Improvisation order of the day in Papua jungle hospital

By Christiane Oelrich Jan 17, 2012, 2:06 GMT

Karkar Island, Papua New Guinea - Two doctors working on remote Karkar Island off the northern coast of Papua New Guinea are used to operating with the bare minimum of equipment - to the extent of using the lights in their mobile phones to inspect patients' injuries.

Christof and Tanja Ihle, 38 and 37 respectively, left their comfortable lives in Germany in 2008 to work for a Lutheran mission on the island. The Gaubin Clinic, which has 180 beds, treats 2,000 inpatients and as many as 30,000 outpatients a year.

'Not much that can be done,' Ihle murmurs in German as he inspects a ruptured cornea resulting from a jungle accident by the light of his phone. 'Try to pray,' he tells the patient in the local lingua franca, Tok Pisin.

The head of the Gaubin Clinic believes it helps if the patients feel they can do something to help themselves. The 'House Sik' as it is known locally, has 180 beds and is run by the couple with the help of another doctor from Madagascar and a young local doctor.

Papua New Guinea has one doctor per 100,000 inhabitants, whereas rates of between 200 and 400 are common in the developed world. The government appears little interested in investing in the health sector, leaving churches to run most rural clinics.

'Sometimes the rubber gloves run out, and then I postpone the operations that are not strictly necessary,' Ihle says. Medicines are often in short supply.

This stands in sharp contrast to government plans to build a 300-bed luxury hospital that would have cost 500 million kina (235 million dollars), or more than the entire health budget of this country of 6.5 million inhabitants.

Those plans have been put on ice since Sir Michael Somare, who served repeated terms as prime minister, left office last year.

Somare's own health problems have cost the impoverished country dear. He put in a bill of 2.5 million kina for family visits while he was in hospital in Singapore, according to the Post Courier newspaper.

'It's an insult to our people that the state should have to pay for this,' member of parliament Sir Mekere Morauta stormed. 'Our health system is in ruins, and people are dying for lack of medicines.'

Meanwhile the Ihles get by with donations from Germany, and they occasionally also receive gifts in kind.

The hospital has a beautiful view out over the sea, and there is scarcely any traffic. Birdsong wakes patients in the mornings, and thunder can be heard from a volcano in the distance.

The morning round starts with a young man with a bruised face and inflamed eye, incurred during a fight after a drinking bout in his village. 'You will have to pay a 50-kina fine for fighting,' Christof Ihle tells him.

Patients normally have to pay a fee of 10 kina. It is made clear to them that if they do not pay, the clinic will be forced to close.

Ihle says he has learned to do without all the high-tech gadgetry of a European hospital and to improvise as he goes along.

'Sometimes I have to look up how to carry out complicated operations with limited means,' Ihle says, citing examples such as drilling a hole in the skull or providing an new-born with an anus - all of this without a trained anaesthetist.

Plastic soft drink bottles filled with water are used to stretch legs after operations to correct a broken femur, with a nail inserted below the knee. 'It takes six weeks. Back home in Germany, a patient would have a metal plate inserted and be walking soon after waking from the anaesthetic,' Ihle says.

Tanja Ihle primarily treats patients suffering illnesses like tuberculosis, HIV/AIDS, pneumonia, malaria and cancer. High blood pressure, diabetes and strokes - the ailments typical of rich countries - are a rarity here.

The patients lie on simple beds with bamboo poles on which they can hang mosquito nets. Relatives provide the clean bedding and cook for the patients, as in many Third World clinics.

The Ihles also face another serious problem: belief in sorcery and the powers of the village medicine man. Patients often turn up too late to be cured. Often someone in the village is held responsible for their fate - an elderly or solitary person becomes a scapegoat.

'When we send a fatally ill patient home, we often have a seriously injured patient delivered from the same village the next night,' Tanja Ihle says.

The hospital is trying to solve the problem by issuing a form signed by a doctor, stating that the illness has nothing to do with witchcraft. 'Sometimes it helps,' Tanja Ihle says.