Chris is currently out of the office

I left Papua New Guinea in the middle of October. I am writing this at the end of December. Since then I went to South East Asia with the intention of relaxing, but actually ended up partying all night most of the time. Later, I met with MSF to debrief and then with a psychologist to see if the mission had any adverse affect on my mental health. I also was invited to talk to MSF and others about the PNG mission, opportunities that I really enjoyed. During these talks I received some very thought-provoking questions. People wanted to know if it was difficult to fit into a society that was so different to my own, referring to the sorcery and violence. The truth is that it wasn’t that difficult to adapt to Papua New Guinea. The people were so friendly and warm towards me that it was leaving that was difficult. And as I write this, 2 months after leaving, what I am finding very difficult is adjusting back to the society I left. Media headlines on the personal lives of celebrity singers or sports star disenfranchise me from society. I enjoy partying, but so many times I wonder about how much money we waste on processed food and alcoholic drinks and if we can enjoy ourselves without them.

Photo : C Houston

I spent the first weeks believing that Papua New Guinea was the most wonderful experience of my life so far (I still do) but that it had not fundamentally changed me as a person. My two weeks in post-tsunami Sri Lanka was my life changing experience. But as time passes, I start to realise that PNG did change me. I observe people more and I am saddened by extravagant and unnecessary spending or obsession with fashion and celebrity culture.

In a few weeks I return to the life I had before, I love working for MSF but I have the opportunity to work in London and my bank balance forces me to accept a job back in the UK. But I’m fairly confident that I will return to PNG and that I will return to MSF. I have left a bit of my heart in both of them.

I’ve received quite a lot of nice messages from people who have read this blog, many thanking me for the work I’ve done. Some people say that the MSF logisticians are the ones behind the scenes supplying the medics with the things that they need. But actually there are people behind the logisticians who deserve some thanks: Ken, runs the MSF Canada website and my blog – cheers dude. I want to say thanks to Isa for her inspiration while writing this blog and for the thought provoking questions she asks when we have our conversations. I want to thank my three wonderful bosses, Julia, Isabel and Claire for their direction, for their trust and for the laughs. Huge thanks go out to David J our driver, artist and carpenter in Lae for doing so much. I want to thank David K and Adam B for being my brothers. I want to say thanks to Marc (head of mission) for the sacrifices he has made for MSF and I want to say thanks to Karen for the constant laughs. I want to thank Nadia, the hardest working person I met in MSF. I want to say thanks to Keith and Otas, the guys who took over from me for being so super cool. My biggest worry towards the end of my mission was about leaving what I had been doing with people who would do a good job. With Keith and Otas I can relax knowing things will go well. I want to say thanks to Mevis, Emasi, John, Yako, Kobe and Hewali and especially Awaro for guarding us when we worked and slept and especially thanks to “lifesaver” for putting himself between us and harm’s way in 2009.

I want to say thanks to Jui for being the easiest going person to work with. And I want to say thanks to all the other national staff who continue to work hard, long after us expats complete their missions in Papua New Guinea. A final special thanks go out to Norman, the nurse who saves lives.

Epilogue

So I hope you enjoyed reading my blog. If you are reading it because you want to join Médecins Sans Frontières as a volunteer, I would encourage you to do it. It was the greatest experience of my life. If you are reading this as one of the many individuals who make up the vast majority of our funding, then thanks for allowing me to help. If you are reading this to learn more about PNG then I hope I gave you some insight about the tragic violence that occurs there, but I hope you also saw the warmth of the people there. I met some of the most wonderful, warm friendly and trustworthy people in the world in PNG. The paradox of the violence and the warmth of the people is something I can never understand. If you are reading this because you have an interest in addressing the sexual violence in PNG then I urge you to act. In my last few days in PNG, my former boss told me about a patient who had been imprisoned for weeks, moved around a province and raped by different men each day. Sometimes, when I see what makes the news where I live, I want to scream at people “open you eyes, see what is happening in the world”. But I don’t. Instead I write this blog. Thanks for reading it. Please tell people about PNG.

Every 6 weeks the team in Tari get a weekend rest, so the project  coordinator, the new logistician and the surgeon left me in charge for my  last few days.

Saturdays are always nice because we start at 9am, which permits an extra  hour in bed. Because there is construction going on at the house, this  extra hour in bed tends to be too noisy to sleep, but I had given the construction workers the weekend off too, so Saturday started nicely. The  morning was not too busy and I decided to take the chance to do some “community relations” so I had a smoke with the hospital security guards outside the hospital gates. People in Tari love to talk and ask questions.  “When will MSF leave?” they asked me, so I explained that we did not have a leaving date, but will be in Tari for as long as the Ministry of Health needs our support. The hospital management were currently absent following a security problem, so I had to explain that we were not in charge of the hospital, but just the guests of the management and that we felt it was better long term for Papua New Guineans to run the hospital and for our help to be temporary. They accepted the explanation. They asked if I was sad to be leaving and I explained that I was sad to leave but also happy to be close to seeing my family again. I was also happy to be close to eating some McDonald’s and driving a motorbike, but I decided not to talk so much about that.

After the chat, I went for a last walk around the hospital to ponder my thoughts. Unusually, I saw a child crying. Despite the horrible injuries that come in, it was actually the only time I can remember seeing a child crying. He had his leg in plaster, extended from his wheelchair being supported by a bucket and blood was soaking thought a gap in the middle of the plaster. I decided to go and talk to the Operation Theatre nurse. She thought it best to take a look, but asked me to help out in the OT during her absence by holding the hand of a small boy who had a puncture wound under his shoulder from falling on a stick. It’s was a rare opportunity to actually get involved in medical care, so I was happy to help. As the nurse left she told me “Don’t let go of his hand, no matter what” I realised that I was not there so much to comfort him, but to hold him down as the nursing officer started injecting the anaesthetic around the wound. The boy was terrified. The nursing officer and I both spoke Tok Pisin, but the boy only understood the local dialect of Huli so we could not even explain to him what was happening. As he squirmed and squealed it was clear that some maternal input was needed and we asked his mother to come and help. The nursing officer removed all the bits of dirty T-shirt that had been impaled into him and carefully stitched up the small hole.

He was finishing as the nurse came back. I needed to go and get some stock for the OT but the nurse asked me to come back, while we had been fixing the small boy, a man bleeding badly from his shoulder had arrived outside and she wanted some help moving him. As I left I saw a man slumped on the ground looking distressed in a pool of blood. I bypassed the normal stock system and went straight to the main warehouse so I could quickly grab what was needed and rushed back to the OT to help move the man. But when I returned, I was surprised to see a young woman on the OT table. She had been carried in on a stretcher made from rice bags and sticks which was still below her on the OT table. Both her mutilated arms had sharp bones sticking through ragged holes in her skin, a finger was hanging off and her face was peeled back from a 20cm cut on the side of her head and neck, her skull visible through the wound. “Can I help?” I asked the nurse who had already radioed the anaesthetist for assistance. “Yes, help me find a vein” she said, as all three medical staff were trying to find a blood vessel so they could get a blood sample before giving her the blood that she needed to stay alive. I grabbed a cloth and wiped dirt from her feet as the nurse tried to find a vein. “Her veins are all closed” the anaesthetist exasperated as he tried to extract some blood from her jugular and the nursing officer worked on her arms. “Is she even alive?” the nurse at her feet asked and I looked up to see the patient’s eyes moving although her body appeared lifeless and wrecked. I was sent rushing to the laboratory to get a bottle to collect the sample in, although it looked hopeless for a while just before the nurse tried her neck again and got enough blood for sample. I sprinted to the lab so they could find out the blood type. I then talked to the family, explaining that she would need a lot of blood and that they should ask as many people as possible to donate. In PNG people rely on family and friends to donate, there is no blood bank.

After she was stabilised the anaesthetist had the gory job of removing her destroyed finger and sewing up her arms and neck. I could see the sadness in his eye as I passed him the bone cutters, on his first mission in his first week, our new anaesthetist had already seen more violence than he had expected.

Photo: C Houston, MSF | Nursing Officer Norman and Betty move a patient

The nurse then asked me to move the man outside to the dressing (bandaging) room next to the OT and get him on a bed ready for the other doctor who was finishing off with her own crisis on the other side of the hospital. I moved the bleeding man onto a table, and got all the infusions equipment, bandages and gauze ready for the doctors imminent arrival. The in-patient nurse arrived first and we tried to stop the bleeding and assess his injuries. He had a 15cm deep laceration to his shoulder. We later learned that his cousin had received some money from a telecommunications company to permit them to build near his house. The man wanted his cousin to share the money, but when he asked about this, he was chopped. “I’m dying” he kept telling us. But he wasn’t and we tried our best to convince him of this as the doctor arrived and started stitching up his muscles, artery and skin.

Just as she started there was a knock on the door. I went out to see the nurse of one of the local companies who had brought in a local community member. His hand was hanging on by a piece of skin only and he was shaking and bleeding on the trolley. I stuck my head into the OT to see they were still stitching up the first lady and advised them of what was to come. The man with 1 hand clearly could not wait outside so we moved him into another bed in the dressing room, which was now very busy and very bloody. The doctor took a look and quickly realised that we could not save his hand. I was sent to get another pair of bone cutters, more gauze and some more morphine and tried to empty the bins of blood-soaked clothes and gauze. Another man then arrived with a bush-knife chop to the fore head, but it was clearly not deep or life threatening and thankfully he could wait until the first three patients were dealt with. As things calmed down I organised cleaning up the mess explained to the sister of the patient that her brother would loose his hand and then went home and changed out of my blood soaked clothes. In the midst of it all our new car had been delivered, but as I was holding the shoulder would closed at the time, I had been unable to inspect it following its dangerous journey up the highland’s highway. I instructed the guards to clean it and check over it as I went back to the OT to run more errands for sutures, oxygen, batteries and anything else that the busy medics needed.

I left the OT around 7pm and the rest were home for 8. Saturday night should be our “party night” when we might watch a DVD and have a laugh, but everyone ate and went to bed. At 1130 the radios went off as the nursing officer needed the keys to a building to get more supplies. I heard the drowsy nurse reply and offered to run the keys up as I was clearly more awake than she was. I arrived back at the OT again to see our off duty security guard inside and covered in blood. “What’s happening?” I asked before 2 more men hauled an semi-conscious man from the lavatory. “We heard of a man who had been chopped and dumped in a ditch”, the guard said, “so we looked and found this man”. He had a bush-knife chop to the top of his head that had cracked his skull . “Do you need some help?” I asked the nursing officer, who had already had a busy day, “yes please, can you set up an IV?” he asked. I did so, checking if he wanted medical support rather than a logistician running on adrenaline. “No, it’s OK he said, can you just put in the IV?” he asked. “Sorry, no” I had to explain that I could fetch him things, but my skills didn’t extend to sticking things into people. “Don’t worry, he said calmly, I’ll be fine.” And he was. Working away at midnight stitching up the injured man I saw a true hero of Papua New Guinea. Thank you Norman.

I’m currently back in Lae for the final time. I came back to help out with a few things and then the Cholera outbreak occurred. MSF responded full force and at the time of writing patient numbers have dropped to a couple per day. I am sure that our speedy action prevented the outbreak from mushrooming and I am very proud of what we all did.

In the past few days my replacement has arrived. The team have been nervous about my replacement arriving for some time, but I am so relieved that not only is he enthusiastic and full of ideas but he is also half-Scottish!

The new guy immediately advises that his bus journey from the airport was done at super high speed (as do many first time visitors) thinking that the drivers were a bit reckless. I explain that the airport road is a bit notorious and that moving fast is done to thwart those who would like to stop the vehicle to rob the occupants (earlier in the year, our security guard witnessed an attempted robbery go wrong when an angry mob grabbed the gun from the robber and beat his face with his own gun until his own eye fell out of his skull, chopped the top of his head off and gave him over to the police.)

On Monday we have our daily security meeting and the staff reports the incidents they know of. Monday’s meeting are always full of nasty evenings, and today’s is no exception with stories of robbery, rape, gangs fighting with bushknives and people selling stolen goods on the market. 2 incidents we hear of actually involve our own staff: one lady was chased by a man with a bushknife (machete) after a crowd tried to stop him beating his wife in public and one of our nurses was punched and robbed of her bag of books on Saturday after church.

Photo: C Houston, MSF | Bushknife section in hardware shop.

One of our councillors reported girls being abducted by men, but fortunately they escaped after they shouted out for help and some other men chased the perpetrators away. She also witnessed a fight outside the hardware shop between men with bushknives. I can see that our new log is just a little bit surprised by the number of incidents that our staff encountered of heard.

Later in the day we stop movements after the Cholera team phone us to say their logistician is taking refuge in a hardware store while shots are being fired in the market area. We later learn that “raskols” stole a car and tried to rob a bank. Police killed 2 of them on the scene.

Wednesday bring reports of 63 prisoners escaping from the main prison in the capitol city and a bloody fight at a school in the Eastern Highlands that involved 4 deaths, one by decapitation.

Our new log quickly learns that PNG is a busy place and we agree to continue with the high speed journeys to the airport.

So my contract is due to finish 1st October.  9 months in PNG has flown by. After being sent up to Tari to get 3 building projects moving, Lae were short staffed and asked for me to come back to sort out their clinic extension project and a few pieces of administration.  It was also an ideal time to buy all the things that the Tari construction project needed.

Upon arrival I was very pleased to see that my two assistants has done an excellent job of running things without an expat logistical supervisor.  I started by telling them so, and that I was only here for a short time to sort out a few things and was quite happy to leave them running things.

The next day, stories started coming in of the Cholera.  The medical coordinator phoned to suggest I read the “Cholera guidelines”.  The guideline was an inch thick of paper, so I decided to put it off until the next day (a mistake).

The next day we knew trouble was here.  Reports of people with extreme diarrhea already in the hospital came through.  Some had died.  The boss told me to find a tent.  The biggest tent I had ever seen in PNG was an army one, and the helpful officer in charge agreed to deliver 3 the next day.  I read the cholera guideline and list of contents in the standard MSF cholera emergency kit.  “……buckets, chlorine powder, rope, spraying equipment……. The MSF emergency team were arriving the next day, the hospital CEO, director of medical services, director of nursing, director of finance and admin, the boss and I met first thing.  Well, second thing actually, me and the army met first thing.  Army early.  The hospital had already decided we knew Cholera more than they did and put us in charge. The army put up 5 tents.  The log team went chlorine and bucket and sprayer shopping.

The emergency team arrived and told us to get more tents.  As I write this we have an isolation ward with 15 beds and tents with 21 beds and by noon tomorrow I need to have somehow 75 beds.  Preferably more.

Cholera is spread by “the fecal oral route”.  It is avoided by washing hands after using the toilet.  Cholera sufferers loose up to 40 litres of fluid per day.  From the end you’d rather patients didn’t loose things from. Cholera patients need hygiene and isolation.  Extreme hygiene.  That means Chlorine.  Foot baths at the wards, hand washing at entry.  Cholera doesn’t smell of what you’d think it does.  It smells of Chlorine.  I smell of Chlorine.

The patients lie on beds with holes cut out in the middle and a bucket underneath.  The come in with sunken eyes and looking frail.  50% of people will die of dehydration without medical treatment.  98% will live if they get medical treatment.  The medical treatment is rehydration.  A man came in looking like death yesterday.  He was talking about playing football today.

Chatting to friends tonight I realised that all but one of the health posts that people come to before the hospital are closed.  People are dehydrating all over the province.  Tommorrow they will learn that we can treat them. They will come and we will be busy.  I hope I have enough beds, enough buckets and enough chlorine.

The biggest difficulty with Papua New Guinea for me is trying to understand the paradox: everyone is super friendly, and yet the level of violence is so high.  Today (Sunday) we visited the house of my technical assistant.

Everyone we passed on the road said hello and shook hands or smiled.  Our operating theatre sees between 20 and 60 patients a day, virtually all thetrauma cases are the result of violence. This morning I accompanied the nurse-supervisor to the ward.  We were all woken at 8am (sadly, as Sunday is our chance to sleep late) because one of
the national nursing staff had radioed for assistance.  I decided to go for the walk as I was awake.  Before we reached the ward, a patient’s guardian approached me and explained that he has been referred to us from a local clinic.  I read the referral letter before radioing the project coordinator, he had been chopped by his mother over a land dispute.

There seems to be some basic rules of violence in PNG:  All injuries seem to be sustained from bushknives.  All disputes seem to be over land, women or pigs.  Revenge is more violence than the proceeding act, so it’s a fairly vicious cycle of violence following violence.

So, while I’m very glad to be in PNG, I’m also very glad to get to go home one day.  Not that I actually have a home, but I get to go somewhere with less bushknives.

In some ways it seems like I’ve only been here a few days, things move so fast in Tari – but in other ways it seems like I’ve been here forever, it is so easy to understand the challenges in Tari they are often so similar to those in Lae.

Tari General Hospital

I have actually been in Tari for about 2½ weeks. Since then I’ve been woken by VHF radio most nights when the hospital staff need the assistance of the expat nurses, anesthetist or surgeon. Last week the entire team responded at midnight to a lady who had been stabbed, I dealt with the extended family, tried to persuade them to donate blood, ran errands for the medics, fetching oxygen or passing messages to the laboratory technician who was collecting the blood.

Twice since I’ve been here I’ve had to stop the vehicle to unexpectedly bring people to the hospital. One lady was unmissable: she was lying motionless, bleeding in the middle of the road. My new boss and I jumped out (fortunately she is also a nurse) picked her up, put her in the back of the vehicle and drove back to the hospital. By way of an explanation of her injuries she said only “Niupella Meri” (new woman) and immediately it was clear, I had heard it all before so many times in Lae. Her husband had a new wife and this was his way of letting her know. She had been stabbed in the hip punched in the face so hard she was unconscious.

Stabbings and choppings seem to be the most common problems that I see. I see a lot more here than I did in the clinic in Lae. There is a lot going on and I’m rushing about between building projects, helping a nurse move a patient or trying to get a generator started and so I see a lot of our patients who all love to chat. I was given some wonderful presents when I left Lae, most items of jewelry or bilums (man bags) so a group of patients call me “Morobe Mangi” (Morobe being the province that Lae is within, Mangi meaning “boy”) as they can tell where my bag comes from. Being able to speak Pidgin makes my life easy. Although Huli is the first language of Tari, Tok Pisin is the second language and most people understand it. And everyone likes to talk and knows who MSF are, they all remember when the hospital didn’t function and are very glad that it does now. I’m very glad to be here.

My day started well, I slept in until 830 and took a driver shopping. I had just learned that was going to move to Tari, in the highlands, where MSF provide surgery in the ministry of health hospital. Unlike coastal Lae, Tari is cold so I needed a jacket and a jumper so went to the second hand clothes market and got one of each. Arriving at the office I was surprised not to see either of my assistants. They don’t normally work on Saturdays, but half of our medical cargo that should have arrived at the airport the day before did not turn up, so I told my Robin, my supply assistant that we had work to do and my admin assistant volunteered to help too.

The airport is some 30km outside Lae and the road towards it is dangerous. We travel the road at high speed in the bus of a security company. Getting 1,200 kgs of medicine from the airport to the warehouse (that a friend has let us use for free) is risky business. Having to do the journey twice made me uneasy.

So when it reached 10 o’clock and my supply assistant (who had the only notes on which boxes we received so far) had not arrived, I was annoyed. I don’t get annoyed much, but getting the shipment back into MSF custody was a high priority.

I took the unprecedented step of sending a vehicle to collect Robin from his house. Friday is pay day, is drinking day and is partying day so I was in a foul mood assuming that he had been up late the day before and slept in for one of the most important work days of the year. The car radioed back that
he was not at home. I sent the driver to check the bus stops. It was raining hard and demand for busses would be high.

Then the clinic guard came in to my office. She told me Robin’s brother was here. They were both attacked and robbed last night. I marched through the hospital with his brother, idle visitors jumped out of my way, surprised at our pace. “Where were we going?”, I wondered, panicking as we approached the intensive care department. We walked past, were we going to a ward? No, we walked past. We we going to Accident & Emergency? No. We approach what I assumed to be a dead body, leaning against a wall, under a blood soaked sheet. Robin’s brother points to the figure. My admin assistant who has been trying to catch up with our pace the whole journey and I are speachless as we peel back the sheet and see Robin’s badly beaten face. Emotion overwhelms me, am I am horrified that he has been sitting in the hospital entrance lobby under a sheet having not receive any medical care since he arrived over 12 hours ago. It is obvious that something needs to be done. Immediately. I run through the corridors back to the clinic and arrive at the bosses office out of breath and upset. I tell her the story and she agrees that we put him straight into the private hospital.

Arriving at the hospital I despair to see a room with 50 people waiting. All look rich and healthy reading magazines and drinking tea. I am close to exploding as the slow receptionist asks me Robin’s date of birth, home address, how we will be paying. “Keep calm”, I say inside my head as Robin sits soaking more blood into the sheet over his head. I stand where the doctors come to call the name of the next client. I grab the hand of the first one that comes, reading her name from the box she is about to grab a patient file from. Fortunately, she knows of our clinic. “Have you got a client for me?”, she asks. “Yes. This fellow here, under the sheet has been sitting bleeding all night. He has received no medical attention in 12 hours. He is my colleague and my good friend. I’d like someone to look at him now” (with emphasis on the ‘now’). She can see the determination in my face. The nurses take him straight into their Accident & Emergency room. I relax. A little.

My thoughts turn to the shipment. I get a driver to take my admin assistant, a radio and a plastic sheet to the transport company to arrange the collection of the missing medical items. I then send the other driver to get clean clothes for Robin. I had given a bag of clothes that I wasn’t planning on taking to Tari to the guards on duty at the house and I tell him to go and fetch shorts and T-shirt. Robin asks for some juice too and the driver goes shopping with the money I had given him to buy fuel before things started going wonky. My admin assistant radios. The transport company have already left without him to supervise the collection. They have no means of calling them back. We agree there is nothing they can do, we can only hope they bring back all the items. 10 minutes later he radios again. The vehicle is back at the depot with no medicine. I call the transport company from the hospital and my frustration boils over when he suggests that our airport trip is a waste of his time. “You are a transport company. This is your job. We are paying you. I have 500kgs of medicine sitting getting warm in the airport. It must come here today”, I shout down the phone at him. He agrees to send them back in the afternoon. Being friendly and patient is generally the way to get things done in PNG but by now I don’t have the patience. I can see people glancing at me nervously in my bloody clothes.

I wheel Robin’s wheelchair from A&E to X-ray. I leave the room as I see that the technician isn’t going to warn me before he gamma radiates us all. I’d at least like the option of being a father at some point in the future. 6 pregnant ladies in the corridor are waiting for scans and I strike up a conversation with them in Tok Pisin. Most “white men” just fire someone who is sick and get a new worker, they advise me. I explain that Robin is my friend and colleague and where I work we take care of our staff. “God will thank you” they tell me. I loose it and can’t hold back the tear any longer.

I wheel Robin back to A&E where his wounds are dressed. The doctor calls me over to discuss his X-rays. We chat for about 5 minutes in medical terminology before it strikes me that she thinks I’m a doctor. (“Doctors without Borders” is the claim on my T shirt). I can see relief in her whole body as I tell her that I’m mainly doing security and transport. She had been thinking that I was analysing her medical decision. Robin’s nose is broken, but skull is OK and there are no signs of any brain damage. I take him to our house where we have ice packs before getting a driver to drop him at his home. At the house, an air conditioning engineer has been waiting for me. I grab a cold drink and let him tinker with the medical store air con unit, give him some money, tell him I’m going to Tari and thank him for the good work he has done (much of it for free) as he is just one of many people in Lae who really support what we do and I rush to the transport company to sort out the medical shipment. I was embarrassed to ask him early on the journey, but it seems Robin has wisely kept a copy of all the cargo paper work in the desk and so things are looking brighter in terms of our cargo’s logistics. “Mi sori tru yu no amamas long me”, I apologise to the transport company manager, “wokman bilong mi gat buggerap face long plenti man pitem em assday. Mi askim yu sendim man long airport bringum cargo bilong mi”. My Tok Pisin isn’t great, but good enough to impress locals that a foreigner can try. He smiles and send the same team as yesterday with my admin assistant.

I go to the clinic and tell the boss the morning’s events. With a few hours to kill before the cargo will be back in the town I go home to see if there is any food. It is raining heavily and we drive past an old man sitting on the pavement surrounded by a crowd. We radio base to tell them our plans and spin the car around to see if he needs help. Neither the driver or myself are medics, but I’m guessing the crowd aren’t either. As we cut across the road to approach, the crowd assume we are trying to entre the house they are outside and bundle the old man out of our way. I jump out and ask if he is OK. A lady threw a rock at the man and he can’t walk. I ask him if he wants transport to the hospital but he doesn’t. The crowd are clearly stunned at this turn of events. Ambulances in Lae only seem to be used for transporting dead bodies. I can see the crowd reading “Médecins Sans Frontiers” on the vehicle and staring at us. A man asks us if we would take the old man to the bus stop and we do that. David the driver is very excited that logistics are using our vehicles as quasi-ambulances for 2 times in 1 day. “This is why we are here”, I tell him, “to treat the survivors of violence”. I know that David and I are proud of being able to help, logistics don’t typically get to deliver front line assistance. He is also happy that the public saw that we stopped and went back to help.

The shipment arrives and I trick the boss and mental health supervisor into a “warehouse tour” which result in 2 extra pairs of hands for unloading the truck when it arrives. We all go home and decide it’s time to have night out and treat ourselves to pizza and drinks we cannot afford in the hotel before coming home and dancing in the back garden, barefoot in the mud.

Doctors advise that Robin’s nose will heal in 3 to 6 weeks and that he will be back to his handsome self within a week or so. The robbers took his phone, wallet and pocket contents.

The nurse bought a little weather station when she was in Australia.  Last month (June) we had over a metre of rain – on average 35mm every day.  But it doesn’t rain every day.  Just now it rains about 2 days a week, but when it rains it rains heavy.  And when it rains crime happens – because the security companies and police are slower to respond.  I can’t tell if it is less hot in the past few months or if I’ve just acclimatized.  I could not imagine wearing long trousers in the first few months, but I wear my jeans every day now.  The nurse says the temperature has been between 29 and 39 in June.  Until I went on holiday I only had 1 pair of long trousers and when I arrived I only had 1 pair of shorts.  I don’t think I’ll take any of my current clothes home.  They get worn out so quickly here.  I’m not sure what the pattern of the seasons is here.  None of the expats stay long enough to work it out and when I ask any of the local staff they tell me it is
currently wet seasons (if it is raining) or dry season (if it is not).

The current team has 4 girls (project coordinator, nurse, doctor, mental health supervisor) and me.  Everyone I speak to seems to think that working with 4 women must either be heaven or hell.  Most people assume the later. Actually they are cool and we get on really well most of the time.  Most evenings we sit under the canopy at the back of the house and talk about our day or what direction the project should be taking.

We have a cook, which surprised me when I arrived.  It turns out that when projects have a cook the team will eat well, when they don’t the team eat badly and are more likely to be sick.  Our cook is a wonderful old man called Adam who calls me “pikinini” (the Tok Pisin word for child – like I am his son).

The clinic is open 6 days a week and we stay open on public holidays (people don’t stop bashing/chopping/burning/biting their wives for public holidays) and so we can take a Sunday off when we want.  But for me it never works out like that.  Much of our operation is at the house – it’s the location of the medical store, where the vehicles are based, the guard’s base and the house itself needs things fixed.  So Sunday tends to be fixing things at home, making up medical orders and counting stock day.  Last Sunday was an exception however and we were given permission to go to a nearby peninsula by boat.  It was great – we went snorkeling, hiking and even got to see a WWII Japanese tunnel that foreigners are normally preventing from seeing (the land-owner’s sister works in the hospital, so he liked our work!).

I had to decide last week if I wanted to extend my contract until the end of December.  It was really tough decision.  Reasons to leave include the possibility that my former job in London is being kept open for me to return, but they are not sure – but it would be nice to go back to earning some money!  There are friends that I am missing.  I could really do with a rest.  Reasons to stay are the wonderful people I work with and my love of the job.  I get more effective all the time as I learn about how things work in Lae and in MSF.  In the end I decided to leave, as planned, knowing that
I will do it all again sometime.  Maybe sometime soon.

So today is Sunday.  I’m writing this on my laptop under the mozzy net I put up this week.  I was sick during the week and the doc thought I had malaria but the blood test said otherwise.  I had planned to sleep late here, but it never happens.  The guards are too noisy and it is too light.  I’m going to the shops to stock up on a cola bean based carbonated soft drink and then to the clinic to see if any friends have emailed me.  I’m feeling quite pleased with myself as my assistants did their first full stock count yesterday and we don’t have a massive list of things to do at the moment (just find a warehouse, fix the air conditioning, replace the battery in the landcruiser and input the stock count into the computer – what a breeze!)

The project coordinator and I share a prefabricated building.  The buildings
we use are actually fantastic.  I’m very grateful to the team who set up
this project for the nice buildings they handed over.  It’s good to share a
building with the PC as things run smoothly when the PC and the log* work as
a close team.  One of the few downsides of being so close are overhearing
conversations like I did last week.  The Medical Coordinator, visiting from
the capital city, and the PC were talking out the database we record
information on and the categories that we have to put our clients into:

“……with a finger, penis or object….”

“……knife, gun or other weapon……..”

“……imprisoned for 1 to 2 days, 2 to 4 days or more than 4 days…….”

It’s enough to give you nightmares.  Fortunately, it doesn’t although, I did
have a crazy dream last night about our VHF radios not working and being
unable to contact our security guards.
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On Monday I saw the police pull up outside.  I went to meet them – we always
emphasize to people that we are doctors, not lawyers.  Doctors not
prosecutors.  Doctors not moral judges.  We keep a distance from all these
things.  We are neutral.  So we keep a distance from the police, but also
try to encourage a good working relationship.  So it’s complex and best for
a supervisor to meet them when they arrive.  They came to deliver a patient
to us.  He apologizes that they ran out of official forms so he hands me a
piece of scrap paper with the patient referral written on it.  I fold it
without reading it, the logistician doesn’t need to know her story and I’m
sure she is tired of telling people, but he starts to tells me – “she has
been raped by 6 men”.  We don’t need to talk about these details in the
clinic entrance and I’m not sure how to handle hearing her story like this,
so I try to interrupt his story to get her to the medics as quickly as
possible.
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*Log is the MSF standard abbreviation of “logistician”.  Not only do I have
the misfortunate to be known as a log, but because I’m in the city of Lae,
I’m the “Lae Log”.  For anyone reading this who speaks English as a
second/third language – in English “lay” means “not important” and “log” can
mean a variety of things, some nicer examples being a lump of wood, some of
the more informal interpretations I would not be allowed to write about on
an MSF website.

Shopping in PNG is always an adventure. I try to encourage the other expats to go shopping for themselves so they can understand the difficulties that the buyers face. When I first arrived, I suspected that our buyers were taking breaks when shopping because it took them so long. Then I saw how the shops worked – if you want a discount you need to find a good sales person who will give you a formal written quotation for each item. Then, if you accept his price you need to get him to produce a picking list, then you need to negotiate the check out staff who require a code for every item. It’s depressing.

So we had a visit from one of the Canadian operations team and I was advised to tidy up the table I share with my 2 assistants in the very small logistics office. “Letter trays” were the recommended solution. So the next day I go letter tray shopping.

Shop 1 actually has a wide range of good quality letter trays. Unfortunately, it has none of the riser rods needed to support them. Puzzled, I asked the manager “Have I got this right – you sell the trays but not the riser rods?”. “Yeah, it does seem a bit crazy” he explains, “but our suppliers can’t get them to us”.

Shops in PNG tend not to have a regular stock of anything, they seem to just sell what ever they managed to get hold of. If you see something you need, best to buy it immediately as next week it could be gone. Shop 2 also had a range of letter trays and riser rods. “How much are these?” I asked. Puzzled looks all round. Nobody could tell me the price, “Could you come back tommorrow?” Shop 3 had some, but most were broken, very flimsy and clearly were not sufficiently Chris-proof to survive our cramped and hectic office. “Is there anywhere else?” I asked David, our driver/carpenter/artist/guide. David knows Lae and its’ residents pretty well. A few months ago his wallet was stolen and within a week it was handed back to him – money still inside. Arriving at the last shop I was relieved to see letter trays with riser rods. I got back to the office to find there was only half the number of riser rods needed to support the trays.

So it took 3 hours, but at least I can see the wood on the table. Shopping in PNG is stressful.

Photo: Chris Houston | The wood on the desk.