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.
Karen, immunisation nurse, administering vaccines at the front of the clinic
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.
