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.
.jpg)
.jpg)
