Chris is currently out of the office

Emergency Planning.  That could be the title of just about every blog I write in the next year, I think.  Almost everything I am doing is planning ahead for emergencies.  Some more likely to occur than others.  It rained heavily today.  I was woken at 6:15 by the rain pounding the tin roof like a machine gun.  The rain might please our neighbours in Niger Republic to the north – they have been suffering a dry spell.  But rain here also increases the risk of cholera.

The planning I am doing at the moment is organizing our warehouse.  Compared to where I’ve worked before, the number of different items we stock is not that high.   But the quantity of some items is very high.  We moved an articulated truck, mostly laden with Plumpynut from the office to the warehouse at the weekend.  Plumpynut is a peanut based therapeutic food that is used to treat malnutrition.  I learned today that our warehouse has about half a million portions.  They come in boxes of 150 that weigh about 15 kilos each.  I thought I was good, carrying 2 at a time until a helper turned up and lifted 3 at a time all day long in the heat.

We also have quite a stock of auto-disabling syringes.  There are the type used in a vaccination campaign.  The warehouse has exactly 393,877 of them.  Plus whatever extra we just carried in.  I’ve not counted them yet.

Getting our stock levels right for these items is critical.  Our medics will call for them one day and we need to know exactly how many we have and everything needs to be ready to go.  We also have lower quantities of technical items.  A lot of what we stock isn’t items, but kits.  MSF is great at this.  Our logistical people at HQ have learned from the countless emergencies in the past and put together everything you might need for a particular scenario.  So the water pump comes with all the gaskets, tools, spare parts, instruction manual, jerry can, hose and oil.  The bladder tanks come with shovel, pickaxe, valves, boundary tape and repair kit.  We spent a lot of today making sure kits that have been used in the past have all the accessories.

The power at the warehouse is reliable.  It reliably stops every day at 12 noon.  So we have a generator.  Thankfully, our capital management team is not in the national capital, right next to us.  So we benefit from them being nearby by using their resources.  They have a guy who fuels and services the generator.  That’s one less thing for me to worry about.  I’m used to being the only technical person in the region, so it’s nice to have support close by.

That also means I can call upon their assistance to fix things at our locations.  But sometimes I prefer to fix things myself.  Every time I fix something I improve my technical skills.  Yesterday, I cemented all the holes in our house walls.  Hopefully, that will reduce the mosquito and mouse situation.  I only mixed cement for the first time this year on a MSF course, so it was good to get the skills into practice.

This evenings’ task was to put a seat on the toilet in the house.  I’d been putting  it off until I could find a pair of surgical gloves.  The bolts (which were the only remaining part of the previous seat) weren’t looking so clean.  So trying to put on the gloves with my hands still wet was the first mistake.  Picking up gloves made for the hands of a pixie was the second mistake.  I ended up with the glove palm stretched over my whole hands with the tiny fingers not fitting on to my sausage fingers.

Then I realized that the new seat had no bolts in the pack.  I had to use the horrible plastic bolts from the old seat.  But the heads on them were too wide.  So I had to file them down with a metal file.  Which only just clogged up with plastic, as I used it.  Sweating in the heat I was worried I would rip through the gloves and unleash an ecosystem of bacteria.  I eventually filed down the bolt and wished I had left the tasks to the support team.  I left the tools in the bathroom floor planning to soap and shower them tomorrow.

I had spent about an hour of my first weekend trying to buy a solid plastic or ceramic seat, everyone I saw was flimsy plastic.  “I was looking for a stronger one” I explained to the salesmen in every shop. “But this one is stronger” each of them told me, more confidently and with a wider smile each time.   I hope it lasts until at least my end of mission.

The team were very busy prior to my arrival and with no NERU emergencies (another MSF team were dealing with lead poisoning) in our 4 North-West states being self-sufficient, they decided to take the full weekend off for the first time in months.

Having only been here for a few days, I didn’t feel like spending a Saturday doing nothing and decided to take the opportunity to visit one of the nearby projects. The Zamfara lead poisoning project was 3 hours away, and Goronyo was only 1 hour, so I decided to visit the closer one.

After getting approval from the Logistic Coordinator for the trip, I wasn’t able to reach my counterpart logistician or the project coordinator by phone. I send them an email telling them to call me if my visit would be inconvenient.

I packed one of the large chocolate bars that I had brought with me from Scotland, some water, my camera, some tools and clothes. I wasn’t planning on staying overnight but during the week, recent visitors were forced to spend an extra night there after some confusion about the local security situation.

The journey took an hour through beautiful scenery, mostly flat orange-red desert with small dry bushes. We passed dried out river beds about 2 to 5 metres wide. After an hour and various police check points we arrived in Goronyo. The team were working, but not too many outpatients come on a Saturday so they had time to show me around the hospital site that we share with the Ministry of Health. I saw limp and skinny children with their mothers in consultation with our medical staff and some very sick looking patients lying in the hot hospital rooms. Not yet knowing what is culturally acceptable, I kept my distance.

Photo: Chris H | Hospital Ward

My logistical colleague, a water and sanitation specialist showed me around the hospital and told me about his plans to improve the waste disposal area, the sewerage system and the water distribution. He also showed me around town. On Sundays there is a large market and people travel from Abuja and Lagos to buy onions, maize and millet. Grumpy camels carried sacks for the traders setting up their stalls for tomorrow’s sale.

Photo: Chris H | Grumpy Camels

We departed a few hours later and during the journey home I saw the rain of the rainy season. It fell heavy and the passing motorbike drivers were soaked through, but the ground never held the water and it soaked into the dust. A few minutes later the rain stopped and everything looked just as it did before the rain.

On Sunday I went to Sokoto’s “International Airport” (there is indeed an annual flight to Mecca, but on the other 364 days it only receives planes from Abuja and Lagos). The team doctor and coordinator arrived and I got the chance to meet my new boss for the first time.

I now have 3 weeks to absorb as much information as I can from the boss before he leaves after a 16 month stint in Nigeria.

After numerous warnings about the problems that me and my luggage might face on our journey from London to Sokoto, via Abuja, I was pleasantly surprised by the efficiency and friendliness I encountered at all stages of my flights to Nigeria.  An immigration officer even walked me through to the departure lounge to show me where to board my connecting flight.

A smiling driver was waiting for me at the airport, as were a number of new colleagues who were on their way back to Amsterdam or Abuja.  The coordinator of the team I was joining was going to the capitol to get a Canadian visa for a training course and the rest of them had finished shorter missions that MSF had been running, some were dealing with measles and meningitis while others had been part of our response to lead poisoning.

I jumped into our vehicle along with a Dutch lady who had been on the same flight and was coming to be the new coordinator of the lead poisoning team.  She had been to Nigeria before and chatted to the driver about other international staff who had passed through Nigeria in the past few years.

I listened and observed my new home.  The main roads were sealed and in good condition and on either side of them was red dusty ground.  Small, single story blockwork houses and makeshift shops constructed from timber and corrugated iron stood back from the road as people and goats wandered between.  Men in their full-length elegant shirts with matching brightly coloured trousers whizzed about us on motorbikes.

Sokoto is hot, but not unbearably so.  After Wikipedia taught me it was the hottest city in the world, I had prepared myself for worse.  Apparently I’m here in the cooler period known as the “rainy season” although I’ve not seen any actual rain yet.

The office that the Nigerian Emergency Response Unit occupy was a bit of a mess upon arrival.  The logistical staff were counting and packing the items left over from the recent emergency interventions.  I’ll be in charge of the logistical element of the emergency responses to emergencies that occur in the North West part of Nigeria.  My tasks in the short term are to plan ahead for the various emergencies that could occur and make sure we have suitable stock levels and are ready to respond as best we can.

For me the first few days have seemed a bit strange.  My MSF experience to date has all been in hospital settings with all the drama of sick and injured patients.  So far, I’ve only seen an office and a warehouse.  Hearing the stories of the recent outbreaks in which we vaccinated over 80,000 people for meningitis and over 75,000 children for measles, I know we are going to be busy and I’m looking forward to seeing some action.

Driving through town today (I noticed the Landcruiser had done over 335,000 kilometers) I asked the driver what the people of Nigeria thought of MSF.  He said that people were very happy with what we did, but at first they didn’t understand why we came to their country.  At first people – unfamiliar with international aid – thought that our injected vaccines were designed to sterilize their children.  I’m glad we clarified that misunderstanding!

After Chris’s end of mission in Papua New Guinea, he has decided to take on a new challenge by working as the logistician for MSF’s Nigeria Emergency Response Unit. The NERU as it’s known in MSF, specializes in sending its emergency team, composed of doctors, nurses and logisticians, to respond to epidemics in the northwestern states of Nigeria. Chris arrived in Nigeria in July 2010, and will be working as part of the NERU team for the next year.

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.