We had a busy time in July with three lots of guests on board "Courtesan." Afterwards we chilled out in Luganville, doing our chores leisurely (extending visas, refueling, filling gas bottles, provisioning and washing) with numerous iced coffees and milk shakes at the Natangora café. We dived the SS President Coolidge three times: the first dive to the Cargo Holds full of jeeps, electric clams and flashlight fish, the second dive to see "The Lady," a ceramic mural which used to adorn the Smoking Room when the Coolidge was a luxury liner, and the third dive to the A, B & C decks to check out the state of the latrines!

 

 

We are now circumnavigating Malakula carrying out clinics and visiting schools under the umbrella of Project MARC (Medical Assistance to Remote Communities). David does an amazing job - few of the cases are straight forward (back home he would refer many of these cases to an oral surgeon) and he often extracts up to 4 teeth, or the remains thereof, from a single patient.  He is also called upon to dress wounds, tropical ulcers and horrific boils. On Maewo the chief paddled his canoe out to the boat and asked David to look at a man suffering from abdominal pain and blood in the urine.  Liaising by phone with brother Mark in Ballarat, David warned the chief the patient was probably suffering from appendicitis or a kidney infection and needed to start the long boat trip and connecting plane flight to Luganville straight away.  Sadly, we have heard rumours that this man died en route to Luganville.  It's a tough life out here for the villagers.  David has helped out over 100 islanders now, as well as half a dozen yachties, recementing crowns, reconstructing an anterior tooth and starting a root filling for a friend, hopefully saving her an airtrip to Germany or Australia for an emergency dental appointment. As dental nurse / receptionist / steri queen / record keeper, I seem to be doing well, although the Health Worker at the Banam Bay Clinic presented me with a "Mother Hubbard," the voluminous dress introduced by the missionaries into the South Pacific - perhaps I was showing too much flesh!

 

Culinary Corner:  "Provisioning" in Luganville was more like "foraging." Although fruit, vegetables and export quality beef are readily available, procuring processed food is a challenge.  There are a dozen or so Chinese named supermarkets each selling a conglomeration of goods (clothes, fishing hooks, pots and pans, canned mackerel, SPAM, powdered milk etc.).  If you scout around enough of these you can accumulate Weet-Bix from one, bread flour from a second, rock salt from the next, and on it goes.  Eggs are a luxury because no-one knows where the chooks have laid them! 

Now we are staying in the villages longer we are building stronger relationships with locals which may result in an invitation to eat with them, sometimes an apprehensive experience. We met a most hospitable family who guided us on a long walk upstream to a spectacular waterfall.  We showered under the falls, swam in the perfectly clear pool beneath and crawled through a small hole in the mountainside into a chamber of stalactites and stalagmites.  We shared two meals in their bamboo dining hut.  Inside was a platform covered with pandanus mats on which we sat cross legged.  A cloth, strewn with marigolds, delineated the table - alas the cat did not understand this.   That morning the girls of the family had collected prawns for us in an ingenious trap made from stones, some coconut used as bait and a covering of coconut leaves.  The prawns are left to feast on the coconut for three days and are then easily harvested. The prawns were cooked in coconut milk and were delicious, even the cabbage cooked in coconut milk was rather nice, but I'm not a big fan of their staple laplap, which is grated manioc cooked with coconut milk in banana leaves under hot rocks.  On another occasion a headmaster invited us to dinner and we ate parrotfish cooked in coconut milk.  A young man "Bong," who we met three years ago when he was 17, paddled out to the canoe with a straggly looking chook and 2 litres (!) of Kava to share with us for dinner.  He gutted the chook (and eventually gutted David too), cleaning the stomach and liver as delicacies, and thoughtfully chopping off the head and claws, and we roasted it with sweet potatoes.  David and Bong proceeded to drink the Kava, standing up and clapping at each round.  I suspect Kava must slow down the digestive system (as well as the brain) as I finished my meal and had to wait over an hour for them to finish. On the other hand I did notice David making several visits to the "Head." The two of them became increasingly more lethargic and less sociable with time and I was glad when the evening finally ground to a halt.  Despite numerous invitations to have Kava here at our next anchorage at Akhamb Island, David has strongly resisted.  

We have aborted our clinic for today.  It's Saturday and apparently everyone is too busy preparing for the Sabbath to come to the dentist!  It's sometimes hard to realize that they have busy lives too.  As for me, I quite like the busyness of this part of our trip. It's hard to feel motivated every time we head off to run a clinic as they are long days, but there is definitely a sense of meaning and purpose that makes idling away time on a yacht in the tropics even more ideal. 

I'll pass over to David for his version of events.

Love, Heather

Isn't the patient the one who is usually scared during the dental experience? So why am I the one sweating with a racing pulse? The patient, 10 year old "Jessica," has 3 of her 4 first permanent molars [yes the big ones down the back] grossly decayed, infected and painful. The crowns are soggy, hollowed out caverns. They have to come out and there is little to nothing to get hold of with the forceps; if I crush the crown we will have a surgical procedure here…..please not a surgical for this little girl having her first dental experience with a portable dental kit on a remote island…….Ahh….. and I volunteered to do this!! Victory! The tooth came out cleanly with a large abscess dangling off the palatal root!  The things that make me happy??!!

This morning as I walk to the clinic, Jessica is playing with her friends and gives me a big smile.  She's slept well, is eating and coming back in 2 days to remove another crippled tooth….will we be lucky again?

Am I overwhelmed with the extent of the oral health problems we are seeing?  "Yes" because almost everyone over 30 has advanced, aggressive gum disease and root decay ie no hope.  And "No" because the children usually have great teeth and if they practiced the most basic dental care each day  (effective brushing) they don't have to suffer the same fate as their parents' mouths.  Bad teeth and gums are debilitating, an ongoing access point for infection to enter the body, sleep depriving and painful to chew on…….nothing to smile about there.  Will the kids to whom we are teaching tooth brushing and food choices keep up the habit and use the knowledge? Some will; most won't.  Is it worth the effort? Absolutely. 

We are experiencing village life more intimately this time round. The sense of community in these subsistence villages really comes through, the thoughtfulness of the people and the appreciation for our efforts. Here your health is not taken for granted.  A simple cut soon becomes a tropical ulcer that just grows bigger month by month. A man I diagnosed with appendicitis and referred to hospital straight away, died on an intervening island because the weather meant the boat couldn't leave and the plane couldn't land. Here there is often no medicine, no doctor, you live with the pain or the problem and often enough you die because of it.

Most subsistence villagers speak at least 3 languages; we discuss topics including terrorism, global warming, the popularity of Kevin Rudd, Bob Marley, the Victorian Bushfires, and corrupt politicians selling off the land to equally corrupt Aussies. The kids learn fast, show them once and they have got it, anything from tooth brushing to tying a bowline or sheet bend.   

We met a laconic Yank sailing out of Oz, a loner on the yacht "Thunderbolt" (which looks like something out of Mad Max and Water World).  He comes to the same spot at Banam Bay Vanuatu year after year, drops the pick and stays a few months, gets in to the kava and spear fishing and spends a lot of time with chief Sam in the village. Tom has no time for "do gooders," interfering in the lives of the locals. "They're tough" he says, "the teeth just rot away and then they're fine, they just get on with it!  Not like the whinging whiners in Oz."  To some extent he is right, what choice do they have, but as we sailed away I couldn't help the thought, "I hope he gets a tooth ache soon after we sail over the horizon and he can just "get over it".  We know what we are doing is just a drop in the ocean, but the ocean is just a hell of a lot of drops.

At each Island I'm asked by the men, "do I take the Kava."  I now answer "No."  It's not the taste, which is like muddy pepper, or the colour which is dishwater brown, not even the effect of numbing lethargy, no the problem with Kava consumption for me is gas! Bloating for days … and days and more days!! I'm now officially off the Kava. 

So life's good, busy and interesting, and there is no shame in reefing early.

David