Letter from Palau Number Eight
July 21, 2006

Greetings from Room 710 of the telemetry unit of Manila’s Asian Hospital and Medical Center.  And you thought the crocodile in the laundry room was dramatic.  What happened?  Ever hear of kidney stones?  They’re the things that every woman knows can be almost as painful as having a baby (a knowledge she is happy to share with any hapless man unlucky enough to be suffering from them—men just look at the poor guy and slink away).  Here’s the story so far:

A kidney stone made itself known in the usual, excruciating way on Saturday night while Bobby, Sunny Williams, and I were visiting Kayangel (Palau’s beautiful northern atoll) for the inauguration and celebration of the 12th Constitutional Government of the State of Kayangel.  Probably triggered by the boat ride north—pounding waves and dehydration—the first episode passed and in my ignorance of what was to come I shrugged it off and went back to sleep on the floor of the house where Sunny’s uncle had generously given us shelter for what turned out to be a very rainy, but highly entertaining, weekend.  Sunday afternoon, back in our apartment, the stone suddenly got serious again and I found myself in the Belau National Hospital emergency room, thanks to Huan Hosei who responded to Bobby’s call for help.  

The next three days are a blur.  The pain was awful and mostly uncontrolled.  The hospital staff and my doctor, Emais Roberts, were wonderful. The hospital is a very clean and welcoming place.  I have to tell you that I couldn’t be happier that McDonald Memorial Hospital is gone—an unlamented and rat infested shame of the old US administration.  Its records survive though and my existing hospital number caused considerable comment since it predated the birth of most of the current hospital staff.  The decision to refer me to the hospital in Manila was made Tuesday morning, driven not so much by my condition at the time as by a concern that should one of several ugly possibilities develop it would be much better for all concerned if I were already in the place I would have to be evacuated to.  In the past, I would have argued for Honolulu or at least Guam, the Philippines being generally rated as second best.  But not today.  This hospital is a highly regarded, world class facility, built to serve the Pacific Rim’s newly prosperous classes.

Since Continental Airlines requires 48 hours notice and a doctor’s certification to fly a sick patient and this was in the nature of an emergency, we didn’t want them to know I was sick.  Unfortunately this required that I be wide awake and alert which meant not too much Demerol beforehand. (Dr. Roberts was also on the plane and we had Demerol and needles with us just in case).  My feeling is that anyone who took a look at me sitting there at the check in counter in my wheelchair knew I was in bad trouble, but no one had to acknowledge it and, of course, they all knew Dr. Roberts.  In any event, we successfully boarded and since Continental had nicely upgraded us (probably because I looked almost as bad as I felt), we had a very smooth and blessedly short (two hours) flight to Manila.  An agonizing ambulance ride, expedited admission, heart scare, and failed procedure to learn exactly what was going on was followed by a new CT scan the next morning.  That scan revealed that the blockage had decreased and the stone was shrinking; no surgery required.  Now, we are waiting for the stone to move.  That was great news for us, as you can imagine.  It turns out that I also have a gall stone, so if the kidney stone passes and the heart doctor signs off, I will have my gall bladder removed early next week.  We’ll be here for about another week or ten days and then it’s back to Palau and my new found fame as the human quarry.  We are being very cautious; these are very smart docs we are working with; the care here is first class.

This is a very fancy joint and I am being treated like some minor Saudi prince.  But my neighbor is not a money-wise Queensland billionaire in for a very affordable “executive check-up” or the petted offspring of some Indonesian rajah here for some discrete plastic surgery.  Instead Bilung Salii is in the very next room.  She is a genuine Palauan VIP, the sister of Ibedul, high chief of Koror, and chair of the board of Palau Community College, among many other things.  Palau may well be described as a micro state but its politics cannot be called petty. Women play a leading role, and the issues addressed often are highly substantive.  Bilung’s was one of the strongest voices in opposition to Pentagon and State Department plans for the future of her country and many an admiral and many an under secretary in the Reagan and first Bush administrations must have wished they had listened to the anthropologists when advised not to dismiss her opinion, especially after a well-timed lawsuit tied them into absolute knots. It will be great if during our mutual recovery (she from multiple bypass surgery) we can talk about those days.  It’s an unexpected treat to have her and her husband Carlos next door.

Of course the failure of those admirals and under secretaries to listen certainly can be understood, given the goofy statements that have been attributed to anthropologists.  Margaret Mead, for example, is said to have once claimed that as an experienced anthropologist all she would need to make definitive statements about Canadian culture would be a coast to coast ride on the trans-Canadian railroad.  Well, I had a half hour ambulance ride from Aquino International Airport to this hospital and I’m prepared to make a couple of observations, but no definitive statements, just yet.  There is something odd about a place where dogs ride on roofs of cars and where jitney drivers seem to have taken over such crucial hospital duties as wheelchair and gurney management.  But until I get out of here and visit Cowboy Town, a place I’ve treasured in my mind for years, I really can’t confirm exactly what that is.  Cowboy Town, or so I heard in Palau years and years ago, is a village founded by an American GI from Texas who stayed here after the end of World War II.  In this village, so the story goes, there is an annual fiesta much like that in any south Texas town, except the piñatas hold not candy but soup.

No such soggy piñatas at that Kayangel party.  First a few speeches, then mountains of very good food, dancing (some of us more than others) to the music of Lisa (the chart topping Palauan pop star), dashing in and out of the rain, snorkeling in the lagoon, and, of course, lots and lots of talk.  My friend Rich Howell served on Kayangel in the Peace Corps when I was first in Palau and I visited him once or twice before going down to Tobi.  People were interested in my stories of those visits and had some stories of their own.  We all could look around and marvel at the changes on the island since his day.  New:  cell tower; huge dock with reefer for making ice to serve the island’s fishing boat; a marine protected area to the north; electricity; motorized vehicles; many more fast boats and many fewer people.  Gone:  the world’s fiercest duck.  Still there:  a total ban on alcohol; beautiful islets strung along a spectacular lagoon; white beaches, sand paths lined  with houses set among flowering shrubs and coconut trees; ancient stone platforms; birds; fish. 

When I first went up to Kayangel there were no fast boats there and very few in Palau.  We traveled in what were called sampans, orange and white diesel driven wooden boats that slowly thumped their way up the green Babeldaob coast spewing black smoke into the blue sky, delivering the mail and supplies to the villages lining the shore.  Those who remember Bert and I, the Maine lobstermen, know that sound.  These beasts didn’t have to be particularly seaworthy because most of the trip was in sheltered waters inside the reef which has made Palau so famous; if I remember right a lot of the trip was spent bailing.  Depending on wind and tides and the boat driver’s skills it could take a day to get to the northern Babeldaob villages where the night was spent waiting to cross the channel of open water to the passage into Kayangel reef.  Well, that slow boat to Kayangel with its trolling for fish, chewing betel, leisurely composing photographs of  tropical wonders, reading, talking, snacking and napping, and mostly just watching that magnificent coast roll by, with its mangrove swamps and beaches, old stone piers and hidden channels, bamboo rafts with fishermen and school children poling along inshore, is over.  These days it’s 90 minutes of excitement hunched over under a snapping canvas tarp, a pair of giant twin Yamahas in the stern kicking up a huge rooster tail, with the wind and roar and spray keeping you awake and alert and the driver sliding the boat expertly down the sides of the big rollers, and weaving in and out of channels over the reef and around big coral heads.  No point in taking out the camera; don’t even try to eat anything.  But many still find that betel nut goes well with the journey to Kayangel.  A two day boat trip has been transformed into a three betel nut ride.  One measure of progress in Palau’s part of the world.

This letter hasn’t been physically easy to write, what with all the lines and tubes going in and out of my body; my apologies if it is a little choppy.  Demerol no doubt also is playing a significant role in its production.  I’ve tried to sustain a jaunty tone to reflect how I feel now at the end of a pretty bad week.  The outpouring of affection, sympathy, and help in Palau was absolutely overwhelming.  I have no news of this week’s Rotary meeting since I left Koror before it happened.  But this experience has given me a look at health care in Palau from the patient’s point of view and the germ of an idea or two about possible Rotary partnerships in helping to meet its challenges.  I am not talking here about instituting a first kidney stone ceremony for men, either.  As for the raffle, well you know who got lucky in Palau this week. 

I don’t know about you but I have a small set of very intense memories of moments when the curtain of everyday reality seems to slip a little, revealing something beyond words but somehow deeper and more profound.  Some of these are associated with music and now I have another to treasure.  The agony of Lebanon playing out on CNN, Beethoven’s Emperor Concerto, the same music that Bobby and I heard at the Kennedy Center the night she was given a reprieve from a horrible diagnosis, on my iPod here in this room looking at her silhouette against the window, high above Manila.

That was a day or so ago.  Now she and I are getting ready to go find a network to send this out on.  If you are worried about Bobby’s capacity to cope with this situation, I think you can relax.  Her strength is undiminished and she is wise in the ways of hospitals.  Without her (whose father served in Manila in World War II, by the way), this letter would have had a very different, and much grimmer, story to tell.

Bestly cards,

Kayangel Atoll
Kayangel Atoll

PWB & Sunny on Kyangel
Sunny & me on Kayangel

Palau Hospital
Belau National Hospital

Asian Hospital  Manila
Asian Hospital

Jitney outside Asian Hospital
Jitney outside Asian Hospital

Kayangel Inauguration
The inauguration

Cooking fish
Cooking fish

Kayangel dock
New (for some) dock at Kayangel

Waiting for the boat

Waiting for the boat
Waiting for the boat back to Koror

View of Manila
View of rainy Manila from my hospital room

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