Papua New Guinea: the operating theatre where shoes are left at the door

1 May 2012

Wellington nurse NICKI BABBAGE writes about her fortnight’s experience with low-tech theatre nursing in an isolated town in the Papua New Guinea highlands.

Last October, I spent two weeks working as a volunteer in a hospital in the Papua New Guinea highlands – a very different experience to the high-tech environment I am used to.

I was working as a volunteer with an Australian organisation called the Highlands Foundation as an operating theatre educator in the hospital at Goroka, a town of 12,000 people about an hour’s flight from Port Morseby.

The 350-bed Goroka hospital was built in the 1960s and has remained virtually unchanged since then. They have 235 nurses, 156 of whom are registered and there are 79 community health workers.

The hospital depends on ‘guardians’ (relatives) to care for the patients. A 30-bed ward has two nurses per shift and sometimes a community health worker. The hospital is understaffed, but due to financial constraints it cannot afford to employ any more nurses. Volunteers are housed in the hospital compound along with the nursing school and other ancillary services, all surrounded by a high, perimeter fence.

Most of the nurses I worked with were the first generation to leave their villages and take up a career. Theatre nurses pack their own swabs and abdominal sponges, thread their needles with silk and wash their own instruments. Counting is haphazard. To say I was in a time warp would not be an exaggeration, as these practices were current before my time.

Following initial observations, I decided what was important was to target the main areas of concern. I knew I could not change their practices overnight, nor did I want to. My role was to suggest things to make their lives easier, safer and cost-free. The older nurses saw me as a threat initially, and as their first educator, I understood their resistance.

Lack of water and other hygiene hurdles

One of the main issues was handwashing. The key factor here was a lack of water. For two days, surgery was cancelled as there was no water. This was obviously a major impediment to maintaining adequate hygiene. The hospital infection control nurse had been given the formula to make alcoholic hand gel, but for some reason, the theatre had not been back to have their bottles refilled after using their initial quota. This was easily remedied.

The disposal of waste between cases was another issue that needed addressing. Osteomyelitis is a common condition in PNG. In one instance, we had cleaned an osteomyelitis patient’s leg when a burns case was scheduled immediately afterwards. I explained the infection control ramifications of changing patients without cleaning the theatre first. Again, this was easily fixed.

HIV, typhoid, hepatitis and Aids were all prevalent conditions there. “Universal precautions” was the catch phrase that I employed every day. I focused on the fact that the staff members were too valuable to risk becoming infected.

When the staff arrived for work, they would take their outside shoes off at the theatre door then spend the rest of the day with bare feet. The few that did wear shoes had open toes. With the danger of BBFE (blood and body fluid exposure), wearing shoes in theatre was a mandatory requirement. The hospital manager promised to look at funding for this.

Another issue was planning. As an organised person, I found the haphazard daily routine to be quite unnerving. There was no clear picture of what was needed for the next day’s surgery and no team focus either within the hospital or in the theatre itself. I suggested planning measures and the importance of teamwork to improve the situation.

While the hospital seemed to have an adequate supply of aid, a lot of it was totally inappropriate. For instance, a box of laparoscopic disposable items sent in good faith had arrived, yet the hospital undertook no laparoscopic work. The hospital does not have access to the internet, and this seemed to be an unfortunate barrier to communication with their aid donors in Australia.

Villagers trek to outreach clinic

The highlight of my trip would have to have been the day I spent at the outreach programme. We travelled by four-wheel drive to Lepegu and set up a clinic in an empty field. This was the first time any medical personnel had come to this area, and some villagers trekked over the hills for eight hours to see us.

Patients waited for hours in the searing sun to see a doctor or nurse. The complaints were mainly related to their daily living. A lot had arthritis or neck, back or knee pain. They were prescribed indocid and panadol. The pharmacist sitting at her table in the field had a bucket of pills from which she dispensed the drugs.

Other complaints related to STDs. Polygamy was an accepted practice for men, and many of the women paid the price with infertility. Being told by the doctor “to keep your men faithful” was obviously easier said than done.

My overall impression was the nurses were contented and resigned to their lot. They made do with limited resources, never knowing when the next supply of aid was coming or what it would consist of. It was a challenging and rewarding snapshot of life from another perspective.

Nicki Babbage at the time was general team leader theatre at Wakefield Hospital, Wellington.