Kudjip Nazarene Hospital has a specific area that it primarily serves, the Jiwaka province, with some very specific boundaries. Other parts of the country are covered by other hospitals. This is important for multiple reasons. Patient fees are based on whether someone is from Jiwaka or “longwe”. When the hospital is full, we close to “longwe” admissions altogether and refer those patients to other hospitals. This was the case a couple weeks ago in the medical ward when we had 5 people on the floor. And lastly, we only have one surgeon here, and as amazing as Dr. Jim is he can’t take every surgical patient in all of PNG, so we don’t accept longwe surgical patients unless it’s an emergency.
I’m explaining all this because a week or so ago I had a patient who had been injured 2 weeks previously and by ultrasound had a ruptured spleen. Because it happened two weeks ago it wasn’t an emergency at the moment, but it was unclear whether this man would need surgery or not. He certainly needed to be monitored to see if he was continuing to bleed. Since it was possible he would need surgery it was very important for us to determine whether he was longwe or not in case we need to refer him to another hospital.
He was from a village called Tuning, which is right on the edge of our hospital’s territory. In fact, the specific boundary is a river that goes right through Tuning. So the question gets more specific – Which side of the river are you from, Jiwaka side or Hagen side? The problem with this particular boundary is that the people of Tuning don’t make that distinction. They consider all of Tuning to be Jiwaka.
This past Thursday Ryan and I had a chance to go to Tuning. Part of the community based health program here is the Village Birth Attendant program and Tuning just graduated 8 new VBA’s. It was a very exciting time for the community with a ceremony and mumu. It was great for us to be a part of but really needs a blog all it’s own.
For me, it was great to go to Tuning that day and realize how far my patient had come and what this river was everyone kept talking about. Tuning was about 45 minutes to an hour away by car down a very bumpy, rocky road. Now imagine taking that road right after a large branch hit you in the back and you’re in extreme pain, and that’s assuming anyone is around with a vehicle who could take you. Suddenly it makes more sense why I saw this man two weeks after the accident. He was still in pain, but probably nothing like the day it had happened. And then to be asked what side of the river you’re from, knowing if you answer wrong you may be sent on another long car ride…
In the end, my patient answered Jiwaka side and stayed at our hospital. He never needed surgery, but Jim monitored him on the surgical ward to make sure he was alright. The hospital has to have boundaries, that’s an absolute necessity. But it’s interesting to see what those boundaries mean for those living on the edge. For those living in Tuning perhaps a simpler boundary can be found, but for now the question is still – What side of the river do you live on?