My name is Rebekah, a recent graduate from the University of Edinburgh about to start work as a resident doctor in Severn Foundation School! Thanks to generous financial support from Medical Missionary Network I was able to spend my 6 week medical elective at Kapuna Rural Hospital in Gulf Province, Papua New Guinea earlier this year. It was an absolutely incredible opportunity with far too many adventures, learning experiences and photos to condense into this short reflective report, but I’ll give it a go!
Kapuna Rural Hospital is one of two hospitals in Gulf Province run by Gulf Christian Services serving the people of PNG since 1949. It has an incredible history and legacy which I highly recommend you look into for those of you interested! (www.gcspng.org)
Gulf Province is one of the most remote regions in the country. Access to Kapuna Hospital is via light aircraft from Port Moresby to Purari or Kikori airstrips followed by a 3-5hour boat ride along the river in a dinghy. Alongside its sister hospital in Kikori, Kapuna Hospital serves over 30,000 PNG locals across multiple tribal villages. With only 3 full-time doctors employed between the two sites you can imagine the vast needs and challenges faced by staff and patients alike. For context, in the UK there would be approximately 120 licenced doctors for the equivalent 30,000 people that these 3 doctors serve (Source: GMC, Office for National Statistics)!
The hospital comprises 5 wards (Maternity including 2 delivery rooms and a postnatal suite, adult, children, TB and antenatal), an outpatient/emergency department and two operating theatres. Accessible only by river, Kapuna Rural Hospital is surrounded by extensive swamps and dense bush and patients travel for hours to days via canoe and dinghy to access these medical services.
Nothing could have prepared me for day-to-day life at the hospital! For starters, being on-call 24/7 has certainly made my rota for FY1 look comparatively relaxing, and the tragic national shortage of basic medications such as ibuprofen and amoxicillin put into perspective the privileges we take for granted each day working in the NHS!
The morning after arriving I was immediately thrown into the deep-end reviewing and examining patients, making management plans and performing basic procedures. This was incredibly daunting as a lot of the major presentations were illnesses I had very little clinical knowledge or experience in treating including TB, malaria, and a variety of gastrointestinal and skin diseases! Although thankful to have an Oxford Handbook of Tropical Medicine in hand, even that failed me when I realised that many of the medications or tests recommended were not even available at the hospital! I am therefore SO grateful to Dr Valerie and Dr Jessley who alongside the rest of the incredible nurses and Community Health Workers (CHWs) mentored and taught me along the way, answered my gazillion questions and provided a helping hand when my competencies were stretched a little too far!
Each day brought new challenges and learning experiences as we rotated through the various ward rounds to review and treat sick patients, and perform both elective and emergency surgeries. Two of the theatre cases which remain in my memory most vividly include a successful emergency operation on a 11-year old boy with a penetrative abdominal injury (with protruding small intestine) sustained by falling on a nipa palm, and a ruptured ectopic pregnancy where we had to use an autologous blood transfusion (unfiltered!!) to try and stabilise the patient on the operating table whilst awaiting the cross-matching and donation of further blood.
It was fantastic as well to practice various clinical procedures outside the theatre in tasks such as reducing and immobilising complex fractures, fitting chest drains, joint aspirations, skin biopsies and grafts, paediatric immunisations, antenatal USS, helping with complex deliveries, performing CPR and managing an airway in a cardiac arrest to name but a few. I also had the opportunity during my time at Kapuna to run some teaching sessions for the CHW interns, passing on some of my knowledge and skills to those at an earlier stage of their training than I.
As the hospital has no blood bank, the staff volunteer to donate blood as and when is needed. One of the most cherished moments of my time at Kapuna was being able to donate blood to a small child with thalassaemia and witness the huge improvement in the child’s condition within hours of receiving this.
Hand-over started at 7.45am every morning followed by a team devotional and time of prayer. The nursing teams would then lead a short devotional with the patients each day before starting the medication rounds, and prayer and praise was scattered throughout the events of the day – singing praise to God when a new baby was born, and praying with sick patients traversing difficult seasons of their lives. One poignant memory I have is singing “God be with you till we meet again” around the bedside of one of the staff’s mother who was dying from advanced thyroid cancer. She passed away peacefully just moments after we finished praying for her and her family. It was incredible to see the impact prayer had on the day to day functioning of the hospital, and see God at work amongst the staff and patients in many different ways. Being able to share at the women’s fellowship and church was also a blessing as we mutually encouraged and learnt from each other’s testimonies and meditations about the Lord’s love, power and faithfulness in all areas of our lives.
Although communication between staff was all in English, I found it useful to learn some basic Tok Pisin to better communicate with some of the patients coming under my care. Perhaps not the most useful phrases for every day conversation I admit, but I’m happy to inform you I can now confidently ask someone about their bowel and bladder habits in Tok Pisin!
Going on a 6-day village patrol to two poorly functioning health centres to run pop-up clinics was an eye opening experience. The journey to each of these villages was an event in and of itself! After a long dingy ride, we had to trek for hours barefoot along bush trails, through rivers and shin-deep in mud to reach the dilapidated health centres. All the medical supplies were carried on our backs and we stopped at small villages to treat people along the way. We slept on the floor of these deserted health centres under our mosquito nets, cooked our food over open fires, and washed our sweaty bodies and sore feet in buckets under the stars! As a team, we were faced with hundreds of patients queueing each day from dawn until dusk to receive basic medical treatment and advice. It was only as the moon made an appearance, and the queues started dwindling that we would realise that we hadn’t even stopped to eat all day! God was truly powering us on, and giving us the strength for every moment!
Being able to house-share with 4 other University of PNG medical students was such a blessing as not only did it provide companionship and a feeling of home away from home, but also some much needed PNG cooking lessons to learn how to utilise the local produce (comprised mainly of sago, sweet potato, plantains, seafood, and a vast variety of greens and tropical fruit) to put food on the table! A few foodie highlights include python, bandicoot, and shark meat!
It was wonderful as well to observe Easter as a church and hospital community, celebrate nurses day together, attend weddings, birthdays and baptisms with my new PNG friends. I was also able to visit a number of the nearby villages to experience village life firsthand, and learn about various grassroots literacy projects springing up to combat the high illiteracy rates and poor access to reading resources. These experiences have given me valuable insight into some of the cultural factors which undergird society and how these impact the healthcare system and spread of the Gospel on both a local and national level.
I feel incredibly privileged to have been welcomed into the warm community that is Kapuna Rural Hospital. Not only was I fully immersed into the world of rural medicine, but I was able to experience local culture and hospitality, and embrace a very different way of living, eating and thinking for a time. I have made friends for life, learnt new skills and broadened my perspective, and have memories to reflect on for many years to come!
Although but a brief introduction to rural medicine in Papua New Guinea, it has been so helpful for me to be able to explore further a call to medical mission, and learn from those going before me about both the challenges and rewards of life on the mission field. I have much to ponder on as I embark on the next stage of my medical training, and reflect on how and where God is calling me practice medicine in the future. I am very grateful for the financial support from Medical Missionary Network which made this incredible experience possible.
