulate therapy tools and interventions used in the U.S. They are the real experts here since this is their home turf.
Another really fun thing I get to be a part of on Thursdays is a prenatal group session for first-time mothers. Attending mothers come from all over the island to learn about the basics of pregnancy, anatomical changes their body is going through, how to manage pain and discomfort (cue, yoga!), and the stages of labor. In the U.S. someone would generally just pick up a book and read about these things or ask their doctor at a routine visit, but this is Fiji. Many people don’t have access to books OR internet. If they are traveling from hours away on the opposite side of the island, it might be the only time they see their doctor. This class might be the only time they learn information about their pregnancy from a medical professional.
Lots to juggle, and lots to keep me busy. I’m excited for what the next two months has to offer here in Fiji. Here are some snapshots of life the last two weeks.
The most important thing yoga teaches us is not the asana, or postures, that we hold for exercise. As I have described before, yoga is a study of self-healing and a way of life. Central to the practice, there is the notion that our external world is out of our locus of control, and it will never be in our control even if we perceive it to be at times. Yoga helps us to feel centered in the chaotic external world.
Cue, total disorder in Fiji.
That might sound kind of dramatic, but if you read my previous post and have been following some of my stories, you probably know what I’m talking about. It’s the peak of tropical storm season, and Cyclone Gita pummeled through southern Fiji earlier this week at a category 5. We were very lucky in our village not to be hit by the belly of the beast, but Tonga is in a state of emergency and practically under water from flooding. Additionally, our visa extension has still not been stamped and we are 3 days past our current visa. Our application materials are in, but the process leading up to this was not promising, with lots of mishaps and headaches. On the school-front, my residency has been crumbled and re-built a few times since my arrival. Culturally, things run at a different pace in Fiji, but I have also planned this trip for almost a year with my objectives in place with my prospective entities in Fiji so it has been confusing to me as to why prior agreements were nil when I arrived. Flexibility is an understatement. My specialization in adult treatment is not my leading focus as I had first planned, and has shifted to pediatrics, because that is what is currently available. It nearly compromised my capstone, and it took lots of unplanned hours and late nights re-writing session plans and data grids. Serious gratitude goes out to my OT mentors who have given many hours of their own time in aiding me through this process. Every time I get off the phone with my mentor in Phoenix I spend about five minutes thanking her, and it is worth every penny of our limited internet.
So here I am! Hanging out in Fiji with a brand new residency. Thankfully it is still yoga-based, which was a requirement since my first month gaining my certification in India had to be tied to my residency per obligations of the national board. Most importantly, my new residency is of benefit to the community of Labasa, which is why I am here in the first place. If this project was not tied to school, I would be stress-free, and using my skills as needed anywhere and everywhere as the day presented itself, but that is obviously not reality. Damned be the real world.
Dare I present to you my current project? Please pause for a minute and find some wood to knock on for me.
I started a yoga-based stress-management class for the teaching staff that I am running weekly, using a perceived stress scale and mood scale to measure outcomes. On Monday I begin one of my primary residency objectives which is a yoga-based program for improved executive functioning, with a focus on increased sustained attention and mood control for school-aged kids. I am running this program 3x/week in a classroom with kids 11-18 years old, who have attention deficits and other executive functioning limitations. I am really excited about this program and hope there will be good outcomes with the assessments I am using. The teacher is a fantastic support and is on board with the program as well, which is truly the backbone to making this possible. I have approval to work at the hospital too, which is a sliver of hope to use my adult program I had already written out in length. Pending connection with the supervising liason, I will be able to get into the physio department to work with the amputee population. Lots of blessings come with change, yet some are under muddied water at first glance.
In the midst of these changes, one of my mentors suggested adding a side objective of journaling about my use of the yogic Yamas and Niyamas to facilitate flexibility and resilience in a cross-cultural clinical experience. I have been digging deep into my yogic stores in this realm, so for those who aren’t familiar with those terms, let me describe their significance. Yamas and Niyamas refer to one’s personal moral guidelines, which we use every day in our interactions with those around us and our self. Yamas include components such as nonviolence, truthfulness, and non-greed, while Niyamas include contentment, self-study, and self-discipline, to name a few. Think about these components as such – if you were to attempt a project or a new job without first addressing that you are anxious, depressed, or violent, those traits will rear their head in future experiences. It is essential to have a strong foundation of moral precepts in order to contain your newfound energy, otherwise you may unintentionally disturb or harm another person’s autonomy. The Yamas and Niyamas can be interpreted very literally, such as not hurting another person under the precept of nonviolence, or it can mean refraining from gossip or complaining about others. Certainly something I am being tested in with the changes of my former agreements going nil, but it does nothing good for myself or society to spit fire at them. And so this is yoga, establishing safety and steadiness in a life of constant change, with many milestones left without conclusion. Nothing truly is in control, but our ethical compass can serve as a means to shape our reactions to disorderly experiences. It is our choice how we portray ourselves to the world, and inward to ourselves. I am embracing Fiji for what it is, and what is to come. All I can do is present myself as I am, with what I have to offer.
No one said it would be smooth sailing. I made my way to Fiji in high spirits, feeling empowered by positive self-talk, as you might have seen from one of my previous posts. I needed every ounce of that optimism come touch down, because it would be tested within minutes of entering immigration. Justin and I closely followed the visa requirements with the guidance of my mentor, and had all materials in line before flying to Fiji. A few days prior to our arrival without notice, the Department of Immigration placed a stronghold on the visa process and added some lofty changes. Surprise! You are only allowed in the country for two weeks! Justin and I sat stunned in the immigration office outside of the international arrival hall. We had all the requested materials, but the clerk said they could no longer accept any applications after January 31 (It was February 1) and all applications for the year must have been made before that date. I tried not to freak out, so I called my mentor, and then we freaked out together. After a hot minute we re-grouped and tried to problem-solve and came up with a plan. We would take our flight to Labasa the next day (my residency site), my mentor would request permission from the director of immigration in Suva for our extension, and take it from there. If it was rejected again, we would fly to Tonga or Samoa and try to re-enter on a tourist visa. Our ideas were a little comical in retrospect, but creativity was of the essence.
By the next morning, we received notice that the director of immigration approved our visa extension and we were to get our passport stamped before taking our flight to Labasa. Relief! Or so we thought. We reared our American faces at the immigration office with the letter from the director, and again, it was not good enough and they began requesting further materials. Meanwhile, a tropical depression was forming over the South Pacific and heading straight for Fiji, placing the community on cyclone watch. But who has time to worry about natural disasters when your visa is restricted, and residency compromised?
I’ll cut the visa story short and let you know that we still do not have the stamp, but we have been told by the director it should be approved. With unplanned funds from our starving bank account, obscure requested materials (ie. FIRCA Tax Form… I still don’t know what that is, but we got one), and approximately 17 trips to the immigration office, we are crossing our fingers that before our 14 days are up we can rest assured of our visas and my residency. As one of my yoga mentors told me, Ishvara Pranidhana all the way…
Oh, the humanity! Let’s knock the drama and talk about something better – occupational therapy! The town of Labasa is small, upbeat, incredibly friendly, dense with greenery, and far off the tourist track. You won’t find any pictures on my feed of white sand beaches or dreamy resorts. This town has other things to offer, and it’s not for luxury travelers. I have seen one small hotel on the main strip and wonder who stays there. Labasa is a great fit for my chosen intentions with global health, but I can feel myself missing creature comforts that were abundant in our travels leading up to Labasa. Fiji is prohibitively expensive, which I believe is largely in part to its isolation in the South Pacific. Unlike other resort islands like Bali or the Philippines, it is much more outlying and harder to reach. Thankfully my focus is on school, so it will push me to stay buckled down. The weather is hot and humid right now, and we do not have the extravagance of air conditioning. I am currently sleeping on a foam pad on the floor and wake up in a hot sweat every hour or so. I would be lying if I said I wasn’t exhausted from the conditions. There is a high risk for Dengue Fever and Zika in Fiji, particularly right now in the rainy season. We try to keep our arms and legs covered, which is a task in itself given the heat and humidity. I get bit every day, so I just think healthy thoughts. Justin and I are also frequently hungry but are slowly adapting. I have had to unsubscribe to some of my favorite food blogs because receiving pictures of food in my inbox is torture. I have reminded myself as to why communities such as Labasa are in greater need of services such as occupational therapy, because most people don’t want to sacrifice the comfort of their routine and homes. I miss those comforts, but I know the rewards that come from immersing myself in this community are far greater had I chosen a different route. The next three months will stretch me in many directions, and I welcome the challenges with open arms.
Right now, Justin and I are contracted with the Board of Education and the Ministry of Health. We are working in two locations: The Labasa School for Special Education and the Senior Living Center (‘Baba Siga Ashram’). The school happens to have a woodshop as part of their vocational program, which is a great fit for Justin. My specialty so far based on my fieldwork rotations is with adults, so my primary focus is with program development and at the Senior Living Center, with an emphasis on yoga therapy. My first week on the island has been mostly orientation and assessing the specific needs of the area. I have also laid out workshops for the vocational program and staff members, focusing on components relative to Labasa. Our work is cut out for us, and we are ready to give all that we can to this community over the next three months. I have immense gratitude for my lifelines in the United States who are continually helping problem solve all things yoga and occupational therapy related. You know who you are, so thank you a million times over!
The best part about being involved in this community is the people. Everyone is SO friendly and hospitable, it is impossible not to feel welcome. We are living with a lovely couple, who also happen to have a beautiful flourishing garden of tropical plants. After work, Justin and I sometimes stroll the neighborhood and have been eagerly invited into people’s home for tea and dinner. The joys of small town living shine bright in Labasa, and I could not feel more fortunate to be a part of the community here.
My husband and I are outdoor travel junkies who like to spend our free time experiencing nature and new cultures. On Sweet World Travels you will find stories of our adventures, our lives as health care practitioners, and the communities we serve in our travels.