For my medical elective, I spent five weeks at the St. Barnabas Health Centre in Dogura, working under the supervision of the two expatriate doctors recruited by VSO. St. Barnabas is the chief health centre of the Rabaraba district, serving a population of 20,000, with in-patient wards for obstetrics, general medicine and close observation. It is run by the Anglican Health Service, with limited subsidies provided by the PNG government.
I attended general out-patient clinics, ward rounds and antenatal clinics (where I was asked to conduct an audit of current management of anaemia in pregnant women, and found that all the women attending the antenatal clinic had haemoglobin levels between 6 and 10 g / dl). I also took histories from patients presenting at the health centre, using basic English plus the few words of Wedau I picked up, such as 'kai kai' (food), 'pis pis' (urine), and 'pek pek' (faeces).
St. Barnabas Health Centre is equipped with a basic operating theatre, but due to the lack of daytime electricity, the overhead lamp has to be run from a car battery. Elective surgery is usually started at 6.30 a.m. (soon after sunrise) before the heat and humidity become too oppressive. I assisted with a tubal ligation carried out under local anaesthesia, in which a head-torch was used in order to preserve the car battery. We scrubbed and wore sterile gloves, but there were no gowns, hats, facemasks or theatre shoes.
Clinic Patrols
I accompanied the doctors on a clinic patrol to Rabaraba Health Centre, which is run by two health extension officers (who receive intermediate training between nurses and doctors), and to Menapi. While on patrol, we were well looked after by the locals, with plenty of food, and I was able to sleep under my mosquito net on the veranda of a beautiful bush material house. The sounds of the nearby rainforest were quite something as I went off to sleep, and the sky was full of incredibly bright stars.
In Menapi we conducted a school medical, screening new entrants to the community school (age 7- 8) and the school leavers (age 13-14) for splenomegaly caused by recurrent malaria, and for anaemia (clinical assessment alone). A crucial part of each examination was to test for evidence of tuberculosis. We also tested the children's eyesight, ordering glasses if necessary, and examined their ears.
No doctors had been to Menapi for several years, and when it came to seeing adult patients, the crowds gathered around to watch as patients were examined on the pandanis leaf mat under a mango tree for shade. Patients of all ages sat around waiting to be seen, and helped each other by trying to explain each other's complaints in English to the doctors. I had a group of old ladies in fits of laughter while trying to examine their arthritic knees and hips on the hard ground in full view of the crowds.
I also had the opportunity to accompany the nurses and student nurses on two maternal and child health patrols to nearby villages. For one, we travelled by dinghy to Lavora, Aigura and Topura, examining, weighing and immunising children at each village, and offering family planning pills and injections and health education to the mothers. We then walked inland to Yapoa for a further clinic. While we were there, a massive rainstorm started, and on the way back the mud paths had turned to rivers, and I had to use the 1.5 metre-high grasses on either side of the path to help me stay on my feet while climbing up and down the mountains.
Arriving by dinghy was an interesting experience if the sea was rough, as it involved jumping into the water quite far out, to avoid the boat being damaged by the fringing coral reef. I also accompanied nurses on a patrol to Waimira, a neighbouring village to Dogura. We walked there, saw each of the children, and then snorkelled back to Dogura along the coast. I spent my sixth week visiting healthcare teams in Alotau, the capital city of Milne Bay Province, and Popondetta, capital of Oro Province. In Alotau I was shown around the hospital by a medical elective student from Edinburgh, and was able to appreciate the superior facilities in this large government-run hospital.
In Alotau there is electricity all day, and the Intensive Care Unit is equipped with modem ECG machines and mechanical ventilators. However, the medical student explained how the greater financial resources did not necessarily mean a better service due to poor administration. For example, failure to order even basic inexpensive supplies before they have completely run out meant that a severely ill man with renal failure had no more fluid available for the peritoneal dialysis he was receiving. In Alotau, I also saw the St. Barnabas School of Nursing, which is run by the Anglican Health Service to provide a three-year training course for student nurses. Many of these student nurses carry out their rural attachments in Dogura.
In Popondetta, I stayed with the National Health Secretary of the Anglican Health Service, and was able to meet students at the St. Margaret School of Nursing, which provides a two-year training course for community health workers. By spending a day in the Anglican Health Service office, I was also able to grasp a little of what is involved in the management of the various Anglican health centres and training schools around PNG. I also visited Popondetta General hospital, a large government-run hospital with reasonably good facilities. One of the nurses teaching at the St. Margaret School of Nursing kindly showed me around the laboratory, radiography department, theatre and wards.
Points to consider in deciding if a placement in PNG is right for you I chose rural Papua New Guinea as an ideal location to experience tropical medicine in an environment totally different from my own. I was fascinated by the cultural diversity of PNG (over 700 languages are spoken by a population of less than 5 million). The landscape is spectacular, with mountains rolling into the ocean, vast expanses of tropical rainforest and countless species of animal, bird and other wildlife.
I am seriously considering long-term overseas medical work in a developing country and felt it was important to experience a taste of this kind of work before qualification, to clarify future plans in my mind, enabling me to maximise the benefit I derive from the rest of my studies and postgraduate trainee posts.
Elective placements with the Anglican Health Service are intended for Christian medical students, as you are expected to participate in the life of the village community, which involves attending church and living according to Christian principles. It is not a place for those who are looking for exciting nightlife, as the generator is only on for four hours in the evening, so all lights go off at 10 p.m. It is also not a place for people who like their comfort. The water supply is temperamental (although there is usually plenty of rainwater in the tanks) and there will be toads and snails in the shower room. You have to take a fairly liberal attitude towards sharing your bedroom with geckos, cockroaches, spiders and whatever else fancies living there.
Food is pretty basic - you can buy scones (complete with baked-in beetles!), bananas, coconuts, peanuts and all sorts of vegetables very cheaply at the market, but the rice and tinned meat and fish in the trade store are at UK prices or more, due to high freight costs. You can get by comfortably on a couple of pounds a day, but it's more fun to buy lots of food and invite lots of people round to help you eat it (a good way of getting to know people!)
Snorkelling is a must if you go to Dogura. Take your own snorkel, mask and fins, as to get there and find there were none available to borrow would be a real shame. There is nowhere to buy snorkelling gear near Dogura, and the angelfish, butterflyfish, anemone fish, massive blue starfish and countless other species are too good to be missed. The locals catch fish by diving and spearing them with a spear attached to a long pole by elastic, which works like a catapult. I met a large moray eel defending its territory on the outer edge of the reef and sharks are certainly present in the water (in some coastal areas of PNG, the locals catch them and bludgeon them to death in their tiny canoes), so you have to keep a constant look-out, and not go too far from the shore.
