In German times the interior of New Guinea was a blank on the map, with the occasional, usually punitive, expedition into the foothills uncovering no hint of the wonders in the mountains beyond them. When Australia took the Territory of New Guinea as a League of Nations mandate after the Great War the few personnel in the fledgling colonial service were fully occupied on the coast, and scanty budgets meant that officially sponsored pure exploration was out of the question.
Europeans first saw Goroka in October 1929. Privateers in search of gold, they came upon a large and highly organised stone-age culture where the wheel had never been seen. Indeed, the first wheels in Goroka were on planes bringing supplies to the airstrips that explorers hacked out of the jungle. An old theatre orderly told me he remembered the first plane landing, but this seems doubtful.
Goroka became the original highlands administrative centre for several reasons. The locals were as friendly as could be expected, the area was well watered, appeared readily defensible, and had adequate more or less level ground for a commercial airstrip and other possible developments. At a little under 2000 m ASL it lies towards the western end of a broad deforested valley bounded by sharp, smoky blue-green mountains, with six or seven more ranges rising behind them. Fainter and fainter as they stretch into the distance, the farthest pastel-toned peaks merge imperceptibly with the sky.
Goroka was a rough and ready frontier station when I first saw it at Easter 1961, when Roy Scragg had me escort a Brisbane ENT surgeon around the Territory. The hospital consisted of modified highland longhouses with thatched roofs, except for the operating theatre, which was a simple wooden shed. The ENT man and I found Goroka’s (and the whole highlands’) Hungarian surgeon Lajos Roth expertly draining an abscess deep in the back of a warrior’s neck, one thin layer outside the junction of the brain and spinal cord.
We arrived just in time to see him extract triumphantly a long-buried arrow tip, the cause of the problem. This operation would have been neurosurgeon’s work in Australia, but was little more than an interesting but unremarkable item on the sort of list Roth dealt with every day. He was notably neat and gentle, with an enviable ability to cope with almost any surgically treatable problem that came his way.
As more of the highlands came under control its enormous area was broken up for administrative convenience. Goroka became the headquarters of the Eastern Highlands District (later, Province), but remained the regional centre for many purposes, including health. When the two-storey hospital was erected it proved to be the most functional in the country. I visited it often when I worked out of Madang, and always saw interesting cases. Frank Smith (not to be confused with Frank Smyth, Port Moresby’s mouth cancer expert) and Alan Shepherd each worked there as solo surgeons for long periods and attracted difficult cases from all over the highlands. They and the trainees fortunate enough to work with them dealt with a referral population of over a million in addition to the 200,000 or so Eastern Highlanders. Most nursing aides and a few sisters were Eastern Highlanders, with vigour and initiative that was less common on the coast. The near-perfect climate must have helped, but the highlanders were, and are, in many ways a different people, tough and resilient almost beyond belief.
By 1984 Goroka was officially a two-surgeon station, and when I arrived my colleague was Fe’ao Takitaki, a Tongan UPNG graduate who had been my student. He was a sound and level-headed clinician and a quick, expert operator. His laid-back Polynesian style was an excellent foil for the more volatile and impetuous of our juniors, who saw him as a natural leader and role model. He was greatly missed when he followed many other postgraduates into general practice, where the money was ten or more times better than in government service as a specialist.
Repeated efforts were made to persuade the Public Service Commission (PSC) to allow UPNG medical graduates to combine public and private practice, a concession that would have been a logical way to keep them in the government system as part-timers for long enough to pay back some of their training costs. The idea had always been anathema to the PSC, and before independence the argument went that if doctors were allowed private practice other public servants would want it too. The only exempt cadre was the small number of licensed marine surveyors. Insurers required foreign-going vessels, and for all I know, local ones too, to be inspected after even the most minor accident. Time was money, and ships couldn’t lie idle for days while inspectors flew up from Brisbane to do what might be a few minutes work. Thus big business could exert irresistible pressure on the PSC, but government departments could not.
So it often happened that I was the only surgeon in town, but at least I had good trainees, usually two at a time. We were all kept busy. We spent Monday and Thursday mornings in the wards, and with about 60 adult patients and a swag in the children’s ward we had abundant teaching material for medical students and surgeons-in-training. The Goroka surgical unit provided me with the greatest variety of challenging experiences I’ve ever had. Its only rival was my last workplace, in the Yemen highlands. We kept three theatres busy on Tuesdays and Fridays, and on many Wednesdays too, with emergencies in between. A gynaecologist and an eye specialist had the place humming at other times. On Monday afternoons I saw outpatients, and if weekend admissions provided less than a full day’s operating on Tuesday this clinic filled the gaps.
GBH had long been known for peptic ulcer cases. This problem was uncommon on the coast but we saw hundreds, usually in thin old men complaining of chronic upper abdominal pain and vomiting. Typically they came in rubbing their thumbnails up and down their midriffs, indicating that they knew what they needed. Almost all were well beyond drug treatment, even if this had been practicable. Our registrars learnt to cut the vagus nerves to the stomach and perform the bypass operation favoured by most surgeons in PNG. Just as in other countries with a large ulcer burden, many cases really had stomach cancer, and I remember a session in which we operated on three before morning tea, all incurable.
A more famous highlands problem was a peculiar gastro-enteritis known as pigbel. In Roth’s time this was the commonest abdominal emergency, but it had almost disappeared by the late ’80s. It followed the infrequent pig feasts that were a central feature of highland culture, and at first the doctors assumed it to be somehow due to eating improperly cooked meat. Gregor Lawrence, Tim Murrell and others took years to prove that it followed a massive protein, not necessarily porcine, meal in people who ordinarily ate little protein. Starving Germans had the same disease in 1945.
The highlanders’ staple was sweet potato that has so small a protein content that we were amazed at their physique. Their digestive processes were so adapted to this monotonous fare that they couldn’t cope with a massive protein load. Sudden alteration of the contents of the gut after the gorging of pig meat encouraged enormous overgrowth of certain bacteria that were harmless in small numbers. These germs produced toxins that clotted blood vessels in variable lengths of the small bowel. Minor cases suffered mild colic and diarrhoea, but at the other end of the scale enough gut went rotten to kill the patient unless the diseased segment was removed.
Frank Smith has a photo of five children whose pigbel he operated on, all having been guests at the funeral of another child who had died of pigbel. Pig feasts are still held, but with increasing general protein intake the ecological balance of the gut became much firmer. As this dietary transition occurred a vaccination program was developed, just as the need for it was disappearing.
Before pigbel’s exact nature had been worked out we heard of it in places where pork could not be incriminated. I spoke about New Guinea’s surgical problems at a hospital in western India in 1968 and found that they saw cases exactly like pigbel. Reports from Bangladesh, Thailand and elsewhere described the same disease, with sudden massive protein intake in people who ordinarily ate very little of it being the common factor.
The GBH physician was a young Englishman, John Richens, who combined exceptional clinical ability with energy that left me breathless. He always carried his camera and amassed a better collection of clinical photographs in a few years than I did in half a lifetime. His pianism was probably the best ever heard in Goroka, and he could have made a career of it if he hadn’t studied medicine. GBH had always been blessed with fine paediatricians, as befitted a busy referral hospital, but in the area of adult medicine John Richens was outstanding.
He was an excellent teacher and of great help with the medical students who came to Goroka for six or eight weeks at a time. Looking after them had its problems. One group included two girls, and for safety’s sake we accommodated them in a vacant house well inside the compound fence, but on their first night three attempts were made to broach their rooms, so they shifted to the nurses’ home. One was so distressed that we had to allow her to return to Port Moresby.
John made supervisory visits to other hospitals and returned with neurosurgical or other problems for me. He brought many cases of pituitary tumour, almost always those that produce growth hormone. In Port Moresby I’d operated on several such patients referred from the highlands, and it now appeared to be largely a highland disease. More than that, most came from Enga Province, in the far west. I returned from one holiday to find two Enga women from the same village and a Southern Highlander with this tumour. This last woman’s husband complained that the beautiful girl he married was now ugly, but it seemed to have escaped him that she’d also become totally blind. Sadly, operation did nothing for her eyesight, but at least she went home free of headache.
I forget how I chose which of the Enga women to operate on first, but I remember the close interest the other took in her post-operative progress. After twice watching me changing the daily head dressing she asked when I planned to get on with it and do her operation too. I said I thought she’d like to see that all was well with her friend first. She gave me a big Enga smile and said, ‘OK, how about tomorrow?’ in its pidgin equivalent.
The highly malignant brain tumours so common in Western countries seemed to be rare, and I saw very few. One of the first was in about 1974, in a Gorokan diagnosed by Alan Shepherd and Frank Wagner, a physician with an interest in radiology. Frank performed a primitive carotid angiogram that nevertheless demonstrated a right frontal lobe tumour. Alan wanted to assist me, and as it was far cheaper for me to go to Goroka than for him, the patient and a relative to come to Port Moresby I spent the weekend there, and on Saturday morning removed what proved to be a fairly slow growing malignancy. All was well for several years until the man strayed too close to his brother’s wife, which led to a family fight with bows and arrows. The avenging cuckold scored a bullseye of a kind when he chanced to put an arrow through one of my burr holes. The injury was fatal, and the coronial autopsy revealed recurrent tumour.
A much commoner tumour all over PNG was the meningioma, which isn’t malignant but nevertheless has an aggressive tendency to recur if incompletely removed, a feature precisely documented long ago in a landmark paper by my friend Donald Simpson. Their vigorous blood supply and other idiosyncratic features have made meningiomas special challenges since Cushing’s day, and like real neurosurgeons usually do I came to enjoy them too. I was fortunate in having a Sikh anaesthetist, Gajinder Oberoi, with skills far above the ordinary, so our patients left the theatre awake.
Sometimes a meningioma so encased the great arteries at the base of the brain that I couldn’t achieve complete removal, as recorded in this 1988 family letter.
On Tuesday I removed a chap’s brain tumour – well, almost all of it, and as much as could be removed safely without doing more harm than good. By Saturday morning he was unhappy with his progress, so signed himself out for the day to go and see a local medicine man. How much that cost I do not know, but it will have been much more than the K5 [about $5] for his hospital admission. He came back no better, with a promise from the medicine man that he will deliver his verdict later. On Sunday he was still unimproved, and it may be that he has a bit of a clot collected.
I re-explored him, and sure enough he had a substantial extradural clot, my first such complication in years. Happily he then recovered.
Dr Oberoi, or Roy as I called him, was exactly the one I needed at the top end of the table when I operated on another condition that I collected from all over. This rare tumour, called phaeochromocytoma, usually occurs in the adrenal gland and secretes adrenalin and a related hormone, resulting in wild swings in blood pressure. This can be fatal, before, during or after operation unless counter-active drugs are used expertly, and the operator knows exactly what he is about. A Mayo Clinic surgeon has described removing a phaeo as a fun operation, but I never became that blasé about it. We had some exciting times, including the successful removal of bilateral tumours from a boy whose father’s unilateral phaeo I’d removed in Port Moresby more than ten years before. The Lae paediatrician referring the lad had already suspected the diagnosis, which John Richens confirmed by imaging the tumours with our portable ultrasound machine.
A few months later the same doctor sent me another child with bilateral phaeos, from a different tribe, so that there was no possibility of them being related. The odds against seeing two children with such a great rarity in one year must be astronomical, but I was hungry for another. Sure enough, the Lae paediatrician found what he thought was a third case. He wasn’t far wrong, because the child had another rare variety of surgically treatable hypertension, as was proven when I removed a shrivelled kidney.
Some conditions common in the West were rarities in Goroka, despite our large referral population. John Richens was there almost three years before he saw a highlander with a myocardial infarct. Apart from arrow wounds in arteries, which were common enough, our people seemed to be almost free of all kinds of vascular disease. Diabetes was rare (although not on the coast), and I saw many more pituitary tumours than cases of diabetes.
Gallstones were rare, always with advanced disease that provides major challenges for young surgeons meeting them once or twice a year, instead of every week as I did in my training days. An inexperienced surgeon in this area can run into trouble and produce serious, sometimes fatal, complications in the kind of case we saw. The simplest approach is to keep out of harm’s way by opening the gallbladder, removing the stones and putting in a temporary drain. Not removing the gallbladder sometimes means that gallstones recur in later life, although this isn’t as inevitable as many people think. About 1930 my mother-in-law had this limited operation at the hands of her GP and had no more trouble for nearly 40 years. When her pain returned she took to her bed with a hot-water bottle on her old scar, and a few days later this came up like a boil and burst, discharging bilious pus and gallstones. She soon healed and was still symptom-free when she died at 94.
Because the simple drainage operation is regarded as a halfway house, young surgeons sometimes perform it unwillingly, seeing it as an admission of defeat. (A real man takes out the gallbladder!) I aimed to protect my trainees from falling into this error, and developed (so I thought) a new definitive operation, safe and satisfactory in almost anyone’s hands. Instead of draining the gallbladder externally I removed the stones and sewed the gallbladder to the immediately adjacent duodenum, with a wide opening in the new party wall. Bile could then run from the liver into the gallbladder and onwards into the gut, hopefully with little risk of recurrent stones. End of problem.
This worked well and spared us (and more importantly, our patients) from difficult and possibly dangerous surgical adventures in what is commonly known as tiger country. After three cases went well I decided that such unorthodox surgery needed the imprimatur of an acknowledged authority, so I wrote to a renowned expert explaining the circumstances in which I worked, why I had done it, and asked for his opinion. He replied saying that he’d never heard of the operation, but readily understood my reasoning. (So he should have, as much of his time was spent dealing with cases referred with the disastrous damage to bile ducts my operation was designed to avoid.) He said that if it worked he saw no reason why I shouldn’t continue with it, and asked me to report progress, which I did.
Some time later I opened a surgical journal and read a fine description of a new operation from this man’s unit, in which they were doing exactly as I did, although for marginally different reasons. In vain my eyes ran down the list of references for ‘Clezy (personal communication)’ or some such. Not that it mattered; long afterwards I discovered that Riedel, a German, did ‘my operation’ a century ago, with the same rationale. I’d invented nothing, but when I described it at a Brisbane meeting the Adelaide surgeon Lehonde Hoare, who had trained a few years ahead of me, said it was the only original idea he’d heard all day. This was generosity born out of old acquaintance, because the ritual three minutes’ question period after my paper was memorable only for the numbing silence that guarantees to deflate over-enthusiastic speakers like nothing else does.
My senior trainee was Leonard Kaupa, a highlander with abundant common sense and rapidly maturing ability who had been educated at Geelong Grammar. He often attended to major emergencies without needing help from me, and when I left PNG I rated him as more experienced and more widely competent than I was when I went to Rabaul with my FRCS. So it was common for me to find new cases in my ward that Leonard had been busy dealing with while I was asleep.
Late one night he admitted a friend who had comprehensively torn and broken his right forearm in a car accident. The wounds were ragged and dirty, but Leonard knew what to do as we saw such injuries regularly. The man had a good job, and Goroka’s large horsey set regarded him as the best farrier in the country. He was in the private ward, which we habitually visited last when making our rounds. My team and I were discussing a patient in our high dependency unit (the first row in the large public ward, in front of the window into the nurse’s station) when a female unknown to us, but apparently a leading equestrienne, strode in. As I paused for breath, and without so much as a ‘Good morning,’ she asked me for details about the farrier. I said I hadn’t yet seen him and that Dr Kaupa had attended to him. She knew he’d been to theatre in the night, so my answer didn’t compute. She expostulated, ‘But he’s your patient, isn’t he?’
She had the archetypical imperious and terse proprietary tone we sometimes saw in ‘befores’, the anglicised pidgin nickname given to foreigners who’d lived in New Guinea before the war and returned afterwards. (Older New Guineans commonly shrugged off their blimpish behaviour with the explanation emi bipo tasol – ‘he’s a before; that’s all that need be said’.) By the late 1980s the ‘befores’ were almost all dead and/or gone, but this lady brought back rancid memories of her type, and for once I lost my cool. ‘Look,’ I said, ‘you don’t go into BP’s and expect to see Mr Burns or Mr Philp, do you? It’s a bit like that here. My name is over his bed and I’ll be seeing him in due course, but we have a lot of sick people to see in this ward first.’
Her jaw dropped and she left us without a word, with the New Guinean staff unable to conceal their delight at the put-down that would have branded them as bigheads or sophisticates had it come from any of their mouths. As expected, I found that Leonard’s management of his friend’s injury was faultless.
Firearms weren’t yet widely available, and tribal fighters still used spears, bows and arrows, and axes. These non-explosive injuries meant that warriors (and occasionally, others) suffering them almost always survived if they reached hospital alive. In some months the commonest male adult admission diagnosis was ‘arrow wound’. The variety and combination of injuries seemed endless, with our commonest being the arrow in the chest. This produced air leaks and mild internal bleeding but rarely other problems, and was treated by insertion of a chest drain for a couple of days.
I went in one morning to find that Leonard & Co had been busy with half-a-dozen men after a fight between two clans over election results that had seen, according to one side, the wrong candidate elected, undeservedly and perhaps crookedly so. In the front row we had a sorry old man injured more in pride than in person, still in his arse-grass (the bunch of leaves highland men stuff into their belts to cover the buttock cleft). I’d just seen him when a nurse reported that his son was on the phone.
‘Tell him he’s OK,’ I said. ‘He’ll be ready for home in a day or two.’
‘You’d better talk to him,’ she said, ‘he’s calling from New York.’ I sprang to and found that the son worked at the PNG mission to the UN. This incident illustrates how great were the changes in New Guinea in a generation.
In my time women and children were rarely injured deliberately in these fights, at least around Goroka. The only female I remember with an arrow injury escaped diagnosis for months. She presented with an abscess behind her left ear, said to have followed an arrow wound. It seemed a minor matter and like so many abscesses its drainage was delegated to the most junior team member, at that time a competent young American. She made an incision, released disappointingly little pus, and that was that.
A few weeks later the patient returned, still draining. This time the junior registrar explored the wound, again with little success. Next time I did it, and failed to explain the ongoing problem. Weeks later she came in yet again, now complaining of something in her right eye, between eyeball and nose. This was obviously an arrow tip, and pulsated. It was finding its own way out successfully and trying to hurry it could only do harm, as its path must have been within a whisker of numerous vital parts of the brain. Another half millimetre or so of arrow tip appeared each day. She interpreted our masterful inactivity as reprehensible dithering and took herself home in disgust, but returned a fortnight later with more than two centimetres protruding into the middle of her field of view. A genuine, if astonishingly indirect, bullseye.
Not unreasonably, she demanded its removal. The wound behind her ear had healed, and apart from the arrow tethering her eyeball slightly, producing double vision, there was no neurological defect. Our eye specialist came to assist if need be, but when I extracted the arrow she bled briskly for a minute or two but had no further problem. She left us wondering what all the fuss had been about.
The payback principle guaranteed that tribal fighting, and violence generally, had no end. It sometimes came close to home. In 1988 I wrote:
We are rather nervous on account of a man being axed to death up near the Teachers’ College on Tuesday night, with people from [my junior registrar] Kris’s village being suspects. The chap had been warned, but after drinking with his friends at the Zokozoi Tavern he was foolish enough to walk home alone in the dark. So there will be a payback sooner or later, and the rule is that the better educated the victim, the better a payback it is. Kris feels that he is likely to be at the top of the list, and has applied for a pistol licence, which I think isn’t very sensible. He has moved his family to his wife’s uncle’s house in North Goroka.
Earlier that year I wrote:
Iga, our acting matron, has a problem. He is an Okapa, and their national government MP died in Lae on Thursday of complications of untreated high blood pressure. His line has decided that Iga’s line worked sorcery on him, and it seems that Iga has been nominated, you might say, as suitable payback material. Fortunately he is married to a woman from the other side of Goroka, so they have gone home to her village. He is an exceptionally good worker as well as a very pleasant chap, so we are more than ordinarily concerned for his safety.
By the mid 1980s travelling on the Highlands Highway was hazardous for both locals and foreigners. In 1986 a Gorokan Christian leader drove a truckload of valuable furniture up from Lae and happened upon a bus hold-up. He sent up a Nehemiah-type prayer and was waved through by the bandits, apparently because they knew him slightly. The bus people didn’t fare so well; the driver was relieved of about K200 and passengers were levied K20 each. When an old lady said K5 was all she had, a raskol lopped off an ear.
Raskols were sometimes more gentlemanly, but not often. John and Veronica Richens were showing her mother the sights when they were held up close to town. The raskol didn’t know what to do with a refined English matron, and John had to push things along by asking how much he wanted. He looked them up and down and suggested K20. They handed this over before he had time to change his mind, whereupon he shook hands with them all and waved them on. A few weeks later a busload of nursing students returning from a rural assignment had their money, wristwatches and shoes taken at the same spot, so the Richens family got off lightly.
Personal safety was rarely a major issue for foreigners, but occasionally we had problems. Early one morning we admitted the burly leader of a notorious raskol gang long sought by the police who had trapped him at a drinking party. During a wild scuffle he took a bullet in the thigh just above the knee, holing the bone without actually breaking it. The ER nurse was a Salvation Army lad and had been at an evangelistic meeting at which the gangster had professed conversion. This nurse rarely missed an opportunity, so reminded the raskol that those who mock God often reap what they sow.
A bellyful of food and drink made early administration of an anaesthetic dangerous, so the staff bandaged his leg and sent him to the ward, where I saw him in the morning. The wound needed exploring under anaesthesia so we added him to the list. It was a straightforward procedure, and he was returned to the ward awake and in good condition. At lunchtime our police chief called, wanting to put the man in gaol. I protested that he had a nasty injury and needed hospital treatment. The officer said emphatically that gaol was the place, because he’d heard that the gang proposed making a rescue attempt, and he didn’t want innocent people caught in any crossfire. He’d keep him in the town lock-up (rather than miles away in Goroka’s main gaol) for as long as I thought necessary. As this was five minutes’ drive away I decided that under the circs we should fall in with this idea. We’d send a nurse up every few hours with injections for pain relief. When asked for a pick-up time I suggested 6 pm.
But this was not to be. He dropped dead at about 5.30 with no warning. A Port Moresby pathologist came up next morning and to our great relief he found a rare condition to explain the sudden death. Already there were rumours in town that a nurse had given a fatal injection. The gang promised to deal with the police, and after taking appropriate revenge in that direction they’d attend to the hospital. We all knew that this was no empty threat, although in the end nothing happened. For weeks the hospital was battened down at sundown, and patients appearing after dark had great difficulty in having the ER door opened. I was offered a transfer but I turned it down, remembering that a New Guinean doctor in a similar situation had refused this option, his reason being that if they really wanted to get him, nowhere in the country was safe. We knew he was right.
I was fortified in my stance a day or two later when reading the passage in the Acts of the Apostles about Paul’s apparent danger in Corinth. He had a vision in which he was told not to be afraid, and to stay where he was, because God had many people in that town, and nobody would harm him. Although I read my Bible regularly I don’t expect quite such vivid personalised assurances about my safety, my future or more mundane matters on a daily basis, but this morning was different, and the words leapt off the page as God’s word for me, so we were greatly encouraged.
All senior specialists had administrative duties, sometimes tedious or irritating but occasionally of interest. The Department once sent a file to Goroka for review shortly after I returned from leave. A planter in an outlying province walked home from a party late on a Friday night and was set upon by hooligans who knocked him briefly unconscious. Someone helped him home, where his astute wife noticed slight but worrying deterioration in consciousness over the next few hours, so she rushed him to the provincial hospital where the duty doctor was a dark-skinned foreigner who, extraordinarily, had spent several years in neurosurgery before coming to PNG. He diagnosed an extradural haematoma requiring urgent removal, which he was competent to do. The wife refused, but agreed to his consulting the regional surgeon by phone. He agreed with the diagnosis and said that, if treatment locally was unacceptable, the chap should be flown to him ASAP. It was now 3 am.
The wife insisted on treatment in Australia despite warnings that her husband could die first. At first light he was put aboard a small twin-engine plane, now so far gone, deeply unconscious and with one pupil dilated, that the doctor had to pass a tube into his windpipe to control his airway. He was operated on immediately he reached hospital in Australia, and spent weeks recovering.
The file came to me because he’d presented his accounts to the Department for payment, on the grounds that his operation couldn’t have been performed in New Guinea, and his medical insurance policy had been exhausted by the cost of the chartered plane. The neurosurgeon’s fee was $5000. Should the Department pay it?
I said the first doctor could and should have dealt with what he correctly diagnosed as a life-threatening clot, and would have done so without hesitation but for the wife’s refusal, and the surgeon he consulted at 3 am was competent to handle the case. The main point to be made was that the family should know they were unbelievably fortunate that he hadn’t died long before reaching Australia. As for the surgeon’s fee, which was far above the so-called scheduled fee for this particular operation, no doubt it was no more than might sometimes be expected when a plantation owner at the point of death arrives from overseas by chartered aircraft on a Saturday afternoon. Whether or not the Department paid I do not know.
Like many public servants, all of us with a contract requirement that we work ourselves out of our jobs by training our successors, I saw myself as having an open-ended future in PNG. So it came as a very sharp shock indeed when I learnt in 1988 that I was to be offered a twelve months extension only to my contract. This was the government’s polite way of telling me my time was up. The news I’d already received that I was to be awarded an OBE may have been a clue that yet another senior public servant was about to be dispensed with, but if it was I missed it.
Our sorrow at the prospect of leaving Goroka, which we loved, was relieved only slightly by the knowledge that it would resolve a barely manageable situation. A new trainee wasn’t part of the team, and was unwilling to pull his weight. Worse still, he persistently and proudly refused to follow instructions. The knowledge that the lore of the decolonisation process elsewhere was full of such stories was no comfort.
Many events pointed to it being time to leave. In April I wrote:
It has been a rather traumatic week. On Tuesday a pilot of a small plane crashed in Simbu [the next province west of Goroka] somewhere about 11 am, and although Leonard was informed around midday he didn’t tell me. The first I heard about it was about 3 pm when I was in X-ray with a patient under anaesthesia. The surgical registrar who has been so difficult decided to rush the guy straight to theatre, not properly resuscitated, no blood available, and without telling me what he was doing. By the time I got upstairs he was dead. The junior anaesthetist hadn’t called his boss either.
The chap had a whole lot of serious injuries, and we hoped the autopsy would disclose something untreatable, but it didn’t. It’s clear that six or eight bags of blood should have been found (which was possible) and pumped into him before anything at all was done. He may have died even then, but the coroner isn’t likely to give that much consideration.
The crash investigator tells me he was overloaded 160 kg, which is quite substantial at this altitude, he made a poor approach to the airstrip, and then did the wrong thing when he realised he couldn’t land. So it was a disaster from start to finish.
We have of course had our own internal investigation, but the real reason for me not being informed didn’t come out. It seems pretty obvious that this was just one more expression of nationalism – the desire to do without the foreigner.
Another 1988 letter included this passage.
This afternoon my registrar rang me rather cross because he had a patient in theatre with a ruptured appendix, and everybody was there except the anaesthetic service. What to do? I said I’d ring the betting shop, and sure enough the national doctor on duty for anaesthetics was there. Our only functioning ambulance was out on a call so I sent a police vehicle to fetch him, which I imagine was a bit of an indignity. I’ll find out tomorrow.
To compound these problems, infrastructure was disintegrating. Villagers who owned the land through which water was piped to Goroka felt that they deserved fatter fees, so pipes were cut repeatedly and we would go for days without running water. One Tuesday
we persuaded theatre staff to carry water for the morning, but after lunch the senior nurses didn’t come back, so several major cases didn’t get done. Normally we operate on Wednesday afternoons too, but they jacked up again. I was very cross, and stormed out to ring the Post-Courier. After the chap on the line had heard me out I suggested he ring our medical superintendent. The result was a good page 3 story about ‘Water crisis at Goroka Hospital’ which seems to have stirred up a bit of action. We’ll see how long it lasts.
Twenty years later this problem still plagued Goroka.
Water was only one of our troubles. Often we ran out of oxygen, which almost brought the theatres to a standstill, and blood, which we sometimes had to import from Port Moresby. For months the theatre air conditioning functioned on a fierce freeze setting or not at all, which was dangerous for many patients and made working conditions almost unbearable. Was it time to go?