Let me tell you of the pulse of Papua New Guinea
31 July 2016
HESELIBI Aid Post is in the Middle Fly District of Western Province. I had just finished weekend work at Rumginae and had taken a 6:00am Mission Aviation Fellowship flight to Heselibi via Kiunga.
"Doctor, there's a woman who has a breast abscess for you to review."
An innocuous phrase; a common phrase I've heard time and time again.
Hearing it from community health worker Fauwena Maliabu, staff member at Heselibi Aid Post, was not unusual.
"That's okay. Where is she?"
"She's in the house. She's too sick to come to the aid post".
I've travelled this far, I thought, a hundred meters more won't kill me.
So I was aghast when a 20 year old man half dragged, half carried the woman, his mother, into the aid post. She was acutely short of breath.
Immediately I regretted not sprinting to her house to review her when I first heard she had a breast abscess.
How could I let this poor woman walk to me in this condition. What type of clinical skill is this? I need to take a step back and humble my sorry self. What was I thinking?
I read her clinic book and referral letter.
These pieces of paper had been kept in remarkable condition. Rural citizens guard their clinic books as if their lives depend on it.
I read the referral letter which was dated one year ago and written by a visiting volunteer, Dr Shamini from Australia.
I was in denial. This couldn't possibly be....
As each sentence unfolded, so did the dread.
I was reading a referral letter kept in pristine condition in a remote village. I wished the papers had been too illegible to read.
With each sentence, I could feel the pulse fading away.
All the while the young man, her son watched me. So here I was, letter in my hand, the woman on the bed short of breath, the son looking at me and I am in one of the most remote communities in Papua New Guinea.
"Doctor," said the strong spirited son.
"Hmm?" I said, my heart in tattered pieces on the floor, my mind already preparing my ‘explaining the prognosis to relatives’ talk.
Then the soldier is turned on. The drill has to be performed.
Leave your heart out of it. Who needs a heart when a heart can be broken? Who would have known it would be broken in a remote, isolated community, one I'd never been to, by people I had never met before that day.
By a letter that was typed a year ago on the very laptop which, just this morning, I had seen as I picked up the Doctor's Outstation Visit Box back in Rumginae.
The woman had been referred to Kiunga Hospital. Attached to the letter were the findings of the FNAB, the fine-needle aspiration biopsy.
A sample had been taken and sent to Tabubil and then to Cairns for review by a pathologist.
I felt the pulse fading in the first letter. The second attachment was the pathologist’s report. I began reading it. Without seeing the woman, I could sense her pulse fading.
"Ol lain lo Kiunga talk olsem em needim operation but mipla nogat moni lo baim blood test fee na mipla kam back lo Heselibi." [The people in Kiunga told me she needed an operation but we didn’t have the money for blood tests so we came to Heselibi.]
I'm sure that there are pieces of my heart still on the floor of Heselibi Aid Post, in a place that time forgot. Broken by people I don't know, have no relationship with, had not texted, added as a FB friend. I don't know these people. They have no right to any part of my heart. How dare they?
The referral letter was the result of the Cairns pathology. There in black and white. Challenging me to defy its authority.
The axial lymph nodes showed metastatic changes. It was breast cancer in its final stages. Had it been dealt with a year ago there would have been hope.
There was no hope now. Death was inevitable. And I had let her walk 100 meters to see me. With her last reserves of strength, she had walked over to see me.
Due to the cut in the Christian Health Services Budget, hospitals had started charging fees so they could keep their doors open.
The blood test fees prior to the operation would have been K50.
But mother and son had been discharged to their remote home and told to return when they had the money.
The son continued to cut at my heart with surgical precision .
"Doctor, mipla gat moni now. Inap ba mipla kam na wokim operation." [Doctor, we have the money now. That’s why we’re here for the operation.]
Turn on the soldier. Perform the drill. Soldiers sing the songs that soldiers sing, the songs that you and I won't sing. They march along and look so strong. Like nothing in the world was wrong.
Each word was like fire burning my tongue, tearing at me and inflicting unimaginable torture on the strong spirited son.
"Mipla gat moni now", he repeated.
Now I had to destroy every ounce of hope that magnificent son had left. The drill had begun.
"Doctor. But mipla gat moni now,” he said again, in the hope repetition could change the outcome.
Step by step. I was determined to extinguish the spirit of this young man.
It was his eyes.
That look that Papua New Guineans have when they've been through a lot and this is one more situation to endure.
But it was his eyes that vanquished me.
"But doctor, mipla gat moni now."
I was sitting in the doctor's office. It was a daily routine to read the emails. I had developed a joy of reading the emails every morning.
But when I returned from Heselibi, I couldn't sit at the laptop. I couldn't touch it.
"Hello stations. This is Bravo 568. Any stations with medical for Bravo 568 come in. Over."
I was at the radio room in Rumginae talking to remote aid posts in Western Province, Hela Province and sometimes Western Highlands and Eastern Highlands.
"Heselibi here." It was our man on the ground, Fauwena.
"Doctor, she died".
If you ever, have the opportunity to visit Heselibi Aid Post, a remote and rural community, far removed from the outside world, a place where time stood still, you will find a strong spirited son there.
I want you to tell him I haven't moved on.
Tell him that every step he takes, he treads upon the pieces of my heart that was broken there in Heselibi.
The fading pulse of his mother has ceased.
But the strong spirited son, he is The Pulse of Papua New Guinea.
Good experience working in the most remotest part of the country & world. A good entry
Posted by: Leo Maso Malala | 06 February 2017 at 01:08 PM
Dr Kevin, A very touching story and it made me drop tears.
I came across many similar stories for patients with so many conditions such as advance cancers who were waiting for their death in their villages during my health patrols.
My heart broke over them because I cannot do anything to help them. Only in my imagination.
I would wait for their last breath to cease.
Thank you so much for allowing me to read this article which is so well expressed.
Posted by: Rita Kenge | 26 November 2016 at 07:52 AM
A very touching piece on health situation in PNG.
Posted by: Martinez Wasuak | 03 August 2016 at 04:28 PM
Excellent piece Kevin! Thoroughly enjoyed it!
Posted by: Robin Oge | 03 August 2016 at 10:14 AM
Kevin, I'd like to republish this in PNG Report with your permission? Grateful if you would kindly email me at email@example.com Thanks.
Posted by: Barry Avery | 01 August 2016 at 10:28 AM
Bless you Kevin for sharing this. Can I remind you that you too are the Pulse of PNG.
You and many others like you who do the work that needs to be done to keep our people alive, out there where the pay is not so great, out there where nobody sees your great work, out there where you are your own greatest resource, out there, where your work truly matters and you are the difference between life and death more millions.
Posted by: Anja Blyton | 01 August 2016 at 08:33 AM
Well written, Kevin. One more tragic story highlighting the plight of remote rural residents.
Posted by: `Robin Lillicrapp | 31 July 2016 at 04:09 PM