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Dr Chandni, an anaesthetist from Agra, India, spent 10 weeks in Papua New Guinea with Doctors Without Borders / Médecins Sans Frontières (MSF). In this letter written upon her return earlier this year, she reflects on her experience and shares her learnings.
I was excited to be in Papua New Guinea (PNG). As I sat in the MSF Landcruiser, I felt proud to be working for MSF. MSF works in providing healthcare in even the most inaccessible areas and Tari in PNG was one such place.
Located in the Hela Province of Papua New Guinea, it is only accessible from the capital by air as there are no roads connecting it from there. It is beautiful countryside where there is a lot of greenery, but is also home to a lot of violence. MSF runs an emergency surgical programme and a Family Support Centre where we provide medical and pyschological care to victims of sexual, family and tribal violence. Apart from this MSF also helps the National Department of Health in providing emergency surgical obstetric care.
While I was made aware before I left that the program would be a lot about trauma, it was so much more difficult while dealing with it on a day-to-day basis. . I have never seen the prevalence of violence in this scale, with most patients coming in with knife wounds typically inflicted by tribal or domestic violence.
Tribal violence
If an offense is committed by a person belonging to a certain tribe, the entire tribe has to contribute towards the compensation to the victim. The entire community, in keeping with PNG’s intricate and complex social system called wantok, is in that sense obliged to pay for mistakes committed by others irrespective of their financial status. Often the compensation is in the form of pigs or money. If the compensation is not paid then it can lead to violence between the tribes. Tired of compensating the victim on a repeat offender’s behalf, he can even be chopped or assaulted by his own tribe or family. Sometimes the bush knives, the usual weapon for violence, are replaced with handguns –this means even graver injuries, which means tougher injuries for the surgical team to address.
MSF nurses treat an emergency patient brought in with deep bush knife wounds in the minor operating theatre at the Tari hospital in Papua New Guinea. Photo: Kate Geraghty
The other commonly witnessed trauma is that of sexual violence. I saw many women who bear severe trauma caused by sexual assault by their husbands or other men. Some women self inflict injuries to escape graver assaults by their husbands. For instance, I saw women in Tari who chopped their own fingers.
Stories which left an impact
There was a nine-month-old boy who was admitted with major accidental burns over his scalp and chest. We dressed him for the next few days, till he was ready for a skin graft. He had low haemoglobin and would not gain weight. On deworming he vomited worms. Our team supplemented his food with iron tablets and also counselled his mother on proper nutrition. He is now gaining weight and recovering, which is heartening.
On another day, our team received a very young, very short woman who was unfortunately also deaf. A victim of sexual violence, she had become pregnant. As she was very short, she suffered from a severe cephalopelvic disproportion – her baby’s head couldn’t fit through her pelvis. As a result, most of her relatives believed that she would never make it alive during labor.
When it was time for delivery, she was taken in for caesarean section. Professionally, it was quite challenging for me to administer spinal anaesthesia but in the end, both she and her baby emerged alive and healthy. Her relatives had promised her baby to another member of the tribe (Possibly against her wishes), and despite this fact, she still smiled: I think she was just very happy to be alive. I have learnt that despite the harsh living conditions in Tari, it is the commitment of the national staff that makes MSF’s programme a success. It is very important to have knowledge and attitude to work in such a difficult context. I had the knowledge but I learnt the attitude working with MSF.
MSF began treating survivors of FSV (Family and sexual violence) in Papua New Guinea in December 2007, and since then have provided more than 18,000 survivors with emergency medical and psychosocial care in Lae, Tari and Port Moresby. MSF and partner organisations have also trained clinical staff from 28 hospitals across PNG on how to establish and run much-needed medical emergency services for survivors.
