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Was it Goodenough?

February 11, 2013

Part of the plan for my medical elective placement was to head out to Goodenough Island, the furthest of the d’Entrecasteux group, to the Catholic run mission hospital at Wataluma on the northern side of the island. Currently there is no doctor out there and it is incredibly remote. Even the Lonely Planet gets it wrong about these islands, stating that there are weekly flights from Alotau. There are actually airstrips on each of the three islands, constructed during WWII, but planes haven’t landed there for over 50 years according to locals! The grass is over head height on the strip. I was quite excited reading about this island as it is one of the steepest sided on earth. Approximately 50km in diameter it has a mountain peak over 2500m high.

View of Goodenough Island from West Fergusson Island

View of Goodenough Island from West Fergusson Island

I spent at least a week waiting for a boat that was going to Wataluma. Finally I got news that the MV Goodenough I was at the wharf and I went down to reserve a spot. Boats wait in a queue to load cargo (food and fuel) and leave when full, often overloaded, and take as many passengers as they can fit on top. People pile into every inch of deck space and even sit on the roof of the cabin. The journey can take up to 24 hours, often in poor weather. The MV Goodenough I was an old wooden boat that looked a pretty dodgy, but boats like this are the main transport option for the region. I left my number with Captain to call me when they were ready to leave. After 3 days I got the call. There were rumours of a cyclone wind warning and other boats were under instructions not to depart that evening. Later I learned that the Captain had ignored the warning, saying that we would sail to East Cape and assess the weather from there. In reality the wind wasn’t that bad, but there was a bit of wind swell, nothing out of the ordinary coming from Perth, the windy city! Luckily the cyclone wind warning was downgraded too.

Boarding the boat, I had a bad feeling in my guts about this journey. The weather, the state of the ship, the length of the journey at sea and the remoteness made me feel really uneasy. Later, reading my textbook on Tropical Medicine I read some reasonable advice: on your elective in the tropics the risk of injury from transport accidents is much greater than the threat from tropical diseases. Don’t be afraid to get off that car, bus or boat if it doesn’t seem safe, you never know, you might meet someone interesting along the way. Sage advice in hindsight! At 7pm in the dark we set off. 5 hours later we were at East Cape pushing through some decent sized waves. These little boats really rock in swell too. The only white person on the boat, I was a special passenger and allowed to sit up front in the cabin with Captain. I was given the bench to sleep on. I get sea sick, but I was telling myself to imagine that the rocking was a pleasant sensation ‘like a baby in cradle’ and to think about being gently rocked to sleep. It seemed to work.

At 4am, in the pitch black, the sound of the engine died down and we suddenly lost all speed. The crew starts running around and the Captain repeatedly pulled at a handle at the dash board which clearly wasn’t having any effect. Don’t panic, I thought, but this is your worst nightmare coming true. They’ll fix it, maybe they know what to do. Half an hour later, it was clear that we had broken down. The captain apologised to me that I was a part of their disaster and that I could be on the first rescue boat. Thanks, I think. Cup of tea? Lucky at this point that we had mobile phone reception! The radio signal was weak and we couldn’t seem to make anything out. Many mobile calls were made back to Alotau. At 7am, people start their work day in Alotau and the remote settlements get on the radios for the daily communication. Word started to get around that our ship was broken down and that we were ‘floating somewhere outside Esala passage, off the Fergusson Coast.’ We anchored to slow our drag, but when these boats have no speed they toss horribly side to side with even the smallest waves. The plan was to wait for rescue, which would come in the form of a dinghy with a mechanic, or another big boat who could give us a tow. This was not a situation that I wanted to be in. I turned the GPS on my mobile on, to see that we weren’t ‘far’ off the point from West Fergusson, but I couldn’t see the scale of the map. I estimated anything from 10-50km. When dawn came, I could see the land quite clearly and we were lucky that despite some rain, the wind was dying down. I figured that we would be in for a wait, anything up to a few days until we were found. I had 3.5 litres of water. Hope for good weather but if we floated closer to land we could crash on reef. If the boat sunk, I thought it could go down very quickly, but at least reef usually means you’re close to land and I thought I could swim up to 10km slowly comfortably. I kept thinking what Bear Grylls would recommend in this situation! I took a Maxalon and decided not to panic, just wait and hope. We lost all phone reception and radio a few hours later as we drifted.

Thank you God for having mercy on us! In the mid-afternoon, a dinghy appeared on the horizon. Our saviour came in the form of Father Alfredo’s dinghy from Mopamoya off the point of West Fergusson. ‘That’s Father’s boat,’ all the passengers commented from miles away. There were three boatmen, the motorman standing tall at the helm. I am amazed at their distance vision, able to spot boats far on the horizon and the fact they found us in rainy conditions as we floated away. They roped up, gave out some betel nut to the crew (very important), assessed the situation, attempted to tow the boat, which clearly wasn’t working, then decided to take a bunch of passengers, mostly young children, two mothers and me with my bags, back to the Mission! I felt guilty that I was getting out of this situation when other women and children were being left on the boat, but I wasn’t going to hang around on a sinking ship, so to speak. It took us 1 hour to reach the coastline and another hour to get to the Mission. These dinghies go along at around 50-60km an hour. Even the land looks like it’s ‘just there,’ it’s a deceptively long way as the mountains are truly massive! Any attempt to swim would have been stupid. We arrived at Mopamoya drenched from rain and spray and I was so happy to be on land that I wanted to cry.

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The Mission at Mopamoya

Some local West Fergusson boys are a bit stunned by my arrival

Some local West Fergusson boys are a bit stunned by my arrival

Father Alfredo is the Catholic Priest at the Mission station; an Italian (Roman) nearing 70, with a strong accent and losing his hearing. He has spent 17 years at Missions around Goodenough and Fergusson. He opened up the church and rooms and gave me a bed and dinner for the night. He radioed Sister Irene at Wataluma Station to organise a dinghy to come for me the next day. He asked me if I was frightened out there. I said I had tried not be. He said it’s a horrible feeling and that he wanted people to know that they were safe. He said it’s incredibly isolated out here, pointed to his chest and commented that it’s an uncomfortable feeling inside but you eventually get used to it, maybe even come to appreciate it. Boats go missing and go down all the time out here, the weather can be terrible and getting enough fuel (called zoom) for dinghies is a challenge. I was incredibly grateful. I couldn’t believe what had just happened. Even though night was approaching Father sent his dinghy out again and organised another one from a neighbouring village with permission to use a barrel of someone else’s zoom on the boat to rescue the remaining passengers. By 10pm, everyone except the crew and 8 other men were arriving to spend the night in the church. They had floated another hour away by the time the dinghies reached them. As I met more locals, and people heard about our story, no one was surprised. Boats regularly break down, dinghies run out of fuel, some tip and sink in bad weather or from hitting reef, and many overload and pay the price. When I got back to Alotau, I heard another student trying to visit Goodenough floated for 7 days in his boat that broke down!

At sunset I went down and stood on the beach. This place is stunningly beautiful. We were lucky that the wind had completely died down leaving a still evening with glassy water. I looked across the water towards Goodenough Island. It seemed like every canoe was out making the most of good fishing conditions. As the sun went down the canoes started heading in to the land. The light, the reflection on the water and the silhouettes of the canoes were amazing. I’m thinking: am I lucky to alive? I’m lucky that this situation wasn’t any worse.

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A calm sunset at West Fergusson Island

The next morning at 6:30, one of the nurses heading to Wataluma knocks on my door. ‘Doctor, wake up, the boat is here. We were about to leave but then I remembered you were still here.’ I throw my bags together and rush down to the shore to see the bloody MV Goodenough being towed past by a smaller wooden boat! Here we go again… We board the dinghy, load back onto the boat heading for Bolu Bolu station on Goodenough Island. After an hour, Sister Irene’s dinghy turns up to get ‘the doctor’ and a few other staff heading for Wataluma. They pull up and I throw my bags and myself into the boat in a moving transfer, but the others don’t want to come because they’ve got cargo on board. I look forward to being at Wataluma in a couple of hours. We zoom along and flying fish jump out of the bow waves. These small blue fish seem to get a launch out of a wave and like little machines, open their fins like a fan and glide up to 50m above the surface of the water. There’s nothing like zooming along in a banana boat in good conditions with the wind in your hair, flying fish and amazing views of the surrounding mountainous islands!

Half an hour later it’s obvious that a storm is coming with a headwind and accompanying swell picking up. We divert our course into a bay to radio Wataluma, to let them know they found me and that the others didn’t want to come. I get to visit Wailagi, a small settlement in a deep water bay. As we enter the bay, it’s clearly protected from this northerly wind by steep hills; some are clad in emerald green grass plunging down to the water, some covered in dense jungle. Villages are clustered along the shore. Dolphins surface in our bow waves. Wow! We pull in at the settlement to use the radio. The locals apologise that they don’t have a wharf after a boat roped up to it pulled it down in a storm. Sister Irene advises that we should wait for the boat again and try to take some more passengers. I meet Lydia, the local Health Extension Officer (HEO) who runs the health centre. She gives me a tour, then takes me to the Pastor’s house; Wailagi is a Uniting Church Mission. I suspect we’re in for a wait as the boats struggle against the head wind. I take coffee with the Pastor and then offer to help out with antenatal clinic that morning. Incredibly, after an hour the MV Goodenough and towboat chug past! After some mucking around, the passengers refuse again to get in the dinghy preferring to stay with their cargo. I suspect they’re worried they’ll have to pay for zoom. Finally two mothers with newborn babies climb into the dinghy on their way back from deliveries at Alotau Hospital. Finally, someone makes a sensible decision! I don’t care what the cost. After 2 days, I’ll pay anything not to spend another night with the MV Goodenough!

We prepare to leave but one of the boatmen has gone missing in the nearby village. We pull up on the shore, and the entire village comes including over 20 kids out to gawk at me. I think, I really need to pee, it’s going to be 3 hours until Wataluma, so I jump out of the boat and request to use their toilet. The whole village points down there. I walk through the village with all the kids following me. Where? There, there. Then I see the village loo. About 10m offshore is a shack is perched over the water with a tree trunk mounted on forked sticks leading out to it. Awesome. If I fall in, I will literally be the laughing stock of the village! I take off my shoes and balance out along the log, do my business, with everyone probably watching what drops out below the platform and balance back along the log. The kids are all giggling but seemingly satisfied that I didn’t fall in the water!

The wind has died down, and we zoom off for Wataluma. The coastline changes as the north side of the island reveals a flat plain and mangroves. People are out fishing from their canoes. The boatman points out a massive saltwater crocodile   ! There goes any chance of me snorkelling out here! We arrive at Wataluma wharf, on a shallow bay, not anywhere near as impressive as Wailagi. A tractor pulls the boat out of the water and we head for the settlement about a kilometre inland. I hop up front with Sixtus the driver, who gives me the tour coming in.

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Wataluma Bay and wharf

BJM Hospital

BJM Hospital

One of the lovely Virgin Mary statues

One of the lovely Virgin Mary statues

The Catholic Hospital buildings

The Catholic Hospital buildings

The Doctor's quarters where I stayed on the right side of the building

The Doctor’s quarters where I stayed on the right side of the building

The Mission is a neat settlement of buildings laid out on nice green lawns with some established frangipani, hibiscus and mango trees. It includes a long Church, hospital and lodgings. I meet Sister Irene, the head nun who runs the hospital and she greets me with a massive hug, glad that I am safe. I get the doctor’s quarters to myself; living room, kitchen, bathroom and bedroom. There is power from a generator 2 hours in the morning and 3 hours at night. I visit the hospital later that afternoon, it’s clean and well organised. They don’t have a doctor but have a HEO who has been there for 5 years. The staff are great. Student doctor / doctor, same thing to them. Everyone calls me doctor. No really, I’m a student, I’m still learning! I’m humbled by my reception here. The nurses promise to call me for all deliveries as 6 very pregnant ladies wait in the antenatal ward for their time. There are about 14 inpatients and Outpatients sees around 25 patients per day. As I flick through their immaculately kept patient log book, many of the cases are infected skin sores, pneumonia, malaria even some cases of fish poisoning! Unfortunately, I’ve arrived in a week where the team is based at the Mission. Next week they head out to local villages to do clinics, rotating through the villages for the next 3 weeks, each week further afield.

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Waiting to get their sores attended to

The ground was often flooded

The ground was often flooded

It rains heavily every night as massive tropical thunder storms roll in and dump over Wataluma and the mountain. The ground regularly floods. On Saturday morning, Niberta one of the nurses collects me for market. We walk on the plain on the muddy road in the direction of the mountain. I can see waterfalls coming down the mountain in the distance. It’s stormy ahead, but the sun over us is really strong. At the market, ladies are filing in with garden produce balanced on their heads. It starts to get busy. Niberta points out the good bananas and chooses me a good pineapple. We head back and some people are selling smoked reef fish on the road. I attend mass on Saturday and Sunday, curious to see how things run and for something to do. I sing the hymns with my terribly out of tune voice!

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Walking to market across the plain on Saturday as a storm rolls in over the mountains

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Local ladies and their produce

Wataluma community market

Wataluma community market

Every day I spend most of the time in Outpatients, diagnosing falciparum malaria, pneumonia, a corneal laceration (from a stick in the eye), gastroenteritis, fevers, peptic ulcers, heart failure, sore backs, abscesses, arthritis, typhoid fever and prescribing from the little blue manual for the treatment of common disease in PNG. On Saturday night they call me in to help deliver one of the ladies. It’s her 7th baby. After rupturing the membranes, a baby boy arrives rather quickly! The mother says that she would like me to give him his name. I’m a bit stunned, but I decide to name him after Lachlan, because it’s a good name and quite popular again in Australia! His last name is James, my brother’s name so Lachlan it is! So Lachie has a namesake out on Goodenough Island. On Monday morning I get to deliver another lady, another 7th baby and I run the delivery myself, really worried about a post partum haemorrhage that these ladies are at risk of after so many babies. Again, a baby boy arrives very quickly and I literally catch him! All is well and this one is named Maxmin by his mother. Unfortunately no one else goes into labour until the day I depart.

Ladies waiting for check up at Antenatal clinic

Ladies waiting for check up at Antenatal clinic

Baby Lachlan

Baby Lachlan

A nasty abscess due a a palm frond

A nasty abscess due a a palm frond

This little girl was treated for pneumoniaThis little girl was treated for pneumonia

I get to do some incision and drainages on some terribly pus filled abscesses. A palm frond spear in the hand of a little boy. Another 23 year old male, paddles himself 2 hours around the island in a canoe unable to walk anymore because the infection in his foot is so bad. He said it really hurt when the waves splashed onto his sore as he rested his foot on the edge of the canoe. I do a pretty crude job of opening up the abscess unfortunately without adequate analgesia because I’m not sure what to give him. I’m totally out of my depth, ashamed that as a final year student I haven’t learnt how to do an incision and drainage yet, the most basic of surgical procedures. Yet, after a few days of dressings and antibiotics it’s healing, so we’ve made a difference. We do an ECG on a 46 year old with severe valvular heart disease and prescribe some blood pressure medication and a diuretic that helps her symptoms, knowing that her prognosis is poor without heart surgery. On my last day, another elder with his wife arrive by dinghy from West Fergusson, referred by the local health centre still unable to walk from a spear wound to the foot (black palm frond), most likely retaining a piece of the spear. We do an xray, which reveals a fractured lateral cuneiform, but we’re unsure if there’s still some spear inside. He’ll need an exploration of the wound. I hear that their village was attacked, this guy was speared twice in the leg, their huts were burnt and all their cooking utensils were stolen. I realise that this couple has nothing to go home to, but they’re grateful for their lives and after his foot is healed they’ll go back and start again. It’s a wild place! I wish I could stay longer and learn more, do the village clinics but I’m also worried about getting stuck out there for too long, so when I hear about a good big boat coming on the weekend, I decide it’s time to head back to Alotau.


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