“We are all visitors to this time, this place. We are just passing through. Our purpose here is to observe, to learn, to grow, to love and then we return home.” – Aboriginal proverb
Like many healthcare professionals before me, a lifelong professional and personal aspiration of mine has been to volunteer and give back some of the good fortune I have been graced with. In May 2018, an advertisement landed in my inbox – an opportunity to join Volunteer Service Abroad (VSA NZ) in Papua New Guinea (PNG) as a diabetes nursing advisor.
PNG sits in the southwestern Pacific. East New Britain is part of the small group of islands referred to as the New Guinea Islands, off the mainland. The population is estimated at 8 million and there are more than 850 languages and many traditional tribal villages and customs.
The first weeks
I began by joining ward rounds, sitting in diabetes physician appointments and working alongside the nursing staff who prepared patients for their appointments.
I was overwhelmed by the absolute lack of both basic and sophisticated resources. The impact of this and the culture, and how this translated into care delivery, was often confronting.
For example, patients would come out of a below-the-knee amputation and there would be no dressings or pain relief, instead a pillow case placed gently over the wound. The surgical team would go from a young man of 32 with heart failure (childhood rheumatic fever) to a ruptured spleen (where they did emergency surgery with no blood in the blood bank) to a woman with stage 4 breast cancer, to a spinal injury in a five-year-old boy who had fallen from a coconut tree (this is an occupational hazard).
The surgical team contained no specialists in the various medical/surgical areas. An old British saying, “Jack of all trades, master of none” sprang to mind. However, I realised very quickly the truth, in fact, was that this surgical team were indeed ‘masters’ of their profession, who demonstrated expertly what resilience, faith, hope, trust and compassion look and sound like.
Every day a challenge
Every single day, despite so many challenges and a continued and prolonged lack of resources, the team of medical professionals faced each day with compassion and strength. They put aside all their challenges to be at their patients’ bedsides with humility, compassion and strength and a professionalism that reached deep into my heart and soul. I will forever be touched by this entire team, for the service they have provided and will continue to provide for their people.
The bi-weekly diabetes clinic – usually just one doctor and one nurse – saw over 60 patients each day. Patients travelled from rural villages, often a three-hour walk at 5am in order to catch up to three or four local buses – then waited anything upward of three hours to be seen. More often they would leave with limited understanding of their diagnosis and the impact of it. They were also unlikely to fill the prescription as this often equalled the cost of their families’ monthly budgets. On top of this, they had to face a long and arduous journey back home.
Clinic and workshops
The Frangipani Friendly Clinic is one of two clinics in the whole of PNG that offers free health screening appointments (CVD risk assessment and health promotion advice). Funded by awareness campaigns and one local oil company, this clinic was set up by PNG’s leading physician Dr Al Maha to combat the rapidly rising numbers facing amputations – one of the many complications of their often undiagnosed and or untreated, diabetes.
Metformin was rarely prescribed because of both financial and culture challenges and insulin was rare and hugely expensive. I listened as patients described what was likely to be a hypoglycaemic event following the commencement of a sulphonoyarua (anti-diabetic drug) as first-line treatment.
I discovered that general knowledge of diabetes was minimal, and there was much confusion between type 1 diabetes and type 2 diabetes.
I set up two eight-week workshops for all staff across both hospital sites; these were well attended and received, something I had not really anticipated. Everyone I met listened, absorbed every single piece of information and then acted on their improved knowledge. I felt like I was holding a snow globe, shaking up the environment and watching life resettle and the picture change. I am not sure that I would afford such graciousness to visitors entering my workplace suggesting different ways to work.
Weekends were spent playing basketball with the local children and at churches: I was invited to share our journey. My lessons on health promotion now have a home in almost every church and school in Kokopo.
Openness to learn
My energy levels were high and continued when each day I was met with such openness to learn and create a healthier and safer community. I needed to embrace the power of this community. I connected with the local Christian radio show, liaising with Joe Dunlee and his team every Tuesday morning. The impact of this weekly radio show was astonishing. I shouldn’t have been surprised, for anyone who knows me will agree that at the best of times I have a distinctive voice – no more so than miles from home in this quietly modest Pacific island that is PNG.
The clinic was suddenly overwhelmed, and we were seeing up to 50 people a day for healthy screening. “We listen on the radio” was the reason for the influx. The clinic provides workplace screening on Fridays and suddenly we were booked up for the next four months.
I began to understand that this community was unsure what a healthy, balanced plate could look like. The basic concept of half a plate of vegetables, quarter of protein and quarter of carbohydrates was introduced. Nursing Officer Ashwin Lau was flying high with this concept. We met at the end of the session and the Healthy Eating Plate and ‘the seven goals’ was created.
The fizzy drink challenge was next. A local company, alongside all the giants, produces sugar-filled fizzy drinks in mass supply; you rarely find diet or no-sugar options. The sugar information was met with astonishment and disbelief that companies would produce and heavily advertise products that were full of sugar and damage health.
A long, steady process of education began to unfold – PNG was standing tall and strong and wanting change – not an easy feat in PNG. The healthy eating plate began to come to the fore as local businesses, the ENBP Market Authority and church communities came together to embrace the knowledge and power of good food.
Evenings were spent getting creative putting together two sets of large posters – all things diabetes: prevention, detection and management. I encountered so much generosity: a local business man donated four mobile phones as spot prizes for our live-on-air screening show; another local business house paid for a full set of posters. I was overwhelmed but inspired by this community’s connections to each other and the greater good of the entire community.
Momentum was steadily growing, and we now had four nurses helping in the Frangipani Friendly Clinic.
The hospital CEO welcomed my thoughts and we discussed Metformin. I was encouraged to discuss with patients and ask them to find a way to pay for this, and I recorded the results. Again, the CEO’s door was wide open. Incredibly, he managed to find funding for all in-patients with diabetes to receive Metformin. Ten weeks and we saw a noticeable difference in recovery, shorter hospital stays and the uptake of a drug that has very few side effects and has powerful protective factors across all areas of health; a drug that suits the demographics of rural communities with often little food or ability to get into town, and has virtually no risk of hypoglycaemia.
I was asked to present to food franchise Ground Round. The entire team shared their minds and time with me and revelled in the power of Metformin.
I challenged myself to write some easy-to-follow T2DM diabetes prescribing guidelines that incorporated the healthy eating plate and basic but crucial nutritional advice. I asked some of the team to peer review; the joy in their eyes was all the encouragement I needed.
Loving and giving
Before leaving for PNG I was given glucose meters and stethoscopes by colleagues: these were received at Nonga Hospital as if it was Christmas.
My blogs were reaching friends in New Zealand and the UK. Bernadette in New Zealand found a spare AED at her workplace in Palmerston North and organised for this to be sent to PNG. This gift was received with no words; the stunned face of the medical officer and the way his eyes glistened was a touching and humbling moment.
As we returned from a New Zealand holiday, we were loaded up with stethoscopes and BP machines to give to the dedicated healthcare professionals who were rounding up their own communities to take control of their health by starting up community-run and owned screening clinics.
Friends from the UK were collecting old prescription glasses; fellow VSA volunteers asked their New Zealand friends to do the same. We got 130 prescription glasses. The joy and delight of the staff in the eye unit was priceless. The love continues, and another box of glasses has recently been received.
A New Zealand diabetes nurse visited us, with suitcases crammed full of metres, strips, leaflets, plastic healthy eating plates and a heart full of love. Another friend left his family behind in the UK as he sponsored the production of all the printed guidelines and posters armed with much needed sterile surgical gloves. Tears of love and gratitude flowed.
As a ‘white couple’, my husband and I were becoming well known around town. I found myself being greeted with “Boss Meri” and “Aunty”. One day, a group of elders came up to myself and my husband and remarked, “Hey you two, you are not white, you walk around town as if you are one of us black fellows.” I’m not sure it can get any better than that.
World Diabetes Day was at the market; an education tent and testing station, the last of the donated glucose strips, screening 110 people. Staff came from all areas of the hospital, unpaid on their day off to help continue the empowerment of their community.
The World Health Organization’s 16 Days of Activism against Gender-Based Violence Campaign was marked under the bus shelter outside the market; another Saturday on which 20 dedicated hospital staff were working hard on their day off. We screened 320 people for diabetes and hypertension.
Time was disappearing fast, and my focus had to shift to what lasting resources to leave behind.
I amassed 40 plastic resources folders; I included as much information and resources as I had left, using every opportunity to take sneaky copies at various business houses and local council offices. These were received with gratitude and nurses organised for further copies for community members to photocopy and use for their own communities – sustainability and capability building at its best.
Farewells were tearful and heartfelt. Two of our closest friends and their families were with us through our last night and our 5am start to the airport.
In reflecting on our year in ‘the land of the unexpected’, my first thought is that theTolai community are a straightforward community: if you show them a smile, it will be returned; share your heart and you will be overwhelmed with a love that is true, resilient and loyal. It is the connections we made that wholeheartedly made 2018 a treasured gift – the memories of our year’s journey are glued together by love, joy and laughter .
Belonging is all about the people and the connections you make – being open and warm was all the Tolai community needed to share their loyalty and love. I will be forever in debt to the entire community, who opened their hearts and minds and welcomed us to share just a small part of their long challenging ride.
Since our return, I have connected my mind and physical self with yoga and find myself using my muscles and limbs in the way they were designed for (something that is very apparent in PNG) and I have started to learn to paint.
PNG will be forever etched in our hearts.