Where There Is No 9-1-1: Two Stories of Health in PNG

My first taste of PNG’s health system came just a week into last year’s Panango tour when I found myself catching our malaria-stricken (Or was it even malaria? Results were never conclusive) leader Christa as she collapsed in the waiting room or Karkar’s only hospital, Gaubin. The nurses pricked her for a blood sample to test and stuck her with a serious shot of cloroquine in the bum (leaving an inflamed lump for the rest of the summer) while I divided my time between looking on to insure her attending nurse used a sterile needle and calming a second volunteer who was close to hyperventilating from the appallingly unsanitary conditions, particularly the dog inside the waiting room bating at the flies swarming his grossly infected open sores. Christa recovered, but any faith I might have had in Karkar’s health system never did. I swore I’d never go back to Gaubin if I could help it.

But just weeks from the end of our trip, toting only the bilum I’d packed with a Nalgene, camera, and book for my ‘rounds to visit Kinim Village for a bilum making lesson and Tabel for Steven’s birthday festivities, I found myself back at the hospital preparing to execute an emergency evacuation for a volunteer. I’d learned that afternoon that Yihana had gone to Gaubin for a second check on her eyes, which had developed what she thought was a typical case of conjunctivitis Thursday night. She hadn’t taken her phone with her (Stephen had used up the battery and it was charging), so getting in touch was difficult. Word of mouth told me she’d traveled with the Goodyears, who were on their way to deliver another patient, but Paul Goodyear wasn’t answering his phone. Fortunately, we met Barbara Goodyear on the truck trip back from the birthday party, and she quickly regaled me with an update: Yihana had been given a shot in the eye and was going to be spending the night at the hospital. My worst fear come true, I jumped off the truck and onto the one Barbara arranged to take me to Gaubin.

I found Yihana in the pitch dark of Gaubin’s guesthouse. I flicked the light switch (they have generator power until 10pm) to make my way to the bedroom, but quickly turned it off again as she emerged and painfully winced in the brightness. We would maneuver by the flashlights of our cell phones. It was immediately apparent I would be spending the night.

Admitting a white woman to a bed on a ward clearly wasn’t something the young husband-and-wife team of German doctors were ready to do, so they had set her up in the relatively well-equipped two-bedroom guesthouse. (The house was at the expense of 50 kina/night, which they didn’t expect us to pay, but we paid later anyway. They refused payment for any services or the treatment they gave her, including the last bottle of an antibiotic they had at the clinic, requesting that if at all possible we return what we didn’t use later. I did.)

Walking out to the hospital’s courtyard, the only place in the whole establishment with cell service, we met Dr. Chris, her attending doctor, a surgeon actually. For the next two hours we would play phone tag with insurance, demanding calls back as our prepaid phone minutes dwindled that were then missed as service faltered. By 9 p.m. the insurance rep had spoken to the doctor who described the situation in as dire terms as he could (“She’s in serious danger of losing her vision. Yes, she needs an escort; she can’t see!”), words which, even when cognizant of some probable exaggeration, are harrowing to hear. Insurance wanted an emailed scan of Yihana’s insurance card, which we tried to finagle with the hospital’s theoretical dial-up connection (it didn’t work) and for the doctor to fill out insurance forms, again via email.
While working with insurance was a hassle (we kept the doctors up to 11 p.m., and they had small children to put to bed and rounds to do early the next morning), how fortunate we were to have it! A trip to find more Flex minutes to top up our phone credits took me by six wards packed with moaning residents for whom a trip to the specialist in Madang, let alone an evacuation to Brisbane, would never be an option. Even for the few who do carry some form of medical insurance, they are often left to pay out of pocket for what services they can afford and bet against the odds that insurance reimburses them later. I will shortly illustrate.

But first, our odyssey: Our self-executed evacuation began at 6:30 the next morning when I led a tea towel-blindfolded (to block the light) Yihana down to the beach to catch a speedboat to the mainland. I had only what I was wearing and the contents of my bilum, which fortunately included a bunch of bananas we would eat for breakfast and lunch; Yihana had only the contents of the backpack I had packed hastily for her the day before with important documents and few clothes—including a shirt we discovered the rats had chewed a stain out of the night before. If you’ve never ridden a speedboat blindfolded, I’m told its quite a disconcerting experience; try it sometime.

I had orchestrated a complicated plan to rendezvous with my bag, involving Donald motorbiking to Gial to pick up the bag Mama sent down the hill with Archie and the passport that followed in another sibling’s hands, then delivering the bag to Manus’s boat at Kinim Station, which by no small miracle, met us at Kubugame beach two hours later, bearing the welcome addition to our breakfast of peanut butter and crackers as well as my laptop, change of clothes, med kit, and blessedly, passport.

At Kubugame, the haggle with insurance to guarantee that they would cover flights for both us continued (I finally took the phone from Yihana who was playing down the situation in a perfectly congenial tone, as she is apt to do.) From there, an incredibly generous PMV driver chauffeured us the hour into town, taking us directly to the Air Niugini offices to book plane tickets and then to Modillion Hospital, where we received immediate attention from the eye specialist (whether as a result of a forewarning from the Gaubin doctor or our white skin, I can’t be sure). He described her eye as “geographical”, that is, metaphorically the blue ocean of her iris had a distinctly continental mass of green growing above it, indicating a corneal ulcer.

Our story continues with a trip to the chemist to pick up anti-viral ointment that we would later discover was treatment for herpes, then confusion that resulted in my cell phone being taken back to Karkar (I left it charging at the hospital, an unidentified someone rang, discovered I had left the phone when a nurse answered and thought they were doing me a favor by picking it up and carrying back to the island), a lift from the doctor himself to the airport (this I can only attribute to the color of our skin; he had other patients waiting at the clinic), a flight to Port Moresby, the generous hospitality of our friend Solomon Kantha and his family who opened their house to us that night, a flight to Brisbane the next morning, a taxi to a clinic insurance had given us the address for, the realization that insurance had given us the wrong address and that we needed to report next door to the public hospital’s ER instead, a three hour wait in the ER—we were apparently still plagued by PNG time—and finally an audience with an eye doctor who, as you might imagine, could hardly believe our story.

After doing an ultrasound of her eye and scraping samples of the growth from her lens for the first of many cultures they would do over the coming days, the doctors decided against admitting her to the hospital and sent us off in search of a hostel for the night with the task of putting drops in her eye every hour indefinitely. (That night, we bunked myself on the top and Yihana on the bottom so I could reach over the rail when my alarm went off every hour and administer the drops; the system worked remarkably well.)

Her parents finally returned our many phone calls via email that evening. Fortuitously, they had been sailing off the coast of Australia and had actually accidentally returned to port—and cell service reception—a day earlier than planned. They caught the next flight to Brisbane and picked us up from the koala and kangaroo reserve we visited in our free time the following afternoon. (I had not expected to spoon with kangaroos this summer, but when in Australia…)

After an unnecessary hassle to obtain a visa to get back into PNG, I caught a flight to Moresby Thursday. On the plane back, I rehearsed my story, confident that for once I was guaranteed to have a hit. (Karkar to a koala sanctuary? This isn’t something that happens everyday…) As it turned out, I hadn’t calculated how incomprehensible the premise of the whole story would be. An infection threatening permanent vision damage? Yes, this was all too familiar. But a flight to a foreign hospital for treatment? This was unheard of, or more accurately, something only white people would do.

I admit, the inequality problem didn’t really dawn on me until I was telling the tale to two of my students who were accompanying me on my rounds to say last goodbyes Saturday. Luther, one of my hardest-working grade 8’s, was one of them. He had always sat at the front of the class, presumably to see the board better since his left appeared to have a yellow-grey growth and disfiguration on its lens. I had always assumed his vision was completely impaired in this eye, but I don’t think I had ever really considered how it had gotten to that state—and what might have been done to treat it had he had the access to doctors Yihana had. Now retelling my evacuation tale and showing off the gnarly shot we had of Yihana’s bloodshot eye to him, I was uncomfortably conscious of my medical privilege which had probably saved her eye from the fate Luther had never had a chance to escape: partial blindness.

Throughout out evacuation, I had accepted the preferential treatment we were given with gratitude, conscious of our favored position as white volunteers but doing little to rectify the unequal attention and treatment Yihana was receiving; we needed all the help we could get. We thanked the Gaubin doctors’ for their after-hours attention and free treatment, the Modillion doctor for his carriage to the Air Niugini offices and the airport, and Solomon for taking us in on a moment’s notice. In the process, we took the entirety of Gaubin’s stock of one antibiotic, took a doctor away from waiting patients, and put a 6-year-old out of her bedroom for a night.

I had my taste of PNG’s medical care for its own earlier in the summer when Mama traveled to Lae for a gynecological appointment at one of the few women’s clinics in the country. Mama left Karkar on Friday for a Monday morning appointment; unbeknownst to us at the time, she wouldn’t return for two weeks. I traveled with her on the speedy into Madang, where she had to negotiate a loan from the teacher’s district office before she could take the 6-hour bus trip to Lae the following morning. She was lucky they let her take out the loan; if she hadn’t gotten the K600, she wouldn’t have been able to make the trip—and keep the appointment she had set up months in advance. Her accommodation in Lae? The floor of her daughter’s dorm room.

What doctors’ discovered in the proceeding week would be nothing short of devastating for any woman, but for a woman with limited insurance, the prognosis was terrifying: a cyst had taken root on her uterus and was growing. Her physician recommended a hysterectomy, a surgery for which her relatives apparently scrapped together the bill until she could theoretically get reimbursed from her teacher’s insurance, from which payment may take years, even decades. The morning of, however, she decided against it. I believe fear dealt the determining card and, as she told the school in a testimonial weeks later, she chose to trust in her faith over the answers—and dangers–of modern medicine. Mama was going to be able to afford the operation because she was at a public hospital, and with that came very real problems.

The one that was salient to her decision was something we hear in the US take for granted every day: power. The public hospital had power, sometimes, and when it switched off, there were theoretically a few generators to back it up. But theoretically isn’t good enough when you’re talking about putting patients under for surgery; rumor has it that cuts in power have left some “under” forever. Mama wasn’t willing to take the risk, so she came home. She continues to mull her only other option: surgery at a private hospital to the tune of K7,000 or 8,000, or 8-months salary—money that simply isn’t there. After a frank discussion on the topic a few weeks later, I made her promise to do the follow-up appointments in October, and if it has grown, to somehow get the surgery. If I had had the cash then—or now—I would have insisted on immediate treatment.

Mama wasn’t the only person affected by her prognosis. All the appointments—and their distance—kept her from Karkar, her classes, and her children for two weeks. in which she left her classes in my charge, doubling my load. She left all her classes in my charge, which doubled my load, but had I not been there, the students would have been teacher-less for weeks. Substitutes on Karkar are nowhere to be had. Her children are independent and resourceful, but our dinners were markedly meager in her absence. Listen Congress: inadequate healthcare coverage hurts everybody.

Mama will return for a follow-up appointment this month, when she will undoubtedly miss more school and face what may become a life or death choice to operate. She’s only 46.

Yihana has since returned to the States, consulted a corneal specialist at Johns Hopkins—who never did figure out if the bug was viral, bacterial, or fungal—and resumed life at Stanford. Her eye has healed, mostly, but left a significant scar that continues to severely blur her vision, a defect that may or may not be able to be corrected with Lasic surgery down the road.

My heart goes out to both courageous women.