KOLONIA, Pohnpei (The Kaselehlie Press): February 21 - March 6, 2002 - "A Pohnpeian gentleman, in his mid-40's, was admitted to Pohnpei Hospital recently due to increasing right upper belly pain with increasing fever, restricting breathing over a seven day period. Further interrogations revealed that he had been a regular 'sakau' drinker, three to four times per week, over the last 8-10 years. Examination and further tests revealed that he had a softball size single abscess in his liver. He was treated over a few days in the hospital, and discharged to continue his medications for another four to six weeks. He had lost at least seven productive days of his life, and had been advised against heavy duty work during his treatment period."

Over the last few years, this similar story had been repeated over and over again by different patients to Pohnpei Hospital. On a single day in February 2002 two patients were admitted to the hospital with the exact same diagnosis as above!

The preparation of Piper methysticum ('sakau') for consumption in Pohnpei is quite different than in Fiji or Vanuatu. The roots are pulled from the ground, soils removed by coconut husk, then pounded on a rock, and finally the thick liquid is squeezed out through a green sheet of hibiscus bark into a half coconut shell for consumption.

The preparation of the 'sakau' can be heavily contaminated with soil and microbes. It is a ceremonial drink for adults and highly referred to in the Pohnpeian custom. But it has become more commercialized, and intake has become more frequent and regular.

Has 'kava' or 'sakau' contributed to liver failure, as claimed by some European countries? Pohnpeians, for that matter, have been drinking 'sakau,' the way they had sacredly referred to, for over centuries.

Do the hospital statistics show any significant increased incidence of liver failure over these centuries among Pohnpeian 'sakau' drinkers?

Frankly, no.

It is true that an increasing number of liver abscesses have been noticed among 'sakau' drinkers, and treated over the years due to better facilities for diagnosing liver abscesses. But there has been no significant increase in the incidence of liver failure attributed to consumption of 'sakau,' as may be "presumed" by some European countries due to kava or 'sakau' consumption.

Liver failure and cancer have been observed locally, but mostly among patients who have been exposed to the hepatitis B virus.

A retrospective study on liver abscess was done at the Pohnpei State Hospital over a two year and nine month period (January '93 to September '96), and it was found that Pohnpei had the highest rate of liver abscess admittances to the hospital in the world!

The admission rate was averaging 160/100,000 admissions per year, as compared to the second highest in the world (India) with 60/100,000 admissions per year. All were presumably caused by amoeba, a bug that usually causes bloody and/or mucoid diarrhea in the gut, and can migrate to the liver causing liver abscess. Most, if not all, were treated successfully with the medications for amoeba.

Pohnpei, with a conducive environment for amoeba to grow and thrive, is endemic for symptomatic and asymptomatic amoebiasis. The most recent report in the FSM revealed a symptomatic infection rate between 1.03 to 1.43 per 100 people, and quite prevalent among school children.

I tend to agree with Mr. Vincent Lehof, of Port Villa, Vanuatu, that perhaps the solvents or other ingredients used in the preparation of the kava (sakau) tablets, may have contributed to the noticed incidence of liver disease or failure observed in Europe. Or perhaps additional medications had contributed to liver failure, taken concomitantly with kava tablets. Only a scientific and control study can clarify these claims.

From a local observational point of view, 'sakau' has not contributed significantly to liver failure in Pohnpei, but has it contributed to the susceptibility of the liver to amoebic abscess? Quite possibly, as the retrospective study above showed that more than 95% of the patients studied had been regular Pohnpeian 'sakau' drinkers over some years.

Why is liver abscess not common in school children, who have endemic cases of intestinal or gut amoebiasis, as with 'sakau' drinkers? Perhaps, 'sakau' may have increased the susceptibility of the liver to contract amoebic liver abscess, but this is only pure speculation. Only further scientific studies can sort out these issues.

Pohnpeian 'kava' or 'sakau' - how significant is its insult to the liver? Perhaps to microbes infection, but remotely to liver failure, pending scientific proof.