Ob/Gyn Team Brings Health
Care to Women of Yap

10/27/01

The concept of health care for women is a familiar one to people here in the United States. Certainly our system needs improvement, but such things as pap smears and pelvic exams for women are well known and commonly available in this country.

Not so for the women of Yap, one of the Federated States of Micronesia. In this tiny Pacific nation of 12,000 people, medical services for women are severely limited. They lack any sort of gynecological screening program; in fact, many women have never even had a pap test.

On Sept. 28, 2001, a Canvasback ob/gyn team began a two-week clinic at the Yap State Hospital.

Canvasback ob/gyn team members included John Anholm; 
Anne Anholm, M.D.; Robert Blue, M.D.; Cheryl Hickethier, M.D.;
 Kathleen Kimball, N.P.; and Lauren Petford, R.N., team coordinator.

This was the second time a Canvasback ob/gyn team had been to Yap. In 1999 another team had screened 209 women and found that a number of them had suspicious results. What happened to those women? Did anyone ever follow up on them? How were they doing now? The team was anxious to find out.

The Canvasback ob/gyn clinic turned out to be quite a momentous event for the islanders. The clinic’s anteroom filled to capacity with women who willingly waited for many hours to be seen by the mission doctors.

Most of the 345 women who came to the clinic had multiple problems. For example, one typical patient was diagnosed with thyroid dysfunction, high blood pressure and diabetes, plus urinary tract and vaginal infections. 

The team also made a number of first-time diagnoses on women who didn’t know they had such conditions as diabetes and hypertension.

The Canvasback physicians performed 22 surgical procedures ranging from hysterectomies to breast mass excisions. They worked side-by-side with Dr. Ramon Vista, the hospital’s only surgeon, to perform many complication-free surgeries. Extra medications brought by the team were donated to the hospital pharmacy.

The surgical team (from left) included nurse anesthetist "Dr. Jay;" nurse Regina Suwei; Canvasback surgeons Robert Blue and Anne Anholm; and Yap surgeon Ramon Vista, Jr.

A Woman’s Place

Investigating the fate of the suspicious pap smears from two years ago, Dr. Anholm was disheartened to learn that they had been simply filed away in charts with no follow up. The team speculated that this may be because women’s health needs are not considered a priority in their culture.

Yap is arguably the most traditional corner of Micronesia, and this strong adherence to custom has helped the Yapese people to preserve many of the distinctive features of their culture—such as dress and dance and social organization—to this day. One element of the culture that has survived is a caste system that accords little value to women. What respect a woman does enjoy in Yap society is related to her fertility, and much of a woman’s self-esteem hinges on being able to bear many children.

Affirming the value of women and the love that God has for them is one of the main motivations the team members cited for making this journey.

Can I Really Make a Difference?

Dr. Anholm tells of one woman who had sought treatment for abnormal bleeding over a seven-year period. She made various visits to the clinic, but no one knew what to do. "The woman had a hysterectomy during our mission trip," Dr. Anholm says, "Sadly, she has an aggressive type of uterine cancer and it may have progressed too far. This could have been entirely prevented with the right bit of knowledge." Working side-by-side with the team in all facets of the seemed to really ignite her enthusiasm. She soaked up information like a sponge as she gained a new appreciation for her role as one of the sole health care advocates for the island women. Dr. Gurweg agreed to continue consulting with Dr. Anholm as she dedicates herself to providing the very best care that she can to her female patients.

Dr. Anholm performed  surgery on a 37-year-old  woman who had an ovarian  tumor the size of a grapefruit.

Dr. Anholm hopes that continued consultation with Dr. Vista and Dr. Gurweg will prevent the needless progression of disease and be the beginning of a more effective screening program for the island women. "The opportunity to help the local practitioners and general surgeon exand their skills in gynecology will bring a more long-lasting kind of assistance than we could ever provide in person."

The ob/gyn team is one example of how Canvasback medical teams are working to improve health care for the less fortunate through the practice of "compassionate Christianity." Using Jesus’ ministry as their model, Canvasback teams offer cultural sensitivity and respect for tradition, at the same time showing the island people a better way. Thus, short term missions inspire and support long-term improvements in health programs for our brothers and sisters in Micronesia.

Yap: A Nation of Betel Nut Chewers

Everywhere you go in Yap there are strategically-placed spittoons for the betel nut that virtually all the islanders chew, even the children. One 20-year-old public health worker is pregnant with her first child. The bag she carries around containing her betel nut supplies is as ubiquitous in Yap as the purse is in America. 

About once every hour, she stops to prepare a little packet containing betel nut and lime ground from coral, to which she folds in part of a vodka-soaked cigarette. She then rolls it in a pepper leaf and sticks it in her cheek like a wad of tobacco. The combination provides a temporary high that lasts only about 10 minutes then must be repeated. Thus, nearly everyone you meet has a brick-toothed smile that is the hallmark of the betel nut addicted.

Wrapping the betel nut in a pepper leaf.

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