I know what you are thinking, You are on a tropical island! How could that possibly be less than paradise? I got many comments before departing for residency on how I would be in paradise, and how lucky I was to be in a place like Fiji. I always paused for a minute, trying to figure out what the outside impression was of where I was going. I was not going to live in a resort on the beach… I was going to Fiji to bring services to marginalized populations. We are nowhere near the tourist track, or the beach. In fact, we have seen two other white people in this town since our arrival. The profile of Labasa was exactly what I was looking for regarding my residency, because it was an area of need without occupational therapy services, leaving lots of room for program development.
Although the lifestyle can be taxing in areas of need, the work is always intellectually stimulating. A lack of resources leads to great creativity. I have learned things about healthcare that never would have surfaced had I stayed in the United States. One example includes the discovery of a literature pool regarding the effectiveness of wound healing with banana leaf dressings. There is a shortage in wound dressings here in Fiji, particularly for the patients. There is no proper bandaging material available outside of town, so patients who travel hours to get to the hospital with a large abscess cannot safely change their bandages at home. This is a huge problem that leads to high rates of infection, and commonly amputation. My last educational lecture to the hospital staff focused on wound care, and I presented the findings from the studies that successfully used banana leaves and boiled potato peel for wound care. It was fascinating to listen to the discussion unfold with the staff and hear stories about what has been used in the past in Fiji and how things are changing. Big ideas don’t require fancy technology.
My experience working at the Labasa Hospital has truly forced me to step back and look at the big picture. As an aspiring type-A hand therapist, I find myself worrying about the elements of what is missing relative to my experience in the United States with hand therapy, because I have learned that evidence-driven interventions are most effective. I continue to remind myself that the way things are done in the states is not always relative to Fiji. Small gains in Fiji end up feeling like big rewards.
Now let’s talk about the beach. 5 weeks into Fiji and I still hadn’t seen the white sand beaches and blue ocean everyone raved about. I know, first world problems. I don’t want to give Labasa a bad rap, but Justin and I were ready to start exploring. Although Labasa can be rough living at time, the areas outside of town are dripping with heavenly beauty. Our first month in Fiji we stayed in town every weekend. I was working on my projects every Saturday, and we wanted to get oriented to our new home town. We also wanted to save money, because, student loans don't dwindle while in school. We gave ourselves a swift kick in the britches and got to planning some weekend excursions. My previous post highlighted our first getaway at Palm Lea Farm in Tambia. It was a short ride from Labasa (~30 min) and was a little slice of jungle paradise. But, the water on the north side of the island is murky and brown from the mangroves which is slightly nerve-wracking given there is a high concentration of bull sharks. Unless you can get on a boat out to the reef (which by the way, is the third largest reef in the world), brown water awaits you at the shore. I still can’t figure out why most people don’t venture out to the reef. After feeling like our batteries were recharged 110% at Palm Lea Farm, we decided it was worth our mental health to start taking weekend trips. We are nomads by nature and have never been the type to stay home when opportunities are at our fingertips. And working on a Saturday? I’ll be having no more of that.
Savusavu is a hidden gem in southern Vanua Levu. We hopped a 2-hour bus ride to arrive at the sight of the bluest ocean I have ever seen. The change of pace from Labasa was immediately palpable down to my heartbeat. This was the slow life I was looking for.
We chose Savusavu because of its convenience to Labasa. Reading about this sleepy beach town on travel sites sounded nice, but it was definitely downplayed. My first though upon arrival was – why aren’t people flipping out about this place? I just couldn’t believe how glorious everything felt. High hills of pristine greenery surrounded town and across the bay. And that insanely blue water with visibility down to the ocean floor made my heart sing. I suppose most people want luxury during vacation, which Savusavu lacks. It is a simple place, with a tiny strip-mall of local shops to cover basic necessities. There was a power outage on Saturday that lasted most of the day, but it didn’t bother us because we were out swimming and lounging until sunset. What Savusavu is missing in high-end creature comforts, it makes up for with jaw-dropping scenery.
And now, pictures of paradise.
Fiji is not a place that accepts physical disabilities as a society. Nothing is ADA-accessible to even a mild degree, which makes my daily commute a constant adventure. I knew I was entering this country with added challenge if I was going to require a wheelchair for walking tasks. Once that notion became a lived experience, the anticipated challenge was so much harder than I could have imagined. One of the most shocking experiences I endure multiple times during my work commute is random people walking up to me, blocking the path, and asking why I am outside in a wheelchair. Comments such as “you cannot be out here as a woman like that!” or statements that prod at my personal information like “What happened to you? What did your doctor say?” happen nearly every day. Sometimes it’s humorous, other times it’s bizarre, and most of the time I am just overwhelmed as to why a complete stranger is touching me or demanding answers to questions about my health. Frequently, they will not even speak to me, they question Justin directly as if I am invisible.
I had many concerns about how my patients would view me, but this has ended up being easier than I anticipated. My yoga programs I wrote before coming to Fiji had to be changed to a sitting position on the floor or in a chair. I had fears of my patients disliking my classes because they would be taught in this manner, but people are surprisingly adaptable. What I have also found, is that my classes have required adaptations regardless of my own injury because my patients ALSO need adaptations. Thus, the nature of the class needs no explanation. Most of my patients have never done yoga either, giving me a blank slate to work with and formulate my classes however I want. I gained trust from the kids at the special needs school quickly, because I was relatable as a person navigating my environment with a disability. At the hospital, I generally assist with upper extremity patients, so I get to sit during patient treatment. But most days I am asked by other patients if I am in the physio department for treatment, and I catch them by surprise when I say, no, I'm here to give you treatment.
I’m trying to see things in a light that offer growth and flexibility. But there are days where I feel knocked down, because it’s all just too much. Last week I was exhausted, sick of being in a wheelchair, sick of the stigmas, tired of being constantly stared at, and overwhelmed by the cultural differences. The chronic pain I push through each day breaks my focus at times and I yearn for normalcy. I had to stop and reset. This type of environmental setting is not new to me, but the wheelchair makes me feel like an alien in my own body. Self-care has been pushed to the side for many weeks so I can focus on the care of my patients. But we all know that if we don’t take care of ourselves, we can’t take care of others. I was not practicing what I was preaching. Justin and I were long overdue for a weekend vacation. I have been logging many overtime hours on Saturdays working on my projects so they are ready for the following week. But not last weekend. Justin and I found an affordable resort to the west of Labasa and made a last minute booking. I eagerly counted down the minutes to sleeping on an actual mattress and having a hot shower. The true luxuries in life are the little things we take for granted.
The weekend was a dream. We slept in and ate fresh fruit and vegetables from the organic farm on the premises. We kayaked to a secluded beach and swam in the private pool under the palms. We spent our afternoons reading on the porch and staring at the big blue ocean. I tried to let go of any school tasks on my mind (emphasis on tried) and treated the weekend like time off. The life changing magic of self-care should never be underestimated.
I was torturing myself for a while by continuing to hide my physical limitation I am currently living with. I posted one photo on Facebook exposing my reality, and thereafter continued to portray myself on social media in a wheelchair-free manner. I am slowly accepting my reality. I mean, do I have any other choice? I still shudder when I see my reflection in a wheelchair. Self-love is complicated. The cultural stigmas in Fiji amplify my desire to hide this part of me. Fiji’s culture wreaks havoc on my ego, but at the same time it brings me peace. I don’t know anyone here, and the people I am meeting don’t know my past. I have nothing to live up to or explain of my changed life. I don’t always have the gumption to stand up for myself, but when I do, I hope I can use the abrupt confrontations from strangers in the street as an opportunity to educate people about disabilities. Fiji is not progressive in this manner and badly needs reform. Simply being out in the community, no matter how horrified passersby are by the sight of a woman in a wheelchair, is a means to show the community that everyone is capable of participating in daily life.
And now, some snaps from the weekend.
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.
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.