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.

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.

***

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.

Tuesday December 23, 2014

The last two weeks of my internship at Asian Liver Center (ALC) have come to a close. It was a strange way to end, with people gradually leaving here and there; a drawn-out series of small goodbyes. The first goodbye kind of hit me unexpectedly, it felt too soon and as if I’d be seeing them again after the weekend. We were busy too, and that was a kind of distraction. (PS. I’m writing this in a rush one week later, so dear reader, forgive me for the chaotic and somewhat unstructured post.)

Since it’s all jumbled up anyways, here’s an update on what I was involved:

Outreach is never a cookie-cutter exercise. You’re constantly learning on the run and adjusting as you go. Flexibility and people skills are key, and it makes a huge difference to be doing it with a partner or a team so you can encourage each other and continually evaluate/refine how things are going.

I was presenting on a fitness/awareness walks program we had been developing for a few weeks, which involved Taichi exercises for the liver, a short walk around the company campus, and an educational booth. The purpose was to develop an engaging and time-efficient (sustainable) way to update the current program, which involves a lecture from Dr So and onsite screening for hepatitis B. I’m not going to go into full details of what happened except to say that I was very nervous, feeling out of my league amongst all the older executives, the discussion didn’t really go as we expected but it was a good learning experience for all of us.

***

I keep saying this again and again, but I felt like another week or so would have given me time to tie up some loose ends in those projects. I wanted to follow up those calls in Cupertino, especially having said to the restaurant workers that we would call one week later. Next year won’t be soon enough, they may have forgotten or stopped caring by then. I wanted to consolidate the work on the youth leadership conference themes, to continue developing the pitch for the online store. Leaving that work unfinished is unsettling, and makes me question myself. Did I work hard enough during that period? How will the next person be able to continue where I left off? Will it be dropped and go to waste? Did I make a worthwhile contribution, or at the very least, did I try?

In retrospect, I can see that this internship has taught me a few things. The first is quite simply that although I do really care about public health, I could not forsee myself working in a public health department without a direct connection with the patient-doctor front. The more steps between the people we are trying to help and the program we are developing to help them, the harder I find to feel that sense of purpose and really direct it towards fulfilling a need. Conversely, I really admire people who are suited for these roles, because we do need them for sure.

Another big lesson I’ve learnt has been the importance of planning. Oh boy, I’ve never been much of a planner, which is why a lot of the time I can feel chaotic and confused doing things, as if I’m constantly running around and recalibrating like a headless homing chicken. But by planning ahead, there’s a much greater chance you can make sure gaps are covered, and once the foundation is set, you can see even more potential for new ideas. I believe that you need good intention + good implementation for things to work out, and planning is inevitably part of good implementation (I begrudgingly admit).

I’ve got a few more days here, visiting places with friends, touring around other parts of California and beyond with people so kind to take me. I’m in awe of how much time has passed, how quickly it all accelerated towards the end, with every day packed full of things to do and people to meet. That’s really been the most incredible part of being here: meeting people, getting to know them, sharing meals and car-trips and New Year’s resolutions. I’m excited to go home, I really am. My head is swimming with ideas and things to do (more than the time I have!! ARGH!!) Things are still messed up in my mind, with lists and responsibilities and plans.

But golly gosh, there is something more that underlies everything that’s happened and everything that is about to happen. Why has this experience been so fulfilling, so rich with awesomeness!? I can’t answer that to completion, but what I do know is that spending time with people and being the recipient of so much love and kindness has really made this time meaningful and full of joy. It feels unfair, the amount that people have helped me during this trip, whether it has been giving me a place to stay, showing me around San Francisco (do not call it ‘Frisco’!!), taking me on roadtrips into the great beyond, letting me tag along for the ride and sharing a bit of their lives. And dear reader, whoever you are, wherever you are, thank you for reading this story and I can only hope that these things will inspire you to appreciate everyday as it comes, be honest and open, give back as much as you can. These are things I’m constantly learning too. One more special post to come and then that closes this series!

Mate, what a journey! Hope you have a very merry Christmas and embrace the new year :)

Carrie

Thursday September 12, 2014

Palo Alto, California

On the road, San Francisco

They say you should never start by describing the weather, but I’m going to start this post by describing the weather. 

We’re having the “worst storms since 1988”, schools have allegedly been closed due to flash flooding and cars are clogging up the big highways like blocked plumbing. It’s kind of exciting (floods! Storms! much needed rain in a drought-stricken area! Drama! Exclamation mark!) but mainly because I know it won’t last for very long. Soon things will go back to normal.

I’ve passed the half-way point in this internship. This week has been 1000x better than the last. In retrospect, it feels like week 1 was orientation, week 2 was idle-thanksgiving-everyone’s-gone-home time, and week 3 things are getting more exciting!

Quick overview of what I’ve been doing since my last post:

There’s a lot of stuff I could go on about Cupertino yesterday. But let’s just say that when it comes to non-profit/community outreach – it comes down to people. You can prepare all you want, write out scripts, but in the end reality is messy and slightly unpredictable. You need to be flexible, adapt to different people and environments, and this is definitely something I’m still getting the hang of. Little people skills like speaking slowly, smiling, introducing yourself, listening, all these things matter. No one is perfect. But we can try our best to be genuine.

Being able to take part in this internship has been an incredible opportunity. On one level, it’s given me a huge insight into how ALC operates, the kind of scale and logistics involved, what public health looks like in an institution, picking up skills etc. But moreover, it’s granted me time – time to spend getting to know the other interns, meeting people around the area (including family!) and understanding life in the Bay Area/Silicon Valley/AMERICA. Sure, I’m not going out ticking off all the touristy attractions. But I’m getting a real experience by engaging with everyday people and their lives here, which means so much more to me.

Carrie

3 for Life - Week 2/3 at Asian Liver Center (ALC)

Wednesday, December 4, 2014

Thanksgiving came and went in a blur of turkey, pumpkin pie and online sales. Meanwhile, I had been taking a break from ALC, which was closed for the thanksgiving weekend. Things had gotten a little quiet at the office in the lead up to thanksgiving. Some of the staff and interns had gone to their respective homes for the week. In those fragmented days, I floated, pottered, was assigned a few tasks, sat in on a meeting or so.

Justin (social media), Angelica (corporate) and I (general/miscellaneous) joined brains and came up with this masterpiece, wishing the invisible social media audience a happy thanksgiving. The expert artwork was the product of peer-teaching, Justin and Angelica evoked a sense of childhood nostalgia in their demonstration of tracing around one’s palm to draw a turkey.

Ie. I drew a turkey by tracing my hand (masterpiece shown below).

Here’s a brief overview of what I’ve been working on lately:

***

I’m going to go ahead and be a little bit honest for a moment. It’s challenging sometimes, finding ways to be real and honest whilst realising that an “audience” will be reading these words. (By the way: Hi there, thanks for reading!) But that was the point of this blog; to be honest, or at least to try and be honest.

So, for the past week or so, I’ve had a few ups and downs. There were times where I felt idle and useless, questioned what I was doing here, whether I could have any contribution, or if I was just a random pleb floating around, not really having much input and kind of being in the way. Basically, I was having doubts. For sure, it’s been amazing getting to know the people at ALC, especially the other interns, and I’m so grateful for the opportunity. But I’m not used to the idea of stringent quality control, just pushing through and revising what I think are menial things again and again, sometimes just to be scrapped when they’re sent for approval. At other times I felt like I had nothing to do, and was almost ‘making up’ tasks to do.

Somewhere in that period, I was caught thinking about that idea of expectations vs reality (yup – go re-watch that wrenching scene in 500 Days of Summer, it gets me every time). Things weren’t going how I expected them to. And that meant something: I was actually hanging onto expectations, which contradicted the very task I had given myself in the first place. Wasn’t the point to come in without expectations, be open to learn, and contribute wherever I could?

***

I’ll just tie up this post with a little comment about travel. I’ve been finding that travelling abroad makes me feel a stronger sense of connection with Australia. I feel proud to be Australian and embrace a sense of Aussie identity, something I rarely experience at home. Perhaps being surrounded by a foreign environment and being around people of different backgrounds has an alienating effect. Perhaps then, the instinctive response is to cling tighter to what is familiar and feels like home.

Carrie

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!