September 26. Scuba!

 Sunday found us with 6 other divers, Janet and Jacque, our colleagues and 4 others to head out for two morning dives.  Three of them worked for the US government, and the third, was a retired attorney.  All had interesting backstories, indeed we invited Jason Frohnmayer the Embassy Consular Chief to dinner later in the week.  He's got Foreign Service stories!

Dives were 'average'.  We have dived a bit over the years and with the weather, clouds, rain and 4 foot chop, we have had better dives, frankly.  But, a few pictures. 

No large fish were at the 'cleaning station', so our guide

let the little fish clean his teeth!

Lion Fish

Sea Turtle

Angel Fish

September 25. Jellyfish Lake, the Milky Way, Rock Island and Clam City

 The weekend!  The dental clinic staff has invited us for a day of adventure.  Janice, the clinic administrator, has hired her cousin to motor our way among the countless islands in Palau to enjoy some of its unique experiences.  First is the Milky Way.  In a small inlet rather than sand or black mud is white pulverized limestone sediment.  Amazing.  Great opportunities to enjoy 'mudpacks'.

We then went to Rock Island so that the clinic staff could set up lunch and the bar-b-q as we boated over to Jellyfish Lake.  A VERY unusual lake.  It is saltwater but totally isolated from the ocean.  Indeed you have to hike up the side of the island then hike down to the lake and it is full of jellyfish!  Until the last several years there were clouds of Moon and Golden jellyfish.  Fewer now, they believe due to global warming, but plenty for us to enjoy swimming among them.  Through time, they lost their ability to sting with their tentacles so you could gently handle them as they pulsated all around you.

Next was lunch.  Staff bar-b-qued fish, chicken and beef with all the western and Palauan sides.  Really a feast.  After, more snorkeling on Rock Island with black-tipped sharks!  We've dived with black tips before in Fiji, they are moderate in size, 3-5 feet long and very curious and friendly.  Some call them 'vegetarian sharks'.

Next was clam city.  A unique spot where there are small to massive clams in about 20 feet of water!  

September 23....Meeting the Queen of Palau and a US Ambasador

Our fifth clinic day was routine.  More conversations with and mentoring of the staff.  We are getting to know each other better and they are more comfortable asking questions.

Outside of the clinic, Thursday night was a real treat in that we were invited to the 29th annual Mechesil Belau Conference.  Basically entertainment by the local kids, (over 100 of them) and a very traditional Palauan buffet.

Biggest buffet we've ever seen!

This is the Queen of Palau, Her Majesty Bilung Gloria.  Very pleasant.

She chatted with us briefly on our way out after the festivities.

Friday evening as we met in the lobby of the hotel to head out for dinner, Jacque was talking to someone that she ended up inviting to join us for dinner.  She turned out to be Ambassador Chantale Wong the Director of the Asian Development Bank.  She tried to explain what she does and what the Asian Development Bank is; it is very complicated!  She has worked under Barack Obama as vice president for administration and finance and was the previous budget director for NASA.  And, the list goes on.  Very pleasant lady, she had just had a meeting with the president of Palau earlier in the day to discuss the country's sewage system.

September 21,22......Hitting our stride, setting a rhythm

 We had a full staff meeting Wednesday morning to discuss with both Palauan doctors and staff that we aren't here to see THEIR patients but to help them carry the load and work with them on new techniques.  I think it answered a lot of their questions and made them more at ease with our presence.  Also, I think we are more productive with the local doctors either assisting or observing us as we worked.  

I have noticed as the week has progressed that they are booking Rick and me tighter and tighter.  First, I don't believe that they have been doing root canals for sometime; saving them all for us!  Then, they have started to book me on the half hour instead of on the hour.  And, frequently I am double booked.  

They will set the charts in the room as the patients come in.  At one point on Thursday, I had 5 charts in my room.  I was seeing one patient with four waiting!  I then have to get up, find the Palauan dentists 'hiding out' and get them to see THEIR patients!  Hmm.    Anyway, the patients are great, (except for the betalnut chewers).  Routine dentistry, good assisting, the Palauan dentists continue to be more engaged in watching our techniques as the week goes.  

The chief dentist (she doesn't see patients, just stays in her office on the computer) would like me to work with her on ordering.  They can only order once a year (?) from just three suppliers.  I have to figure that out first, then see if they can streamline that.  We see mounds of supplies all over that they don't use and many products are outdated.  A mess.  I have discovered that Palau is part of the US Mail System, so you gotta think it shouldn't be such a challenge.  Plus, Amazon?  The Covid reason/excuse is starting to wear a bit thin.

You may or may not want to see the following x-rays, but an interesting case.  This middle aged man appears with an abscess around a front tooth.  X-ray reveals an upper incisor was broken, probably in childhood then the root migrated over the years away from the tooth.  The dark area is an infection.  So, I decided to do a root canal on the remaining part!  Not exactly textbook work but if the infection clears in a month or two, a home run.  If not, the tooth will have to come out, but this is worth a try.

September 19, 20....Clinic begins

 Breakfast at 6:30 and we leave for the clinic at 7:30, patients arrive at 8:00.  So, 6 treatment rooms, 11 providers (US--2 hygienists and 4 dentists and  Paluaian--5 dentists).  How do we do this?  Rick and I have our own rooms, one Palauian dentist watches me.  Gloria and Jeannette share their two rooms with one Palauian dentist, Adrian does triage, and Dave is making dentures.  One Palauian dentist assists him.  Finally another Palauian dentist, he is Japanese, seems to stay busy seeing his own patients.  Confusing?  Us too!  But. it seemed to work on our first day.  Didn't get the official count yet, probably around 20 patients were seen.

There was a break for most of us at 9:00 when we formally met Palau's Minister of Health.  A formal greeting and thank you, now back to work.  Otherwise, routine work.  Fillings, extractions, one root canal and Dave is making same-day dentures.  That is a break from the traditional 3-5 week denture.  I won't bore you with the details but so far, we are impressed.  He is working with two local lab techs so they can learn his unique approach. 

The low point of the day was the two oral cancer patients that came in.  One had already had his tongue removed but there was a recurrent legion on the floor of his mouth the size of a nickle.  Not good.  The other patient had what looked like oral cancer in the right cheek area.  She had been told about it about 8 years ago.  Also, not good.

Day two of clinic was similar to day one.  Routine procedures but it seems that we are just replacing the resident dentists; seeing their patients while they relax. Not much mentoring going on.  We will discuss this with them tomorrow.  

The view from our clinic.

September 15-18....In transit to Palau, crossing the International Date Line, setting up for work

We were home for 36 hours then drove to the Bay Area to muster at Jacque's house, the founder of Canvasback, with equipment and supplies, spend the night then leave for SFO at 5am for our 9am flight to Palau.  5 hours to Honolulu, 2-hour layover, 8 hours to Guam, 1-hour layover then 2 hours to Palau.  Pretty punch-drunk on arrival, collapsed in the hotel.

So, we are actually 20 hours ahead of PDT.  Late breakfast is a buffet, similar to Sandals in Grenada but much-much smaller.  However, what is different is they offer both a 'western' and and 'asian' breakfast, so in addition to oatmeal, eggs, fruit, waffles and bacon/sausage, they have rice, stir-fry noodles, soup and pot stickers.  A nice variety to choose from.  

Saturday saw us taking a tour of the island.  The president of Palau is a friend of Jacque, our leader and has loaned us two vans to move around the island.  We visited the seat of governmnet enjoying the architecture with no other tourists or government workers.

Sunday morning we shopped at Surangels the 'Walmart/Costco' of Palau.  Very nice and modern.  BTW, it too is owned by the President of Palau, Surangel Whipps.  More to that story for another day.

Sunday afternoon saw us in the clinic setting up for the next two weeks.  Many of the staff were there to help us unload our supplies and equipment.  Nice, modern clinic, 6 rooms to work out of.  They have already scheduled most of our patients for the next two weeks.

This is the national bird.  The Whimbrel, also called The Money Bird.  

It adorns many of the columns.  We were told. that is poops money?!

The signs below are all over the hospital.  Seems to be a problem!

 

September 14----We're doing it again! Off to Palau in Micronesia.

Well, we just got back from two weeks in Grenada yesterday at 4am and we leave for Palau this afternoon at 4pm!  So, yesterday and today we are washing clothes, repacking all of our dental supplies and equipment, and trying to troubleshoot and fix problems in and around the house before we head out again.

What did we miss at home the last two weeks?  A historic heat wave in California that cooked a lot of our landscaping, a dead deer hung up in some fencing, and a serious pool leak.  Life.

This trip is with Canvasback Missions, a great group we went with to Yap several years ago.  In Yap we partnered with an ophthalmology team doing cataract surgery.  This year, since Micronesia is just opening up post-Covid it is just our dental team.  This is a two-week mission with some diving on the weekends.  We will be working in the hospital dental clinic in Koror, the largest city in Palau with about 11,000 residents.