Period of Complete Adjustment

21-August-2011, 1725

The end of August is coming up very quickly and my excitement can’t be contained since yours truly will be heading back to the playground down south.  I decided to just go back to Cairns, Australia on my 60-day PNG visa restriction because that will be the shortest trip.  The thought of going to Singapore, Fiji, Brisbane, Sydney, or New Zealand crossed my mind many times, but since time is of the essence, I decided not to as I really didn’t want to be spending precious play time on midair.  I booked a nice and decent hotel right at the heart of the Esplanade, close to the shopping centers and the Casino.  Maybe this time, I will try my luck and my itchy hand at the Caribbean Stud Poker.  I am really looking forward to this nice break again, and this is going to be the very last one as well.

I suppose I can say that my mindset has now completely adjusted to all things PNG.  I honestly admit that I had a very hard time psychologically adjusting in the beginning.  But around the middle of the assignment, ever since my entire focus shifted to work and objectives that I set for myself in this Fellowship, my appreciation of the whole experience itself turned around.  One of my saving grace is the Alcoholics Anonymous prayer line—“GOD, grant me the serenity to accept the things that I cannot change, courage to change the things that I can, and wisdom to know the difference”.  I framed this on a PPT slide, printed it, and tacked it at my desk wall so that every morning and every time I sit behind my desk, I am reminded of the true purpose and objective of me being here.  I understand that I will not be able to change everything or most of the things that I identified and outlined that needs changing or modifying.  Even if I am just able to bring about change in practice in one or maybe two items that I identified, I will be able to say that I made a difference in PNG and that I had done my job as a Global Health Fellow. 

Having said that, I immerse myself at work and spend my time working with PNG folks at the clinics.  They enjoy my company when I am working side by side with them at the VCT counselors’ room, at the treatment room, at the STI examination room, even at the reception area.  Patients and clients shake my hands as the nurses introduce me.  Last week, I tried to comfort a patient who will be receiving her second IM shot of Benzathine Penicillin G 2.4 million Units for primary syphilis infection.  Matt, the male STI nurse was a bit apprehensive because the client was a female.  He described to me the procedure he’s just about to do.  He will be giving the 10 ml IM injection once at the dorsogluteal site.  I learned quickly that PNG nurses have never been taught or heard of the ventrogluteal site.  A quick demonstration and teaching soon followed as I gave him the evidenced-based rationale on why VG site is more superior to DG site.  We both identified landmarks after obtaining informed consent.  I described to Matt the Z-Track technique.  We had to divide the shots into two this time since it was 10 ml.  I gave the first, he gave the second.  The patient actually did verbalize less pain compared to last week’s shot.  After my quick IM session with Matt, I went outside of the clinic to visit the tent where the Case Management Team is holding counseling sessions.  When I went back inside the clinic, almost all the nurses and Community Health Workers (akin to LPNs in US) asked me if I could hold a training session on intramuscular injections.  Matt supposedly told the folks about the new technique he just learned from me.  I now have an additional training session that I will be doing in September. 

Two weeks ago, the clinic physician asked for my professional opinion on a case of a 35 y/o cachexic and HIV+ male who has been having progressive further weight loss and productive cough.  Acid fast bacilli on the sputum were negative X 3.  Thank goodness I always bring a handkerchief with me.  Quite subtle pulmonary changes and infiltrates were evident at the most recent CXR.  Both the physician and I were thinking of either pneumocystis carinii or jejuvecter pneumonia.  He will have a return visit the following month for a repeat CXR and AFB test, then will be decided to start on quadruple anti-tuberculous medications—INH, Ethambutol, Pyrazinamide, and Rifampicin. 

Pulmonary tuberculosis is one of the prominent problems in PNG aside from STIs and HIV, there’s no doubt about it.  With the case I just described above, and many others similar to this one, the clinics and the community have a weak knowledge on the disease process, pathophysiology, treatment, prevention, and protection.   I developed a simplified training program on pulmonary tuberculosis for the community outreach volunteers, clearly identifying the statistics of TB in PNG from World Health Organization.  Then, we talked about Standard Precautions, Transmission-Based Precautions, and Airborne Transmission.  I strengthened the notion of physical barrier (mask, handkerchief) and handwashing.  Every single one of the OVs and Field Support Supervisors were so interested that we exceeded the time limit again.  Many questions and comments came afterwards.  At the very end of it, they wanted me to facilitate another training program, this time on HIV. 

So, it has been a very busy past two weeks and I am happy that its weekend.  I need to catch up on laundry and ironing.  I am really starting to become a master of this ironing craft since I’ve been in PNG.  Yesterday, I took an afternoon nap and was woken up by loud voices yelling and screaming.  Then I hear footsteps running on the street.  Tom and I went to the verandah and we both witnessed a very up close inter-tribal warfare between CHIMBU and TARIMA tribes.  The fight supposedly started with just two men drinking.  A disagreement happened, and the next thing you know, the whole tribe on each opposing ends of the street became engaged in the fight.  It was an all-out brawl needless to say as the men and adolescent young men started bringing out the machetes, axes, bows and arrows, and galvanized iron roof for shields.  The other guys were throwing and hurling rocks, bottles, and bricks in every single direction.  Most of all, the two tribes now engaged in an all-out fight started doing their war chants and cries.  We were just watching in our terrace as it was really a scene to be had.  If this would have happened in May or June, I would have freaked out and said “I’m going back to the States, the heck with this stuff!”.  But I am more sensitized now, it’s as if another event happened in PNG, the land of the unexpected.  I actually found myself saying “Yeah, so what else is new?”