Leaving Sue aboard Chandrika as well off as I could, I rowed ashore with the stripped, rusty-rimmed bicycle we’d bought two years prior from a bicycle mechanic in Belize. The clutch brakes work during the sometimes brief intervals when the chain stays on the spokes. Fortunately Duke of York Island, Papua New Guinea, is reasonably flat. The nearest medical facility is an hour’s bike ride for one of reasonable fitness. I biked hard, enjoying the physical exertion rarely experienced in the recent months of cruising. Coconut grove canopy flew by above my head as I passed many villagers making low incomes from copra production. Light road traffic consists of people on foot and buffalo pulled two wheel carts loaded with forty to fifty kilogram burlap bags of copra (dried coconut meat), which is then sold to both Australia and south east Asia for the production of soaps and other oil based products. Roads constructed during the reign of Queen Emma, as well as the later built World War II Japanese roads are of coral based gravel. Now over half a century later muddy potholes and ruts abound, flinging both myself and the rusty chain off kilter.
Armed with medications for malaria, worms, amoebas, and bacteria, and having paid an above average medical bill of $7, I returned to Chandrika ignoring the monsoon rains. A couple days passed and Sue had healed up from suspected moderate food poisoning when trouble came.
My fever spiked to 104.2 as I lay on my back with abdominal pain. I had no appetite. My body shook from chills. My whole digestive track pulsated. Severe dysentery and diarrhea followed as I lost not just concerning amounts of blood and mucus, but what I now think was pieces of the two millimeter thick white walls lining my stomach and intestinal track. Two days on anti-malarial medications and antibiotics passed. It was getting worse. At 2:00 am Sue sailed us twenty miles to the city of Rabaul, East New Britain.
The town of Rabaul lies amidst the ash of this active volcano, which was unusually quiet when this photo was taken .
Ash strewn from decades of volcanic activity preceding World War II, including two eruptions and an almost constant shower of ash most recently coming to a near stop around December, 2009, it’s a wonder people have stayed. On your car, on your clothes, in your lungs, through your windows, or blanketing your sailboat, the ash goes everywhere. After three months of sun, showers, and no ash, the mountainsides were blanketed with green grass brining a little more life to the land and the people. Has the volcano stopped for good? I have my doubts. Regardless of the hardships, or perhaps because of them, the people are as loving and altruistic as ever.
My fever was now consistently below 102. I was slightly dehydrated after drinking rehydrating solution, slightly anemic, and perhaps my blood sugar was low as well. My body ached as I got 
out of the dinghy. A kind stranger drove us to the health center. I received the standard treatment with medicine for malaria, worms, amoebas, and bacteria. Glucose and saline IVs were also administered. Blood and mucus excretions from the walls of my GI track continued and worsened. My low grade fever continued to fluctuate. Neither time nor medicine had brought about healing. I was starting to get scared.
out of the dinghy. A kind stranger drove us to the health center. I received the standard treatment with medicine for malaria, worms, amoebas, and bacteria. Glucose and saline IVs were also administered. Blood and mucus excretions from the walls of my GI track continued and worsened. My low grade fever continued to fluctuate. Neither time nor medicine had brought about healing. I was starting to get scared. 
Nurses care for a patient inside Rabaul's town health center.
After just a couple visits to the health center I am no longer being charged. While treatment here cost pennies on the dollar, compared to first world medical costs, this is PNG where people are thoughtful and caring of others. A truly human component exists to almost all facets of life here. Free of charge we are kindly driven to the nearest hospital in the ambulance, a Toyota Landcruiser, with snorkel. Monsoon rains have eroded this ash strewn landscape due to lack of vegetation. The road soon parallels a river bed. Like a bite out of a sandwich half the road is missing in places where a vertical fifteen foot wall of volcanic sediment goes into the dried up river bed. Nature enforces drunk driving here.
A free ambulance ride takes me to Nonga General Hospital.
The hospital is sparse and slightly run down. Half the building is not utilized. It is clearly underfunded. It is March 17th and a week has passed and with blood and mucus increasing in the stools, it is time to have some tests done. Malaria is negative. Typhoid is negative. E. coli amoeba cysts are detected by microscopy. This is not the commonly known bacteria, but rather amoeba cysts called Entamoeba coli. I am put on more medications but we are not going to wait any longer. I need first world medicine. There are no cruisers around to look after Chandrika for the minimum two weeks we’ll be gone. We have a cat that needs to be watched as well. Our cruising permit expires in eleven days. We make one phone call to the friend of an acquaintance and all the logistics are solved. Within twenty four hours Chandrika is moved in front of a private estate where she will be watched over and the cat taken care of. We have reserved next day tickets to Cairns, Australia. We have a letter from immigration for our one way return flight to PNG and a one month extension on our cruising permit.
Nonga General Hospital
Amoeboid cysts are detected by microscopy.
First world medicine here I come!
We pass through Australian immigration and customs. “We are here for holiday” is all we need to say. I am even allowed to keep my few slices of bread, exhibiting far less stringent regulations than is pressed upon the incoming sailboat to Australian waters. Rather than skydiving, bungi-jumping, swimming with domesticated dolphins, and snorkeling amongst dead reef with all the other tourists, we head straight for Cairns Base Hospital emergency room. More tests are done. Blood tests reveal a high white blood cell count, including the presence of myelocytes and metamyelocytes (specific types of white blood cells), common with severe infection. My doctor, an intern, advises me to leave the emergency room, go off all medications, and let the pathogen run its course. Some patients never question a doctor’s advice. I’m not one of them so not desiring any more from his overpriced brain I walk out, a few hundred dollars poorer. Now intelligence varies from president to president just as it does from doctor to doctor and you can tell by the way they speak and respond to a given question, as well as their ability to analyze a situation and make sound decisions. We went to the 24 Medical Center to get further advice. She listened to the symptoms, made an analysis, and said it was good I ignored the intern. I was to continue on medication called Flagyl for amoebas but change antibiotics to Cipro. My fever, having been at about 101, broke just fourteen hours after starting on Cipro. It was now March 20th.
Some symptoms were improving but bureaucracy was limiting our ability to properly treat this illness. The Cairns Base Hospital did not allow me to see my own test results, the ones which took a few days, and so I had them requested through the more personable 24 Hour Medical Center. So kind was the 24 Hour Medical Center that the doctor signed a release form without payment of another consultation fee. Still further testing showed high enzyme levels in the liver, along with other concerns. An ultrasound of the liver was required. Medical fees were adding up. The earliest possible ultrasound was a week away. There are drugs in PNG for amoebas not available in the U.S. or Australia. I had learned the hard way that Cairns, though tropical, had little exposure to, and hence little expertise on, tropical diseases. This is where to go to treat heart disease and diabetes, amongst other first world diseases. A private hospital in Port Moresby, PNG, could schedule an ultrasound two days away. We flew to Port Moresby.
Port Moresby is of great contrast to almost all else of PNG with higher standards of living, good paying jobs, professional public and private hospitals, and hotels starting at about $300 a night. Wait a minute, where the heck are we going to sleep? We can’t afford that! After all we were sleeping in our car under bridges in Florida when we were shopping for a sailboat. But this is not to say Port Moresby is a haven for those better acclimated to western culture. It’s a city with numerous unemployment-driven thieves running about, commonly referred to as raskols. Ask the majority of compassionate, genuinely concerned Papua New Guineans if a given street or area is safe and you will likely have a personal guide going out of their way to bring you safely to your destination.
Sue’s face lit up. Our friends from the village of Kabatarai (the Rock), on Duke of York Island have family in Port Moresby. Wantok in Pidgin means family or clan. If someone is wantok you love them and take care of them like family. To the village of Kabatarai, we had become wantok. We placed a phone call.
March 25th we walked outside the terminal to meet a woman and her family who had never seen our faces before. They took us in as wantok. In stark contrast to the self indulging, first world culture of Australia, it was pleasant to be back in PNG. Granted it’s not always easy to live and work a nine to five job with the multitude of other distractions, complications, and responsibilities that come along with it. I understand why even friends and family have been slightly reserved at times to lend a hand when I’ve been in need. Yet amongst these strangers I felt none of it. Their compassion to help us was absolutely genuine. For nine days, every day, we were driven to the hospital, pharmacy, grocery store, air port, internet café, bank, etc. Never once in their words, eyes, and actions did they show a lack of desire to help.
Hendrick drives us all over Port Moresby.
The ultrasound showed no abscess in my liver. I believe had I stayed in Australia the conclusion would be just that. Fortunately the technician decided to do some exploring. An abscess was found in my stomach. My left kidney appeared infected. White spots also appeared throughout my entire gastro intestinal track. The amoebas were gone and I hoped the sometimes resilient cysts (eggs) were gone as well. I stopped taking the Flagyl and time would tell. The bacteria was gone as well but with damage done, abscesses cause susceptibility to blood stream infection like an open wound in a mangrove swamp, so I stayed on Cipro.
It was March 31st. Sue soon flew back to Chandrika for a solo sail to the Solomon Islands, for long term storage at a marina. I flew back to the U.S. for potential surgery, long term lab tests, resting, and healing.
Amongst our housemates in Port Moresby were both the leader and a couple members of the KB Stone Band. Good music was abundant. Norman, a band member, was five years old when his parents divorced. He stayed with his mother. Girl children are more valuable than boy children in PNG because the women inherit the land. The young man his mother remarried had a capitalistic mind and soon gave her an ultimatum. The mother chose her new husband over Norman. Norman after moving in with his mother’s brother was not allowed to leave the property and conversing with other children was punished by twenty lashings. “By the time I was twelve I ran away. I had to leave. When I was found my uncle tied me up and kept me in a fifty five gallon drum so I couldn’t escape.” At the age of sixteen with a sixth grade education he ran away for good. “I stole what I needed to survive.” After being released from jail for the third time he finally found music. Playing with KB Stone has kept him strait and out of jail.
KB Stone practices below the house.
The KB Stone Band
Prevention of tropical diseases infecting the gastro intestinal track includes basic clean living but more importantly knowing that many preventative treatments such as bleach will not kill amoebas and some parasites in drinking water and is therefore not effective in cleaning local fruits and vegetables. If you question the cleanliness of food or water being kindly offered it is best to politely refuse.
Many lessons were learned about dealing with tropical diseases in underdeveloped countries like Papua New Guinea including the following:
1) Upon going to a doctor, request as many tests as possible. Most facilities have the ability to test specifically for Malaria, Typhoid, and Hepatitis. General blood tests are informative on what you are fighting. Also a microscopy will give fast conclusions on the presence of amoebas and cysts in stool samples. Fewer drugs are better for maintaining overall healthy immune and digestive systems.
2) Go to the best medical facility in your region. A doctor, who sees tropical disease patients daily, in my opinion, is more valuable than top notch facilities. Try to find both and don’t keep changing doctors.
3) An online subscription to medical information such as http://www.uptodate.com/ will help keep you better educated and on the healing track.
4) Cruisers are very often in a wilderness setting, defined as over an hour from professional medical treatment. A broad spectrum medical kit and the education to use it are important but should not delay actively seeking professional treatment. Time may be critical so don’t wait around.
I feel of all the lessons I could offer these people, my wantok, on how the rest of the world works it would bear little importance. In PNG there exists a culture that puts the caring of family, the development of friendships, and even a conversation with a stranger, above careers and financial security. I don’t know the limit of how far my wantok would go for me, but I don’t think I even came close. Perhaps they are wiser than they will ever know.
March 2010
