Prologue

     In 1977, I was a year out of medical school, barely finished my internship, and convinced I could pull magic out of a doctor’s bag.
     I volunteered for a two-year stint with CUSO at a Catholic mission on a remote South Pacific island, where an array of tribes practiced bush medicine and magic in the sweltering heat.
     It was an uneventful stay, except… I faced amputating a young woman’s leg with a handsaw; I performed my first-ever appendectomy during an earthquake; the hospital was turned into a temporary tavern to treat alcohol poisoning victims with free drinks; I delivered babies unassisted; I broke a baby’s collar bone to free her from the mother’s birth canal; I removed a woman’s giant cyst, bigger than any baby; I travelled deep into the jungle to find the source – a fertility elixir – and cure for an outbreak of typhoid fever; I treated a well-endowed Australian’s sexually transmitted diseases; I developed a therapeutic milk formula that saved the lives of scores of malnourished children; I grappled with culture shock and indifference to my efforts; and I encountered a life-altering crisis of confidence that left me questioning why I’d ever gone to Papua New Guinea in the first place.
     Along the way, I contended with cantankerous hospital staff and an island full of colourful characters. I also learned many valuable life lessons, and these too are shared in the pages of this book. This is my story. And I’m sticking to it.

     - Ross Pennie

Chapter 1:
Dokta?

     A jarring ring! Shaken, I slid a hand across sweat-soaked sheets, fumbling for the phone in the brutally hot night air. I grabbed the receiver on the second ring.

     A female whisper barely rose above the crackles on the line. “Dokta?”
     “Yes, it’s Doctor Pennie,” I rasped, reluctantly shaking the last blissful shreds of a rare, deep sleep.
     “This is Children’s Ward.”
     “Yes,” I said impatiently. The phone line connected solely      to the local hospital, a short jog from my own quarters at Catholic Mission Vunapope in northeast Papua New Guinea.
     “Wanpela pikinini meri i-got pekpek wara,” the nurse stated in a Pidgin dialect, advising me a child has severe diarrhea.
     Now the voice switched back to English: “And Dokta,” she added, “we can’t find the blood pressure. Sorry, Dokta.”
     A pause, then: “You coming now, Dokta?”
     No detectable blood pressure – the child must be in shock. There was no point asking for more details. “Yeah,” I sighed. “I’ll be there right away.”
     I sprang out of bed, knocking my paperback to the floor. I’d read three such potboilers in the six days since I arrived at Vunapope mission. There was little other entertainment available in this primitive outpost in the South Pacific two thousand miles away from any place I’d ever learned about in school.

     The entire sun-baked collection of islands north of Australia had just one radio station and no television. What passed as Papua New Guinea’s cinema was a smoke-filled hall with a torn screen and a temperamental projector. It served up a menu of Kung-fu movies and ancient Hollywood westerns.
     Snaking out of the mission and along the coconut coast was a rough strip of tarmac that terminated in the lazy, heat-shimmering avenues of Rabaul. A car could make the trip in under an hour if the radiator didn’t run dry halfway there. The town was home to fifteen thousand humans, as many barking dogs, and four jungle-green volcanoes that coughed and shuddered in their sleep. Two main streets boasted clapboard businesses – banks, department stores, hotels, Chinese restaurants. Like the road, the phone line from my house stretched no further than Rabaul.
     I had found myself in Papua New Guinea – PNG – as a result of my own lobbying. While in medical school in Canada, I had eagerly volunteered to serve on an overseas assignment with CUSO (the initials once meant Canadian University Service Overseas but the acronym had become a name unto itself). Fresh out of med school, I headed for PNG to practice medicine on people who just as frequently turned to spirits and magic to heal them. My positing was in New Britain, an island off PNG’s northeast coast.

     I threw a clean shirt over my twenty-five year-old frame, slid my feet into flip-flops, grabbed my army-surplus canvas satchel, and ran through the door – all in one continuous motion.
     My year of interning at a big London, Ontario hospital, just a few weeks behind me, hadn’t made me a seasoned medical practitioner. But it had taught me how to hustle. A three-minute dash took me up the driveway, across the dewy lawn, and into the children’s ward.
     The paediatric bungalow looked and felt more like a rustic kitchen than a hospital. Waist-high counters with cupboards above lined two walls. Although the place was tidy, dim lighting and faded paint made it appear grimy.
     Swells of air – heavy with the odours of sweat, grease, and cabbage – oozed over me like warm molasses. My chest heaved from the jog up the hill.
     At the far end of the room, beside an iron trolley table, a chunky teenager stood rolling strips of white cotton into bandages. She had nutmeg skin and wore the navy shift and white apron of a student nurse.
     Near her, a clove-skinned nurse shook pills from a bottle and counted them onto a tray.
     Now, a third student approached as the door swung shut behind me. Taller than the others, she had cinnamon skin, five chevrons tattooed unevenly across her forehead, and a wide halo of shimmering black hair, almost too springy to support her cap. Pinned to her apron was a nametag stating: “Veronika.”
     This late at night, the supervising nuns were asleep in their beds. Now it was just the three student nurses – all of them teenagers – joining me, an untested doctor in his mid-twenties.
     Veronika looked straight into my eyes. “Good evening, Dokta. I’m sorry I disturbed you. But – but the girl is very sick.”
     In the centre of the room a little girl, about three-years-old, lay naked on a grey table. Her eyes were closed. A cowrie shell, dangling from a fibrous thread around her neck, rose and fell with the rhythm of her bird-like chest.
     A stocky, barefoot couple, presumably her parents, crouched together in a corner, their eyes fixed on the table. Dry mud splattered their limbs. Their chests were bare, and each wore nothing but a laplap – a crude skirt fashioned of red and black cotton wrapped around the waist like a flimsy bath towel. Crops of open sores, raw and crusty, oozed from their earth-brown skin.
     “What’s her name?” I asked.
     Veronika lifted a clipboard chart from the counter and scanned its front sheet. “Lillianna, Dokta.”
     I pulled my stethoscope from my satchel and bent over the child, listening with one ear while Veronika gave me the story. For the past few days, Lillianna had severe pekpek wara – watery poop.
     Tonight, when she became too weak to sit up, the family made the trek from their village to the hospital. The girl’s unresponsive state had alarmed the nurses into calling me, especially when they couldn’t detect her blood pressure.
     My fingertips gently touched her forehead. Lillianna’s skin had the feel of crinkled brown paper. Her cheekbones bulged grotesquely; her dark eyes lay sunken and unfocussed in their sockets; her mouth gaped in a prolonged but silent scream.
     Because her vital body fluids, lost in countless liquid stools, had not been replaced, she had withered like a houseplant deprived of water – a desiccated violet with a faint pulse and no flicker of consciousness.
     Having descended into shock, she would suffer a cardiac arrest at any moment unless I could deliver a salvo of fluids into her bloodstream.
     I quickly barked orders, and the nurses, in search of supplies, scattered like startled pigeons towards drawers and cupboards.
     When the student nurses couldn’t produce the swab, the needle, the salt solution I wanted instantly, a heavy knot of panic gripped my stomach and rose into my throat.
“Don’t just stand there, get that I.V. bottle ready.” My words echoed loudly and their harshness surprised me; but I couldn’t stop the explosive volley. “I want it now, not tomorrow. For heaven’s sakes hurry up!”
     Jabbing at one site after another on the child’s hands, wrists, and forearms, I shot for a vein, any vein, which would accept a needle. But they all had collapsed from dehydration. I despaired of ever getting the intravenous running.
     In one final try, I tightened the rubber tourniquet high on Lillianna’s arm, felt for a vein at the elbow with as much care as my agitated state would permit, and stabbed at something vaguely like a vessel. There was a flash of blood. The needle had hit a vein!
     I secured the intravenous tubing, opened the valve wide, and let the infusion run full speed. The colourless solution left the bottle in a barrage of hurried droplets.
     Within minutes, one quarter of the bottle’s contents had poured into her bloodstream.
     Veronika held Lillianna’s wrist and calmly reported that the girl’s pulse felt a little stronger. A few minutes later, the pulse was stronger still.
     One of the nurses pumped up the blood pressure cuff and actually managed to get a reading. We had reversed the girl’s shock--we were winning.
     The odds of a cardiac arrest were dwindling to nothing. Lillianna even looked better. The corpse-like pallor of her lips had given way to a hint of colour. I took a deep, calming breath.
     Then, inexplicably, the little girl’s eyes rolled upwards. Her arms and legs stiffened like the branches of a Canadian poplar in winter. Her lips leered a gargoyle’s grimace across clenching teeth.
     For a minute, maybe more, she lay motionless on the table--a piece of driftwood, dry and contorted. Her breathing ceased. A sickly blue tarnished her lips and gums. Green spittle welled from her slackened mouth. The pulse in her neck grew weaker and slower until every muscle in her body slumped in a single, soundless sigh.
     I listened for a faint heartbeat, desperate to hear at least a flutter. Nothing.
     “She’s arrested!” I shouted, the stethoscope still plugging my ears. “We have to do CPR. Can any of you give mouth-to-mouth?”
     No answer came from the three teenagers at my side. Two of them looked expectantly towards Veronika; she raised her eyebrows a fraction, wrinkling the tattooed chevrons on her forehead. Yes, she could do it.
     “All right,” I said urgently, “you start the mouth-to-mouth. I’ll do the cardiac massage.”
     With steady hands, Veronika lifted the toddler’s chin, pinched the nose, and blew into the reluctant lungs.
     Then I, with crossed hands, I pumped up and down on the breastbone.
     I called for injections – adrenaline, bicarbonate, calcium. The minutes ticked by.
     “Can you feel a pulse?” I asked. My voice was hoarse, strained with despair.
     “No, Dokta.”
     “More adrenaline. Hurry!”
     The parents cowered against the wall. Their faces gaped in horror. Desperation – theirs and mine – threatened to consume me, but I dared not break the rhythm of my slippery palms against the small chest.
     After twenty minutes there still was no heartbeat. The inner candle of life had guttered and burned out; no amount of shouting, injecting, inflating, and pounding could re-light its flame. Lillianna, alive only minutes ago, was now deceased.
     I gave the signal to stop with a waving motion of my heavy, down-turned palms. We took our hands off the body and stood transfixed in a ring around the table.
     Moments later there began a heart-rending wailing, a screeching of startling intensity. In a wild delirium, the parents rocked their heads and flung their arms. They moaned and staggered and pawed and clutched – at each other, at me, at their flaccid child upon the table.
     I forced myself to not recoil at the strong smells of fermented sweat, smoke, and feces rising from the grime on their unwashed bodies.
     With our resuscitative efforts terminated, I didn’t know what to do next. A minute ago, I had been the dominant force in the room. Now, I felt out of place, a stranger.
     I backed away from the table, leaned heavily against a counter, and stared at the patterns made by the cracks in the grey concrete floor.
     The mother sobbed her little girl’s name over and over, stroking her cheeks with an unbearable tenderness.

     A wave of nausea rose from deep within my belly and swept into my throat. I quickly grabbed my satchel to escape into the moonless night.
     I bolted from the hospital and headed down the driveway towards the rhythmic sound of the sea crashing against the reef. The wind hissed through the coconut fronds high above me. In the distance, two dogs barked a duet of warning and fear.
     The avenue soon led me to the main coastal road, my flashlight’s beam barely revealing the potholes in the crumbling asphalt.
     I crossed the roadway, carefully edged my feet down the grassy embankment, and stepped onto the beach.
     In a spot above the high tide mark I found a log, which long ago had been hauled up like a lost whale. The broken shells of hundreds of dead barnacles covered its sides, but its top was smooth, polished by years of sea spray, wind, and rain.
     I sat down in a saddle-shaped groove between two knots and let out a long sigh that was lost in the sound of crashing waves.
     Sharp scents of iodine and dead fish wafted upwards from the dry beach sand beneath my toes. The unseen rollers, bursting one after another onto the outer reef, boomed a hypnotic chant.
     After some time, I rose and gathered a handful of smooth, flat stones. Heeding a summertime compulsion imprinted during my childhood in the Gatineau Hills of Quebec, I skipped them one by one across the surface of the water. The stones went click, click, plop as they skimmed the gentle swells of the lagoon.
     For a moment, I was a carefree boy standing on a Canadian lakeshore on the other side of the world, sunshine blazing my cheeks, and the smell of pine needles tickling my nostrils.

     The clock atop Saint Mary’s Church clanged, wrenching me back to New Guinea time and the reality of my CUSO mission.
     I flicked one last pebble into the water. I was the only person on the beach and my footprints in the wet shoreline sand were the only other indication of a human presence.
     Turning away from the breakers, I began trudging inland. But with a backward glance I witnessed the warm water rush in toward my footprints, the tides playfully licking the tips of my toe-prints, but otherwise leaving my tracks intact. The next wash of warm salty water fell short of the footprints, seemingly content to let them be and accept this modest alteration to the raw beachscape. But with another surge, the unforgiving tides consumed them, removing any trace of my presence in a slick of wet sand.
     The brief impression I’d made was now erased, lost in the unforgiving tides. It was as though I was never there. With a sinking feeling in my stomach, I wondered if this was also prophetic of my voluntary posting. Was I to endure further surgical failures, fall short of the CUSO goal of fostering lasting positive change and in the end leave only a soon-forgotten impression?
     I pushed these haunting questions from my mind. If I intended to survive the next two years here at Vunapope Mission, I would have to focus purely on the task at hand, confront my failures and learn from them.
     As a sliver of moon crept out of the sea, the mission buildings emerged from the void. The angular shapes of the wharves and warehouses on the foreshore blocked most of the view of the church beyond them, but I could see the steeple’s luminous cross of white neon.
     I headed back to the children’s ward. Outside the entrance to the ward, a heavy-set man leaned against a pickup truck. He drew on a cigarette and greeted me with a nod. “Goodnight, Dokta. Me kam kisim pikinini belong wantok belong me.” He’d come to collect his neighbour’s child.
     I nodded in response.
     He shook his head slowly. “Sorry tumas.”
     “Yes,” I agreed. “Sorry too much.”
     He took a last puff and dropped the butt onto the dirt, then shrugged and ground the embers with his heel.
     I pulled open the hospital door and braced myself for the misery of the unbroken keening.
     But the room was silent. The nurses were back to rolling bandages and counting pills. The grieving parents were caressing their child’s skin with a moist cloth, rubbing the spatters of blood from her arms where I’d made so many stabs with my needle. Her limbs and buttocks were thin and wasted, as if she’d been deprived of proper food for weeks, even months. The father wiped green spittle from Lillianna’s chin and plucked bits of green-grey seeds from her kinky hair. I hadn’t noticed the strange-looking seeds before. They looked like broken pieces of velvet-covered buttons.
     The mother reached into a string bag and pulled out a length of cotton, printed in blue flowers. Although the material was smudged with grime and ripped along one edge, she spread it on the table and flattened the wrinkles as best she could. She helped her husband lift the little girl onto the impromptu shroud and fold it over her, leaving her face for us all to see.
     The father, his pectorals broad and bulging, picked up his daughter to cradle her in his arms as though carrying her off to bed.
     “Tenkyu, Dokta.” His face held no hint of anger or resentment. Just resignation.
     “Bai mipela i-go long place wantime Lillianna,” he said as he pushed open the door with his shoulder. They were ready to take Lillianna home.
     Before following them out the door, the mother dropped her bag and grasped my hand with both of hers. Her hands were sweaty and leathery against my skin, but warm and solid. She gave a squeeze. “Tenkyu, Dokta. Tenkyu tru.”
     I swallowed hard and barely managed to nod in reply.
     The doors creaked and banged as the couple settled into the truck. The engine revved, the gears grumbled, and the vehicle rattled into the night. There would be no formalities to mark Lillianna’s death. No undertaker, no autopsy, not even a death certificate. Just a simple grave in the family garden between the taro and banana plants.
     I picked up several pieces of seed that had fallen onto the floor. They felt smooth and soft, like satin or velvet. “Do you girls know what these are?”
     No answer. Just stony faces.
     “Come on, girls,” I insisted. “Tell me what they’re for.”
     Still no answer.
     “Please,” I implored impatiently. “You can tell me.”
“Bush medicine,” one of them whispered.
     “Hush,” hissed Veronika. “Matron says we not to talk about it – says it’s poison.”
     “Poison! Are they really poisonous?” I asked.
     Veronika’s shoulders stiffened. “We don’t believe in that stuff.” She lifted my satchel off the counter, handed it to me, and shot me a look that warned they’d said too much already. I got the message: It was time I went home.

     In the guava trees beside my garden gate, the fruit bats screeched and chattered above me in the darkness. I couldn’t tell whether they were fighting, playing, or warning of my approach.
     My heart, too, was a jumble: there was blinding disappointment, but with it a feeling of hope, of inner release. Perhaps the bush medicine, not my ineptitude, had provoked Lillianna’s fatal seizure. I fingered the seeds I’d secreted in my pocket and reflected on how I might achieve my CUSO mandate of affecting lasting positive change in a primitive culture where poison can be embraced as medicine, where death comes too often to the very young, where few people live long enough to celebrate their fiftieth birthday.

     Abruptly, a sound trilled louder than the squeals in the guavas. The telephone, its ring jarring and insistent, summoned through the open louvers of my unlit bedroom window. I fumbled for my house key, shoved open the door, and hustled to answer what was sure to be another emergency call.