A long Day on the Keram

It was now really hot. Even though we were still travelling quite fast and the breeze from the speed was keeping us cool, I could still feel I was baking in the heat and being exposed to the sun’s rays. After what felt like a long time we pulled in to stop at the village of Yar. Morix lives in Yar. He’s the youth pastor and has been confined to a wheelchair for a number of years after an accident left him paralysed from the waist down. The people look after him so well, carrying him around, helping him with his wheelchair. He has a huge smile and always seems to be happy despite his predicament. Last year in Yamen Lyn attended to his pressure sores which she said were quite horrific. She had given me some dressings and a lovely soft cushion to give him but they were at the bottom of the luggage pile under the plastic. I told him I had those things for him and we decided that we’d drop them off on the way back down or hand them over if he made it up to Bunam.

All of a sudden there was much commotion and a little boy was climbing a coconut palm. He dropped a coconut down and then a man skilfully used a bush knife to cut a hole in it and they served each of us with a fresh drink of coconut milk. It was delicious. Fizzy and refreshing – but way too much for us to finish a whole one each. I got the impression they were being really generous and I felt very grateful. So warm, friendly and inviting.

I was feeling really hot and sweaty and felt claustrophobic with so many people crowding around us so I walked to the side of the crowd where I saw a woman sitting holding a baby. She looked familiar. I asked her if she had been in Yamen last year and she said she had. I asked her if she was a VBA and she nodded. It was coming back to me. I said, “Are you Priscilla from Yar” and she said yes with a small smile on her face. I was so excited to meet a VBA who had come to training last year. I asked her if she had used the birthing kits and she said she had used about 15 already. I asked her if she had had any mother’s die and unfortunately she said yes, there had been 2 mothers die in Yar since August last year. Both of them had given birth to twins and then died. She held the little baby up and said this was one of the twins and she was looking after her now. I have to say I felt really sad. Overcome with sadness. 2 mothers died in this village. That’s terrible. Awful. Preventable. I felt heavy in my heart. I asked Priscilla if she was planning to come to the training at Bunam and she said ‘yes’. I turned slowly away and then realised the others were already in the boat waiting for me.

We were off again. I was feeling so sad for those women who had died. I was feeling that this whole gig is just too much for us to do. It’s impossible to work in this area. The needs are too great. The obstacles to high. We live too far away to truly make a difference…

Another 45 minutes and we arrived at Bunam.

It was a huge climb up the bank of the river to get to the village on the river’s edge. We then had to walk for about 10 minutes at a slow incline to the actual village of Bunam. The path was narrow with long grass on either side and the jungle was thick – huge bread trees with massive leaves and ginormous sago palms. Everything is this part of PNG is big.

There was much excitement as the locals hurried along the path carrying our bags. And the bags were heavy. With birthing kits! I still hadn’t seen anyone I knew yet. It was a strange feeling. Nothing like when we arrived in Yamen where the whole village was out to give us a warm, traditional welcome. Even though we knew no one, we felt very welcome. I consciously had to set aside my Yamen experience and say to myself, “expect nothing, don’t compare to Yamen”. Easier said than done.

Ahead of us I saw some western style buildings on stilts and we were led to the first one. It was right on the edge of the village. I couldn’t see any traditional huts. The grass had been freshly cut around the house and there was a lawnmower parked under the veranda. There was a dilapidated house across the way with very tall grass all around it. There were a couple of rainwater tanks next to the house but they didn’t have taps on them and one looked like it had a big hole in the side. There was a long drop toilet quite close to the building and I noticed an outdoor shower – with taps and all! We climbed the stairs of the house. Upstairs there was a living room with a desk and old chair, a kitchen area, then 3 rooms. All had louver windows with flyscreens although there were rips in the screens. There were power switches and lights, taps, but no power or water. I felt I was in the bad end of town! In Yamen we were in a haus right in the centre of the village where all the action was next to the ‘green’ and the church.

 

Mike enjoying fresh coconut milk

Debbie, Deb and I keeping cool on the boat

Walking up to Bunam at the end of a long day


Our house in Bunam

 

 

Confusion

Although I cried on the first night in Wewak, by the next day I was feeling really positive and settled again. It was a good day wandering around Wewak, taking in the sights and sounds (and smells) of the supermarket, fresh markets and the stationary shop. I was calm and optimistic about our trip, relaxed and confident again. Arriving in Kambot though, seeing Brigit looking so unwell and distant and then facing this obviously angry man at the health centre just shook me to the core. At this moment I wished I wasn’t a tall, white woman with silver hair and could just blend in with the locals!

As my mind raced with answers to his confronting question, “What is your business here?” I looked across at Yabru for some inspiration. Yabru is an amazing man who has such a heart for his people, and is the reason we are working in this part of PNG. He has a lovely warm voice that resonates with grace and humility. I listened carefully as he told the man the reason we were there, in Pidgen English. Wise words. He explained that we were on our way to Bunam to give some health training to the Village Birth Attendants, returning to the region after visiting Yamen last year. We just thought it would be a good idea to visit Kambot and see what services they provided.

I tried hard to soften my face and smile kindly, smothering the look of disdain and anger that I felt deep within. In that moment I found it really hard not to feel really angry and just turn around and walk away. It’s such a tricky situation to find yourself in because despite working really hard to try and link in with people, not as ‘authority’ but just as wanting to support and help them with what they are already doing, not to intimidate them, but you end up intimidating them anyway just by your mere presence! What a fine line. I felt I was teetering on the verge of collapse, tipping over to allow myself to fall away from the line I knew I needed to walk if I was going to make connections and network with existing people and systems. Respect. Honour. Respect is earned, honour is a gift. “Ok, I choose to honour this man right now, even though he’s being incredibly rude to us, but he may be feeling we’re checking up on him and insecure. So, it is up to me to make him feel comfortable. I am the visitor. I am the alien.”

He relaxed a little and allowed us to look at the health centre. Debbie was great in offering him congratulations for such a neat and clean health centre. Us girls were taken on a tour of the labour and birth room, with the 2 nurses – men are not allowed in these places. It was a very simple room, had a bed with lithotomy attachments, gas and air cylinder, fantastic records of all the births. Apparently they have 3-5 births a month. Not a lot really when you consider all the surrounding villages and the numbers of women giving birth at home. The nurses said that most women who birth there are from Kambot which has a population of about 3000. Few travel from other villages for a supervised birth. One of the sad things I felt about the health centre, and Dr G at Wewak hospital had warned us about this, is that it was empty. Beds in wards, but with no one in them. And yet I knew, from previous experience, that there were lots of sick people out in the villages, but they’re not getting the health care they need because they don’t travel (or can’t afford to travel) the distance to the Health Centre. Dr G had said he’s been trying to encourage the health centres to use the beds as a ‘waiting room’ for women who travel from surrounding villages to give birth, but this has not been taken up. “Still so much to do,” I thought.

The men then took us to the training centre where there are living quarters for visiting health volunteers who come for training which was apparently scheduled for next month. It was all very nice, but I couldn’t help but wonder if it was making a difference, because certainly our experience last year had been overwhelming and many health volunteers had told us they hadn’t had training for a very long time. I was now starting to feel confused about what was Living Child doing in this part of PNG to train health volunteers – had we got it all wrong – there’s a perfectly good system of training and support already in this region, so no need for the likes of Living Child. What is the truth about what’s happening in this part of the world?

I suppose this is a classic example of the importance of not only listening to what the authorities tell you and reading about the programs and systems already in place. You have to weigh that up against what you physically see happening in the villages. What is the evidence. This is why it has been so important for us to visit a second time, to such a remote part again. We needed to see for ourselves what was happening because the stories coming out of the ‘bush’ were of terrible suffering and pain related to the many deaths of mothers and babies because of a lack of health care and support.

I left Kambot feeling confused. A headache was developing and it was hot too. I was relieved to be on the boat again. Our visit to the health centre wasn’t as I expected.

KAMBOT Health Centre

The training centre complete with flushing toilets and showers

Debbie and I handing over gifts to the nurses.

On the road to Bunam

Early on Sunday morning, after a restless night’s sleep, we had to wake at 4am, ready to leave for the drive to Angoram. Our aim was to leave at 4.30, to reduce the amount of time travelling along the river in the sun. Well that was the plan. By 5am the car still hadn’t arrived and we didn’t even know who our driver was going to be. The day before we’d been told we’d have 2 vehicles which was wonderful news because we had quite a few bags – full of birthing kits! Finally, just after 5, the vehicle arrived. A Toyota 4 wheel drive people mover. One vehicle. We were learning to be flexible.

After what seemed like a very long time, the vehicle was carefully and skilfully packed by Yabru. We crammed in to the back and were on our way by 5.30.

The road was rough! Sitting over the back axel I felt every bump, dip and sway. Our driver was very good – he never travelled more than 45km an hour, but the road was in terrible condition after so much rain this last wet season. It was a tough journey. Deb was feeling ill and I was certainly digging deep and gritting my teeth. We counted the bridges, 7 in all before finally reaching Angoram. What a relief to get there: a strange town. Rundown, unused telegraph and electricity poles, a reminder of the swinging days when Angoram was the place to be seen.

This time the Sepik River looked full of debris: lots of water hyacinth floating downstream along with logs travelling at quite a fast pace. Our boat was on the other side of the river so we had to wait for them to come across and collect us. Waiting. Again.

It was lovely to see Gina again. This time she had a baby: Massi, whom she and John had adopted as of the beginning of this year. He was about 16 months old. John is the owner of the boat and our skipper – same as last year. Gina was our beautiful companion last year who cooked for us and generally took care of us in her home village of Yamen. It was really nice to see them again. Dokop too, the Merisen Man and general helper to John. We loaded up and were off. I wondered if we’d stop on the other side again like last time and didn’t have to wait long before the same routine occurred. We hopped off the boat while the men repacked our luggage and covered it, loaded up the fuel and generally had a chat. Welcome to PNG time. Deb, Debbie and I joined in a local game of hopscotch, much to the delight of the children and a funny guy who took a shine to us. It was stinking hot, but we all had a go hopping through the challenge. After about 30 minutes we were finally boarding our carrier and on our way. Travelling fast with the wind in our faces was bliss. We were going against the current so the trip was going to take a while.

We could see evidence of the recent floods – the worst in many years apparently. A number of huts along the river had been damaged or washed away, but there were signs of them being rebuilt already.

We were all feeling quite tired after such a restless night and early start. It was lovely to just rest back on the luggage and have a snooze with the monotonous engine sound in the background. I was so thankful to have my sunglasses this time: last trip they were pickpocketed in Wewak, so I had to deal with the glare.

After 3 hours travelling we finally arrived at the Catholic village of Kambot where Brigit lives. She had told me and Yabru that the health people were expecting us and really looking forward to seeing us. She had also told Yabru that the village had prepared a warm welcome for us. Well, that didn’t happen! We climbed out of the boat and up the river bank to the sounds of a few people saying “Get Brigit”. Eventually she appeared and looked terrible: pale, underweight, dehydrated. She wouldn’t look me in the eye. It was really strange. I felt really sad but could see she wasn’t feeling herself. We asked if it was still ok for us to see the Health Centre. A couple of men led us down a manicured path, past the church building and then towards some nicely built western style buildings. We waited a while. There was a bit of scuffling in the building and eventually a rather tall man came out. He was not happy. He looked directly at me and demanded, “So what is your business here?”

Getting to know the seaside town

Saturday morning we had a leisurely time waiting for our transport around town. The wontok system in PNG is rife and whether you know it or not you become part of that system by your mere presence. Wontok is where family members and relations, however distant, sort you out. If you need a place to stay you go to your wontok, if you need money to travel to the health centre you discuss with your wontok and they’ll sort you out. We were going to be driven around Wewak by a family friend.

The vehicle arrived at 10 and we went to the local stationary shop to buy exercise books and pens for the people who were going to attend the training sessions. We did not see another white person anywhere. Then we went to the local supermarket that had hordes of people spilling out onto the streets. It was shoulder to shoulder, hip to hip in there, so we kept a close handle on our bags. I saw one old white lady and a young guy. There was a reasonable variety of food available – plenty of items that we see on our shelves as well but very expensive. We stuck to simple and cheap – tins of tuna, dry crackers, weetbix, milk powder and then lashed out and bought some bread rolls for lunch with cheese. Next we stopped in at the local market to buy some tomatoes, greens and peanuts. As we walked to the market, our driver Peter, spotted his sister-in-law who is the Director of Nursing at Boram Hospital – the main hospital in Wewak. He introduced us to her and mentioned that we were hoping to visit the hospital and meet with the Obstetrician. Classic wontok action!! She made a few calls to the hospital and arranged for us to meet the hospital supervisor after lunch.

The hospital is way out of town on a very flat piece of ground that looks like it floods regularly. We were met by Sister, the hospital supervisor. We were welcomed warmly and she took us to the maternity section of the hospital where we met the midwife in charge of the postnatal ward and had a bit of a chat. It really was a shock to see as the condition of the building was really bad – flooring lifting and peeling, holes in the floor, wooden doorposts rotting, the bathroom was smelling of urine. The midwives we met had been recently trained by Australian midwives in Madang – their documentation was really good, but they were working in difficult conditions in a building that if it was in Australia would have been condemned and bull dozed years ago. The beds had very poor mattresses on them that were ripped and had no covering. Many of the women were lying on the floor because it was cooler there. The one hand wash basin that I saw was stained black, had one normal screw tap and a bottle of hand wash detergent in a recycled tomato sauce container. The infection control was out of control. At that moment a rat raced past my backpack.

After a little while Dr G arrived and he was full of beans. He was super friendly and showed us around further to the labour room where a woman was currently in labour at 8cm, behind a flimsy curtain. The beds (2 of them) in the labour room were the original ones from when the hospital first opened in 1962. They had rusty legs and were really in bad shape. Here the midwives are allowed to do Vacuum Extraction – 2 pulls only though. There are no epidurals, only pethidine and that is limited to 2 doses per woman as well (50mg per dose). Dr G is the only Obstetrician, he has a Registrar and a resident. They deliver over 2000 babies per year! He and his registrar are the only doctors in the whole of the East Sepik Province that are able to perform Caesarean Sections (population 500 000). There is no Paediatric doctor so Dr G and his team cover that area as well!! They are desperate for equipment – he said he puts in submissions for equipment and medical supplies, but only some items come through. The government has promised to build a new hospital, but there is no evidence of that happening as yet.

While chatting, the midwife came rushing in to ask for assistance as the woman had delivered her baby, but it was flat. Debbie tagged along to help if needed. She said the baby was as flat as a pancake and needed lots of stimulation. They used the neopuff on one of the resus cots, and eventually after what felt like quite a while, the baby responded and started breathing on his own.

I talked to Dr G about what Living Child was doing in the villages and he had some great suggestions and insight. He was supportive of what we were doing and acknowledged that the Health Centre in Bunam was probably feeling isolated and neglected from Wewak because of the distances. He said any encouragement and support will be a good thing – little did we all know then that the centre was closed and had been for nearly 2 years!! He also was very supportive of trying to introduce a Family Planning initiative which I learned about through Rotary. Ticks of approval from the locals – that’s always a good sign and makes you feel a bit better!

I showed him my form to record the stories of deaths of mothers in remote villages and he was rather impressed, saying that we were one step ahead of them as this is what they were thinking of doing. Many people are illiterate he said and so filling out the ‘official’ maternal mortality form is a step too far. I left a copy with him. I also asked him to write down a list of priorities of equipment for the maternity section of the hospital because we have contacts here in Perth who may be able to help in getting some items over to them. Deb Badger was given a neonatal resus bag and mask which we handed over to them as well as a few neonatal ETT tubes and suction tubes. Such small items and yet they meant a lot to these health professionals who work with very little.

I came away from Wewak Hospital feeling pleased that we had made contact with Dr G and met some of the midwives, but also feeling really overwhelmed by the needs of the place. How could the main hospital come to be in such disrepair? Is it worth doing anything about? Yes, I believe so. We can encourage them. We can support them to make the changes they know need to happen, but which right now they feel are not able to achieve because they feel overwhelmed by the size of the task ahead. But one step at a time.

So, from a distance the seaside town of Wewak looks like a tropical paradise, but when you dig deeper, the cracks and problems are vast. Does it mean that we turn a blind eye and pretend its all ok or do we roll up our sleeves, swallow our pride and get in alongside them to offer support and help as requested? YES! Let’s do it!

Mike and I outside the stationary shop. The kids who walked out of the shop were hand frisked by the security guard. I was a little nervous to see how he was going to check us for shoplifting, but we were waved through!! After paying ,of course.

Crowds of people spilling out from the supermarket

Smoked fish – part of their staple diet

Dr G receiving the neonatal resus bag and mask from Deb Badger while Sister looks on.

Welcome to Wewak

On arrival in Wewak I cried. Again. Just like last time.

This time we arrived at the CBC Guesthouse, next door to the Sea View Hotel where we stayed last time, and the power was out. It was pitch black. There were dishes strewn all over the kitchen (but that was because of the power blackout), under torchlight everything looked a little grimy; I was tired and hot – since leaving Perth we’d been travelling for nearly 24 hours! I felt relieved to finally be in Wewak. But overwhelmed again! This time I had another midwife and an ambulance volunteer: I was meant to be strong, capable, lead the way confidently. And all I could muster was a snivelling apology for my show of emotion. “I’ll have to warn future team members that I always cry on the first night”, I said jokingly. Inwardly I wondered what they thought of me. We boiled some water on the gas stove and made our dehydrated meal for the night; nothing to write home about, but it was warm and it was food. The bin was overflowing with rubbish and I saw a rat scuttle away into the lounge area. Then the lights came on.

Oh what a relief to have power. We turned on the fans and felt instantly cooler. The bathroom was very basic but it did have a lovely shower head and the water was cool from the water tanks. Bliss. The toilet flushed – yay! A massive cockroach ran across the bathmat on the floor. “Where is the rat?” I thought.

The tears flowed a little more. The enormity of the week ahead was really weighing on my shoulders. I’d returned. “Why?” I remember asking myself in my head. This is such a far far far away place. “What on Earth can you do here from that distance?”. I thought of the village, the women I met last time, the stories of suffering and death and I told myself, “Just get over yourself. A little bit of suffering for a short time is all you’ll have to deal with and then you can go home to your comfortable life in Perth.”

Mike was great. He reminded us of all the things we could be thankful for over the past 24 hours and even admitted he had had a few moments of concern. We had difficulty with our excess baggage at the Air Nuigini checkin and had to run around a bit to sort that out. Then when we arrived at the domestic terminal in Port Moresby, our flight to Wewak wasn’t even listed on the screen and it looked like it had gone without us!! The flight was late to leave and we arrived in Wewak after a huge rain storm and with plenty of clouds still hanging about, so the fact that we actually landed in Wewak was a good sign.

Things to be thankful for? Arrived in Wewak safely, we had enough money to pay for the excess baggage in Port Moresby, the people who said they’d be there to meet us at the airport were there and it was good to see them again: John, Susie and Yabru. The guesthouse was warm and welcoming – the other guests were all local missionaries from mostly West Sepik area and we had a few good conversations with them, the power was back on and we had clean beds to sleep in, a fan above our heads and a flushing toilet. After praying, we all went to bed and had a restless night’s sleep – the guests at the Sea View Hotel next door were playing up: lots of shouting and carrying on late into the night and early morning!

We also didn’t have to wake up too early for the car ride to Angoram as we did last time. We had a rest day in Wewak. Nice.

Mike, Deborah (seated) and me in our room. We even had a fridge to keep our water cool and the food away from the rats and cockroaches!

Deb, Debbie, me and Mike at Brisbane Airport ready to depart for Port Moresby

One of the beautiful views from the guesthouse

 

On Our Way

I’m resting in bed with my electric blanket on, the cat snuggled up closely for warmth and a view of pink outside my window as the morning sun makes her entrance. It is quiet – the dog and the children are now safely deposited with my Mum in Busselton eagerly looking forward to some fun holiday activities: clay modelling, ‘mosaicking’ and bike riding. The coffee is not good as the milk has gone sour!

So, am I ready? Well I hope so. I don’t know if you ever feel completely ready for a trip like this as there are so many unknowns. Thankfully there’s a baggage and weight restriction otherwise I’d have so much stuff ‘just in case’. I’ve had to remind myself of the priorities – education and basic practical resources that they can use to keep educating the people in their villages. So, birthing kits, 4 dolls and model pelvis’, knitted uterus’, pinnard stethoscopes, normal stethoscopes, a couple of birthing charts and some basic portable first aid equipment kindly donated by St John Ambulance substations in the Great Southern part of WA. In PNG we’ll have time and the opportunity to do a bit of shopping and so we’ll buy a whole heap of exercise books and pens so that the women can take notes – something as simple as this is a huge gift for them. We’ve photocopied some notes, but weight is a problem so I think it’s best we do talking, listening and practical demonstrating and then they write/draw so that they will remember.

I’m hoping we’ll be able to meet the Provincial Health representative in Wewak hospital so that we can at least mention to him what we’re doing! Also get some official permission to introduce a Family Planning intervention that has been successfully trialled in 2 other provinces and supported by Rotary International. See http://youtu.be/VJs_ZAOwPlkhave

We have a few pieces of neonatal resus equipment to donate to them as well. Once travelling along the Keram River we’re going to stop in at Kambot Health Centre which apparently has a Dr and 2 nurses. Brigit who we met last year in Yamen has arranged this for us as it is her village. She’s very excited that we’re returning to the area and said that the health workers at the Centre are very pleased we’re coming too. It will be good to listen to them and hear what they think the needs are with regards to health of mothers and babies.

I’ve developed a ‘verbal autopsy’ form to be used to gather the stories about the deaths of mothers in the villages. I don’t believe these stories are getting out to the Health Authorities so hopefully I’ll be able to collate them into a report and then pass them on to the relevant people in governing positions. I hope to get at least 20 responses.

Dr Tim, a medical colleague and tropic medicine specialist, who has just returned from spending a month in Wewak and Vanimo, has asked us to collect a couple of samples from women as he has a hunch that Streptococcus is the cause of many deaths related to sepsis (infection). Apparently in Wewak hospital the neonates are dying at an incredibly high rate due to infection. It was great to meet with him the other night and gain a lot more understanding and knowledge about malaria from a public health perspective, as well as other infections that are rife in the area at the moment: such as tuberculosis and leprosy. I’m feeling a lot more informed this time in regards to infectious diseases.

So, bags nearly packed, equipment and food supplies all gathered, passport and travel insurance documents all in a safe spot. Jewellery removed. Legs plucked of winter growth – it’s hot over there! We’re on our way.

Thanks for your prayers!!