Everyone has something to say about Coronavirus..!
I often think about unfollowing the ones that are too vocal about Coronavirus. It’s all I see on my feeds… and it gets old. Everyone seems to have a strong opinion about it and people that disagree with them “are wrong”. Some people are strongly for the vaccine, others strongly against the vaccine, and I’m certain they all have their reasons, which I won’t debate here.
I will write about Coronavirus, but not to express my opinions or convince you of anything. I’ll share in case you’re interested to read about what has dominated my world for the last 4 months and the reality we are facing in some of the remotest parts of the world today.
COVID19 hit PNG in 2020. At the time, many didn’t believe that Coronavirus was real or that it’d have a negative impact on Papua New Guineans. Most had a strong faith that the virus would by-pass PNG. There was just enough information to slow down all official business, including customs, travel, health care and government processes. But in the villages, it was as if nothing had changed. This “Niupela Pasin” or “New way of life” that had been mandated by the government had been heard of (social distance, mask and hand hygiene) but not applied.
COVID19 disrupted health services in a big way. The already meagre immunisation coverage for childhood immunisation has plummeted. The national vaccination coverage now stands around 35% for measles and pentavalent. With such low immunisation coverage, children are likely to die from an outbreak of vaccine preventable diseases like whooping cough.
I took a team of nurses out on a routine childhood immunisation patrol to help boost this coverage and help prevent diseases and deaths. In some remote areas, people ran away from our team. They had heard rumours and needed to receive health awareness, voice their fears, be heard, ask their questions and hear our answers. Once that was done, people would readily bring their children to receive childhood immunisations.
We experienced that despite not carrying the COVID vaccines initially, people were still afraid. The fear came not from the services that were offered, but by the fact that we were health workers in the midst of the pandemic. This fear was not exclusively towards foreigners, but towards the local health workers as well. As we asked questions and took time to hear from the communities we found that there was a lot of misunderstanding, rumours, lack of awareness and a deep thirst for accurate information. Once people heard facts about Coronavirus and the vaccine, once they understood that nobody would be forced to be immunised, that we would never immunise their children against COVID19, they felt at peace. They no longer feared our face masks and they agreed to wash their hands prior to coming in for clinic.
Our days would always start with a lengthy awareness session, we’d discuss Coronavirus, then the vaccine and ask for their questions, listen to them, offer explanations, dispel many myths and finally we’d finish with what we could offer those days: routine immunisation for children. By then, those would be well received.
Every country has their own myths about the vaccine I’m sure, so here are just a few that we came across and would answer on a regular basis… If you wonder how I’d answer one of these questions, feel free to reach out ;)
- The vaccine is a microchip
- The vaccine is connected to 5G
- It’s an experiment, PNG is trialling it for safety before it gets administer in the rest of the world
- It’s the mark of the beast “666” from Revelation 13:16-19
- The vaccine will cause you to die after 2 years of receiving it
- If you refuse the vaccine, the Roman soldiers will come and kill you
- The vaccine will make you infertile or to only give birth to girls
- It’s the New World Order, the government will track you
- Once you receive the vaccine, a coin will stick to your arm, a light bulb will glow if it touches you
- If you accept the vaccine you will be able to fly for free and go to the shops and get everything you want
In the early weeks, we actually used the fact that we didn’t carry the vaccine to our advantage! Some places were so afraid, they would tell us, “please never bring this vaccine here”, or even “it’s good that you don’t have this vaccine”. To which I would answer “I wish that I could give you the vaccine, because it’s really good and helps saves lives, but I don’t have it, so you don’t need to worry, I only have vaccines for children.”
Halfway through our 16 week patrol, we went to a very different area! With close proximity to Australia and Indonesia, most inhabitants had heard of the benefits of the vaccine, were convinced that they wanted it and were simply waiting on availability of stock or a health care team to patrol their village and offer it to them. Actually the first village in that area, people ran to us for the vaccine.
There was a lot of hesitancy in the health care field to combine the childhood immunisations program with the COVID vaccine activities, saying that one would hurt the delivery of the other. To us it looked like such a waste of money, time, and resources not to do both at the same time, as one group of people would have had to miss out otherwise. How do you say no to either? How do you choose between saving lives of children from vaccine preventable diseases or saving adults from Coronavirus, when both were not necessarily impending outbreaks. We couldn’t.
We would set up two stations: one for adults and one for children. Use different colours of eskys/cold-chains and explain clearly where adults were to go to receive their COVID vaccine and where children were to be taken for their routine childhood immunisations. It worked so well that this became our new model. We also became quite proficient in answering questions! These awareness sessions became some of our favourite parts of the clinic days. Local health workers were usually quite timid and refused to answer questions at the beginning, but the more we worked alongside, the more they heard our presentations the more they grew in understanding and confidence. I was always a bit proud and very encouraged when our local health workers decided to take the plunge and deliver the health awareness message and answer the questions. There’s two particular instances that I’ll remember for a very long time. One was when we trekked into a small village on one of our last clinic days in a catchment and a local health worker that had been our with me multiple days turned to me with excitement in his eyes and asked for the flipchart with confidence and said “I want to share this information with my people, Ange, can I do the Tok Save today!?” Oh absolutely, please and thank you! He did really well! On another instance, we had an upskilling session with the local health workers and discussed the importance of truly understanding the message in order to accept it. The following day, a health worker started thinking out loud as we waited for the community to gather… “It’d be much better if they could understand the information in their own language directly rather than translating 2 or 3 times… Maybe I can do it?” Yes, please! I gave him our education flipchart when we left so he could continue to share this information.
Because this integration worked so well, I was convinced we should continue that way, and I even wondered if we should do more..? I met with one of the leaders for the COVID response in the province and suggested that we could take some tests with us and screen people for Coronavirus if he thought it’d be helpful to know what might be hiding in the remote area we were about to travel to. He was very enthusiastic at the idea and organised the right tests and personal protective equipment (PPE) to come with us.
For the first week in this new area, we’ve offered testing and to my surprise, people wanted to get tested. Not only they wanted to get tested, but it made COVID19 seem more tangible to them. These villagers that previously were afraid of us, now were asking for the Coronavirus vaccine! We had brought some, in hope that perhaps every now and again we’d get a handful of keen people. But we were massively surprised by how many people wanted the vaccine. We ran out! We ran out twice! A plane was flying over the area and dropped us all they could spare yet, it still wasn’t enough. Where fear used to paralyse communities, we were able to bring light and accurate information to enable people to make their own decision free of fear or guilt. Bringing hope and life.
A week into our new routine of awareness, vaccines for everyone and testing for COVID19, we came across our first positive patient. The man had travelled to Indonesia for business. Indonesia is currently experiencing a massive outbreak of Coronavirus of the Delta variant. The man was in Indonesia for 2 months, got sick there and waited until he felt better to return to his village. We visited shortly after he returned. His test had the slightest positive line, a repeat test was negative. Still we tested all his close contact and his travel buddy all of whom tested negative. The man was advised to stay home for 14 days. This was the first person we had come across with a positive result. This test became our conversation over dinner with the local officer in charge (OIC) of the health centre. A man from a different village came that day experiencing signs and symptoms of malaria, but when tested, he was negative for malaria. Our finding that day led the OIC to believe that we should test the man in the ward for COVID19. When tested, his test quickly became positive, an indicator of a high viral load. After asking a few questions, it was discovered that a family had recently returned to his village with a dead body from the big city. After the dead body was brought back to the community, many people started feeling sick with fever and cough like this man. The patient’s son advised that 20-30 people in their community would most likely have the same sickness.
Instead of continuing patrol as usual, we went to the market place and conducted our typical health awareness session and informed the community to come for vaccine and testing if they felt sick. By the end of the day, we had 7 confirmed cases around the station and were sitting on an imminent outbreak with an additional suspected 20-30 cases in a community across the lake. During that day and the next, we made a plan and sent for help. We reported the situation and made a strong plea for help, for more PPE (masks, gloves, gowns, face shields), test kits and vaccines to be sent. Communications between the provincial health authority, us and the department of foreign affairs made it all happen. A chopper was sent for us. It felt like Christmas! We received boxes of PPE and >900 doses of vaccines.
Some of our local friends had never put on full PPE before. We spent some time that morning going over infection prevention and control and donning and doffing of PPE. We would be set to respond to the communities’ cry for help. Before long, our running total was over 30 positive cases. We also learnt a bit more about the spread of the disease through contact tracing. One of the positive patient had attended a men’s gathering the previous weekend. He informed us that 200 were in attendance from villages around the lake. Every man that we came across who attended the gathering tested positive. This did not look good for the communities around the lake. We had bought a lot of the remaining supplies of bleach and soap on the lake, but wanted to leave some for villagers to be able to purchase some. therefore, we asked for more sanitation items to be sent up to us, along with additional staff to be able to respond appropriately by not only focusing on testing and giving home quarantine advise but also preempting the spread by offering more vaccine in the villages not yet reached by the outbreak.
Home quarantine is really hard. It’s hard to be at home and order groceries online, be depraved of the freedom to wander the aisles and pick your food, not be allowed to go for a walk or run. It gets depressing to be inside for two weeks, but it’s manageable. There’s electricity, running water and our homes are generally comfortable. Home quarantine in PNG is very different. It doesn’t matter what guidelines are written from a capital city, in the remote village, it is extremely hard to apply it. Try telling a man that nobody in his household can leave: they cannot go to the garden to fetch food, they cannot go to the market, they cannot go to the village’s water tank, or to fetch fire food. That they would need to depend on someone else who’s also a subsistance farmer working really hard to survive. Our local health workers were devastated and didn’t want to tell families that they had to quarantine, but they understood that it’d be a disaster waiting to happen if they didn’t. After a prayer for divine wisdom and a good brainstorming session, the idea of quarantining in the bush/camping place was brought forward. Every family has a patch of land for gardening or Sago harvesting, and usually those have a makeshift hut a family can live in. There’s usually ample food in the garden and water nearby. This was a good solution!
We came across our first case of COVID19 in week 13 of our patrol. It’d be fair to say we weren’t as fresh as week 1, but also very grateful for the ground experience gathered over the last months. Unfortunately we could not stay forever, and had to handover the COVID response to continue with our mission. By the time we left, there had been 73 cases diagnosed, 4 suspected COVID related deaths, and over 1200 doses of the vaccine administered, and still so much contact tracing to happen and communities to visit. What had seemed like a well rehearsed explanation, a question and answer ritual over the previous weeks had become what we hope we’d never have to see in a remote place. It was week 16 when we returned to the ship.
Week 14 a plane was sent from the district and provincial headquarters with additional supplies and 3 health workers to join us in the response. I remember standing on the side of the airstrip and hearing the plane approach. That sound was more than an airplane, it was an answer to prayers, it was support, it was light being shined in a dark place, it was hope, it was life.