On this island, people have an unhealthy acceptance of death. - Bill Stinnet, Chuuk, FSM
 

As a retired FBI agent who has made his home on Chuuk, Bill has seen his fair share of difficult situations. But when death becomes so comfortable, so unquestioned, so easy, even he takes notice. People die and then they are buried; there is no autopsy, no investigation, and certainly no lawsuits. So why has death become so commonplace and so readily accepted on the island? As discussed earlier, the advent of Western influences has brought many conveniences to the area. However, one such Western

Aisle in a Chuuk grocery store

“convenience” that has really taken hold on the island is the canned meat Spam. The people apparently love the stuff. At 174 calories, 15 grams of fat (23% daily value) and 767 mg of sodium (32% daily value) per serving, and people are certainly not limiting themselves to one serving, it is no wonder that the rates of obesity, hypertension, and diabetes have exploded on the island. Not only is this island state still battling many communicable diseases virtually non-existent in the United States, but on top of it they must deal with the burden, cost and mortality associated with some of the deadliest chronic diseases on Earth. 

Needless to say, the hospital in Chuuk is dangerously under staffed and under resourced. The power goes out every few hours in the hospital. We can only imagine the anxiety associated with performing (or receiving) surgery under such circumstances. Officials try to compensate for the shortage of providers by hiring physicians from China on short term contracts, but these doctors speak virtually no English or Chuukese- the two languages used on the island. Having just completed our first year of medical school, one of the things we learned early on was that the patient history and physical examination are the two most valuable skills and sources of data a doctor can have, more so than any fancy test or imaging technique. If a doctor cannot adequately communicate with a patient, how can they adequately treat the patient? When people tell Bill about their experiences in Chuuk’s hospital, his response is “you went to that hospital- and you survived?”. Drugs are dispensed from a small shop in town and placed into unmarked plastic bags. People often have no idea where the drugs originally came from, how old they are, or even if they received the correct medication.