Partly on impulse, and partly to prove to myself that I could do it, I applied for an internship halfway across the world in a place I knew virtually nothing about. Like many naïve, idealistic young people, I had been inspired by stories from other idealistic young people who had travelled the world and returned enlightened and world-wisened. Yup, someday I want to travel alone as well, I had been saying. But why not now? What was I waiting for?

That’s only half of the picture. I applied to Stanford University’s Asian Liver Centre (ALC) with a clear, yet ambiguous goal: to learn and experience as much as possible, and to bring those ideas home to further the Hepatitis B/liver advocacy back in Australia. The internship opportunity itself had been a product of a growing relationship with the mysterious “Mie-Na”, whom I occasionally emailed and shared progress from our Hepatitis B Free UNSW activities, and sheer timing.

Granted, I hadn’t put much serious thought into what I was getting myself into. Being swept up in the end-of-year hurricane of organising, exams and general kerfuffle, the idea of being away from home for 6 weeks didn’t really sink in. (As my mum put so eloquently: “you haven’t really had time to think about and digest this properly, and you’re probably going to get there and wonder what the hell you’ve gotten yourself into” – or something along those lines).

I’m proud to say I didn’t freak out too much or cause a public disturbance. Granted, I think I must have been feeling pretty nervous at the airport – hands aren’t usually supposed to shake checking in at the airline desk, and the last time I checked, I didn’t have a resting tremor.

13 hours or so later, after a brief triumph for clearing customs (the queue had been agonisingly long), I had a dark moment of panic in the arrivals hall. Mie-Na’s friend Ken, another ALC veteran, was kindly picking me up from the airport and I had no clue how I was going to find him, apart from “meet curbside at the arrivals terminal”. But the hall was freakishly long, I thought I was about to be lost 5eva, stupidly berating myself for not clarifying our meeting point more clearly. Luckily, Ken drove by in his conspicuously blue pick-up truck (thank goodness for that description) and I was saved. It gave me a sense of how powerless you feel as a stranger in a foreign country.

So, dear reader, I will try my best to give you a glimpse into the wonderful organisation that is Asian Liver Centre (ALC). In a nutshell, they are dedicated to reducing deaths and suffering from Hepatitis B locally and in the Asia-Pacific region. They are a powerhouse; pumping out resources ranging from easy-to-understand pamphlets in 7 different languages about Hepatitis B, to online training modules for health care workers, to websites for mothers with Hepatitis B. They run community and corporate outreach programs promoting early diagnosis of Hep B for high-risk ethnicities, they do research for new diagnostic tools and treatments for liver cancer, they work with government health departments internationally to create sustainable infrastructure that supports Hep B care.

I don’t know if any of that sunk in for you. It takes some time, and I’ll be writing a lot about it over the next few weeks.

So basically: they do a lot of stuff for Hep B.

Tangent aside, I spent this week at ALC getting a feel for their spectrum of advocacy, meeting the team (supervisors and interns included), and starting to jump in on some of their projects. For example, some recent corporate outreach programs – trying to engage local businesses in hosting free onsite Hepatitis B education sessions for their employees. I’m not gonna sugar-coat it: this has been challenging at times for me, especially as I have little experience with the corporate world (and that’s a hopeful exaggeration: I have NO experience with the corporate world). I often find myself unable to put myself in the position of a company, seeing our program.

It’s been an incredible learning experience, and I’ve only been there for 3 days. Some lessons learnt:

Stay tuned for more on the Project Scrapbook!

Carrie

PS. Excuse that clumsy ending, I was trying to think of a better way to end…but it is late and I am out of ideas…

PPS. Happy thanksgiving, people!

Friday, September 19 - Karkar Island

Our time on Karkar Island ended not with a bang, but a whisper.

The morning began on a hopeful note. The weather was calm and beautiful. Over a breakfast of tropical fruit, we chatted about marine wildlife on Karkar. Brett was telling us about what they had encountered in the waters - green and leatherback turtles to sharks of all kinds – reef sharks, grey nurse, the occasional school of hammerheads, whaler shakers and less commonly, tiger sharks. The animals here are not protected, but that also means that traditional hunting keeps their numbers down without driving them into extinction.

Today the plan was to join the regular day of the immunisation team here as they travel around and service the island, as well as to return to the CHW school later in the afternoon for Mel/mum to deliver the gastro presentation. It seemed simple enough.

On the way to Gaubin hospital, Pablo gave us a crash course in Pidgin. Over the last few days, and especially today, I’ve really come to love this language; its straight forward, easy-to-pick up manner (at least compared to some other languages *cough* Chinese). It rolls easily off the tongue and makes a lot of sense. For example, when leaving, you might say, “mipela go, yupela stap” which literally means “we are going, you are staying”. Another way to say goodbye is “lookin yu” or “lookin yu behind”. One of my favourites is “sun cooking me”, which means sunburn. When greeting a group of people, you would say “Mornin al geta, yu stap alright?” Don’t forget the chirpy little inflexion in “Mornin!” Another one of my favourites – “lik lik”, meaning a little bit, and our crowd favourite “pikinini” (child). Some other phrases Pablo taught us were “bugger up”, which is like damage or break, and “em tassol” which roughly translates to “that’s all”. Pidgin is a fun, easygoing, laid-back language to pick up, absolutely beautiful.

When we arrived at Gaubin at 9am, the transport for the mobile immunisation clinic was yet to arrive. (PNG time runs a little on the slower side, its part of a generally laid-back culture). We killed time by going for a wander around the nearby market, where there were people selling all sorts of food and knick knacks – dried fish and octopus, fresh fruit, clothing, stationery, toys, betel nut and other smoke-able things…

We came back and waited for the vehicle to arrive. During this time we had a chat to Christina and the head of the Maternal Child Health clinic, Sister Alexia about the Hepatitis B vaccine coverage in the hospital. Doses are given on Mondays, Wednesdays and Fridays in batches of around 10 (the vaccine comes in 5mL bottles and a child-size dose is 0.5mL). Somewhere in between, Jodee befriended a little boy (his name is Shane) who had an injured toe, and they communicated in a mish-mash between English and Pidgin. She disappeared for a while and it turned out that she met his mother and siblings.

Anyhoos, we did make it out to the clinic eventually (yay!). I called it a “scouting trip” to Ragon village, a beautiful little village about 5 km out from Gaubin hospital. We tumbled up the mountainside in the hospital four-wheel drive (the “ambulance”) up a steep, bumpy dirt road lined by tall grasses. It became a little cooler as we headed higher up and deeper into the forest. A decent amount of bumping around later (all the while staring warily at the amber yellow “empty fuel” light and thinking any minute we’d be out of gas), little huts and gardens came into view. We pulled into a small dirt-floor clearing around the base of a tall tree, behind which were rows of huts (the villagers later told me it is a Talis nut tree, and you can see the reddy-brown ripe nuts hanging high above your head).

To my surprise-yet-not-surprise (as we’d encountered similar before on the plateau) we came across at least two albino children. Albinism is a congenital condition in which a person is born without melanin pigment in their skin, giving them a snow-white appearance that is quite easy to recognise amongst their darker-skinned community. They are much more susceptible to sun damage as their skin lacks the natural protection. There were also a few children with measles in the village, apparently there had been an outbreak in a neighbouring village.

Visiting this village was the highlight of our time on Karkar, if not one of the highlights of the whole trip. It was really special to have the opportunity to meet and talk to the people who live in Ragon about their daily lives, take photos with the children – extremely shy at first, but with a little bit of time, become more comfortable and giggly. 

Most of the people gathered were women and children visiting the regular clinic, where health care workers recorded details, took weights and delivered vaccinations (we didn’t see the vaccines, which were likely given after we left). Mothers carrying babies in colourful, hand-woven billum bags weighed their babies on a scale hanging from the tree – it’s always so interesting to see the head of an adorable baby pop out of a bag. It’s not as though they’re going to have a lot of prams out here.

I’ve been really interested to hear about the education system and the kinds of opportunities the children have to go to school in PNG. James, who lives in Ragon, said that their village has an elementary school, primary school and secondary school (he pointed to the high school across the road, which looked like a medium to large sized hut with exposed wooden framework, a little higher off the ground). Just taking one look at the structure makes you wonder what kind of resources (if any) they’d have out here to learn. He said that there are 200-300 students and about 5-6 teachers, which would make about 1 teacher per 50 students.

After spending some time in Ragon, we bundled back into the vehicle to return to the CHW school for the presentation. There were a lot of exchanges of goodbyes, “lookin yu” and “yupela stap, mipela go”, and even after we pulled back out into the road there were a group of children running after the car and calling out “Byeeee!” We rolled away and tumbled back down the dirt road to the hospital. (Thankfully we made it back to the hospital even with the fuel light still shining bright.)

The afternoon was a little bit of an anti-climax, or if you’d like, a bit of an expectations vs reality situation. The hope/expectation was to test the hospital staff and CHW school for Hepatitis B using the test kits we had brought, which would be an opportunity to train the health workers on how to use them. Vaccines would be offered to anyone with negative antibody results (which means they don’t have immune protection against Hep B). Then we’d deliver the gastro presentation to the CHW school. In reality, because it was the “Friday fortnight” (aka. Payday and end of the week), the lab tech staff and students had gone home, it was difficult to get into contact with the Provincial government for official approval, there was hesitancy about possible cultural barriers. We did end up testing the hospital administrator Dr Cephuly, but the other parts of the plan kind of disippated into the air.

In our final moments at Gaubin hospital, I met a mother and son waiting outside the outpatients clinic. I had seen the young boy from inside the room where we were testing, and asked him for his name, “Nem belong yu?” (To no success, all I managed to do was scare him away – do I really look that frightening? O.O) A few minutes later, he ran past the door and called out something at me. I went outside and sat down with them – his name is Andy, his mother Rame (pronounced Rah-meh). He is in Grade 1 (elementary school) and she is a CHW at the hospital who has lived in Karkar all her life. With 3 other children spanning ages of 1 year to 16 years, all she wants is for her “children’s wishes to be true”. I gave Andy the “Liveright” (Live right/ Liver right) wristband and told him about how it means to look after your liver and be healthy and happy.

The day finished early and quietly, bringing a close to the working part of this journey in PNG. Now we are relaxing and waiting in Karkar to return to Madang by boat today, where we will stay a night before flying onwards to Port Moresby and then home to Sydney. It feels strange to travel so far when I’ve met people who may never have left their village or their island for their whole life. I feel so incredibly lucky to have had this experience, to have met the beautiful people who live on this island and understand lik lik about their lives here. They are honest, resilient people with a strong sense of family and community identity and an instinct for survival, ripened under harsh conditions.

[And here's a series of pictures taken from the port on the main island, after returning from Karkar. Yes - the water was that blue!!]

I’ve also been coming to understand a little bit more about the concept of aid work and volunteering overseas. When you’re working on a grass-roots level and carving out new paths, new projects and partnerships, it is of utmost importance to have absolute moral clarity, clear priorities and objectives, strong local partnerships, focus on sustainability and a lot of patience. It’s the perfect match between intention and action, where you need both in the right place for it to work. There simply isn’t enough money and time in the world to parachute in, build a school or a building somewhere just to abandon it under poor/no management after a year or so.

Now I’m just blabbering. In attempt to wrap up this chapter, the story ends here for now, but there’s a long way to go. A lot of work remains to be done, and there will be new adventures to come. Here ends my perspective of our journey, but with any luck (fingers crossed) I’ll be trying to publish some interviews with the other team members to share their perspective too. Each time we go on these trips/medical missions/whatever you want to call it, our eyes are opened a little wider, our experiences broadened a little further, and we come back slightly different people. 

Tenk yu tru, PNG, lookin yu soon.

Carrie