Playing Along: Fieldwork, Emotional Labor and Self-Care

My reflections on fieldwork in Fiji during my service as a Peace Corps volunteer and the emotional considerations of living in another culture.

The Geek Anthropologist

By Emma Louise Backe

For any practicing or aspiring anthropologist, fieldwork is the defining, almost qualifying practice of the discipline. As an undergraduate studying sociocultural anthropology, we read the seminal journals of Bronislaw Malinowski, followed by foundational ethnographic research from around the world. Even though the field has ostensibly moved beyond the “exotic”—no longer wholly consumed with discovering new indigenous communities or uncovering a culture untouched by capitalism and globalization—students are still encouraged to conduct their fieldwork in remote, isolated, and, yes, tacitly exotic locations. As my professor lectured during my Anthropology Senior Seminar at Vassar College, you have to conduct your first fieldwork abroad if you want to be taken seriously as an anthropologist. The implication was that if you don’t go somewhere distant and strange, you won’t experience the same level of cultural difference, linguistic estrangement, physical hardship, and existential negotiation that molds the student into a consummate…

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Ferðast: A Trip to Iceland

I’ve been dwelling a lot lately on journeys. A year ago, I was departing from Fiji, walking away from my Peace Corps service on a small island in the South Pacific. It therefore seems fitting that the first international trip I take after my Peace Corps service was to another island, although one that could not be more different in custom and climate. I went to Iceland to visit my friend Sophie, whom I’ve known since studying at Vassar College. She too spent 2013-2014 in an isolated, tropical environment interning at a study abroad program at the Turks and Caicos. She too had difficult experiences with island life, complicated by institutional grievances and professional obstacles. There is this certain juncture that come after finishing your undergraduate career, where you realize that you cannot always control how the professional world will perceive you—we are intellectually qualified but practically under qualified, penalized for our young age and supposed naïveté, yet finally given a critical lens with which to see the world and understand our position within it. That liberal arts degree which trained us in critical thinking, analytic writing, rhetoric and creative problem solving suddenly isn’t applicable. Though Sophie and I both worked in grassroots, informal communities, we both learned quickly that negotiations of place and space also begin with how you orient yourself in the world, acknowledging that others’ values may run askew of yours. In these moments, it is easy to feel rudderless, even in the most beautiful of places. So we reconnected in the loveably frigid land of fire and ice over beer, adventures, and plenty of licorice candy.

I have found that the best kind of travels occur when you don’t go in with too many expectation. This is not to say that you shouldn’t be excited about a vacation, but rather that if you have an open mind about your journey, it makes it easier to be flexible with how you get there and remain open to new possibilities you couldn’t have initially planned for. Traveling used to scare me. I always wanted to travel, but I grew up in a family that bred travel anxiety into me from an early age. Every trip was planned down to the minute and there were few opportunities to stray from the path. Part of the reason why I joined Peace Corps was to become a better traveler, which I believe I accomplished to a certain extent. You can’t really plan in Fiji—there are too many contingencies to control for. The rainy season may unleash a flood you cannot ford and eliminate any possibilities of taking a bus into town. The minibus may break down halfway up the mountain. Roads may deteriorate or rocks collapse or phones malfunction and you just have to learn to sega na lega your way through. I still stressed out a lot about it, but I also learned to live out of a backpack and be appreciative for the small things—an offer of ivi nuts on the bus or a free ride from a distant cousin. I packed the warmest clothes I could find (a necessity), did some preliminary research on Lonely Planet, and flew across the Atlantic simply hoping to explore a part of the world I’d never seen before, get in touch with a culture whose infrastructure is built around their folklore, and be outside.


I was greeted with a sunny, windy day that ended up being one of the warmest of the trip. At the beginning of May, winter is still clinging to the landscape, which has a quiet, almost desolate beauty about it. For the fields that aren’t populated with lava, basalt columns or spiny rocks, mosses and dried grasses sprawl across the landscape between rushing rivers and waterfalls. It truly felt like a Martian landscape, were it not for the random herds of sheep and ponies along the highway. You can drive for miles without seeing another car. You get the sense that Icelanders respect the ferocity of the climate—they have not tried to colonize the landscape so much as carve out small niches here and there where the cold is tolerable and the community close-knit enough to abide the harsh winters. It is hard not to be in awe of the profusion of delicate, dangerous natural formations—the bubbling hot springs, the geysers, the barely dormant volcanoes. It’s no wonder myths about trolls and faeries persist—it is a land still latent with potent magic, strength shapes scattered across the horizon that could easily be mistaken for crabbed, humanoid shapes hunkered against the sun’s rays.

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One of the things I was most moved by was the seeming lack of ownership of the land. As we turned and twisted along the highway lined with glaciers and mountains, we could pull off to the side of the road wherever we wanted to explore or stretch our legs. There was little concern about private property, apart from the errant signs warning walkers to be conscientious of the ecosystem, the delicacy and importance of their mosses. On any given stretch of the road, you could pull over to follow a river to a miniature waterfall or discover archaeological ruins, the outlines of a great hearth still piled with the shells of mussels. In the distance, you could always vaguely see the outline of a church, but the architecture was surprising and vaguely alien, bowed against the weather yet spiraling toward the clouds like a space age spiritual spine. As long as you respected the natural landscape, it was yours to explore and discover. In the process, you are constantly dwarfed by the sheer scale of things, as well as the tenacity of the farms that barely exist on the fringes of wilderness, alone for hundreds of miles with nothing bug a herd of shaggy ponies and the patient promise of spring.

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I was struck by the dogged determination a person and a culture must have to persist and remain under such conditions, as well as the kindness and care Icelanders showed to us as we traveled. Though it is a Christian nation, you can still feel the Old Gods rippling beneath the surface, nestled like barnacles into the spiritual lives of its people. I’ve always found it interesting to examine the kinds of stories and art that a culture produces and how much these narratives are shaped by the environment. In the old days of Iceland history, the composition of a poem could save a person from the gallows. Now, visitors throw Kroner into the aquamarine waters of Alþingi, the Viking Parliament, where they drowned women condemned as criminals.


The water sparkles and glitters, as if some spirit still remains. There is both the old and the new, a combination embodied by the capital of Reykjavik. There is a certain fierceness and comfort to the land, the way that the wool clothing knitted for warmth and survival is so beautifully and delicately made, to the point where you almost forget the garment is a necessity the majority of the year. The capital is full of cozy coffee shops bursting with old portraits, idiosyncratic African masks, and tchotchkes, making even the most “commercial” café feel homey and familiar. The horrific images of Ragnarok are balanced out by diminutive cartoons like Moomin. Iceland is an enchanting land fortified by their fascinating history, incredible vistas and unique charm. And their dogs are pretty friendly too.

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A new friend in Álafoss

A new friend in Álafoss

Perhaps the most enchanting part of my trip was our expedition to Helgafell, or “Holy Mountain”. En route to Snæfellsnes Peninsula, where we would spend one night at an adorable guesthouse called Sundabakki (try the wedding bars), we stopped at a small hill called Helgafell. The hill, like many parts of Iceland’s natural landscape, is haunted. As a portal to the afterlife, moribund Icelanders would travel to the hill on their final journey into death. A small white church and a graveyard sit at the base of the hill, where Guðrún Ósvífursdóttir is buried, a woman made famous from the Laxdæla Saga. As the folklore goes, a visitor to the hill must follow very strict instructions if you want to tap into the magical reservoir. Above all, you must not speak the moment you begin your trek. In mythology and folklore around the world, silence is often associated with gravesites, either out of respect or to keep the dead from awakening. Some have said that you cannot defile the hill with bloodshed, which made me wonder whether menstruating women were forbidden from visiting. First you must visit the lone gravesite of Guðrún surrounded by her own fence, before beginning the climb up the hill. Like the Greek myth of Orpheus and Eurydice, you cannot look behind you as you walk up the hill—otherwise the journey will have been made in vain. When you reach the top of the hill (about a ten minute walk), there is a sundial. You must face due east and only then can you make a wish, which may be granted by the spirits. The trip down the hill must be conducted in a similarly sedate manner.

As a lover of folklore and ghost stories, I was excited to follow the rules and make the trek myself. We arrived at Helgafell around 4:30 pm, when the sun is still high but shadows scuttle across the crenellations of the landscape. As soon as we stepped out of the car, however, fingers to our lips, we heard the bleating of baby lambs. Huddled against the larger sheep, black and white lambs were crying out, shivering in the wind surrounding the Church at the base of the holy mountain. They looked like they had only been bore days, if not hours ago. They were all standing by the graveyard, but as we approached, the mothers shuffled the babies away. Most of the livestock in Iceland are free range and permitted to wander wherever they want within the vast expanses of open farmland. But one little black lamb got separated from the tiny flock in the tall grasses. Clearly confused and scared, he scrambled over to us from a wary distance. Unable to speak, we tried to chivvy him towards the nursing mothers scattered along the graveyard’s fence. As we did so, we heard a more piercing, plaintive cry from the small grave we had driving to visit. Upon approaching the ramshackle gravesite, a small white lamb ambled out, having been hiding behind the gravestone. Having paid our respects to the grave, we began to walk toward the hill for the climb, yet the white lamb followed us, crying out and walking just a few paces behind. His cry was so sad and desperate I almost turned around, but my friend grabbed my arm. We could not look back. It felt as though the lamb was tempting us, coaxing us to look away from our destination at the top of the hill. A shiver rolled up my spine, realizing, in that moment, how easily an urban legend can slide into reality, the small indications the world gives us that there are still some elements of magic, especially in spaces where we have already populated the landscape with ghosts.


Guðrún Ósvífursdóttir’s grave

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View from the top of Helgafell

View from the top of Helgafell


Kana Mai: Food in Fiji

The significance of food and eating practices in the South Pacific has a long and rich history. Many indigenous rituals and important cultural traditions that solidify kinship networks and reify community cohesion and hierarchies revolve around food. Anne Becker, a medical anthropologist at Harvard, has written about the relationship between food and care in Fiji, noting in her ethnography Body, Self and Society: A View from Fiji how, “The Fijian core emphasis on expression of care (best represented in the local idiom of vikawaitaki), is concretized in formal exchange, feast preparation, and routine food sharing in the community” (5). It is customary, when you travel anywhere in Fiji as a guest or visitor, for the host village to prepare food, as a demonstration both of their wealth as a community and their desire to care for and welcome you. Whether these food preparations are cakes and fruits for morning or afternoon tea, or a complete lunch or dinner, Fijians are always careful to cook an overabundance of food for their guests. The surfeits of dalo, cassava, curry and rourou signal both the South Pacific value for having a heavier, more robust frame as a sign of good health, and the social responsibility to care for the needs of your guest, no matter how vast. As Becker observes, “Just as there is a vested interest in creating an impression of abundance at the magisi, householders are equally concerned that their food supply meet extraneous demands. This is reflected in their habit of cooking extraordinarily excessive quantities of food, especially root crops, which are later fed to pigs if uneaten by household members or guests. Heaps of plantains, yams, taro and/or cassava are peeled and boiled for routine meals, but rarely finished. A woman observed that ‘in some homes, food is a problem, that is disgraceful…the most important thing is that we have enough food’ either to feed to one’s family or to contribute to mataqwali functions. She continued that to fall short of food during a meal constitutes the ultimate social disgrace” (69).


In more recent research conducted on the obesity epidemic in Fiji, Becker writes, “a number of cultural traditions strongly support robust appetites and body shapes, including local norms that encourage hearty consumption of relatively calorie-dense foods, esthetic ideals favoring robust bodies, the centrality of food presentation and feasts as facilitators of social exchange and networks, and local illness categories that formalize vigilance for weight or appetite loss” (2005:111). Due to the communal structure of Fijian society and the large size of families, households must always be prepared to offer food to passersby or visiting cousins. In return, the guests are expected to consume large quantities of food—both to demonstrate their own health and their appreciation for the food that has been prepared for them. Some of these eating practices have changed in response to the influence of Western media and the current health concerns of obesity and non-communicable diseases, but men and women alike still generally consume large quantities of food at both lunch (vakasigalevu) and dinner (vakayakavi), expecting those around them to do the same.

In my experience, women typically prepare the food, cooking multiple bowls of ota in miti, fried fish and mounds of root crops so that their guests and visitors can eat multiple helpings. Not eating large portions of the offered food is considered rude or to be a sign of illness. Before you can eat, there are also a number of rituals the guests must first perform. The leader of the host group, or the person of the highest status in the group (whether due to clan lineage or a senior professional position) must bless the food by touching the pots and pans in which the food was prepared, followed by a prayer in thanks to the hosts. The hosts and guests must gather in a collective masu or prayer, thanking the host community for the food and offering the food to God/Turaga/Kalou as well. When visiting communities you have never visited before, it’s also important to bring yaqona (the highly valued root that is made into kava or grog) to present as a sevu-sevu to the chief or Turaganikoro, an elected representative for the village. It is important to be aware of the social hierarchies that dictate and imbue eating practices here. It is considered exceptionally rude and potentially socially ruinous to start eating before the people of higher rank than you or before all the rituals have been performed. The smartest thing to do, despite a growling stomach, is to defer to the older men and women in your group and wait for their signal before you start to serve yourself.

Meals are usually taken on the ground. A cloth or sulu is typically laid out on top of the ibe/woven mats that cover the floors of most Fijian homes and community halls. Everyone gathers cross-legged on the ground—women must be careful that their knees are not exposed, with their legs are modestly tucked underneath sulus. Most Fijians eat with their hands, with two plates or bowls placed in front of them—one for their helping of food and one for the refuse of fish and chicken bones, orange peels and crab shells. These refuse plates may be shared between those sitting next to each other. The guests typically eat before the hosts; the women who cooked the food instead assume the role of warding off the persistent flies that buzz around the meals. These women will use fans or rags to create a steady current of air around the food in an attempt to keep fly contamination to a minimum, an important health task considering the prevalence of Typhoid and H. pylori in the country.


Throughout the meal, guests and hosts alike invite one another emphatically to “kana mai” or “kana vakalevu,” meaning “Eat a lot, eat more.” These invitations are almost rhetorical statements, but also serve as ubiquitous dialogical markers meant to affirm charity and care for one another’s well being. If your plate is empty, they will point out “Dalo there,” or “More fish here,” not because these dishes weren’t accessible to you, but rather to nudge you into third or fourth helpings. These repetitions and reminders to eat can be seen as concern for the health of one another, encouraging the production of heavier, fatter body sizes. The meals draw the group together into a tightly knit unit bound by the mutual desire to be full of food and care between clans. This concern for one another’s health reflects the emphasis of community over individual in Fijian culture, where people are seen as dividuals, rather than individuals—representatives of their family, villages and large kinship circles, tied together through mutual bonds of responsibility and respect. The self, in these social scenarios, is more porous and readily shaped by community expectations and roles than societies that give precedence to the autonomous, independent individual.

Bowls of water are also distributed along the floor for their guests to rinse their hands after they’re done eating. If you want to excuse yourself, you have to first thank the hosts for the food and ask if you can take a rest: “Vinaka na kakana, kerekere vakacegu.” Only after the last guest has finished eating may the hosts partake of the food, and this is usually after deferring to the appetites of the men first, as men have a higher social status than women.


During our school health outreach trips, it is also common for the host communities to send us with parting gifts. The village may gather sugar cane, plantain, papaya, bananas, guava, passion fruit or moli for the guests to take home and share with their families. Food helps to solidify the bonds between villages and clans, create social ties and foster relationships between strangers. In fact, for many of our outreach trips, the meals are the most important component, solidifying and ensuring a future relationship with that community. Though food preparation in such large quantities tends to be labor intensive, it is also a great source of pride for the women who prepare it. It is almost a devotional practice, not unlike communion. You take their food into your body as a source of strength and faith in your relationship with one another.


Typical Fijian Fare:

  • Dalo/taro: root crop that grows year round; root must be washed, peeled and then boiled before eating; usually marbled purple or gray in color; staple of Fijian diet—any meal will be served with at least one plate heaping with slices of dalo; increases testosterone and can lead to more masculine features in women (especially growth of facial hair)
  • Cassava/tavioka: root crop that grows year round; similar to dalo, cassava must first be peeled and boiled before eating; usually white or light yellow in color, stringy consistency; other staple starch of Fijian diet—typically Fijians prefer either dalo or cassava with their meals


  • Breadfruit/uto: seasonal starch that grows on trees; either boiled or cooked over an open fire; yellow in color, consistency lighter, softer and spongier than dalo or cassava; tends to have more flavor than other local starches
  • Fish in coconut milk/ika vakalolo: fish is usually either boiled in a broth of onions (varasa), cabbage and spinach (bele) or fried (tavoteketaka) in oil, usually with onions as well. Fish dishes are typically served in lolo, which is made my scraping brown coconut (bu), soaking the shavings in water, then squeezing the water our of the coconut shavings. Despite our love of coconut shavings back in the States, this excess coconut is actually given to the pigs and rarely eaten. Sometimes salt and citrus fruit (moli) is added to the lolo as well. Lolo tends to be delicious but high in fat content. Fish is served with the bones and usually the head and fins are still attached.
  • Palusami: traditional Fijian dish; can be made over an open fire or in a lovo (earth oven usually specially prepared for birthdays and other auspicious celebrations) which usually gives the food a smokey flavor; boiled rourou cooked in lolo; sometimes palusami is stuffed with shrimp, corned beef or fish as well
palusami in coconut shells prepared in a lovo

palusami in coconut shells prepared in a lovo

  • Ferns/ota: ferns found throughout Fiji; there are two kinds, both of which are edible; can be boiled or served raw; when boiled, the ota is usually served in lolo with onions, carrots, and chilies, as well as tinned fish or tuna.


  • Miti: lolo prepared with salt (masima), onions, tomatoes, citrus fruit (moli) and shredded carrots
  • Rourou: made from dalo leaves; leave have to be washed and boiled for at least 15-20 minutes. When preparing rourou, the cooks usually get itchy hands and if the rourou isn’t cooked for long enough, it can cause itchiness in the throat and mouth. Rourou can be served in a variety of ways—rourou vakalolo; rourou vakalolo with boiled eggs, onions and tomatoes; fried rourou patties in lolo; rourou vakalolo with tinned fish; rourou vakalolo with onions, tomatoes, carrots and kai; rourou is high in iron content
  • Mussels/kai: there are fresh and saltwater kai. These are usually cooked in lolo and added to rourou, ota or bundled into roti parcels.


  • Roti parcel: a favorite Fijian snack; comes from Indo-Fijian cooking tradition; roti (Indian tortilla) filled with chicken curry, potato curry, pumpkin curry, mixed vegetables, tinned fish or kai. “Vegetarian” roti parcels are usually just potato curry, sometimes with tinned tuna. Taste best with chutney, tamarind sauce or chilies for flavor.
  • Dhal: lentil bean cooked into soup with tomatoes, onions, carrots and any other vegetables available; one of healthier meal options available in Fiji
  • Plantain/vudi: seasonal; can be boiled before ripe and cut into slices as additional starch, or boiled when ripe to add to stir fry or soaked in sugar or lolo for dessert
  • Sweet potatoes/kumala: purple on the outside and wish on the inside tend to have less flavor than brown on the outside and orange on the inside variety; seasonal; orange kumala can also grow in fingerling sizes
  • Curry: traditional Indo-Fijian dish that has been incorporated into many iTaukei meals; usually cooked in lots of oil; if chicken is used, still contains bones—often called “chicken shrapnel”
  • Lumi: seaweed; cooked in lolo on a baking pan into gelatinous squares; salty with disquieting texture
  • Tahitian chestnuts/ivi: seasonal nut; high in vitamin C; must be boiled before eating; sold wrapped in leaves or plastic bags in most markets
  • Druka: seasonal food that grows similar to sugar cane; very little is known about its nutritional content; usually boiled in fish broth
  • Chop suey: Chinese dish that has also been incorporated into many Fijian meals; chicken or beef, carrot, cabbage and other vegetables cooked in copious amounts of oil and soy sauce
  • Eggplant/baigani: usually cooked into curries or fried with lolo and onions
  • Pumpkin/pumpukini: usually cooked into a curry; pumpkin leaves can also be boiled and cooked in lolo or fried

Notes From the Field: Gender in Fiji

(The name of the woman I interviewed has been changed to ensure her anonymity. The pseudonym was chosen both for the mythological role the character Salome has played in understandings of gender and because the name is very common around Fiji.) 

“Men are up here,” Salome begins, gesturing above her head, as if at the top rung of a ladder, “and women are always down here,” she finishes, bending forward from her sitting position so that her hand barely brushes the soles of her shoes. “We are always treated like we are under men,” she explains, elaborating that in traditional Fijian culture, “men are always the heads of the families,” even though, “women have to be at home all the time. Some women have to do all the work.” This work, however, is gendered and often separated into the public and private spheres. “Women’s work” includes housework, like cooking and cleaning, as well as tending to the children, while “men’s work” typically means physical or manual labor, such as working in the fields or the plantations, although men also dominate the public sphere of civil servant jobs as well, such as shop owners, police officers, government officials and teachers. The gendered dimensions of work, however, have begun to change and bleed over into one another. Salome notes how more women are now doing “man’s job” and “man’s work,” including both acquiring gainful employment, like becoming a nurse, and doing more physical labor in addition to their expected domestic chores. “We are the helper,” she elaborates. “Everything is for men. Everything has to be the last for women.” These gendered dimensions of work are often expressed as “inside” vs. “outside” work, and although women have started to adopt more stereotypically masculine roles, men have not become more flexible and learned to cook for themselves or assume more responsibility in the domestic sphere.

Salome, a woman in her fifties who runs the Maternal and Child Health Clinic at a local hospital, expresses the internal contradictions and inherent misogyny of Christianity endemic of the way gender is generally understood in traditional Fijian society. She references a doctor she heard speak, who apparently claimed that men have a “hormone by God which directs them that they are the head of the family.” She notes that the different positions men and women hold in Fijian society are due to the fact that men and women were “created differently” in the Bible—Eve was made from the rib of Adam. When I asked her what part of the Bible stipulates that women should be treated as lesser than men, though, she faltered, uncertain. “Maybe Genesis?” she hazarded. According to her reading of the Bible, Adam was bored and couldn’t take care of himself. That’s why God created Eve—to ease his boredom and help to take care of him. Already there seems to be a complicated internal logic—men are considered superior to women, and yet they couldn’t have survived without the presence of women, and women were created (so to speak) due to the ineptitude of men. The irony of this logic, however, doesn’t seem to register for Salome, though she articulates these internal contradictions. She states that women are “not strong like men,” and yet “we [women] can handle the consequences,” as in the pain and struggle, of being a woman, including pregnancy, delivery and child rearing. Men and women, therefore, have different kinds of strength. There are moments when she elevates the strength of women over men. Laughing, she says to me, “I don’t think any men can handle [the pain of] childbirth. If they could, they would only have one child.”

Salome delves into the family dynamics of a typical Fijian home. Women are not allowed to speak up or voice their opinions when men are around, and they usually have to get permission from their partners or spouses if they want to leave the house. And yet men “can’t be alone without women. Women can stay longer alone, men can’t stay longer alone without women.” Apparently, if the husband were to pass away, it is acceptable for the woman to continue to manage the household as a single widow and often succeeds as the new head of the household. If the wife passes away, however, men immediately go looking for another woman or wife to clean the house, cook the food and take care of the children.

When asked about the health issues that plague women in Fiji, Salome turns to a discussion of violence in the household, or “commotion in the family” as she calls it. As an MCH nurse, her work also falls under the category of family planning, so she gets insight into the daily lives of Fijian families. Divorce, extramarital affairs and domestic violence, as well as rape, are the problems she gravitates toward throughout our discussion. While women are expected to stay home, “men always go clubbing,” and “husbands are always drunk and disorderly.” She says that violence in the family is not necessarily new—husbands and wives often fight over money, food or other social problems, such as conflicts over religion or maintenance of the monogamous relationship. Rape, she explains, happens because “we [women] are showing our body to people,” referencing the changes in modesty and dress in Fiji. Fijians increasingly have access to Western television, movies and magazines, which has also triggered a shift in the younger generation away from the traditionally modest and conservative sulu jaba, which includes a long skirt down to the feet, and a blouse that covers the shoulders. Younger women and girls are starting to experiment with Western clothing, wearing tank tops and shorts, fashion decisions that Salome believes are to blame for rape. Gender-based violence in Fiji, I recently learned from a report released by the Fiji Women’s Crisis Center, has reached epidemic proportions, especially considering the culture of silence that socially sanctions the “discipline” of women who speak or act out of turn. Yet Salome exclaims that women were created “to be loved, not to be kicked or punched—that’s why the rib is so close to the heart,” returning again to the Genesis of Eve.

When I asked whether men and women are created equally, she nodded in affirmation, saying, “We are all human beings.” But when I asked how Fijian women could be treated more equally to men, she reverted to the entrenched hierarchies, stating, “Women can’t go up.” She suggested that education might help to bring equality to female Fijians, but didn’t seem to think it was culturally appropriate for women to have the same rights as men. Men could only go “down” to the woman’s level, but the women can’t ascend the stratified social system. “Fijians, we still look at it differently,” she justifies. Men may be “weak,” and women may be “strong,” but even this empowered woman is hesitant to level the playing field, or predict that equality will come any time soon.

Dredre: No Day Is Ever Easy

Although the pictures you see of Fiji may depict an idyllic paradise, as we know of photographic representations of the developing world, images can be deceiving. The lush tropical beauty of the landscape is often starkly contrasted by the blistering heat and suffocating humidity that accompanies the climate, as well as the daily struggles and frustrations that typify life here. Let me be plain: no day is ever easy here. I will start with a snapshot of one of my days to dispel the illusion that my working life is the blissful tropical breeze the pictures may belie and try to give a more well rounded understanding of challenges of a Peace Corps experience in Fiji.

I wake up sweating. I go to bed sweating and I wake up sweating. I went to bed exhausted because Fiji has the kind of heat that sucks all the moisture from your body and makes you feel like a wrung, desiccated sponge by the end of the day. It is hot and moist as Hell’s ass crack here and just as unbearable. It saps away all your strength and energy, especially when everyone else around you is just as discomforted and unmotivated due to the heat. The previous day I had come home to find a letter slipped under my door by the Fiji Water Authority, informing me that they would be disconnecting my water in 24 hours for a fee I didn’t owe, left by the previous tenant. This is not uncommon in Fiji. Most PCV’s have a story about how they inherited hundreds of dollars in water debt from the person who lived in their house before. The bureaucracy of Fiji can be disorganized and representatives difficult to track down, which makes situations like these a bit of an exercise in futility.

Not only was my water disconnection an inconvenience (considering that my sulu jaba was damp from that day’s sweat), but not having water is also dangerous when you spend all day perspiring any fluids left in your body. Without water, I risk dehydration. In fact, every day I play a game of cat and mouse with dehydration, because to make up for the water I sweat out, I’d have to drink at least a bottle of water an hour. This is all well and good if you can be assured that you will always be close to a useable bathroom, but in Fiji, you don’t have that kind of guarantee. I sometimes spend hours driving to outreach in the interior of the island, where they may not have running water, let alone a toilet. So every day you have to make a decision—conserve water and chug when you get home or risk having to pee in a hole in the ground in the bush. Hopefully you remembered to bring toilet paper with you, because Fiji is BYOTP. The lack of water also complicates the constant skin problems I’ve had since I arrived in Fiji, which I keep under control with antiseptic soap, unless, in this case, I can’t take a shower or a bucket bath. It also hinders my ability to cook. There are no pre-made foods here and the vegetables and fruits I buy from my local market need to be thoroughly cleaned in case they carry disease from lingering animal feces, urine or run-off.

In the middle of cooking my dinner, my propane gas tank suddenly runs out of gas. Luckily I have some leftovers in my fridge, but it’s an uninspired dinner damped by the soot left on my half-baked sweet potato and the prospect of replacing my gas tank the next morning as well. A full gas tank weighs close to 60 or 70 pounds, and despite my own strength, I can’t carry one from town all the way up the hill to my house. Which means in the morning I will have to hire a cab to pick me and my gas tank up, drive me into town, buy the replacement, drive the new one up and help me install the new tank. Unless there’s a broken regulator or tear in the hose, in which case I will need to make several trips into town and enlist the help of a neighbor to ensure that everything is installed properly and I don’t burn my house down or accidentally asphyxiate on leaking gas.

So I wake up sweating with no water or gas, knowing that I am going to have to tackle the tangle that is the Fijian bureaucracy to ensure that they turn my water back on. I go into my kitchen, where I find a swarm of ants on the counter I thought I’d cleaned. So before I can have breakfast, I have to sanitize my kitchen, lay out more seemingly ineffectual ant traps, and line my walls and shelves with HIT chalk. I eat a quick breakfast because I have to go into town to make a copy of the latest water bill I paid to take into the Fiji Water Authority and fetch a new propane tank. Though Korovou is inhabited by government workers and full of local government offices, the ones I visit don’t have a photocopier, their photocopier is broken, or no one knows how to use or fix their photocopier. My other option is to visit an Internet shop. Though these shops are supposed to open at 8:00 am, everything here operates on Fiji Time, so the shops open whenever the staff decides they want to open. As I go from building to building looking for a working photocopier, I am given vague directions about where to look—“Go to that building,” or “Over there”—which seems to be sufficient information for their orientation but is infuriatingly ambiguous early in the morning when my clothes are already soaked through with sweat and I have to get to work.

After I finally manage to make a copy of my paid bills, I rush up the hill to my health center for our school outreach visit into the interior of Waidalice. Although we are supposed to leave by 9:00, considering that we have to screen every student in the school (a number usually between 150-250), we only have one driver for all the transportation needs of the whole of the medical sub-division. Sometimes the drivers stay up for 24 hours at a time on a shift, and this morning one the drivers is sick, so we have one driver and one vehicle for all the day’s outreach programs and medical emergencies. The driver doesn’t arrive until 10:00 and we have to pile all the screening supplies and seven staff members into the back of the ambulance. We get about halfway to the school we are visiting for the day along a bumpy, pothole filled road, before we pull onto a farm. The head father of the farm was gored by one of his bulls and needs to be taken immediately to the hospital. We subsequently have to unload our supplies as they carefully wheel the patient into the back of the ambulance to be taken to Suva. The family of the man lends us the use of their pick-up trucks and takes us the rest of the way to the school, although we have no way of being sure we’ll have transport back to Korovou at the end of our outreach session. We could be waiting at the school until 7 or 8 p.m.

We also have to be careful about the recent outbreak of dengue fever that has spread throughout the province. The hospitals are overwhelmed with the number of dengue patients and although health inspectors are supposed to be spraying and collaborating with the villages to cut grass and dispose of mosquito breeding grounds (like old tires or empty food containers), both health inspectors are currently sick with dengue, so the prevention efforts have ground to a halt. I try to layer bug repellant lotion over every part of my body, but I still end up discovering new bug bites at the end of the day, often in the places most difficult to scratch. The District Officer for our government compound has organized a dengue clean up for the afternoon, so I also know that I will need to spend about an hour and a half raking up the cut grass from my lawn when I get back from my school outreach.

 Each day, just like I fix my hair, I have to adjust my disposition to make sure that to each Fijian I encounter, I am the best American I can be.

We end up arrive at the school around 11:00. There was no way to call ahead to let the school know we would be late, because the school doesn’t have a landline or is so far into the interior of the island that cell service doesn’t work. This would be a useful place for carrier pigeons. It takes the teachers about a half an hour to corral the students, so we don’t begin screenings until 11:30. My role is to serve as the Reproductive Health Peer Educator for classes 7 and 8. I go to their classroom to begin my presentation, but the room is connected to another classroom, the two separated by thin compartments of wood they can install or remove easily to make the space bigger. The room connected to mine is full of the din of talking, squabbling children, so I practically have to shout over the ruckus about puberty, reproductive health and condom use, which makes the lesson more didactic than I had intended. Reproductive health classes are difficult effectively even in English-language settings like the United States, but my job requires a certain amount of stealth and finesse. Firstly, sexuality is a taboo subject in Fiji, so I have no way of knowing how much of the information I present is new to the students. Secondly, because English is their second language and they might struggle with the language, I have to ensure that I speak slowly and at their language level, defining and elaborating whenever I see looks of confusion. I don’t want to infantilize them, but there are also basic health concepts, like germs and the immune system, that may still be new or unfamiliar to them, and scientific jargon like ovulation and fertilization are difficult to break down into easily understood, digestible concepts. Thirdly, the Ministry of Health has strict policies on what topics can and cannot be taught in schools. Conservative parents have been known to complain and my school health team was kicked out of the province’s secondary schools years ago because of some aspect of the content that the MOE found offensive or inappropriate for the students. I was not provided with the MOE approved curriculum though, and the nurses haven’t been able to articulate what areas are off-limits to talk about within the purview of my MOH mandate, so each class I am walking on egg shells. I have to carefully communicate the knowledge the students need to make informed decisions about their sexual health, while also upholding a lot of the Ministry’s bylines, which advocate abstinence and do not condone pre-marital sex or the use of contraception. It’s a tightrope act and I am still fumbling.

As a PCV, I am also expected to be “on” 24/7. As one of the only Americans for miles and miles, perhaps the only American many Fijians will ever meet, I recognize that I am perceived as a walking embodiment of all American culture. Those around me will understand everything I do and say as indicative of American behavior, and it’s part of one of the Peace Corps goals to facilitate a cross-cultural exchange by fostering a better understanding of American culture abroad. This means that I have to be my best self constantly. When I am waiting in line in the sweltering grocery and someone cuts in front of me, I can’t make a fuss. When I didn’t bring a snack because we were assured be given tea and lunch, and it turns out the school doesn’t have any food prepared for us, I have to keep my cool. When we are standing outside for hours on end waiting for transport because nobody thought to call ahead to ensure we’d have timely transportation back to Korovou, I can’t snap into a harangue about short-term planning and time management. Even small glimpses of my anger or frustration could be misconstrued as emblematic of American culture, so every day is also an effort to manage any negative feelings or emotions and keep them in check, striving to always remain polite and respectful. This has been a challenge because, for those who know me, I have a terrible poker face. This issue even emerges in more intimate settings, during which I have to reconcile cultural conceptions of my gender and my own liberal ideologies. Staff members will inquire why I’m not married yet, and then insist that I go out with their cousin or friend and marry a Fijian. When I walk by a group of youths on the way to work, they will all shout what they likely think are compliments, but from an American (and, frankly, jaded) mindset I read as sexual harassment. References to weight are common practice here, so I’ve grown used to having my physique examined and scrutinized, despite my attempts to cover it up in billowy shirts and skirts. Each day, just like I fix my hair, I have to adjust my disposition to make sure that to each Fijian I encounter, I am the best American I can be.

There is also the existential struggle of being a Peace Corps volunteer. In the Peace Corps handbook, they have a chart outlining the critical periods of service, with different behaviors or reactions for each period. Each day, mark it, each day a PCV with cycle through feelings of loneliness, abandonment, self-doubt, elation, anxiety, nerves, restlessness, irritation, fright, frustration, feelings of uselessness, tolerance or intolerance of host culture, homesickness, lethargy, over-zealousness, self-recrimination, resignation, panic, disappointment, and giddiness. If you think that no healthy human being can cycle through that many emotions in one day, you’re right. It’s exhausting having to field so many feelings in a single 24 hours, only to know they’ll likely disrupt your sleep and reemerge in the morning. And one of the feelings I struggle with the most here is guilt.

When you join the Peace Corps, you have an image of the “typical Peace Corps experience.” Now, there is no “typical Peace Corps experience,” that’s the point, but that doesn’t mean that I hadn’t built up in my mind what it would be like. I had mentally prepared myself to live a Spartan, acetic lifestyle, out in a remote, nearly inaccessible part of the world among a small collective or tribe, likely in a hut, where I’d speak a foreign language every day and be submerged in a culture totally foreign to my own. Instead, I am in a three room wooden house on government quarters, with running water (sometimes), electricity, a local grocery store, neighbors with televisions and a job where I don’t have to speak Fijian all the time. Fiji was colonized, so there is enough familiarity that things don’t seem completely alien, and yet enough cultural difference that I miss the things I had at home and I never feel totally at ease. These conditions may seem preferable to the hut in the middle of nowhere but for the first several months at my site, I was full of nothing but self-loathing. I hated myself for getting such a “cushy” site placement. I was disgusted with myself that I had bought a little mini-fridge and a couch to furnish my empty house with, that I had afforded myself such luxuries. I was supposed to be a Peace Corps volunteer, roughing it and toughing out the difficult conditions of a treacherous landscape—that was what I had prepared for. And despite these small luxuries and my placement, every day was hard. Then I would berate myself for complaining and considering my conditions difficult—what right did I have to consider my job easy, when I could come home and put ice in my filtered water? That was a luxury many PCV’s don’t get. For weeks I mooned over these feelings of guilt and shame—I felt like a fraud. I felt like a fake PCV: sad that I hadn’t been placed in a village as I had desperately wished, despite my language training test scores and cultural integration; torn between buying small things that would make my life easier and adhering to the bare bones image of Peace Corps life I had constructed for myself; angry at myself for feelings so frustrated and put upon when I imagined the far more difficult struggles other PCV’s were having in other parts of the world; and, ultimately, unwilling to authorize the validity of my own emotions.


I cannot speak for other PCV’s on this count, but this feeling of guilt, almost of self-abasement—that I had to make my life harder and atone for the “luxuries” I’d been given to call myself a true PCV—ate at my conscience every day. But my days, as you’ve seen, are hard enough without feelings of shame and self-recrimination. There is no one true, typical Peace Corps experience and this is, and likely will remain, the toughest job I’ve ever had. Every small act here is mentally taxing, and at the end of the day, I am physically and psychologically exhausted. Every day is another existential crisis waiting to happen, and even the small trips away from site that I allow myself for a mental break are stressful. You have to plan for every contingency. Even if you’re just going on a day trip, the buses may not arrive on time, or may not come at all, and you could have to unexpectedly sleep over at someone’s house, so you always have to pack for Plans A, B and C. We are living on a volunteer allowance, and consequently conserve our food as much as possible, so traveling is also an exercise in figuring out how to spend the least on food and not feel like you’re constantly on the brink of starvation. You’re always trying to plan around buses that are unreliable, relax while making sure none of your valuables get stolen, and enjoy yourself even though you’ve been sick for months now. You lose clumps of hair daily, never drink enough water or eat enough protein, and feel your most unattractive and ineffectual.  So I’ve made peace with my placement and learned that it’s okay to treat myself every so often—the Peace Corps does not have to be a daily penance, it’s difficult enough as it is.

 Every small act here is mentally taxing, and at the end of the day, I am physically and psychologically exhausted. Every day is another existential crisis waiting to happen, and even the small trips away from site that I allow myself for a mental break are stressful.

In the Fijian language, dredre has two meanings, depending on where you place the emphasis. One way, dredre can mean challenging, or difficult; the other way it can mean smile or laughter. In Fijian culture, internal emotions are not readily or easily expressed through words or body language. Instead of asking people how they are doing, Fijians will typically ask “Where are you going,” or “Where are you coming from?” To show emotion, to reveal that you are sad or upset, is considered weak and inappropriate, especially for males in the culture. In difficult situations, therefore, Fijians will laugh. When a 12-year-old girl at one of our schools stepped up to have a rotten front tooth removed, she was giggling. As she tilted her head back for the anesthetic, her giggles transformed into the kind of laughter that shook her whole body. There’s a certain logic to this—to forestall the pain, to keep it at arm’s length, they laugh at it. Perhaps then no one will be looking when they wipe the tears away from their eyes. You have to learn to find the dark humor in the challenges here, or else they will wear you and break down your resiliency. In German there’s the word Schadenfreude, which means laughing at other people’s pain. In Fiji, I suppose I’ll have to invert that, and learn to laugh at my own pain.df569d7093e2372ffd10addf0377ab06

Mental Health and Mental Illness in Fiji

The concept of mental health and mental illness, like biomedicine, is still a relatively new concept in Fiji. As a Western, allopathic psychological model, very few people in Fiji are trained in appropriately and sensitively treat mental illness, and, thusly, the resources available to individuals who suffer from mental illness are fairly limited. In addition, very little research has been conducted within the country to assess the success of the training given to health care professionals, the indigenous attitudes toward mental illness, and the experienceof Fijians who are diagnosed with a mental illness or a mental disorder. Most of the services available to address issues of mental health are still very new, understaffed, in a stage of nascent development and largely inaccessible to those outside of Suva or Lautoka (the major cities in Viti Levu). St. Giles hospital is the only mental health facility in the whole country that cares for and treats patients with a variety of mental illnesses; it provides occupational therapy, day care facilities, forensic assessments, counseling services, community psychiatric nursing, electro-convulsive therapy and pharmaceuticals. The support systems for those who may be suffering from mental illness or distress—such as the Hope Center in Lautoka, the Community Recovery Outreach Program (CROP), Lifeline Fiji, Youth Champs 4 Mental Health, the Psychiatric Survivors Association, the Fiji Alliance for Mental Health, Empower Pacific Counselling Services, and the Hope Health Centre—are all contactable by phone, even though many Fijians still do not possess telephone land lines or mobiles/cell phones, so their ability to aid and counsel the majority of the Fijian population is narrow and imperfect.

This restricted level of access is only further complicated by the lack of education or awareness many Fijians possess about mental illness or mental health. Just as doctors and nurses in Fiji must attempt to reconcile indigenous models of the body and traditional aetiologies with biomedical frameworks, those that work in the mental health sector must attempt to explain, often in the most simplified scientific terms they can find, what mental illness is, a task difficult in almost any language. As a developing country, the Fijian education system may not provide information on the biological and genetic components that contribute to mental illness, insight which would afford Fijians with the baseline knowledge to understand the manifestation and effects of mental illness. Even if psychology is taught in schools, many adolescents tend drop out of school early and may never have been exposed to terms like “neurology,” “dopamine,” or “neural transmitters.” For communities that have never been introduced to concepts like brain chemistry and psychology, how do you effectively communicate the complicated array of factors that contribute to mental illness that many neurologists still puzzle over? Finding the proper explanatory models, metaphors and analogies is a huge challenge for health care workers, especially when you consider the consequences of language and how important medical discourse is to a patient’s understanding and approach to illness. Final Mental Health in the Pacific Region-01Mental health is also affected by “social, cultural, economic, political and environmental factors such as national policies, social protection, living standards, working conditions, and community social supports. Exposure to adversity at a young age is an established preventable risk factor for mental disorders [and] Depending on the local context, certain individuals and groups in society may be placed at a significantly higher risk of experiencing mental health problems” Mental Health Action Plan 2013-2020,” World Health Organization: 9). This interaction between biology, genetics, environment and culture requires an integrated, multisectoral approach to addressing mental illness, especially in the wake of Fiji’s NCD (non-communicable diseases) crisis.

The World Health Organization recently released a Mental Health Action Plan to address the growing concern of mental illness globally, especially in countries that lack comprehensive and institutionalized health care programs. Within Fiji, mental illness is characterized by ignorance or stigma due to indigenous interpretations of madness or family embarrassment. The nurses that are assigned to treat patients with mental illnesses, at least in Tailevu, seem to lack a basic knowledge of mental illnesses, what causes them, and how to sensitively treat patients, even though the topic is taught in nursing school. Nurses will glibly swap stories about their “mental cases,” and refer to patients who have a history of not taking their medications as “defaulters,” as if a TB patient who doesn’t take their meds and an individual with depression who refuses medication are equivalent. The term “defaulting” is usually used to refer to patients who have communicable diseases, and, thusly, risk infecting others when they aren’t “medically compliant.” The terms “default” and “compliance” are also morally fraught and often connote condemnation or shame upon the patients. This shame is routinely used as a tool to compel compliance, reifying stigma in an already stigmatized community, even when a patient simply can’t take their medication for social, structural or economic reasons. But individuals who suffer from mental illness are not contagious and, for many, the choice to forgo medication does not endanger those around them. Very little is still known about how different medications affect the brain and the body, especially among adolescents. Many treatments for mental illness have several serious negative side-effects that may only worsen the patient’s condition. Some patients may also be on several medications at once, promulgating negative neurological and physical interactions between the chemicals. When nurses refer to their “mental cases,” they often lump together very different forms of mental illness, from epilepsy to schizophrenia. Many, when asked what the patient has been diagnosed with, though they’ve been assigned to their case, don’t know and will cover up their lack of knowledge by saying, “But they’re not violent,” as if all mental illnesses predispose people to violence. Indeed, in a study on “Mental Health Workers’ Attitudes Toward Mental Illness in Fiji” by Foster et al. (Australian Journal of Advanced Nursing, Vol. 25, No. 3), they found that 91.3% of the health workers they interviewed in Fiji agreed with the statement that “Psychiatric drugs are used to control disruptive behavior,” revealing a flawed and negative attitude about the nature of psychaitric medications and the conditions they treat.

The patients themselves may also lack a thorough understanding of their own conditions. If the health care professionals that treat the patients aren’t able to explain their condition in a culturally salient narrative, then indigenous explanatory models are likely to be employed in lieu of medical ones. Many traditional aetiologies are utilized to explain psychotic breaks, stress or mental illness. I had a conversation with a representative from St. Giles who mentioned that witchcraft and spirits are often still blamed for mental illness. One of the patients who came in during a Korovou Mental Health Clinic (held once every three months), was diagnosed with schizophrenia at 19. Since then, she’s been in and out of St. Giles five times, and though she’s been medicated ever since her diagnosis, had never heard the term “schizophrenia” to explain her illness. The woman, now in her late forties, believed that she was suffering from a curse a “bad man” had laid upon her, which was why she was not always regular with her medications. It is also believed that if a family builds a house on land that does not belong to their clan or mataqali, the ancestors or Vu of that land may bring about madness or misfortune in the new residents. If an individual becomes wealthy or economically successful, they may incur the envy of their neighbours, who may then entreat witchcraft to lay a hex on their neighbour to punish them for their accomplishments. The St. Giles representative also noted that some people believe that if you are particularly bright or smart in school, you’re more likely to develop a mental illness. She elaborated that mental stress is still a relatively new and foreign concept to Fijians, and that part of their job at St. Giles is to explain the relationship between stress, social and environmental factors, and mental illnesses like mood disorders. Patients and family members who utilize indigenous explanatory frameworks are therefore likely to seek out religious leaders, traditional healers or spiritualists for treatment before seeking out help within a biomedical establishment. Many of the cases St. Giles see, therefore, have far progressed psychosis and rapidly declining mental health making them out of touch with the real world when they’re admitted.

Schizophrenia accounts for 70% of the patients St. Giles see and treat. The next most common complaint is mood disorders. The St. Giles representative indicated that globalization and Western media influence may play a role in the increase of mood disorders in the country. She noted that whereas several years ago they’d only have one case of depression a month, they are not receiving anywhere from four to six new cases with mood disorders a week. Dr. Anne Becker, a medical anthropologist out of Harvard, has been conducting research on the increase of eating disorders and binge-eating in Fiji as it correlates with increased exposure to Western media and Western models of the “ideal” body (“Binge Eating and Binge Eating Disorder in a Small-Scale, Indigenous Society: The View From Fiji,” 2003). Although certain conditions like depression and bipolar are caused by a chemical imbalance in the brain, there has also been preliminary research investigating whether Western psychological models of the mind and mental health are necessarily applicable to people in other cultures. Ethan Watters, for example, wrote Crazy Like Us: The Globalization of the American Psyche to complicate our understanding of Western pyschology and its usefulness or salience in other parts of the world. The book researched the new epidemic of eating disorders in China; the treatment of schizophrenia in Zanzibar; and the treatment of PTSD in Sri Lanka.crazylikeus_wide-8f70226ee2a76f78016fcae60bbd0d3ad2549f2e One chapter explores Western pharmaceutical companies’ attempts to market depression drugs in Japan, a country where there was no cultural concept or equivalent for depression as it is understood in America, even though they have one of the highest rates of suicide in the world. He writes, “Americans experience the self as isolated within the individual mind. The Japanese, on the other hand, conceive of a self that is less individuated and more interconnected and dependent on social and environmental contexts. Feelings that Americans associate with depression have, in Japan, been wrapped up in cultural narratives that altered their meaning and the subjective experience for the individual.” (211). Advertisers had to fabricate a culturally salient new framework with which to comprehend sadness in Japan; the Western media literally had to indoctrinate the Japanese into believing that they suffer from depression in order to sell their drugs and make a profit.

In an interview with NPR’s “Talk of the Nation” on his book, Watters said, “I think we do have to understand how these scientific notions cross over into cultural notions of the mind. And I think the only way we can really do that is by looking cross-culturally and understanding that there are other ways to think about the human self. There are other ways to think about the human psyche. And before we tromp into other cultures and try to change them and try to get them to think like us, we should appreciate those differences because they’re really the only mirror we have,” imploring the audience to consider that by exporting Western models of the mind, we are unintentionally perpetrating a form of psychological imperialism. There is still little known about other conditions called “culture bound syndromes,” like susto, which seem to appear only within certain cultural contexts. In fact, medical anthropologists like Margaret Lock have been problematizing biomedical approaches to illness through the theoretical framework of local biologies. Margaret Lock looked at experiences of menopause among women in Japan to scrutinize variations in the ways in which menopause is subjectively experienced, noticing that the physical symptoms of Japanese women differed from those of their American counterparts. She concludes “Menopause, Local Biologies, and Cultures of Aging” (The American Journal of Human Biology, 2001), by stating, “The danger, of course, is that the “Western” body remains unproblematized […] it is appropriate to think of biology and culture as in a continuous feed- back relationship of ongoing exchange, in which both are subject to variation” (503), indicating that bodies nurtured and grown in different cultural context may experience different somatic representations of sickness. The concept of local biologies could, therefore, be applied to the manifestation of mental health and mental illness as well. Not only may we be exporting Western ideas of the mind, but we may also be simultaneously providing a set of symptoms that typically characterize a particular mental disorder that those diagnosed must then fit into. Some believe that the biomedical model of the brain will help to reduce stigma against those suffering from mental illness, but, in reality, quite the opposite might be true. Foster et al. indicated in their study, “contrary to the assumption of de-stigmatization programs, genetic and biological causal beliefs were related to more negative attitudes toward those with mental illness” (73). Watters echoes this trend in his discussion on “Talk of the Nation”: “I mean, we have this assumption that if we can get the world to think like us in terms of the biomedical conception of mental illness, that it’s like a disease like another, that it will reduce stigma. And unfortunately what the studies have found is as this idea gets adopted around the world – and it has been gotten adopted around the world – that oftentimes the very reverse occurs, that people want more distance from the mentally ill. They assume that they’re more dangerous. They want less to do with them.” So perhaps the task to overcome stigma and discrimination lies not in discussions about brain chemistry and biology, but rather the supportive cultural narratives a society already possesses that promote understanding, empathy and support.

The health care workers in Fiji tasked with addressing issues of mental health employ a holistic approach to their outreach and awareness programs. They recognize how important family and local support are to an individual’s health and success. They speak in villages and settlements around the country to increase awareness, while fostering sympathetic understanding, open communication and support so that those with mental illnesses aren’t discriminated against and have the compassion and care of their communities they need to stay healthy. FSNet, another mental health organization in the country, distribute booklets called “The Carer’s Hope for Recovery,” which stresses the carer’s responsibility to be an ally in mental illness and outlines some advice of how to care for those with mental illnesses. The staff at St. Giles, however, only numbers twelve, so their ability to reach all the communities around Viti and Vanua Levu is fairly limited. They’ve been utilizing the media to increase outreach efforts, but television is effective for only a confined target population, as many of the more remote and impoverished villages don’t have television and only sporadic electricity. The demographics that actually do see the television spots, in urbanized areas like Suva or Labasa, are the ones that are closest in proximity to the mental health facilities and thus more likely to have already been exposed to information about mental illness. mental-health-the-factsLegally, the Mental Health Decree of 2010 is supposed to protect the rights of those with mental illness and prevent discrimination. The rights of caretakers or caregivers are also outlined in the Mental Health decree, but it’s unclear how people are informed of their rights if they don’t have access to the Internet and aren’t made aware of the legislation passed down by the government.

The state of mental health services in Fiji is still as poorly understood as the condition of mental health itself. Many individuals suffer in the shadows in a state of emotional and psychological confusion without knowing where to turn for help or support, let alone equipped with the language to describe their condition. Further research on the indigenous understandings of mental health need to be undertaken, particularly in regard to belief in the role of spirits and ancestors in one’s life. Some of these traditional beliefs have become submerged or considered ilicit due to the Christian missionary work, which labeled indigenous belief systems as “devil worship.” These indigenous beliefs do not necessarily preclude biomedical explanations being used in conjunction to explain mental illness. As many medical anthropologists have illustrated, people are self-reflexive beings that understand the influence of their own culture and have the capacity to combine multiple explanatory models to create syncretic systems that make the most sense to them. In Fijian culture, the head is considered the part of the body associated with knowledge and wisdom, and it is therefore taboo to touch the head or hair of another person. Even the emotional states we have in English don’t directly translate or correlate to Fijian equivalents, suggesting the concepts like depression may be further complicated by language barriers as well. A more thorough understanding of the training in mental health that nurses and doctors are given should also take place. We need to understood how health professionals are taught about mental health and mental illness and what sort of sensitivity training they receive. Nurses that make house visits to administer medication are also supposed to offer therapy, even if they’ve never been trained in different therapeutic techniques. If Fiji is to effectively address its NCD crisis, an institutional as well as a social movement needs to begin from the ground up, utilizing grassroots activism, culturally available narratives and scripts, and community/village health workers to create a society conducive to mental health and stability.

HIV/AIDS in Fiji

On November 27, the province of Tailevu, in the Central and Eastern Division of Viti Levu, celebrated World AIDS Day early. The festivities were held in Korovou, so the various youth and community groups that had been invited to attend gathered at the Korovou Sub-divisional hospital, all dressed in different iterations of red. Each group also brought with them a banner they’d decorated for the occasion, working off of the theme for the year: Zero. Zero new cases of HIV infection, zero HIV/AIDS related deaths, zero tolerance of stigma. When I attended the 2012 World AIDS Conference in Washington, D.C. the speeches and discussions also circulated around the population of eliminating the virus altogether within the next twenty years. Even though ARV’s have become more accessible and less expensive, and new discoveries of eliminating the HIV virus completely have been encouraging, the structural factors that contribute to illness still need to be addressed. The belief that AIDS can be eliminated in the next twenty years may be idealistic considering the structural violence many infected populations still face, but in Fiji the potential for elimination may be possible. Since 1994, there have been 482 registered cases of HIV infection, and adult HIV prevalence in 2011 was only 0.1 %. Compared to other countries around the world, Fiji, it would seem, has a relatively low prevalence of HIV/AIDS. These statistics, however, need to be vexed a bit. We have to consider the fact that Fiji also has a fairly small population and that, culturally, sex is still an extremely taboo subject. The conservative qualities of the Fijian population make it extremely difficult to discuss sexual matters and spread awareness, let alone get the consent from Fijian to test for the disease. Though the hospital I work at provides free condoms, I have to bundle the condoms in old yellow pages. Otherwise, the nurses tell me, the patients and visitors will be too ashamed carrying around the condoms. Even as I set about the task of wrapping the small packets, the nurses came by to tut their pity that I even had to handle condoms, themselves quite shy of even touching them. The taboos around sexuality are further complicated by the heavily entrenched religious beliefs of the country; the Catholic communities especially forbid the use of any kind of contraceptives. And though pre-marital sex is culturally taboo, it’s actually extremely common, with young people often having multiple partners. With such a high prevalence of unprotected sex, even among couples who may be having affairs, the chances of contracting and spreading an STI or HIV increase, and the treat of infection continues.Image

Indeed, in a recent article by Fiji Times, it was noted that the prevalence of HIV/AIDS increased by 50% from 2009, indicating that the threat of AIDS is actually expanding rather than abating. And these are simply the reported statistics. As any health worker knows, especially when working on illnesses that may seem culturally or morally fraught, statistics like these are usually only partial indicators of a health condition and don’t fully or exhaustively represent the prevalence of HIV/AIDS in the country. Of those infected in Fiji, the article noted that 70% of the cases were found in the Central and Eastern Divisions, specifically in the provinces of Rewa and Tailevu. The HIV/AIDS Red Zone, as it were, falls right within my assigned sub-division. The potential for HIV/AIDS to turn into a catastrophe seems very real, especially if people continue to have unprotected sex, don’t know their status, and potentially spread the virus from province to province. Unless an individual has been educated about the way the virus is spread and impacts the body, they may be infected and not experience symptoms until it’s too late.DSCF0817

Despite the cultural taboos about sexuality, I was impressed that so many youth groups had congregated to join the fight against HIV/AIDS. One group, to my delight and astonishment, actually started blowing up condoms and tying them to their banners as balloons. This may seem like a trivial act, but in such a conservative and repressive climate, the use of condoms in their presentation was very progressive. Once all of the groups had gathered at the hospital, we marched down the hill, through Korovou Town to the playground off the main road, where two covered structures had been erected for all the guests and speakers. A doctor from the Reproductive and Family Health Association of Fiji spoke, followed by a judging of the banners and an oratory competition between the youths, some of whom were only 14 or 15. After the students’ speeches were given, representatives from each group gathered for a brief quiz on HIV/AIDS.DSCF0813 Though these were all students working towards HIV/AIDS awareness and advocacy, the depth of their ignorance about the disease startled and scared me. They did not know the difference between HIV and AIDS, nor what the acronyms stand for. They could not name the methods of transmission, nor the fluids that transmitted the infection. This ignorance about the most basic information about HIV/AIDS seems to me to be yet another red flag about how precarious Fiji’s situation is. All the youth groups seemed extremely enthusiastic about the day, but festivities don’t matter unless there is something to celebrate. An increase in HIV prevalence and a general lack of knowledge or awareness about HIV/AIDS should only commemorate how much work remains to be done in Fiji, lest it turn into a South Pacific epidemic. Anti-retroviral treatment is completely free to all Fijians, but the will and knowledge to protect themselves still seems woefully lacking. Image

Discussions in the Clinic

The Fiji Ministry of Health has recently rolled out a new method of evaluating doctors’ and nurses’ performances on the job. Based on a point system, nurses and doctors need to pursue activities outside their hours spent attending to patients to ensure that they are expanding their medical knowledge and capitalizing on their time spent in rural settings. In fact, many nurses are expected to spend four out of their five days working doing community outreach in their assigned zones, conducting workshops or doing home visits to follow up on patients that may not have easy access to the hospital or clinic. As I begin to carve out my own niche at Korovou Hospital and Health Clinic, considering that I am neither a nurse nor a doctor, and much of the medical information I possess came from curiosity rather than collegiate training, I’ve found that one way that doctors and nurses can earn points is through Continuing Nursing Education or CNE. Anyone in the hospital or clinic can put together a CNE—usually they are presented by nurses who have just received specialized training in a particular topic, such as mental health awareness or maternal and child care, and want to share their new knowledge with the rest of the staff. As outreach opportunities in the villages and settlements around Tailevu have been fairly limited, I’ve presented two CNE’s for the staff here.

My first CNE was on customer care. Like so many hospitals and clinics, Korovou is dreadfully understaffed. Sometimes only one doctor is available to see all the patients, with only two nurses assisting in triage, one in the IMCI, one dentist and one dental therapist, one nutritionist, and two nurses in the MCH clinic. The waiting room, when the hospital opens at 8:00, may have as many as twenty to thirty adults and children waiting to be seen. Villages in Tailevu have certain transportation days for the MCH clinic, and two MCH nurses may have to see over fifty women and their babies before the lunch hour. Due to the disparity between available nurses and patients, the staff usually has to rush through their examination of the patients and keep a fairly steady pace of intake to ensure that all of the waiting visitors are seen. This can sometimes lead to a callous or insensitive attitude towards patients who may otherwise be scared, frightened and confused. From experience, I know that hospitals in the United States can be some of the most alienating and victimizing spaces a person could experience. I have never yet had a positive experience at the hospital. I’ve anxiously paced waiting rooms waiting to be seen for hours, feeling like the staff was deliberately ignoring me. I’ve been yelled at by nurses for injuring myself when I was already suffering from physical and emotional anguish about an injury. I’ve been shoved behind curtains, cold and hungry, for hours on end, wondering if the doctors had forgotten about me. Nurses, doctors, neurologists, and specialists have told me that my perspective on an injury was wrong, and that my emotions were invalid. I’ve been patronized, devalued and objectified by hospitals in the United States, and I know, based off of my training in medical anthropology, that I’m not the only one who’s feel injured and dispossessed by the very people they sought help from.

Part of the challenge Fijian hospitals and clinics also face is use. Though the waiting rooms are almost always bursting with patients (at least before the lunch hour), the Ministry of Health is struggling with getting people to come in and seek treatment at their hospitals and clinics. Most Fijians have a hierarchy of resort that relies on village or folk remedies. Herbal medicine and massage therapy are often the first remedies sought out when a person becomes ill or injured. The traditional herbal medicines are easily accessible and cheap, and have been used, and therefore trusted, for centuries. Hospitals, on the other hand, may be extremely far away from the more rural and isolated villages and settlements in Fiji, and the cost to get to the hospital may be a further deterrent. Though care and medicine are free, paid for by the Ministry of Health, there seems to be a basic attitude of mistrust and suspicion of hospitals, a negative perception that hospital and clinic staff need to actively dispel. Not only do the hospital staff feel the need to prove that allopathic medicine is useful and effective, as long as you use it correctly and don’t default, but they also have to make the vale ni bula a welcoming, safe space where patients can feel safe seeking treatment. Otherwise, people will continue to visit hospitals and clinics only as a last resort, when the illness or injury have become so bad there’s very little the staff can do to heal or repair them.

Considering all these factors, I decided to present on customer care to the doctors and nurses in Korovou. I outlined the importance of establishing a rapport with the patients by creating an open, welcoming relationship between the carer and the client. I explained that if patients feel validated and supported by the hospital staff, they are less likely to lie about their medical history, more likely to be compliant with medications, more likely to return in a future instance of illness or injury, and more likely to recommend others to seek treatment at Korovou as well. This trust needs to be earned but will have long-term payoffs for both the hospital and the patients. I introduced the concept of clinical ethnography, which is a recent development in medical anthropology that is beginning to be employed in clinical biomedical settings, such as American hospitals. The concept of a clinical ethnography, as Arthur Kleinman outlines in his essay “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It” (PLOS Medicine, 2006), utilizes the critical, empathetic, self-reflexive methodologies used by anthropologists as they write ethnographies to create a “thicker” understanding of a patient’s health and wellbeing. As Kleinman relates, “Anthropologists and clinicians share a common belief—i.e., the primacy of experience. The clinician, as an anthropologist of sorts, can empathize with the lived experience of the patient’s illness, and try to understand the illness as the patient understands, feels, perceives, and responds to it” (1674). Clinical ethnographies and illness narratives, most importantly, take into account the social and cultural factors that impact and inform an individual’s health status. As Steven Feierman and John M. Janzen outline in the introduction to their collection, The Social Basis of Health and Healing in Africa, “Just as disease is not an independent variable in social analysis, so therapeutics is also embedded in and reflecting the concepts, values, institutions, and power relations around it […] In other words, health, however defined, is not something that ‘just happens’: it is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease” (xvii). Not only is an individual’s understanding and approach to healing inflected by the culture or cultures in which they’ve been raised, but the social world they inhabit—their economic situation, kinship network and level of access—also contribute and to a large degree determine illness etiology and treatment options. Paul Farmer has spent his illustrious career outlining the ways in which structural factors contribute to an individual or a community’s health; his numerous essays and ethnographies have capitalized on the stories of people’s lives who have become victimized by structural violence to the detriment of their health. Illness, consequentially, often comes with the results of inequality.

These social and holistic insights into health could not be more important than in clinics in Fiji. Korovou Hospital and Health clinic serve the whole province of Tailevu, which includes hundreds of villages and settlements. Many of these villages are extremely remote, made even more inaccessible by the poor roads and bad weather, which often impedes the occasional truck or lorry that would brave the treacherous conditions. In these remote villages, most people still survive on a subsistence basis—living off of their plantations and backyard gardens, their water source a local stream, river or reliance on rainstorms. To reach Korovou, women might have to walk miles to the nearest highway, and then pay for transport to the hospital and back, an expense they may not be able to afford, even though care at the hospital is free. The most recent crop of the plantation may have been less than expected, and the family may be struggling to find enough food to feed their whole family, especially since Fijian families tend to be fairly large. A mother may therefore be sacrificing her own health to ensure that her children get enough to eat. These social and structural factors need to be considered in a clinical assessment of any patient, especially since doctors and nurses may become frustrated if they’ve given the same instructions to a patient over and over again but they continue to “default” on their medication. A patient’s “compliance” to whatever biomedical treatment is prescribed to them is contingent upon their level of structural vulnerability.

The doctors and nurses in Korovou seemed to respond fairly well to the presentation, and acknowledged that they were sometimes short with patients due to stress and frustration. They voiced the same concerns that most hospitals and clinics share: when you’re understaffed, how do you offer the most empathetic and best care—which often requires taking the time to get to know the patient, learn their life story, and reassure them as a person rather than a case study or a statistic—and treat the large number of patients waiting to be seen in a timely fashion? It felt invigorating to be discussing such a central principle of my training in medical anthropology with practicing health workers, to be able to put theory into practice.

The second Continuing Nursing Education presentation I gave was on the elimination of violence against women. November 25 was the International Day for the Elimination of Violence Against Women, and I thought the occasion was an excellent opportunity to raise awareness on the topic, especially considering my experience in gender-based violence, and begin a conversation with the staff about cultural attitudes towards gender and violence. If sexuality is taboo, sexual assault, domestic violence and rape fall into a whole other level of taboo topics. Since I’ve been in Fiji, I’ve heard accounts from other volunteers who either saw domestic violence occur in their home-stay or witnessed women with bruises and cuts from their spouses. According to the World Health Organization, 1 in 3 women will experience physical and/or sexual violence by a partner or sexual violence by a non-partner within their lifetime. Violence against women is such an invisible, yet pervasive, problem that almost no research on the topic has been conducted. One of the only sources I could find who had attempted to survey the prevalence of violence against women in Fiji came from the Fiji Women’s Crisis Center based in Suva. Their statistics noted that in 2010, there were 887 reports of violence against women, though their website emphasized that there are very few resources available to women who have experienced violence, and thusly limited safe spaces to report the crime.

If violence against women is a culturally acceptable act, and is often dealt with within the family, and therefore considered a private, rather than a public matter, than victims are considerably less likely to seek shelter or remuneration from outside the family. Indeed, most instances of violence against women are perpetrated by someone they know—a friend, family member or intimate partner. If a woman is economically dependent upon her abuser, she may be afraid that reporting the crime would make her even more vulnerable. In the very terse discussions I’ve had about the issue with Fijians and other volunteers, outside intervention is rare and most people simply look the other way when they see or hear abuse occurring in the home. Indeed, the Fiji Women’s Crisis Center website writes, “Sexual assault and violence against women is condoned, reporting of violence is discouraged and women are counseled that it is a sin to divorce and separate by many religious leaders.” Without a social structure that discourages and villainizes violence against women, victims won’t have the social support they need to seek help and cycles of violence will continue to reify themselves generation after generation.

I didn’t end up being able to give the presentation until December 2nd because the hospital was so understaffed, but the date still falls within the 16 Days of Activism that the Fiji Women’s Crisis Center is promoting to increase awareness around the country about violence against women. Though the staff seemed keen for another presentation, I was surprised at how glib their response to the issue was. One of my co-workers, whom I respect and admire, started making jokes about the issue. After the presentation, she turned to me and said, “Thank you for your presentation. It is a very important topic, I guess,” the final clause seeming to undermine the imperative and urgent tone I had tried to strike throughout the presentation. Unfortunately, after the presentation, the doctors and nurses had to leave to catch their buses back home for the night, which forestalled any conversation I was hoping to have about cultural attitudes towards gender-based violence, the services available, and their own experience, as Fijians as well as health clinicians, with the issue. Women’s rights and female empowerment are issues I cannot separate from my role as health worker, especially when I think about the injustices wrought upon female Fijian bodies at the expense of their health and their happiness. Fiji will remain a developing country with an uncertain economy so long as the Fijian women, who are some of the strongest people I have every met, remain subservient and secondary to other members of society. Thankfully, there are some incredibly inspiring women in Fiji who are actively working to promote change and female empowerment throughout the country. The Fiji Women’s Rights Movement and the Women’s Groups in villages around the country are starting to speak up and disrupt the patriarchy that has thus far been shielded under the auspices of cultural tradition. Other indigenous groups around the Pacific, such as the Maori women in New Zealand, have also begun to advocate for a critical discussion about the role of gender in culture. I hope that my role here in the next two years will be to make their voices heard and support them in building a culture in which men stand alongside women, respected and safe. tumblr_mx9qgq6Ss21qgu9k8o1_500

A Day in the Life of a Pre-Service Training Peace Corps Volunteer, Fiji

 The term “a full night’s” sleep has become subjective. My home stay village is populated with a phalanx of particularly vocal animals, particularly chickens and roosters, which cluck and dart from house to house, roosting beneath the elevated foundation or searching for lost eggs in the coconut fireplace. The Fijians say that the rooster crows at particular times of the night, like their own regulated alarm clock—12:00, 3:00, and 5:00. I’ve found, though, that the roosters and chickens tend to crow of their own accord however and whenever they like. Some even get in to tussles with the roving bands of starving dogs in the middle of the night, the vicious snarls and squawks offset by the sound of the bats as they fight over the breadfruits. Sleeping through the ruckus is nigh on impossible, even with earplugs. If it’s not the roosters that wake you up—especially if one happens to accidentally flap into your room and then immediately forget how to get out again—the morning chores of the Fijians can also be an effective wake-up call. Some families may wake up at 3:00 or 4:00 for devotion, going over their prayers before the sun has even risen. Others rise early to take advantage of the tides, slipping softly into the ocean while the fish are still sleeping. Families with plantations may get up early to tend to their crops before the day shucks the cool tendrils of dawn. Fires need to be stoked, breakfast prepared, tavioka peeled, laundry washed, and seeds planted, a steady bustle amidst the calls of “Yandra!” from house to house. The weather itself may also lick away the lullabies. When they say the rainy season in the South Pacific, they mean it. The rain pounds on the tin roofs with such a ferocious force it seems as though the gods themselves are attempting to shake loose the heavens. The rain is incessant and unrelenting; it falls so thick and fast it obscures the mountains in a white fog, turns every swath of grass into a puddle, and refuses to yield, even after hours of sheer downpour. Some days the rain may fall at a constant, tenacious rate throughout the day and night, while on others the weather will inexplicably clear into a perfectly sunny day. Predicting the weather patterns is a fruitless activity, as reliable as the schedules of the minibuses that ferry villages from town to town.

my host sister making roti

my host sister making roti

After waking up around 6:00 or so and disentangling myself from the mosquito net (which hasn’t seemed to prevent a hoard of ants from invading my bedspread), I stumble into the kitchen, only just remembering to throw a sulu around my boxers to make sure I follow my host-family’s standards of modesty. Breakfast is one of the most erratic meals of the day. Tea, served with mountains of sugar and powdered milk is always available, but the types of food my family eats for breakfast seem to rely more upon mood than foresight into what will sustain them throughout the busy workday and kickstart their metabolism. Sometimes my lai prepares bani/ buns or roti, cooked over the coconut fire, served with butter, butter and more butter, if not the occasional lolo/coconut milk. My host father seems to have quite the sweet tooth, and has prepared custard pie, banana bread and cake for breakfast, baking two or three at a time so that each member of the family consumes at least three huge slabs of dessert for breakfast. Sometimes my family cuts up some pawpaw/papaya, but this appears to be more for my benefit than theirs, as I usually eat a banana or an apple for breakfast. They also have breakfast crackers, which taste good enough with ample amounts of jam and peanut butter, but my favorite breakfast has been plantain cooked inside shredded cassava wrapped in rourou/taro leaves. My lai and nau may also have fish for breakfast, depending on how many we ate the previous night for dinner.

our kitchen chicken

our kitchen chicken

After debating what combination of long skirt or sulu and blouse I’ll wear for the day (especially considering the depths of the puddles), I walk to my language training, which is held in my language coordinator’s vale across the village. The first couple of days, my family insisted on escorting me to the home, both to insure that I didn’t get lost and to maintain the practice of escorting young females from place to place. As I walk to class, I hear my name called from every home I pass with the customary Fijian greetings and invitations to tea or katalau/breakfast. To listen to my iPod en route would be rude and perceived as isolating, especially considering the Spartan living conditions of most of the members of the community. Our language classes are an exhilarating struggle, as we attempt to quickly learn as much of the Fijian language as we can in eight weeks, retraining our tongues and parsing sentences. The syntax and the grammar are particularly difficult to grasp—this may be because Fijian was an entirely oral language before the colonists arrived and tried to transcribe the language into a systematic, written form. Even though many Fijians speak English, part of our cultural immersion and effectiveness as volunteers depends on our proficiency in the language, especially since members of different generations have various levels of English understanding and mastery, and some of the Indian populations in the country don’t speak English at all.

Our heads still spinning from new phrases and words, we usually return to our homes for lunch with our families. So far for vakasigalevu/lunch, I’ve had pumpkin, eggplant curry with roti; dhal; boiled vegetables and fish; chicken stew; fish in miti, a sauce made from coconut milk, shredded carrot, tomatoes and onions; and fried egg. My family has thankfully been very flexible with my pescetarianism and has a penchant for frying things, so we’ve been negotiating fat content of food as well as portion size. Fijians constantly encourage you to eat, so I’ve been developing a vocabulary in which I can both compliment the cooking and stand firm that I don’t need fourth or fifth portions, thank you. Some of the other volunteers struggle with lunch because of the ride we have to take to the village where we hold our daily technical training. Around 1:00, or later, depending on Fijian time, we clamber into the back of a white van with benches along the sides. There are no handles by the ceiling to hold onto and the car bucks over the huge ruts formed by travel and constant rain. We jumble around in the back of the van, mumbling prayers that we don’t fall off the cliff (especially when another van approaches along the inexplicably one way dirt road), spin, or stall out. Some parts of the road are so steep our driver has to speed up to build up enough momentum to reach the top, and pebbles and rocks fly up behind the wheels, spewing our desperation to make it to the village alive. Those that get carsick have taken to chewing ginger and we’ve developed defensive strategies to ensure that we don’t fall into each other’s laps, as I happened to do in the first week. Apart from the few paved streets and highways, which tend to be closer to the tourist destinations, these types of road conditions are fairly standard in Fiji; driving around here seems to depend on aggressive optimism that you simply will not die, despite all the obstacles and dangers that accompany most road trips.

Our technical training is held in the village’s community hall where they usually hold special cultural events. The floors are lined with woven mats and we’ve all started transitioning into sitting cross-legged for hours at a time, with intermittent groans and rearrangements. Furniture is uncommon in Fiji, especially since it is considered rude to be seated higher than someone who is of a more distinguished rank than you in the community. Our technical training runs the gambit of topics—safety and security; medical training; lectures from cultural experts, Ministry of Health representatives, and current PCV’s; discussions about program development, implementation and sustainability; and outlines for the Ministry’s plan to diminish non-communicable diseases throughout the country. Our technical training is supposed to not only bring us up to speed about our relationship with the Ministry of Health and the current health situation of the Fijian population, but also illuminate elements of Fijian culture we may encounter during our stay and provide a foundation in participatory action, needs assessment, community empowerment, and critical awareness of our own positionality within the country once we receive our official job placements. Throughout these technical sessions, different PCV officials and coordinators also interview us to better determine the positions we’d be best suited for, slowly narrowing down our jobs, which will be announced in late October. Needless to say, we’re all eager to learn as much as possible, intensely curious about what the next two years in the South Pacific will bring.

Technical training usually ends late afternoon, sometimes delayed by afternoon tea, which we’ve all come to love and depend upon for stamina throughout the day. After returning to our home stay village, the six of us scatter. Every day except Sunday, every man in the village, regardless of age, gathers at the schoolyard from 4:30 to 6 to play rugby, so I’ve been playing touch with the men some days. Part of our job as volunteers during our home stay, though, is also to teach healthy behavioral practices to our families, so some of us have started running Zumba classes for whomever wants to join. The sight of three American girls dancing in sulus usually elicits raucous laughter from the villagers, but all the children swarm the hall to join in, and some of the older women have been brave enough to give it a try too. Though our village is right next to the ocean, the beach is polluted, which means we can’t safely go swimming. We can go hiking, if we’re willing to brave the vicious centipedes and slicks of mud that complicate any hiking paths. Women are not supposed to run by themselves, so I’ve had to adjust my exercise regimen, trying to find inventive ways to stay fit while safe, complicated by the fact that there are certain clothes we simply can’t wear to exercise in without offending the village’s standards of modesty.

Working up a sweat, though, is imperative if you want to enjoy bathing. Everyone’s house in the village is different, but most people have outside showers and toilets. The water comes from a simple faucet and is always very, very cold. My shower is located in an outside section of the house, next to a basin usually full of brackish water to keep my lai’s latest catch alive for cooking. Sometimes my family is kind enough to boil water for a warm bucket bath on particularly cold and rainy days, but it’s easier to get as sweaty and overheated as possible, so that the shower is an enjoyable, rather than painful experience. Despite the cultural modesty norms, most people walk around simply wrapped in their towels after their baths. On the first night I arrived in my home stay, I was introduced to two of my host brothers, a cousin and my nau all while they were still dripping from their showers, wrapped in nothing but a towel. A prayer always precedes dinner, and the order of who eats first is fairly sporadic. Evenings are typically spent sipping tea and chatting in the kitchen or watching tv. Electricity only came to the village five years ago, so lamps and other amenities like a refrigerator and oven are still novelties. The radio is constantly blaring, day and night—apparently the men in the Kubunayanua family love music. The music selection, though, is anything from expected. In the morning it’s not uncommon to hear gospel or Christian music. Throughout the rest of the day, though, the family listens to a station that plays primarily American music. The logic that dictates the music selection, if there is a logic at all, is beyond me. Top hits, such as Miley Cyrus’s “We Can’t Stop,” may be playing one moment, and the next it might be Bruce Springsteen or The Lumineers. Primarily, the radio highlights pop hits from different decades. The other day, I inexplicably heard a dubstep remix of Credence Clearwater Revival’ “Bad Moon Rising.”

When the radio isn’t on, it’s usually because people are watching television. For them, any kind of television, even a TV show, is called a movie. In the Fijian language, they have no nouns to differentiate between the different media platforms and experiences. The movies screened on their Sky Pacific Network are simply dreadful. Think of all the bad movies that went straight to DVD versions. Within the past week, I’ve watched the recent remake of The Three Stooges, The Fantastic Four, and The Mummy: Tomb of the Dragon Emperor (who knew they kept going after The Scorpion King?). The primary television channel is Fiji One, with news reports in English, Fijian and Hindi, as well as ample coverage of rugby, particularly of the Fijian Bati (warriors), the country’s premier rugby team. My family also seems to be infatuated with Pro Wrestling. It’s fascinating to see what aspects of Western culture they are exposed to and the quality of their access to movies and television shows. Considering that I am here to work on encouraging Fijians to pursue a more active, healthy lifestyle, the television may prove to be yet another obstacle to be address or useful campaign tool.

While the men watch rugby in the family room area, splayed out on the woven mats, the women, visiting cousins, and some of the older generation will gather in the kitchen for tea, grog and talanoa. Cava is usually saved for special occasions, though some families eschew it completely because of religious principles, but tea is a constant companion late at night. My lai may be shelling the creatures she caught in the Pacific an hour before, while a cousin straightens reeds that will later be woven into a mat as a gift or offering to a grieving family member.

my lai preparing her catch for the market

my lai preparing her catch for the market

On weekend nights, there may be a social hosted in the community hall, where villagers gather to share grog, listen to music, swap gossip, and maybe do a little dancing, but there’s not a lot of difference to weekdays. No one is ever alone, and even if you are sitting in silence finishing chores or mulling over your fifth cup of tea, you are always accompanied by at least two or three other family members and friends. The pitter-patter of rain and shooing of precocious chicks from the house threshold elicit sporadic clucks and clicks of distaste from the women, but I usually slip in to bed fairly early, exhausted from the language immersion, training, rocky car ride to and from the neighboring village, and constant, almost hyper-awareness of what’s going on around me, trying to take in and engage as much as possible. I still haven’t learned the Fijian attitude of relaxation and sega na lega, or no worries. Hopefully, the more I settle in to my routine and the cultural mores, the more I can assimilate into the community and truly loosen up a bit. DSCF0164

“Going Thin”

In preparation for my impending trip to Fiji with the Peace Corps, where I’ll be serving in the Health Sector working on community health development and empowerment on a variety of health concerns, though primarily non-communicable diseases such as obesity and diabetes, I’ve begun research on the cultural beliefs and practices of the Fijians. One of the most useful authors I’ve encountered is Anne E. Becker, a professor of Global Health and Social Medicine at Harvard Medical School, who’s conducted extensive fieldwork in Fiji and whose research focuses specifically on eating disorders and body image in relation to their social or cultural environment. In 1995 she wrote Body, Self and Society: The View From Fiji, an ethnography that relates her fieldwork and experiences while studying in the country, highlighting the cultural conceptions of the body and health in relation to the larger community or society that an individual is inevitably enmeshed in. She notes how, in juxtaposition to typically Western notions of the body—which is conceived of as independent and separate from society, each individual body its own autonomous entity—Fijian society emphasizes a community, in which each person is responsible to and for the other people in their geographic area and kin group. As Becker notes, “A body is the responsibility of the micro-community that feeds and cares for it; consequently, crafting its form is the province of the community rather than the self. And because the individual body is the locus of vested efforts of this community, the individual’s own efforts are directed back toward the community” (57). Subsequently, attempts at bodily cultivation or efforts to distinguish the body as a unique entity from the group is looked down upon. In reading the blogs of other volunteers currently working in Fiji on community health, I’ve encountered attempts to establish exercise groups or regimen for their local communities, in an effort to impart Western notions of bodily healthy and physical fitness. I wonder how Fijians have responded to these encouragements to exercise and whether it’s considered socially acceptable to spend time cultivating your body. It seems that this may be regarded as selfish, as it takes time away from the community and represents an attempt to separate, rather than engage with neighbors and kin. Image

            Two thirds of the Fijian population is either categorized as obese or overweight, yet Anne Becker notes, “many obese and overweight Fijian women apparently perceived their own weight as appropriate or under a desirable weight, with 54 percent of obese female respondents indicating they felt they should maintain their weight and around 72 percent of overweight women answering they felt they should maintain their present weight. In addition, 17 percent of obese women and 8 percent of overweight women responded that they wished actually to gain weight” (41). I don’t want to diminish the severity or seriousness of the health complications that accompany obesity, one of the most prevalent being diabetes, which is also rampant in the country, but overall health is not solely dependent on physical health. Under the ascendency of Western biomedicine, the body is often atomized, segregated into supposedly discrete and separable parts accessed separately to ascertain a diagnosis, rather than looking at the body holistically or within a larger social context. Concepts of health and illness are socially contingent and constructed, and while these men and women may need to reassess their diet and level of physical activity, I think mental health is just as important of a consideration, especially since Becker’s recent work has focused on the recent phenomenon of eating disorders among the young generations of Fijians. She indicates that the recent introduction of Western media, such as movies, television shows and magazines, has also imported Western body ideals, as well as Western conceptions of the way the body should be regimented, controlled and disciplined, often into unrealistic or fetishized weights. In her book, Becker indicated that “Any evidence of weight loss is assumed to reflect a disruption in connectedness to the social milieu or gross negligence on the part of the caretakers. The common phrase ‘going thin’ (e luju hara ga elala) generally identifies a perceived weight loss as a social loss” (79), which raises questions not only about how a group or organization would approach a program specifically geared to help Fijians lose weight, but also about how the older generation is reacting and will react in the future to the younger Fijians suffering from anorexia or bulimia.

            During my orientation and training upon my arrival in Fiji, I’m eager to learn about how the Peace Corps considers these cultural conceptions of the body in developing and implementing health programs targeted at obesity. I also wonder how much they consider the larger political, economic and historical factors that likely contributed to the obesity epidemic, such as colonization and tourism. In a culture that demonstrates connections and forms social bonds by feeding one another and by providing bountiful feasts to guests and loved ones, how do you intervene in a way that is culturally sensitive and isn’t simply a neo-imperial indoctrination into Western conceptions of the body and health? My hope is to learn as much as I can about Fijian culture before I depart and use my anthropological training and expertise in the field to best serve the Fijian community I’m placed in, remaining constantly aware of my own Western biases and prejudices toward health. I’m sure that the Fijians I will work with have a lot to teach me.