Spiritual Care

Spiritual Care

The young man was working as a casual labourer on the hospital rebuild project and had strained  his back. He attended outpatients along with his mother to have it seen to and in the hope of receiving one or two paracetamol or ibuprofen tablets maybe. But there was time to consider more than just his back. Doctor moved on from his physical injury to asking about his life. The young man man had achieved Grade 10, not something to be looked down on in an area where teaches rarely continue working their hours all year round. Now he was a village one helping in the garden and generally being there, though at the moment he was doing heavy labour for just a couple of kina an hour hardly his dream job. Doctor asked him what his interests were, he looked at his feet, but she spoke directly. “You’re a smart young man. You need to think what you want to do. God loves you and he has a plan for your life and it will be a good one”. Then she asked to pray for him with the laying on of hands, for his back but also for a revelation of a good way ahead. He smiled as he looked up.

˜™

You could say the boy was tired, but this was so far beyond something that mere tiredness could explain. You could say he was angry, but it was well beyond anger as well. It was as if there were a wild animal inside, one that was scared and going on the attack. And the animal was strong. His mother could not hold him, nor could his father. The anger was turned inwards as well, as if it had a life of its own and wanted to destroy the boy. He climbed the balcony saying he was going to leap off the second story and die. He said he wanted to go to the devil who he loved.

The boy’s mother was distraught. She was used to managing childish mood swings with a firm and loving hand. She was used to emotional outbursts too, but this situation exceeded her ability to cope. The dark hopeless rage had manifest itself several times before, each time worse than the previous. Though there were months between, the ‘episodes’ were getting increasingly hard to dismiss but even harder to understand.

His parents had arranged for some elders to come to the house to pray that particular night, not for the boy but for other reasons. Their timing was impeccable. Just as the parents were beyond knowing what to do, the men arrived. Two strong, tall PNG men of great faith were there in the living room. No explanation was required, they sat down on the woven coconut leaf mat on the floor and started praying aloud, in unison, each with a clear strong voice and with authority. The parents joined them holding the boy. They laid hands on him. He continued to rage. Where before he had been desperate to join the visitors, now he was desperate to escape, though he was held in gentle arms by those who loved him most in the world. It was overwhelming. The boy’s father began to cry- what had overcome his beautiful son? The mother, on her knees, looked up. “Do we need to get more help?” she asked. “I’ll go” said the tallest visitor.

Five minutes later two elders emerged from the darkness and joined the group on the coconut mat. The father said later that they couldn’t have seemed more angelic if they had been surrounded by light. They seemed as warriors of light even without the luminescence. The fervent prayer continued, all together, interceding for the boy. And then it was over. He was still in his mother’s arms. He looked at them, wearily but his eyes focusing for the first time. He asked what had happened. She told him the men had come to pray the protection of the blood of Jesus over him. He said he was tired and she took him upstairs to bed where he slept soundly. The visitors had tea and doughnuts.

There was a change in the boy from that night on. He was aware of the spiritual battle in a new way. He understood that “the devil comes to steal, kill and destroy, but Jesus came that we might have life in it’s fullness”. He understood the choice between obedience and rebellion. And several weeks later his parents noticed that he no longer woke with nightmares or night terrors.

˜™

It was meant to be a simple operation to remove a large benign tumour. Actually, a very large but benign tumour that was impeding the man’s ability to walk. He had been to Port Morseby General to have it removed, but they had decided not to do anything as it was deemed a cosmetic rather than life threatening problem, so he returned to the bush hospital and sought treatment from there once again. Doctor is experienced she has done many varied operations out of necessity rather than preference. She felt the operation needed to be done and had the confidence to try it despite the risk of post-op infection. The man’s sister accompanied him to theatre and donned the requisite theatre. The pulse ox was connected to monitor the patient’s heart rate. All was going well. Large volumes of tissue were removed from the man’s thigh. The ketamine sedation was working and he wasn’t experiencing any major discomfort. Then, all of a sudden everything went wrong. He stop breathing. The trace on the pulse oxy was hard to read, then non-existent. The staff hurried to locate an oral airway and bag and mask for manual ventilation. Doctor could not feel his pulse. She could not hear his heart with her stethoscope either. The staff commenced CPR, rhythmically pressing down on his chest to stimulate the absent heart beat and circulate the blood. Other staff became aware of the situation and gathered outside the theatre to pray in the normal PNG way, aloud, in unison – a cacophony of sounds and yet with some deep sense of order beneath the seeming disorder. The CPR continued, long, stressful, physically exhausting, until eventually a faint pulse could be felt, then a stronger one. Finally he was breathing. 90 minutes after the surgery he still had the oral airway in. He was starting to rouse, but was groaning, agitated. Another staff came in, unaware of the drama but hearing the sounds and identifying them as abnormal. New continuous cardiac monitoring equipment was brought in. He was identified to still have dangerously low blood pressure, he was not localising pain. Was the cause of the low blood pressure a massive heart attack, or something else? He sounded like someone who had has a massive stroke but that wouldn’t account for the blood pressure. What was the right course of action? Not knowing the cause made the correct response difficult to determine. The staff prayed again in power. His blood pressure came up 20 points without any intervention, still dangerously low but going in the right direction. A fast IV was started and he was transferred to the ward for recovery. I did not expect him to live.

The next morning he was awake, sitting up, talking in local Baimuru language to his sister. The night staff reported that he had told this story overnight:

“While I was in the theatre I came up out of my body. I was above the hospital and I was looking             down at lots and lots of people all dressed in white around my body. Then I heard a voice from                 heaven telling       me to go back down into my body, so I did”

˜™

The man was sick. He’d had a terrible run with sickness for several months and so had the children. It was one thing after another after another. Now it was influenza. Not a bad cold that people like to call ‘the flu’ but rather a contagious viral illness that left him exhausted, feverish, unable to eat and in pain. He could not walk down the stairs without becoming short of breath, and the psychological burden was a massive added weight. The women came in the afternoon, again sitting on the woven mat, singing praise songs while he was upstairs in bed. The men came the next day, a chair was placed in the middle of the room. The men surrounded it laying on hands and praying powerfully again. He sat helplessly, humbled in the presence of the body of Christ, surrounded by a strong arms of spiritual brothers extending a tangible expression of the love of the Father.

˜™

The woman woke early one morning and was shocked to find she was bleeding and in pain. She was only in her 31st week and it was far too early to have the baby. Even the big hospital in Port Moresby is not equipped to offer intensive care to neonates at such a early gestation and in the remote rural area premature labour almost certainly results in the death of the infant, if not the mother as well. The man went straight to the office to organise a medivac. It took all morning, despite the help of half of the office staff. The rest could not concentrate and went over to the woman’s house to pray with her. Several people climbed the stairs and sat with her and held her. She sat very still trying to cope with the intense pain made worse every time the baby kicked. Her face showed her raw grief and her fear. The several more visitors remained downstairs beneath the balcony where the woman sat. They began to sing and the visitors began to pray. Prayer and singing of quiet worship songs continued for an hour. More people gathered. The singing and prayer continued. The man returned and announced that the medivac had been organised. They had been planning to return to their homeland the next week, but they would now be leaving in 2 hours. Their passports were still in the immigration office and the friend in charge of their visas was on a boat several hours north of Port Moresby.

The rest of the village arrived. The woman was too sick to go down for the impromptu blessing and farewell, but remained upstairs as blessings were given, hymns sung and tears were cried. An hour later the helicopter arrived. Loaded up with medicines for a ‘worst case scenario’ the chopper ascended into the sky. The people continued to commit them to prayer. Would they make it to Australia and to medical safety or would a premature birth take place in the sky, in the capital or enroute to developed-world medical care? The friend in charge of immigration issues got off the boat and and the local health centre agreed to driver her the hour down the highway to the capital in the ambulance! The passports were retrieved, but the ticket office was due to close at 4.15, the last flight out of the country left at 5pm. Would the woman receive the all clear from the Obstetric Specialist at POM to fly on this last commercial flight or would she have to stay longer arranging an international medivac? At 4.15 the all clear was given and the tickets were purchased and boarding passes printed. But would the woman make it back from the hospital in time to board the flight with her family? She made it, with only a few minutes to spare.

An hour later she arrived in Australia and an hour after that she was admitted to the well equipped and well staffed hospital. She was in a lot of pain, but all tests showed baby to be well and mother to be improving. It remained a serious situation however. The community rejoiced at her safe arrival and continued to pray. The pain continued, intense at times. Medical staff ruled out an immediate return to the woman’s home country. Would the baby be born prematurely in a developed but still foreign country? The Australian church community gathered around them. At the Sunday service they discovered friends of friends and unexpected support. Over the next two weeks the pain gradually subsided and eventually the family were cleared to make the final leg of the journey home. The baby boy remains safely ensconced in his mothers ‘baby bilum’ while we pray for a full-term delivery.

˜™

Grandma

Grandma’s chair sits in a small spot of sun near the bottom of the steps to her house. It is a plastic chair with metal legs, the kind that sit in mechanic’s waiting rooms. Grandma was sitting on the chair breaking sticks for kindling as I went past after work today, the cat sitting on her lap to keep her company and to warm her legs. I stopped to greet her. Sometimes she brings a book out to read in the mid afternoon sunshine – usually a Christian biography that she makes short notes in to guide subsequent readers. I often ask what she is reading. I doubt she knows who I am, but that doesn’t stop her chatting kindly with me. She has something interesting to say on many subjects and is happy to talk to any who stop and past time with her.

12 years ago when I was here she was still conducting ward rounds on the front veranda of the hospital surrounded by CHWs students. She would chop her own firewood aged 81. Now days she has given up public life, and the wood chopping, but still keeps herself busy with the kindling,sterilising the obstetric drums for the wards and folding the laundry. She reads her large print Bible at night  before climbing into her many-blanketed bed with its hot water bottles. It may be the tropics, but the rainy season is still cold for a 92 year old who has been here for more than 60 years.

Lin Calvert is something of a celebrity. She has appeared in books and magazine articles both here in PNG and in New Zealand and her life story was recently made into a short documentary film by one of her grandchildren. She moved out here, to one of the most remote places of the world, in a time before helicopters, satellite internet and outboard motors. She and her late husband Peter were dropped off by ship and made their way inland by dugout canoe to Kapuna Station in the early 1950s. Apart from short trips away, Lin has remained here ever since.

We are now nearly decades into the 21st Century and life continues on in Gulf Province much as it has for generations. The Australian Government granted PNG independence in the 70s and a succession of governments have come and gone. Lin’s son and daughter-in-law returned in the 1980s to help manage the hospital, and her daughter, herself a doctor, returned in the mid 2000s. Time has passed, but the geographical challenges mean Gulf still has no significant industry to speak of, no cash crops, no income and virtually no social, educational, civil or health services. Dr Lin has continued on here caring for the sick, teaching health workers and being God’s hands and feet to the small people here amongst the mud, mosquitoes and malaria that she was promised all those years ago.

It is inevitable that as one prepares to meet their maker ones world shrink. Bubu Mai gave up hospital work after her daughter returned, and gave up teaching several years after that. Now she isn’t seen at church any more. But while her world may now be much smaller, she is still very much connected to it. She continues in the only home she has known for the vast majority of her life. She has her bedroom at one end, and the hospital office is at the other. Grandma takes naps on the ‘front veranda’ but the room is also the video room for the school children and the small meeting room where big decisions are made. The school children pray for her daily and occasionally have to climb on her roof to retrieve a ball. She continues to read medical journals and, on good days, takes a walk around the garden, inspecting the pineapples and hibiscus with Uncle Colin and two walking sticks for support.

In Dr Lin I see a model I want to emulate. Intelligent and outspoken she has never been one to hid her light beneath a bushel. She has taken on spiritual, community, and professional leadership roles without a hit of that shame so often affects me when offer something of myself. Alongside this is a robust kindness, made up of repeated small acts of compassion- giving the cat some precious milk, giving me the excess bananas to take to the patient children who are always hungry, the kindness of holding hands.  And there is that determination, what one of my spiritual parents called ‘a long obedience in the same direction’. In her own words, “God called me here, and didn’t called me anywhere else, so I stayed”.

I don’t know what the future holds for me but as I think through where serving God with my whole life might take me Bubu Mai’s old age shows an inspiring example of a life well lived, right to the end.

Missionary.

Mapang missionary home, Port Moresby, has something of an old world feel about it. It is ‘homely’ in both the best and worst senses of the word. It is the staging ground for journeys by Christian workers into the rest of PNG, a holding tank for people of a range of nationalities and languages as they await transport or visit government offices. It is comfortable and affordable. It is run by a ‘host couple’ who act a little like camp Mother and Father on form 2 school camp. They provide practical help as well as orientation and support to those who may have arrived from very different environments sometimes jet lagged, culture shocked, or, like us, with young children in tow. Some guests like the ‘mature’ Souther Baptist couple we met, proclaim their status as Missionaries loudly and everything about them accords with all of the assumptions that the word ‘Missionary’ conjures up. Then there was us. newly arrived off the plane, sweltering in the heat and full of nervous anticipation.

I’m a nurse, and proudly one. In nursing I’ve found a ‘ministry’ that seems to fit. It’s more than a job, it’s a calling. In health work, that is in caring work…..people work, I’ve found my passion. It takes all I have to give and makes sense to me given the way the Lord has created me. Standing next to me as we climbed out of the taxi with the cracked windscreen that January day was my darling husband. ‘Deer in the headlights’, ‘fish out of water’, it’s fair to say all of those clichés applied. It’s a bit of a transition engineering supply shop with a small brewery out back, to Mapang Missionary home PNG. I think he said something along the lines of “am I the least likely ‘missionary’ ever?”. I very much doubt that he is, but I sympathised with his sentiment.

At the end of Mark’s gospel the risen Christ commands his disciples:

Go ye therefore into all the world starting in Jerusalem, Judea and to the ends of the earth, preaching the good news and baptising in the name of the Father, Son and Holy Spirit, and lo, I will be with you even until the end of the age.

It’s definitely one of the better known passage in scripture, and is generally referred to as ‘The Great Commission’. Jesus sent out his disciples, and the imperative to ‘go’ applies to all those who call Him Lord, as it did to those first faithful followers. Most of Jesus’ closest followers paid the ‘ultimate price’ for their obedience to his command, and so have millions more in the 20 centuries since, with the greatest number of martyers of all time dying for their faith in the 20th Century. Jesus command  wasn’t conditional. It was spoken to all who followed regardless of the cost. While the command may not sit comfortably with everyone, is difficult to wiggle out of. The disciples were told first to ‘go’ to the place where they already were, Jerusalem, then to places close by, and, after that, to the ‘world’. The place of calling was secondary to the nature of the call. They were told to ‘make disciples and preach the good news’. We’re all called. Even if we never leave the place where we are – the call remains the same. In this sense, we’re all to be ‘missionaries’. Perhaps Matt and I can cope with that a bit better.

Down through the centuries the church has been somewhat obedient to the command and has ‘gone’ not only to its own, but to ‘all nations’ to make disciples. In New Zealand they were well received and Maori accepted the faith in great numbers. The Christian revival was hampered only by the coming of the settlers, their government, and the unjust land purchase and seizure that followed closely behind the missionary endeavour as to be indistinguishable in some places. Many Maori and Pakeha still blame our countries chequered past on the missionaries.

In PNG the missionary story is somewhat different. In many places missionaries were met with significant hostility before ‘cargo cults’ developed in which large numbers of converts were made alongside the coming of unseen consumer goods and a syncretism that in some places is still being unravelled. The ‘civilising’ influence of the white man with his church over the ‘natives’ brought powerful cultural change to a deeply spiritual, animist and polytheistic cultures. Cannibalistic rituals ended, even if sorcery did not. As I read autobiographies of early 20th Century missionaries to Papua New Guinea the benevolence is obvious, but also, in many cases, paternalism and an incredible amount of condescention. With all this history weighing on us it is hardly surprising that we are ill at ease with the word ‘missionary’ despite the command. 

We had a church service not long ago. We have them every Sunday of course, but this one was particularly significant for me. After giving an unrelated message the preacher, a Kiwi, unexpectedly asked the congregation to split into two. He separated the local people and the visitors. With our hospital rebuild under way, our small village is full to capacity and most of the extras. Most of the extras are ‘Na’o people’ in the local Baimuru language, that is, Pakeha/foreigners. They call us missionaries. The preacher called us “the white man” He laid a stern challenge on us. “Why are you here?” he asked. “Are you here because you want to make yourself feel important? Are you here to look good? Unless you are here because you love these people, you’re here for the wrong reasons”. He asked us to kneel before our local brothers and sisters in a posture of humility. He asked the local people to pray for us.

As Leah, my PNG sister, and Aunty Ana laid hands on me something stirred from the deepest part of me. I began to sob. I’m not sure how the preacher was hoping we would respond, how he judged the condition of our hearts. But his human judgement was irrelevant; God had lead him and it was God I met me in that moment. Being held in tears by a woman I love dearly and another whom I know less well but have great respect for, I felt overwhelmed by the privilege of my situation. I felt similar as I  washed my brother’s and sister’s feet at Easter. God taught me long ago that “no one is a fool who gives what he cannot keep to gain what he cannot loose”. A life lived in obedience to God and compassion for others is the best of all possible lives, and I knew in that moment I was living my dream and I wanted nothing more. I knew I was with people I loved. 

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.