Thursday September 18, 2014

Madang/Karkar Island

I’m back underneath the mosquito net, typing for a precious few minutes before the electricity gets turned off at 10pm. Outside the window come the sound of gently crashing waves, the buzz of insects and the croaky chatter of frogs (including barking toads, they just can’t keep quiet).

We’re in a place known as Karkar Island, home to about 80 000 local residents and a handful of expats. It’s a hot island, it feels as if someone turned up the thermostat between leaving Oro and arriving in Madang/Karkar. What’s quite unique to this island is the black sand beaches, made black by the volcano, don’t ask me how. Something else I find absolutely fascinating is the biodiesel industry here: coconuts - abundant on the island - are transformed into biodiesel, making a sustainable and ecological fuel that apparently smells lovely, like a fruity perfume.

Here’s the rundown of what happened today. Woke up early this morning in Madang, grabbed a quick breakfast and headed down to the wharf to board a teeny tiny little speedboat that took us to the island, about a 1-2 hour trip. We left the tranquil, protected bay in Madang and bumped along (there’s been a lot of bumping on this trip) across crests of waves. As the distance between us and solid ground grew, so did my nervousness, and I can say honestly that I was gripping on tightly to that little metal handrail. Luckily, the further out we went, the closer the outline of Karkar island came into view, its iconic mountaintops rising high into the air.

Sometimes when we looked into the shallows, we could see the sandy bottom covered with coral through pristine, turquoise water. It was something quite special. Out in the open sea, a surprised cry from mum of “Dolphin!!” alerted us to the majestic form of a dolphin leaping high over a wave. We had a slight scare when the engine stalled about a kilometre out from the shore and we were left bobbing haphazardly in the rolling waves. Nevertheless, we broke out of the surf into the waveless shallows.

I was exhilarated to be facing a whole new sight. We slowly drifted along the sandy banks, passing children playing in the black sand or paddling in wooden canoes, behind which was visible little huts made of woven grass and wood. Beyond, the land was covered by dense, tropical forest, unfamiliar and exotic. The boat stopped about a metre out from the sand, we hopped out and waded the last bit through water.

A man wearing glasses, a striped short-sleeved shirt and light safari pants eagerly burst through the back gate of a property which opened out onto the beach. He introduced himself as Pablo, a logistics officer from Spain with extensive field experience with MSF (Doctors Without Borders) in countries including Pakistan. He and his wife Dr Constanze work on Karkar Island at Gaubin Hospital. (He is fantastic, one of the friendliest people you could ever meet. He helped us out so much today, picking us up from the boat, introducing us to the hospital staff, letting us rest in his home and even showing us around his garden – complete with an assortment of colourful flowers and coconut, passionfruit and pawpaw trees, and pineapple plants. It was the first time I’d ever seen how pineapple grow and boy, was I surprised. Pablo explained how fertile the soil is here, “Stick anything in the ground and it grows. Put a rock in the ground and it will grow into bananas.”)

Anyhoos. We all weren’t sure what to expect from our time here, as the communication over the last few months had been patch at best, leaving us in a bit of an unpredictable pickle. Thankfully, things turned out pretty well today. After arriving at Gaubin hospital, we met with the hospital administrator. Mum discussed ways to support the hospital and went through explanations of the supplies we had brought. 










Over the day, we went on a tour and ward round of the hospital, took a break at Pablo/Constanze’s house, and finally returned to the school for Community Health Workers (CHWs) adjacent to the hospital for a couple education sessions.

The hospital tour was fascinating. The wards looked very similar to what we had seen in other areas of PNG/Timor – limited and under-resourced. In the surgical ward I met a man with a bandage on his left arm. When I asked him how it happened, he said that a shark had bitten him and taken out some meat off his arm. My immediate reaction was: wait, what…did you just say a shark? (I swear he just said shark. Oh my god, he really did.) That was probably the most noteworthy thing I saw in the hospital.

There was also a child in the paediatrics ward with malnourishment - the distended belly, difficulty breathing and skinny limbs was a giveaway. Asking the mother, the child was “7 moons” old and had no name.

Other things we came across – Xray facilities, not in operation for the last 12 months due to lack of film, an old weights scale sitting outside with a rake leaning against it, clothes drying in the sun on a hills hoist, an all-paper filing system, a tiny little hole-in-the-wall laboratory on the top floor.

Here’s something you don’t see everyday. After we had finished the hospital tour and was standing outside the entrance waiting, we heard shouting outside the gate and people dashing down the street, shouting “Go, go!” A minute later, they were followed by an intoxicated man wielding a bush knife, swinging it around and yelling at the people behind the fence. Crowds gathered on the hospital and schoolyards, which were facing each other across the now-empty road. Eventually he left; things gradually settled down and went back to normal. As it turns out, alcohol + marijuana + bush knives meant that these situations were not all that uncommon: “PNG way of life.”

Education sessions at the CHW school later in the afternoon were interesting. The session was focused on Hepatitis B education today. Mum’s talk included information on Hepatitis B, vaccination coverage (especially birth dose), clinical features and management. Jodee also gave her talk on conjunctivitis.

The students studying here come from different parts of PNG. Most of the ones I spoke to came from Madang, but I’m sure others come from elsewhere too. After completing grade 12 high school they study here for 2 years and complete 41 modules, including eyes, upper and lower respiratory and many other topics. Then they are allocated positions at health outposts or hospitals around the country. In their spare time some of their favourite activities are playing sport, music, telling stories and jokes, just like students anywhere else in the world.

Driving around the island to where we are staying, we passed by many people going about their daily lives, dogs casually hanging around the road, families of pigs going about their own business, and a lot of coconut trees growing all around. Apparently a lot of injuries are caused by coconuts falling on people’s heads, which goes to show that coconuts are not to be taken lightly.

Okay, lights are well and truly out (power goes off), I’m sweating from the heat, the frogs are making a ruckus (still) and I’m getting a little paranoid about the bugs that may or may not be falling through holes in the net onto meeeeeee (ouch – what was that…) I think it’s time to call it a night, tomorrow brings another day!

Carrie

Just another manic Wednesday.

Today was our last day in Popondetta. In the morning we held an education session with a small group of nurses and community health workers (CHWs). It was our second round of presentations and the topics were:

Meeting everyone and introductions to the training session

I didn’t really know what to expect about these sessions. I wondered how useful they would be and how much the health workers already knew on these topics, as they have a vast amount of clinical experience. On the topic of infection control, I thought that they would already know the basics about the importance of hand washing, but perhaps didn’t know as much about implementing it in practice (it turned out they knew both – the problem was the same as it is in Australia and anywhere else: we all know what to do, but it’s a matter of getting everyone to practice hand hygiene all the time).

In order from top: presentations from Sue, Radha, myself, Mel

What I found most interesting was talking to and getting feedback from the health workers at the end of the session. Olive said that it was new material, especially with the obstetric emergencies. In terms of infection control, she said it was things they already knew but good to be reminded on, as optimal hand hygiene may not always be practiced. 

I also really enjoyed having a chat to Karen, the immunisation nurse at Siroga clinic (see Day 4). With a particular interest in the obstetrics talk, she is really keen on learning and was seeking more resources such as textbooks and drug guidelines. 

She also explained how the schooling system works in PNG, with elementary school until grade 3, primary school until grade 8, high school beyond that. Students are required to sit a series of entrance exams at 3 main points – to progress from Year 8 to Year 9, Year 10 to Year 11, and from Year 12 onto university. It also means that students who do not meet the selection criteria don’t continue their education through that pathway, and may join the workforce, continue training/studies elsewhere, or do something else entirely. Little by little I’m coming to understand a bit more about life here (perspective yo).

***

After packing up, farewelling Liz at the airport, a short flight back to Port Moresby and quite a few salted peanuts later, we were high up in the clouds on our way to Madang, where we’ll be embarking from onto the next stage of our adventure. Tonight we’re staying in Madang, tomorrow we’ll be catching a boat across to Kaka island for a 2 day adventure – not exaggerating – as we really aren’t quite sure what to expect.

I’m constantly reminded of how very lucky we are, and overwhelmed by the abundance of opportunities that we have in Australia. We can learn what we want to learn, dream what we want to dream, and best of all, have the ability to carve out our dreams and make them happen. We enjoy such a good quality of life, such richness and diversity of our culture and society. We are taught from a young age to be open-minded and tolerant, to respect and to be respected, and to treat everyone as equals. Nothing has opened my eyes to the world we live in as much as they have been by being here, having a glimpse and a listen to other people’s lives.

I’m feeling a little drowsy and a little nervous/excited about what tomorrow brings. I’m half anticipating getting sea-sick on the 2 hour boat ride across (touch wood!?) and the uncertainty of what is next to come is a little unnerving. Here's to something new, we're glad to have each other.

Carrie