Just what the doctor ordered: musings on a time abroad

Guest blog by Daniel Natanek

Iowara Refugee Camp, or Iowara-East Awin Relocation Camp, is located in the North Fly District of Western Province, Papua New Guinea. A short fifteen minute helicopter ride from Kiunga (or seven day walk, depending on your level of fitness), Iowara was established in 1987 and served as a relocation point for West Papuan refugees. In April 2019, I was fortunate enough to visit this community alongside Sarah, a fellow final year medical student, and Dr Coventry, volunteer doctor for Australian Doctors International (ADI). As our helicopter descended onto a clearing, we were greeted by a vast sea of inquisitive, smiling faces. Little did I know that the experience I was about to embark upon would be one of the most rewarding of my life, and a highlight of my medical education.

The next three days consisted mostly of clinic time, with some education and teaching, preventive medicine and the odd excursion thrown into the mix. Clinic exposed us to a wide range of complaints, ranging from malaria, to worm infections and extrapulmonary tuberculosis. The Catholic Missionary sisters, who turned out to be very skilled midwives, were integral at breaking down the cultural and linguistic barriers that existed between doctor and patient. I was surprised to learn that Iowara did not have a resident doctor or nurse, and was often run solely by the sisters. The humility, resilience and hardworking nature of the locals is something that still resonates with me to this day.

Dr Coventry, Sarah and I took a break from clinic one day to address students at the local school. As expected, the kids were all very excited to hear from us! We delivered brief educational sessions on general health and hygiene, reproductive health and infectious disease. An ounce of prevention is worth a pound of cure, and this holds particularly true in a developing country like Papua New Guinea, where curative or reparative medicine is not as readily accessible as it is in the West.

The local markets saw us sampling a wide range of local delicacies, including sago, coconut and rambutan. Beyond being a place of trade, markets were also a public speaking ground, playing host to animated and lively displays from locals. On our final day, Dr Coventry, Sarah and I journeyed for several hours by foot to a nearby settlement, where we set up a clinic specifically for those who could not reach Iowara. As a thank you gift, some of the locals sourced fresh coconut for us, which provided much needed relief from the sweltering heat! And before we knew it, we were on a helicopter back to Kiunga, even more smiling faces waving us off as we propelled into the sky.

I often reflect on my time in Papua New Guinea, and all the valuable lessons I learnt whilst abroad. First and foremost, medicine is an art, never perfected but constantly refined. In a resource stripped setting, it becomes important to go back to basics, drawing upon simple history and examination techniques in an attempt to discern what is wrong with the patient. Secondly, the social determinants of health have a major impact on health outcomes. Access to healthcare remains a big issue in rural and remote settings, not just in the developing world but also in Australia. Thirdly, as the Hippocratic Oath states, ”prevention is preferable to cure.” In a country where resources are limited, knowledge is a very powerful tool indeed. Last of all, we are all in this together. Don’t be afraid to rely on those around you for support. There is no shame in asking for help. Medicine is a collective fraternity, and we must not lose sight of what is most important: promoting good health and advocating on behalf of the patient.

Many thanks to Queensland Rural Medical Education (QRME) and Australian Doctors International (ADI) for helping me transform my idea of the perfect elective into a reality

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