For my elective I spent six weeks at Rumginae Rural Hospital in the Western Province of Papua New Guinea with my classmate, Rachel Palmer. Papua New Guinea frequently referred to as "The Last Unknown", lies south of the equator, north of Australia and borders the Indonesian province of Irian Jaya. It has a population of 5.29 million (95% Melanesian; 5% Polynesian, Micronesian, Chinese). There are over seven hundred and fifty languages in Papua New Guinea, however the majority of nationals also speak English or Pidgin (a lingua franca derived from English and German). Both Christian and pantheistic beliefs are widespread and the tendency for the two to become intermingled is strong. A common spiritualistic belief confronted by healthcare workers is the notion that illness occurs becomes someone has 'worked sorcery' on the affected individual and therefore revenge must be sought. Healthcare in Papua New Guinea is provided by a mixture of government-run and mission-run hospitals and the average lifespan is fifty-seven years.

The mission station at Rumginae was set up by the Evangelical Church of Papua New Guinea on the banks of the Weimary River and features a hospital, a community health worker (CHW) training school, a primary school, an airstrip with attached six-seater plane and a Bible college. The sixty bed hospital contains one operating theatre, a TB ward, a 'special care' ward with twenty-four hour staffing, two inpatient wards and one antenatal ward. There is one portable X-ray machine and a laboratory capable of performing basic blood tests including full blood count, urea and electrolytes, liver function tests, blood films and sputum and urine microscopy. The antenatal unit is staffed by a trained midwife and the wards are staffed by nursing officers and community health workers. The hospital also serves a number community health sub-centres and a radio system exists as a means of communication between the hospital doctors and the village outposts. At the time there was one full-time doctor and one short-term doctor (six months) working in the hospital. There were also three missionary families based at the station: two involved in maintenance training and the Mission Aviation Fellowship (MAF) pilot family.

The CHW training school served to train up CHWs to work in the hospital or to be sent out into the bush to man the various village health sub-centres. We attended daily morning devotions with the CHW students and the weekly hospital staff prayer meeting. Attending devotions and helping to lead them on occasion allowed us to get to know students better. We really enjoyed spending time with them and they taught us much about Papua New Guinean ways and culture. Getting to know the missionary families was also a great blessing and gave us more insight into what everyday life is like for missionaries in a cross-cultural setting.

As elective students in the hospital, we were able to participate in twice weekly ward rounds, assist in theatre either with operating or in administering the anaesthetic and spend some time 'on call'. We were well supervised and supported by the medical staff at all times and were given opportunities to be more involved in surgical procedures than we had been at medical school. Within the hospital, we saw a variety of tropical infections including malaria, tuberculosis and pneumonia. We observed the management of snakebite, a variety of trauma (fractures, bush knife injuries) and several obstetric emergencies including a retained placenta and a footling breech delivery.

In addition to our time spent at Rumginae, we were given the opportunity to visit a village health sub-centre and live in with the CHW to get a taste of Papua New Guinean village life. Unfortunately our stay was shortened when the CHW fell ill, however we were able to visit a nearby Indonesian refugee camp and eat a few home-cooked Papua New Guinean meals - one which featured freshly hunted cassowary (emu)!

The highlight of my trip was accompanying the MAF plane on a 'Medivac' (evacuation of a medical emergency). The MAF plane was called out to the health sub-centre based at the village of Mogulu to bring in a mother in obstructed labour with a face presentation. From the sky, we enjoyed fantastic views and were given a greater perspective of where Rumginae was situated within the grand scheme of Western Province. We arrived at Mogulu to find that the mother's membranes had been ruptured for several hours and contractions had ceased. Following a brief review of one or two other patients, we hurried the patient onto the plane and began the half hour flight back to Rumginae. Five minutes after take-off, the contractions re-commenced and remained steady at five-minute intervals. I can remember spending the next twenty minutes rubbing the lady's back, mopping her brow with a damp cloth and praying inside frantically that she wouldn't deliver in the back of that tiny plane with only me to assist her!

Fortunately, thanks to the pilot, we made it back to Rumginae in record-time and were able to transfer the patient to theatre for an emergency Caesarean section. Theatre was packed with people – two doctors, two medical students, one midwife and a selection of nurses and CHW students and of course, the patient. I recall this afternoon very vividly as I believe it was on this day that I was given a true picture of what it means to be a missionary doctor. Throughout the afternoon, we observed the resident long-term doctor multi-task as surgeon, anaesthetist, paediatrician and team leader. The level of responsibility placed on one individual was immense and it was comforting for all to know that God was in control.

Having never experienced overseas mission before, this trip provided me with greater insight into the challenges faced by cross-cultural mission and a deeper understanding of what medical mission involves. I was struck by the necessity for cultural orientation before working in such an environment and impelled to think more about the types of training doctors need before going to work in a Third World mission setting. As a Christian, it was very refreshing to work alongside Christian doctors in a setting where the emphasis is on spiritual as well as physical needs and where prayer is large part of everyday medical practice. This was also a profound challenge to me with regard to my future practice. I would encourage any Christian medical students who are considering an elective in a mission hospital not to hesitate but to go, be encouraged, be challenged in their faith and in their pre-conceptions about overseas mission and to have a great time.

Information for future students

Background Info on PNG

When planning my trip, I had difficulty finding enough information about PNG to get a picture of what it would be like as it has not yet established itself as a major tourist destination. PNG is also extremely diverse, differing markedly from one province to the next, so what you may read about one region will probably not apply to another. Useful websites to refer to are:
Lonely Planet website

Foreign Office websitea>

Expenses

For a developing country, PNG is surprisingly expensive. This is because nearly all of its goods are imported so bear that in mind when planning your budget. You will be able to buy food on your initial arrival in Kiunga (the missionaries are great and will guide you as to what you might need) so it's worth having some PNGean cash on you. Food can also be bought from large storage freezers that the missionaries use at Rumginae and from a small market which occurs twice a week in the hospital grounds.

Traveller's cheques can be exchanged in the bank at Kiunga but be warned – it takes a while. Credit cards are pretty pointless – you can use them in Port Moresby but they won't get you anything anywhere else. Your main expenses will be: internal flights, accommodation and food.

Accommodation

Rachel and I stayed in one of the empty missionary houses. The house was extremely nice with a well-equipped kitchen. You will have a Western toilet, shower and a twin-tub washing machine. Consider bringing a sleeping bag liner/carry mat if you make a trip to a village outpost however you can borrow most things from the mission station.

What to bring

Someone at Rumginae will email you a list of useful items to bring and what types of clothing are suitable. Some things on the list may sound strange, but go along with it, it will all become clear when you get there. There is a copy of the Oxford Handbook at Rumginae but it remains in the doctor's office for reference purposes so it is worth bringing your own to carry around with you.

There are plenty of opportunities to get to know the CHW students and play games with them. You can borrow games and things from the missionaries (including a volleyball and net!) but you may want to bring your own things e.g. a Frisbee or tennis balls along as well.