Welcome to Papua New Guinea

In the beginning…

A week ago, I got up before the sun to begin the long awaited journey to Papua New Guinea.

Six months ago, I had been studying quietly at home when I got a call from the sub-dean at my clinical school. She sounded quite consolatory when she spoke. I’d had the interview for the Hospital/RSL scholarship only two days prior and thought this must mean I’d been unsuccessful. I was thus taken aback when she said I had been the successful recipient. That is, she followed, if I was still interested. Still interested?! Of course! Of course I wanted to visit Australia’s nearest neighbour, a nation with over 870 Indigenous languages, beautiful terrain and myriad tropical health issues. Overwhelmed by excitement and disbelief, I had to sit down for a moment.

That night, I ran into a close friend who has spent extended periods of time in PNG. “You’ll really enjoy it,” he said, “it’s different.” Since then, I’ve heard similar comments a thousand times over. The warnings – “it’s dangerous, make sure you stay safe!” – and the worries – “don’t go catching any tropical diseases!” – as well as the enthusiasm – “you’ll learn so much!” None of which truly prepared us for the reality of this experience.

The journey

A week ago, I arrived at the airport with stacks of medical supplies in tow, ready to check in. I drove the uncontrollable airport trolley towards the check-in counter and spoke with authority on my previous conversation with airline staff about being able to take charitable goods for free. The staff were unrelenting at 6.15am. Neither was I. When I went to Ghana, I continued, there were no issues about the 15 or so extra kilograms of luggage I took. These are goods for the use of the hospital. For people who don’t have access to the wonders of Medicare and the MBS we’re lucky enough to have in Australia. I’m a student. I bit back the desire to use my debating voice, knowing it would be all too forceful. In the end, they agreed. Because they were being compassionate. Thanking them profusely, I took myself off to a café in an attempt to shake off the fatigue that comes with several days of four to five hours sleep preparing for a month away.

Two hours later, my travel buddy arrived at our gate, ready to take off. Yes, I had been ridiculously early. He’d had no trouble checking in his half of the goods – he had the letters from the Dean. We were about to leave. This was really happening.

Three hours of flying and we were in Cairns. I had only been checked through to Cairns on a domestic ticket. My travel buddy had left his passport on the plane. With it retrieved, we showed our tickets to the flight hostess in the hope of navigating a different airport that seemed to be lacking in signage. She looked at the “D” on my ticket and shook her head. “Oh, that’s a no-no!” Apparently I should have been on an international ticket and checked right through to Port Moresby, just like my luggage. My travel buddy, on the other hand, had been checked through to Port Moresby but his luggage had only been checked to Cairns. We faced some very suspicious questioning from the customs and immigration staff, who said they’d never seen anything like this happen before. Things were getting interesting. And we hadn’t even left the country yet.

Two hours later - and finally allowed to check in for our second flight. We faced yet another opportunity to beg for our luggage to be checked for free. Success at hand, we made it through security and immigration with a chuckle from the staff we’d met earlier. If things could get so difficult in Australia, what were we in for in PNG?

A short two hour flight and we were about to find out.

Arrival

We walked down the stairs off the plane. The first thing we noticed? The wave of humidity that washed up to greet us. My flip-flops felt like they’d been for a swim. People weren’t kidding when they said it was hot here. The terrain was beautiful. Sparsely dotted trees. Rolling mountains in the distance. Afternoon light shining through the clouds. Very few buildings visible. Entering the airport, the first thing I noticed was the handrail on the staircase from the tarmac. Rounded handrail on top, jagged sawtooth on the bottom. You wouldn’t want to need it. “Welcome to the country,” I thought to myself, mental sarcasm in tow.

On the other side of crowded arrivals, we searched for our ride home. Going off a tiny black and white photo in our handbooks, my travel buddy did a quick tour outside and had to beg to come back in to find me and our luggage. Eventually, after much umming and ahhing, we made a decision that the woman in the purple shirt must be the same one as in the picture. We were finally in a little bit of luck. Not wanting to get our hopes up about arriving safely until we actually set foot in our dorms, we recounted the tale of our day.

That evening, we settled in to our 60s dorms, using the 60s bathrooms that appeared not to have been cleaned or maintained in the intervening 50 years. “Guess I better get used to it” was my first thought. The second, “what on earth will the hospital be like?” The third, “what on earth am I doing here?”

The next morning, it was the last thought that battered loudly around the insides of my brain. We were taken down to the Emergency department by one of the consultant doctors. My very first thought on seeing the hospital was if the Ministry of Love from 1984 had a real-world equivalent, this would be it. It is the most soulless building I’ve ever seen. Our guide began, “the hospital was built in the 90s by the Japanese.” And as he continued telling us about the hospital, all I could was wonder what I possibly thought I could do here.

We entered the main corridor, overwhelmed by the smell of dust and sweat, of the open sewerage drain just outside the door and of sickness. The handrails had fallen off, dragging along the ground. The iron bars on the doors had been broken in, spikey edges endangering careless hands. In many cases, the glass had also broken, leaving gaping holes. The suggestion box had disappeared. Tiles were missing. Long queues stood waiting outside of the pharmacy.

Our guide paused, “this is where the new emergency department will be. The first contractor ran away with the money, so it’s long overdue. We’re temporarily located in the Children’s Outpatient Clinic.” A whole new level of overwhelmed awaited us.

Back outside in the blistering heat, we saw a long queue of people waiting to be admitted. Security guards let us through the rusted, tall iron gate. Emergency looked a shambles. There were only a handful of beds available, everyone else on the floor or on benches, awaiting treatment. There was a man lying supine on his bed, star-shape, with his relative manually ventilating him. Wide-eyed, overwhelmed and light-headed from the heat, we looked at each other. What on earth were we going to be able to do here? And, we don’t really know anything. We went on the morning rounds. The ventilated patient was a snakebite victim, something exceedingly common here. He hadn’t received antivenom in time and so it would take a week for his synapses to grow back. In the mean time, there weren’t enough beds in ICU for him. So his family would just have to take turns. There was a woman with suspected cerebral malaria having a fit. There were half a dozen cases of hypo- or hyper-glycaemia – complications of a growing diabetes epidemic. There were malnourished individuals with infections; a woman with metastatic breast cancer; TB patients; severe asthma cases; a young boy with appendicitis. Yet again, I asked myself, how on earth will I be useful here?

Our guide took us around the rest of the hospital. I was glad to see the rest of the hospital seemed orderly. Things might be different, but at least they seemed logical. Nurses taking temperatures and administering treatments. Doctors doing procedures and asking histories. Patients who smiled as we walked past.

The next day we started our Paediatric rotation. Rounds started at 7.45am. We ran around the hospital seeing the many children. Upstairs to the Cardiac and ICU ward. Downstairs. Across halls. Past the gawking locals who were puzzled by these pale individuals who definitely didn't fit in. There are probably in excess of 100 paediatric beds here, four times as many as we have at home in a similarly sized hospital. We quickly learnt that the pathologies were reduced to a short list – malaria, TB, typhoid, neonatal sepsis, congenital heart defects, failure to thrive, pneumonia and snakebites. We also learnt that 1^st-line drug treatments we would use at home were often in short supply, meaning the doctors had to innovate treatments. Our patients were much younger than we expected – from a few days to about 11 years old. The majority was still in diapers, and of those, the majority was under a year old. Where, at home, a paediatric unit often has separate rooms for each child and couches available for parents, here, there were single beds accommodating parents and child in a long ward of 30 beds.

As we got used to our new environment, one thing became exceptionally clear. Despite the disrepair of hospital, you could never doubt the dedication of the doctors here. Their training is rigorous and often involves stints in Australia and elsewhere abroad. Their compassion for their patients is endless. They work tirelessly to ensure everyone gets the best treatment possible given what is available. And they keep people alive.

With every patient we saw, I was more and more impressed with their skill. The doctors allayed the fears of the parents. They examined the children without causing unnecessary distress. They cannulated the most difficult veins in very sick little children with cannulas much larger than we’d use at home. They explained to us the pathologies, saddened by the few cases that were outside the reach of the PNG health system. They showed us that even though you mightn’t be able to do everything you know possible, you could do enough.

There have been a few other life lessons this week. Travelling in a country where we’ve been told not to go anywhere alone, life has become a “we” rather than a “me”. Despite the dangers of which we were well-warned, people here are generally incredibly welcoming and accepting. That especially goes for the families of the patients in the paediatric ward, who greet us with warm smiles whenever we seem them. There is no graded assessment here. Rather than worrying about ticking boxes for my clinical school, I have to make sure I’m measuring heart and respiratory rates correctly and taking a detailed history because if I don’t, that could bode badly for the little person I’m examining. Here, I’m living in the present. I’m not worrying about tomorrow or next week – I’m worrying about the sick baby in front of me and what differential diagnoses I would report to the doctors. And what treatments I would suggest when they quizzed me. The reward? Seeing the kids get better day by day. Seeing them go home, smiling and jumping around the way little kids do.

Today, life at home seems a world away. The things I normally worry about seem insignificant. I’ve stopped noticing the appearance of the hospital, instead focusing on what we can do to help out the doctors. I wake up in the morning and think about how the patients must be going. The first patient I’ve ever admitted (with help, of course) turns two weeks old today. If he hadn’t come into hospital, he mightn’t be here anymore. What could be more special than that?