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St Margaret's Health Centre, 2004 - Hannah Ellis, nursing elective

As a nursing student studying in Birmingham, I was used to working with people from different cultural backgrounds, but nothing could have prepared me for Papua New Guinea. Arriving at the health centre, there was little to distinguish the building as a hospital and I noticed the great need for an input of resources and skill. I also was amazed by how different the role of the nurse is in such a needy place and how useful my skills learned over the past three years could be.

My first difficulty was in getting the people to understand that I was a student nurse, and not a doctor. There are so few white people seen in the parts I visited, that white people are associated with 'help' and 'doctors'. I therefore had many mothers bringing me their children hoping I could help. Many of the under fives in the villages just cried when they saw me as they'd never seen a white person before. I was told that to the children I looked like a ghost. The older children wanted to touch me, to braid my hair and to just watch my every move. I had mixed feelings giving immunisations worrying they would remember me as 'the white lady that hurt my arm' rather than the one who prevented them getting childhood diseases which, unfortunately, are so common due to poor vaccination programmes. I just had to remind myself that it was for the greater good.

Secondly, I had to get used to no running water and generally, no electricity – not even in the health centre.

As I settled in to my new environment, I gradually began to learn Pidgin English and started to take on the role of the nurse – as it is in Papua New Guinea. As there is currently no doctor at St Margaret's Health Centre, the nursing role includes diagnosing, prescribing (under supervision, of course!), and making treatment decisions. I found it was a great privilege to serve amongst a very needy yet accepting population. For the nursing staff, I was a real boost to their confidence and morale. They work in such hard conditions and were really encouraged when I marvelled at how they overcame problems we never even dream of.

There were many things I saw and heard of in my time in Oro Bay that will stay with me forever. If I'd known I would be delivering babies by candlelight, I'd have never believed it. It really surprised the staff that nurses in the UK do not deliver babies. It was almost an everyday occurrence in the health centre, so the staff were keen for me to increase my knowledge and midwifery skills. The first antenatal patient I examined seemed to me to carrying twins – but none of the nurses agreed. With no Ultra Sound or Doopler, it was impossible to confirm my suspicions, but that night she went into labour. Two months early, this first time mother gave birth to twin boys weighing 1.35kg and 1.5kg. The delivery was difficult as there is no pain relief and we were working in candle and torchlight. Also, the second twin was breech. With the generator broken and no running water, we carried buckets of water from the rainwater tank and used manual suction devices for the babies when they were born.

Strong and healthy looking, the boys were kept in the health centre overnight, and then we referred them to the general hospital in town for a check by a paediatrician who was known to be there at the time.

Two days later the twins died at the general hospital. The doctors were on strike. The first time mother had been left to hold her babies in her arms and watch them die. Back at the health centre and busy with other people – we weren't to know.

The mother returned to her village with her babies and buried them outside her house by her door. I travelled by dinghy to the village a couple of weeks later to carry out a clinic patrol in the area and there was Beverley with a bag of fruit for me. She had come to say thank you to me for sharing with her the birth of her first babies, which for me was also my first experience of deliveries. Amongst all the commotion of vaccinating children, I just held her hands and told her how sorry I was to hear about her boys. Next time, I said. Next time. She just smiled and wandered into the people.

This is the way things are for the people there. There is barley any hope for tiny babies. There are very few doctors; there is little support, no aftercare and seemingly nobody to take responsibility. But the people don't blame you. Their expectations are so different from ours. At the health centre I treated TB, pneumonia and malaria cases. It amazed me that small children were walking around with distended abdomens because their spleen had become so enlarged by malaria. The awful truth was that a kick in the stomach whilst playing could be fatal to these children.

I was also involved in caring for inpatients, dressing tropical ulcers and suturing deep grass knife (machete) wounds. As anaesthetics are practically non-existent and pain-killing drugs few and far between, I found I became skilled at distracting children whilst they had wounds sutured. Giving a child a wrapped sweet could occupy them for long enough whilst they first worked out how to remove the wrapper, then ate the sweet. It was hard to see that the limited stocks of lignocaine were not always used and that many patients just had to 'grin and bear it' during minor theatre such as incision & drainage and suturing.

Two weeks before I arrived at the health centre, a woman had given birth to triplets – the first for the health centre, and a rarity for the region. The babies were all healthy and the family travelled back to their village a few days later. On arrival back home, the community told the mother that triplets were the work of the devil and that coming in threes these children were demons. Sadly, having become an outcast, the mother didn't feed her babies and consequently they died. There are lots of indigenous beliefs amongst the people and they often hold stronger than more educated ideas. This makes health education and treatment of illness difficult as many people refuse to accept 'conventional' treatments until they've tried witch doctors and herbal remedies first. This often means that the disease has progressed much further than would usually be allowed by the time they reach the health centre, and regrettably this often means there is little hope left for the patient.

I return so much more grateful for the NHS, for full store cupboards and, even more humbling, our access to clean running water and electricity. I now have friends at the other side of the world working in such poor conditions and I'm all the richer having experience life there. I learned so much from them.

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