SO here I was at Mirsey health sub-centre in the Ambunti area of the upper Sepik. There was no oxygen, the hydrocortisone and salbutamol had run out and even the manual foot pump for nebulising the patient was malfunctioning.
Martin, my patient, was developing severe shortness of breath and was cyanosed due to lack of oxygen. Even the antibiotics had not helped. He was restless and gasping for air.
I tried to resuscitate him but failed. He needed anti-asthma drugs to revive him. The only option was to refer him to Boram hospital in Wewak - 14 hours by dinghy along the main Sepik River and then by ambulance to Wewak.
After sorting out the fuel and the boat operator we trundled off following a tributary of the Sepik. Due to low water levels and submarine tree stumps, we could not travel at speed.
At seven o’clock in the night my patient Martin told me to stop and turn back to the health centre. I hesitated. My aim was to save his life.
On our way, he had made several attempts to jump overboard but was held back by his guardian. Martins’ voice had become very weak and then he slipped into unconsciousness. His eyes turned upwards, saliva and mucus drained from his nose and mouth and he died in our arms inside the dinghy. Unfortunately I had lost my patient.
As I lowered my head, I thought to myself that Martin should not have died if only the medical kits had arrived on time and all the necessary drugs were in stock.
People could argue that it’s the responsibility of the officer in charge to make sure the kits are there and the stocks are maintained and the life-saving equipment is in place.
But this is all sweet talk from people in comfortable chairs. It’s tough managing complex cases in remote settings where there are poor or no roads or long water journeys. The town is far away and so are the people responsible for maintaining the liens of supply.
There are other factors. Will patients assent to be referred when they are told the medical and other fees? Do they have wantoks in town who can support them?
Some people refuse to be referred because of these reasons and accept death as normal. But down deep in their hearts they feel the pain. Parents accepting the death of their children, a husband can the death of his beloved wife, children accepting the death of parents.
This is a continuing tragedy happening in many parts of remote Papua New Guinea.