Australian doctor Barry Kirby runs Hands of Rescue, a not-for-profit medical service in Alotau, in the Milne Bay province on the south-eastern tip of Papua New Guinea. In January this year, GE’s PNG Country Leader, Peter Loko, donated a Vscan Dual Probe portable ultrasound to Dr Kirby. Six months later, he emailed in this story about how he’s using it.
Last Thursday I flew to Sehulea health centre through the only hole in the sky for months.
At midday there was a slight easing of the constant rain squalls that have plagued us—a small window of opportunity for me to jump in the Beaver and get a mother-to-be who was waiting for us.
I had seen Beatrice five days earlier at Sehulea health centre. Emergency nurse Kila Koupere and I had been doing obstetrics training and assisting in the antenatal clinic. On that visit we’d travelled by boat, circumnavigating Normanby Island, dropping into seven health centres, delivering 100 mother-and-baby gifts, training and assisting staff, and doing ward rounds at each centre.
Beatrice is 39 years old and was 32 weeks pregnant and her baby was lying transverse (sleeping sideways) when I examined her that day with my Vscan—the state-of-the-art handheld ultrasound provided by GE. It clearly showed that Beatrice had a placenta praevia major.
In this deadly condition, the placenta covers the cervix, and as the uterus grows near term and stretches, the placenta detaches from the uterine wall and begins to bleed. Bleeding may be minimal at first, but can become catastrophic. Mother and baby can die unless a caesarean section is performed.
I hadn’t been able to take Beatrice back to Alotau on our boat as seas were rough. Instead I’d promised to return in the Beaver in two days. But the weather had prevented me from flying.
On Thursday, with low cloud but no rain falling, I took off from Gurney airstrip. After takeoff and wheels up, the control panel showed four blue lights, indicating the wheels were now retracted inside the floats. The flaps also retracted and I gently reduced the manifold pressure and brought back the revs—the usual sequence for getting airborne in a Beaver amphibian. I climbed to 1,400 metres to get over the misty clouds ahead.
As I approached Sehulea airstrip and levelled off at 300 metres, I proceeded with checks for a runway landing. Landing on ground, rather than on water, when ‘gear down’ is selected the four blue lights should become four green lights. But when I switched to ‘gear down’ only three green lights showed on the instrument panel.
The landing gear had engaged, except for the rear port side. I glanced in the wing mirrors, which confirmed my nightmare situation, that the rear wheel on the pilot’s side was still retracted inside the float.
I considered aborting the mission and returning to Alotau to do a water landing, but thinking of Beatrice and her deadly condition, I instead engaged the manual hydraulic override and pumped the system. The wheels came down and locked into place. I now had four green lights. After successfully landing on the grassy strip I was told that Beatrice was on her way to the health centre. She’d heard the Beaver fly over her coastal village and had started walking.
After greetings and hugs, Sister Dorcas John, the nurse in charge, asked whether I could also review a five-year-old boy with a fractured left forearm. He appeared with his arm in a nice sling. He was excited at the prospect of riding in the ‘mighty Beaver’—it was even worth breaking an arm for.
When Beatrice arrived, I examined her and found her baby was now head down, hard against the placenta and clearly not happy that the placenta was preventing it from nestling deep into the mother’s pelvis. I checked the position of the placenta with my Vscan and was convinced it was covering the opening to the cervix. Beatrice could start bleeding at any time.
Conscious of the closing weather I urged that we must get going. We were making our way out when Sister Dorcas hesitantly asked if I could review just one more patient. We walked to the room they call the general ward.
Lying on the floor beside his father was a 10-year-old boy with a grossly swollen, smelly right thigh with a discharging wound sinus. He was wasted and pale. Memories from a time I’d rather forget flooded back to me. I told Sister Dorcas, “I have to take him out now.”
Seventeen years earlier as a 50-year-old intern I was visiting Mapamoya health centre on a health patrol boat, not far from Sehulea as the crow flies. The sister in charge at Mapamoya asked me to see a boy she had been treating for a few weeks without success. “He has a boil on his right thigh, but doctor I’m sorry he smells rather offensive,” she said.
As I approached the derelict building which served as an inpatient ward my senses picked up the odour of infected flesh. At the end of a long, dark, empty ward was a small boy lying on a wooden bed.
He had a discharging wound sinus which could have been a boil draining, but the smell suggested something else. I incised and drained the wound under light anaesthesia, hoping to release the trapped infection from his thigh muscle, but quickly realised this was not a deep skin infection. It looked like a fungating growth of abnormal tissue. He had a Ewing’s Sarcoma arising from the femur, a fairly common condition in PNG.
I told the father we should immediately take the boy to Alotau with us. The father said he would go home and get some things and return, which would have taken a whole day. I told him we couldn’t wait and that he would have to get another boat into Alotau. A month later, when the boy and his father turned up at Alotau hospital, it was too late. The child went into theatre for amputation of his right leg, but died under anaesthesia.
Seventeen years later, it seemed to me that here was the same little boy. This time it would be different.
They hurriedly placed him on a stretcher in preparation for boarding. With Beatrice and her precious baby sitting in the co-pilot seat, the boy with fracture sitting in the back with one of the fathers, and my anaemic little friend who was unable to walk lying on the floor behind me, we closed doors and fired up.
The plane’s engine came to life with a reassuring rumble and we lifted off in half the length of the strip. Gear up and we had four blue lights. We climbed out through a gap in the range underneath a low bank of angry cloud and headed towards Alotau, 40 minutes away. There was no chance of turning back as our track in the sky seemed to be swallowed up by the advancing weather.
As we approached Gurney (Alotau), it was hard to see the airstrip even from two kilometres away. Everything was white out. I commenced landing procedures. Selecting ‘Gear down’, I waited for the four blue lights to turn green. Again only three of four sets of landing gear locked into place. I selected manual override and was able to pump it down and lock it in. We landed safely.
Yesterday I visited my patients at the hospital. My boy with a fracture is all smiles in his new cast of plaster and will remember his flight in a Dehavilland Beaver for the rest of his life.
X-ray confirmed that my little boy with the smelly big leg has a Ewing’s Sarcoma. He will have his leg amputated in order to save his life.
Beatrice—in a satisfying end to this story—was confirmed by the hospital’s larger ultrasound as suffering from placenta praevia major. She has blood matched and is ready for caesarian section. Her baby has received steroid to mature its lungs in preparation for an early delivery, before bleeding starts—probably in a week’s time.
Thank heaven for Sister Dorcas, and thank heaven for Vscan. It helped save Beatrice’s life and that of her baby. It’s so reassuring to have it with me to identify those mothers at high risk in remote health centres, knowing that the Vscan is as good, if not better, than the larger machines used in our provincial hospitals. Thank you, Peter and GE.
Peter Loko, country leader for GE in his homeland of Papua New Guinea since 2014, passed away on July 12 after an illness. His death was widely mourned, with colleagues and friends describing him as a “great man of PNG”.
Geoff Culbert, CEO and president of GE in the region, attended Peter Loko’s funeral in PNG last week. “It was scheduled to go for an hour, but went for three hours … full of family, friends and colleagues from across all the areas of Peter’s life,” said Culbert. “I knew Peter was held in high regard by the PNG community, but I probably underestimated how much—there was genuine reverence for what Peter had achieved and what he stood for.” Matt Tucker, CEO and president of GE Healthcare for Australia, New Zealand and Papua New Guinea said: “Peter was on a mission with us in improving lives in moments that matter within PNG.”
Vale, Peter Loko.