Karina Severin is a GP who was working in Papua New Guinea (PNG)
One fine morning I arrive at work to overhear our nursing staff discussing trouble that occurred in their village overnight. A well-known trouble maker from the village had attempted to burn down a house with six people trapped inside. Luckily they all managed to escape, however the village leaders were outraged at yet another incident instigated by this man. The man’s father, a respected village leader, had now given permission for his son to be hunted down and “when they find him, they’ll chop off his legs so he’ll never walk again”. What astounded me most was not the horrific story itself, but the matter of fact way in which our staff described it – such events are so common as to be almost normal here.
Welcome to Tari in the remote Southern Highlands Province of Papua New Guinea (PNG), where Médecins Sans Frontières has been working since 2008. Just eighty years ago this area had had no contact with the outside world. Now, due to significant development of the natural resources sector, change is coming rapidly. It is a place where all our staff own a mobile phone, yet no one lives in a house with electricity with which to charge it.
The local Huli tribesmen are renowned and feared throughout PNG for their fierce warrior spirit. A man or woman who fights is respected for being strong, so many disputes are resolved in this manner – often involving a large machete-like instrument known as a ‘bush knife’. Disputes range from clashes over land and mining royalty money, to mundane disagreements involving mobile phones or a married woman talking to another man. The resulting injuries can be horrific. Before Médecins Sans Frontières arrived in 2009 the hospital had been without a doctor for many years – no one was prepared to work in such a remote, lawless, violent place. Now we run two programs related to violence – a surgical program largely dealing with wounds, and a Family Support Centre which supports women and children who are victims of domestic and sexual violence. We also provide general support to other areas of the hospital.
"My favorite place is our short stay ward, a safe place where women can spend the night while the conflict at home settles down. Often little can be done to change their personal situation, yet a night of peace and rest can mean a world of difference."
My role in Tari predominantly involves providing care to women, who in Huli culture are usually considered a family’s possession in the same manner as money and pigs. A typical day begins with a ward round in maternity, where I am the local ‘obstetrician’. Many women deliver their babies in the village without skilled attendants, and then present to hospital with complications late in the labour. One woman I met had been in a long phase of early labour and then labour, which totaled two weeks for her. She was forced to walk for several days to reach the hospital. By the time she arrived the baby was dead and the pressure of the baby’s head had made a hole between the vagina and bladder so that she had urinary incontinence. As a result, a permeating odour followed her wherever she went. This condition, called obstetric fistula, is never seen in Australia thanks to universal access to obstetric care and I had only ever read about it before in medical books. Over several weeks we were able to provide medical care which allowed the hole to heal and she returned to her village – no longer a potential outcast but a normal young woman with a life ahead of her.
The rest of my day is usually spent in the Family Support Centre, where a team of local nurses and counselors mostly see women and children who are survivors of sexual and domestic violence. With patient consent, we provide medication for the prevention of HIV and other sexually transmitted infections, emergency contraception and pregnancy counseling for rape survivors, as well as treatment of fractures and wounds, and counseling and emotional support. My favorite place is our short stay ward, a safe place where women can spend the night while the conflict at home settles down. Often little can be done to change their personal situation, yet a night of peace and rest can mean a world of difference.
I have been here for five months now and it has been a steep learning curve both medically and personally, compared to life as a suburban Melbourne GP. I have seen and done things I never thought possible of myself, and I will return with an even greater appreciation of the fantastic medical facilities and social opportunities we take for granted at home. I might miss the challenge and excitement, but on the other hand there is a little part of me looking forward to being able to sleep through the night without the likelihood of being called to an obstetric emergency.