Working In Vanuatu: Politics and Medicine

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“By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third by experience, which is the bitterest” is a saying attributed to Confucius.  One of our trainees recently started a talk with it. She had asked if she could use some of my slides. I have taken the liberty of using her quote. Anecdotal experience is the greatest driver of practice. As I have aged I have reflected more and more on my own experiences. As a doctor one has the privilege of looking after some fascinating people and I like to think I have learned from them.

Working In Vanuatu: Politics and Medicine

You couldn’t invent a more exotic place than Vanuatu; a novelist or scriptwriter who did would have audiences questioning their credibility. Could a country of active volcanic islands surrounded by shark-infested waters and subject to devastating cyclones really be home to the happiest, if some of the poorest, people in the world?

Who would create a land populated by people speaking over a hundred different languages who, within living memory, were animist cannibals; whose grandparents had eaten the first missionaries but who were now devout Christians? A country where the men celebrated the legend of an adulterous wife tricking her husband into killing himself by leaping off tall towers with vines strapped to their ankles, and so inspired the craze of bungy jumping?

What fictional country ever had a colonial history of rule by the French and the British, both at the same time? Many territories have had successive colonial powers, but where else did the French and British share power for the best part of a century? When did those two traditional enemies ever agree on anything? Who would ever make that up?

Throw in a coconut rebellion financed by right-wing investors, an unstable and often corrupt government, off-shore tax haven status, flags of convenience, shady Asian businessmen and dodgy expatriates and you could have the setting for a Bond film.

One of the starring roles would have been Jimmy Stevens, the government’s public enemy number one. I first met Jimmy when he arrived in Outpatients with a prison guard to have his blood pressure checked. Despite multiple drugs, his blood pressure remained uncontrolled and I admitted him. I never got around to discharging Jimmy back to prison; he was to stay in hospital until his eventual pardon on the 10th anniversary of independence two years later.

Jimmy had been the leader of the so-called “Coconut Rebellion” in the New Hebrides nearly 10 years earlier. He was quite a character; with his long grey hair and beard he resembled an Old Testament prophet; he usually wore just a wrap around his waist.

Jimmy had entered politics pushing the cause of a group of bush people who were protesting at the clearance of their kastom land for cattle ranching. Through multiple marriages (to an estimated 31 wives from different villages and islands) and the foundation of his own church he was able to extend his influence throughout the country. Under his charismatic leadership he went on to take Santo to the verge of independence as a separate island state.

Unfortunately he fell under the influence of manipulative French planters and American investors; an ill-fated attempt at secession led to his arrest and he was imprisoned when all the other leaders were celebrating the independence of Vanuatu.

At Jimmy’s trial, it was revealed that he had received USD $250,000 from the American-based Phoenix group, which had previously attempted to establish an independent tax-haven state in the Bahamas. He was convicted and sentenced to 14 years in prison.

Jimmy had little formal education but he had imagination and a memorable presence and he was still well-respected despite his conviction. He was generally acknowledged to have healing powers of his own and was often consulted by my patients and their relatives. He did his own ward rounds after mine.

Jimmy’s length of stay was not quite a record for me; I had a longer-staying patient in rural New Zealand (a sad case of a young woman with severe brain injury following a Caesarean section), but Jimmy’s was the most prolonged admission of someone I could have discharged, albeit if only to go back to prison.

Jimmy ended up babysitting my children one weekend. My Saturday morning ward round had gone on longer than expected and my wife, Elizabeth, appeared with the children; she was due to start her half-hour stint hand-ventilating a baby in the nursery.

The Vila Central Hospital medical superintendent’s secretary had delivered a premature girl the week before. Breathing problems developed and because of the mother’s very poor obstetric history our new paediatrician had decided to attempt ventilation. With no mechanical ventilator available, a group of expatriate ladies were taking turns at bagging the baby. It was Elizabeth’s shift; someone had to look after the children and Jimmy volunteered, or at least he agreed to when I asked him.

I collected the children, Clare and John, from my office just as Jimmy finished relating his own version of the Coconut Rebellion; he was in the middle of telling them how one of his adult children had been shot. His son was the only fatality of the independence struggle in Vanuatu.

My experience with Jimmy wasn’t the only time medicine got mixed up with politics. I was the only physician in Vanuatu, then a country of about 200,000 people. In my four years there I treated the Prime Minister, the President and the Chief of Chiefs. It wasn’t always straightforward.

A couple of days after the Prime Minister was admitted with a heart attack, a senior nurse came to see me and said: “It might not be a bad thing if the Prime Minister doesn’t survive”, the implication being that I might be able to influence the outcome. I was shocked, but only briefly. The nurse belonged to a very political family that was at odds with the PM’s own faction of the ruling party. There had been a split within the party and the nurse’s brother, who had been a minister, was challenging for the leadership.

Needless to say I didn’t do anything to change his prognosis. The PM had a small and uncomplicated myocardial infarction. I did stay home over the weekend so that I was readily available had there been a problem. After five days the PM was discharged and flew out to Australia for further tests.

Expatriates and senior government officials sometimes tried to bypass the hospital and see me directly, so I tried not to be too available. Elizabeth got very good at fielding phone calls. Theoretically I was always on call, but only if I could be contacted by the hospital. Any caller had to go through the hospital switchboard; if connected to me, they then had to deal with Elizabeth.

One evening there was a call from a patient’s wife. Elizabeth diplomatically suggested she follow the normal process and that she should try the hospital, but the caller was insistent that her husband was “my patient” and she needed to talk to me. Again, Elizabeth made the point that I only saw patients that the hospital staff could not handle.

The caller was politely persistent. Elizabeth realised that there was something more to it and asked to whom she was talking; it was the President’s wife. I had been treating him for chronic myeloid leukaemia. The phone was passed over to me.

I quickly established that the President had collapsed at home. I drove straight round to the Presidential residence. The President was lying on the floor of his private nakamal (kava-bar); he was semiconscious but responding to painful stimuli. On the Glasgow coma scale he would have rated a 7/15: he was withdrawing to pain, his best verbal response was a grunt but his eyes remained closed. He was moving all four limbs; at least it didn’t look like a stroke, despite his vascular risk factors.

It is always a good idea to take a history first: I quickly established that the President had been drinking kava and mixing it with beer; it wasn’t a good combination, but at least it explained his state. I helped his aide de camp get him to bed. His wife was very grateful, if a little embarrassed. We never talked about it again, but when I left Vanuatu the family were invited around for tea and I was presented with a wooden carving.

I also treated the most senior chief in Vanuatu, the “Chief of Chiefs”, who developed heart failure. A big man, literally and metaphorically. He actually did well and was the longest lived of the three top men, surviving until he was 69. The President died at 59 and the Prime Minister at 56 or 57, his exact date of birth never having been recorded. Power and affluence aren’t necessarily good for your health.

Jimmy Stevens was in hospital during all these admissions; I am not sure that he actually visited any of his political opponents.

When it came to the 10 year Independence Anniversary, Jimmy’s release, along with a number of other prisoners, was being considered as part of the celebrations. I had to present myself to the PM’s office and answer whether Jimmy would be able to be discharged if he was freed. I bluffed my way through a response but nobody seemed to question the coincidental timing of Jimmy’s cure and the amnesty.

After he went home I saw Jimmy again on a visit to Santo in 1992; he was accompanied by two new and very young wives; he smiled knowingly at my congratulations. Sadly, Jimmy never enjoyed good health after his discharge and he died shortly after that. Jimmy’s obituaries make interesting reading but they never did mention his prolonged hospital stay.

As a post-script, another of Jimmy’s sons achieved fame (or notoriety) after surviving the sinking of a fishing boat. Several days after the boat had disappeared he turned up in Noumea, the sole survivor of the shipwreck, suffering from exposure but alive. He maintained he had been rescued by a large manta-ray which carried him to shore.

Surprisingly, or maybe not in Vanuatu, his story, laughed at by the expatriates, was accepted by most locals. Melanesian and Polynesian mythology is full of stories of men traveling on the backs of sea creatures.

What happened to the ventilated baby?

She survived and was named Victoria after the paediatrician’s daughter.

– Paul Reeve

Paul Reeve is a general physician in Waikato Hospital. He was brought up in Hong Kong, went to medical school in London and worked in Africa and Vanuatu before moving to  New Zealand.