By any means
By Noreen Chambers
If I had known a health trip for a mobile immunisation activity to a remote inland Rigo community in the Central Province of Papua New Guinea would be a gruelling 10-hour foot journey, I might have had second thoughts about going along.
An initial itinerary indicating the travel would consist of a road trip and then a two-hour dinghy ride up the Omand River to our final destination at Didigoro, was abandoned 24 hours before the trip started because the water level was too low for the dinghy to travel in. Didigoro is situated in the interior hinterland of Rigo and devoid of most government services.
So here we were my UNICEF colleague, Dr. Grace Kariwiga, I and 20 or so other people, offloaded at Lepamakana, just off the Magi Highway, close to about two hours drive east of Port Moresby. This is where the road to Didigoro ends and the foot trek begins.
UNICEF was accompanying a team of health workers from the National Department of Health led by Dr. Paison Dakulala, Deputy Secretary, National Health Services and Standards. Included in this group also were two health teams from the Central Province going on a foot patrol to implement and monitor the Supplementary Immunisation Activity (SIA) in Rigo villages.
The SIA is a special immunisation activity that the Health Department carries out every two years country wide to vaccinate children less than three years against measles and pregnant women against tetanus. Unlike the previous two SIAs in 2008 and 2010, this SIA is providing a one stop shop for children under three to receive the measles and oral polio vaccines, get de-worming medicine to prevent intestinal worms, and vitamin A. All women of child bearing age between 15 and 45 including pregnant women will also receive the tetanus immunisation to prevent tetanus, a highly preventable but deadly disease that potentially kills many women and children. UNICEF supplied fifty per cent of the measles vaccines for this activity.
Much to every ones relief, ten Didigoro villagers are waiting to help us carry the vaccines, medical supplies and our own cargo. They tell us the trip to Didigoro usually takes them about six hours on foot but with all our cargo and at our pace, it would probably take us eight hours at least.
We set off on the bush track at 10:15am. We climb and descend a few small hills, cross a couple of streams and the first hour passes quickly. We stop to take a break. The next leg of the journey is the toughest. The locals tell us to be prepared to climb mountains. Our first climb is very steep, our legs are screaming to stop and we’re panting so hard we can hear our own hearts thud loudly against our chests. We’re stopping every ten or so steps to catch our breath while the local villagers with medical supplies carried either on their head or in a string bag, calmly pass us by and continue the climb with what seems to be little effort.
Halfway up the mountain, we stop for a rest. The view at this point is scenic and overwhelmingly breathtaking but all we’re thinking about is if we have enough stamina to make it up to the top of the mountain. After an hour of struggling up an often overgrown and discernible bush track in the midday heat, we finally make it to the top and flop down on the ground, cargo and all, completely exhausted and drained of all energy.
Half an hour later, we’re off again. The next eight hours take us through some of the harshest and unforgiving environments. There are some more small mountains to conquer and a stretch of savannah grassland that takes us straight into the jungle and down the side of a huge mountain for almost two hours. The track is so discernible that we don’t even know if we’re going in the right direction. Apparently we are, because at about 8:30pm, we see the lamp lights of the Goutakogena village. What a welcome sight! This village and the neighbouring Kwairuka village make up the Didigoro community.
There are no government services in Didigoro. The closest place one can get a mobile phone reception is a 30 minute hike up a steep hill. An aid post that provided health services functioned well in the colonial days but closed its door some 23 years ago when services and infrastructure deteriorated. The community’s Diguarubo Primary School has only ever had 2 teachers who teach all grades from elementary to grade six. The locals say the school is only open half the year most times and students have to repeat their grades because of this.
The CRC church hall in Goutakomena village is a hive of activity the next morning. Dr. Dakulala is busy with his team setting up the immunisation clinic. Throughout the day there is a steady stream of villagers coming from nearby and far off villagers. This is an opportunity not to be missed. For the first time in so many years, service has come to the people of Didigoro and they are pleased. In all, 65 children are immunised against measles and polio and 34 mothers and young women receive tetanus shots.
Dr. Dakulala says 5,000 children and women in the Rigo district are expected to be immunised. The national target is for 800,000 children and two million women of child bearing age (15 – 45) to be immunised.
Drs. Dakulala and Kariwiga take this opportunity to attend to the sick people as well. One hundred and two patients turn up hoping to be seen by a doctor and they are seen. It is a one time opportunity for them. Health worker, Kimberley Kwapuro is busy doing rapid diagnostic tests for malaria and pharmacist Daphne Ian-Ghabu keeps supplying the sick with medicine.
I ask a few people what they would do if the health team wasn’t there and they say there’s nothing they can do apart from taking herbal medicine and hoping the illness goes away. I see a mother with a brand new baby and she tells me the baby is four days old. She never attended an antenatal clinic throughout her pregnancy and delivered her baby at home the same way she had delivered her other four older children.
Another child, four-year-old Eric almost lost his mother when she gave birth to him at home too. She had a retained placenta and was bleeding heavily and if it wasn’t for a helicopter that was in the area at the time supplying treated mosquito nets, Eric’s mother probably wouldn’t be alive today.
I see many young mothers waiting with their children to be immunised and I wonder how many more of them delivered their babies at home. It is heartbreaking.
In a telephone interview with radio station, NBC and hooked up by UNICEF’s satellite phone, an emotional Dr. Dakulala pays tribute to the health workers who work in difficult parts of the country. One never knows how tough it is really is until you experience it yourself.
The team is satisfied with the days’ work as it packs up at the end of the day. Dr. Dakulala and most male members of the team trek back to Port Moresby on Saturday morning. The rest of us beg the locals to make us bamboo rafts so we can raft down the Omand River on Sunday morning. The villagers quickly construct four bamboo rafts and we are ready to head back to Port Moresby.
On Sunday morning we say our goodbyes to the Didigoro community on the bank of the Omand River and head off. We raft for seven hours before we reach the Omand Bridge on the Magi Highway where we get picked up. We are all extremely tired and exhausted but very glad we made the trip. It was a worthwhile trip.
We are eager to get back to the comforts of city life but we are saddened at knowing life for the Didigoro villagers is still the same. They will still trek the six hour foot journey to get basic services, their women will continue to deliver babies at home, the school children will be lucky if they get a full days class and the sick will just treat themselves with herbal medicine and hope for the best.