Day 2, September 14 2014

Popondetta/Mamba

We woke up this morning at the crack of dawn (~4.45am), scoffed down some breakfast and headed off to Port Moresby Jackson airport to join the long, snaking queue at the entrance to departures. Boarded our Popondetta-bound domestic flight and a 30 minute hop and a skip later, we skidded down onto the sun-baked tarmac in lush Oro Province.

Inland PNG is a very different world to urban, coastal life. As you descend through the clouds into Oro, you are welcomed by a dramatic landscape of majestic, jagged mountaintops covered in rich forest, green sweeping planes and a vast lake.

Arriving at Popondetta airport. Above 2 photos, Jodee and Rahda enjoy a moment of excitement. The incredible scenery can be seen even from the airstrip.

We were met at Popondetta airport by our incredible partner and friend, Liz Cazulet. Liz is the nurse manager of various health outposts for New British Palm Oil, she coordinated the logistics of our sessions together with the community health workers as well as making sure we were well looked after and secure. We bundled into four wheel drives and soared down the highway, about a one-lane road. Familiar sights greeted us, tall sugarcanes, grassy plains, palm trees and mountaintops in the distance. As we travelled further inland, we passed people walking down the road, clusters of wooden huts on stilts, rock-strewn rivers where women were washing clothes by hand. Everything is a vivid green and blue.

I’m going to be brutally honest and admit that on the plane I was feeling somewhere in the range between a little nervous and scared out of my wits about running the upcoming glasses clinics. With Joel’s help back home, we had found a fantastic app known as Peek vision which we planned to use as preliminary visual assessments. It would be a trial of its usefulness as a tool, and an improvement from our last methodology. The focus at the moment is on refining the whole glasses process, to make it as accurate, effective and sustainable as possible. I knew how to use the app but was still sketchy on how to interpret the results and match it with a suitable pair of frames. My idea was to find a balance between a basic history and a Peek vision eye test, trying on a few pairs for best possible fit, then recording the relevant data.

Birds of prey seen circling in the sky

We stopped off at a small clinic called Saiho on the way through to meet some of the staff working there:

A football field was right outside the clinic. There was a team of young boys waiting to get out on the field and play a game of soccer, how they do that in the heat I don't know - hats off to them!

SO, our very first clinic of the trip was held at Mamba, a 2 hour drive out of Popondetta and just a few minutes away from Kokoda village (I snoozed most of the way up). We ran vaccinations sessions (Hepatitis B mainly), general medical consultations and our first eye clinic. The clinic is a modest building equipped with some basic equipment and 2 small partitioned rooms, one labelled “injection room”. On the wall there were a few posters, and I noted the sign saying something along the lines of “Antibiotics are miracle drugs. We must use them responsibly if we want to keep them that way”. There was also a sign about domestic violence.

I was excited to begin. It was already the second half of our second day and I was starting to feel just like a tourist – it felt like about time to really get in and start doing some work.

Overall the clinic seemed to run pretty smoothly. HepB vaccines were given, a few medical consultations and a bustling eye clinic. 

The most severe case was a man which a huge, swollen belly, a condition known as ascites. (bells were ringing in my head as I remembered asking the 2^nd years in class, “Soz… what’s ascites?”) When I came into the room, with mum and the other health workers standing around the bed, the man’s belly protruded into the air from where he was lying down, distended and blown up like a balloon full of fluid. He was clearly uncomfortable and mum pointed out his difficulty breathing. The root cause wasn’t known (mum hypothesised portal hypertension, cirrhosis and possible liver cancer). She demonstrated and explained to the health workers how to drain the fluid out, emphasising aseptic technique to minimise contamination. “In Australia we’d do diagnostics and imaging,” mum mentioned quietly, concern written all over her face. Suddenly this simple, matter-of-fact statement meant so much more, realising that the quality of health care comes down to which country you happened to be born into. Seeing this man’s emaciated body, swollen legs and belly swollen like a watermelon, I thought about how this would never happen in Australia – to progress to such a terrible stage.

About 5.5-6L of fluid was drained out today, and the size of his belly was notable smaller. With less fluid surrounding them, the spleen and liver could be felt – indicating hepatosplenomegaly (enlarged liver and spleen), a sign of disease. Although a relatively large amount of fluid remained, enough was drained for the man to be able to feel much more comfortable. Mel said that as the fluid left his body, she could see the look of relief on his face. In mum’s words, he’d be able to sleep properly for the first time in months. The fluid would be back in about 6 weeks, and then Dorothy and the other health worker would then be able to repeat the procedure. This was not an uncommon case.

Back to our eye clinic – being here and seeing the potential impact and the need for eyecare in Popondetta and the Oro province has been a huge encouragement and a spur forward in this project. It’s absolutely surreal to consider all the efforts and collaboration between students, faculties, high schools, doctors and friends to make the collection and measurements work. Being able to gain a better understanding of the eyecare situation here has been invaluable in identifying what the priority areas are and focusing on how to address the needs of the communities.

9 months of medschool has made a huge impact for me personally. Last time I was in PNG, and even Timor earlier this year, I had zero to no medical understanding. Many of the things that were happening were lost to me, and it was difficult to really understand what was going on. How could I possibly begin to understand the disparity between health services here and in Australia when I don’t even understand the standard of health care in Australia?

It’s taken a day or so to get into the swing of things, trying to get the hang of my documenting role. I remember before I started this process earlier this year I made a goal, or if you’d like, a promise to myself to be as honest as possible. It’s challenging, and I don’t think I’m quite there yet – to be open, and to write openly. I guess what I need to remember is that I’m sharing a story – our story, everyone’s story – but it is ultimately a story seen through my own eyes.

Carrie

Our PNG adventure begins! After a hectic final night of turning the house inside out for miscellaneous supplies (medical equipment, clothing/personal gear, glasses) and stuffing them into bags like Christmas turkey, we’ve arrived at Port Moresby – the first stop in our journey. It felt incredibly surreal to depart from overcast Sydney and find ourselves a few hours later blinded by a vast curtain of blue – electric hues blended at the horizon. Looking out from the tiny airplane window, I couldn’t find the point where the ocean met the skies.

                The plan was to stay in Port Moresby for the night and travel onwards to Popondetta the next morning. Apart from mum and Sue, it was our first time staying in the capital of PNG, and apart from the stories of crime and instability, we didn’t really know what to expect. Port Moresby is a city of high fences and razor wire. Security is an issue here, and we travelled from door to door between guarded complexes.

From the window of the car, this is what we saw – dry, sun-baked dirt by the side of the road; people walking around, going about their daily lives at the marketplace. Vendors selling trinkets, snacks and food produce. In the flash of a moment, I saw a glimpse of two men fighting. A crowded, open air bus, with the faces of passengers visible between wooden slates. Signs displaying the bright red and yellow logo of MAGGI (yes, as in Maggi noodles) and the telecommunication company Digicel.

We drove past the squatter settlements in the heart of the city as well. These were areas of high density living, nested into little plots of land adjacent to the main road. In the seconds as we drove past, I caught only glimpses of corrugated iron sheets, lopsided houses, lines where laundry was hanging out to dry, smoke plumes and short orange flames from burning garbage. Call it what you will, these are the slums of Port Moresby, and it is confronting to see that people live in these appalling conditions. We all know it – millions of people around the wall living like this, or even worse. But it’s different when all of a sudden, it’s there in front of you, the undeniable truth.

Later that night we were joined by the Provincial Governor for Oro Province, Gary Juffa. Although the conversation was mainly between Gary and mum, it was an incredibly fascinating discussion to listen to. I came away with a very strong impression of a few key features needed for real change for the people on a systems-based level. Sustainability,  allocation of resources based on needs and not political interests, emphasis on partnership right from the start, understanding cultural attitudes. For example, in PNG tribal custom and laws are central to what happens in the community – whether it is the diet, the behaviours of the people, whether the community is patriarchal or matriarchal.

Here’s another thing that sounds obvious but, sadly, is too rarely followed through – you have to care. The outcome of any program can be extremely dependent on how much you care about the people being serviced, and the people providing the services. Caring must come from all levels – if there is poor management, an attitude of complacency trickles all the way down and spreads its crippling roots wherever it goes. Here’s an example Gary brought up: how can you go to work and be productive when you live in a ghetto, and your children go to school in a ghetto? There is a difference between going to work and actually doing your work. Care for the carers by providing better housing, motivation goes up, and they feel loyal and happy to work for an organisation that cares about them.

Here’s something you don’t hear a politician saying every day, and the world would probably be a much better place if more did. Once you strip things down to basics, it’s the absolute truth. Here’s an example from Gary: Oro Province is a challenging terrain, and every year the people are faced with deadly mudslides, floods, strong winds and king tides. Putting together a disaster policy as a priority to cope with these incidents has saved 150 lives in the Oro Province. When you put the focus on caring for people, and build strong management and sustainable policy, things really do work.

Here’s another thing put into perspective: it is important to understand what is ‘normal’ here in PNG. Take Gary’s example: where he grew up, there was a nearby river where children would go to play. Sometimes the current would be very strong, and around 5 children would drown every year. What could be considered an outrageous tragedy (which it still is) in other parts of the world could be accepted as normal here, and it is part of a culture which builds up a strong survival instinct even from a young age. It is ingrained in the mindset of a resilient people.

All that there was left to do for the rest of the evening was to rest and refuel for the big journey ahead. Sorted out the last of some presentations, prepared as many glasses as we could (wiping off the refractive error written on the lens and writing the details on a plastic bag).  Tomorrow, off to Popondetta!

Carrie

A belated update from our second day in Timor Leste...

***

It’s 7am and I have an appointment with Dr Dan. Better not be late.

Winding our way through Dili’s streets and alleys as he drives to the clinic, I got to hear a snapshot of his busy life. Stressful, but rewarding. Hearing that things don’t always go according to plan, but that makes it even more important to have a continual process of self-evaluation and even second-guessing: what could I have done better? Where did I go wrong? What can be done to prevent this? The “What ifs” are a crucial part of careful assessment.

I was lucky enough to be able to sit through a session where Dr Dan was training the lay midwife named Lydia. As mentioned in the last post, Bairo Pite Clinic (BPC) runs a program where midwives who are elected from their villages receive about one month’s training in the maternity wards of BPC. Well-experienced and equipped with knowledge, they then return to their village and provide life-saving maternal care. Amazing!

Just before we left Sydney, the incredible group of women from Days for Girls donated another bag full of women’s personal hygiene kits to distribute in Timor. It was really great to witness Sue passing over the kits to the team members at BPC, hopefully for distribution in the rural communities serviced by the mobile remote clinics.

Trips such as these bring to one’s attention gross inequalities in health care and access to services. What other words besides gross or obscene describe the disparity which leaves women dying of simple birth complications in remote and developing areas, whilst others have access to the best chance of safe and sanitary delivery simply for being born into the “right” country?

It pains me to think that some of these women are my age or even younger.

***

It wasn’t all gloom, but a mixture of quiet confronting moments that shake your world view, and exciting and inspirational moments – seeing compassion and resilience under difficult circumstances, and catching glimpses into the world real, adult medicine.

My favourite part was being able to go on the ward round, and having the opportunity to learn from the senior doctors and medical students on elective. I loved the environment of efficiency and collaboration: Dr Dan translating in Tetum on behalf of the patient; the students jotting down review notes and analysing X-ray images; all the doctors together discussing their interpretation of the problem, and the most appropriate management plan to undertake.

I was the noob again. Tagging along like an ignorant but excited puppy, asking all the basic questions…(bringing back PNG memories of asking questions like “what’s hypertension?”). I was just really grateful that the students Sally, Louisa, Scott, James and Tom were so patient in answering and explaining along the way. In other words, translating what was medically going on into “plain English”. It was a fascinating process, and it brings into perspective the fact that I really don’t know anything. It stimulates that urgency to learn and catch up, fill that void of medical knowledge. It’s true when people say that the more you understand, the more you can do to help – and this is especially true for medics.

***

We left the hospital at midday and headed back to where we were staying. Sue and mum spent the afternoon in meetings while I tried (with variable success) to catch up on my uni assignment.

Our evening flight path was Dili to Darwin, then Darwin to Sydney in the middle of the night. The first flight was delayed about 45 minutes, and after waiting for a few hours in Darwin, our second flight was delayed too. We got on the plane around 1am, flew through the sunrise and landed in Sydney around 7:30am, just in time for 9am Monday lecture!

General feedback from mum, Sue and I was that it was a very rewarding and re-affirming trip. We were very moved by the energy and passion of the Bairo Pite team, who came from all walks of life and yet were bonded together by the common desire to help. What they have achieved and are continually working towards is truly incredible. Mum and Sue also found the people that they arranged to meet with to discuss action plans where very receptive, which was very encouraging.

Personally, the trip was a re-affirmation of the utter disparity of health care services available for the needy. It’s really just in your face, and you can’t walk away without having that imprinted into you. Where else in the world do you wander through a “middle-class suburb” where the houses are made of corrugated iron, the windows absent of glass, and the drains simply a trench dug into the side of the dirt road? Being young, naïve and idealistic, it’s hard to digest the idea that poverty is just so freaking widespread.

The question is, then, what are we going to do about it?

Carrie

Arrived in Darwin after midnight on Friday night, woke up early the next day while it was still dark. It was worth it – nothing beats watching the sun rise from a vantage point up in the clouds. 45 minutes later, we were descending into the land called Timor Leste, sometimes known as “East Timor.” Through the window we could see sheets of mist blanketing the tree-covered hills, and a sleepy haze over the lush green land…

The first thing you notice when you step off the plane onto the tarmac is the heat – the stickiness that preludes the sweat that begins to fall off every body surface you never knew existed. The next thing you notice is the smell: the thickness and humidity, the chemical smog, all tempered by a faint, lingering smell of body odour… It was a sensory reminiscence of PNG. So too were the corrugated iron roofs; the stray dogs pottering around the streets; the stalls where bottles of cold water and knick-knacks were peddled; the piles of rubble, signs of shabby half-development here and there…

All these sights and sounds and smells were to me, the thrill of a new place, and reminders of the reality of the people who live in those conditions there day by day.

Some quick stats about Timor Leste:

Bairo Pite Clinic is a community health care centre located in the heart of Dili, the capital of Timor Leste. Run by a small group of passionate volunteers on donations alone , it provides free, quality health care around the clock, 24 hours a day, 7 days a week. On top of treating patients with a wide variety of conditions, they also provide opportunities for volunteering, training and employment for local Timorese; and volunteer positions for doctors and medical students.

It’s not an easy environment to work in. Humid, limited resources, and language or cultural barriers are amongst the challenges faced on a regular basis. But most importantly, they are team who exhibit resilience and are expert at finding innovative solutions to get on the job.

So, we took a tour of the hospital Bairo Pite Clinic for a few hours in the morning: outpatients, general admissions, malnutrition ward (you know you’re in a developing country when malnutrition is even such a problem…), maternity ward, tuberculosis (TB) wards, and HIV centres. It’s the little things that brighten up the compound: the cheerful tropical fish and rainbows are painted onto the sky-blue walls of the malnutrition clinic, and the lilac-coloured shipping containers converted into the HIV/TB Dots clinic centres. At the front of these lilac buildings is a humble garden that was planted together by the initiative of patients and their doctors.

TB is a terrible burden on the Timorese people, even more so than in PNG. The tragic effect it has was made strikingly apparent on one of the patients. Due to TB, his body was wasted away so he was little more than skin and bones. His eyes protruded from a sunken face, and his demeanour emanated suffering and loneliness. 

In the afternoon we had a series of presentations from the hospital team to the supporters. What I found to be most interesting were the talks from local staff, especially of the lay midwives in training. These women had been elected from their own home villages to come to Bairo Pite and undergo a month of midwife training, during which time they may experience around 300 deliveries.

As Sue said, it is inspiring to see when people are motivated to help their own people. Let’s face it – nothing will get done unless health care is modelled around partnership with local communities.