Island Medicine

They say there is no word for "time" or "health" in the Micronesian dialect of Chuukese, but an Israeli doctor has introduced both concepts to the Pacific Islanders by treating as many patients and helping train as many medical staff as possible during his short tour of duty.

Dr. Amnon Tsvieli, a family physician from the southern Israeli desert village of Sapir, spent three months, from October 2000 to January 2001, on a MASHAV-sponsored assignment to the Micronesian island of Chuuk. With almost 30 years of medical experience in rural health and emergency rescue, Tsvieli worked with local medical practitioners at the Chuuk State Hospital on the main island of Weno, trying to assist in promoting public health.

"We are certain that the presence of Dr. Tsvieli at the Chuuk State Hospital will provide an additional sense of security for both clinical and health needs of our people," Chuuk State Governor Ansito Walter wrote in a letter to the Israeli Embassy in Australia prior to Tsvieli's visit.

Located in the Pacific Ocean, some 4,830 km. west of Hawaii, Chuuk, together with Kosrae, Yap and Pohnpei, make up the 600 tiny islands and atolls of the Federated States of Micronesia. A predominantly Christian nation of 135,000, each of the island-states still speaks its own language with its own distinctive culture and traditions.

During his time in Chuuk, Tsvieli had the opportunity to travel to many of the surrounding, more isolated islands where locals are in desperate need of medical attention and are often denied access to the health facilities that many Israelis and westerners take for granted.

"I am here on behalf of Israel to help improve Chuuk's primary health care," Tsvieli said from his temporary island home. "Although Israel is not a rich state that can aid by funding heavy investments, we are rich with experience in solving some of the problems encountered here," he added.

Micronesians, as well as many other Pacific islanders, suffer from high rates of diabetes often associated with high sugar and processed food diets introduced by western society. Micronesia was set up as a UN Trust Territory shortly after World War II, with the United States given administrative rights over the islands. In 1986 the federated island states implemented a Compact of Free Association with the U.S., which dissolved its trust status. Despite independence, locals continue to consume mostly American-made food products, including such fatty imports as: potato chips, candy bars and other junk foods, as well as the ever popular spam, a high-sodium canned meat product made up of pork and ham. White rice, and more recently instant noodles, have in many cases replaced such nutritional local foods as bananas, yams and taro.

High infant mortality rates and heart disease, coupled with the lack of basic medical resources and facilities also present serious health problems in many parts of the archipelago. According to World Health Organization, the average Micronesian male lives to the age of 58.7, compared with 76.69 for Israel. Many of the health problems throughout Micronesia are related to poor sanitation and hygiene and unsafe water supply, which contribute to excessive rates of death and suffering among infants and children. The infant mortality rate in Micronesia is estimated at 53 per 1,000 births, while Israel has 7.72 deaths per 1,000 births (CIA World Factbook 2001).

To make matters worse, most of the health facilities in Micronesia, particularly in Chuuk, suffer from a lack of sufficient professional training in the medical and nursing staff, lack of medicines, and lack of funding for equipment. According to Tsvieli, there are only 16 trained doctors who serve the entire Chuuk State population of 60,000 - that's nearly half the population of all of Micronesia.

Such conditions are no surprise for Tsvieli, who served nine months as a military physician on the front during the Yom Kippur War. In more recent years, he has participated in numerous Israeli medical aid missions throughout the developing world, including attending to refugees in Cambodia, Albania and Congo, as well as providing relief for victims of the August 1999 earthquake disaster in northwest Turkey, which claimed the lives of some 20,000 people and injured thousands more.

He also conducted a survey for MASHAV in 1996 in Eritrea to help develop ideas for improving health services for local nomadic-pastoral populations. "Most of my 29 years of medical work has been in third world conditions," Tsvieli said about his experience. "You can't get frustrated by the conditions, otherwise you might as well stay in the comfort of your home."

"For me, it's about the challenge of trying to make even a small difference in the lives of people who need help."

Using his skills in hypnosis and intra-muscular stimulation (IMS) - a western type of needling that uses acupuncture needles - Tsvieli found the time to set up a Pain Clinic to treat those in need of quick relief. In one case, he helped a man who for six years could not move his neck. In another, he helped an elderly woman who for two years could not make a fist or pick up household objects with her right hand. And, the list goes on.

"Pain is the most universal complaint of people seeking medical help, especially chronic pain," Tsvieli explained. "I use these techniques on my trips to the far outer islands when I have barely any medicines to work with," he added.

Another particular experience that stands out during his time in Chuuk was on a boat ride to a remote island of Onoun when he was asked to help deliver a baby with severe bleeding. In honor of saving the life of the baby, the thankful father asked Tsvieli to give the newborn "a name in the language of the Bible." After several suggestions, the father chose to call his son Nolad Bayam (Born at Sea in Hebrew). He also gave him a local name, Riav Metaw, a local sea bird which mariners use as a navigational mechanism to indicate that land is nearby.

When he wasn't hopping from island to island offering his services to rural clinics, Dr. Tsvieli spent much of his time discussing health issues with the director and staff of the Chuuk State Hospital, often joining them on their rounds throughout the wards and visiting patients. He also spent a significant amount of time teaching nurses and other health practitioners, with the goal of helping to improve local primary health care, as well as clinical and administrative procedures.

One workshop was designed to give nurses a practical understanding of the respiratory system, instructing them on the use of the stethoscope and how to listen to the lungs. The newly acquired skills were soon applied as they entered the wards and learned to detect patients suffering from pneumonia and asthma.

Dr. Tsvieli's mission to Chuuk followed a visit in May 2000 by the Foreign Ministry's Special Medical and Humanitarian Advisor, Dr. Yossi Baratz, who was in Micronesia, as well as Palau and the Marshall Islands to assess further areas of cooperation and assistance between Israel and the Pacific region. His visit was so appreciated that the Pohnpei Legislature passed an official resolution acknowledging Israel's efforts to assist Micronesia in the field of health.

In January 2001, Israel sent two eye doctors to Micronesia to conduct on-the-spot clinics, or "eye camps," for hundreds of islanders suffering from eye disease. And in July 2000, two other Israeli doctors conducted a training program in anesthesiology and emergency room procedures in Chuuk, Yap and Pohnpei.

Under MASHAV's cooperation program, not only have Israeli experts been sent to work abroad, but foreign nationals have also had the opportunity to study in Israel. Each year, hundreds of candidates from the Pacific, as well as other parts of the world, are sent to Israel to participate in profession training courses. This program is considered a key element in strengthening bilateral relations and regional cooperation.

"We are putting a lot of effort into expanding our relations in the Pacific by way of continuous diplomatic contacts, as well as through our aid program, particularly in the area of health," said Gabby Levy, Israel's Ambassador to Australia. Resident in Canberra, Levy is also accredited to Micronesia, as well as Fiji, the Marshall Islands, Nauru, Palau, Papua New Guinea and Vanuatu. The Israeli Embassy in New Zealand covers the rest of the Pacific, including the Solomon Islands, Kiribati, Samoa, Tonga, Tuvalu and the Cook Islands.

"Israel has generated a lot of support in the Pacific region and has a vast interest in maintaining relations with these countries," Ambassador Levy said.

The work Dr. Tsvieli and other MASHAV experts are doing in the field - whether it is providing medical aid, training staff, or simply sharing their knowledge and experience - goes a long way in strengthening these relations, not just between countries, but more importantly, between peoples.