Day 1 5/7/15

Sydney to Port Moresby 

Our adventure starts at 6am. It’s a chilly 6 degrees in Sydney, and we rendezvous at the airport just after the sun has risen. We’re a team of 9 this time – 2 doctors (Alice/mum, Moe Moe), 2 nurses (Mel, Jodee), Sue, 1 pharmacist (Fiona), 1 optomestrist (John), 1 bioinformatician (Magda) and me – the resident pleb, aka documentarian/student. We’re a mix-and-match multi-disciplinary team, a lot of newcomers. But some things never change – the massive trolleys piled with suitcases, travel backpacks, bulgingly obese duffel bags; crammed full of medical supplies.

We touched down in Port Morseby just after 2 o’clock in the afternoon. Today heralds the opening day of the 2015 Pacific Games, this year hosted by PNG’s very own Port Moresby capital. It’s a momentous occasion, with athletes here to compete from 24 countries including New Caledonia, Fiji, Vanuatu, Fiji, Tahiti, Australia and New Zealand. Signs of the event are everywhere – from the freshly renovated airport interiors, to the Australian girls rugby team dressed in green and gold who we spotted on our flight, to the orange traffic cones marking the inner lanes of the main roads for speedy passage of athletes. Driving through Port Moresby we were pointed out to the games village, build on the grounds of the university of PNG.

Everytime we come back there are signs of new development. The streets are cleaner, the roads busier, and high rise buildings more abundant. Joe – a manager at the Lutheran guest house where we stayed overnight – told me that the crime rates have dropped too, and the population has grown to about 600 000. He comes from an industrial city on the north coast called Lae, where he used to be a schoolteacher – he gave us (John and I) a geography lesson on some major landmarks in PNG. He was sincere and enthusiastic in sharing his knowledge, answering our questions about PNG, and it made me wonder about the circumstances that would have shaped his journey from pedagogy to hospitality, and on the other side of the country.

Despite the physical, aesthetic improvements in infrastructure, other features are familiar and stir a sense of nostalgia and curiosity. It was the afternoon when we arrived, and in PNG afternoon means burning, much like in other countries around the world. Mist-like billows of smoke emerged from ditches along the highway and plots of land beside smaller roads; glowing piles of burning rubbish. We passed gravel fields where children were playing soccer; markets where women were selling drinks, packaged food, BBQ meat; and scores of buses and trucks where people ride open-air. In the back of one of these trucks there was a group of women dressed in vibrant traditional costume: feather headdresses in black, red and yellow plume, with matching coloured skirts. They were a “sing-sing”, Joe told us, on their way to perform at the Pacific Games opening ceremony, which we watched on an ancient television later that evening. Performers from all across the country had come to showcase their province’s unique cultural songs and dances on national television, a celebration of diversity with a sense of unity – national pride in one’s incredible rich culture and traditions. As part of the Oro Province’s performance there was a man dressed in bright green butterfly costume, depicting their native Queen Alexandra butterfly (the largest in the world at a whopping 30cm!). Tomorrow we head to the Oro Province.

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Day 3, 7/7/15

Popondetta Clinics

The team set out on our maiden clinic voyage this morning, full of hope and excitement. It was the beginning of our third day in PNG, and although the first two days had been great for relationship building and planning meetings, we were itching to get our hands dirty and start the work that we came here for.

The clinic we worked at today is called Saiho, it is one of the major community service providers in the Popondetta area. Saiho clinic is run by a highly dedicated (if not overworked) staff team of 13 Community Health Workers (CHWs) and one nursing officer. The clinic itself is a cluster of buildings painted green and blue, each block dedicated to a specific purpose, be it treatment/medication distribution, inpatient beds (a small room with 6 beds lined by worn mattresses, family members hovering around bedside and children seated on the floor), a TB clinic building from which the DOTS (Direct Observed Treatment, Short Course) program is coordinated. In between the buildings is a grassy plain bordered by trees, the shade of which gave refuge to patients waiting for the eye clinic.

We practically leaped out of the 4WDs at 8:30am and were received by community elders who warmly greeted each one of use with a smile and friendly handshake. A small crowd gathered outside the TB clinic building and both the Hep B Free team and each of the Saiho staff introduced themselves and their roles. A Provincial Health official named Dr Toro also addressed the community and explained our purpose and the set-up of the clinic. The people gave 3 hearty cheers of “Oro, Oro, Oro!”, meaning “Welcome!” And we scurried off to our respective positions.

As Sue put it, each clinic we run is a little different – to an extent we don’t really know what to expect before it happens. There are features common to our set-up: registrations (Mel), triage, immunisation, outpatient/treatment clinic (Mum + Moe Moe), drug dispensary (Fiona), wound dressings (Sue/Jodee), eye clinic (John). We adapt to the space, the available supplies, the time and the people. Being my third trip, there was a sense of familiarity in our rhythm and drill, mixed with a sense of excitement about what was different.

I’ll try write up a few snapshots of some things we saw in today’s clinic. There was a woman with asthma who had been taking salbutamol tablets. When offered by the doctors on our team, she declined a salbutamol puffer. This stemmed from a cultural fear that people who start using the asthma puffers will die. Considering how commonly asthma puffers are used in Australia, and with virtually no ill-effects, we postulated why she might feel this way. Was it because only people with really severe asthma were given puffers, who might be more likely to have a fatal asthma attack? Despite some gentle encouragement and reassurance, this lady’s opinion was firmly established and she left without accepting the treatment. It’s difficult to swallow…but ultimately it’s her health and her right to choose, and whilst we can try to educate and provide reassurance, sometimes cultural assumptions and beliefs can be complex and deeply entrenched.

There was an elderly man with deafness in both his ears, he came accompanied by his wife, who throughout the consultation, interpreted to her deaf husband using a combination of mouthing, speech and hand gestures. The man previously had otitis media (middle ear infection) with perforation, and this had presumably contributed to if not caused his deafness. He had come with an expectation that he would be able to have his deafness cured. The sheer disappointment on his face when he was told that we didn’t have the equipment or expertise to help him was heartbreaking. It made me wonder whether we were close to his last hopes of some kind of recovery. There’s very little that is comparable to the hopelessness of telling someone, “sorry, there is nothing we can do.”

In most of our clinics, we get about one acute/emergency case. On this particular day we met a young man who had walked 3 km to the clinic using a self-made wooden crutch, where he presented with severe abdominal pain. The multi-disciplinary team of doctors, pharmacist and CHWs hustled to their action stations – after brief examination it was determined that this man’s appendix had developed an abscess and ruptured, leading to very dangerous and painful peritonitis. He needed surgery – urgently. After the exertion of his journey to clinic, he was laid to rest on a simple cot in the corner of the treatment room while waiting for transfer to hospital, and administered IV fluids containing gentamycin, the first of a triple antibiotic series to cover a broad spectrum of bacteria (gram pos, neg and anaerobic). This was to act against a barrage of nasty critters that could have escaped into the peritoneal space as the appendix ruptured.

These are just a few stories out of what happened today. Overall it was an encouragingly positive start to our work here, and there was a good sense of team morale as we faced challenges together, shared laughs bumping over crooked roads, worked together in the clinics and collapsed with satisfied exhaustion at the end of the day. We felt so warmly welcomed by the local people who had travelled from the surrounds to attend this clinic, and by the CHWs who were so friendly and engaging. But at the same time, it's utterly frustrating and disillusioning at times to encounter people suffering for no fault of their own. Each person who arrives at the clinics comes with some degree of hope - no matter how big or small - that they'll be helped or cured. And sometimes that's just not the case, because we don't have the equipment that we can access so easily back home, or the knowledge to correctly diagnose and treat the problem. Sometimes it's just too severe. Often people expect a simple solution - a tablet, a drug mostly - that can cure them. But there are many patients waiting, so the best we can do is to hear them out, apologise that there's nothing to be done, and send in the next person, hoping this time there'll be something we can help them with.