Vulnerability

Vulnerability recently took on new meaning for me. I have always enjoyed good health, never succumbing to anything that could not be fixed with a visit to my general practitioner or a doctor specializing in whatever body part was afflicted. Someone was always a quick drive or subway ride away. In my last year in New York, my doctors were often a three-block walk away since I was surrounded by the many buildings that make up Columbia Presbyterian Hospital, home to more than a few of my doctors over the years.

But now I am living on a small, remote island in the western end of the Pacific Ocean. There is a hospital with medical professionals.  And there are other hospitals and clinics on the other three islands that make up the Federated States of Micronesia where some Peace Corps volunteers are sent. However, there are no ophthalmologists within the region. No doctors work here who are trained in treating eyes. And eyes are my vulnerable part after a series of operations two summers ago to scrape away scar tissue that had formed who-knows-how on my corneas. While my corneal specialist at New York Eye and Ear was at it, he also took care of the cataracts that were forming. “They aren’t that bad yet but let’s do it now and we won’t have to do it later,” he reasoned.  It took three months for the four surgeries to be performed but my corrective prescription changed for the better and the haze that was like an undetected tea stain over my vision was removed, resulting in a renewed realization of clear whites, brilliant blues, grass greens and stoplight yellows. When, more than a year later, I was diagnosed with a tiny retinal tear, a quick visit to a retina specialist at the same world-renowned clinic took care of it within two hours.

Three days after arriving in Yap, I was attending a meeting of the marketing committee for the 2018 Micronesian Games. I stood up at the end of the meeting and my left eye suddenly exploded with swirls and floaters the color of coffee. There was no pain but my first thought was “retinal detachment” and my second thought was “retinal tear.” I said nothing to anyone during the meeting but when everyone left I stayed behind for a few minutes in an attempt to grasp what I was experiencing and decide what to do next.

The Peace Corps doctor was packing up the medical office nearby and getting ready to leave her position at the end of the week.  After she left, the only medical support would be the Peace Corps’ Regional Medical Officer (RMO) in Pohnpei, the island where the Peace Corps’ regional office is based. However, there are only two flights a week, on Tuesday and Saturday, in and out of Yap to Guam, the layover hub for all flights going to the four islands of Micronesia, and one to and from Palau, a neighboring country.  However, “neighboring” in this 1 million square mile region is relative. If an ailment cannot be treated at the local hospital with long-distance consultations by the RMO, the patient is medevacked to Bangkok where another Peace Corps RMO meets the patient and takes her to see a specialist at Bumrungrad Hospital, one of the top 10 “world medical destinations” according to Newsweek.

Panic-stricken, I left the meeting room and walked, disoriented, around the small, open-air shopping plaza that makes up the center of Colonia, the main…and only…town on the 38-square-mile island. I walked up the stairs to the medical office but the doctor was not there, nor were the two Peace Corps staff members in the adjacent office. It was lunchtime. Since there was no pain, I went down the hallway to a restaurant and ordered something, trying to make sense of the swirling liquid in my eye. Eating very little of the heavily salted teriyaki and rice, I paid the cashier and went back to the office. “I may have a detached retina,” I announced to the doctor when she answered my knock on the door. Looking disturbed, she brought me in for a fast exam but could see nothing. She called the RMO in Pohnpei and left a message. Turning back to me, she said she would have a consultation with the RMO and would call me when it was decided what should be done. “You will probably be sent to Bangkok to see an eye specialist,” she said.

Within a few hours I was given comprehensive information on being medevacked to Bangkok. The local doctor who was packing to leave the island would go with me as far as Manila. A wheelchair was arranged at each stop in Yap, Guam, Manila and Bangkok since the distances between flights and customs were long. I was instructed to walk as little as possible and not carry anything heavy. From there I would be met by a car and driver at the Bangkok airport and taken to a hotel that was next to Bumrungrad Hospital. Several friends assured me, from their personal experience and the hospital’s reputation, that it was superior. A quick internet search assured me further that there was a well-staffed eye clinic on premise. The day following my late afternoon arrival in Bangkok, I would be met by the RMO and taken to an appointment with a retina specialist.

The next few days were spent preparing to leave on the Sunday morning flight at 3:00 am. It would take nearly 24 hours to get to Bangkok. The Peace Corps made plans for me to be in Bangkok for three weeks in case a long treatment was required, returning on September 10th.

But there was another complication. I had acquired a bronchial infection two weeks prior while in Pohnpei for orientation. The extreme pressure produced by the deep coughing and respiratory distress from a build-up of phlegm surely had something to do with whatever was going on in the eye.  Flying from Pohnpei to Guam to Yap the prior weekend produced intense pain in my ear to the point of tears and silent screams due to the pressure of the nasal congestion. Now I had to fly again one week later and the infection was not yet gone. The Peace Corps did not provide an expectorant in their volunteer medical kit and there was none on the island. I doubled up on the decongestant that the doctor prescribed, but I knew it would still be painful to fly.

By the time we arrived at the small Yap airport at 1:00 am Sunday morning, other than a few residual floaters, my eye was clear much to my relief. But I still needed to get to a retina specialist. Climbing into the first of four wheelchairs, I was pushed across the tarmac and up the ramp leading into the plane.  Once aboard and aloft, my ear felt clogged. As we started the descent into Guam, the pain was beginning. From Guam to Manila it increased to the point that I was doubled over. The flight attendant gave me a cup of hot water and told me to sip it. The heat would help, she said. I also held the steaming cup to my ear. The pain continued to increase but the steam seemed to help a little. At last, the eardrum popped and the pain subsided immediately. But now I had a bleeding eardrum to add to the list of maladies. 

I was met in Bangkok by the car and driver who took me to the small hotel. A pleasant, clean room was assigned, and I had dinner at the hotel restaurant that offered both Thai and Hallal food. There were many couples and families from the Middle East staying at the hotel. Most, if not all, were seeing doctors at the hospital. Many of the women were completely covered in the heavy, black layers of an abaya and the niqab, a head-covering veil, with only their eyes revealed through slim slits. The heat and humidity of Bangkok were oppressive even when dressed in light linen garments as I was. I could not imagine the discomfort they must feel.

The following morning after my arrival, the RMO met me in the lobby and escorted me to the hospital where an appointment had been made with the retina doctor. The doctor, a woman, discovered that there was a broken blood vessel inside the eye that was clearing up and would cause me no more problems. After a sigh of relief and instructions to switch from aspirin to ibuprofen in the future, the RMO said she would text me when the appointment with the ear doctor had been set. Before we parted company, she got an expectorant from the pharmacy to help clear up the bronchial infection. The following day I met her again and she took me to the ear doctor. A brief exam and he discovered a hematoma or bruise inside the ear from the pressure of the flight.  I was given pills for the ear and received medical clearance to return to Yap on the next flight the following Saturday.

I bought a guidebook in the hospital’s gift shop, ordered an iced tea at the adjacent Starbucks, and began to plan some sightseeing. Prior to leaving Yap, a friend in New York City graciously offered to introduce me to her cousin who lives in Bangkok. I immediately sent an email and made plans to meet for dinner. She became an invaluable resource and a new friend. We met several times over the next few days, sharing Thai food, hamburgers and sushi while talking politics and trading life experiences. When you are feeling vulnerable in new surroundings, having someone to talk with helps to calm nerves and set things right.

On Wednesday, my third day in Bangkok, I received an email from the RMO asking me to meet her at the hospital at 11:30. She needed to talk with me about follow-up care, she said. As we sat down she began by saying, “I’ve spoken with the medical team at Peace Corps headquarters in Washington. They’re all at a conference there and I needed to bring them up to date on your progress. I must tell you that they recommended medical separation.” My heart sank. The Peace Corps has the right to “separate” volunteers for various reasons; a medical condition is one of them. In my case they realized, I had “slipped through the cracks” and should not have been sent to Micronesia in the first place since there are no eye specialists in the region.  This was despite a deep dive into my medical history prior to leaving for my assignment.

“But wait, there’s good news,” she said, seeing the distress on my face. “I told them that you were given medical clearance to return to Yap. I also told them you do not have a ‘Home of Record’ to return to; that you got rid of everything before you left New York. I also told them that you’re excited about your assignment and that the people you’re working with are excited to have you there. So it was decided to let you return to Yap. However, you will be sent to Manila in November for a check-up. I strongly recommend that you prepare to be given medical separation at that time in case the decision is made then.”

It took a few minutes for this news to sink in. I responded that I was fine…was given clearance as she knew...that my eyes were fine as was my overall health and I doubted it would happen again. She agreed but had received orders from her superiors. She said she would write everything down and I would be required to sign the document stating the options and the directive to have a check-up in Manila with the possibility of a medical separation at that time. I agreed and we departed after a hug and thanks for everything that she had done for me, including advocating for my return to Peace Corps service. Had I been sent to a region where eye care was available, she said, medical separation would probably not be considered and I would have been allowed to serve with no problem. But I was on the remote island of Yap thousands of miles from the nearest eye clinic and specialists.

The rest of the week I wandered around the city, did some sightseeing, shopped for items that I wanted to take back for my apartment. 

On Friday night, my last evening, I met my friend’s cousin for sushi, went back to the hotel to meet the driver who took me to the airport, and arrived three hours early for my 12:30am flight. Sauntering up to the desk with my luggage piled on a cart, I handed the reservation information to the Nippon Air clerk. She went to work on her computer. After a few minutes, she looked up and told me that my reservation had not been changed. I was still ticketed to leave on September 10^th, not on August 27^th. “But I have the confirmation number! It’s right there. Please check again,” I said. “I’m sorry, but it’s not for tonight’s flight,” she insisted. There was nothing she could do. I asked for her supervisor.

The next two and a half hours were more than I could bear. I rarely get angry but bile rose up from my toes. I moved down the row of check-in desks to a line of managers and supervisors. A self-important man overseeing several women, told me he could do nothing. Nippon was contracted by United to run this route from Bangkok to Tokyo but they were not allowed to contact United. I would have to do that myself.  “That’s crazy!” I said. “Why can’t you talk with United?” “We just can’t,” he replied.

I went from confidently arriving with plenty of time to spare to completely vulnerable with no local SIM card in my phone to call anyone, no local currency in my purse and a heavy, awkward cart piled with luggage. He pointed in the direction of a phone “down there at the end of this hallway” that I could use.  I stood my ground and finally started an email thread with the RMO who had helped me throughout my medical appointments.

The Peace Corps’ staff is available 24/7. Their phones are always with them. The RMO brought three other people onto the thread including the RMO in Pohnpei and two staff members. It was after hours in both locations but they all swung into action. However, no one could figure out why the change in date had not made it into the Nippon system. The man behind the counter was now ignoring me as much as he could despite my rage and barrage of expletives. At one point he told me to calm down. “Excuse me!” I stormed.

As Peace Corps volunteers, we must act at all times as ambassadors of the United States. I was not a good ambassador at that moment.

At long last, over an hour into my tirade and frantic emailing with the Peace Corps staff, a young Japanese woman behind the counter said quietly, “I will call United for you and see if I can work it out.” My body sagged with relief and I thanked her. Had I been able to leap over the counter I would have hugged her.  The email thread with the Peace Corps continued as they worked from their end to get resolution as the clock continued to tick down the time.  Forty-five minutes before the flight was to take off, the young Nippon representative at long last was able to correct the ticket, pushed my luggage through priority, gave me a priority boarding card, bowed in that Japanese way, and thanked me for flying Nippon. After thanking her profusely, saying in a loud voice aimed at the man who was still ignoring me, “Whenever you need to get something done, ask a woman!” I raced to the plane with a few minutes to spare.  

Now that I am back in Yap and settled in my apartment, getting to know people in the community, and learning about the job that I was brought here to do, I am thinking about what I learned by feeling vulnerable outside the comfort and familiarity of my culture and home environment. My intention is to travel around the world for an indefinite period of time after I leave the Peace Corps. My experience made me feel less sure of myself but I am talking with new friends, many from Australia but also Americans, who have lived and worked and traveled abroad for many years. Some are single women and single men, some are couples, some are widowed or divorced; some have parents, children and grandchildren and other relatives back home or living in other countries. Their stories are important to my continuing education about what it means to travel to places where the language, the culture, the lifestyles, the people are outside my experience. I consider myself “worldly” but I have begun to think about what it means to be a single woman traveling alone; about the presence of mind and strength it requires and brings to the fore when we must take charge in those moments of uncertainty, when outside one’s experience and comfort zone.

If I had not had the support of the Peace Corps, would I have been able to make my way to the hospital to be taken care of? Would I have been able to solve the puzzle of the missing flight change? Probably. But I was fortunate to have that support at this point in the journey. I am now stronger and more resilient for the next challenge when it arises.  And it will.