Friday, February 19, 2010

Marshallese Medical Customs


Marshallese friend and co-teacher Donna, catching a few zzz’s after helping to get me set up at the hospital

Here are some interesting things I learned from my (largely unnecessary) 3 ½ day stay in Ebeye Hospital. I was admitted for observation after bumping my head. I’ll describe these insights in approximately the order I discovered them.

* AIR CONDITIONING (called “aircon” here). It’s turned up to the max. I FROZE the whole time, which kept me quiet and under the covers just to stay warm, having not brought a sweatshirt or other warm clothing to the RMI.

* BEDDING. There is none in a Marshallese hospital. My discovery of this fact is related to the previous discovery about the aircon. While the doctor was stitching up my forehead, and I was shivering, with teeth chattering, I asked for a blanket. “Ejelok (there are none).” I thought, “there are HOW many beds in this hospital and NO blankets?” A nurse found a clean curtain and draped it over me, while the Guegeegue neighbor who drove me to the hospital walked over to his sister’s house near the hospital to get me a blanket. There is a good reason for this lack of bedding, which is:

* COMMUNAL HOSPITAL STAYS. Coming from an individualistic society, it took me awhile to realize that although all 5 beds in my room were continuously occupied, they were not necessarily occupied by patients. No Marshallese stays in the hospital alone. In fact, one of my students was more upset that I had stayed in the hospital alone than that I was in the hospital in the first place. If all the beds did happen to be filled with patients, the companion slept either on the floor on a sleeping mat, or in the same bed (depending on the size of the individuals involved).

This applied even to the domestic abuse victim in bed #4 (remember there’s no privacy here of any kind). Her husband and two of their three sons slept in the bed next to hers. (FYI: 93% of Marshallese women are abused either physically, sexually, or emotionally, often while the man is drunk.)

These live-in hospital companions explain the lack of bedding: if a bed is empty, someone will sleep in it. Everyone brings their own bedding. Hospital companions are useful because of:

* NURSING CARE. Adequate, but minimal. Nurses dispense medications and take vital signs. That’s it. No nurse call buttons anywhere, or nurses making rounds just to check on patients. Companions fetch nurses when needed. Companions also do such things as deliver stool samples to the lab. My nurse was helpful but slightly put out that she had to take care of this for me. Most of the medical staff were Filipino, with one doctor from Yap, one from Burma, and a few Marshallese. All seemed to be quite knowledgeable, and I always felt like I was in very good hands.

* WEEKEND HOURS. Checking in around 4:45 a.m. on Saturday morning meant that nothing whatsoever happened until Monday, because no one is in the lab or radiology over the weekend. I’m sure if I had been in critical condition they would have found me the hospital personnel needed, but since I kept insisting I was fine, they were happy to just let me stay bundled up under the covers for 72 hours instead of 24.

* FOOD. Although the doctor ordered a bland diet for the first 24 hours, the plate of food that arrived was the same as everyone else’s. “We don’t have special diets,” a nurse explained, “because we have no dietician. The food is cooked by women in the neighborhood.” Three times a day, a styrofoam plate covered with foil arrived with a traditional Marshallese diet:

Breakfast - bread or pancakes, plus meat (a hot dog, Vienna sausages, or ham), and an egg (either hard boiled or scrambled, which might come with or without green beans!!! Why are green peppers OK to put in scrambled eggs, but canned green beans look weird in there?)

Lunch: rice & fish, or rice & chicken.

Dinner: rice & chicken, or rice & fish, whichever one we didn’t get for lunch.

Both lunch and dinner had a vegetable on the side, but not so fast . . . remember “macaroni salad” and “potato salad”? In the Marshall Islands, these are taken literally and are equivalent to a green salad. So lunch might be rice and fish with macaroni salad, and dinner might be rice and chicken with a baked potato for a vegetable.

* VISITING HOURS. Posted at 8 a.m. to 8 p.m., but in reality, it was anytime friends wanted to drop in. Over the 3 ½ days, I had no fewer than 53 visits from students, neighbors, church friends, and fellow teachers. Visitors came as early as 6:30 a.m. or as late as a few minutes after midnight. It didn’t matter, though, because with nurses coming in at 1 a.m. and 5 a.m. to take vital signs, and with new patients arriving anytime night or day and the resulting displacement to clear out the bed, I slept anytime I could. Visitors seldom arrived empty-handed, so I had quite an assortment of snacks, fruits & drinks in gargantuan quantities, because of course they weren’t meant for just me, but for sharing with everyone in the room whenever I decided I wanted to break into them.

* GENERAL CONDITIONS. Of course my room was oceanview. On a narrow island, almost everything is oceanview or lagoonview. On the plus side were the air conditioning, hot running water for showers instead of the cold bucket showers I take at home, and sometimes-functioning flush toilets instead of the bucket flushing I do at home. The cockroaches and general cleanliness were a minus. I gather that keeping the room and bathroom clean is largely the hospital companion’s job, and I gather that my roommates’ companions weren’t particularly fastidious.

I have little to compare to the Ebeye Hospital, having never been hospitalized in the US except to have babies, when I had a lot of other things on my mind than the hospital itself. Even the most recent of those hospital stays was 30 years ago (take a bow, Evelyn). But having lived here in the RMI, I realize cockroaches are a fact of life, regardless of how clean one is. In fact, the ants I’m “used to” in my apartment were noticeably absent. I never thought I’d say this, but I was surprised to realize that I sort of missed the ants. I swear, without a speck of food on the counter EVER to attract them, I think the ants stay around just to keep me company.

* COST. If I were Marshallese, the inpatient stay per night would be the same as an outpatient clinic visit: $5. That hardly covers the food, much less the lab, X-ray, round-the-clock nursing care, daily doctor check-ins, and even a month’s supply of whatever prescription medicines I’m on (whether or not they’re related to the inpatient stay), plus any routine meds needed, like a fresh tube of Bacitracin ointment for my two forehead stitches. For me, the ribelle rate was $17 a night – a whopping $51 medical bill for my hospital stay, which will be completely reimbursed by WorldTeach’s insurance provider. Naturally, medical costs are heavily subsidized by the Ministry of Health (which is heavily subsidized by the US government. Thank you, US taxpayers). But even at $5 per visit, many Marshallese women skip prenatal care until close to their due dates because of the cost.

* SUBSTITUTE TEACHER TO COVER MY CLASS WHILE I WAS OUT. No such thing. If I’m there, students have class. If I’m not there, students have a free period to hang out, making it all the more surprising to receive “I miss you and promise I’ll never skip your class again” notes from my students (particularly the 7th period class, who got to take the early bus home at 2:30 instead of 3:30 when my class usually ends).

* THE RESULT. Like I said, I’m fine. This fact is confirmed by blood tests, stool analysis, a skull X-ray, and even a quick 3-day trip (a week after I came home from the hospital) to the capital Majuro for a CT scan. All came back perfectly normal. I’m fine, and I have a swell Harry Potter-esque small forehead scar as a souvenir of my investigation of Marshallese medical customs.


  1. wow! what an experience! i will admit i cringe in horror at all the "communal" ness of the hospital. you are a trooper and i am glad you're ok.

  2. Seems like you took it all in stride, Marci!

  3. Just talked to a Haitian sister in our ward about hospital conditions in Haiti (prior to the earthquake) and it sounds very similair...except they don't serve food. If you want to eat the family has to bring it in for you. Glad you are okay and it wasn't serious. Please come back in one piece. Please!!!! No more bumps on the head dear.

  4. Goodness. I'm glad you are well and from the sound of it had an interesting experience. But WOW. Communal hospital....a little scary.