Vector Volume 11 Issue 2 - 2017

Paddling upstream:
Experiences from a medical placement in
rural Papua New Guinea
[Feature Article]
Nicholas Snels
I sit in an office on my GP rotation. My insides burn,
courtesy of my morning doxycycline. The patient, who
has come in with fever and a sore throat, coughs. I flinch.
My eyes fly across the room, searching for a face mask.
Then I remember I am back in Toowoomba, and not
every fever is likely due to an unpronounceable parasitic
infection. This is perhaps a slight
dramatisation of my GP block, however,
I cannot help but cast my mind back to
when a cough could signal something
far more sinister than an URTI.
I was recently given the opportunity
to spend six weeks at the Kiunga
District Hospital in rural Papua New
Guinea (PNG) as part of the Griffith
Rural Medical Education program. Every rotation block,
four students are given the opportunity to spend six
weeks in Kiunga hospital. For those as unfamiliar with
Papua New Guinean geography as me prior to my visit,
Kiunga is a town in the western province of PNG, on
the banks of the Fly River. The hospital serves a town
of approximately 13000 people, in addition to being
a referral centre for the region, with approximately 45
beds spread over numerous wards (medical, surgical,
women’s), as well as a pathology lab and an emergency
department/outpatient department (OPD). The wards
are managed by a physician and a surgical/obstetrics
and gynaecology doctor, health extension officers,
community health workers and nurses. As medical
students we were well accustomed to being at the
bottom of this hierarchy; however, in PNG we were given
far greater responsibility.
General Ward
Nick is a final year medical student from Griffith University. Throughout his degree he
has been interested in gaining clinical exposure in a variety of settings, ranging from
a rural experience in Warwick to furthering an interest in global health in Papua New
Guinea and India.
Common things occur commonly. This phrase had
been thrown at me all throughout my clinical years. Most
coughs are probably not cancer, most sore throats are
not the harbinger of quinsy. However, the medical ward
showed us just how context-specific this phrase is, with
...the words ‘common things
occur commonly, therefore,
this is probably tuberculosis or
malaria’ heard at least once
per ward round.
the words ‘common things occur commonly, therefore,
this is probably tuberculosis or malaria’ heard at least
once per ward round. Ascites was probably due to
abdominal seeding of tuberculosis, a headache was
probably due to cerebral malaria. We quickly learned to
appease the ward doctor by suggesting tuberculosis as
the cause for nearly every presenting
complaint. The range of tropical
diseases surpassed my expectations,
from tuberculosis, malaria and
malnutrition, to less common cases of
severe AIDS and Buruli ulcers. I was
even exposed to diseases I had not
even fathomed I might see, such as
toxic epidermal necrolysis as a result
of leprosy medications.
Our time in the general ward consisted of a morning
ward round followed by jobs, and it was eye-opening
to see how health care could be limited by a lack of
resources. Intramuscular antimalarials often ran out,
meaning that oral antimalarials had to be followed by
an ondansetron chaser. There was no adrenaline in the
emergency room, meaning it was necessary to trawl the
hospital to find some before it was needed. A lack of
funds for staff meant the occupants of the tuberculosis
ward were at the far end of the general ward, placing
the rest of the patients at risk of nosocomial infection.
Consequently, we soon learned that ward rounds began
by applying appropriate PPE as soon as we entered the
building (Figure 1).
One patient made a particular impression on me. M
was a 7-month old female admitted due to malnutrition.
Throughout the week, she slowly gained weight and
started to take an interest in the strange pale humans
trying to make her smile with a toy koala, and was
eventually discharged. The next week she returned with
a cough, initially thought to be viral in origin. However,
common things occur commonly, and imaging suggested
M had tuberculosis. While unable to pinpoint the exact
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