Dr Günter Kittel: July 2013

A UK medical student’s elective to Etep Rural Hospital in May/June 2013

Although I had grown up with the odd Papua New Guinean carving in my parents’ house, I went to the country with a good deal of trepidation. I had been warned numerous times by various sources that PNG, the death place of Amelia Earhart and apparently the site of the least popular British embassy for consular staff, was almost impassable for tourists. Thankfully because of the help that I received from Dr Kittel, the staff at Etep Rural Hospital and many incredibly generous ex-pats in Lae the trip passed remarkably trouble free. I had a wonderful time in Etep and had a great many experiences that will stay with me. Selecting a few highlights to write about here can barely do them justice.

Etep Rural Hospital

I flew directly from London to Lae, and spent a few days there organising food, flights and money. The flight from Lae to Wasu was an adventure in and of itself, crossing the cloud covered highlands on a 6-seater battered plane to land on a grass airfield by the coast. After this I joined many of the hospital staff on the back of a truck for an hour along a horrendous dirt track to arrive at Etep, where I was welcomed with songs and flowers.

Photo 1: Arriving into Wasu
© 2013 D. Whiteside

Photo 2: The arrival party
© 2013 D. Whiteside

Although Etep is a small hospital there is enough to keep medical students as occupied as they would like. Regular opportunities are available on the obstetric wards, where there are normally a few deliveries each day. I found the nurses and midwives to be always willing to help, particular with examinations, deliveries and suturing – skills that I had found difficult to develop while on my obstetric rotation in London.

A few tropical diseases, particularly malaria and tuberculosis, were commonplace and occupied much of the time of the hospital staff. I was able to observe and assist in the management of these conditions through ward rounds and new admissions. Many patients also attended with conditions I have often seen during my training, particularly musculoskeletal conditionals resulting from the vast loads individuals carry on a daily basis.

Despite limited resources the outcomes of treatment were often impressive. However I also witnessed the frustrations of working in a developing country, notably the struggles associated with arranging pathological and imaging tests. I was particularly struck by a number of cases of pulmonary oedema and gross ascites in patients of all ages, which had resulted in seventeen deaths in one village alone. Given problems with power the laboratory was unable to perform blood cultures, making diagnosis challenging.

Two of the more memorable cases I saw while I was in Etep were a consequence of trauma. In one a young male’s bowel was perforated in multiple places following a knife wound, in another an individual’s Achilles tendon was severed and fingers amputated. In both cases the doctors and operating theatre staff were able to perform complex sterile procedures, with ingenious solutions to the problems arising from the hospital’s limited resources. I was also able to observe and assist in various other surgical procedures, including draining abscesses, tubular ligations and hernia repairs.

An outreach clinic

During my time in Etep I joined the doctor’s monthly outreach clinic. We visited Sapmanga, a small village within a valley in the middle of Morobe province. Access was not straightforward; following a trip up the coast by speed boat we trekked for three days over altitude in high humidity, staying along the way in bush houses in villages without power. Although the trip was exhausting, and made tougher by the leeches and treacherous footing, our time in Sapmanga justified the effort we had put in.

Photo 3: Departing for Sapmanga
© 2013 D. Whiteside

Photo 4: Accommodation en route
© 2013 D. Whiteside

This was the first time a doctor had come to Sapmanga, and as a result the clinics were very busy. We saw a number of challenging cases, including advanced mouth cancers, cervical cancer, congenital heart failure, ascites, schizophrenia, huge abscesses and widespread fungal infections. The clinics were something of an emotional rollercoaster, and for every case for which we had a solution there was another where we could not offer curative treatment. This was particularly difficult when specialist help and facilities might provide hope, but such options were prohibitively expensive and sometimes simply not available.

Sapmanga itself is spectacular, an immaculately kept tropical village without roads or cars. Everyone in the village ensured that we were well looked after with plentiful supplies of food. I also witnessed some of the activities of everyday life; including a dawn bow and arrow hunt for a lost chicken through the bush and military organised grass cutting with bush knives at school.

Life in Etep and travel in PNG

Experiencing a different way of life is one of Etep’s key attractions. There is little money culture, with no banking and goods only brought in by a weekly ship into Wasu. A limited but vibrant market runs three times a week in Wasu, where it is important to pounce quickly on any desired item. The lack of Western staples requires inventive cooking, and I was fortunate to eat traditionally cooked meals on the pyre on a number of occasions. I also saw the food production process from the start to the finish – being born and bred in the city I found watching a chicken’s head cut off particularly traumatic!

Frequent power shortages mean that spare time needed to be used creatively. I found wonderful opportunities to swim in Etep, both in the stream that runs past the hospital and in a nearby pool encircled by rainforest. Volleyball is a regular weekend and evening activity at the hospital, and can be taken very lightly or extremely seriously, depending on who is taking part! On one weekend a fundraising fair was organised for the local school, with darts, football and multiple stalls running. The community in and around the hospital were incredibly welcoming and I found it easy to join in activities, or to simply have a chat with them (despite my hopeless Tok Pisin).

It is difficult after a 5 week trip to make an accurate assessment as to the safety of travel within PNG. Although I was never threatened myself it is not difficult to find stories of foreigners and expats coming into trouble. Attitudes to violence differ from those in the West, and it seems that the unsettling of traditional lifestyles and the influx of money has worsened the situation. Particularly in Lae and Port Moresby it is sensible to take precautions, but I still found it possible to travel around them. Without the assistance of Dr Kittel and the Lutheran Mission I would have found visiting these cities intimidating, but with this help in place I felt as protected as I could be.

Indeed I would encourage any medical student to grab the opportunity to go on elective to Etep. Without some footing in Papua New Guinea it is a very difficult country to visit. Yet once I was given that basis many opportunities arose, notably to gain some insight into the attitudes, concerns and beliefs of normal Papua New Guineans. I was also able to learn a fair bit of medicine along the way! The many wood carvings, bilums and necklaces I have collected will remind me of it all long into the future.

Saturday, July 13, 2013