It was early morning when we arrived at Siroga clinic. For some, we were greeted by familiar sights, vividly evoking experiences of last September’s visit. For the newer team members, the sky blue wood panels of the clinic’s exterior, the front veranda – now empty, but soon to be crowded with patients, and surrounding forest-green stilt houses were seen for the first time.

As the major health post under Liz’s care, Siroga was one of the better-equipped clinics, consisting of various consulting rooms, in-patient areas, a lab, and well-stocked pharmacy. There was even air-conditioning in some of the rooms! We split up throughout the clinic, and the building was quickly filled with the constant flow of people moving in and out of rooms, passing messages and arranging various aspects of care for each patient. Patients waited on benches and corners all around the building, fighting heat and flies outside on the veranda, or in crowded corridors indoors.

As resident young-pleb-person, I floated back and forth, lending a hand where needed and becoming well-acquainted with the general activities of the clinic. Hours passed by drawing vaccine vials, listening to doctor consultations, seeing the drug dispensary, taking photos, helping out with visual acuity measurements.

Darlene (left) and Fiona (right) in the drug dispensary

The way that sickness touches not only individuals, but families is incredibly striking. And it is often in these settings that the doctor’s greatest asset is not their technical expertise, but their empathy and ability to reach out with words of reassurance. I watched my mum consult with a man whose wife had died from complications of hepatitis B, who continues to look after a family of many children and worries about their future, whether they too have hepatitis B. Immediately he was given a kind listening ear, reassurance that his wife’s passing was of no fault of his own, and arrangement for him and his family to be tested that day for hepatitis B.

Another of the patients I met at Siroga who made a vivid impression on me was a softly-spoken lady in a yellow dress. She had nodules/bumps on her face, and the fingers on her left hand were locked into a bent, rigid position. She has a disease virtually forgotten to the developed world, one that has become something of “fiction” or past history, and remains classified as a “neglected tropical disease”. This is leprosy. It has not disappeared. It is not eradicated, indeed there are over 200 000 people living with highly stigmatising disease.

Meanwhile, lucky Moe Moe (paediatrician) was being swamped by screaming children… she put on a brave smile and soldiered on for hours, seeing pikinini after pikinini (pikinini – child) come with fevers, watery diarrhoea, chronic cough (TB), and the characteristic swirly-skin pattern of grille infection.

Marcel, a community health worker at Siroga (left), a family, and Dr Moe Moe (right)

Rex, the lab technician, gave me a tour of his laboratory, explaining the tests he ran for TB (A real life Acid Fast/Ziehl Neelson Stain, my nerdy dreams come true!). A poster illustrating how to do the AFB stain hung over a violet-dye-splattered sink, and on a bench to the left lay rows of sputum smears waiting to be examined under microscope. Rex also spoke about what his work involved, trips out to the other health posts to collect samples, his accountability and reporting to national health officials, and his anticipation of a CD4+ count machine (for HIV detection).

Rex, his microscope and rows of sputum smears on the desk (right)

In the office next to Rex’s lab, there works another highly motivated officer named Morris, Siroga’s young TB officer. Fiona (pharmacist) and I spent some time talking to Morris about his work, Fiona and Morris barely containing their excitement as they shared stories about how TB is treated in PNG and Australia. They compared their “Bibles” – a highlighted and annotated copy of the PNG Standard TB Protocols for Morris, and a pink pocket-sized Thearapeutic Guidelines for Antibiotics for Fiona.

Morris was enthusiastic in talking about the various medications he gives to patients (Directly Observed Treatment Standard Course – DOTS program). The TB meds stood out brightly in red pockets, each pill containing a combination of the 4 first-line drugs Rifampicin, Pyrazinamide, Ethambutol and Isoniazid. Standing on the shelves, the boxes of drugs weren’t labelled with patient names, but rather numbers. Morris explained that he did this to protect his patients from the stigma that still pervades about TB. There are still many people that believe in sorcery, he said, and I educate children in schools about health and diseases. Things will change, but it will take time.