Thursday, August 11, 2011

What I am learning

August 7, 2011

When I look back on these past months and weeks, I feel they have been more of a learning process in attempting to find ways to better Samoan’s health and lives. Here are a few of my thoughts.

Ignorance is Not Bless

There is almost no attempt by schools and health departments to educate Samoan adults and children about the effects of obesity. Simply weighing people and determining what color on a Samoan BMI chart (red being obese, yellow overweight, green normal) raises their attention level and concern. Providing easy-to-read health tips gives some information they can use to reduce weight. The National Health Service does screen rural villages, but unless they are critically ill, which many of the elderly are, they receive no preventative medical information. The schools likewise have no consistent health program for students or parents. When authority figures from the Prime Minister and other governmental ministers, to nurses, to teachers, to village mati, to ministers are among the most obese, it is understandable of their reluctance to tackle the subject. But, tackle it they must, if they are to serve the citizenry. It is not that Samoans think being obese is beautiful or their fate; it is they simply don’t know how to prevent obesity and its consequences.

Role of Peace Corps

All Peace Corps Volunteers in Samoa are now teachers of ESL in rural primary schools with a secondary mission of community health. The school is their world and any health program needs to have as its base, the school. When teachers are screened or find out what color they are on the BMI chart, obesity becomes a personal subject affecting them. They realize their role in teaching youngsters about obesity is also their role of parent and spouse. The teachers get the message making it easier for the Peace Corps Volunteer to conduct health education, not only in the school, but bringing them in contact with the wider community. The Peace Corps experience becomes more rewarding.

The Bible

Samoans may not understand Western concepts of BMI ratios, nutrition, calories, vitamins, cholesterol, etc., but they do understand that what is said in the Holy Bible is an indisputable fact. Fortunately, the Bible has passages on taking care of “God’s body” and the sins of overindulgence and gluttony. The Bible is how to be understood in Samoan.

The Message

The concepts of obesity and resultant diabetes, hypertension, and joint problems are difficult for anyone to comprehend, let alone change life-long which are the leading causes. The message needs to address the major causes in a language which is understood and is doable. Since the causes of obesity are many and varied, one needs to choose the message and cause carefully. Water and salt are messages I find easily understood and doable.

Water: Samoans drink very little of it. The water they do consume is sweetened in the form of koko Samoa, tea, and soft drinks. The amount of sugar consumed in a day by the average Samoan can range from 10-100 tablespoons of sugar a day. Samoans start heaping tablespoons of it when they get up and throughout the day, ending just before going to sleep. Sugar is probably the single biggest expense any family spends on food. How this habit started, I don’t know, but I do know a lot of what they drink is because they are thirsty. Their body’s grave water, their taste buds trained on sugar.

My message is “Water comes from God (the sky, heaven), unsweetened. Sugared drinks are to make money, not for your health. Drink two glasses of water when you wake up, and 10-15 minutes before you eat. You won’t be as thirsty for sweetened drinks. Carry water with you. Drink it when you are thirsty or hungry”. I bring a bag of only 150 tablespoons of sugar and a Coke bottle with a corresponding amount of raw sugar as a demonstration. Of course, they ask whether I plan to leave the bag of sugar at the conclusion of my demonstration. My homily is longer than this, but you get the message and the depth of the problem.

A liter of bottled water cost $4 WST, a liter of Coke costs $5 WST, and a liter of beer $10 WST.

Salt: The consumption of salt by Samoans is only exceeded by sugar. Salted canned meats, salted corn beef, handfuls of salt go into a pot of soup, dumping heaps of salt on the food you are served even before tasting, it is on everything. Little wonder combined with obesity the levels of high blood pressure are among the highest in the world and why they are so thirsty. Like sugar, salting of food is a habit, done thoughtlessly.

Since I can’t turn people into pillars of salt, I ask why they don’t drink sea water. After all 250 milliliters of sea water contains about a teaspoon of salt, the minimum daily amount. I show them a small can of corned beef and canned fish in tomato sauce which each contains the same amount of salt as 250 milliliters of sea water. They drool over the can of corned beef which is like giving a bottle of good wine in the U.S.

I am having trouble finding a biblical passage about consuming too much salt, so my words fade in the sound of the pounding surf. “Just don’t put the container of salt on the table”, I plead.” There is enough salt in what you eat to keep you healthy.” Habits are hard to break, including mine of sounding like Jimmy Swaggert.

Of course, I have learned a lot more, including of knowing when people have read enough of this blog.

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