29-June-2011, 1625
Violence is a real pervasive problem in PNG, a real threat not only to the growth and development of its national identity, but also to the local folks and residents, as well as expatriates. This countrywide problem is of resounding concern to me that I often find myself mentioning anecdotal occurrences in my previous blog entries. As per usual, I was again a spectator to similar events that occurred these past two weeks. Without compromising the identity and privacy of the person involved, only the most important aspects of the following events will be revealed.
One of the staff that I work with went to work as per usual last week, only this time, I happen to notice him with bloodshot eyes, bruising on the zygomatic arch, and 2 band-aids on the cheek. The usual morning conciliatory greetings were exchanged and I glanced at him as discreetly as possible to note the extent of the “facial damage”. I have learned early on that folks in here do not like to talk about things that will cause an embarrassment to them. So I did not asked what happened. I figured if he would really like to tell me, he will. Surprisingly enough, he approached me at noon during lunch time to tell me about the brawl he was into the day before. Alcohol and betel nuts were involved of course. Worst, it was a brawl between him and a family member. A few of the staff also mentioned something like this had happened to him a few times before, mostly because of drinking and fighting.
In another event, last weekend, I asked my hired driver to go with me to Malaoro public market place so I can get some fresh vegetables and spices. From what I was told, this particular marketplace has always been a spot for crimes and violence. Raskols carjacking and pick-pocketing are ubiquitous. Being the nervous person that I am, I made sure that Gary (my driver) was always at my side whenever and wherever I go. He is actually very good at what he does, because his eyes are always on me wherever I go. The shopping was uneventful thankfully. When I was just about to get back into the car though, I saw a man and a woman, presumably husband and wife from what Gary told me, having a physical fight right there at the sidewalk of the market. The husband was pulling wife’s hair and he had a piece of wood in his hand that he used to hit wife on the back. Wife was screaming at the top of her lungs, in Tok Pisin of course so I could not understand. At one point, husband dragged her along the sidewalk by her hair. I was so astonished and dumbfounded with what I was looking at and witnessing. I was really struck with the fact that no one came to this woman’s rescue at all. The market was filled with shoppers because it was a Saturday. With that amount of people, nobody bothered to call the police or even made a physical attempt to separate the two. I wasn’t going to play “hero” and intervene, being an expatriate and an outsider. Gary told me she was screaming for him to stop because she was hurting terribly. Finally, he said that bystanders did not bother to intervene or call law enforcement because it was a domestic issue, a fight between a husband and wife. Therefore, anyone outside the circle of that family, by the virtue of being an “outsider”, will have no business to interfere or intervene. It will take massive effort to raise awareness, let alone change ideology or point of view, on something that is heavily ingrained and inculcated like this. There are advertisements on billboards that indicate beating the crap out of your wife is illegal and unlawful. But there is nothing a complainant could do if law enforcement itself will act slowly, if not at all, to remediate the problem. Not only will the ideology need to change, the law enforcement system will also need to be re-structured and re-formulated. So there it is, the violent episodes of the last two weeks, the physical assault of one of the staff two weeks ago, then these two additional instances of physical violence. These really gives credence to the personal security and safety mandate that staff tells me all the time—“Be careful and always on the lookout!”.
I was able to finally visit Port Moresby General Hospital and look inside. Let me make it perfectly clear, it was NOT ME needing to be hospitalized! One of the sick clients in the clinic had a worsening change in condition and the family brought him into the clinic. The nurse on duty started an IV line and took history. I was observing the interactions and processes taking place and jotting down notes on what areas can be improved upon. I had several items on my list: history taking, vital signs, physical examination, etc… Based on this incident alone, I thought that more work needs to be done on strengthening clinical practice and improving quality of care. Initially, the family was adamant for the patient to just go back home after the IV infusion was finished. The mother of the patient, who was at home at that time, was reluctant to have him admitted at the hospital. She said that if he was actively dying, she would be most confident and at peace to care for him at home. Then all of a sudden, they all turned to me wondering if I had something to say as I was auscultating his heart and lungs. So I explained that he needed clinical care and services found in a tertiary facility where laboratory and diagnostic testing could be done. Carefully crafting my words, I expressed regret that we were only able to care for him in a limited fashion since the place is just a clinic. More can be done at the hospital, i.e. blood counts, x-ray, intravenous fluids and medications, maybe parenteral feeding (the patient was bone thin and emaciated!!!). The family readily agreed thankfully. Since they were very poor and could not afford to have an ambulance drive the patient, they rode on the back of the clinic/company vehicle (truck) and we dropped them off to the Urgent/Ambulatory Care side of the hospital. Immediately, I assessed that the setting was just pure chaos, with patients and family scattered everywhere. I was not able to readily identify who’s who in the milieu. There were a lot of papers at the desk and there was not one single computer to be found at all. No one wore scrubs. The troubling part was that this patient was put on a wooden bench at the back of the hall while his “referral” form was submitted to one of the physicians. I don’t know how quickly he will be seen because the physician was nodding her head and whispered PLHIV (Person Living with HIV). Pervasive stigmatization and marginalization of people with HIV is a real problem and threat to the healthcare infrastructure in PNG! I’m afraid that the patient will not get seen in time just because of the “red-flag” diagnosis. I also did not hear the familiar beeps and sounds of hospital techies and gadgets, i.e. cardiac monitors, Dynamaps, and call lights! The X-Ray hallway was filled with people in three different lines from end to end. I did not even tried to venture inside the psychiatric ward because judging by the looks of the halls inside, I might not actually come out of there alive. The pediatric ward was the only place in the hospital where at least order and cleanliness were immediately noticeable. Even though I had a camera with me and I was really itching to take some photos, I decided not to. I don’t like the feeling of having to take a snapshot of their ill physical state for my own record-keeping purposes.
For a change, I did something out of the house last weekend. One of the security guards at home mentioned a mini cultural show held at one of the Caritas Catholic School just around the block. I was welcomed to go for a nominal fee – 10 Kina, which is not bad, but since Paul (the security guard) was going with me as my own personal security person, I had to pay for him as well, which I didn’t mind. Since I was readily identified as an expatriate, the guards at the door automatically gave me a “Guest of Honor” ribbon and pinned it on my shirt. I did not ask what it was for, I just said “Yes I am and I am glad to be here”. Later on, I found out that Guests of Honor were major funders and contributors to the school cause. I just wore it for the day, that’s all. I liked the benefits of it too—sitting up front, lunch, and beverages. But I gave my lunch and beverage to Paul, since he did not have the ribbon. I have many pictures and a few videos. I will post them separately and hope that you enjoy a glimpse of the Papua New Guinea culture, tradition, and attire.
So, this is going to be the last blog entry under heading “The Beginning”. It finally came to it; the first 2 months of this Fellowship is over. 1/3 of the proverbial pie has been consumed already and the leftover 2/3 are well under way as well. Tomorrow, July 1st, I will be heading to Cairns Australia for 3 days for a much needed personal R & R, a mental break that is so richly deserved, I think. It also means to say that I will be starting on the third month by the time that I get back. I am missing home already. Hopefully, the days will go and fly by a bit faster from this point forward. The next blog installments will be under the heading of “The Middle”. Ta – ta for now!!!
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