Nits and Snot Bubbles

There are three things in Fiji that I have determined are absolute certainties: (1) a dropped slice of buttered toast always lands butter side down…on a trail of ants; (2) a cat that falls out of a tree always lands on its feet…immediately before being eaten by the village stray dogs; and (3) the child with the largest snot bubble inevitably targets the biggest germaphobe in your group like a heat seeking missile…and I’ve seen some trophy snot bubbles since arriving in Fiji! From the single-nostril slinger to the nose-to-lip green double runner, I’ve seen some whoppers. Now, this gets me to a discussion about public health in Fiji.

It wasn’t that long ago in the U.S. that people thought getting wet when it was cold outside caused head colds, so I make no judgments about the Fijian peoples understanding of what causes disease or illness. Since Leuwenhoek first peered through his pinhole microscope at the little monsters in a droplet of water over a century ago, western science has come a long way in understanding that disease is not caused by evil spirits, curses, or the weather, but by tiny little critters we now know as viruses and bacteria. Fiji, especially rural Fiji, is still learning about these advances.

One volunteer, who came down with a particularly bad case of explosive diarrhea, was told by his Fijian host family that it was the result of him walking past the “devil tree.” Now, this is not like the proverbial and hypothetical “ugly tree” that many of us in the U.S. have experienced either first hand or after a long night drinking and the donning of the “beer goggles.” These particular folks genuinely believed that this devil tree, which happened to be a common tree in the region, caused sickness just through the simple act of walking past it. Why they just didn’t cut the tree down and solve their disease problems altogether I have no idea, but my suspicion is that they felt an even greater curse than the trots would befall them if they did. Either way, it makes no logical sense to those of us with even the most rudimentary health education.

In Fiji, ailments are also often blamed on the weather, the wind, and, of course, missing church. However, when people do not have access to the same level of health education that we in the U.S. benefit from, you can’t expect them to understand that bacteria and viruses spread through human contact, water, or food are really causing the disease and, moreover, that it could be easily prevented, or at least mitigated, by simply washing using soap and water and thoroughly cooking food. But even “cleanliness” has a subjective meaning here in Fiji no different than it does in the U.S.

One good example of the impact of culture on the concept of cleanliness involved a volunteer living in an Indo-Fijian settlement. This volunteer, in an effort to win over her family, committed to preparing an entire Indian meal for a special dinner. After hours of preparing roti, chutney, and various curries she came to the point where she was ready to serve the meal. What she didn’t know was that despite the hundreds of times she likely washed her hands and dishes throughout the day she was unclean!

In the course of conversation with one of the older Indo-Fijian women, they came to the subject of women’s cultural role in the Indo-Fijian society where, through some unexplained diversion the subject of women’s monthly visitor came up and that women experiencing this are deemed “unclean” and are limited in things that they can do during this time. So the volunteer expressed, “Well I guess it’s a good thing that I’m just coming off mine!”

Collective gasps and shocked expressions preceded the women virtually picking her off the floor as they shuttled her to the most remote part of the house in a swirl of saris and indistinguishable panicked Hindi expressions in an effort to remove the unclean creature from the presence of others and the food that had been prepared…by her. Yes, the most offensive of offensive things that one can do when Aunt Flo comes to visit is to prepare food with unclean hands! After some discussion, and the realization that the ENTIRE meal for about 15 people had been prepared by this volunteer, they were able to rationalize that since it was the end of her period that they could overlook her filthiness just this once.

But there are issues of genuine hygiene and sanitation that have a profound impact on public health in Fiji. Much of it stems from the lack of clean running water or the fact that when it comes down to buying two loaves of bread or a bar of soap for $1.15, the bread is generally going to have priority. Shampoo isn’t even a consideration for a number of reasons including expense. Nonetheless, some of the most problematic health issues could be resolved with these simple substances.

A good example is the profound existence of boils in Fiji. A boil is a staphylococcus infection that encysts at the base of a hair follicle. For those of you unfamiliar with what a boil is, imagine the worst zit of your teenage years so large and swollen that it hurt to look at or touch, much less squeeze. Multiply that times 10 and place it anywhere on your body and you have a boil. These things are so tenacious and painful they can prevent you from walking or sitting…depending on where the boil is located. And, as many Fijians exhibit, they can leave physical scars if not treated properly. They can be treated with antibiotics, but it’s much easier to simply avoid them to begin with by washing with an antibiotic soap. The soap may not prevent them completely in Fiji’s brutal heat and humidity, but it least it improves your chances of not having a swollen, red, oozing sore the size of a golf ball where your lip should be.

Boils are just the beginning. There are plenty of other preventable health issues in Fiji as well. One of my favorite stories from a current volunteer involves the prevalence of lice in the rural areas. Keep in mind this is an absolutely true story, or, as we called it in the Navy, a “real no shitter.” This volunteer was walking home from training one day when she came upon what appeared to be an outdoor hair styling session where the person standing appeared to be removing bobby pins from the hair of the woman sitting in the chair and placing them in her mouth…only they weren’t bobby pins and she wasn’t just holding them in her mouth… It seems the current method, at least in this village, of dealing with lice is to use an herbal wash to try and remove the crawlies and then pick the nits, or the eggs, from the hair using one’s fingers…followed by placing it in your mouth and biting down to a crisp ‘pop’. It makes sense, really. This way you’re killing the lice whereas if you just through the nit in the grass another person could get lice from that discarded egg. And if you’re wondering, neither I nor the volunteer who witnessed this asked what it tasted like, but my guess is the response would be “like chicken.”

This volunteer kept her composure, though, and, very matter-of-factly, asked about lice and how common it was in the village. Unfortunately, her inquisitiveness was misinterpreted by some of the young girls standing by and one fresh-faced youth stepped forward to proudly exclaim, “I have the most nits of all the girls in my village!” I guess everyone needs to be the best at something… How this volunteer suppressed an expression of being completely appalled I have no idea, but she has my respect and admiration.

Nevertheless, overall the people in Fiji are relatively clean, happy, and healthy. Every day education, and public health, improves and, maybe one day, things like boils and lice will be concerns of the past and they can have the luxury of worrying about things like cancer from environmental toxins and type II diabetes caused by a processed food diet like we do in the U.S.