Culture of Wellness in Palau

Koror, November 2007

 

Introduction

 

The Culture of Wellness. The theme is an important one, but perhaps unmanageable. After all, culture is a key ingredient in just about everything we do–beginning with what we smile at, what we eat and feed our children, and how we prioritize our spending.  As for wellness, the term embraces not just our physical health, but health of mind and spirit in addition.

 

I can’t possibly do justice to the theme of this year’s convention, so let me pick a few salient points for discussion and hope that this stimulates further reflection over the course of meetings.

 

This is an outsider’s view, of course, but one informed by a long history of visits here.  After all, I’ve been making occasional visits to Palau for over 40 years.

 

My first visit in summer of 1964: the days of the Boom Boom Room, and the club in the cave just before the causeway to Malakal.  When the old Royal Palauan Hotel was in its prime.  What I found was a fast-paced life, at least in Koror–and more and more people were swarming into Koror all the time.  Motorcycles were the vehicles of choice for the young.  They whizzed by late at night, often with a girl clinging tightly to the driver. I could hear them as they down-shifted to make the hill next to Sacred Heart Church while I lay there thinking of all the things I was missing.  I can’t say much about the old-timers because I was hanging with Xavier students, but the culture of the young was beer-guzzling, whiskey-swilling, pedal-to-the-floor, go-for-broke.

 

It was the time of the New Frontier.  There was more US money around, and there would be much more in the future.  The sale of alcohol to Micronesians was just a few years old, and lots of people were taking advantage of it.  Cigarettes were cheap and plentiful.  “Let’s party” seemed to be the theme of the age.

 

I like to contrast this first visit with another I made in the early 90s, thirty years later.  The contrast couldn’t have been greater.  President Tommy Remengesau, the VP at the time, was on the basketball court at Palau HS, and there were two other members of OEK also playing, if I remember correctly.  The next day I met Moses Uludong, in his running shorts, fresh from a run to the K-B Bridge.  When I tried to invite out some of the women from the Osiachl for a drink, I was warned that we would have to end the evening early so that they could wake up in time to do their long morning walks.

 

Was this the same Palau that I thought I knew so well from the 60s and 70s?  What happened? Was it that we had all aged and had become sated with the fast life?  Whatever the case, I found myself surrounded by people who decided that they were going to live a healthy lifestyle.  Everyone but me had given up smoking, people were now drinking red wine (a drink that was almost unknown in the 60s), and exercise was now considered a legitimate activity even for middle-agers or beyond.  Something had changed–for the better.

 

“Highs”

 

Palau went through some bad times with drugs, as one cycle gave way to the next.  Marijuana was probably the least damaging, but there was heroin, and then ice.  For two or three periods, a drug subculture was established here on Palau.

 

One contributing factor may have been Palau’s geographic location, with its easy access to the Golden Triangle and the other portals of Asian.  I’m sure that the heroin problem was a spillover from Guam in the waning years of the Vietnam War. The same geographical conditions that helped create a booming tourist industry here led to the drug problem as well.

 

Palau has always had a sharp eye out on the western world.  It was the first island group to emigrate–to Guam during the late 40s and 50s, and later to everywhere else.  Our Xavier students in the 60s and 70s used to bring the latest dance crazes and musical tastes to school with them–they had a reputation for being at the cutting edge.  But the cutting edge has its downside as well, especially when it leads to the introduction of the latest fads in drugs.

 

Consequently, Palau was afflicted by drugs to a degree that no other island group in the old TT, with the exception of the Northern Marianas, was.  Since then, you’ve learned to be vigilant, to tighten controls–not just at the airport and harbor, but especially in the family.  By this time you must have learned that the greatest protection against harmful drugs is a strong family life. You’ve also mounted on-going campaigns against drug use, as I see from the signs that are posted around the track behind PCC.

 

Remember, though, that most cultures provide for “highs” in some form or other.  Beware of a drug-free campaign that makes no distinctions between the drugs.  Betelnut use or a daily glass or two of wine is not the same as shabu.  Caffeine may be a drug, but it is far preferable to nicotine, as my doctor continually reminds me. The health costs are enormously different.  You can’t suppress all drugs, and it is pointless to try.  Choose your battles wisely, the more so because your dollars and personnel are limited.  Don’t let yourselves be bullied or bribed into picking the wrong battles.

 

Food

 

Palau, like the rest of the Pacific, has what might be called a culture of food.  I don’t need to tell you that food is used to celebrate just about everything life event in this society.  It also is used to bond relatives–you give me food, and I reciprocate, thus binding us into a deeper unity, as a family, as a village, as a people.

 

A few years ago, members of our church on Pohnpei were bringing over food to the Jesuit house on Sunday evenings since they knew our cook didn’t work on weekends.  The problem is that they brought so much that some of my brother Jesuits began complaining that there was not enough space in the refrigerator to store the leftovers.  So our Jesuit community decided to put an end to the practice.

 

Too much food to finish at a meal?  From a cultural point of view, the surplus is entirely understandable.  No one wants to be tagged as the kind of person who leaves his or her guests hungry.  Besides, the extra food can always be redistributed, of course.

 

Food gifts are heavily weighted with cultural meaning, as we all know.  But food also puts weight on bodies, and that weight puts our people at risk of the non-communicable diseases that are ravishing our islands–especially diabetes and heart disease.

 

How do you diet in a “fiesta culture”?  This is the question that haunts us all over the Pacific.  It’s a quandary in Saipan no less than in Palau.  In an earlier day in which everyone grew or caught their own food, we might not have had to struggle so hard to limit calory intake, but that was before the age of the white collar worker and the security guard and the taxi driver.

 

For that matter, how easy is it is to exercise on an island that leads the Pacific in the ratio of automobiles to persons, an island that has more 100 and 200 HP outboard engines than anywhere else?

 

Can we adapt the food culture enough to control against the new lifestyle diseases, but without becoming un-Palauan?

 

Sex

 

Sex, besides being one of the strongest human urges, is right up there with food in the degree to which it is woven into the culture of the Pacific Islands.  After all, the myths associated with the Pacific over the centuries have at least as much to do with enticing women and easy-going mores as they do with swaying coconut palms and moonlit nights.

 

When we dig beneath the myths, we find that there was in fact a place for casual sex, even apart from the nightcrawling that was common in other parts of Micronesia.  First, there was the tradition of the mongol who served in the clubhouses.  The Germans had a hand in the elimination of this practice because they afraid that the population decline was brought on by infertility caused by venereal disease.  Similarly, the first German priests to Palau were hesitant to bless marriages because they were so unstable–not just because men were tomcatting around, but because of the enormous pressures that couples were under to either satisfy the demands of their blood relatives or else terminate the marriage.

 

But let’s talk about the present rather than the past.

 

First, teen pregnancies.  Palau’s teen pregnancy rate has always been high–right up there with Majuro and Pohnpei, and far higher than the more conservative islands of Chuuk and Kosrae.  DeVerne Smith’s book on Palau makes mention of the fact that some Palauans not many years ago began referring to PHS as Pregnancy High School because so many of the girls were finding themselves with child.

 

But there is something that worries me even more–and that is the age of first sexual contact.  In the last ten years we have had four Pohnpeian girls aged 12 or younger bear children.  That’s not an urban legend, as one American anthropologist thought it was, but a fact.  Is there evidence here that the age of first sexual intercourse in Palau is dropping in like fashion?  If so, doesn’t that present us with a serious health problem

that may require more than just effective education on contraception?

 

In a few other islands in the Pacific, there is evidence of growing sexual initiation within the family itself–in other words, incest.  Girls may be expected to satisfy the desires of older males in the family, those without their own partners and who are incapable of finding them.  I don’t know whether this is true here, but there are hints of it every now and then. If this is the case, how do we respond to it?  I have known three older women who have been sexually abused within their families (none of them Micronesian, I should add).  It is no exaggeration to say that they have been scarred for life.

 

Then there is the problem of STDs (sexually transmitted diseases), especially HIV.  There has been such a strong campaign mounted everywhere to deal with this problem that we need not go into it at length here.  We at MicSem tried to present our own analysis of the HIV problem in this area, but we encountered a host of what I consider silly objections based on political correctness. At bottom, in my opinion, the sooner we incorporate HIV testing into the routine blood work that we do on patients the better off we’ll all be.  Be brotherly and sisterly to those with HIV, by all means, but the real job is to prevent others from getting the virus.

 

Finally, since we are speaking to the theme of wellness in culture, let’s go beyond the boundaries of physical health–that is, the diseases that can be contracted sexually and ways to prevent them from being passed on.  If we’re genuinely concerned about wellness–the total package, that is–then we must understand that sex is a weapon that is powerful beyond any other. It has ruined more lives than just about anything else I know of.  If we want to keep ourselves and those we care about well, let’s not break hearts.  Condoms protect against disease, but maturity and self-discipline and love guard against a type of emotional damage that can be far worse in the long run.

 

Competition

 

Palauans are legendary competitors.  Competitors in sports, and in academics, and in just about everything else. I think that’s why I found it so easy to relate to them during my earliest years at Xavier.  But why shouldn’t Palauans be competitive?  You have a perfect social structure for engendering competition, as the early anthropologists were so fond of pointing out, with a sharp line splitting everything into halves–competing clubhouses, competing villages, competing confederations–bital ma bital, I think you say.

 

I, too, come from a culture that prides itself on its competitiveness–maybe even twice over, since three of my grandparents immigrated from Germany to America, where they found a fine outlet for their drive to excel.  In addition, I was educated at a Jesuit high school where the motto, taken from the Greek classic Iliad, was “always to excel and surpass all others.”  Even so, I found that I could learn a trick or two from my Palauan friends when it came to the workings of that competitive drive.

 

As we age, however, we become more compassionate, more ready to see life as something more than just a contest.  At some point, we begin asking whether our society has a place for those who don’t win, even for those who never win.

 

I imagine that in traditional Palau the pain of losing was assuaged by the fact that the individual had an extended matrilineal family that would provide care and would accept him for what he was. Fr. Felix was always telling us that a young man had to work to be accepted into his father’s family, but he always had a home with his mother’s family, no matter what. Is that still true today?

 

Increasingly we are forced to depend on our personal resources.  We live in nuclear families today, we provide for our own children, we ourselves determine what we shall be and where we shall make our homes.  Nevertheless, the cultural pressures are brought to bear on us today, just as they were in the past, to comply with customary giving (siukang)–whether for house-building, first-births, marriages, funerals, or any number of other events. For those who have the wealth to do so, this can be a marvelous opportunity to display the success that life has brought.  But what about those who are struggling to get by?

 

It seems to me that for an islander there is no more damning failure than to have to admit: “I have let my family down.”  This feeds into any number of social problems that plague us today–suicide, alcohol and drugs, and any of the other ways in which lack of self-esteem shows itself.  My feeling is that this entire subject will require much more reflection by Palauans, and perhaps more readiness to adjust old customs to present-day realities.

 

Along the same lines, there is another caution I would offer. We can be measured by our output–the work we’ve done and the money we’ve earned–in gauging how high we score in a competitive society.  But we may have to lower our sights a bit to provide time for our children and spouses.  We are told over and over again that personal presence is indispensable in creating a happy child.  That means that in our rush to compete, we will have to factor in obligations to the young people we should be helping to develop.

 

The Gender Divide and Mental Illness

 

Palau, as some of you know, has one of the highest rates of schizophrenia in the Pacific.  This in itself is not due to a cultural failure, but simply to the fact that in some relatively isolated societies, such as we find in parts of Scandinavia, the limited gene pool seems to favor the passing on of genetic diseases such as schizophrenia.

 

The late Dr. Tony Polloi did outstanding work in charting the family trees of those afflicted with this disease so that others might map the genetic distribution of the disease.  Once Palau had been put on the map for its high rates of mental illness, a number of other medical researchers came to study the genetic component of schizophrenia.  I suppose they were impelled by the exciting work in gene mapping that was going on at the time.

 

But let’s not get carried away by the genetic element in the disease.  The social environment also plays a role in the onset of schizophrenia, as I always try to remind those in health services and social work.  Perhaps we should pay more attention to what I regard as the most astonishing fact about schizophrenia in Palau, and all over Micronesia.  There are two or three times as many males who show symptoms of schizophrenia as females.

 

If I were working in mental health, I’d be asking myself why the male rate is so disproportionately high.  Is it that males tend to be drug users?  Are there other socio-cultural pressures that push males over the brink at a greater rate than females?  What, if anything, does this have to tell us about wellness and culture, especially as it relates to gender?

 

The Life of the Spirit

 

By this I don’t mean simply religion, although religion can certainly contribute to the life of the spirit.  I am referring to the fact that true wellness or health goes beyond the physical and extends to the deepest parts of the human person.  A person may have a normal heart rate, no signs of high blood sugar, and be in fine physical condition, but that alone doesn’t make the person healthy.  The emotional side of the individual has to be well grounded, and that person has to have a vision that he or she can steer by–a sense of purpose in life, something to hope for.

 

Book after book on drugstore shelves offers the old bromide about the importance of wholeness in the person.  This may be a bromide, but it’s no joke.  We commonly speak with admiration of a person who “has it all together.”  What can we do to foster this life of the spirit?

 

Palau has rightly emphasized wholeness in other dimensions.  There have been insistent calls to recognize the oneness of people with their environment in the hope that this awareness will promote conservation.  There have been pleas for a sense of national unity in an effort to bring together a people raised in a famously competitive society.  How about recognition of the importance of wholeness within the individuals who make up this society?  What do we need as persons to deepen this sense of wholeness?

 

Conclusion

 

The Palau I see today has come a long way from the 1960s.  It has developed a health services system that is the envy of its neighbors, one that appears to have successfully taken on many battles with disease and established high standards of health care.  There are still more battles to be fought, of course, but there always will be.

 

As I conclude, may I suggest that you heed your president’s advice to retain the heart of your tradition, but make adaptations where needed. “Save the best and change the rest,” as the saying goes.  But the matter doesn’t end there.  You’ll have to constantly examine the cultural ground to decide which is which.  That’s what I’ve been trying to suggest in this talk.  Can we say: “Save the best, change the rest, and continue to test?”

 

 

11/29/07