The White Plague

The white plague

“I forgot to put a place to tick ‘dead’ on this form” I said to my darling the other day. One of the nice things about being here is sharing an office with my husband. It’s nice for me, anyway. “Baby, that’s not the sort of thing you say” he replied.  I’m a nurse and for me death is a clinical reality that has been a part of my working experience for over 10 years. I’m under no illusions about it and deal with it as such.  But he had a point, it’s hardly polite conversation. For him, the realisation that he’s building a hospital in the middle of nowhere, and that children die in hospitals, is confronting. A few days ago a little one died of TB malnutrition here. The family had taken her to the witch doctor when she got sick, and relied on his skills for many months before, as a last resort, bringing her to hospital. It was too late. The mother wailed loudly, supported by another woman, as a nurse carried the small corpse of her child, wrapped in a sheet, to the canoe. Matt and I both witnessed the anguished procession; such things are not hidden away.

I was working on an admission to discharge form when I made my comment to Matt. The new form is a round-about way of fighting tuberculosis, the disease of poverty that is so affecting this place including the small girl who died far too soon. Much of what I am doing at the moment is about tuberculosis one way or another. But it’s a strategic battle and this morning it saw me doing data entry on a huge pile of hospital records. The new admission to discharge form is aimed at ensuring that staff collect all the information we need in order to be able to retrieve their records at a later date and ensure that we have the best possible chance of following patients up in the places they spend most of their time. It’s also about clearly recording final diagnostic and referral information for statistical and research purposes, and prompting staff to consider broader nursing roles like patient education. It sounds interesting, but data entry is about as interesting as watching grass grow. The hospital records themselves, however, are revealing. By my estimation fully one third of the records relate to TB and most of these patients have either a personal or family history of TB. A few have even been in treatment before. I’ll tell you the exact numbers when I’ve got up to date with data entry. I’m starting from the first of January this year, but there are already plenty of new TB cases to join the malaria and skin infections.

Tuberculosis is a bacterial infection that is spread by coughing. TB often infects the lungs and this is the type that is contagious. It can also affect a range of other sites in the body, commonly the spine, glands or abdomen. It is one of the oldest diseases known to humanity and has coexisted with us since our earliest days. It’s a fascinating disease that has unusual mechanisms that make it incredibly difficult to eliminate. It can remain dormant for many many years in hosts who may show no symptoms then suddenly become active again. It can slow down and speed up its growth rate and has a thick, almost impenetrable fatty cell wall giving it great advantages in avoiding elimination by the host’s immune system. It has been called the ‘perfect disease’ because it kills neither too quickly nor too slowly and so gives itself the maximum chance of being transmitted. Its slow growth rate makes it difficult to differentiate one strain from another. Where facilities exist to do so, ie not Kapuna, it takes long weeks in a laboratory to culture and to check sensitivity to antibiotics, by which stage most people have already begun treatment, with either the right medications or the wrong ones potentially adding to the drug resistance problem. Until the discovery of antibiotics in the 20th century it was almost always fatal. ‘Consumptives’ died of massive lung infections, coughing up blood. While the poor have always been disproportionally affected, even the very rich were not immune. Novelists wrote tragedies about young lovers separated by the death of one, cut down in his prime, dying dramatically of the white plague. Such novels echoed their readers’ experiences. Then along came streptomycin and that changed everything.

These days tuberculosis is treatable or at least most of it is. The science is not new; it evolving, certainly, but not new. We have been waging the war on TB for many years now and in the developed world it is rarely seen. Effective TB treatment relies on courses of four or more antibiotics  given over a minimum 9 month period. Unfortunately, there have been no new antibiotics for TB developed in the last 40 years. In the meantime, HIV has emerged, particularly in sub-saharan Africa. HIV/TB co infection makes up as much as 50% of all TB in some areas. And in other areas less affected by HIV, like the Gulf Province, geopolitical factors have meant an explosion in the rates of TB. These days there are acronyms for types of TB, explaining their drug resistance patterns. There is regular TB which, thankfully, is still 90% of the TB we come across here in the Gulf, but increasingly we are seeing MDR-TB,  which is resistant to one or two of the usual antibiotics used for treatment. Elsewhere in the world, in Swaziland for example, they’re now seeing XDR- TB which is extremely drug resistant. The first cases of TDR-TB, totally drug resistant TB, are being documented in medical literature.  The spectre of the post-antibiotic age casts a deep dark shadow over not only places with high rates of TB, like Gulf Province, but the rest of the world as well. TB is the perfect disease and if it’s not eliminated while we still have antibiotics to treat it, it’s only a matter of time until it becomes endemic worldwide, as it once was. All of which brings me back to the data entry I was doing this morning.

In order to be able to kill the enemy, we need to get it in our cross hairs and keep it there long enough until we can fill it full of our metaphorical bullets. We need to be able to find the tuberculosis and keep track of it. Some tuberculosis patients are in then hospitals receiving their cocktail of drugs, but other sufferers are still in their villages hacking away in dark corners in the night as they lie next to their children and grandchildren. They’re at their fishing camps, their sago places, they’re paddling down the river to visit their relatives, all the time getting skinnier and skinnier. We need to get these people in to a health centre. But the health centres are few and far between, a long way to paddle to get symptoms checked that have become normal to the patient.

We are pretty good at diagnosing and treating TB here in the Gulf, so we can stop sick people being sick most of the time. But on the other hand, everyone knows TB symptoms can also be caused by sorcery. Getting a local sorcerer to put a counter spell on whoever cursed the symptomatic person is at least as intuitive as seeking health care for many village people. It’s also far more appealing than taking handfuls of medicine with side effects each day for 9 months, three months of which must be taken at a hospital far from their homes, their relatives who support them and the gardens that sustain them, and under the strict observation of staff.  That any seek treatment at all is a triumph. Eventually the weight loss and night sweats become too much, the symptoms undeniable and they come seeking help.

One they have been diagnosed patients move to the TB ward. Those with active pulmonary TB have single cubical just big enough for a raised platform for a sleeping matt and floor space for a few belongings. It’s tough being a TB patient. The mask they have to wear outside their cubical singles them out as TB sufferer and there is an understandable level of fear associated with the disease. Relatives accompany patients on their journey to hospital bringing canoe loads of coconuts and sago to feed them through the treatment process, some willing to work as labourers to earn some cash during the long wait. They sleep elsewhere. For the patients it’s hard to keep taking medicine when it makes your knees hurt, when it makes you nauseous. One of the drugs for MDR-TB can cause permanent hearing loss. Even a standard TB treatment regime is a lot for a body to take, and this far from anywhere there is no way to monitor kidney and liver function to check that the organs responsible for clearing the drug are able to cope with the assault. It’s unsurprising that many think the cure is as bad as the disease.

After the 3 months of the intensive phase we send them back to their places with a bunch of pills and hope that our ‘education’ has worked and that they take them all as instructed. Their yellow card gets filed. Theoretically, when we go on patrol to the patient’s village we follow up and check that they’re still taking their medicines, encourage them, answer their questions, check out their relatives for the disease and try to make sure that it hasn’t all been in vain.  But the cards get forgotten and we don’t know what their plan is, or the cards are left behind in the village when we leave.  Village TB volunteers are trained to help with case finding and referral, but after training they don’t hear us or see us. They’re not always respected in their villages and their basic level of education means some struggle to interpret what their scales are telling them about a patient’s weight compared to earlier in the year. Sometimes villages aren’t aware the patrol is coming and when we get there patients or volunteers are out in their gardens or they’ve gone fishing.  Sometimes the patients simply aren’t where we think they are, or they’re there but they’re use their husband’s name in that village rather than their fathers. So many things can stand in the way of our follow up and, without follow up, our chances of our patients completing their course and getting free of TB is that much slimmer.

The fight against TB, against an enemy as old as humanity, is a long one, but it’s one I’m passionate about. I believe the first steps involve getting the basics right. I believe that it’s about having accurate information and ensuring that it is at the right place at the right time. It’s about sending letters ahead with lists of follow up patients. It’s asking the right questions of our patients.  It’s about using supporting village volunteers to be our eyes ears and mouth when we’re not there, which is 99% of the time. It’s about supporting them in case finding and making sure they have the fuel to get suspects to hospital. This is a fight I am so ready to take part in. I’m in the right place at the right time with the right skills. I’ve read and thought, and now it’s time for me to do my little bit. It’s time to close the information loops and take all the good work that has been happening here for so very long to the next level. I just hope I have enough time!

The Culinary Delights

The culinary delights

I had a friend that we used to call ‘gourmet’ because he had very epicurean tastes. La rouse gastronomique was his cook book of choice. After his meals it was always advisable to avoid washing up because every pan in the house would be waiting for the one who drew that short straw. Gulf cooking is, in many respects, the polar opposite of ‘gourmet’.  For Gulf people food is fuel for survival, not a creative expression.

Gulf province has no major industry to speak of. It is isolated and lacks any significant infrastructure. It is hot, humid, costal and its people are subsistence gardeners as they have been since the stone age, ie since last century. The 6th graders I have been teaching, delight in way food grows easily in the Gulf, and mention it frequently in their writing. Indeed, if you’re physically well you’re unlikely to starve here. Most people live out their days in their remote villages tending to their gardens, fishing and beating sago. There is little else to do here. Many older people never travel out of their district so life continues on as it always has, growing what grows, catching what can be caught and eating it.

Every day except Sunday the local market is open. Sellers, always women, from the next door villages or sometimes further afield, gather to sell their produce. They carry them on their heads or in bundles on their backs down the back paths, or paddling them up in the dugout canoes. Commercially produced items are banned from sale at our market- our own store has the monopoly and uses its profits for some of the hospital’s running costs. Careful consideration is given to what items should and should not be sold at the store. Only items that offer overall benefit the community are sold in the store. There is no coca cola at Kapuna.  Never mind, it is entirely possible to live forever only on locally produced food, as many do.

The market place itself is due for a major upgrade, being both significantly too small and in a poor state of repair with uneven muddy floor that gets boggy in the rain especially at the entrance.  Here I come, almost daily, to buy great bunches of sweet bananas in an astounding variety of sizes, shapes and flavours. Here are 5 varieties of leafy greens only 2 of which I personally find edible. There are long gourd pumpkins and short fat ones. Enormous watermelons are a perpetual favourite and not only in my family. For 7 kina I can have the whole enormous melon to pop into my freezer and devour for ‘desert’ later in the day, or for a delicious snack we all love the chopped watermelon pieces for 50 toea each. There are snake beans that look like tiny snakes, or enormous big beans sold individually for 50 toea each that make a fantastic side dish when fried with a bit of ‘all purpose seasoning’ imported by yours truly from Port Moreseby. There are kau kaus (kumera) sized from babies through to giants, and tapioca that makes a tolerable substitute for potatoes which are impossible to grow in the perpetually waterlogged earth. On the ground in large bags woven quickly from coconut leaves are enormous shellfish gathered from I’m not quite sure where. Down the back are piles of live crabs, pincers tucked under their shells and individually tied with coconut leaves. Some days there are fish at the market, lying on beds of banana leaves, occasionally they are still flapping and gasping for breath.  Some sellers are vigilant at waving a small branch over the fish to shoo away the flies, others less so.  If you purchase one, the seller will thread a coconut frond through its gill and out its mouth so you can carry it home without having to dirty your shopping bilum.

It’s the end of the dry season and that means guavas. I don’t have to buy any as we have our own tree and ours are enormous and juicy, with a flavour I have not found rivalled in any other guava so far. Our friends also have a tree and their supply is similarly plentiful. I made guava jam once after a another volunteer inspired me. If you can avoid comparing it to delicious blackberry jam while eating it is a nice addition to the diet. There are also still paw paw around, the soft delicately flavoured fruit that boasts medicinal properties. Regrettably, it quickly disintegrates if your children are picky eaters and cannot be persuaded that this is a fruit worth digesting, or so I hear. A tiny pineapple can be yours for just 1 kina, but for K3.50 you can take home a large ripe juicy one with unbeatable flavour.

Then there are the coconuts.  Coconut palms are called the plant of a thousand uses. So far I have become aware of its usefulness for making brooms, mats, thatching, rope and kindling, but the Gulf diet would be very impoverished without their contribution. Sometimes you can buy a bottle of coconut oil constituting many hours of labour for 8 kina or so. Or there are green coconuts for drinking on the spot or brown ones to take home and scrape for coconut cream to add to the boiled starchy veges and greens to make a meal.  I don’t have to buy coconuts, however, as Kapuna houses come with their own coconut trees, so essential are they to life here. A coconut scraper is similar to a medieval torture device in that it inevitably scrapes the fingers of the uninitiated as you wield it against the coconut. Nevertheless it is as essential piece of kitchen equipment and the sound of coconuts being scraped bookend the daylight. Vegetables, fish and greens are all boiled in coconut milk as part of a traditional Gulf diet and the coconut adds essential fatty acids and calories to the diet

The central tables in the market are reserved for great slabs of sago, Queen of Gulf food. The sago is carved into pieces sold on small trays of sago bark topped with a banana leaf – no plastic packaging here in the market! The prices are carved into the glutinous starch with a twig. I usually go for the smallest piece, having not yet become proficient in the variety of sago cooking techniques that my neighbours consider standard. The tradition tells that sago, made from the bark of the plentiful sago palm, was first discovered by local people who observed wild pigs eating from the trunks of fallen palms. The people decided that what was good enough for their porcine friends was likely good enough for them, and so it has proved to be.

 If I were translating the New Testament into the local dialect I would render Jesus words at the Last Supper “I am the Sago of Life”, such is the importance of the food to sustaining life in this region.  As a Kiwi of Scottish decent, no matter what food I may have in the house, I feel the lack of bread here most acutely.  Gulf people feel about the same about sago. It is consumed as a porridge for breakfast, a stick cooked in bamboo or coconut leaves for lunch and potentially again at dinner time. It is mixed with fish, banana or coconut, can be cooked as a pancake or added to soup. Similar to cornflour in consistency, it forms a surprising jelly-like food when cooked with moist ingredients, but can also be cooked to form dry, powdery cakes. It has a non-descript slightly earthy flavour and it oxidises when left in the air, drying out and changing from a light beige colour to a deep rust brown.

I am coming, slowly, to appreciate the virtues of sago, but for all of these it is very labour intensive to produce.  It takes a whole family labouring in the bush most of a day to produce a quantity of sago. First the palm is felled, usually by the men of the family. Then its outer bark is stripped away and the fibrous inner layers are dug out and shredded. These are then mixed with water and the resulting pulp is beaten with long polls by the women of the family. More water is added throughout the beating process and then everything is filtered through a series of sieves set along  a hollow piece of sago bark until a stiff sediment forms at the bottom.  While not high in calories, it contains a variety of nutrients and is readily available all year round, growing in places that are totally unsuitable for wheat, corn and rice. It may yet prove to be an unexpected contributor to the enormous challenge of feeding the world in the 21st century.

It is entirely possible to achieve a balanced diet by eating only food produced within a 5km radius of this place and there is even a reasonable amount of seasonal variety. Mercy and Isaiah have done remarkably well adapting to a way of eating completely devoid of all convenience foods with the exceptions of God’s perfect snack, the banana. We eat three reasonable meals a day, but rarely in between times. Necessity is the mother of invention and I have made marmalade from kalamansis, a local citrus fruit like a kumquat, a fermented guava drink of my discovery, and steamed bread made on the gas cooker. I can make donuts and scones on the pan, pancakes and toast, I can combine precious foods carried in by friends from other worlds like Port Moresby and Brisbane with local ingredients in ways that would make even some of my culinary friends proud. In the end, though, when it all gets too much, as it sometimes does, there are always two minute noodles and spam. Some days that is a pretty big relief. 

Community:

Community

One of my favourite quotes has long been that “it takes a village to raise a child”. Sitting alone in an empty house in Naenae with a young child I used to wonder how different it would be like to raise a child in a physical village surrounded by others.  Now I am here, at Kapuna, raising my now much older children in the most village-like setting you can imagine and I have some sense of the answer.

Just moments ago the 7 year old popped in for a brief conversation. He told me he’s been swimming in a friend’s pool – a damaged rain water collection tank kept for the purpose – all afternoon with two of his age, making their own fun. One day it will be bows and arrows, another day catching fish, a third soccer, colouring in, climbing trees. Sometimes I don’t even understand what the games are. The 5 year old is at the neighbour’s house playing with their children and the much loved kitten. It’s been almost 8 weeks since we arrived. Isaiah roams free with a variety of children, mainly boys around his own age. The activity they are engaged in seems secondary to the fact that they are together. Isaiah relates easily to a wide range of other. He’s our outdoor boy and Kapuna is, in a way, his version of heaven.  As long as the children stay out of the river, the deep, wide, swiftly flowing expanse known to harbour crocodiles, and away from the base of coconut trees where they risk fatal blows from falling projectiles, the dangers are few. There are easily 30 households in the village, plus men’s and women’s dorms for students and single staff, but everyone is connected. Patients and their guardians or caregivers are the only outsiders but remain in the public areas unless they’re providing casual labour on projects or earning some kina helping in gardens . As two of only four light-skinned children there are many watchful eyes on them both of our pikaninis.  Mercy needs to stay closer to the house, but that is scarcely a hardship for her as our two closest neighbours both have young children and she can usually be found at one house or the other. A gentle engaging child, she is popular not only because she is different and both families are as happy as I am that their children have suitable playmates. 

We employ a babysitter for Mercy in the afternoons as her preschool finishes at midday and I’m occupied until 4pm, but it has turned out this is more to do with keeping track of what she is up to than any actual hands-on childcare.  While Mercy plays happily with local children, the ‘baby sitter’ sweeps endless cobwebs from the ceiling, husks and scrapes coconuts for coconut cream and runs errands to the shop or market for us. This home help is as much about keeping the kina circulating as it is about us having help with the more labour intensive aspects of village life. We have gone from being people of quite limited means, to people of relative wealth here, and employing others is a dignified and appropriate way to help others.

For all of our wealth, though, we are the beneficiaries of astounding generosity.  I read in a PNG history book that PNG people may have been some of the world’s first gardeners.  I have no idea if that is true, but gardening is certainly an integral part of Gulf culture. The climate is ideal for growing. The soil is always warm and damp and it is surreal to feel the heat of the grass on bare feet. A bit of judicious weeding in the garden, or rather hacking with a bush knife, is usually sufficient to ensure that crops grow happily. Most local people subsist on their own gardens with wild bush food or sea food thrown in. Sago, a starch made by beating the pulp of the plentiful sago palm, is labour intensive to produce, but is an all-year staple, even during the wet season when other food sources stop producing. Even employed people with cash income have fruit trees and a banana or pineapple patch and the Community Health Worker students grow their own food by labouring in their gardens 1 hour a day.  We have some fruit trees, a couple of coconut palms and an area of ‘garden’ but as I can’t tell a weed from a plant in this ecosystem, I’m yet to feel an overwhelming need to get gardening, despite the welcome assistance of some students who cleared the area for us  a couple of weeks back. We get much of our food from the market where sellers come from the nearby villages to exchange produce for cash and I’m very happy to pay. Several times a week we will hear a knock on the door and someone will be on our step with a pineapple or pumpkin in hand.  It’s the village way, and a sign of gratitude that we have come to live and work here, and it’s incredibly humbling .

We were having a rough time here a few weeks ago so we asked our near neighbours to come and pray with us one evening. I made sugar donuts and tea for the occasion. At the appointed time two mighty men of God stepped out of the darkness and joining us in the living room. They sat down on the woven mat and immediately began to pray. Later on, we felt to call others to come so one visitor left to carry the message. He returned minutes later with two more friends. We found ourselves surrounded by mature men of great faith, earnestly interceding with us and for us. We will not easily forget how quickly they came at a time of need or the sense of being upheld by others when we were unable to do it ourselves.

I know this place is not a ‘normal’ village. We live in close proximity to others and interconnected as tribal societies have done for millennia, and as those in the surrounding villages still do. But more than that, we are also at a Christian village. The bonds between all here are not only natural, but spiritual bonds of brothers and sisters in Christ. There is one purpose here, to shine the light of Christ in this place with both words and actions, and all share in the purpose. There is a common life of work rhythms and meeting together and a common expectation regarding behaviour- that we all ought to, as much as possible, imitate Christ. It’s far from perfect, but we’re trying.

School Teacher

School Teacher

When I was a little girl I used to torment my younger sister by insisting that we play Schools and insisting that on I would be the teacher.  I was an unusual, solitary child and I didn’t have the same need for a playmate as my sister. To get me to play with her she always indulged me. I would set real maths problems and tasks involving maps and actually expect my student to complete the tasks. Hannah has never excelled in Maths and has little interest in geography so she must have really wanted to play with me to submit to such ‘games’.

Teaching is in my blood. Both Mum and Dad are primary teachers. Dad taught intermediate school until I was about 10, taught adults New Testament Greek and Bible Studies and now does literacy work in the Forensic Mental Health Unit at Kenepuru Hospital. Mum taught primary school and when she returned to work after raising us when I was about 13 she worked in special education, first with students with physical challenges and now with students with visual impairments. It was natural that I should want to be a teacher “when I grew up”. Besides, as a child I knew few adults outside my immediate family and had little idea what other people did for work. It all made complete sense to my young mind.

Experiences with leading youth through church in my teens and early 20s changed that- it wasn’t as easy as I thought it would be. Everyone said I ‘came out of my shell’ as a teenager, and I certainly gained some confidence and learned how to interact with people and develop meaningful relationships. Still, I felt I lacked the natural authority a teacher should have. Teachers need not only to teach, but also to manage a class full of students and this idea held less and less appeal as I grew older. My life was taking a different track.

I completed my BA, retaining my education major, though my heart wasn’t really in it. Then, after a heartbreak and before I’d had time to consider my vocation I decided I needed to leave New Zealand for a while.  I spent time volunteering in a Johannesburg children’s home and came home via Europe and America with even less of an idea of what I wanted to do than when I started out. I quickly found work doing administration for Government department knowing full well that it would never satisfy me. All I really knew was that I wanted to be useful to God.

So I went on, through a lonely, melancholy time of wondering for a year until, fed up, I decided to take a fast and commit to discerning my future with God. Several days into it I found myself discussing the question with my Mother and heard my voice saying that “if I had my time again I think I would do nursing”. For some reason I thought that, at age 25 I was too old to study again, it seems quite ridiculous now. From that point it became clearer and clearing that Nursing was exactly what I should be doing and that it was a good match for my skills, interests and passions.

***

Fast forward 14 years and I am an experienced nurse embarking on a new adventure in Papua New Guinea, this time with a husband and two beautiful children. I became a nurse to fulfil the calling of God in my life, to work out his just and compassionate nature in the world he created. I believed and still believe that he calls me to serve the ‘least of these’ those who lack money, power, privilege, beauty and all the things the world holds in such high regard, through my nursing training.  Returning to PNG with some capacity to make a real contribution had been in my mind since the summer I spent here 12 years ago. I couldn’t wait to get started with the important Nursing work the Lord had prepared for me in this part of the world. Then this happened….

“I’m going to need you to teach Primary School when you get here” Barbara, the School principle and my PNG mother said by text message. Um? Teach School?! I said, but I’m a nurse not a teacher! I protested inwardly. Teaching was not part of my mental picture of this at all. And besides, I’m meant to be working on TB control! My old childhood dream suddenly came back to me, but that was a long time ago and I’d taken a different road. But how could I say no? Of course I could not. “Sure” I told her, “I’m really keen to do nursing, but if you need me, I’ll help out for a few weeks.”

And so, three weeks ago, I stood in front of a real live class of 6th Graders and embarked on my teaching career. I can tell you, it is not like playing schools with your 7 year old sister. I love explaining things and sharing my insights, I’m excited to think I may be able to make a difference in the lives of the young people in my class, and maths and English are subjects that are not difficult for me, especially not at grade 6 level. But I have no training, have had next to no induction and I’m working in a cross cultural context. To say “in over my head” is a considerable understatement. Just yesterday I remembered, for the first time, that teachers need to take a role call and record absences in a book. It had not occurred to me to do that previously.

Our school consists of is 4 class rooms, all much like mine, build out over the swamp beside the village. At high tide the water comes up under the classrooms and mudfish skip along among the reeds. In a king tide the water covers the concrete path as well. Like all the buildings in our village, the classrooms are built for airflow- there is no glass in the windows just a wide wire mesh. In a rain storm the noise on the iron roof is deafening. In my class there are 10 wooden desks with bench seats attached in rows facing the chalkboard.  For resources I have a class set of maths books, an English and a social studies curriculum book, an encyclopaedia, a set of map books, 4 balls and a pump, and 2 shelves of assortment of books that the students may borrow for a week- mainly Enid Blyton novels, and a machete for students to use to cut the grass.  The students bring their own exercise books and pencils, but I scavenge for scrap paper for other tasks. The toilets are composting and are much better than they sound. The students are rostered to bring in dry grass, coconut husks and cold fire ash to use to cover the pek pek and pis pis (use your imagination) and ensure that they function effectively.  The water fountain is a tap connected to a rainwater tank, and the bell is an old piece of iron that is struck with a rod, usually by a proactive student who has sensed the teacher has forgotten this task. In this environment every week day 60 students gather to drink from the cup of learning and it is my job to fill it daily for 10 of them.

Although I am teaching grade 6 my students range in age from 13 to 24. Many have had variable careers in schooling. Some have completed the first 5 grades at Kapuna. Others have attended village schools where teachers may or may not have turned up for school on any given day and this is a second chance at schooling. Educational standards in PNG are low, especially in isolated places like the Gulf. Physical punishment of students within Government classrooms is common and it is not uncommon for government teachers to misuse their position of authority over students in the most inappropriate or even criminal ways. I am absolutely certain that, however poor my offerings may be, they are a vast improvement on that low standard!

After two weeks with my small group of students I have found a sort of muddled rhythm. I have learnt their names and am beginning to learn their characters, strengths and weaknesses. Our days begin with devotions and I have discovered a new delight- teaching students from the Word of God and seeing their faces light up as some new insight is suddenly clear. I have long had a passion to see people of all ages understand the faith they are growing in and in this place there is plenty of opportunity for that, and it integrates seamlessly with all the other aspects of learning that we do in the classroom.

The students and I have formed a pattern together of basic facts drill, spelling lists and tests, maths problems, speaking challenges, vocab games, comprehension exercises, writing exercises and reading.  My mornings are full of explaining tasks again and again in careful detail, waiting patiently as my students write beautiful headings, hoping I’ve explained well enough and finding that I often haven’t. Tasks involving creative thinking or developing one’s own ideas are a tough sell in a PNG class room, or at least certainly in mine, so we’ve been working a lot around local knowledge and culturally important skills and events.  And then there are the verbs. You may remember them from your own school days – ‘doing words’ or ‘action words’, often contrasted with ‘nouns’ or ‘naming words’. Was this the main reason for my year of French lessons in the third form that I have a concept of how to conjugate a verb and can teach it?  I guess I’ll never know, but it wouldn’t surprise me- I have found few other uses for that year of knowledge (with the possible exception of making a stab at translating the French occasionally included in a few classic novels).  Verbs are incredibly challenging for students who grew up speaking another, or several other, languages so I’ve taken to teaching them explicitly. Even so, with my scant knowledge of the grammatical structure of my own language I may need to brush up if I’m to teach for many more weeks. English is a hard language for any learner and I’m not sure how many will ever master the intricacies of the irregular verbs. Fortunately for me and in the afternoon students go to Barbara for art, science sport and, exhausted, I’m relieved for other duties.

I’m not the most dynamic teacher, and I  aspire to be more creative, but I’m there, doing what needs to be done and hoping I’m getting it right some of the time.  Each one of my students has so much potential, so many gifts and abilities waiting to be unearthed. Many of those talents will be discovered outside the classroom I’m sure, but if just one discovers a love of learning some new thing in my class I will be delighted.

Fire Flies – Bekah

Fire flies

Living in the PNG bush, far from your family and friends, far from so many aspects of life that you know, can be challenging.  When the Mulder’s longstanding friends from home asked to visit, the Mulders were enthusiastic.  They wanted to make the most of their time together and show their visitors what the Gulf is like. There isn’t much to see though. The river is omnipresent, the coconut trees and sago palms are ubiquitous. Ahh but the fireflies! They’re quite something! So a group was put together for a boat trip down river and we were invited.

Matt had to travel to Kikori the next day so decided that was more than enough boat transport for one week. I intended to surprise the children.  I got them ready after dinner. We put on our long pants and gumboots despite the temperature still being up around 30- the mosquitos you see. We set off in the dark for the jetty. “Stop shining your torch in my eyes Isaiah!” I complained, though it fell on deaf ears.

 We arrived at the jetty but it was obvious we were not going anywhere. The tide was out – completely out. With a tidal variation of about 3 metres at Kapuna, a full low tide meant our boat was well and truly stuck. We went for a walk along the long jetty instead promising the kids we would go the next day and this time we would make sure the canoe was right out before the tide went down.

The next afternoon Isaiah went to check on the canoe. He found it still sitting in its normal position up stream with the tide rapidly going out around it. Our driver had gone out and the message had not been passed along to take the boat out. Oh dear. Isaiah went to find the new driver. They decided to push the canoe out and gathered a group of hands to make it happen. Isaiah came home, changed into shorts, then climbed down from the jetty into the deep, thick mud and got stuck in along with the men and bigger boys. He came home triumphant at his success. “Pushing the canoe was such hard work Mummy!” he exclaimed, “I’m going to get really big muscles [bicep flex gesture]. “And I saw a mud snake! It was really big! It was just by my feet!”  I have no idea what sort of creature a mud snake is, but as my eldest was in one piece, and no adults were disturbed enough by the incident to feel the need to mention it to me I comforted myself that mud snakes must be serpents of the benign variety.

As dusk fell we prepared ourselves again and this time successfully embarked.  I don’t know how the Kapuna drivers manage their work in the pitch black darkness. In Wellington there is always light pollution, but this far from anywhere there is none at all. The sky stretched out towards infinity above us as we moved slowly away from the jetty and the stars gained incredible depth. We tried to make out constellations as we went along and the trees were silhouettes on the banks of the sedately flowing river. Even at low flow, however, the Wame, a tributary of the mighty Purari river moves thousands of cubic meters of water every minute. We were only moving at half speed, but in the near total darkness it felt dramatic and exhilarating. I wondered if I should pinch myself to check I was really and truly there. It was beautiful, it was surreal.  I tried not to think about what would happen if we capsized for some reason.  How would I reach both children? Isaiah was at one end of the canoe with the big boys and Mercy was at the back nearer the driver with two other little girls. Then we saw our first fireflies and I forgot all of those thoughts.  

The first flies buzzed along near our canoe, we could reach out towards them and play games trying to capture them, like tinker bell, in our hands. Our driver skilfully steered us close to the far bank  and we saw it was alight with hundreds of fireflies clinging to the bushes like tiny holes poked in the black sheet of darkness. It was magical. We travelled along the bank for several minutes before the driver again crossed over to our side of the river. We came across the famed firefly tree. It was like a huge Christmas tree covered in the warm glow of ever so many insects. The children laughed and reached out their hands for the insects. The second driver climbed skilfully from our canoe onto one the low branches and began shaking the tree. It started raining glowing insects all over us. They were on us and around us flying through the air. They crawled over our hands and lit up our tshirts. The children were delighted. Mercy took one in her hands.

We stayed for some time below the tree, looking up, trying to imprint the scene on our memories. I knew that, for our family at least, this was likely to be a once-in-a-lifetime experience. Then it was time to go home. The canoe picked up speed and the warm breeze covered us again. Mercy had a little friend along for the ride though, her little firefly. “He wants to stay with me Mummy!” she exclaimed, “I’ll put him in a jar beside my bed”. “But darling” I explained, “if you keep him in a jar his light will go out”. “Oh” she said, unwilling to give up on the idea of a pet firefly just yet. But as we drew up alongside the jetty she told me “Mummy, my firefly has gone home”.  Yes, I thought, that kind of magic can’t be held onto.

Arriving – Bekah

Arriving

Nothing that is truly worthwhile ever comes easy. This is a very worthwhile project so, sure enough, we’ve had more than our fair share of challenges getting here. I first heard of the Kapuna hospital rebuild after a time of prayer and fasting. My beloved was struggling on many fronts, and I was struggling by extension. I know the Lord is Good and his timing is perfect, and yet I called out to him “how long Lord?”. When I saw the video calling for workers my heart was stirred and I cried- “could this be the next thing for us?” I was afraid to give voice to my hopes, they were too precious and I was frightened of misunderstanding.

What I found was so surprising as to be miraculous. Mister Cautions, aka Mr Worst-Case-Scenario was positive, more than positive, enthusiastic. You could have bowled me over with a feather. And so we began making plans. The signs seemed to be there, my clinic was closing after key people had left meaning my work situation was in a state of flux anyway. A dear friend of Matt’s needed a place to stay for a few months and was eager to rent our house. So we applied to take our children and go and live in the tropical swamp.

They were excited about the possibility of having Matt on board. His wealth of experience in industrial supplies, his technical ability and his ability to solve problems made him just what was needed for this project. But me, well they already had nurses, local nurses with the language, culture and experience. Perhaps I could teach nursing? The training school would see when they met me. Registering me with the PNG Nursing Council would be costly. It is not the PNG way to make hasty decisions and despite having been here before, I was an unknown quantity. Again, I sought the Lord “what on earth does this all mean?!, please help me understand!”  It was agreed that I would be registered, not for ward work, but for wider nursing administration work. Two days later we were handed a stack of $50 notes – exactly the right amount of money to cover our registration costs. My discouragement turned to joyful trust once again.

There were delays to our departure, and then more delays. The project funders needed some changes made to the proposals and the rebuild would not be starting in September after all. In November we found out our visas could take some weeks to process and a couple of weeks after that we were horrified to hear it could take until March before we had visas in hand. By this stage we had already rented our house in anticipation of the move. Matt had resigned, and my own boss was awaiting a formal resignation letter from me also. We were staying with Matt’s parents who were gracious in their hospitality, but had not anticipated having us for a long time. They were themselves retiring and moving house in early January. But there was nothing to be done. We waited, prayed, and waited some more. Finally I got the much anticipated call from the PNG High Commission, our visas were available for pick up. It had taken every one of the 20 working days of the suggested timeframe, but the March ‘worst case scenario’ never eventuated. We could finally rest in the plans that we had made, the plan that had been in my heart for so many years.

We took a long holiday over Christmas to spend with family and friends. We stayed at Raumati, the summer place, my turangawaewae from boxing day until the 12th. We had restful days reading and swimming at the beach. We had the extended family with us and we took the time we needed to settle ourselves. We had Tayla, Matt’s first born, to stay with us and took our leave of her with tears and the heartache of wishing that she did not have to sacrifice for our plan. In the end, the timing was perfect.

We spent three nights in Brisbane. The children experienced their first plane journey and did very well, but not so well as to make us regret the stop over. We took the trip of a lifetime to Morton Island off the coast of Brisbane and saw dolphins, dugongs green turtles and other creatures playing. The conditions were perfect and the sand island was a paradise on earth. Arriving into Port Moresby (POM), though, we got back into the challenges.

“You’re not in Kansas now Dorothy” I thought as I boarded the plane. I saw plenty of Australian men – a homogenous group of balding middle aged oil company executives, engineers with the occasional civil servant in the mix. I saw a few PNGs, but only one or two women and only one other child on the plane. Stepping out onto the tarmac the wall of heat hit me. Even after 3 nights in Brisbane and all the mental preparation I was still not ready for it. We waited at the terminal – the excruciatingly obtrusive tone of our skin  and the presence of the equally pale children made us a source of polite curiosity as we waited for the friend of a friend to pick us up. We waited. And we waited. The children were thirsty. Mercy was crying. I had no water. I decided that we had been forgotten and called the name of a reliable taxi driver to come and pick us up. Then the friend arrived. She had thought our plan was landing ¾ hour later.

POM is a sprawling city reminding me every bit of Tanzania, or the South African townships I had stayed in, but with more rubbish.  It’s a crazy mixture of developed and developing world all mixed together and shaken for good measure. There are expensive hotels and shopping centres, and if we were taking another kind of journey I may have seen more of that. But for the journey we were on it was the back roads, past the ditches, the roadside stalls selling just a few items, the children with bare feet, the hillsides without trees, the smouldering  cooking fires, the graffiti and the gates with ‘security guards’ posted at the entrance to any functional place of business or residence.

Mapang Missionary Home is a unique place with a long history of serving ‘missionaries’ and Christian workers for decades. For us it was a haven, a safe place to land and to rest. We ate together in the dining room with other guests, I played old hymns and new songs on the piano, read a book or two and the hosts helped us arrange ourselves and our luggage for the next leg of the journey, into the bush. We were to fly out on Wednesday. On Tuesday we received word that we had been bumped off our flight.

While Exon-Mobil pumps crude oil out of the Gulf Province, one of the paybacks to the locals is that they fly hospital and associated workers into the Gulf for free on their aircraft. Sometimes space is available and sometimes it isn’t, and sometimes the space that was there the day before has disappeared.  No space for us on Wednesday, or Thursday or Friday. On Saturday AusAid had charted and aircraft to pick up their officials who had been attending the Community Health Worker Graduation Ceremony at Kapuna. Fortunately for us we were able to be the ‘back fill’ on the aircraft heading in.  We had to be at the airport at 6.30am for the 9am flight. Thunderstorms were predicted for our boat ride after we disembarked. We packed our rain coats and our families at home started praying about thunderstorms.

At 6.30am we duly arrived at the Tropicair terminal. The security guard would not let us enter the compound.  We were too early – “come back later”. We did. At 8am we e returned “Why are you here so early? The flight is at 11am to Purari” they said, but we refused to be deterred. Some others of our party flying to Kapuna were arriving. The securities took pity on us and let us into the compound. We waited. They weighed our luggage. They weighed us, and we waited some more. Past 9am, no sign of a pilot. It must be an 11am flight after all. Then Isaiah vomited.

Isaiah has two speeds: full on or asleep. If he is stationary there is usually a very good reason and if he complains of cold in New Zealand, let alone a tropical morning with the mercury hovering around 33degrees, he is sick. My medical bag was in my pack and had already passed through to be loaded but I spoke nicely to the official and went around the back and retrieved it. His fever was 39.7 and he was lethargic. I gave him paracetamol and water.  Isaiah was vomiting into a plastic bag as the plane taxied down the runway. 

Mercy enjoyed the aeroplane ride, her third ever, in the 9 seater prop plane. We flew through a couple of rain storms and she loved every minutes of it. Poor Isaiah though, slept through it all. He doesn’t remember me pointing out the narrow strip of grass amongst the jungle or the winding tributaries of the Purari river as they snaked their way towards the sea carrying and immeasurable volume of water and silt with them. Isaiah was unable to get off the plane by himself. Matt lifted him and layed him down on the gravel near the plane. I tried to get his long pants off him and put up my umbrella to shade him.

There was a boy who had come up from Kapuna with the AusAid officials for transfer to POM General Hospital. He had fallen from a coconut tree and impaled himself on a sharp stick damaging his urethra and giving him urinary retention. He had a catheter and was draining profuse haematuria. He had been brought up by stretch and the pilot was reluctant to fly him out. Fearing that he might collapse en route, the pilot was asking if medevac was more appropriate.  Even without assessing him I could ascertain that is injury was not very recent and that he was alert and able to sit up so likely stable enough for the hour long flight.  I pointed this out to the pilot and offered to assess him. This seemed sufficient and the small boy was loaded into the aircraft and Isaiah was loaded onto the now vacant stretcher.

Matt and one of the AusAid visitors carried Isaiah down to the Oil Company Purari base where personelle come in and out to work on the pipeline.  Like a great open garage built over planks it offered all the necessary shelter in the jungle. We availed ourselves of a water cooler from inside an air conditioned container and a flush toilet, like alien things from another world amidst the verdant growth and the mud and the warm clawing air. I checked Isaiah’s temperature again, 39.8 with resp rate around 50. He would no longer take water. I started praying as he lay in the shade. Aaron, the Oil Company guy, took Isaiah and I down to the boat in his air conditioned 4 wheel drive. Isaiah lay on the back seat until the last possible minute. Once everything else was loaded I took my place and Isaiah was brought down by stretch and somehow we got him into the boat. He was in and out of consciousness so he lay in the bottom of the boat and I sat next to him covering him with my lap lap [sarong], wetting his forehead from time to time and with my hand on his back, counting his resps as if I didn’t already know how sick he was.

It was a beautiful journey. The predicted thunderstorms remained a perfectly tolerable distance off to the east and the canoe was fast. Our driver kept a good pace, pausing only to change fuel or if we passed a dugout so as to not disturb our fellow travellers with our bow wave. Traveling quickly gave us the first sensation of being cool that we had had since arriving in POM and the natural beauty of the place is astounding. The clouds were incredible, great billowing cumulous, high wispy altostratus. I remembered Da Vinci’s cloud sketches and promised myself that I would sit down and so some of my own one day.

The journey wore on. I shared a papaya with my grateful boatmates. Manoa, who had travelled with us from POM helped me keep Isaiah covered in the laplap. Mercy enjoyed the fast ride, but Isaiah lay in the boat, unseeing. Finally we rounded the final bend in the river and Kapuna was suddenly upon us. The tide was out. There was a good stretch of mud to get the boat up before it could be unloaded.  Everyone but Isaiah and I jumped out and helped push the boat up the river. I felt a regal wave was in order, but I was mainly just relieved to have finally arrived. Isaiah walked a few steps after being helped out of the boat. He took a very little bit of water and then lay down on the grass again. A friend retrieved a wheelbarrow and he was taken down the path to our new house.  I laid him down on a thin mattress on the livingroom floor. The stairs were too steep to get him into bed.

They call the housing here ‘bush luxury’ and it is not too dissimilar to glamping, but with a lot more heat and plenty of bugs.  Out house was two stories of unlined, diesel-stained wood, with shutters for windows, cold running water, a flush toilet and even a washing machine and freezer to use as a fridge with  the 4 hours of electricity daily in the evening. Having such a home, while surrounded by such simplicity of living, feels immensely luxurious despite the challenges of living here.

The doctor came. Not much to be done for Isaiah, he was alert enough when she passed by. I asked for oral rehydration solution.  He would not take it. He wouldn’t take watermelon either, or pineapple. He slept. The other doctor came around with dinner. I explained how worried I was. His fever was still far too high, I couldn’t get him to drink. I was thinking it was time for IV fluids and was well ready for a night in the hospital. She made him a milo. A MILO!!! He drank it! His fever broke. He turned a corner and the knot in my stomach unclenched. We had arrived, it was going to be ok.

We settled down for the night in beds graciously made for us before we had arrived. Isaiah called me every hour to change his bed. He had profuse watery diarrhoea and couldn’t get to the toilet. I ran out of linen. I took him downstairs and made up a bed with wet sheet over a thin mattress under the dining table so we could hang the mosquito net over him. The power finished for the night. I came down to him by torchlight. He dirtied both towels. My torch battery ran out. I stumbled down in the dark and tried to clean his bed with the dirty towels. I had no disinfectant. He dirtied my lap lap and my kimono. I blessed the friend who had given me a small bottle of hand sanitiser. Finally morning came and with it the light.

Matt wasn’t feeling well. I needed to get help. I borrowed bed sheets and bleach, rags and towels. Someone brought bread for our breakfast, but no one could eat. I was exhausted. I set up three mattresses with wet sheets in the living room to nurse everyone close to the bathroom. I put stories on the ipod and hooked up a speaker. I tried to keep each person’s identical cup separate somehow. I bleached the dishes and the toilet. It was Sunday so the power was on for Church. I didn’t go to worship with others, I stayed home to do laundry. I hung things off our beautiful balcony. I rested with the kids. Matt cried. “Remind me why we’re doing this again?” That night Isaiah was able to get up to the toilet and I had head torches for us all.

On Monday the toilet stopped working. Isaiah was still not eating. He was crying for home and Matt had gone in to start work. I was exhausted. I went to find Matt and when he couldn’t come I went to ask a friend to help find the doctor for Isaiah. I vomited on the path at her feet. I staggered back to the house and lay down with my sick son. Thankfully Mercy seemed to bounce back and was all but recovered as I was coming down with the bug. Matt also got of relatively lightly as well.  He came home to look after us. I lay in my mosquito netted bed sleeping feverishly in the heat, and then suddenly cold despite 35 degree heat.  The doctor brought medicine and asked Mercy to be my 5 year old nurse. Mercy took the responsibility very seriously. I rested.

The next day the drain layers got to work to fix our plumbing.  In the hot sun they worked with shovels digging out the dense waterlogged clay from around our tank and digging a large trench to sort out the overflow. The plumbing was restored and what a wonderful thing plumbing is. I took some food, so did Isaiah.

The next day we took Isaiah for a walk to see the village. He knew nothing of the coconut trees, the paw paw trees, the pineapple patches. He had not met the village boys who catch fish with bows and arrows they make from coconut fronds and was incredibly homesick. We showed him the gardens, the jetty out to the river, we showed him his school built out over the swamp. We took him to the playground. It was all beautiful, hot, so very hot, and beautiful. We had finally arrived. It was such a hard journey, but we had arrived.

Baimuru Ward Round – Bekah

Baimuru ward round

Kapuna Rural Hospital is not like a New Zealand hospital- that is obvious on so many levels. But it functions. Patients come, are assessed, treated, discharged or referred. It is a haven in this vast isolated jungle. The staff are diligent and have studied hard to gain the necessary knowledge and skills to care for their community. They are punctual and attentive. My ‘ward round’ to Baimuru showed me the other face, the much more common face, of health care in PNG.

Baimuru is a large village or station 1 hour up river by fast canoe. It has a large store, an air strip that can be used in the dry season, and has, for many years, had a school and health centre. Recently the facilities for the health centre became so run down as to be all but unusable so the decision was made to rebuild the station. A lovely new complex with running water, louver windows and intact floor and ceilings was build next to the original health centre. However, the new health centre has not yet been ‘officially opened’. I understand that despite having been competed months ago, this opening requires the presence of some dignitaries and has not yet been arranged.  In the meantime health services are being provided out of the old condemned building. That, however, is not the most frustrating aspect of the Baimuru situation.

The Baimuru health centre is staffed by a number of trained nurses and community health workers. They are paid by the government and receive their pay into their bank accounts.  Unfortunately, there is no cash machine in Baimuru, and no bank. As there is no way for health workers to access their pay at their place of work, they travel to Port Moreseby periodically. Many do not return for duty. For a considerable period of time the Kapuna doctor has attended Baimuru monthly to do ‘ward round’ at the health centre with a group of volunteers from Kapuna who are not technically on duty. The paid Health Centre staff have simply disappeared. The Kapuna staff are filling the gap.

We were in good spirits as we made the canoe journey up from Kapuna on the morning of the ‘ward round’. We were hoping to get through our duties quickly, hoping that some staff might show up to help with the scheduled clinic. It was a beautiful day and we could see the mountains of the highlands in the distance as we moored our boat and climbed the ladder to reach our destination. I knew the facilities were run down, but was still surprised at what I found. Floor boards were rotted out, the ceiling was sagging, mosquito net over the open windows was ripped. There was one table and a few shelves, two iron bed frames and one filthy foam mattress. Yet the drug store, while lacking any organisation, was topped up to the brim with a wide range of medicines, many still well within date.  Staff had clearly come in, taken what they needed and left what they didn’t packed in opened and unopened boxes, lying here and there. The dressings were mixed in with papers and full and empty bottles. There were boxes full of rubbish and some drawing needles still poking out of antibiotic vials. The ordering schema inside me ached to put it right, to make it orderly, to banish the chaos. There is no point I was told, it won’t last, no one maintains it.

We hoped to get to the store before the patients started arriving, but it was not to be. They were already filling up the room, sitting and standing here and there as we put some supplies on a table and divided up duties. Several staff would work on vaccinating children and doing their health checks, one would offer contraception and the doctor and I would assess unwell patients. I inwardly thanked God for my years of nursing in medical wards, emergency department and, most useful of all, at Hutt Union where I did extensive assessment, diagnosis and treatment under standing orders. Armed with my copies of the PNG treatment guidelines for both adults and children I prayed for help in my overwhelming task. I had brought my medical bag with me, with all the instruments I had brought from New Zealand for use in such circumstances – there would have been none available for me otherwise and I could not imagine providing care without a stethoscope and thermometer.

My first patient was an elderly lady who looked about 80, but was probably no more than 60. She had a swollen foot and ankle pain. I was struggling with language. Was this a new injury or a long standing problem? Fortunately I was saved by a Village Volunteer Health worker – Peter who appeared at an opportune moment. He stuck with me all day translating and helping me when I got stuck. Together we treated chest infections, skin infections, handed out salbutamol pills (!) to the asthmatics who don’t think inhalers constitute medicine. We did a renewal of antihypertensives for a patient who had been started on these in a previous clinic – I was very surprised to unearth atenolol in the disordered drug store room.  I frustrated a couple of mothers by prescribing recuperation for children who appeared otherwise well. We prescribed panadol for musculo-skeletal injuries of unknown origin and did simple dressings for a range of minor skin wounds, bitterly regretting the lack of running water most at that time. I was astounded that, in these conditions, a colleague undertook the minor surgery needed to replace contraceptive implants in patients’ arms. The women submitted to this with astounding strength and determination.

We saw far too many children with weight and height for age below the second standard deviation. PNGs are small by any standards but many in the Gulf many also lack protein, especially inland where fishing is more difficult. We referred one malnourished little one for TB assessment after a year with persistent cough while living with her Bubus (grandparents). I found another little girl with a significantly swollen lymph node characteristic of extra pulmonary TB and asked the doctor to look at her too.  It was a unilateral swelling – ear infection more likely! Silly me. One wee baby worried me with a high fever and lethargy, not feeding properly for more than a week. She saw the doctor and came with us on the boat for better assessment at Kapuna. All through the clinic Peter, the Village Volunteer, stuck by me helping me immensely.  

I was very concerned to ‘first do no harm’ and comforted myself that all the treatments we gave or plans that we made were unlikely to risk any harm.  I wrote in the patient’s exercise books – their version of clinic books, or perhaps just a scrap of paper for those who didn’t have one. The task of noting presenting complaint, history, subjective and objective findings cleared my head and helped me to work through things in an orderly way to minimise the risk of missing something important.  

The tide of patients finally subsided and I was well ready for lunch, I figured it was about 2pm.  I was told it was more like 5pm. We had worked the whole day away.  It turned out one of our patients was in fact the Chinese owner of the Baimuru store. In his gratitude he donated cold coke cans and crackers to our cause – we were more than amply rewarded in this.

The boat ride home gave me time to reflect on a system in which a new purpose-built building sits empty, while we work without water or privacy in a dilapidated building next door; a system where one group is paid and do not work and another group is not paid and yet work. Truly PNG is a land of the surprising.