A Change Of Helping Hands -- U.S. Volunteers Turn Their Spectacular Floating Clinic Over The Marshallese

INFORMATION

For additional information on the Tole Mour's activities or how to donate, contact Marimed Foundation, 1050 Ala Moana Blvd., Building D, Honolulu, Hawaii 96814. Phone: 808-537-5586. Fax: 808-526-9736.

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MAJURO, Marshall Islands - It wasn't exactly a mutiny, but the Tole Mour has a new crew of medical officers.

Marshall Islanders have replaced most of the American volunteers aboard the 156-foot Whidbey Island-built schooner, which has been bringing much-needed medical service to isolated island communities in the Marshalls for the past year and a half.

``It's good news for the Marshalls,'' said Dr. Richard Coughlin, a Seattle surgeon and the Tole Mour's outgoing medical director. ``The time has come. We need to back out.''

The Tole Mour, a spectacular floating clinic, was built by Nichols Brothers at Freeland on Whidbey Island and outfitted on Lake Union, the first tall ship launched in the Puget Sound area since the 1920s.

Many Seattle-area people, clubs and foundations have contributed to the non-profit Marimed Foundation of Honolulu, which commissioned and operates the vessel under contract to the Marshallese government.

Several volunteer crew members have hailed from the Puget Sound area. Ending their tours this summer were skipper Wayne Chimenti, his Belgian-born wife, Nicole, and their infant daughter, Nahja, who live on Marrowstone Island; bosun Doug Hilty, who lives in Bellingham; purser and medical records keeper Charlotte Bottoms of Bellevue, and nurse Melody Music of Seattle.

The ship has had considerable impact on health care in the Marshall Islands, a developing country with a population of 43,000 spread over an immense expanse of the mid-Pacific.

In 1989, its first full year on station, the Tole Mour medical staff saw 15,006 patients in 59 communities.

Ron Olmstead, spokesman for Marimed in Honolulu, said the foundation's plan all along has been to ``work ourselves out of a job'' by turning over

to Marshallese as much of the operation as possible as soon as practical.

``They've moved faster than they, or we, would have thought,'' Olmstead said. ``But we've encouraged it. Self-sufficiency is a very big issue.''

That was underscored by Dr. Neal Palafox, the Marshallese government's medical director for preventive services, who said, ``We want to staff the ship at the same level, but with our own people. The energy is here, and people can and want to do it.''

After decades of living under colonial powers, including the Germans, the Japanese and, from the end of World War II until 1986, the Americans, the Marshallese are trying to assert control over their national destiny.

So it is natural that the islanders want a large role in controlling an asset as visible and prestigious as the Tole Mour.

Marimed and the Tole Mour were conceived by David Higgins of Boston, a lawyer and sailor who pulled an oar for the U.S. heavyweight crew in the 1968 Olympics, and his wife, Dr. Ilona Higgins, an obstetrician and gynecologist.

Tiring of a fast-track pursuit of careers, they bought a 96-foot schooner in 1982 and, with their two young children, set off on an 18-month Pacific cruise. Along the way, they found medical care is pretty poor in most island paradises. Dr. Higgins treated people in the places they visited, and gradually the concept of Marimed took shape.

Marimed set up shop in Honolulu in 1984 and began working on collecting the $2.5 million needed for construction of the Tole Mour.

The vessel was completed in the summer of 1988 and operates under an agreement in which the Marshall Islands government contributes $350,000 of the roughly $1 million per year it takes to run the ship.

Tole Mour means ``gift of life and health'' in Marshallese, and

medical services are one of the country's most acute needs, especially in the outer islands that the ship was intended to serve. The Tole Mour's facilities include an operating room, a dental and eye clinic, an x-ray machine, a pharmacy and a computerized records system.

For the more than 40 years that the Marshall Islands were under U.S. rule, medical care was based on the American curative treatment model centered around a single hospital at Majuro, the country's capital and major population center. Acutely ill people were brought to the hospital, and if the case was too complex for the staff there, were flown to Honolulu or Manila.

This approach did not work well.

``The infant mortality rate is 63 per 1,000 - six times the U.S. rate despite access to U.S. programs for the past 40 years,'' said David Higgins.

Children were dying of mostly preventable problems - of malnutrition, because parents didn't understand that American processed and junk foods for which islanders quickly developed a taste don't contain adequate nutrients; of dehydration associated with diarrhea, and of upper respiratory infections. Adults suffered from other treatable or avoidable maladies, such as tuberculosis, hepatitis and diabetes.

Some of the islands also had an unusual problem - radiation-induced illnesses caused by the fallout from 66 nuclear weapons tests the U.S. conducted in the open atmosphere between 1946 and 1958.

Palafox, the islands' medical director, said a 1985 task force charged with determining why the medical care system wasn't serving national needs concluded that the curative approach was at fault and recommended a 180-degree shift to an almost total emphasis on preventive medicine.

``The decision was made to strengthen primary care and self-reliance, rather than waiting for someone to come in and save them,'' Palafox said. ``It took a long, hard effort to make it happen.''

But the overhaul in services, which relies primarily on 67 dispensaries and 22 female birth attendants scattered among 26 inhabited atolls, is beginning to show results and has increased morale among health workers.

``There is a new confidence in the (Health) Ministry that wasn't that evident,'' said Marie Maddison, the government's minister of health.

``What has been done by the Health Ministry over the past several years is truly astonishing,'' said David Higgins. The country's medical problems remain serious, he said, ``but now there is a sense of hope rather than frustration and desperation.''

Marimed's contract with the Marshall Islands for the Tole Mour runs through 1991. Marimed will continue to supply an American medical director, dentist, and captain and crew for the ship, and may sometimes provide medical specialists unavailable in the islands, Olmstead said. Marshallese will fill most of the other 10 or so medical jobs.

Olmstead said the Marshall Islands government has not indicated what course it will take when the contract expires. The options could include a new contract under similar conditions, a changed contract - or no contract at all, a possibility raised by Palafox.

``At the time of its (Tole Mour's) conception, island health services were so weak that it had a needed role,'' the Hawaii-born Palafox said.

But now, though the vessel provides valuable services, Palafox fears its imposing presence - its size, its gleaming hull, teak deck houses and 8,500 square feet of sail - may be subtly undermining the government's redirected health policy.

The reason, he said, is that at the core of the government's program is ``self-reliance . . . the basic principle that people have to do it themselves and recognize that they're doing it.''

The arrival at isolated communities of the Tole Mour, which is probably the best-known and most impressive man-made object in the Marshall Islands, may detract from that sense of self-reliance, Palafox said.

The assumption of most jobs aboard by Marshallese may lessen Palafox's concerns. If not, and if the government decides the Tole Mour has accomplished its mission in the Marshalls, the vessel's unique capabilities for delivering medical services to island communities mean its services will probably be needed somewhere in the developing world for a long time to come.

-- Giff Johnson of the Marshall Islands Journal contributed to this story.