Pacific Paradise? … Pitcairn Island
Marc Shaw FRNZCGP, FACTM, FFTM (ACTM), MFTM RCPS (Glas), DipTravMed
0600 hours. The sound of the surf plunging against the volcanic rocks that form a unique island is heard. A harsh and unforgiving land, Pitcairn has a life to match. For a couple of hundred years it has survived on its own and not sought any aid from the outside other than necessary sales from its stamps, and buyers from passing ships to purchase its fresh fruit and vegetables. Life has seemed good.
Then came the influence of 'the outside world'. Communications improved and more and more folk came to visit, to probe into the history of the mutineers and their descendents, and to pry into the private lives and foibles of the Pitcairners. Huge problems started to arise in the late 1990s when local children commented to outsiders that they had been sexually abused. Once this got out then all hell broke loose and global focus was on the Pitcairn Islands - a dot on the map in the wide Pacific, somewhere to the right of Tahiti.
For the last 6-8 years there has been huge pressure on the island to cleanse itself of its image of 'underage sex'. Attorneys of prisoners for such crimes held here on the Island debate at length on the whys and wherefores of Pitcairn and British law on underage sex. Sadly, no one considers the children, adolescents or women raped and the effect of such trauma on them. There are currently five men in prison here for a variety of sexual offences; yet most here consider the whole issue a 'set up' by the British Government to get rid of the Pitcairn population, and believe that no cases of rape ever occurred here.
It is into this clime that my wife Lynne (aka the Memsahib) and I came to work. A flight - business class, for a change - from Auckland to Tahiti: a romantic stopover on our way to a two-months deployment in Pitcairn, and then a beguiling hotel in Papeete, the capital of Tahiti. But everything changes when we walk outside the confines of our deluxe hotel to view the capital, somewhat tired and shopworn place that it is. Nevertheless the Tahitians are happy with their familiar daily bustle and toil, so why should I bother reflecting how the capital looks?
Then another flight, in a significantly smaller plane, to the outer islands of Tahiti and over Mureroa Island - the site in the 1970s of much contention over nuclear arms. Then suddenly we are at Mangareva Island. This is really remote. The place would escape notice from the entire world but for three reasons: it is the place where black pearl farming is done (Memsahib wants 8 of them - I say NO loudly); some time ago someone started to build a church greater than St. Paul's for a congregation of about 50; and it is the embarkation spot for us to climb aboard the 'stout ship Braveheart' and continue on our 36 hours journey to Pitcairn, where there is no airport. This then is what makes Pitcairn one of the most remote places in the world.
Being the doc and nurse in such a community has responsibilities that reflect the island's morale, culture, and humour, and its health, safety, and security. We loved our time here. The Pitcairners are proud of their seven generations of mutineer background. I love their humour, their honesty, their generosity and their lack of any care of their own body image. None of 'ya Women's Weekly' images here, Mate - oh no! There are no metrosexuals here (a new word describing men who have a strong concern for their aesthetic appearance, and spend a substantial amount of time and money on their images and lifestyle). This is the land of bare feet, ripped shorts and slept-in braless shirts - even for the men!
A typical morning begins with the Memsahib and I finishing our breakfast of fresh fruit picked from the trees overlooking our home and delighting in the last drops of our coffee. Another day in Paradise coming right on up - we think. Suddenly a quad bike zooms into view and downloads two lawn mowers. Our landlord has chosen 0630 in the morning to do our lawns. The roar of the mowers snarls and aggrieves an otherwise lovely start to the day. It's not really the mowing that makes us choke - it is the growl as the mowers get snarled up in the lawns and cease to function, and the constant intermittent sound to the pull-start trying to whirr the rotor of the mower once more amidst the overwhelming odds of a lawn that is waist high!
Early evening is the time for a swim in the gorgeous waters of the Pacific, and then back at home to light the outside fire so that we can get hot water for a shower. Then the evening meal put on whilst we shower in a bathroom devoid of any toilet - because this is a 'long drop' (affectionately called 'The Duncan', named after someone who was a little 'ill considered') outside and one which I recently put too much kerosene in (to stop the mossies breeding) so it absolutely stinks of a 'high octane' sort of smell (and I have instructed all never to come closer than a mile with a lighted match). Memsahib just looks at me with those delightful upturned eyes and says it would be better to go the 500 yards down the road to the surgery, which has a flush toilet, rather than worry about third degree burns to our 'nether regions'.
Next, a meal and a huge decision on which wine to have - we brought a few bottles with us, not enough I hear you say - and you are right… so we go on board a passing cruise ship and buy another couple of dozen - that is "The Way" of the Pitcairn's!!! Back onshore I have just finished counting the bottles for the 4th time today, and have arrived at three different answers. Another couple of 'units' tonight and then I'll have another little count tomorrow - another day, another number! If numbers again do not tally, then a medical emergency alert is out for the next ship.
On Saturdays, it is 'church day'. We go: Memsahib with delight and I with a look to see if the Lord is laughing. Last week I sang and the Pastor heard my dulcet tones. Next up I was asked to deliver a sermon. I did so - citing the loss of a murdered colleague as an example of how good can come from bad… part of my philosophising to get folk to realise the need to 'rebuild new energies'. The Memsahib then soothed everyone with her sung rendition of the 'Lord's Prayer', in response to me not realising that four letter expletives were not in the Bible. It was not until after the service that the Pastor reminded me of this with a somewhat stern demeanour. Everyone else on the island kept ringing me up with comments like: 'You'll never get to heaven now, Doc' and 'How much wine did you have before the sermon, Doc?' and "Expletive - I just don't believe WHAT you have said, Doc!" This last one was the most alarming for a four-year old child said it to me. I remain humbled by the intent of the comment!!!!!
Back here in New Zealand, it is time to reflect on and look back and acknowledge the work the Memsahib and I convened on Pitcairn, for this was the reason that we went there in the first place: 160 consults overall in two months (really busy it was!) and over the last two weeks of the stay we had to tend to three major fractures, two evacuations and a death. Gracious, hard to believe retrospectively! Among 52 islanders and 16 off-islanders.
Whilst accidents are the feature that most would say is 'of urgency,' there are the issues of significant chronic medicine that need dayto-day management. Diabetes, gout, obesity, psychological concerns and hypertension are extremely prominent on the island - with over 60% of the islanders having at least one (or more) of these diseases. Over the two months that I was there, less than 5% of the cases I tended to were severe accidents.
One of the worst features of this remote medicine is trying to get outside help to guide management. I rang an orthopod in Auckland over a fracture of the neck of the femur. His helpful comment was 'Bring the patient in tomorrow, not today 'cause we are really busy'! He still did not get it when I said that I was in the South Pacific, halfway to Los Angeles in the USA! Helpful, right? For the whole time I was medically alone there, I was always on tenterhooks thinking 'What happens when someone dissects an aneurysm - or whatever?' It did not really hit me 'til four days before we were to leave that I did not have to worry about this at all, for the folk there believed that Providence would provide. The doctor's role on the island was not just medical but did include social, psychological and academic obligations.
The Pitcairners appreciate the time and effort of the docs that go to their land, for they are a proud and rugged people. I love them and what they represent. Get close and honest and they respond in kind: put up barriers and preach and you'll be removed from society. Their history is full of medical adventures with doctors who preach, but they laugh at them and record thanks for their departure.
Time to go? Yes! Have we enjoyed it? Yes! Have we contributed? Yes! Have we learned anything? Most definitively yes! Will we miss the people? Absolutely!
Marc practices travel and tropical medicine in Aukland New Zealand and is an active member of ISTM, a frequent world and adventure traveler, and a contributor to NewsShare.
