American Samoa Part 3; Conclusion – Why having a curious mind, speaking up, and being the bearer of bad news isn’t always a negative!

I knew before coming on this trip to American Samoa, that it was going to be worthwhile for me in a personal sense. After spending 10 months in Australia, it was certainly time for me to get back in touch with my true self, whom I felt really came out last year whilst travelling on my own in the USA and throughout Europe. There is nothing more that needs to be said, except, I feel like Kara again. Travelling on your own allows you to be completely yourself, you can sit quietly on your own, or go the complete opposite route and speak to everyone, left, right, and centre! You get to throw yourself into the deep end, and hopefully you swim! (metaphorically speaking that is); and most importantly, you can remind yourself what is truly important to you.

Beautiful surrounds in Samoa allowing you to take it all in.

Before I left, and at the start of my trip, the common remarks from people I knew, and those that I met upon my arrival in my stop off in Western Samoa was that American Samoa was dirty, not worth visiting, and that I should definitely be spending more time in Samoa (Western) instead. I am so happy that I trusted my own gut on this one, and didn’t listen to overarching statements (particularly given no one who made the comments had ever actually been to the country!). It just goes to show, and engrains my thoughts, that sweeping remarks are not useful, and that making up your own mind can provide for a lot of very rewarding experiences. On my final day in American Samoa, it was quite amusing to hear the managements comments around “simply believing the products must have been healthy given they were being recommended by the USDA”, and that they didn’t even think to look at the ingredients list or nutrition information panel to check for themselves (linking back to my previous comments!)

Some of the cereals here would have been thought to be “healthy”

After my initial meeting with them on the Monday, I was told as a group the management team went and purchased both the products that I had explained were not so healthy, along with the products that I did recommend (of the ones that were already being imported that is). They apparently had a huge laugh (at themselves) when they saw the sodium, hydrogenated fats, or refined grains, that were making up the majority of the products on their list! Apparently they had a bit of a penny dropping moment all at once, laughing at the fact that no wonder none of their clients on the program were seeing improvements in their blood pressure, blood glucose level readings, cholesterol levels, or weight (given the products they were being told to consume)! It seems following this event, the directors assistant and nutrition manager from the WIC program have called for a meeting early next month with the committee of management and current vendors to discuss and implement (as many as possible of) the recommendations that were provided. They said they intended on straight away telling people on the program which of the products they were currently recommending really were not good for them though (which is a great start itself!), and making alternative suggestions based on the products I found that would be better options (i.e. those higher in either fibre, protein, or monounsaturated fats, as well as lower GI options where possible).

The sanitarium higher fibre ranges seemed to have some of the best options (from what was available) in the country.

I gave recommendations to the nurse who worked directly with clients on how to portion up your plate to promote satiety, increase your resistant starch and fibre intake, as well as easy switches using readily available, local foods that would be culturally acceptable, and inexpensive, as quick meal options. She seemed very receptive which is positive.

Going for the bananas when they were slightly less ripe to boost the resistant starch intake

Currently there are 5 dietitians who are all working within the hospital in a clinical (i.e. not preventative) role. There previously had been one dietitian allocated solely to the WIC program, however this position was ceased a year or so ago (no one could explain why…so we guessed it may have been a cost cutting exercise). There is also a school meals program, which feeds most of the children here up until the age of 15 both breakfast and lunch daily. When I asked if they had tried to make the menu “healthy”, and how they were going about assessing this, they voiced that they had a chef who had been working with them for a number of years who was responsible for this element…lets just say we both looked at each other knowing that this response was not exactly comforting in relation to nutritional quality of the meals from a dietitians perspective! After strong recommendations on the importance of having a dietitian within the community overseeing all the programs that are run, including (but not limited to) the WIC program, and the school meals program, the WIC management team have voiced that they completely agree and will be looking into recreating a position for a registered dietitian that can work across the range of public health initiatives.

School lunches program will benefit immensely from a dietitians input!

Given some of their programs are funded from over in the USA, whilst others are from within the government in American Samoa, I had recommended creating a role that spans across programs, so that this way the funding could be split between sources, and potentially help it get off the ground sooner (incase neither government wanted to fund a full time position which may not have been necessary for either program). They did kindly ask if they could hold me hostage and keep me on the island as their national community dietitian, saying they needed someone who was aggressive (and then straight away rephrasing, and saying ‘someone as passionate’ as me), to bring about change here for them. I honestly think this could be one of the most rewarding positions for a dietitian who really wants to make a difference in this world. I’m not sure of a nation that needs it more at this stage.

Some of the people that work within the health team, who seemed very outgoing! (although they were eating turkey tails!)

Having to be true to myself, and knowing that from a personal life perspective, at this stage of my life, I really would not be happy here, I politely declined the offer to move, but have said that I will remain onboard in a voluntary capacity to provide guidance and advice from afar with whatever they need as they progress forward; and that I would be happy to assist in the recruitment process once they have funding confirmed. Exactly what is to come next for this country, I do not know. Raising awareness is step 1, and I guess that was where I fitted into this story for them. As for me, a little visit to Samoa as a comparison of a country that is developing and lives a more traditional lifestyle, followed by a 12 day stop off in Melbourne, before finally returning to NYC and some other parts of the States still awaits! Honestly, I CAN NOT WAIT!

Learning about how coconut cream is made on my tour in Western Samoa

Looking forward to sharing more of the adventure over the next month, Sending love from afar, Travelling Dietitian x