by John Algate
Next week we are opening a clinic across the Dagi Valley. They are putting on a big feast. They wanted to know if we couldn’t get the helicopter would I walk over. It would probably take me 12 hours. I think my old bones wouldn’t walk that far now so have to hope the helicopter is around this area. (March 1987)
The church has chosen three new trainees to start next week. Pray that I might have a good rapport with them and that I will have the patience to teach them over and over the same things. (January 1989)
But there were also many moments of triumph when clinic workers successfully put their training into practice.
For part of the time when I was away Elinor had the Johnson’s triplets stay with her. The day after I left Korupun they were all practicing doing their cartwheels on the lawn outside Elinor’s house, when Karen fell and broke her leg. After one horrified look at their sister the girls rushed inside to inform Elinor who thought they were pulling her leg! Within minutes the head clinic worker, Sabil, and one of the pastors were busily reducing the fracture and putting on a splint. It was too late in the day to call for a plane so they had to wait till the next morning. She was taken to one of the mission hospitals for an X-ray. They found that Sabil had done such a good job that it didn’t have to be touched, and they just put on a plaster. When they told Sabil that he had done such a good job he wore a big grin for the rest of the day. (September 1990)
A lab technician recently came to Korupun for two weeks to give a crash course (to Amop and Abogen, two of the clinic workers) on how to use a microscope. They are doing well. I did wonder how the people would react when they were asked to bring specimens. After the initial shock at such a strange idea it worked well. The other day nine little six-year-olds appeared at the clinic door amidst much giggling they all held up their little offering tied up in a green leaf. We have found that two thirds of the population have amoeba. We were also horrified to find that all the drinking places are contaminated. (October 1991)
Drugs and equipment were always in short supply, so Jessie was nothing if not resourceful, bringing a touch of Australia to the mountains to ensure supplies of eucalyptus were always on hand.
The people in Sela are very anxious to dig out the airstrip from under the mud. But they needed some direction to make it straight. Last week Mike Akenbach and I went over in the helicopter for him to stake out the strip whilst I went around to visit some of the new clinics that have been built. It was good to see the workers in their own situations. I gave each of them a gum tree to plant near the clinic and later on they can use the leaves for inhalation. I wasn’t able to visit them all as the weather deteriorated and we had to quickly come home. (October 1991)
Kabeyabe who is one of the clinic workers came with great apologies. He told me that two weeks previously he had been called to a village to treat someone who was ill. He had to cross a river. There had been heavy rain the night before and the river was swollen. He tried to cross it but got swept away in the torrent. He cried out to the Lord to help him. He then started to drift towards the branch of a tree that was overhanging the river. He was able to grasp it and eventually dragged himself out. He lost his net bag with all his precious possessions, needles and syringes in it, but was still alive. (March 1994)
Pray for the 10 new clinic trainees whom I have started to teach. They are from a wide area and some have a slightly different dialect. They all understand each other, but I often have to get them to explain different terms they use which are unfamiliar to me. They are all keen to learn. Some have had to be taught how to open a door which has a door knob, turn on a tap AND turn it off again. Everything is new and strange to them including the concepts I am trying to teach them and why they are so important. Their eyes nearly stood out like stalks when I explained about the habits of flies and the life cycle of the round worms in relation to their hygiene. We have lots of laughs. So many different personalities it is interesting to see their reactions. (March 2000)
I arrived back in Korupun to a great welcome as if I had been gone a year instead of three months. The clinic trainees had all walked back from their villages and were ready to settle down and study. I think they were made aware of the things they didn’t know when they had the responsibility in their own village. This week they have been trying to take blood pressures. I am glad my life doesn’t depend on their results at the moment. Then we go into suturing and giving injections, a big challenge for them to absorb and practice. (September 2000)
Jessie’s efforts paid enormous dividends in health and wellbeing in the villages. Sue Trenier, who shared and witnessed so much of Jessie’s nursing ministry, has reflected on the lasting value of her training:
‘To accompany Jessie down to the clinic where she taught many local Kimyals to become village medical workers and village midwives was a treat. Her teaching and training was totally practical and many times I saw her make huge pitchers of Oxo soup (from packages her supporters sent on an amazingly regular basis) and had the workers take those pitchers to each village to give to those with diarrhoea. The medical workers to this day in that area know how to treat, cure and prevent severe hydration and are often teachers to the formally trained government medical workers who come to work in the area now who think every person with diarrhoea needs dehydration intravenously, which of course is often not appropriate or possible in the village setting. In more recent years since Jess has left Papua, when I have visited the Sela Valley or Korupun, the medical workers will always have their new stories about how, when they have met a difficult case and didn’t know what to do - maybe delivering a baby not going well, maybe a broken bone or whatever - and they tell that they have prayed, suddenly something comes back to their memories of what Jessie taught them to do in that particular case. They have tried it and things have worked out and a life saved!!’
15. Village midwives
When I first went to Korupun I really wanted to train girls to be midwives and to be part of the clinic.
All the men said ‘no, no, no, the women are too stupid and they can’t be trained.’ The men wanted the jobs and they didn’t want the women interfering, so I had to let it go. I knew that if I trained the women they wouldn’t be accepted; I had to wait until the men would accept it.
Jessie’s patience was often tested by the realities of local customs but rarely was the frustration more testing than the matter of midwifery. In this male dominated culture local women were excluded from such learning and using the very skills that Jessie used on a daily basis to ease pain and suffering. While she saved the lives of many women and their babies, both at birth and in the critical days and weeks following – not all births ended well.
The other night I woke up at 2 am with a start to hear someone banging on the door. When I opened up the door the man said that his wife had just delivered a baby but it wasn’t breathing properly. When I got there I discovered that it had been a breach birth and although I gave it mouth to mouth resuscitation and drugs it did not respond. It is very hard to try and cope in these little houses with the flickering light from the fire and a torch held by someone else to give light. If they had called earlier maybe I could have saved it. It was the first time they had called me during the night so it was sad that it did not respond. It is very hard to try and cope in these situations. We prayed together before I left. She was one of the few Christian women in the village so I left feeling very sad for her. (January 1982)
Sometimes I wonder if I have strayed into the pages of Gulliver’s Travels when a group of our pygmy people gather around and I am head and shoulders above them. It makes me feel a bit like a giant. It is no wonder that these little women have problems in childbirth. Many of them have lost their first baby and others have died in labour before the missionaries moved into the area. This past month I have had to send out two girls to the government hospital for caesarean operations to save their lives. (March 1985)
At the moment I am tube feeding a little baby who is only three pounds at three months.
The mother lives half-an-hour away so it is a problem to encourage her to come. So I am feeding the mother too, to increase her milk supply and also to encourage her to come back. (March 1987)
Infant mortality rates were inordinately high. For example, a 1994-95 study among the Dani put the death rate for children in the first year of life at 250 deaths per 1000 live births. Vaccination programs and other clinical support obviously made a difference, but how much more could be achieved if every remote village had their own trained midwife on hand to intervene the moment problems arose and to provide immediate care and advice to troubled mothers. In Korupun the long awaited breakthrough came unexpectedly and helped Jess overcome the male prejudice against educating and training women to be midwives.
I had suggested on several occasions that I start a midwifery course, but the men were not interested until some events happened that made them realise how important it was to train these women. Three days walk away in Gobogdua the pregnant wife of one of my clinic workers, Kabeyabe, went into labour. The baby’s hand was sticking out but the baby was not coming. As the labour progressed he realised that the baby was lying cross-ways (transverse lie) and he knew it couldn’t be born normally. He quickly sent a note with a runner over the trail to ask me for a helicopter to take her to hospital. They ran through the jungle day and night for one-and-a-half days to get me the message. Unfortunately the helicopter needed repairs, and it was not flying. I quickly made up some medication for her and sent off a runner over the trail, similar to the Pony Express, or relay runners. All we could do was pray. It was the wet season and it was impossible to bring her by trail.
When I did not hear any news for two days I was afraid she had died. I asked Sabil, my head clinic worker, if he would walk across to be with Kabeyabe if indeed she had died. He said he could get news more quickly than that, so he went up over the ridge and started the bush telegraph going. They shout a shorthand message across to the next valley, then they pass it on, and so on. Within a few hours the message was relayed to the far villages. Another day passed with no word, but then on the second day Kabeyabe himself arrived. He said that when he got the message he realised he should have let me know what had happened. I tentatively asked how his wife was, and he said she was just fine. I then said, ‘I guess the baby died.’ He said, ‘No, the baby is fine too.’ I was amazed as a hand presentation is usually a problem for both mother and baby.
He said, ‘When I heard the helicopter couldn’t come, I sat down and cried and cried, because I knew she was going to die. Then I thought, I shouldn’t be crying: I should be praying as God can help me.’ Whilst he was praying he remembered what I had taught him, but he was so scared and thought he couldn’t do that, so he started to cry again. Then he realised that God would help him. He prayed again. He turned the baby to a breech and delivered it, a little baby girl. At home his wife would have had a caesarean section, or have it turned under anaesthetic: certainly not in a bush hut with animals around her. He was so excited he threw his arms around me and hugged me. He said, ‘God heard my prayer, and helped me, and both my wife and the baby are alive. BUT,’ he said, ‘I realise now we need midwives to help our women. If she hadn’t been my wife I could not have helped her, for in our culture it is forbidden for a man to touch another man’s wife. We need women trained to help women. Would you start to train our women?’ His wife was one of the first people I trained as a midwife, and the last time she came in she told me she also saved a lady with a hand presentation. She said, ‘I knew how to do it as Kabeyabe did it to me, and God helped me too.’ The midwives used to come into Korupun every few months to talk over any problems that they might have and renew the medications that they used to treat their patients.
Jessie capitalised on the opportunity to train women as midwives despite the patience it required and the inevitable frustrations involved.
Have finally got my midwifery class going after a few problems. One trainee now has a new baby so that comes to class in a net bag. Three are from far-away places so they are really ‘green’ and we have to start at the grass roots with them. My lessons vary from arithmetic explaining what is a half and a quarter, to hygiene, reading scales and making out charts. I pray they won’t become discouraged and I will have patience and insight. (July 1993)
The four women who have started in my midwifery classes are coming along very slowly. Three are from outposts so everything is very new to them. They will also be running the village health program of weighing babies, checking for problems with the babies, teaching the mothers hygiene as well as being midwives. Two of the girls are smart and two very slow which makes it hard for me to teach them, but they are keen. (August 1993)
Around this time the need to train midwives was receiving some high level backing in Jakarta where President Suharto’s wife was reportedly promoting a scheme to install a fully-trained midwife in every village within three years. So Jess and her nursing colleagues - Carol from Lolat, and Sue from Soba - were summoned to a government seminar at the home of the Bupati (like a local mayor) in Wamena, a house Jess described as a lovely home with a beautiful garden.
Jessie felt the proposal was totally unrealistic because the lack of basic education meant the local women were ill-equipped for the demands of a formal three-year course. Nevertheless the project went ahead with Sue Trenier asked to supervise. Jessie was often seconded to assist.
I made a quick trip to Soba to meet with the coordinator of the new midwifery school that Sue Trenier is supervising there. I will be doing some practical teaching later in the year. My midwifery students arrived back one by one last week. The last one was a week late (It was a three-day walk). (March 1994)
I should have started my new midwifery classes this week but one of the women didn’t come. So I asked why, and they said two girls from the village wanted to come and were fighting about who was to come – so no-one came! There is still a long list of women who want to train so we will substitute someone else easily enough. (June 1994)
The long awaited day arrived when my midwifery students finally graduated. They cooked up a big feast for all of us, and then left to return to their villages. From all reports they are doing well. Do pray the Lord will give them wisdom for each case. The other day I heard that two of the girls were vying over who would help with the delivery. We have had to define some boundaries for them. Clean banana leaves and new grass spread on the floor is the usual delivery bed. (July 1994)
After our weekend in Wamena I went into Soba to help Sue with the teaching of the government sponsored midwifery school. The midwife who was supposed to help her went off and got married and never came back. A Dutch nurse (plus her dog) and myself went in to help with the teaching for a week. (February 1995)
My new pupil midwives are settling in. The government has given us some money to help feed some of the undernourished children. They are now running the ‘soup kitchen’ non-stop all morning, cooking up corn, soya beans, rice, peanuts, spinach etc. In between times we do some classes. (May 1995)
With so many medical and social emergencies to deal with, the students had ample opportunities to learn from very real and practical experiences.
Yokina was one of my trainee midwives and it is very hard to teach people who don’t have any books to help them understand things. One day I had just finished clinic and I was up in my house. Yokina rushed up to my house and banged on the door stating: ‘quickly, quickly Yetty. There is a lady who has just given birth. She tried to kill the baby by hitting it on the head with a stone and it is not breathing.’ I quickly grabbed my midwifery bag and ran down with Yokina to the area where the lady had given birth amongst the high grasses where she couldn’t be seen. But someone had noted where she had gone and had followed her to stop her from throwing the baby away. I quickly unzipped my bag and took out a baby suction device to suck the mucous out of the baby’s throat and then did mouth to mouth resuscitation and it finally cried. One of the Christian ladies in the village said that she wou
ld take the baby and look after it. This is most unusual as they would not normally give their breast milk to someone else’s child but because she was a Christian she wanted to save this baby.
The following week I had the midwives come in for their regular monthly debriefing. Yokina came to me very excited because she had been called in the middle of the night to deliver a baby up the mountain. After a long labour the baby was delivered but was not breathing. ‘Because I saw what you did to the other baby the other week I did the same thing to this baby and it started to cry,’ she said. In their training I had used a doll to teach them this procedure but obviously it had not sunk in because it wasn’t a living baby. (Later reflections)
We had all the clinic workers and midwives in for their bi-monthly conference. I had promised to teach them how to put down a gastric tube. After explaining how to do it, we made them practice on each other. This caused a lot of laughter and tears as they found that it wasn’t as easy to swallow a tube as it looked. Some were quite hilarious in their actions and comments. I hope they all learned and understood what it was all about and will be able to do it safely to save lives. Then there was the usual scramble to get all their medicines together, listen to all their problems and hear how the Lord had helped them. (August 1995)
We were thrilled to hear that all the trainee midwives passed their final exams. They are part of the government program to put midwives into all villages. Next week the parents of the two midwives from here, plus myself, will be going to Soba to join in the festivities and graduations. They will then go out from Jayapura for a month for practical work before coming home to start work here. They are both only 19 years old. A big responsibility for them. (September 1996)