It had been raining last night. Nothing seemed out of the ordinary until morning, and we woke to the news that the bridge connecting the roads around Kokoda had been washed away by the river. It’s the only road we can take out of Kokoda back to Popondetta, and we had to be back for a morning session at Siroga clinic. Would we have to wait until tomorrow for the road to be fixed?

A few phone calls later (Liz ringing her husband to help us damsels in distress) and we had transport arranged to help us get to Popondetta relatively on schedule. When we reached the bridge, a huge concrete slab was missing, exposing the wild, muddy, swirling waters about 3 metres down below.

To be quite honest, it was a little bit frightening. The truck stopped at the edge of the bridge and we walked up to the point where the concrete fell away – hopped across a ledge and landed on the grass on the other side. Luggage followed closely behind.

The bridge is located around a central area drawing many people together. There were women selling food just on the street – peanuts, green sprouts and palm-stick brooms, lamb heart (2nd/3rd picture below) and betel nuts – a cross-section of market vendor culture.

There were more people than usual today – because the bridge had washed away, and also because it was PNG Independence Day. Everyone carried around a token of national pride – wearing tee-shirts and dresses bearing the national red, black and yellow colours. On the top of a truck were perched a few kids, seated in between two large flags flapping in the wind. Behind them I could see the splendour of the cloud-covered mountain-tops – it was nothing less than picture-perfect.

We bundled back into four wheel drives and sped down a bumpy road littered with pot-holes and mud-puddles at top speed. We were lucky to have Nick, an Australian expat, to drive us back to Popondetta. Sitting in the very back with mum and Mel, every time  we hit a bump in the road, we’d be thrown up, suspended in the air for a moment before crashing back into the seat – ie. it was pretty fun (although to admit, I was holding on pretty tight). Needless to say the trip back to Popondetta was considerably shorter than the trip on the way up.

We passed through rivers and little streams, bump-bump-bumping over rocks. Through the window I saw women washing clothes by hand in the shallows, with children splashing, playing and helping wash clothes nearby. As we crossed one of the deeper streams, we passed a row of lorries decorated festively with flowers and PNG flags in celebration of Independence Day. People were crammed into the back like crowded, open-air buses. Thinking about how comfortable that would be in the stifling heat put all our complaining about Sydney transport into perspective – by comparison, it’s hard to find fault with our home bus/train system.

Road travels have been interesting in PNG. We rolled over a speed bump, unusually placed in the middle of a long stretch of road (it was the first I’d seen the whole trip). The sign nearby read “SLOW DOWN HUMP”, written roughly in black ink. Robert said that it had been informally erected by the community after a young boy was killed when he was hit by a car on this road. I wondered about how much road safety the children would receive, growing up in surroundings where vehicles are few but when they occur, accidents/serious injuries are plenty. We nearly hit a puppy-sized black dog but Nick braked to a halt. Don’t run over these dogs – apparently the compensation for a dog can cost 500 Kina (a pig can be around 600-800 Kina).

Patients patiently waiting

Eye clinics: tested around 40 patients, most of whom we managed to fit with glasses. Most common need was for refractive error, and it became difficult as we ran out of the glasses most needed – roughly +2.00 reading glasses. We also identified cataracts and a few pterigiums requiring surgery. We (being Sue, mum and I) were seeing so many of what we thought were cataracts that we started to become paranoid that we were seeing things.

Sun damage is also a huge issue out here, with many people saying that the sun gave them teary eyes or pain. For these patients we explained the importance of using sunglasses to protect their eyes from sun-induced damage.

The most interesting case was an elderly man who had an accident as a child where a bird had pecked his left eye. Since then, he had lost all vision in that injured eye, and I could see that it was pale, cloudy-coloured and unresponsive to the surroundings. Surprisingly, his other eye maintained function and he just needed some reading glasses to assist him.

I say this again and again, but these eye clinics are so incredibly rewarding. It means so much for the people to have a chance at receiving much-needed eyecare, mainly to help them read. For some people, they have been struggling with strained eyes for anywhere between a few months to a decade.

Even more so, it is such an incredible feeling and experience to be able to be a part of helping this to happen – to meet the men and women of the community, their sense of hope and gratitude. They shake my hand firmly, with affection and with sincerity. The women are so sweet, and some of the elderly women are like grandmothers.

Meanwhile, outside in the fly-infested heat, Mel was booking in patients and triaging them for any combination of vaccinations, eye clinic and medical consult. Jodee and Karen (immunisation nurse) gave Tetanus, Measles and Hepatitis B together. In a room down the corridor, Aunty Rahda (I’m going to abbreviate this to A.Rahda) and nurse Olive ran medical consultations together, dealing with a variety of cases.  Mum floated back and forth wherever she was needed – medical cases, helping out in the eye clinic etc.

A.Rahda showed me an X-ray of the shoulder of a man. There were some areas of white spotting in the right shoulder, and I was super surprised to find out it was remnants of gunpowder from when he was shot! The problem had been going on for some time, but only in the last few months it had started to cause pain. It was likely that there was some kind of inflammatory response to the chemicals in the gunpowder, although exactly what it was reacting to was unknown.

It was suggested by A.Rahda that the best treatment would be to have it fixed by a plastic surgeon. But according to Olive, there is a grand total of 1 plastic surgeon in the whole country. Let that sink in – think about all the plastic surgeons in the US, in Britain, in Australia, then consider 1 plastic surgeon to service the needs of an entire country. And as I suspected, they charge prohibitive fees that only the wealthy can access. 

There are just so many challenges with the health care system here. They’re not issues that can be fixed overnight, but with greater empowerment of motivated health care workers like Olive, Karen and Dorothy, real changes can be made from the ground up. The benefits have immediate impact on the communities they serve.

There are a lot of other little things that happen throughout the day that I can’t go into full detail without becoming a super long essay. Domestic violence – a huge issue, absolutely heartbreaking. On the radio it was said “Men, don’t beat the women, even if it is your wife.” Any further comment needed? There was a case of domestic violence presented in clinic today – I’m not going to go into the details and I wasn’t personally involved, but to put it simply, it was very distressing to hear.

With the end of our last clinic session here in Popondetta, we returned for a little bit of R and R. We’ve been so fortunate to be looked after very well, thanks to Liz’s arrangements. Things are very comfortable here, I feel spoilt or perhaps very fortunate, to put it in another way. I guess I need to mentally prepare myself for whatever is to come on the next stage of our trip, as we travel to Madang and Karkar Island. 

Tomorrow, after a morning session of presentations to the health workers at Siroga clinic tomorrow, we’ll be heading to the airport to depart Popondetta.

Carrie

Day 3 - September 15, 2014

Kokoda

-Morning

Twas our second day of clinics today. In the morning we ran sessions at Kokoda hospital – yes, Kokoda, as in the famous walking trail and WWII history – consultations in one room, eye clinics in another. We could see the famous “Kokoda walking track” arch as we drove into the hospital, framing a backdrop of cloud-covered hills.

Kokoda hospital is a bumpy but beautiful 10 minute drive from Mamba, where we are staying. The panoramic views as we were driving this morning were nothing less than breathtaking – clouds drifting so low you feel as if you can reach out and touch them, crests of lush green mountains, growing palms in the foreground and little winding rivers. Even now writing from our room as we rest from the midday heat, I struggle to capture in words just how incredible the landscapes are – so vivid, so intense, so stunningly beautiful. Hopefully photos can do a better job at what these words can’t.

Morning clinics were busy as usual, although to be honest nothing compares to the lines of hundreds we had at Itokama. Eye clinics were run in a spacious room. People were told in advance that medics would be coming to the hospital and would have glasses sessions available. Again, I was reminded at how huge a need there is for eyecare. Even in one of the best-cared for areas of the province, in a major district hospital, there is an overwhelming sense of just how difficult it is to receive services.

A woman had eye injuries from wood splinters which had caused scarring and irritation, problems that had been going on for 4 years. 4 years!!! Let that sink in.

 Here’s another example – a man with cataracts so bad it stopped him from doing anything – from working, gardening, reading, doing things around the house. Cataracts are not uncommon here, but the necessary surgery to fix it, is. (For cataracts we took down patients details with Liz to create a priority referral list; with over 100 people Fred Hollows may be able to come and offer services.)

Breaktime over, we’re going off now to return to the hospital.

-evening

The day went by with eye clinics, vaccinations, presentations to health care workers + patients, and bumpy car trips. Going on all the time in the background are chatting and jokes, and discussions focused on development, identifying priority areas and brainstorming possible strategies (a network of exchange between mum, Sue, Liz, Dorothy, Robert the government representative and the staff of Kokoda Hospital).

Oh yes, and I forgot to take my camera to the clinic. *facepalm*

I can’t speak much for what was happening in other parts of the clinic, but being involved in the eye sessions with Sue has been very enlightening and interesting. To give you a bit of a picture of how they’re run – it’s a mixture between a short eye history and a brief examination (DISCLAIMER: I’m a student, Sue is a nurse – clearly we’re not eye specialists. Our focus is to match optometrist-measured glasses to refractive error.)

So without going on any more tangents, this is my thought process/what I would do in a typical sesh:

General feedback from these clinics – I find these exhausting but incredibly rewarding. It’s a thousand times easier here with Sue’s help and also with some kind of orderly system (its not perfect but it sure is better than nothing). When its busy we do need to try and work as quickly as possible as people end up waiting for 30 minutes to an hour or more, but that being said – the procedure is still undergoing development, and the whole thing takes time. The history is most important and also the most insightful – both into the patient’s condition and their general life – but it takes up a lot of time. It’s necessary to ask more questions when the situation is more complex, but for the simple needs for reading glasses it can be cut short more.

Some highlights – identifying a woman who had an abnormal history which didn’t seem to add up to be checked by mum. I thought she may have cataracts in both eyes but she had said that her left eye had vision while the right was almost completely gone – seated opposite from me less than 1 metres away, she could only make out my left shoulder. It didn’t make sense to me. From a quick check with mum, moving her fingers around to see in what position it was visible in, she suspected “quadrantinopia” (I could be making this word up) – a visual field defect where the patient could only see in her 4^th quadrant (explaining why she could only see my left shoulder – her 4^th quadrant). Long story short we put her on Liz’s list of people to be referred for eye specialist services.

This is what I love the most about eye clinics – talking to the patients, finding out exactly what it is that their eye problem is affecting in their lives, and seeing the possibility that correcting their refractive error can solve this. The last patient today was a teacher, she had problems reading when she was working at night, mainly marking schoolwork. Every hour or so, her eyes would be strained, she wouldn’t be able to see clearly and she would have to take a break. She also found that strong sunlight caused her pain/discomfort. The sunlight issue was not uncommon – there were a lot of people who appeared to have difficulty seeing in the harsh sunlight. I was kicking myself for deciding against bringing sunglasses in the throes of our 2am packing hurricane the night before departure, for lack of space and prioritising more glasses over sunglasses. We’ve made sunglasses a priority for next trip.

So I just deleted about 1000 words when my computer crashed (sigh) but will try my best to recapture what I was ranting and raving about before, which is basically that we’re trying our best to refine and “finesse” this eye care program to the best of our abilities. We’re asking questions all the time and discussing the possibilities, with the key goal to make this as sustainable and effective as possible. The whole process starts off easy - collections are an absolute no-brainer, followed by measurements (and I am so, so grateful for the help of our amazing UNSW Optom partners who kindly measure the glasses in their own spare time!). When we hit the ground up here is when things really start to get more complicated.

eg. Is there a need? Yes – we established that yesterday and today, and the need is immense. There are a lot of people with eye difficulties, many of them affected in their work, and not so many services to go around. 

Where is the need greatest? Reading glasses around +1.00 - +3.00 is in greatest demand. We are still determining whether its most effective to collect donated glasses of all ranges or to bulk-make glasses within high-yield range.

Whats the best/most appropriate way to test refractive error?

            How can we assess the usefulness/impact of these glasses in correcting refractive error and ultimately, improving quality of life?

Photos from around the hospital earlier in the day:

Mum and Rahda analyse an xray outside in the light

Okay, so something else we were doing in these clinics was presentation sessions. Today, mum gave a talk on Hepatitis B to the hospital staff, and here's her perspective on how it went:

***

                There is a feeling that has been growing gradually over the last day or two since being here. It’s taken a while to develop, especially since the route we have taken from Sydney to Moresby and now here in Popondetta/Kokoda gradually conditions you to the changes in opportunity and standards of living, rather than the full-blown contrast of Cairns/Australia to Itokama in a day.

My mind wanders back to my friends in Sydney and all the experiences I’ve been fortunate enough to have over the last 9 months since we were last here in January. And wow – what an incredible 9 months it has been. Just now, looking at the desktop of my computer and seeing the smiling (okay more like grinning/derping) faces of my friends scrubbed up for medball, it’s a stark reminder of where I’ve come from and the strangeness of the world we live in. I see from the photos of us smiling the difference between life “here” and life “there”, and I can feel a strong sense of how very privileged we are.

And I say this with absolute sincerity – not that we are rolling in bundles of cash or strutting around conceited, but just the fact that we are incredibly fortunate. We have everything and need nothing – or simple we have enough. We are privileged enough to not be fighting for survival and basic needs, they are taken care of one way or another, and we are privileged enough so that we have the luxury to worry about complex, abstract, non-essential, trivial (call it what you will) things. To put it in Gary’s words, our problems seem to be like “staplers” in a sea of real-world problems of survival and basic needs – education, health, employment, security, social infrastructure. “Perspective yo” takes on a whole new meaning and suddenly you don’t really feel entitled to complain much anymore.

Okay, so that was a long rant from me. It’s been nice to just verbally vomit onto this word document and chug out some thoughts before they’re reabsorbed and lost forever in the dark abyss of my brain. Tomorrow brings new learning curves, challenges and experiences (having a camera should also help).

Carrie