Logistician in PNG: Last Days

Nursing Officer Norman and Betty move a patient. Photo: C Houston/MSF.

Médecins Sans Frontières logistician, Chris Houston blogs of his time in Tari, Papua New Guinea.

Every 6 weeks the team in Tari gets 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 Médecins Sans Frontières 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 was 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.

“Can I help?” I asked the nurse who had already radioed the anaesthetist for assistance. “Yes, help me find a vein”

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.

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 doctor’s 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 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. However as I was holding the shoulder wound 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 11:30 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 a 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.