Something Rotten in Paradise - article (long)

[Guest guest]

Hi group,

Worth reading...

Chris.

Something Rotten in Paradise

Approaching Kosrae, Air Micronesia Flight 957 banks gently over twin

volcanic peaks cloaked in rainforest lush with wildflowers and framed

by a crystalline sea. Touching down on the skinny coral landing, strip,

I embrace the thick jungle heat and the unctuous scent of frangipani.

In Kosrae, a tiny island state of fewer than 8000 souls, new arrivals

are a thrilling curiosity and it seems that half the island has come to

greet me. Starving mutts too lethargic to bark line the roadside like

pilgrims. Trees bend nearly double under loads of papaya and

breadfruit. The sea, dazzling and empty, beckons, but I resist the

temptation. I am on my way to a funeral feast.

We arrive to find the wake in full swing. Men huddle in lawn chairs

playing cards, while toddlers squat, transfixed, around a screen

blaring videotaped cartoons. Hovering women fill plates and wipe

toddlers' faces. The deceased, buried four long weeks ago in a nearby

crypt, seems almost beside the point.

Kosraeans die young - the man in the crypt was 56 - but not from the

developing world's usual suspects. There is no famine here and, with

the exception of upper-respiratory infections, there is little evidence

of the relentless microbial scourges that cut life short in, for

example, sub-Saharan Africa. The big killer of adults in Kosrae is what

epidemiologists call New World Syndrome, a constellation of maladies

brought on not by microbes or parasites, but by the brutish assault of

rapid Westernisation on an unassuming traditional culture. Diabetes,

heart disease, high blood pressure - scourges of affluence that long

ago eclipsed infectious disease as killers in the developed world -

have only recently turned their attention here.

We sit with the dead man's brother-in-law, who tells us that he, too,

expects to die soon. He was once fat like the others, he says, but

diabetes has made him thin. His sister's husband died of heart disease

and he himself, will go of diabetes. " But I am 57, an old man, so this

is of no matter, " he says, explaining it is not uncommon for a Kosraean

male to fall prey to a heart attack before his 30th birthday.

A small girl toddles over with a plate of bananas. Thick yellow

fingers, they are the sweetest I've ever tasted. Dozens of bunches hang

like banners around the place, gifts from mourners who have come to pay

their respects. Almost no one seems to eat them. They are beginning to

rot in the sun.

Kosrae was once a mighty kingdom, with the city of Lelu its capital.

Lelu is still the state's largest and most densely populated village, a

jumble of tin-roofed concrete huts connected to Kosrae proper by a

causeway. I drive there to visit the ruins of ancient Lelu.

The old city was built some time between AD1000 and 1400 of immense,

pentagonal, basalt " logs " shuttled by canoe from halfway around the

island and assembled into 100 or so individual compounds, some with

walls reaching as high as six meters. It took strong men to raise these

walls, strong beyond anything I can imagine. These looming remains are

silent with the secrets of a once-great civilisation abandoned and

largely forgotten.

The place is impressive and humbling. It is also unbearably humid, and

a steady stream of salty sweat obscures my vision and sours the mood. I

duck into a nearby general store for a cold drink. Inside my eyes

adjust slowly to the gloom. There are no bananas here, no breadfruit,

no papayas, no coconuts. What I see is row after row of canned goods:

Spam and corned beef and Vienna sausages spiffy in couture tins. There

are cake and muffin mixes from the US; ramen noodle soup from the

Philippines; 25kg sacks of polished white rice; slabs of softdrink and

Budweiser beer; and shelf upon shelf of chocolate bars and potato

chips. In a far corner a freezer is reserved for turkey tails - a

fatty, gristly hunk of the bird not popular in the West. The turkey

tail freezer is empty. The delicacy is so popular, I am told, that the

month's shipment ran out weeks earlier. Another boat is due next week.

I should come back then. I had hoped for coconut milk, but I settle for

a Coke.

Louis son called the coconut tree the " giraffe of

vegetables " . A freakish, almost ludicrous plant, it was at one time the

cornerstone of life in Micronesia. It offered shade from the sun and

thatch for housing, clothing and baskets. The nuts were food and drink.

But in Kosrae today coconuts are mostly a liability, leaving their mark

on the smashed windscreens of what seems like every 10th car. Thick

rings of coconuts circle the palms outside my hotel, rotting in the

sun, like the bananas. No one gathers them.

I visit every grocery store on the island and find no coconuts. But

there are plenty of salty, sweet and fatty imports - pudding mix,

macaroni and cheese, and Day-Glo breakfast cereals. There is canned

tuna and, incredibly, something called " artificial coconut flavouring " .

There is no fresh fish or breadfruit, mango or papaya. This is not to

say that such things aren't sold on the island. A smattering of fruit

stands hawk sacks of Kosrae's famously luscious green tangerines, juicy

in their baggy, elephantine skins. There is a fish shack or two. But

the fish stands are usually empty or closed and the fruit stands

forlorn. I am told Kosraeans don't often patronise these places. Not so

long ago people here grew their own produce on family plots and pulled

tuna and reef fish from the sea. But this is now the exception. Modern

Kosraeans don't have the time or the energy to farm or to fish - they

are too busy with their office jobs.

Once a fiercely independent kingdom, Kosrae today is one of four island

states that make up the Federated States of Micronesia (FSM). The

islands were under American administration after World War II until

1986 and the US remains its chief benefactor, supplying most of its

revenue, about $140m in aid each year, in exchange for free access for

the US military.

The bureaucracy required to manage and distribute this windfall has

grown into Kosrae's single largest employer. Few jobs here demand the

level of skill or physical effort required by traditional fishing and

farming. And people tend to move slowly, as befits the tropical

climate. Physical exertion has been further discouraged by the steady

importation of cars and trucks, and by the expansion of the island's

encompassing coastal road. To walk in Kosrae is to announce that one is

too poor to own a car, and Kosraeans, renowned for their generosity and

kindness, offer lifts to every casual stroller.

This newfound convenience has come at a high price, as a tour of the

state hospital reveals. A low-slung concrete structure with greasy

windows and no air-conditioning, it is poorly equipped to handle

anything but basic needs. Serious cases are airlifted to Guam or the

Philippines. Although he assured me his staff was excellent and the

facilities adequate, the hospital director, a former vice president of

the FSM takes no risks with his own health. His wife told me they both

travel abroad even for routine check-ups.

The hospital in-patient ward has perhaps two dozen beds, of which 19

are occupied when I visit. Thirteen are here for complications of

diet-related diabetes and two for heart conditions. One doctor laments

that diabetes; hypertension and heart disease are as common as coconuts

on this island and even more dangerous. Another jokes that even

health-care professionals succumb. " Look at me, " he says, pointing to

his paunch. " I am, myself, obese. How long before I have these

diseases? "

In 1993-94, the FSM Department of Health, with funding from the Centres

for Disease Control and Prevention, screened all the adults on the

island and found almost 85 per cent aged 45 to 64 were obese. It is

perhaps not surprising that many of these people were also diabetic and

that more than a third suffered from high blood pressure. Dr Vita

Skilling, the island's chief of public and community health, says

efforts to reverse this trend have been disappointing.

" Here you buy imported food in the store to show that you have money, "

she says. Some Kosraeans scatter empty Spam and corned beef tins around

their property as status symbols. But whatever cachet imported foods

carry is not really due to their extravagance - in fact, quite the

opposite. Imported food is cheap and children have learned to demand

it. A 15kg case of turkey tails imported from the US costs $15 or $16,

a locally grown chicken $7; a 25kg bag of polished white rice can feed

an extended family for weeks and it doesn't rot in the tropical sun.

Rice is not native to the island, but when there was a rice shortage a

few months earlier, some children actually went hungry rather than eat

breadfruit or taro.

" We eat white rice for breakfast, lunch and dinner, " Skilling says. " We

make the excuse that children prefer it, but the real reason is that it

is so easy to cook. It's so much easier to cook rice for the day than

to go to the farm to pick fruit. The imported food we eat is too high

in salt and fat and we eat far too much of it. And we've gotten used to

sugar - some older people can no longer drink plain, unsweetened water. "

Skilling is not too proud to make mention of the obvious - that even

she, with her knowledge, is fat. She has no immediate plans to remedy

this, but she does worry. " Diet-linked diabetes is the No. 1 health

problem in Kosrae. It cuts us down, " she says.

Uncontrolled diabetes leads to circulatory problems, foot ulcers, skin

abscesses, and eventually to heart disease, kidney failure, and

blindness. It is a First World disorder that increasingly has come to

plague the developing world. In Kosrae, 90 per cent of hospital

surgical admissions are diabetes-related, often amputations are

necessitated by vascular breakdown. There are more cases of renal

failure than the hospital can handle, and cardiovascular disease is

pervasive.

" People deny having symptoms until they are very sick, and then they

demand a miracle to fix it, " Skilling says. " And they are fatalistic:

they expect to get diabetes because so many of their friends and

neighbours and family have gotten it. " Many choose not to have their

diabetes treated. At age 55 or so they begin to feel they are living on

borrowed time. They are not greedy for longevity.

I stop at a fruit stand for a bag of tangerines, and notice a white man

in surgical scrubs hovering over a pile of papayas. He tells me his

name is Ken Miklos, and that he first came here from his native

California in 1995 on a mission with the Seventh-Day Adventists. He

liked the place - in particular the surfing, which is wild and lonely;

Kosreans respect and work the sea, but rarely play in it. When his

mission was over he returned to California to complete dental training,

but he couldn't get Kosrae out of his mind. So after a couple of years

he came back to set up practice at the state hospital and to marry a

Kosraean woman. He has been surfing and pulling rotten teeth ever since.

I see kids with 20 primary teeth, every one of them not just with

cavities, but bombed, " he says. " We're talking abscesses, six to eight

at a time. I have to yank 'em. In church they have candy to keep them

quiet. They're nursed with sugar water. They have calcium deficiency

and vitamin A deficiency. Half the teenage girls are obese. They eat US

imports loaded with fat. It's tough to change your lifestyle. They are

sick, their legs are amputated, they're dying. But it's what they're

used to. "

The World Health Organisation describes over-eating as the world's

" fastest-growing form of malnourishment " . While outbreaks of HIV,

tuberculosis and malaria are horrifying, these are not the primary

killers of man. That dubious distinction goes to ischemic heart disease

(IHD), in which blood flow to the heart is blocked. More than 60 per

cent of the global burden of IHD is borne by the developing world, and

that percentage is expected to grow. The WHO also estimates that the

incidence of obesity will double to 300 million cases worldwide by

2005. Most of those affected will live in the developing world, where

treatment is hard to come by.

I meet a 29-year-old heart attack survivor, a mother of three. Her

husband, who is 31, has debilitating diabetes. They are fortunate in

that their parents are alive, to care for their children in case the

unthinkable - but far from unlikely - occurs.

In speaking with agricultural and business leaders in Micronesia, it is

clear that a concerted government effort to fight noncommunicable

disease is not imminent on these islands. I hear repeatedly that health

is a matter of willpower and individual effort, and that there is

nothing government or business can do to curb the public taste for

imports. I hear from their own leaders that the people of Kosrae are

" lazy " - too lazy, presumable, to farm or fish for food, too lazy to

pound breadfruit rather than open a can.

I've seen breadfruit being peeled with a machete, boiled and mashed,

and I can't imagine why anyone would voluntarily take on this laborious

task had they less arduous alternatives. I don't mention this to the

business or government people. It doesn't take an expert to know that

their charges of " laziness " are a mere distraction. After all, the

health administrators and public figures who complain about the

lifestyle habits of their countrymen are doing so over a lunch of pork

fried rice in a restaurant where breadfruit is not on the menu.

The reality is that those in power in Kosrae have a large stake in the

commerce that is making their people sick. They make light of the fact

that many legislators in Micronesia are businessmen, including food

wholesalers. They show little interest in discussing the particulars of

automobile imports in a tiny county already overrun with pick-up

trucks. They prefer to focus on individuals' responsibility to carve

out a healthy life in a social and economic climate that makes healthy

living all but impossible.

Father Francis Hezel is a Jesuit priest from Buffalo, New York, who has

spent more than two decades living, teaching and writing in Micronesia.

White0bearded and springy-limbed, he has the vigour of an evangelical

teenager. But he cannot help but be discouraged by what he sees on

these islands. " I know that it's a bit odd for a man of the cross to

admit, but I don't believe in intentions, " he says. " Intentions mean

nothing; you have to create structures in which people can perform. The

hardest thing to do is to convince people that they can take control of

their own lives, and to offer structures to allow them to do this. You

can enter any clinic here and smell the decaying limbs, rotted by

diabetes. But even church people here are reluctant to speak out

because they are beholden to the government. They don't want to rock

the boat. " In Micronesia, as in much of the world, it is more expedient

for authorities to promote policies that encourage over-consumption

than to discourage it.

Food merchandisers see in the developing world an untapped " land of

opportunity " . In 1997, according to the World Watch Institute, five new

Mc's restaurants opened every day - four of them outside the US.

" How long can a company of our scope keep doubling its size? " asked

Coca Cola CEO o C. Goizueta. " Where will the next 10 billion unit

cases come from? And the 20 billion after that? The fact is that we are

just now seriously entering and developing the soft drink markets that

account for the majority of the world's population, but are also

culturally and climatically ripe for significantly increased soft drink

consumption. " Given this, is it any wonder why the " climatically ripe "

people of Kosrae are no longer content to drink plain water?

Obesity, diabetes and other manifestations of the New World Syndrome

are not infectious, but like infectious disease, they can be contained

with environmental change. In Singapore, the nationwide Trim and Fit

Scheme, which began in 1992, has, through regulated school diet and

exercise programs, cut childhood obesity by as much as 30 per cent,

albeit with measures including an annual childhood " fatness score " that

would be unacceptable in some less authoritarian cultures. In one

region of Finland, government-sponsored advertisements, strict

food-labelling regulations and school-based fitness programs helped

slash rates of coronary heart disease and obesity. And in Hawaii,

doctors and health authorities have sown long-term health benefits from

a program emphasising exercise and a return to traditional local foods.

I spot a glimmer of progress in Micronesia, though not in any organised

Western-style wellness programs. One of my hosts, a soft-spoken

hospital administrator, confesses that he neither farms nor fishes, but

he enjoys playing basketball, and he sometimes jogs rather than drives

to the high-school gym to play. As a result, he has lost 15kg and

avoided some of the health problems suffered by his more sedentary

compatriots, including his wife, who is a doctor. Basketball, he says,

is catching on in Kosrae, as is baseball. " Imports made us sick, " he

says. " Now, maybe imports will help us get well. "

But it is unlikely other Kosraeans will join him on the basketball

court to stem the tide of the epidemic. Most Kosreans would as soon don

a pink tutu and tights as jog. When I ask a nurse if she and her

friends swim, her lip curls into an ironic smirk. Interviews with food

importers point to more - not less - processed food being shipped into

Kosrae from the West, and the island has just brought in television

programming.

With TV beamed into homes, even making the effort to pick up the

night's entertainment at the video shack will no longer be necessary.

Kosraeans will be able to return from a day of sitting around a

government office, crank open some Spam, switch on the tube, and kick

back for a relaxing evening with the family. It is then that they will

truly be able to live - and to die - in the manner of their Western

benefactors.

Edited extract from The Hungry Gene, by Ellen Ruppel Shell