Grace Chew’s Blog

21/2/2009: Day 10, Kapuna Hospital

We had the 48th graduation ceremony for the
community health worker trainees today. I didn’t
realize that the school had been going for so
long, but they have – started in the 1950s,
they’ve had the titles of the graduates change
from nursing assistants to maternal and child
care workers to health care workers, to suit the changing times.

They had been getting ready for it all week, and
probably before that too – building the shelters,
getting logistics ready, etc. Yesterday night was
the big “kenduri makan”, or muu muu as it’s
supposedly called here, a big dinner to celebrate
their success and to welcome their guests. Before
dinner a group of their mentors and teachers
gathered to pray and minister to each one of the
12 graduates in front of the large dinner party.
Dinner itself was alright – there were chunks of
wild boar, and crab, and rice in coconut milk,
and sweet potato in coconut milk, and greens in
coconut milk (you get the picture), some Maggi
mee with chicken, round yellow buns that reminded
me of the butter buns from Terengganu, and of
course, sago. Didn’t eat much as there were still
a lot of guests, and how our stomachs would agree
with the food was quite circumspect (indeed, a
few of us not really used to it got the runs a day or two later).

The weather was cool, thanks to the rain earlier
in the morning. What a blessing, because if we’d
had sun all morning we’d have been baking under
the coconut leaves-covered shelters. Each
graduate was introduced by a song of their own
choosing (very individualized) and as they walked
from their shelter to the guest shelter their
relatives would come up, some dancing and
prancing, to circle them, hug them, hang garlands
on their necks, and take pictures of and with
them. Some mothers/grandmothers brought gifts for
their child/grandchild and the teachers – one
danced about holding a long rolled-up mat (a gift
for Dr Lin), another was clutching a small chick,
which was given away later. Many of the female
graduates (there were 9, and only 3 guys) were
given brooms made from dried grass (lidi!), as if
they were going to set up home somewhere. But all
the gifts and garlands were lovingly handmade,
fruit of the earth that they work on daily.

It was a very intimate graduation ceremony, even
with the masses of patients looking on from the
verandahs of the wards (the shelters were built
in the yard in front of the wards), and was full
of little human touches. Very PNG-like, we heard
Dr Lin (Grandma) say, and very unlike the
graduation that Ruth and I will be attending in
June (if and when we pass hehe). Our graduation
would pale in comparison, I should think, with
the mass of our year (5-year and 4-year graduate
entry program together!) all shepherded up then
down the stage, probably to the grand but
slightly dreary “Pomp and Circumstance” march.
It’ll be up to us to make the time special, and
with grandparents and family coming up, I hope it’ll be!

19/2/2009: Day 8, Kapuna Hospital

This whole week Ruth and I have been giving
keyboard lessons to some of the staff and their
children. They’ve actually been getting recorder
lessons from Dr. Valerie (who’s teaching herself
to play recorder and keyboard!) and are pretty
good! Ruth and I started off with high
expectations because of that fact, and also
because they seemed to pick things up fast, but
they’re used to learning things by rote (sounds
familiar… ;P) so getting them to understand the
theory of things has proven quite difficult.
They’re okay with treble clef notes (thanks to
their recorder experience) but are clueless about
bass clef! So we’ve scaled things back and are
taking things one step at a time now. The lessons
have also transformed into two classes, Ruth
taking the older ones and me taking the younger
ones (and their school teacher!). The early
enthusiasm they had for wanting to learn the
keyboard seems to have worn off since we’ve
started teaching everyday and giving them things
of substance to learn and remember, but they’re
bright kids and we’ll get there in the end.

The people here are actually very musical! They
readily and regularly harmonise when singing
songs and hymns, getting most if not all notes in
tune, and are not shy in singing out, which makes
listening to them very enjoyable. A whole group
of men have taught themselves to play the guitar
and now compose songs in their various languages.
When I first heard them play for Sunday worship
they sounded really professional (although tuning was a tad off).

Then there’s this guy who likes to think of
himself as the musical man. I think he started
off playing the guitar, and wanted to learn the
keyboard, so asked God to give him the ability.
And in a few days, he could play the keyboard! I
wouldn’t really have guessed he was self-taught
at first listen, then I realised that he plays
keyboard like a guitar – all chords and no
individual notes. Yet he manages to hold it
together to play for Sunday worship. And after a
few days in Ruth’s class, he developed some
note-playing skills, although still not fully
comprehending the theory behind things, and could
play “Twinkle twinkle little star” with left-hand
chord accompaniment, and play little decorative
runs on the right hand. He’s also got a little
piece he plays on the recorder that sounds like
he were a lone piper on a cliff in Scotland or Ireland.

So there’s definitely raw and untapped talent
here. Just needs a bit of coaching and
instruments, which are unfortunately in short
supply. What Ruth and I can do is small, but
hopefully will set them on the road to making wonderful music!

17/2/2009: Day 6, Kapuna Hospital

We’ve sort of settled into a makeshift routine,
with Ruth taking the adult ward and me taking the
children’s ward, and everything else taken by at
least someone. It gives us some days where we can
take our time to wake up in the morning. I don’t
know if it’s the heat, or if we’re actually
expending so much energy, but for the last few
days we’ve been in bed around the time the
generator goes off (about 11 pm) and some days I
haven’t been awake to see the lights suddenly blink off!

The children are quite fun to be around,
especially if one takes out a camera and starts
taking pictures of them. They’re all fascinated
by cameras, especially digital ones. The adults
are too, but are more restrained in their
fascination. The kids stand shyly grinning,
waiting for their pictures to be taken, and then
rush around to be shown it on the screen. And
then they call their friends to sit around and
get their pictures taken too. They are quite
photogenic – most have big round eyes framed by
the long graceful lashes that I also want, and
often their curly hair stands up or is tamed down
in interesting ways, or is a short crop that is
surprisingly soft to touch. And their smiles are
wide and open, so typical of innocent children’s smiles.

Ruth and my antics (somewhat like clowns) get
them laughing too, and we “perform” for them
sometimes while waiting for rounds to start –
pulling faces, “disturbing” each other, etc. Some
have lost their initial shyness, and run towards
us and hang on our legs. The language barrier is
not really a problem, as long as there’re games
to play. A ball can be kicked (or preferably
thrown in my case), and a wheelbarrow can be used
in mock charges at a group of children sitting on
the grass, scattering them in shrieks of delight.

Examining them can be a pain though. They have
the usual doctor phobia – fear of a stethoscope
put on them, or a tongue depressor in their
mouth, or the otoscope in the ear (though I must
say they’re better bearing this than some Western
kids!). Some are scared of being put on the
weighing scale (!) though that sometimes
disappears when they get better and are more used
to standing on that odd piece of metal. The
white-man fear gets some of them, and though
sometimes one is okay, two or three of us aren’t
and it takes them a while to get settled again.
When they start crying Ruth and I hurriedly move
away and make like we’ve not been looking at him/her at all!

Having quite rarely worked with children (the
last time was probably paediatrics rotation early
last year!) I’m still finding it challenging to
make them not cry, and better yet, work through
their crying and struggling! But yet, this week
in children’s ward continues to confirm my dream
of working with children, one way or another, no
matter how rudimentary my children-dealing skills
may be. I may not have the gift, but I sure can try and develop it.

15/2/2009: Day 4, Kapuna Hospital

First Sunday at Kapuna, and more glimpses into
God’s family which has taken root here. Service
starts between 9 and 930 am, in typical PNG style
(and also Malaysian, I must add) with people
trickling in at any time they want. The
musicians, 3 guitarists and a keyboardist, are
all self-taught, but the music they make is quite
professional. And sitting in the midst of the
crowd of singing PNGians makes for one
surround-sound experience. More about the
musicality of this people another time!

Most of the congregation are the staff members,
who come from all parts of the country – from the
Highlands to just down the river. Some parents
choose to send their children here to study
because it’s the only Christian-based community
health worker training centre, as I found out
when talking to some of the new students. Some
are roped in by marrying into the community, and
some join the discipleship courses held in Kapuna
for the youth of the surrounding villages and end up staying.

There are some patients I suppose, but only a
few, and perhaps only the kids. The staff members
hold separate services in several languages for
the patients later in the evening. The rest of
the congregation are the light-skinned people –
regulars like Dr Calvert, Dr Archer, and the
Calvert family; regular visitors like Uncle John
the resident engineer who comes at least twice a
year from Australia to make sure everything runs
smoothly; another Uncle John who flew in with us
to do electrical stuff; and the Pettersons –
Debbie whom we met in Port Moresby and her
husband Rob, who are with SAL and help train
people to translate their language into English
and vice versa. And occasionally there’s the odd
visitor – some Chinese girls like us, maybe some
Japanese, the occasional American student through INMED.

There is a family-like atmosphere in the church
service, and what underlines that for me is the
sitting on the ground, with older people at the
back on chairs, and the little kids fidgeting up
front, as well as the laid back way things are
handled – no worries, no pressure of schedule –
just God’s family meeting together on a Sunday to worship Him.

Later on in the day, when the heat was more
bearable, we took a walk downriver to the nearby
village Ara’ava. Dr. Valerie led the way, and led
the greetings as well, saying hello to almost
everyone we passed. People from Ara’ava regularly
come up to the hospital for treatment, and so
they have sort of a congenial relationship. And
having grown up here and treated them, the
doctors are definitely well-known. That being
said, everyone’s pretty friendly anyway. The walk
along the river was breezy and picturesque, and
I’d like to do it more often, except for my knee
and the fact that the heat is only bearable for
exercise for about 1 hour in the evening, then it
gets too dark to walk safely. Now most exercise
is from going produce-gathering in the surrounding garden!

14/2/2009: Day 3, Kapuna Hospital

We’re now going to macro mode and take a closer
look at an emergency that took place today. It
was probably the hottest day so far, the
temperature rising fast and early, and the wind
hardly picking up in the morning. Thankfully
there was only going to be one round, it being
Saturday, or so we thought. Ruth and I saw some
interesting patients, and another delivery,
during first rounds. We were to go back to see
several other patients after breakfast, but there
was an emergency – a lady had taken a swing had
her left arm with her machete (unintentionally of
course, she was going after bananas on the tree)
and had severed her extensor digitorum tendons,
that straightens up the fingers. When we arrived
at the outpatients examination room, Dr. Archer
was fishing around in the rather deep cut, trying
to find the ends of the severed tendons. She
eventually found the ends connected to the
fingers, but then couldn’t find the ends attached
to the muscles towards the elbow, so she decided
to extend the wound upwards. All this while, the
lady had only local anaesthetic put in and around
the wound, and I can’t imagine whether she was
bearing the pain wonderfully or she just didn’t feel any pain.

Dr. Archer did a zigzag incision up the hand, and
with more blind (or rather, with educated
guesses) fishing around, and thanks to the sharp
eyes of her assistant, found the tendon ends! We
had to go find some suitable suture material from
the operating theatre storeroom (which still had
boxes of catgut) and she stitched the two bundles
together with some PDS monofilament we’d found,
then closed the wound and incisions she’d made
with silk mattress stitches on a rethreadable
(old school!) suture needle. Then her hand was
put in a plaster of Paris backslab, with the
wrist extended, so that the tendons, hopefully, will reunite in time.

All this took just over 2 hours, with the sun
turning the room into a veritable oven, and the
wind cruelly refusing to blow. Even the medical
student enthusiasm of seeing a tendon repair in
the bush couldn’t keep me from wilting a bit. And
not one shout or even whimper of pain from the
lady, although all she had was local anaesthetic
+ adrenaline on her arm, no nerve block, no
nothing. As I held her arm up while the plaster
set, she told us her story, and how her
confidence in Dr. Archer’s expertise (who’d just
seen tendon repairs so far) and her faith in God
made her certain that she’d get back her hand function again, at least in part.

I wonder what I’d had done in Dr. Archer’s shoes.
She’d carried on, with an open mind and a prayer
on her lips, with the knowledge that the only
next option for this lady would be the long trip
to Port Moresby. Would I just give up, or would I
continue on like she did, trusting that the
results of my handiwork would not be worse than
if I’d just left it alone, but better? I wonder.
As of now, I’d be hard-pressed to do anything,
this being the first tendon repair I’ve seen, and
the medical-student feeling of helplessness
strikes again. What’s certain is that little
miracles are constantly happening in this place,
with each emergency, and each patient.

(Update on 19/2/2009: The incision is healing
nicely [the PNGians have amazing healing times!]
and she can twitch her fingers towards extension, albeit with a little pain.)

12/2/2009: Day 1, Kapuna Hospital

First whole day in Kapuna. Talking with Ruth, we
realize that this is a place of relativism –
relative cleanliness, relative health, relative
heat/coolness; everything is just about okay, and
they’re okay with that, especially since there’s
nothing much that can be done about it at the
time. There are reasons for that though. For
these two “housewives” who bustle about cleaning
everything, even some things defeat us. For
example, starting the fire today took a good 1
hour, so cooking 2-minutes Maggi mee took about 1
½ hours. Boiling water with the same fire took
another ½ hour or so. And in starting the fire
the kitchen which we had conscientiously swept
just minutes before became littered with debris
from dead leaves and split logs. By the time we
finished eating, we weren’t too bothered about
that mess, and just swept it to one side – we
were going to repeat the mess again the next day
anyway! Feet just grey from traipsing around were
clean, compared to them getting black. Hot and
cool become relative terms separated by
estimation and mood (and clothes – hot in
t-shirts becomes bearable in sleeveless tops, and
unbearable when you’re hungry).

Health decisions are relative too – with very
little or no diagnostic tests available,
diagnosis is clinical-based or trial by therapy.
If you have a fever, you probably have malaria so
let’s put you on anti-malarials just in case. If
you have a fever and a cough, you probably have
TB, but you may have malaria too, so we could try
treatment for both. That actually seems like an
unfair description of how they work here, and I
can assure you that the thought processes in Dr
Valerie Archer’s mind are more refined than that
above. The end result for most patients is still
the same though, and the TB ward is never empty
and anti-malarial drug names are bandied about like the letter ‘e’.

But with the relativism, there are also
absolutes. No betel-nut chewing whatsoever,
leaving the premises nice and non red-stained.
Best care for everyone who comes, so each
patients sees Dr Archer on ward rounds, and their
care is tailored to their needs (within reason,
or they are convinced to modify their plans
somewhat). Friendliness from everyone around, so
two Chinese girls always find smiles and laughter
and people to talk to. And best of all, a very
Christian attitude permeates the place, and God is an absolute here.

One day and a bit seems like forever, partly
because we’re awake from before 7 am till after
11 pm. And there are long periods in the
afternoon where one just doesn’t want to do
anything but sit and wait for any breeze to pass
by. But there is potential for this place to feel like home. Somewhat.

13/2/2009: Day 2, Kapuna Hospital

Let’s devote this day to the products of this
place. We’ve been picking from this garden of
plenty and will probably never be found wanting.
There are row upon row of banana and pineapple
trees and papaya (or paw-paw) trees are scattered
around. The ma’a trees serve up mini jambu air
(what’s this in English?) which are more tart
than their large Malaysian counterparts but just
as juicy. The guavas (jambu batu!) here grow
small and cute and with sweet pink interiors.
There’s starfruit as well, but they’re called
five-corner fruits here (it figures). Dry
coconuts fall from the trees, and the locals
grind them to make coconut cream/milk, but to
save time and life, we buy fresh green coconuts
from the market to drink and eat. Eggs can be
picked from just near the doorstep, perhaps under
the longbean vine, and if the chickens that gave
us those eggs were ever to grace the table, we’d
have the best free-range (kampung) chicken
around! With the river a stone’s throw away, we
have seafood abounding available from the market
– fish, prawns, shrimp, and crab, all sweet and
succulent, only needing boiling/steaming. They
have an abundance of sago as well, it being their
staple, and they make it like a chewy thick
pancake (think oa-chien – oyster omelet,
Penang-style, without the oysters), which is
quite pleasant, especially with the crunchy crust
from baking on a woodstove. They also mix it with
coconut (which may become like the Melanau
tebaloi – must observe how they cook sago!); and
Dr Calvert has extolled to us the many benefits
of sago and coconut cream, especially as baby
food, which even newborn infants can tolerate!

One very important product of this hospital are
the community health workers. They run a 2-year
course here, taking in between 20-30 students,
one intake every 2 years. I think they’ve run 3
cycles now (?) and many of the graduates are
working in Kapuna itself. These CHWs are always
smiling, and are the main caretakers of the
patients with the nurses. They are like
mini-doctors, maybe even like F1s/HOs, as they
are taught everything about the main diseases
here so that when they go out alone to man their
own aidposts, they would know how to treat the
myriad ailments of their patients, and when to
refer on. Isn’t that like F1s? Except that most
F1s don’t do that alone, and would try not to put
themselves into that situation, my future self
included. It’ll be good to learn from their
education, hopefully to become a more independent F1!

Related to that is the end-product of the
people’s health and education - it is a hospital
after all! There’s music and computer lessons in
addition to the run-of-the-mill health and
general education: Ruth has taken a keyboard
class already (while I slaved over the stove -
another 1 hour of smoke-making), and the sounds
of recorders puncture the air. If kids are of a
schooling age, the most likely question they’d be
asked by Dr Valerie is “Why are you not at school?”

So, what will Kapuna produce in me? Or will I
just be going back with lots of its fruit in my belly?

The journey in…

So I’m here in Port Moresby, sitting in the little corner of Mapang Guesthouse where the computer is, while warm air condenses around me. To get here, I’ve been in a plane from London-KL-Kch-KL-Gold Coast, bus to Brisbane, then another plane from Brisbane-Port Moresby, discounting the numerous car rides in between. Onwards is another plane ride from Port Moresby-Baimuru, then a boat rid from Baimuru-Kapuna Hospital.

My journey so far has been dotted with millions of tiny blessings and coincidences (or God-incidences). The expansive generosity of the Lee family in KL was heartwarming, fellowship with various friends met was heartlifing. Even in the short time in Australia en route to PNG, a kind Chinese lady offered to help me find my way from Gold Coast airport into Brisbane, and I had the happy surprise of seeing a familiar face in Gold Coast airport who pointed me on my way! In exiting the airport in Port Moresby, we were gladdened to see our names held by an English man with a tinkling smile and an enormous heart who took us around his adopted hometown and shared his family’s stories with us, even gifting us some of his cartoon books to read (and maybe learn pidgin from!). If only this has happened, what more could happen in the next 6 weeks, I can only imagine. We’ve been told a few times that PNG is known as the land of the unexpected, so I’ll just prepare to be surprised.

Coming from Malaysia has prepared me somewhat for coming to this place. It’s not as bad as I thought it would be, but that may perhaps be because we haven’t ventured out alone and we’re still in the city, shelthered from the “real” life out in the country. All that will change when we board that plane tomorrow which will bring us to the swamps that is Kapuna. As for now, we will sit in the shade of the guesthouse, reading, watching TV (when we still have the chance) and tinkering on the lovely piano that we have here. Even now Ruth is entertaining me. ;>

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