Hi, my name’s Brioni Moore and this is my story about my time in PNG. So, my story really begins on September the eighth in 2008. And I still remember this day like it was yesterday. It was the day that I first stepped off the plane into Papua New Guinea. Everything about that day still is incredibly vivid. The humidity, the smells, the noise, the vibrancy, the colour that surrounded it. That bright red beetle nut spit that was all over the footpaths and what seemed like a million pairs of incredibly curious eyes just boring into me. I’ll never forget that moment I stepped off the plane. And I also will not forget that overwhelming fear of what am I doing here? And get back on that plane and go back to your comfort zone. But I’m incredibly thankful that I strode forward and continued my journey in PNG and was able to get so much from a country. It’s a country that has given me so much, continues to give me so much, and which I can never repay or give quite as much as I have received. I was born a nurturer, since early childhood I’ve always needed to fix people to care for them, particularly children. From an early age if there was a baby in the room I was a mesmerized admirer and I always looked forward to going to church on Sunday so that I could take care of the babies in the crèche. That was the highlight, perhaps quite appropriately.
I always wanted to be a doctor throughout childhood, and I worked incredibly hard throughout high school to make sure this dream could become a reality. The complete devastation that I felt when I was not offered a place in the UWA medical course is an understatement. It’s unimaginable the sense of loss I felt. I was lost. I had no idea what I wanted to do because all I ever wanted to do was be a doctor. Thankfully, I have a very wise mother who is able to guide me to a plan B. I would enrol at Curtin in a biomedical science degree and then reapply for medicine the next year. Problem solved. This plan, I thought, was completely foolproof. What I didn’t imagine or intend was that I would actually fall in love with the science behind medicine, with the ability to look into innovations for new drug treatments, for new diagnostics and to change treatment policy for patients. Needless to say, I didn’t actually ever enrol in a medical degree and I saw out bio medical science and embraced wholeheartedly this new career path of research.
My fascination with research and making a career for myself in this field really went on from there. I completed my undergraduate degree and an honours degree after that looking at research. Then was offered several PhD projects to consider. There was one in cancer therapeutics, a bioterrorism, but also a project and looking at new treatments for malaria. Now, I’m not quite sure why, but this project and the idea of looking at malaria research really resonated with me. And I jumped into the laboratory work looking at new treatments for malaria in a pre-clinical model. Whilst I really enjoyed the time in my PhD and the challenges and also the contribution that I made to science during this time, I also discovered that as a very social person working in the laboratory didn’t really suit my personality and I craved and needed human contact. So in August 2008 a month after I had completed all of my laboratory work for my project, a collaborator contacted me to see if I was interested to go up for a three month work trip to Papua New Guinea to actually be involved in a clinical trial that was working with some of the new treatments that I had looked at in my PhD. Despite me being a ridiculously cautious over thinker and lover of staying within my own comfort zone, I actually jumped at the opportunity to have hands on experience in malaria research clinics where in my mind I imagined how my day to day activities would have a direct impact on human health. In fact, I was so empowered by the ideals and the ideas of this research that I actually thought very little about the environment that I was about to completely immerse myself into.
Arriving at Madang Airport was a revelation. It was just like the Australian outback only it was lush and tropical, complete with its own tin shed arrival hall at the airport. However, that is where all the similarities between Australia and this airport ended. When they unloaded the cargo from the plane, it was a complete kaleidoscope. There were bunches of fish wrapped up in banana leaves, bunches of bananas, suitcases, boxes held together precariously with type, a coffin. The variety and array of cargo was ridiculous. I somehow managed to find and claim my ridiculously large suitcase in the pile of cargo which mum and I had packed within an inch of itself with every medical and food item known to man to see me survive these three months. I then exited that tin shed arrival hall with eagerness, as after 21 hours of transiting, I was finally going to see a friendly known face. Another collaborator from Perth, who was also doing malaria research up in Madang, had organised to come and greet me at the airport and helped me settle into my accommodation. So I dragged that suitcase the whole way to the car park and was almost instantly engulfed in the chaos of the arrival centre. Families were crying. There was laughter. There was celebration as everyone was greeting all of those that had got off the flight with me. And there I stood all on my own.
Within 15 minutes, the environment was completely different. The car park was empty. It was silent. There was not a single person around. The airport doors were closed and I was standing there all on my own. I had no telephone. I had no way of contacting my colleague. I was in a foreign country, in a place that I didn’t know. I didn’t know where to go and I just didn’t know what to do. I had two saviours on that day. Eileen at Air New Guinea and John Timay, now Eileen was sitting in her office in the airport when she looked out the window and saw a scared, stressed out, bedraggled, 24-year-old white Mary, standing there all alone, not knowing what to do. She immediately called John Timay, the director of the Medical Research Institute just to inquire to see whether he was expecting anyone. Since John knew that I would be arriving that weekend he and his wife Janet jumped in the car and came out to the airport to greet me. Now, I had never met John or Janet before. I didn’t know Eileen had called them. And I definitely was not expecting a Papua New Guinean couple to come greet me. But when softly spoken, Papua New Guinean John, with his bright red beetle nut stained mouth, softly said to me, ‘I’ve come to pick you up and take you home.’ I jumped in their car because I wanted to be anywhere but that car park.
Papa John and Mama Jana took me home to their family celebration. They fed me. They laughed at me and they laughed with me. But they made me feel completely welcome and safe and helped me settle into my new environment. Needless to say, my colleague did come and look for me several hours later. He had forgotten me since the game of Scrabble he was playing with an incredibly intriguing one. At the conclusion of my three months in Madang I was so enamoured with the research that I was doing that when I returned to Perth. I begged my colleague for the opportunity to go back up to Madang and continue with the research.
So, in April 2009, I completed that same trip up to Madang and there I stayed for five years. My research activities in Madang centrally revolve around improving malaria treatment options for children and for pregnant women. We achieved this by conducting clinical trials where we recruit participants who have malaria and give them a treatment course of the anti-malarial drug that we are studying. We then follow them up for a period of time to monitor whether we have treatment, success or in some cases when the treatment doesn’t actually work. All of this research is done at a field clinic in a coastal town called Alexishafen, which is a 20-minute drive north of Madang town. And here I have established an amazing team of Papua New Guinean clinical researchers, which include doctors, nurses, community health workers and our study drivers. Drivers who, of course, take care of the study car, which is a vital piece of equipment in our research. Every day at the study clinic is incredibly different. New experiences and challenges are always around the corner. Now, these challenges are something that I had never envisaged or experienced here. No power or electricity for hours, days or often weeks. The water tank is empty. Somebody steals the water pump. There’s a tribal fight up the North Coast road. Therefore, we can’t go up there with the car for periods of time. No staff turn up to work. Every day was different. Every day had a new challenge. My favourite activity in the research clinic is always going out to the field sites, out to the follow up visits. The majority of our participants live quite a distance away from the clinic, so therefore we have to use the car in order to go and follow up and check and see how they’re going. For each of these visits the study driver will get a group of nurses and our small team, as well as medical consumables and a list of patients that we need to follow up. We all jump in the car and we head off on the road. It’s a ten seat Toyota Land Cruiser so as you can imagine, it’s full of good atmosphere as well as having a strong purpose of what it is to achieve.
The recruitment area is really large, which means that we can sometimes drive for an hour up the north coast road on a pothole filled road, which takes a really long time and is incredibly uncomfortable. Or sometimes we have to have a 30 to 40 minute walk in land, often crossing rivers and traversing through jungle paths. There’s much camaraderie at all times in the study car, lots of laughter, lots of stories, but the journeys are never easy and we always come back exhausted. However, the sense of purpose is strong if our participants haven’t reacted well to malaria. Then there is the possibility that they could die, and hence it’s imperative that we find them and make sure that everyone’s doing okay. My love for attending these village visits really stems from the overwhelming dose of reality I get every time I step into this setting, which to this day still humbles me. Village homes are really simple. They’re made of bamboo and often cardboard boxes. People are dressed simply and sometimes you’ll even encounter a tribal elder dressed in traditional dress. There is no evidence of excess. In fact, it’s always quite the opposite. Regardless, the village site is always maintained meticulously, and the people are always welcoming.
Despite them having so very little, they always give you so much. I’ve never seen happier people. I’ve never heard such pure laughter nor enjoyed storytelling quite so much. The women in particular always welcomed me into the villages, and I never left empty handed. Papaw peanuts, beetle nut, all very common gifts of appreciation for you making the time to come and see them. Our participants never imply that they are doing you a favour, which actually is the reality. Instead, they’re always overwhelmingly appreciative for you taking the time out of your day to make sure that their children or their pregnant mothers are okay. From this, my greatest life lessons have been learned. Most importantly, there is so much beauty and humanity at the end of every muddy road. I’d be lying if I said that every moment I had in PNG was magical. I’ve been tested. I’ve been pushed to the limit. I’ve had my fair variety of infectious diseases and I’ve seen things I wish I could un see. But I have also learned that you cannot appreciate the good things and celebrate success in life. If you haven’t actually experienced adversity, my most personally challenging moment occurred in September 2010.
It was a Sunday morning and as usual, I was getting ready to head up the north coast to a private beach where a group of expats and I always went for a Sunday barbecue lunch and an afternoon of relaxing in the ocean. My routine on this day was normal. However, I did notice on my right calf muscle that I had a small red pimple, but at the time thought nothing of it. We went up the coast and had a wonderful day, but by 3 p.m I had a high fever. I was hallucinating and my right calf was swollen, hot to touch, bright red and very painful. Given that quite a number of us worked in the medical field, we knew how serious this could potentially be. So, we jumped in the cars and drove back to town, calling past Madang Hospital to get some I.V. antibiotics, which would immediately improve the situation. Unfortunately, the hospital did not have any I.V. antibiotics since all the pharmacies were closed because it was a Sunday. The group of us accumulated all the antibiotics that we had in stock, and I started taking a dose of each of these, hoping that at least one of them would help treat the infection I had. To be honest, I can’t remember much of that night. My friends told me it wasn’t a very pretty night, but when I woke up the next morning, my leg was three times normal size and it turned an ominous shade of purple. Thankfully, there was a seat available on the morning flight out to Cairns, and so we were able to convince everyone that I needed to be on that flight. And I made my way quickly down to Cairns, where the next day I was in surgery and then spent 10 days in an isolation ward with sepsis and isolated because I had a flesh-eating bacteria that caused the infection. Given the nature of the infection that I had, I was not able to return immediately to PNG and had to return to Perth to convalesce for three months.
Whilst I was devastated that I couldn’t go back to my beloved Madang and community immediately. I was also incredibly thankful that I was able to convalesce in Perth where all the medical resources were available to ensure that I completely got better because I do understand that if I hadn’t been able to make that trip out of PNG, my outcome may not have been quite so favourable. So, at the end of my three months when I was declared medically fit, despite my family’s complete utter devastation and protests, I went straight back up to PNG to the research I love and my Madang community. It really never occurred to me that I would not return to PNG. A lasting memory I will always have will be looking out of the plane window as my Madang family waved goodbye from the departure lounge, a singsing group dancing in the airport car park. It really was a time to reflect on my journey and my time in PNG and how actually that could be likened to the muddy road that I transited to villages. It was beautiful, surprising, unpredictable, often very messy, frustrating and exhausting, but yet filled with so much joy and sense of accomplishment at the end. My work in PNG not only strives to improve patient care and save lives, but somehow along the journey it also has significantly improved my life and in a roundabout way saved me.