GÜNTER KITTEL
This is a report of an outreach clinic to Nankina and it is published with the valued assistance of Warime Guti of the Evangelical Lutheran Church of PNG. The participating team was: Dr Günter Kittel, surgeon from Mission EineWelt working at the Etep Rural Hospital; Bindu Karki, his wife, a nurse and midwife from Nepal; Daniel and Zine, two Etep Hospital staff; Tobias Kreuz, a German volunteer; Andrew Mawer, a medical student from Oxford University; and Adi, son of the Kittel family
THE months had flown by since our last trip and we were looking for new places to go. The rainy season had begun and rain was not expected to stop until June. Then the Missionary Aviation Fellowship offered to fly us to Nankina.
The flight was breathtaking. To our surprise, Martin, our pilot, picked us up in Wasu on time, which certainly is exceptional for travel in PNG. We were quite a big group this time. And then there was our personal luggage, a lot of food, medical supplies and a small operating theatre.
We followed the northern coast towards Madang for about half an hour. Then the plane turned south and we had a splendid view of small villages located on steep mountain slopes.
To our left and right, were giant waterfalls and, at the top of a mountain crest in front of us, our destination - Nankina airfield. After some circuits over the village, Martin safely landed. We had arrived.
Sooner than expected, we were told there were a huge number of patients already waiting for us but first we had to transport our luggage to our accommodation, a small guesthouse owned by the village magistrate.
It took us quite a long time to put away and properly store our luggage and the medical supplies and equipment.
Soon after this, the fire crackled and our first meal was prepared. In these higher regions of the Ukata district the temperature stays comfortably cool and it never gets really cold. The people sleep around the fire as it was done by their forefathers.
After the meal we prepared our beds for the night and transported supplies to the clinic.
The village we walked through looked like the cliché of Papua New Guinea. Huts made from sago palms and bamboo, cultivated and decorated pathways, gardens with pigs crossing our path.
Many people might have seen planes here but never a car - almost unbelievable in the 21st century. Every property was adorned by a beautiful carved gate and, passing through these gates, I realised the people here are smaller than elsewhere in PNG. I always had to bend whereas our hosts had no problems.
Arriving at the aid post, we once more saw the poor healthcare in the rural areas of PNG. The aid post had been built 14 years ago but was long abandoned, leaving about 6,000 people without access to vaccinations and treatment.
The number of children was striking: 10 children for each mother the average; many women had more. Family structures are breaking apart. Single mothers are common. On the first day we could only clean up the clinic which had not been used for many years.
Saturday is market day in Nankina. It is a place not only to trade goods but to talk about the latest developments.
On the way to the market we noticed that everywhere was sprinkled with coffee beans and we asked why. The answer was understandable yet unexpected. Coffee had been an important source of income and, until recent years, was transported by plane to Madang or Lae where growers could make good money.
However the falling price of coffee beans on the world market had led to a rapid change. For a kilo of green coffee beans, a farmer earns 80 toea but to transport it by plane costs two kina. So the beans ended up as decorations for the pathways.
Our visit was turning out to be a big event that everybody was speaking about. I was told that never before had a doctor visited Nankina.
Speeches are important in Papua New Guinea. Our nurse David was completely in his element talking about the dangers of HIV and AIDS. For hours he commanded the attention of the audience. It sounded like a political campaign.
I was expecting a run of patients on our clinic and we moved to the clinic which was already crowded. The people were first registered by the magistrate and the number was already 200 and increasing.
Despite all our efforts we were not able to see more than 50 of them that day. The physical problems were numerous. Like everywhere on earth, back pain topped the list.
That evening we were told a young father of four children had stumbled while doing woodwork and died. His injuries must have been severe as nobody attempted to bring him to me.
I witnessed many lung diseases. Tuberculosis is quite common. Despite the seriousness of the cases, I could only advise people to visit the nearest hospital to start the long treatment.
In patients with chronic cough, smoking plays an important role. There is nearly no member of the community who does not smoke. Even at night people do not stop.
In the past, chewing buai (betel nut) only occurred during special occasions. Today everybody chews - from young to old, men and women. Young people in their thirties are already developing non-curable mouth cancer that almost always leads to death.
Young women appear to be exhausted and this is not surprising looking at 30 year olds with 10 children. I know that what our team can do is limited so we focus on what is possible.
Many of the patients need continuing treatment, which we cannot ensure. There is no nurse and no aid post orderlies who can guarantee even a minimum amount of medical care.
Unfortunately this is common in PNG. So we try to motivate the people by showing them that they are not left behind and we will try to take care of their problems where we can.
We decided to continue our clinic on Monday and on Sunday everybody gathered in the open air for a church service. An old man, like a hermit from the Old Testament, preached the gospel.
After the announcements there was another round of health awareness. We talked about HIV, smoking, family planning and hygiene.
On Sunday afternoon the area around the school is reserved for sport. Soccer, volleyball and basketball are important and our volunteer, Tobias, takes part in the soccer tournament, which is greeted enthusiastically.
We decide to play basketball, which I should dominate because of my sheer size but, despite that, the female students show a high extend of marksmanship and demonstrate it was a long time since I last played basketball.
On Monday we were pushed to our limit.
Hundreds of patients were waiting. The area in front of our clinic was crowded with people and had converted into a market. Within hours, vendors started selling buai.
Over 200 patients were on the waiting list and more were expected to arrive. We tried to do what was possible. Many were placated but it seemed to us to be an impossible challenge. In the evening we were totally exhausted.
On this one day we distributed over 4,000 pain killer tablets we had received from Germany.
We barely could sleep that night. Many things were going through our minds. We discussed how the health situation could be improved but we knew that the possibilities were limited.
The people responsible seem to have no interest and they have no idea how difficult the situation is here at Nankina.
The next day was operating day. There was a long list of tasks. Organising them seemed to be even more difficult, whether cleaning, preparing the op table or organising clean water.
We tried to accelerate. We operated on hernias, lumps and ulcers, and pulled teeth until sunset.
This continued over the next days and the work seemed never ending as there were always new people coming in from surrounding villages.
Although we had taken more medicine with us this time we knew we would soon run out of supplies. Furthermore we were not able to sterilise our operating instruments and I had to admit that we had reached the limits of what was feasible and possible.
When we announced our departure, a pastor handed us a letter with the names of 123 other patients in a village one day’s march away, but we did not have a single tablet left. We had to put him off in a friendly manner, telling him we would return another time and this was accepted.
We found some young boys and older women who offered help carry the equipment back to the coast. The luggage was carried by 15 people.
My wife Bindu had to take part in a workshop in Madang and we organised for a pickup by MAF. In the morning we heard the sound of a plane circling over Nankina but, after several landing attempts, the pilot had to return. Flying is still an enormous challenge in PNG. Bindu would walk back to the coast with us.
For a last time we checked our luggage. The carriers had their bows and arrows with them, which is common for this area.
Until recent years, tribal fights were common and we were told that the old weapons would still be used. Every child had to practice shooting with bow and arrow and people learned to catch arrows shot at them. Scars bore witness to the injuries incurred in recent years.
We left Nankina in a relaxed mood. Our transport team was singing and a steep downhill pathway led us to a broad stream. The humidity and heat meant we have to carefully watch our step as the path was slippery.
Finally we reach the river - an ideal opportunity to jump into the cool and refreshing water. Some biscuits provided new energy for the way ahead.
The rain set in and we walked through mud up to our knees. This was hard walking and soon we could feel the soreness in every part of our body.
Our track followed a steep canyon. Below we heard the raging waters of the river. We grabbed for roots and our knees start to shake with exhaustion. We were constantly heading up and down. Walking up was a relief compared with walking down.
And the bridges - quite often only tree trunks. Our skilled local guides crossed without problems but we struggled or chose to wade through the hip deep water.
Somewhere in the afternoon we reached at a small hamlet. We learned that this was the place of a family where the husband had six wives, each one living in her own house.
As we walked on, we saw the gardens full of taro, sweet potato and bananas. At last a steep path led us into a small village consisting of about eight diminutive houses.
We asked for shelter for the night and got a room in a small hut. A fire was started immediately and a simple noodle soup cooked. We were too exhausted to eat and fell into a deep leaden sleep.
The people outside told stories throughout this night. The journey was a big adventure for our carriers and never had there been a waitman in this area. Every word penetrated the thin walls of our hut.
The next morning we got up early as we had only traversed one-third of our journey with our guides telling us the path ahead was in poor condition. Bad news I did not want to hear. I could not imagine worse than yesterday.
We boiled tea and ate some biscuits. Andrew, our medical student, took pictures and we said goodbye to our hosts. Without this shelter we would have been lost as it continued to rain throughout the night and the next village was hours away.
The prediction by the guides was not exaggerated as the pathway was terrible. The continuing rain converted it into a slippery mire not possible to walk without walking sticks. Especially not downhill.
Our carriers were now getting slower but it was incredible how safely they moved, their toes gripping the mud and we with our shoes disadvantaged in every respect.
The number of rivers and creeks crossed seemed endless. We were lucky that this time the leeches are not a problem but the flies accurately targeted every bodily orifice.
We were plagued with hunger after many hours of walking and I hoped the end was close. Then we met a muscular young man walking quite fast who told us that he had left the coast before sunrise and had been on the track for seven hours. A not encouraging message.
But the way became less steep and, after a while, we saw the first coconut palms. The scenery changed and we came to the first cocoa plantations. A young man offered me a freshly picked coconut. Never before had I tasted a more delicious juice.
As more members of our group arrived, there was no stop. The young man climbed the tree and within minutes it was empty of coconuts.
Now, there was light at the end of the tunnel. The path broadened and was not wet any more. The first suspension bridge not made of bamboo appeared around the next bend.
But some steel ropes had been ripped from their anchoring role so it did not appear to be any safer than the bridges we crossed before.
All of a sudden, we arrived in a small modern town. Saidor had a small hospital with 18 nurses but no doctor as well as a hotel and a huge store. The nurse on duty welcomed us in her house, where we showered and organised some food.
We slept on nice soft mattresses and it was wonderful to stretch our tired arms and legs.
The next morning looked for our dinghy. We are told it was already waiting for us at a village nearby. After some hours a small truck drove us to Mur, where our skipper was ready for departure.
Luckily the sea was calm; often not the case. In the rough waters many boats frequently get lost forever. But we enjoyed this voyage.
The tropical landscape passed by and the sun beat down, which was better than the rain beating down. After three hours we entered Wasu marina where the ambulance was waiting to drive us up to Etep.
The journey now lies behind us. We gained new insights into the life of Papua New Guinea. Despite all the wear and tear, it was all worthwhile.
Expressions of thanks: I'd like to thank Mission Eine Welt not only for making the flight to Nankina possible but also for providing drugs and medical equipment for our patients. Thanks to everybody who helped us on site and brought us back safely