WATCHING A FIVE YEAR OLD stand up and walk across a room to say ‘good morning’ shouldn't have reduced me to tears. But last week it did.
Roman was admitted to hospital here in Papua New Guinea in August. Barely conscious, severely malnourished and having multiple seizures, we didn’t think that Roman would survive.
Amazingly he did, but as he began his recovery it became clear that he had had a stroke, leaving him unable to communicate and with weakness of the whole right side of his body.
Such are the effects of tuberculosis. It’s been a long, hard road, and he still has a long way to go, but five months later this little boy is a walking, talking miracle, and an absolute delight.
The same day that Roman started to walk again, a canoe arrived at Kapuna hospital. A young woman in labour was carried in, again semi-conscious, having been fitting on and off for 12 hours. But this wasn’t TB, Maggie had eclampsia and obstructed labour and was unable to deliver her baby.
She had travelled two days by canoe and was fighting for her life. We treated Maggie’s medical problems and she recovered well, but we had no choice but to deliver her unborn baby, who by this time had been dead for a few days. Probably one of the worst things I have ever had to do as a doctor.
Such are the highs and lows of working in a bush hospital. Kapuna Hospital is a remote hospital in the swamps of PNG, and is the only hospital within paddling distance for 30,000 locals living throughout this part of the jungle.
Transport is by canoe as the rivers provide the only transport system. As one of just two doctors at the hospital we have to deal with everything that comes through our doors.
Tropical diseases and infections are rife, with one in four of our patients being treated for tuberculosis, and leprosy and HIV causing significant disability. Being in the jungle where people have to hunt and work the land to survive, our emergency department deals with a continuous stream of snake bites, machete wounds and crocodile injuries.
Aside from the health problems specific to the tropics, on the wards we have patients with lung and heart disease, stroke, cancer, and all the same problems as that which people in the UK have to deal with also.
There are days when it is incredibly rewarding working here when I have the absolute privilege of being involved with patients like Roman and seeing lives changed. But then there are days when I end up discouraged and frustrated as I know I cannot provide the same level of care to my patients as I want to; as I could in the UK.
Today is one of those days. I have a patient with a broken spine, again due to TB, who is in severe pain. But the only pain relief I have to offer her is paracetamol, and with only three bottles of that left in the hospital and no idea when our supplies will turn up, even the paracetamol is severely rationed.
We also have a five month old baby on the ward with a broken leg. Babies shouldn’t break bones, so there is clearly some other problem underlying this, but we have no x-ray, and no facilities to do any sort of blood test. To get an x-ray, this family would have to travel about 80 miles and the nearest place for blood tests is the capital Port Moresby, a 200 mile trip. Not exactly possible in a canoe.
But I knew I was coming to a place with limited resources, so it is a daily challenge to provide the best care possible. The question I am often asked is “what made you leave [northern England] and move to the jungle?”
It’s a long story, but I guess it had been my goal for many years, that last year eventually became reality. I wanted to be working in the developing world, teaching and training local health-workers to care for their own people. I wanted to try and tackle the health inequalities that affect so many people worldwide.
Naïve and idealistic? Probably. But that was the only reason I ever wanted to be a doctor, and that dream only grew when I first visited PNG. It was in my fourth year of medical school and we had been given two months to spend at a hospital anywhere in the world.
I took the opportunity to come here to PNG, looking to gain some experience in tropical medicine. Little did I know how much I would fall head over heels in love with the people, the country and the culture.
The next four years was a long wait as I finished studying and then worked as a junior doctor in Middlesbrough before moving back here to PNG last year.
But the health inequalities are still too great and we need to do more for our patients. Our dream is to acquire an ultrasound machine for Kapuna hospital to aid us in accurate diagnosis and to guide treatment and the people back home can help us make this dream a reality