Family Planning is the Key

One of the things that was really special and an eye opener for Debbie and I was to witness what a PNG village looks like that has good health care, education and clean running water. Karkar Island is a volcano that rises up to the clouds (or the clouds descend on the volcano whichever way you look at it – by the way, apparently in 1978 the volcano blew its lid and killed 2 volcanologists in the process). There is a ring road around the island which links all the villages lying on the fringes. Spring water is piped from the higher reaches of the side of the volcano and this is then piped to the villages. Apparently smashing opposition village’s water supply line is a routine way to show your anger about something they have done! So throughout the villages we saw taps with shower heads on them – they were used for showering, washing dishes and collecting drinking water. Lovely crystal clean water.

As we drove along the ring road we saw a number of schools – primary schools, high schools and even a college where nurses, health workers, mechanics and carpenters are trained. There are 2 hospitals, one government run and the other run by the Lutheran churches. As well as that, there are numerous Health Centres dotted around which are staffed with fully trained nurses, midwives and Healht Care workers. We were impressed with their layout and the quality of the staff who we had the pleasure of working with. Then, in the villages are first aid posts which are stocked with basic supplies and staffed by health volunteers (I think some may even have a paid health care worker). Apparently on Karkar Island there are so many Health care workers that they can’t find work! This in direct contrast to East Sepik Province where they are battling to scrape together trained staff even for the main hospital!

The biggest problem facing Karkar Island is the rising population and that is why the local member for the district has sponsored Wendy to introduce the implants as a method of family planning. The population is 80 000 at the moment and unsustainable. As I mentioned earlier one of the hospitals is run by the Lutheran church which is a predominant denomination along with Catholic. Due to this there has been quite a bit of resistence and ‘false teaching’ with regards to the implants such as them being the ‘sign of the beast’ or ‘666’. Many women were afraid to have the implant because of this scaremongering which is false doctrine anyway. We spent a lot of time allaying their fears in this regard. I took the position that God is a God of love and He doesn’t want to see women dying from having too many babies or the children suffering because of a lack of food and other basic necessities due to poverty related to a large number of children. They seemed to agree with this and boldly took the step to have an implant.

The first village we visited had a lovely first aid post. We worked in one room alongside the ‘well baby clinic’. As women came with their babies to have them weighed and vaccinated, one of the health workers would give them some education about family planning and tell them about the implants. Then, if they decided they did want one, they came to us for further counselling and consent before an implant was inserted. It was hot in the building, a plywood structure with bars on the open window frames. We looked out over another primary school and a little stream that meandered into the ocean below. It was wonderful to see so many mothers with their babies coming for check ups and vaccinations – again something that the women in remote villages of East Sepik do not have the privilege of experiencing. The nurses and health workers diligently weighed the babies, plotted their growth on charts and wrote clear notes about the general health of the children. When I spoke to the women, most of them had had their babies in the Health Centre or Hospital assisted by a skilled attendant.

During their lunch break 2 teachers from the primary school came to have an implant. They were incredibly well dressed and well spoken! Each of them had one child each and were using depo provera as contraceptive until planning another pregnancy. It struck me that education is the key to improving the health of mothers and babies because family planning does make a difference to the life of a woman.



Sitting on the lawns outside the front of the guest house, Wendy gave us a lesson about the implant Sino II. The dog Gus joined in too and was great company (more on him later). The cool sea breeze brought welcome relief from the heat and humidity and the sound of waves was soothing.

The implants have been around for 24 years and researched extensively for their effectiveness in particular in developing nations. There is a recognition that it is difficult for women to travel the distances for health care, in particular traditional family planning medications such as contraceptive pills, depo provera injections or even tubal ligation. The Sino II implant is 2 rubber rods filled with a hormone progesterone which is slowly released into the woman’s body and provides protection against pregnancy for 4-5 years. If she chooses to have another baby, the implants can be removed and her fertility returns within a few days rather than months as per depo injection. The rods are inserted just under the skin of the upper arm.

There is a technique to inserting them and so we began our lesson practising on Wendy’s pillow! First putting in local anaesthetic forming a V shape under the surface of the skin. Then opening the trocar packaging without contaminating the sterile equipment, puncturing the skin with the trocar and then sliding it under the skin as superficially as possible. Leaving the trocar in place, removing the introducer and keeping that sterile, then carefully feeding the implant into the trocar, slowly inserting the introducer again and carefully retracting the trocar, but leaving the implant in place. Forming a V, repeating the process to insert the second implant.

The next morning we visited a village to find some clients to practise on! Debbie and I picked it up very quickly and Wendy was an excellent instructor.

Kulili Plantation

We hopped into Wendy’s ute with “Ken says do it” plastered on the side of the door as well as “Boroko Motors supports Family Planning” and off we went on the ring road towards Kaviak Estate, one of the plantations owned by the Middleton family who have been on the island since 1910 growing coconut palms and cocoa. Such a beautiful drive hugging the coast. After a 35 minute drive we arrived at the guesthouse. It was overwhelmingly beautiful. Manicured lawns, tropical flowers growing everywhere, guesthouse right on the beach, breakers gentle crashing in towards the shore. Wendy showed us to our rooms. Rebekah, Ester and Alexia had a whole suite to themselves which included a lounge room, bar, balcony and separate shower and toilet. Now remember these are women from a very remote village where they live in simple bush huts with no luxuries such as beds, chairs, flushing toilets let alone running water. They were amazed and their eyes were lit up like Christmas trees. I showed them where the cold water was in the little bar fridge, the cups to drink out of. Later on I had to show them how to use the ‘mixer’ tap as they had no idea and thought there was no water. I also had to show them how to flush the toilet.

Debbie and I had a lovely room next to Wendy’s and we shared a bathroom with her. There were photos of the exploits of game fishermen all over the guesthouse – blue and black marlin, massive fish as well as a beautiful photo of 3 orcas swimming in a row, apparently a common sight in this part of the world. “Have we got time for a swim?” I asked Wendy. In no time at all the 3 of us were in our bathers plunging into the refreshingly warm water of tropical paradise. We had to wear reef shoes to protect ourselves from the crown of thorns, but otherwise it was quite safe we were reassured. The Sogeram girls didn’t want a swim, but I soon found out that they all had a refreshing shower, something that they would not be used to in the village!

I didn’t venture too far out on my swim as I could a slight current, but put my snorkel and goggles on and saw lots of broken and white coral close to shore. There were a couple of iridescent tropical fish but in small groups.

We showered, got dressed and then head off to the main homestead at Kulili to meet Sir John and Lady Anna Middleton for lunch.

Their home is one of the few original Colonial homes left in PNG and is over 100 years old. It was built by Sir John’s father. He was given the land after returning from the 1st World War – an Australian army veteran that saw action at Le Somme in France. During the second world war when the Japanese invaded PNG, the house was occupied by Japanese fighters and there are still remnants of bullet holes and gunfires in the walls and floorboards. I felt I was stepping back in time. Beautiful colonial home with walls covered in native art and crafts. Everything was big and beautiful. Lady Anna and Sir John were lovely hosts. We were offered wine and more wine and then more wine! In the tropical heat I had to pace myself carefully!

After a few drinks and polite conversation with the elder Middletons, their 2 adult sons who now run the plantation, the biofuel engineer and another Englishman who is a plantation owner, we sat down under the shade of a rainforest tree to a sumptuous lunch of roast ham and vegetables. We were gobsmacked. I said to the Middletons that this is a unique experience for us as we usually have plain food in really remote villages! It was quite bizarre and certainly not what we’d been expecting on this trip either. After lunch we were served freshly made chocolate cake and coffee. 3 hours later we headed back to our accommodation and our first lesson in inserting implants.


Karkar Island

Arriving in Madang I felt a bit disappointed that yet again we were arriving in the dark. It’s really hard to get a good first impression of an unfamiliar place when you can’t see where you’re landing. I find the PNG towns are very dark because there are fewer street lamps than in Perth. So again we arrived at a small airport in the dark. But what a delight to have Yabru meet us there. It is always so good to see a familiar face and be warmly welcomed. Yabru had recruited some Pioneer Bible Translator missionaries who had a vehicle to collect us which was great. They drove us to our accommodation which was behind high fences and electric gates along the main road into Madang town. It was busy and we were warned to be careful. The electric gate opened and the car ducked in, quickly the gates were closed again. I noticed that they were very wary and on the lookout all the time.

Our accommodation was magnificent, like nothing we’d experienced yet in PNG. It was an above ground self-contained flat that had everything we needed including an ice-cream maker on the shelf! It was very comfortable. So after a lovely shower and a change of clothes we sat down to a meal of rice and tuna (thankfully I’d packed a bit of food). Life was good.

After a very disturbed night – traffic, barking dogs, screeching bats, probably some possums too bouncing along the rooftop and men shouting – we were picked up by a woman named Robbie who owned a minivan. She ran a people moving business. We had an hour ride to the venue where the boat would transport us to Karkar Island. Being a Sunday it was difficult to find transport so we were thankful to have found this minibus. Mike was dropped off at the local church as he was giving the sermon that morning and Debbie and I were now on our own. Along the way we picked up 3 women from a very remote village along the Sogeram River where there is no health care and Yabru was keen for us to work with them to give some education about family planning and clean safe birth. Their names were Rebekah, Ester and Alexia. They spoke very little English and were shy. This was there first time travelling in a boat across the ocean and so they felt very nervous.

The road to the pick up point was not too bad – a few potholes towards the end but otherwise quite a smooth ride (a different story on the way back). The area was really beautiful. Cocoa trees and coconut palms dotted along the way and a beautiful flat blue sea to our right and high tree covered mountains to our left. We arrived at the rudimentary harbour where ‘banana boats’ transport people across to the island. It was absolutely idyllic . Crystal clear water, small islands of coconut trees just off the coast with rings of coral around them – just like the coffee table travel books. It was incredibly hot and humid but the ocean was flat and that was what I was interested in. In the distance I could see the magnificent Karkar Island, a volcano rising up to the clouds. We loaded up our luggage, the Sogeram ladies and us and off we went. Bernard was our boat skipper. It was a flat ride and so it was comfortable. Rebekah, Ester and Alexia were relaxing and so were we. We saw a huge pod of dolphins swim by and every now and again a flying fish would take off and flutter across the top of the water, landing about 200m further along. It was magical.

As we came to the edge of the island I could see a group of people waving to us. There was Wendy Stein in her blue top and with camera in hand taking photos. “Which one is Sara?” she asked. “I am” and stepped towards her and gave her a hug. We stood and hugged for a while, it was lovely to finally meet this woman who I’d only spoken to on the phone and in emails, but with whom I felt a natural affinity and who had inspired and encouraged me so much. “Welcome to Karkar Island” she said, “We’ve got an hour and then we’re having lunch with Sir John and Lady Anna Middleton”.

Debbie, Alexia, Ester, Rebekah, Robbie and Me

Another PNG Story begins

I’m not a very disciplined writer as you can tell. I had someone email me because they were very concerned that my last post was about a hostile reception in the village of Bunam and then no more – she was just checking I was ok. I do apologise to those who have been following this blog. I know I’d find it frustrating to be drawn into a story only to have it end abruptly. After I wrote the last entry we returned to South Africa to see my husband’s parents who are quite elderly. 4 days after we returned to Perth my mother in law died, so as a family we have had much to deal with…

And now I am recovering from my most recent trip to PNG, 9 days between Madang (Karkar Island) and Wewak. The opportunity to go again came quite suddenly as a contact of mine Wendy Stein, a Rotarian who has been working tirelessly in PNG for the past 8 years, was relocating to Karkar Island to roll out a Family Planning initiative – the Sino II contraceptive implant that lasts for 5 years. It is inserted under the skin of the upper arm. Wendy suggested we travel across and she could train us officially in inserting the implants. We could then introduce them to East Sepik Province beginning with Wewak. Mike Bullard was already going to Madang to spend time with Yabru and some other church leaders and so we piggy backed with him. We are Debbie Butters and myself. Deb came to Bunam in July with me and is also a midwife.

When I booked the tickets I suffered with sudden onset of fear: this trip was going against my normal route of preparation – control, control, control, especially when travelling through a third world country like PNG. Are we crazy going so soon after our latest trip, nothing in Wewak is set in concrete and organised, the tickets are sooo expensive, there’s only 2 weeks before we leave. But amazingly the money came through in donations and selling of sausages at Bunnings and we were able to fully fund the trip which was just wonderful and certainly something to thank God for.

So, on Nov 15 I set off for Brisbane. This time I travelled through the day and had a sleepover with a cousin in Brisbane. I think this made a huge difference to my overall experience in PNG as I wasn’t so tired and emotional this time round. While transiting in Port Moresby I met up with Norah and Omega again, the 2 MOPS Mothers of Preschoolers leaders in PNG. It is always so good to meet with them and hear about what they’ve been up to. We had about 2 hours together.

Whenever we travel we always meet significant contacts while queuing up at the airport. This time was no different. A guy called Mike overheard us mention Wewak and so he introduced himself and said he was heading to Wewak to visit friends associated with Samaritan Aviation. We said, oh yeh we haven’t met Mark Palm yet but we’re meeting him when in Wewak too. This guy Mike was travelling from California and is an engineer. He was going to help SA by surveying a piece of land that had been given to them by the local people next to the airstrip and which they planned to develop as a mission home base for Samaritan Aviation. We spent some time talking with Mike while waiting for our respective flights. It was amazing, but his flight to Wewak got cancelled and he couldn’t get a SIM card for his ‘locked’ phone so was not able to contact Mark, but we were able to help. Deb gave him her phone to use and a SIM card and I was able to give him Mark’s mobile phone number. I got to see Mike again in Wewak which was great – he’d lost a few kilos by then after sweating it out in the jungles of PNG, uncovering Japanese antiaircraft guns, unexploded bombs and bullet remains from the war! He showed me photos and it was amazing. He said there were bomb craters deeper than his height still scattered over the land.

Thankfully our flight to Madang was on time as we had a tight schedule. As I boarded the plane I began to feel slightly anxious again as I was going to an unknown place. I sat back in my seat and looked out the window taking deep breaths. All of a sudden a magnificent rainbow appeared across the sky. It seemed to envelope the whole area and was very clear. The rainbow extended up over our plane and seemed to form a tunnel for us to go through. I started to relax and feel at peace again as I remembered God’s promise to Noah after the flood. New Beginnings, I thought and God is watching over us.