Tropical matters medical: Paul Oates

At ASOPA, part of our preparation for PNG was to get our “shots”. We were required to attend the Government Health Centre at the old Commonwealth Government Centre in Phillip Street, Sydney. We were then medically inspected and approved for tropical use by a Commonwealth Medical Officer, who in my case was a thick set, grey haired man of about 60.

Then our Course was lined up and inoculated and vaccinated for Smallpox, Typhus, Typhoid, and Cholera. There was a production line for the 39 of us where our arms were scratched and a needle inserted in our arm. A syringe with each type of vaccine was then thumped in through the needle, one after the other. On the third load of serum, the room started to spin and I remember the doctor saying, “Nurse, nurse, look to your patient.”Lying back in a chair and with a wet flannel around my neck brought the room back into focus.

During our training at ASOPA we were given a very basic “walk through” what we might encounter during our daily work. We also were required to qualify for our First Aid Certificates.

Information was showered on us about tropical diseases including Tropical Ulcers, Malaria, Dengue Fever, Skin Fungus, Coral Ear, Leprosy, Snake bite, Leaches, Rat Urine infections, Worms, injuries as a result of tribal warfare, births and deaths and coronial investigations.

All this was presented with an air of “Well it’s nothing too dramatic, you understand”.

A particularly graphic Canadian Air Force film was shown to us and the presenter told us to bring our meat pies and tomato sauce along. I wasn’t the only one who left the room before the film finished, but it was good preparation for the real thing that many us had to cope with. I found that looking at something in cold blood however is entirely different to coping with a
“hot action” situation in practice.

Tropical Ulcers or TUs as they were known were something that you quickly become acquainted with. Any little scratch or cut can quickly become infected and, if not treated, can develop into a very nasty ulcer. Those of us from temperate areas who thought we were well prepared for skin infections had another think coming. Antiseptic creams and lotions were of little or no use in the tropics where sweat will quickly remove them from the cut. They are too slow-acting anyway for the tropical germs. After a while, we learnt to have some antibiotic powders handy and, at the first sign of infection, treat the wound with these.

Later advice suggests these antibiotic powders may be not a good long-term strategy however and an Iodine solution, commercially known as Betadine, is a good standby especially for minor cuts and abrasions. Cuts from coral reefs
were particularly susceptible to infection.

Leach bites and flea bites if left unattended or inadvertently scratched, would very quickly develop into Tropical Ulcers. With particularly bad TUs, a penicillin injection from the local Aid Post was required.

Malaria is a big killer in Papua New Guinea. Not only is the disease a curse but, even if a person has some immunity, the effect on the liver and spleen is permanent and ongoing. We were instructed to be very careful if taking a person into custody as they could well end up with a ruptured spleen if a struggle occurred.

So serious was malaria in PNG that there was an Anti Malaria Unit that went around spraying houses with the insecticide DDT to combat the Anopheles mosquito that spread the disease. When the long-term effects of DDT were discovered, the Unit ceased operations and malaria returned with fierce intensity.

More is known about the disease these days and how it is spread. Mosquito nets sprayed with insecticide are being distributed by Rotary clubs and it is said that if you can cover yourself up and remain unbitten by a mosquito between the hours of dusk and night, you won’t catch the disease as this particular Anopheles mosquito only bites between those hours. However, in 1969 we weren’t privy to all of this information. Dire tales of “Blackwater Fever” and “Cerebral Malaria” were common place and I even remember my father’s stories about how the Australian troops during the war had to take a daily dose of “Atebrin” that turned their skin yellow.

The treatment of Malaria we were told was simple. Take two Anti-Malarials once a week and we wouldn‘t get malaria. Anti-Malarial treatment for us was in tablet form and either called Chloroquine, or distributed under another name, Nivoquine. Sunday morning was reserved for anti-malarials, hopefully downed with swig of beer if there was some available, for the tablets were as bitter as gall.

Leprosy was apparently less common in PNG after there had been concerted efforts to eradicate this disease. The common conception of fingers and limbs falling off the sufferer were however not true. The disease actually eats away at the boney tissues and the limbs and extremities gradually shrink. Traditionally, lepers are shunned and ostracised and in times gone by, isolated from the community. We were told that in order to actually catch leprosy, you have to be in contact with a sufferer for an extended length of time.

On patrol in the Kabwum Sub District in 1972, I remember shaking hands with a leper outside Lama Village. All the villagers had lined up along the track outside the village and as I walked down the line, I would make a few comments to everyone like “Gut Moning” (Good Morning), “Gut de” (Good Day), etc. As I progressed down the line I was suddenly confronted by what I can only call an “‗apparition”. The man’s face was terribly disfigured and he had a hole in what was left of his face where his nose should have been. I looked down and found I was actually “shaking” the ends of what was left of the two main bones of his right forearm that had seemingly fused together.

Not wishing to indicate any emotional reaction, I kept on shaking hands until I was past the village. We had been briefed that you had to have a long period of contact to actually catch the disease however I washed my hands vigorously in
every stream and river we came to for the next few hours.

The common complaint skin fungus (“grille”) or Tinea Embricata was usually observed on PNG people by patches of their skin being light coloured, raised and roughened. This gave rise to the Tokpisin term of “skin pukpuk” or, literally translated, “Crocodile Skin”. If clothes had not been aired and had come into contact with this fungus, it was fairly easy to catch this fairly innocuous disease. The remedy then available was to paint the affected area in a weak solution of Salicylic acid and when the acid started to actually burn your skin, you knew you had successfully burnt off the fungus.

Coral Ear was apparently something that one could catch by swimming in the ocean when coral polyps were spawning. You have to be very careful to check any ear infection if you lived on the coast of PNG.

Papua New Guinean snakes come in all shapes, sizes and potentially lethal varieties. In the hot, humid kunai (2 meter plus high tall grass), Death Adders were very common. A highly venomous black variety of both the Australian Eastern Brown and Black Snake called the Papuan Black are also very important to stay away from. Given that most village people walked around and worked in their gardens in bare feet, snake bite was a fairly common event. Pythons and other “constrictors” are common and often followed their natural prey of rats and mice into buildings and houses.

Rat Urine, we were told was something to be avoided. Rats would scamper about on the rafters of grass houses at night and their urine contained Hepatitis. When the urine dried, the powder would then float around in the air and could be inhaled at night when you were sleeping.

Worms (both Round Worm and Hookworm) were another thing to be avoided we were told. Round Worms could be caught by eating uncooked or poorly cooked village pig. Considering that many pigs at village ceremonies were cooked in ground ovens and might not be properly cooked, it was something to consider when you were offered a piece of pork at a celebration. To refuse would, of course, have been very bad manners. Round worm could, we were told, burrow through your gut wall and give you peritonitis.

Hook Worm was a continual problem in villages where it was traditional for village pigs to roam wild. In some areas, pigs were used to dispose of human faecal matter at night. The pigs helped spread hook worm which people would catch through cracks in their feet when they trod on the faecal matter of pigs. The Hookworm would then work its way through the bloodstream to the lungs and when a person then coughed at the irritation, they would swallow the worm so that it ended up in their gut. There the worms would latch onto the lining of the intestine wall and suck the blood of the unfortunate host. Eggs would then be expelled in the faeces to start the infection process all over again. People who were badly infected could lose so much blood that they became anaemic and could be very susceptible to easily catching or coming down with other diseases.

To break the infection cycle, we kiaps were told to enforce a “pigpen rule” and to also strongly encourage the use of pit latrines. This was a particularly difficult task in some villages who had, after all, never seen a hookworm or how these
worms could be caught from their pigs. Using a pit latrine in the villages, one might see some blood around or even some blood mixed with faeces and worms around the latrine and it didn’t take much to imagine there were plenty of worm eggs around in the vicinity. Usually the hole for each pit latrine would be covered with fresh clay or earth to hopefully prevent further infections but I often wondered if the worm eggs could be inhaled.

It was, after all, nothing too dramatic, you understand!