Fieldset
Papua New Guinea: Healing along the water (Episode 1)

Aurélie's first posting as a nurse with Doctors Without Borders takes her upriver in remote Papua New Guinea. She shares the story...

A traditional wooden house on stilts

I remember the moment when I finally received the email offering me a posting with MSF. My heart was pounding!

I was at work, between two hours of classes I was leading for my nursing students, but I could not resist the urge to open it immediately.

I had expected to return to Africa, I dreamed of the Middle East and now I was going to go to Oceania, to Papua New Guinea..., an unknown territory, conducive to ghosts of all kinds.

The same evening, I read the documents relating to the project, chuckling half-heartedly in the face of the warnings about crocodiles and snakes.

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Sunset in Kerema, Papua New Guinea
Sunset in Kerema

In the documents, I learned that Kerema was an isolated village connected to the capital by a single road, which I imagined was probably closer to a track.

I sent my positive response. It was decided, in three months, I would start my first posting with MSF in Papua New Guinea!

Kerema

After a few days of briefing and rest in the capital (the nine hours’ time difference got me a little!), I took the road to reach my village, located in  Gulf Province.

This province is one of the most isolated, not to say abandoned, and is also the subject of local fears related to witchcraft. It is not easy to recruit qualified staff here and many in the team are staff who have relocated from the capital or other provinces.

Since 2011 the 300 km separating Port Moresby, the capital of Papua New Guinea, from Kerema has been accessible via a road, and it’s actually not too bad! It must be said that after the roads in Madagascar, nothing much on that front surprises me any more...

Soon, the rumor of the city gives way to lush vegetation, betraying abundant rains. The gray ribbon of the road winds between the trees, pierced by some houses on stilts and cut by many streams.

The inhabitants seem to feel so at home on this road that they have forgotten its main function – they are found sitting in the middle of it, scattering in laughter as the car approaches.

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The MSF guesthouse in Kerema, Papua New Guinea

As we approach Kerema, the green gives way to blue, with the ocean colouring in the background.

The base consists of two houses, also blue, nestled in the middle of the vegetation, and straining your neck, you can even see the sea. I am seduced at first glance!

I inherit a room with two windows, I install my sticks of incense and other trinkets and I am at home. For nine months.

Outreach

The advantage of being in an outreach role is that we have the chance to see the country! From my first days in the job, I realised that this would be the main benefit of being the outreach nurse here.

Meeting the patients, in their environment, in their community, to allow them to continue their difficult treatment regimen in the best possible conditions.

Because while tuberculosis can be curable, the treatment is long (between six and 20 months depending on what kind of TB they have). The medication regime must be followed scrupulously, and it is often accompanied by side-effects.

The project strategy is therefore based on the decentralization of services, relying on dedicated teams, in three cities of Gulf Province (Kerema, Malalaua, Ihu), but also via several distribution points in the heart of the villages, whose only names are evocative of elsewhere: Uaripi, Pukari, Uamai, or Hepea...

Up river

I have a ten-day handover with my predecessor, and as part of that I am on my way to Popo Mikafiru, to go to see our patients and give them a month’s worth of medication.

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View from the dinghy
The view from the dinghy

At 9am, in heavy rain, we drive out – me, a community health worker and a person in charge of patient education and support. We arrive two hours later at the edge of a river, and then travel another hour by dinghy.

Our skipper is wearing a suit jacket too wide for him, over an orange Hawaiian shirt. It is still raining hard, he can see almost nothing, and he is bailing out with one hand and maneuvering the dinghy with the other!

Although I have the impression of being in a sketch by the French comedian Dany Boon, since when I turn my head I see mainly the hood of my anorak, I make out the houses made of wood and palm leaves that sit on stilts along the river. On the way we meet one of our patients on a wooden raft, coming to get her treatment using the strength of her arms alone.

Popo Kapure, Popo Luluapo, and finally Popo Mikafiru ...

Popo Mikafiru

On arrival, soaked to the bone, but here at last, the villagers run to help us unload the boat:  we have tuberculosis drugs of course, but also a scale for monitoring malnutrition and how adapting to treatment affects patients’ weight.

The villagers lead us under a stilt-house and provide mats so that we aren't in the mud. There is not much going on here, so it's as if the whole village is attending the consultation!

Of course, medical confidentiality seems difficult to guarantee in these conditions, but it is at the same time an opportunity for greater awareness of this contagious disease, which is the subject of many false beliefs.

The purpose of our monthly visit to this village is to supply our patients with the next month of tuberculosis treatment. At the same time, we make sure that their symptoms are improving and that they haven’t missed a dose. If things aren’t going as we would hope, we evaluate why. And coming to the village also gives us the opportunity to detect possible new patients.

We are assisted in our work by “treatment supporters”, people from the community who are responsible for giving daily medication to the weakest or most isolated patients, ensuring that no one misses a consultation and encouraging people who have signs and symptoms of the disease to show up on the day of our visit.

Miss France

Just an hour and a half later, it’s time to leave; we have to get back before sunset for security reasons.

After all the rain the sun is back, and I feel like Miss France, being hailed and greeting all the people we pass on the shore!

Three hours later we arrive at Kerema.

Six hours of transport for nine patients: the cost-effectiveness ratio can be debated, but lives are probably saved. And isn't one of MSF's principles to go where nobody else will?

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