Malaria and mangoes

Before volunteers leave Australia, we undergo a week-long briefing where we are taught about everything that can go wrong during our assignments.  Health is a major component and diseases are covered in gruesome, unforgettable detail.  For instance, there is a photo of a particular intestinal worm infestation that I’ll never get out of my head.  I am only now beginning to forget the screams of my fellow volunteers and the presenter shouting with barely disguised glee: ‘I TOLD YOU TO LOOK AWAY IF YOU CAN’T HANDLE IT!”

At the end of the briefing, we’re each given a show bag of medication, tailored to the risks in the country that we’re going to.  This kit is the coolest thing I’ve ever got for free in my life.  It contains a ‘Little Book’, a quick-reference guide to the nasties most likely to take you down.  It’s written in plain English in a reassuring tone, with lots of clear headings, obviously aimed at a target audience of sweating twenty-somethings obsessively checking their temperatures and expecting the worst.

The largest part of the Little Book is dedicated to malaria, and the section opens in quite a stirring fashion with a quote by author Fiammetta Rocco:

“Sick with malaria, my body felt as if it was no longer my own.  It had been invaded, as if it had been subject to a military coup…the fever was beginning to shoot up.  The parasites in my blood that had invaded the red corpuscles were splitting them open and destroying them in a rampant urge to reproduce”.

Gets the heart racing, doesn’t it?

PNG is a haven for malaria.  It’s one of the world’s most severely affected nations.  Daily anti-malarials are standard prescription for Australian volunteers in almost all places here.  But these drugs can have some pretty serious side effects.  Take it in the morning, and you’re likely to be sunburned to a crisp by lunch, despite studious reapplication of sunscreen.  Take it at night, and you can find yourself trapped in a hamster wheel of vivid dreams and wake up drenched in sweat, searching through your friend’s kitchen cupboards for a missing animal (true story).

The one exception to the daily anti-malarial rule is volunteers who live in Port Moresby.  The belief seems to be that POM’s urbanised, dry-n-dusty climate is hostile to mosquitoes carrying malaria.  But blame it on global warming, or the fact that the majority of the city’s residents live in settlements where screen doors and mosquito nets are non-existent, but almost every PNGean I’ve met in POM has had malaria at least once. And now I’ve joined them.

At first I thought it was food poisoning, or a one-day bug.  I didn’t have the fevers or sweats I’d heard about, I just felt tired and more misanthropic than I usually do in the morning.  But a reason why malaria is such a successful parasite is that its symptoms could indicate practically any other illness. They come and go – you might be feeling terrible one day, then perfect the next, and you might be fine for the next three months until the parasite emerges from your liver (or wherever it’s decided to camp out) to make a fresh attack on your body.  The only way to know for sure is to get a blood test.

The malaria rapid test is an incredible little invention.  The whole thing takes about three minutes.  A nurse pricked the end of my finger, put a drop of blood on what looked like a tiny sticky pad, and waited for the results.  Positive.  News I met with a sinking feeling and a strange thrill.  Finally, I had earned my stripes as a true tropics dweller!

But strangely enough, when I went back the next day for the second rapid test my result came back negative.   The doctor explained that it could be that I’d picked it up early, and the medication from the previous day (an extremely large needle) was so effective that it’d taken the parasite down below detectable levels.

I decided to get a full blood screen just to make sure it was malaria, and not something really bad like dengue.  Dengue is a disease so painful and brain-scrambling that a former POM dweller, who had contracted it and was medi-vaced back to Australia for a few weeks to recuperate, arrived at the hospital with her suitcase, only to discover all she’d packed was a party dress and one shoe.

I’m no stranger to blood tests, and not a prude when it comes to the general cleanliness of my surrounds, but the clinic, and this test, made me nervous.  It may have been the makeshift tourniquet fashioned out of a latex glove.  Or the stained ‘biological waste’ bucket.  Or hearing every detail of a man behind a curtain having stitches removed from his back.  Or the mere taxonomic offence of syringes being stored in a drawer next to female condoms.

And after all that anxiety, my blood samples were inexplicably ‘discarded’ and never made it past the biological waste bucket and to the lab.  The clinic only realised this when I came back five days later to chase up the results.  I got another blood slide, but by then I’d been on the medication for a week, and the results came back negative.

My malaria (and I personally think it was malaria, even if the facts are in dispute) made me useless.  As well as all the pills, my treatment regime consisted of lying prone on my balcony trying to manifest a gentle breeze, standing in front of my open fridge and freezer in my underwear, and watching the ceiling fan rotate.  After about four days of this I was well enough to feel like if I spent another day at home I’d start chewing up my mattress.  I finished the drugs a week ago and I’m back to my normal self.

All up, I spent about K630 (around AUD$275) for a full treatment.  This includes K100 just to get through the doctor’s door each time I went.  And I had malaria-lite – I only took two days off work, and I had none of the crippling fevers, aches and vomiting that most people get.  With K600 easily being at least a month’s salary for the average working PNGean, most just take a couple of Panadol and pray that it goes away.  Sometimes it does, sometimes it doesn’t.  Often it recurs and leaves a family’s sole earner incapacitated over and over again.

The extreme cost of medical care compared with average earnings mean that many serious, slow-burning conditions such as cancer and heart conditions go undiagnosed until it’s too late.  If you’re seriously sick and can’t afford the consultation fee, your only option is to walk into the main hospital’s Accident and Emergency section and hope that a doctor kneels to talk to you rather than steps over you.  But you might be fighting for space with drunk men with bush knife wounds and women giving birth.  It’s no wonder people just grin and bear it.

In the absence of easily accessible medical care, people turn to traditional treatments.  Steaming yourself for any illness is the first port of call.  Combine it with certain herbs and it’s great for malaria.  Lots of kumu (leafy greens) for nausea.  Black tea for stomach upsets.  Sudden changes in the weather are invariably blamed for most respiratory sicknesses.

Another tropical friend that arrived just in time for my malaria was mangoes.  I spent many hours on my balcony with a thousand-yard stare slowly eating mangoes and, together with the efficacy of modern medicine, I credit them for bringing me back to health.

But I’m also discovering how little I know about my favourite fruit.  That they grow on trees, for instance.  I don’t know why, but I always though they grew on squat shrubs.  Embarrassing for a country girl to admit such ignorance, particularly when I like to believe I have the agricultural edge on my city brethren.

For your information, the mango is an imposing tree which towers up to 20 or 30 metres above the ground.  Trees around the city, which I had previously thought of as ‘just trees’, have now been transformed into flora of value and beauty.  The one at the Aviat Club, with its ancient trunk and massive canopy, is one of these.  Mango trees are also accompanied by bare-chested street kids, throwing rocks up into the arbour to knock the ripe fruit down.

And if your rocks miss, well how do you get the fruit down from such great heights?  You leave it up to the mango.  Without much ado, mango fruit simply loosen their ties with the tree when they’re ripe and fall.  The mangoes at the Aviat fall at frequent intervals, crashing on the corrugated tin roof with such a bang that everyone ducks and screams.  Heather almost got clocked by one a few weeks ago, when she was waiting for the car and it missed her by mere centimetres.

The seasons are changing in PNG, and both mangoes and malaria are signs that the wet season is about to begin.  Which brings with it another M word – monsoon. After five months of clear skies and winds, the city is bracing for torrential downpours and flooding.  And Christmas, when the city apparently goes a little nuts.  But I’m not fazed.  As long as I can keep eating mangoes on my balcony, I can handle anything.

Getting around

I’ve almost been in PNG a month, and I’ve been reflecting on how lucky I was to have spoken to so many ex-PNG dwellers before I came over.   So many coffees, emails, lunches, wine dates and Skype chats with ex-volunteers, colleagues, friends of friends, and total strangers generous enough to give me some of their time.  They were singularly excited about my opportunity and their stories were overwhelmingly positive.  They also laid down some hard truths about daily life in PNG.

The consequence is that I have felt quite well prepared for life here, much better than I was before I moved to Sweden, then Germany a few years later.  Even though those countries were ‘Western’ with all their familiar trimmings, I was totally in the dark about the Swedish state’s monopoly on the sale of liquor, and the German sense of humour, both of which would have been useful to know in advance.

From what I’d been told about Port Moresby, I believed my personal Everest re: life adjustment would be that I couldn’t go where I wanted, when I wanted.  That living out a life in a compound, or certain ‘safe’ areas, would be claustrophobic and suffocating and I would go crazy without serious daily meditation.  That’s a part of it, but not quite.  Restraint on my freedom of movement has been the biggest hurdle, but surprisingly, the problem lies not with the ‘restraint’, but with the ‘movement’.

Port Moresby’s transport options are busses and cars.  The busses, or PMV’s (public motorised vehicle – I think) are cheap, cheerful, and completely off-limits for volunteers under the program.  Don’t even get me started about alternative forms of transport.  The only bicycle I’ve seen was being ridden by a kid across a paddock (extremely poorly, I might add).  And I haven’t seen a single motorbike yet.

So it’s down to cars.  Only two taxi companies are reputable, but even then they’re unreliable and expensive.  To overcome crippling transport issues, and to ensure the safety of their precious cargo, the program has enlisted a hire company to provide an after-hours driver and car to be shared among the volunteers in POM (about 8 at the moment).  You call up the 24-hour number, tell the driver where you are, and if everything works out, they’ll pick you up at roughly the right time and take you where you want to go.

It’s a one-of-a-kind arrangement, which isn’t perfect, and allegedly costs a bomb, but it allows one to carve out a life outside the compound.  The drivers are friendly, professional, and patient.  And we are very lucky.  Some volunteer organisations leave their vollies to fend for themselves.

During business hours I have a different arrangement.  My work has undertaken to provide me with transport between work and home.  When they first agreed to this six months ago, I guess they thought it was in the bag.  But since then, the front tyre fell clean off the company car while it was going around a roundabout, and practically all of the annual transport budget was sunk into getting it repaired until the mechanic finally fessed up that, even if they could fix it, it would be a death trap to drive.

So with no funds left, my transport is my boss, who leaves his home half an hour early to negotiate the traffic on the north side of town.  Or when boss is busy or away, it’s the taxi driver I mentioned a few posts ago (whom I frankly never expected to see again) who flies the Maroons State of Origin flag from his antennae and occasionally texts me updates of the scores of NRL games.  I still don’t know the first thing about rugby, but I appreciate the thought.

Mr Taxi is still K40 (AUD$20) a day, too expensive for an ongoing option. So for the meantime, my transport starts at 7.40am every day, when I hear boss beeping at the guards to let him in the front gate, and then the sound of his sedan groaning up the hill to my house.  I get in the car, and he puts it into reverse, at which time the GPS system greets us in friendly yet cautionary Japanese.  We joke about kidnapping the next Japanese person who comes to town to finally shed some light on what the old duck is saying.

On our way to work, when my boss isn’t encouraging my nascent Tok Pisin (PNG’s national language) he likes point out the number of illegal PMVs on the roads.  PMVs are white and green/purple minibusses, usually packed to bursting with passengers hanging on in the doorway.  They have routes, and collect fares, but you have to pay a registration fee to be legal, and most don’t bother.  With road law enforcement limited to licence checks at lumbering road-blocks (easily avoided once the word gets out), illegal PMVs flourish.  There are a lot of people in POM and they need to get around.  If a driver wants to make extra cash, he’ll only do a half-trip – take everyone’s fare, but order them off the bus at the halfway point and circle back to the start of the route to do the same thing again.

My dad always said the best way to drive was like everyone’s out to get you.  As a learner driver, I didn’t like this approach – I thought it was paranoid and took a dim view of the competency of fellow drivers, who should be given the benefit of the doubt until proven otherwise (sorry Dad!).  But here, people DO drive like they’re out to get you.  Lane lines are treated like a mere decorative feature, speed limits are non-existent, and looking before you merge just does not happen.

But on the flip-side, people also drive like my dad – hyper-vigilant pessimists under constant attack, expecting the worst.  Drivers have lightning-quick reflexes and are responsive to what’s happening around them.  If anyone looks like they’re about to do anything stupid, other drivers will beep at them, and they’ll pull their head in quick-smart.

My drive into work is relatively smooth, thanks in no small part to Prince Charles and Duchess Camilla.  If a royal cavalcade or prime ministerial convoy will be driving along a particular road on their short trip to PNG, you can be certain that in the weeks before that road would have been redone and resealed, bringing the entire city to a standstill while the local government puts on a good front for its international guests.  As the royal couple sailed along the Poreporena Highway late last year, they would have had no inkling that most parts of POM have roads so rough they can break axles and potholes so big you could bathe in them.  Long-term residents now talk about engineering a ‘scenic tour’ which goes right past their compound for the next visiting dignitary.

At around 4.15pm, the end of my working day, my boss drives me back over the hill into Town and drops me off out the front of The Aviat, a dilapidated but much-loved sports club that looks like it’s straight out of Townsville, Queensland, and serves SP Beer at AUD$3.50 a stubbie in return for having every flat surface double as SP Beer advertising space.  It also has a cheap and mostly empty gym, so I muck around there for an hour or so, until 5.30pm, when we call the driver company to pick us up at 6pm.  6pm is the ideal, but PNG is not called the land of the unexpected for nothing.  POM is beating patience into me, one late pickup at a time.

 

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