A Health Patrol

Kapuna hospital runs health patrols to surrounding villages every month or so. We were invited to join the next patrol to a village an hour away called Baimuru. There is a health centre set up here, but the 15 members of staff that should be running it are hardly ever present. Only about three nurses permanently man their post, the rest spend most of their time in Port Moresby. As a result, Kapuna comes here once a month to run a clinic for a day to review any problems and screen for TB.

Lina, ready for action

On the day, we all congregated at the wharf. Elize, Lina, Robbie (more on him soon), two nurses, two CHW’s, our boatman, and I. It was only a short one hour ride before we arrived at the village, where we could take in the splendour of the health centre. The shack that stood before us was shocking to see, it seemed almost unthinkable that it was still a running healthcare facility. Shaky wooden stairs led up to a shaky wooden walkway that ran along the building’s hallways and rooms. One of the first rooms we could look into was missing two walls, providing a great view of the surroundings. Across from this room was what probably used to be one of the wards, a long hallway with regular partitions running along its length. The large room contained a bare bed, a couple of benches, and a set of shelves. Immediately to the right of the entrance was another room that contained the centre’s medication store. This hallway is where we would be holding the clinic.

Our first view of the centre
The ward
The view through one of the rooms

The walkways quickly started filling with patients as word of our arrival spread. Our two nurses set up between one of the partitions to run a vaccination clinic. Our two healthcare workers, and the centre’s own two nurses (who were absolutely great), helped Elize and I with the rest of the patients. They did a history and physical examination of the patient and then sat down with us to review. This method allowed us to work through the patients relatively efficiently. We would immediately have a basic history and could ask focused questions with the nurse translating, before making a decision about treatment. I was relatively surprised by the type of complaints some people came with. There was one woman, for example, who complained of back pain. When I asked when the pain had started she let me know that her aunt had hit her with a stick in 2006 and it had been hurting since then. Looking through her medical booklet I could see multiple visits over the years due to the same chronic back pain, she had even had an X-ray to review the spine but sadly enough had lost the rapport. The pain ran along the muscles of the lower back. Most importantly however, the pain was mainly after a long day of work. When I asked what her work entailed, she replied making sago. Right, I would have back-pain too if I had to make sago.

So, what is sago? It is a staple food that is made from the pulp of the inside of the Metroxylon Sagu palm tree. People chop down the tree, float them along the river to their village and then chop them in half to expose the innards. Then there are two main ways that they process the tree. The most important one in this case is they add some water and then beat the living hell out of the tree for eight hours. This process produces a pulp that sets into a whitish pink block that will crumble into a loose powder when rubbed between your fingers. There are multitudes of ways the sago can then be used. Spread it out as a flat disc into a frying pan and you make sago pancakes. Boil it in water with some banana and you have a lovely dessert. Wrap it in banana leaves and throw it in the fire or, even better, rub it into the burn wounds of people who have fallen into the fire (no I am not being funny, people seem to believe it stops blisters forming. Randomized control trials still pending). When cooked, the sago takes on a gelatinous texture. The pancakes for example have a crisp outside with a soft gelatinous middle, and the banana sago is like a banana pudding. Sago itself doesn’t really have much flavor, or any nutritional value. It literally does not contain any protein, and is low in everything except carbohydrates.

The Sagu palm tree
A block of Sago

Anyway, after a bit of a tangent. What I mean with the above patient is that I was surprised people come in with similar complaints as they would back home. It was like running a little GP clinic. A lot of people have chronic aches and pains, but where we would walk into the closest drugstore and buy some paracetamol, the supply of pain medication here is rather limited. That, and sometimes it’s not a simple lower back pain but tuberculosis of the bone which needs to be treated before it causes anymore problems.

On the other hand, there was also a man who came in with an impressive non-union (when two ends of a broken bone don’t grow back together) of a broken arm. He had broken his right lower arm two years ago and had not received proper treatment. Two years later the break had not healed well. He had a rag wrapped about halfway along his lower arm, and when he let the arm go he could flop the part below the rag up and down (anyone remember the time Harry Potter got his bones magicked out of his arm? It looked a bit like that).

The walkways slowly started to empty out as we worked through it all. A couple of skin infections, a few TB checks, a Parkinson patient coming for a refill of medication, and a little hemorrhoid to finish the day off.

Before heading back, I was shown a very new fancy looking building behind the existing health centre. I was told that they had built a completely new centre, because – as my previous description might have given away – the current one was falling apart. So why are they not using the new building? Why continue working in a mouldy shack that is missing a number of walls? Well, because they are not allowed to use it yet. The building still needs to be officially opened by the local government. Until then they have to continue using a crumbling building. Figures.

I (Lina) might take over from here. My experience of the day differed a little from Sebastiaan’s. For one, of course, I was only an observer. For the other, I had to bite my lips almost constantly to stop me from crying. While everyone was working without as much as a drinking break, I was sitting in a little corner on the ground watching, trying to read. From there I could clearly make out that the ceiling was about to come down at various places. It was a mystery to me how the bed Sebo described earlier was still standing, and the half ripped plastic sheet covering it did not make it more appealing. After a while a women came in who was guided to the bed. She had a cast on her left leg that was being removed. Elize had a look at it and re-positioned the foot to cast it again. Her husband and son were both at her side. As the little, maybe 3 year old, son kept crying, I did my best to entertain him. Seeing a pale face like mine, the son actually stopped crying and started laughing at my funny faces, along with about 5 other kids behind the “window”. Turns out I was being watched. The health worker then explained to me what had happened to the lady. She had cut herself with a machete; in her own ankle; cutting through her own tendon. Her husband was still standing next to her, looking down. I guessed this official story only partly matched reality, domestic violence really is one of the biggest problems here. I sat down again.

Every time I wanted to cry now, I started entertaining all the kids and laughing with them. That helped. Seeing the healthcare centre felt like reality hit me in the face with a chair. Back home if I break my arm, I go to a fancy hospital. There I complain about the long waiting time. 4 hours! I then discuss my treatment with the first doctor who will arrange for me to have an X-ray….and so on. I have the luxury to choose my hospital, the doctor, the preferred method of treatment. I can get a CT-scan, an X-ray, PET-scan, brain surgery, and radiation or chemotherapy if it is ever needed. I can use alternative medicine next to the modern one, and complain about the bad food I get when staying in hospital. I can go to 5 different specialists and still feel like nobody is really taking care of my illness. Every patient room is overly sterile and I will still comment on how unpleasant the hospital atmosphere makes me feel. Now don’t get me wrong, this is not a rant on how privileged we are, it was just me realising how lucky my family and I are. If we are sick, we can receive all the treatment we need, and rightfully so. It is about what people here cannot get. When they have a broken arm, they might have to travel for two days before arriving at a hospital. Here, they most often get a cast that will set their bones more or less correctly. If it is too bad to be repaired with a cast, they have to try to get to one of the bigger hospitals. A costly and long trip for them. Or, like the man in Sebo’s example, wait for two years to go to a hospital. In the region we are staying, there is no X-ray, no CT-scan, and definitely no chemotherapy. I am not saying there are no treatment possibilities, a lot is being done, I am simply saying that they are limited in many areas. And believe me when I say, the healthcare centre here is definitely not too sterile.

All in all it was an interesting experience, and it definitely highlighted the healthcare difficulties rural villages face.

What we learned:
– Lower back pain and achy knees is a universal problem for an aging population
– Sago has no nutritional value and breaks backs. It does make a great banana pudding though!
– A lesson of gratitude was learned for the healthcare system back home. Hooray for X-rays and cheap analgesia!
– Ceremony and tradition can be of great importance, but as with all things, there is a time and a place.

With love,

S&L

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