Serving The Mobile Clinic in Papua

Save Papua was the motto of Mobile Clinic in Papua. The program was aimed at accelerating health improvements by providing direct services to people from one village to another. The Mobile Clinic services were focused on mother and child health, HIV/AIDS, malaria and tuberculosis. The teams would move from one village to another to provide health services to the people in need, especially to people who live far away from public health service.

    

In October 2010, I was assigned for Mobile Clinic in Kebo Distric, Paniai Regency, Papua. There were 5 people in my team. Lina Gobay (midwife), Elkana Kosay (nurse), Selpina Pigome (public health assistant), Yohanes Kayame (laboratorist) and I (the doctor & the leaader). We also had 2 men as laborers who carried our medicines and our foods. Actually, Kebo distric had the easiest access from the main city in Enarotali. From Enarotali City, we used an open motor boat to Kebo. It took about 1 hour to reach Kebo.

From Kebo harbor, we walked to a house that we were going to stay . The house was dirty and unused for long time. It was a small house but it was ok for us. We unpacked our bags and clean our house. We set the fire to cook. In the afternoon, we went to the priest first so that he can announced our Mobile Clinic program in the church, because most people in Kebo have morning mass every morning before they start their activities on the garden or on Paniai Lake.  

We didn’t have a toilet in the house so we had to pee, poop and had a bathe on the river. This was so exciting, especially for me, who used to live in the city. At first, I felt weird to do all these activities not in the toilet but on the river (outdoor!!!) but finally I get used to it. Anyway the water was so cold enough for me because it came from the mountain. Sometimes I wondered, what if someone also pees and poops on the upper stream river. 
Oh nooooooooooooooooooooooooo… 
You can see in the picture, children were bathing on the river.

The temperature in Kebo was cold enough for us at night until early in the morning. At night, we used to set a fire to cook and to warm our bodies. We also sang Papuan song, talked about cannibal in Papua, talked about horrors and comedies (Papuan MOP). It was very cold at night. I had wrapped my head with crochet hat and wrapped my body with a jacket and a sleeping bag, but I still felt so cold. I can’t sleep well at night because I had nasal congestion and my post nasal drip (due to my sinusitis) made me couldn’t breathe well.

In the morning, we went to the chief of the village to tell them that we were going to have a mobile medication there. After that we went to our first village which was Ibomomaida village. There were many patients waiting for us. You see in the picture, we took a picture together with the chief of Kebo District (the man with black jacket).

Please don’t expect us to have a nice bed to examine the patients. We just examined the patients on the floor. Sometimes if we were lucky, we had a long wooden chair to sit and examined the patient. We also didn’t have a mortar or mixing machine to make pulveres (powders) for children. We used a metal bowl and the unused of Vitamin C bottle. I knew it wasn’t sterile at all. Sterile… forget about sterile!!! We were far from sterile. We didn’t even have surgical blade, so we used Gillette blade (the best a doctor could get). Hahahaha… 

Everytime I give the pulveres to my patients, I always say in my heart, “May God heal you”, because it’s not sterile. If you wondered why we didn’t bring medicine in syrup for children, because the syrup is packaged in bottles and it would be very heavy if we brought too many kinds of syrup. We tried to work in a very simple condition. Look at the picture, the metal bowl and the unused of Vitamin C bottle.

Our target in Kebo District was to visit Ibomomaida village, Ayaigo village, Kagopago village, Kebo village and the last was Paniabagata village. Also all small villages near those area.

It was a very busy and tiring moments. We worked mobile from one village to another village. Everyday we wake up before sunrise and come back after sunset. We also have to walk so many kilometers everyday. We didn’t have much time for breakfast so we decided to bring some sweet potatoes, sugar canes, and mineral water in our bags. On the long the way to the village, we ate sweet potatoes while we were walking. Sometimes we chewed the sugar cane while enjoying the beautiful view of Kebo district.

Anyway we had to use plastic boots because the soil was too muddy.  As I crossed the river with torrential stream, the water came into my boots and my socks got wet. I forced myself to walk with wet socks, but after few minutes I decided to open my socks and just walked by using my plastic boots. When we arrived in our destination, I just realized that my toes and heels became sore. I can’t use my plastic boots anymore because it was hurt. I used my sandals to walk in the jungle but then my left big toe stepped on a nail. Thankfully, it wasn’t too deep, but it added my pain. Honestly, I wanted to cry because I felt tired and hurt but I had to walk for many kilometers and I didn’t want to postpone my Mobile Clinic. Sometimes I wish I could order one Superman to carry me from one village to another, so I didn’t have to walk many kilometers. Maybe it would be nice if Paniai government had cable car in here. Hehehehe… It was just my silly thoughts. “Its okay Sinthya… Pain is a booster to make you stronger.”  Sorry I’d like to talk with myself :D

The people in Kebo District were so nice and very enthusiastic with mobile clinic program. We had so many patients, about more than 100 patients per day. Some patients came just with common cold, diarrhea, osteoarthritis. Others came with tuberculosis, conjunctivitis, cataract, hernia, burn injury, frambesia (yaws), worm infection, malnutrition, etc. 

Our health target were mother and child health, HIV/AIDS, malaria and tuberculosis.  Some babies came for basic immunizations, some children came for single dose oral vitamin A and some pregnant woman came for Ante Natal Care.  Usually I gave lollipops to the children to attract them to come to me. I also gave the lollipops for children after they had immunization. They were so happy with my gift, besides I love lollipop too. Hihihihi…

We always have the HIV screening in every village by asking the patients with HIV suspect to have rapid HIV test. We found many patients with HIV positive result. For patients with HIV, we sent them to the hospital.

The Papuan people's sexual behavior contributes to the high level of HIV/AIDS spread over here. The majority of people experiencing sex for the first time are under 15 years old. This tendency is higher among females than males. In addition, more young people, males and females, often change sex partners compared to older people. Generally, over 20 percent of males and 8 percent of females have sex with more than one person. Some 16 percent of the people have sex with non-permanent partners-including with sex workers.

 

Besides rapid HIV test, we also had malaria rapid test. There were many patients who had malaria infection. It is a common thing in Papua because malaria is endemic in Papua. Tuberculosis is everywhere in Papua. I was a bit surprised to see many patients with Morbus Hansen (leprosy) in here. Some of them had serious leprosy. They had lost some of their fingers and/or toes. I also met patients with filariasis, spondylitis tuberculosa (Pott Disease) and lymphadenitis.

Anyway, people in the village believed that they would be cured rapidly if they gave something for the doctor. I thought it was just their positive attitude. So when I served in mobile clinic, I received many gifts from my patients. I received a rabbit, a small bucket of small lake lobster (udang selingkuh), fishes, so many sweet potatoes, taros, and cassavas, many sugar canes, a bunch banana, shallots, garlics, celeries, chilies, peanuts, etc. In the picture, you can see my laborer was cooking the rabbit with wood stove. Hmmmm... very yummy  :)

 

It was really a nice experience to work in Mobile Clinic program. Hopefully this program could keep continue until the government build a permanent public health services in remote villages. It’s very sad to see many people don’t have a well health service. There are not many doctors who want to work in remote village. Of course they prefer to work in the city with complete facilities and nice life style.