Finding Rhythm in Fiji

A shot from Justin's drone. This is our backyard.

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.

Our new roommates!

Sheep grazing the roads by the sugarcane, down the way from our home.

Yoga with my middle school class. Teaching them breathing techniques :).

Chair-based yoga class with the teaching staff for stress-management.

First of my lecture series! What is OT - How it is used for rehabilitation - Why it is Important to Global Health - How can we Integrate it into Fiji Healthcare Services

Yoga Exercises for the Prenatal Group

Yoga Exercises for the Prenatal Group