Day 2, September 14 2014

Popondetta/Mamba

We woke up this morning at the crack of dawn (~4.45am), scoffed down some breakfast and headed off to Port Moresby Jackson airport to join the long, snaking queue at the entrance to departures. Boarded our Popondetta-bound domestic flight and a 30 minute hop and a skip later, we skidded down onto the sun-baked tarmac in lush Oro Province.

Inland PNG is a very different world to urban, coastal life. As you descend through the clouds into Oro, you are welcomed by a dramatic landscape of majestic, jagged mountaintops covered in rich forest, green sweeping planes and a vast lake.

Arriving at Popondetta airport. Above 2 photos, Jodee and Rahda enjoy a moment of excitement. The incredible scenery can be seen even from the airstrip.

We were met at Popondetta airport by our incredible partner and friend, Liz Cazulet. Liz is the nurse manager of various health outposts for New British Palm Oil, she coordinated the logistics of our sessions together with the community health workers as well as making sure we were well looked after and secure. We bundled into four wheel drives and soared down the highway, about a one-lane road. Familiar sights greeted us, tall sugarcanes, grassy plains, palm trees and mountaintops in the distance. As we travelled further inland, we passed people walking down the road, clusters of wooden huts on stilts, rock-strewn rivers where women were washing clothes by hand. Everything is a vivid green and blue.

I’m going to be brutally honest and admit that on the plane I was feeling somewhere in the range between a little nervous and scared out of my wits about running the upcoming glasses clinics. With Joel’s help back home, we had found a fantastic app known as Peek vision which we planned to use as preliminary visual assessments. It would be a trial of its usefulness as a tool, and an improvement from our last methodology. The focus at the moment is on refining the whole glasses process, to make it as accurate, effective and sustainable as possible. I knew how to use the app but was still sketchy on how to interpret the results and match it with a suitable pair of frames. My idea was to find a balance between a basic history and a Peek vision eye test, trying on a few pairs for best possible fit, then recording the relevant data.

Birds of prey seen circling in the sky

We stopped off at a small clinic called Saiho on the way through to meet some of the staff working there:

A football field was right outside the clinic. There was a team of young boys waiting to get out on the field and play a game of soccer, how they do that in the heat I don't know - hats off to them!

SO, our very first clinic of the trip was held at Mamba, a 2 hour drive out of Popondetta and just a few minutes away from Kokoda village (I snoozed most of the way up). We ran vaccinations sessions (Hepatitis B mainly), general medical consultations and our first eye clinic. The clinic is a modest building equipped with some basic equipment and 2 small partitioned rooms, one labelled “injection room”. On the wall there were a few posters, and I noted the sign saying something along the lines of “Antibiotics are miracle drugs. We must use them responsibly if we want to keep them that way”. There was also a sign about domestic violence.

I was excited to begin. It was already the second half of our second day and I was starting to feel just like a tourist – it felt like about time to really get in and start doing some work.

Overall the clinic seemed to run pretty smoothly. HepB vaccines were given, a few medical consultations and a bustling eye clinic. 

The most severe case was a man which a huge, swollen belly, a condition known as ascites. (bells were ringing in my head as I remembered asking the 2^nd years in class, “Soz… what’s ascites?”) When I came into the room, with mum and the other health workers standing around the bed, the man’s belly protruded into the air from where he was lying down, distended and blown up like a balloon full of fluid. He was clearly uncomfortable and mum pointed out his difficulty breathing. The root cause wasn’t known (mum hypothesised portal hypertension, cirrhosis and possible liver cancer). She demonstrated and explained to the health workers how to drain the fluid out, emphasising aseptic technique to minimise contamination. “In Australia we’d do diagnostics and imaging,” mum mentioned quietly, concern written all over her face. Suddenly this simple, matter-of-fact statement meant so much more, realising that the quality of health care comes down to which country you happened to be born into. Seeing this man’s emaciated body, swollen legs and belly swollen like a watermelon, I thought about how this would never happen in Australia – to progress to such a terrible stage.

About 5.5-6L of fluid was drained out today, and the size of his belly was notable smaller. With less fluid surrounding them, the spleen and liver could be felt – indicating hepatosplenomegaly (enlarged liver and spleen), a sign of disease. Although a relatively large amount of fluid remained, enough was drained for the man to be able to feel much more comfortable. Mel said that as the fluid left his body, she could see the look of relief on his face. In mum’s words, he’d be able to sleep properly for the first time in months. The fluid would be back in about 6 weeks, and then Dorothy and the other health worker would then be able to repeat the procedure. This was not an uncommon case.

Back to our eye clinic – being here and seeing the potential impact and the need for eyecare in Popondetta and the Oro province has been a huge encouragement and a spur forward in this project. It’s absolutely surreal to consider all the efforts and collaboration between students, faculties, high schools, doctors and friends to make the collection and measurements work. Being able to gain a better understanding of the eyecare situation here has been invaluable in identifying what the priority areas are and focusing on how to address the needs of the communities.

9 months of medschool has made a huge impact for me personally. Last time I was in PNG, and even Timor earlier this year, I had zero to no medical understanding. Many of the things that were happening were lost to me, and it was difficult to really understand what was going on. How could I possibly begin to understand the disparity between health services here and in Australia when I don’t even understand the standard of health care in Australia?

It’s taken a day or so to get into the swing of things, trying to get the hang of my documenting role. I remember before I started this process earlier this year I made a goal, or if you’d like, a promise to myself to be as honest as possible. It’s challenging, and I don’t think I’m quite there yet – to be open, and to write openly. I guess what I need to remember is that I’m sharing a story – our story, everyone’s story – but it is ultimately a story seen through my own eyes.

Carrie