The Island of the Colorblind

Dusk descended as we drove back slowly to Kolonia, and we began to see occasional bats, then great numbers of them, rising from the trees, taking off on their nighttime forays, emitting shrill cries (and doubtless sonar too). Bats are often the only mammals that manage to make it to distant islands (they were the only mammals on Pohnpei and Guam, until rats and others were introduced from sailing ships), and one feels they ought to be more respected, more loved, than they are. They are considered fancy eating on Guam, and exported by the thousand to the Marianas. But they are an essential part of the island’s ecology, eating many types of fruit and distributing the seeds, and one hopes their delicious taste does not lead to their extinction.

Greg Dever, director of the Pacific Basin Medical Officers Training Program in Kolonia, has a brusque surface, but underneath this is deeply romantic and dedicated to his work. He had gone to Palau as a young man in the Peace Corps, and had been shocked at what he saw – a fearful incidence of treatable diseases, combined with a drastic shortage of doctors – and this decided him on a career in medicine, so that he could return to Micronesia as a doctor. He trained as a pediatrician at the University of Hawaii and moved to the Carolines fifteen years ago. Here on Pohnpei he has established a small hospital, a clinic and outreach service stretching to the outlying atolls, and a medical program aimed at training indigenous students from all the archipelagoes, in the hope that when they graduate as doctors they will stay and practice and teach in the islands (although some, now that their degrees are accepted in the States, have gone on to more lucrative careers on the mainland).[31]

He had asked us, as visiting scientists, to give a presentation on the maskun. We felt odd, as visitors, talking to these doctors, mostly native, about problems they themselves presumably had lived with and knew intimately. Yet we thought that our very naivete, coming at the subject from another angle, might have some value for the audience – and we hoped we might learn more from them as well. But it became increasingly clear – as Bob spoke about the genetics and the retinal basis of the maskun; I about adapting neurologically to such a condition; and Knut about the challenges of actually living with it – that many of those in the audience had never actually encountered the maskun. We found this extraordinary. Even though there are half a dozen papers in the scientific literature on the maskun, here in the capital of achromatopsia there was almost no local medical awareness of the problem.

One reason for this, perhaps, had to do with the simple act of recognizing and naming the phenomenon. Everyone with the maskun has behaviors and strategies which are obvious once one is attuned to them: the squinting, the blinking, the avoidance of bright light. It was these which allowed an instant mutual recognition between Knut and the affected children the moment he landed on Pingelap. But before one has assigned a meaning to these behaviors, categorized them, one may just overlook them.

And there is also a medical attitude, enforced by necessity, which militates against proper recognition of the maskun. Greg and many others have worked incessantly to train good doctors in under-doctored Micronesia. But their hands are constantly full with critical conditions demanding immediate attention. Amebiasis and other parasitic infections are rife (there were four patients with amebic liver abscesses in the hospital while we were there). There are constant outbreaks of measles and other infectious diseases, partly because there are not enough resources to vaccinate the children. Tuberculosis is endemic in the islands, as leprosy once was.[32] Widespread chronic vitamin-A deficiency, probably linked to the shift to a Western diet, can cause severe ear and eye problems (including night blindness), lower resistance to infection, and lead to potentially fatal malabsorption syndromes. Though almost every form of venereal disease is seen, AIDS has not yet appeared in this remote place, but Greg worries about the inevitable: ‘All hell will break loose when we get AIDS,’ he said. ‘We just don’t have the manpower or the resources to deal with it.’

This is the stuff of medicine, the acute medicine which must be the first priority in the islands. There is little time or energy left over for something like the maskun, a congenital, nonprogressive condition which one can live with. There is no time for an existential medicine which enquires into what it might mean to be blind or colorblind or deaf, how those affected might react and adapt, how they might be helped – technologically, psychologically, culturally – to lead fuller lives. ‘You are lucky,’ said Greg. ‘You have the time. We’re too harried here, we don’t have the time.’