Steve Salfield

Having completed our contracts with the Health Department of Papua New Guinea late in 1973 I and my wife decided to explore a remote area of the country where few outsiders had ever been. I had worked in the country for eighteen months and had heard about the area around Telefomin and seen photographs of men wearing “Telefomin trousers” as the traditional penis gourds were fondly known by expats and others. I had met a few of the people in the hospital as my patients. My wife had been to the outstation during her nutrition survey of the East Sepik District and what she described fascinated me. Living here we knew the places to go and how to arrange to visit.
We knew that the country was entering a phase of rapid change and we had a unique opportunity to visit people from a stoneage society and places virtually untouched by modernity. I felt then that modern lifestyles were in many ways retrograde and wanted to understand more of the traditional way of life lived by the people I was meeting.
My brother, his girlfriend and two friends flew in from Australia to join us.
“The weather’s fine so we should reach Oksapmin in about 40 minutes” shouted our Ozzie pilot over the roaring of the Cessna’s twin engines. “The air’s pretty thin up there but I think I can get enough altitude to drop us into Oksapmin. On the way back though, I’ll have to collect you in two loads ‘cos we won’t be able to climb out of the valley with six of you on board.” As we climbed from Wewak, the small administration town on the north coast of Papua New Guinea we saw to our right Boram Hospital our home for the last year, our garden touching the turquoise blue South Pacific and to our left rose the densely forested mountains of the Sepik District.
Forty minutes later we saw far below two or three of the familiar Australian built administration buildings and a small airstrip and nearby a traditional thatched village. We were above a steep sided valley high in the mountains and after descending into the valley we held our breath as the pilot circled round and round the valley descending all the time, the wingtips almost touching the valley sides until we landed on the bumpy grass strip.
We were surrounded by twenty or thirty small smiling people. Most were in everyday traditional dress, penis gourds and a few leaves covering the backside for the men and mudstained old grass skirts for the women. A few men were dressed in torn dirty shorts and teeshirts. They had pierced ears with the lower part of the ear dangling where it had been stretched by heavy ornaments, the redundant earlobe often hooked over the top of the ear. Some had pierced noses, the hole often sporting an insect’s proboscis as decoration or used as storage for a partly smoked leaf cigarette.
“Kiap i no stap. Em i go long liv. Mi wok wantaim Kiap, Mi inap helpim yupela.”
“The Kiap (Austalian patrol officer) isn’t here. He’s gone on leave. I work with the kiap. I can help you” said a smiling small man with a cigarette in the end of his nose. This was Bobbin who became our guide.
We explained that we wanted to go on a patrol into the bush and would need some carriers. He eagerly offered to arrange that for us and told us that there would be a singsing in Okspamin that afternoon.
We had seen twenty or thirty singsings in our eighteen months in Papua New Guinea but this was the most spectacular of all. As we waited near the airstrip in the warm afternoon sun we saw a line of a hundred or more people moving along a track from the forest on the nearby hillside, approaching the valley where we stood. As they neared we heard singing. The men yodelling and whooping, the women singing in high pitched voices and sometimes screaming and wawwawing with their hands on and off their mouths.
When they arrived we saw the most wonderful display of traditional dress. The men wore penis gourds, long pointed gourds strapped around their waists and exaggerating their phalluses, their testicles dangling below. Around their waists were several cane hoops like a belt. They carried bows and arrows and spears and as they ran and danced they beat an adrenaline pumping rhythm on the lizard skins of wooden hand drums. Their bodies and faces were painted red or black and their heads were adorned with complex headgears made of birds of paradise, other feathers, vegetation and possum furs. Some men had impressive dreadlocks although they could not know of rastafarianism. Many wore shell necklaces although they had never seen the sea. Some had large pigs tusks through their nose piercings.
The women wore fine grass skirts, clean and new and with an upper and lower layer. Their faces were painted and their bodies decorated but with less finery than the men. As they ran and danced to the infectious drumming, the young girls’ firm bare breasts bobbed up and down to the rhythm with a life of their own, whilst the older women’s sagging empty “razorstrops”, well used by numerous hungry suckling babies and precious piglets, drooped listlessly.
We studied sketch maps in the Kiap’s office and planned a circular route which we estimated would bring us back to Oksapmin ten days later. The following morning we left Oksapmin with our team of six carriers. Drupe, Gris, Peter and Iyup were young men and wore teeshirts and shorts. Bobbin and another were older and were dressed traditionally. We felt rather embarrassed as the carriers were about half our size but made light work of carrying our rucksacks whereas the combined effects of the heat, altitude and unfitness would have soon exhausted us. Initially we were walking along a muddy track which was being made into a vehicle road. We met some road workers, a group of women in grass skirts working with shovels in the mud, their small naked brown skinned children with ginger brown hair looking curiously at us and some bearded men in penis gourds. The women and some men carried the ubiquitous “bilums” (string bags) slung over their heads. These were used to carry everything from a few sweet potatoes for lunch to babies or massive loads of firewood. We spent a night at the mission station at Tekin with Dorothy Harris, an Australian and we passed nearby Aranimap village.
Our route involved climbing over Bimin mountain. We were carrying a small amount of food but hoped to buy most of our supplies from villagers on the route. Half way up the mountain I started to feel shaky and weak. I knew I needed some food but the party was reluctant to stop for lunch so early as we had only walked for two or three hours. I had to stop and was allowed a small piece of sweet potato. Our carriers were anxious, thinking we had finished walking for the day and knowing there was still a long distance to the next village where we planned to stay the night.
We ascended the steep muddy track, clinging onto tree roots as we went. At the summit we were in a cloud forest. The air was cold and damp and visibility was a few yards. The eerie trees with gnarled branches were covered in thick moss and lichens.
We descended the other side of the mountain and arrived at Bimin the village where we had planned our next stop. There were a few tiny wooden huts with thatch rooves. We were shown to a larger hut on stilts made from tree branches with one large room containing a rough wooden bed on tall legs. An anthropologist had lived here for two or three years but the hut was now unoccupied. It was used by the patrol officer when he did his occasional patrols of the district and so was known as the haus kiap. As we were tired, not yet having built up our fitness we decided to have a rest the next day and spend two nights in this house.
In preparation for the night, one of the first tasks was to inflate our airbeds using the footpump we had brought. We hadn’t anticipated the interest and amazement this caused. We were surrounded by a fascinated audience. People had never seen anything like this before and must have thought it was some kind of magic.
Next morning, lying in the sun I decided to read a Time magazine I had brought with me. I was surrounded by incredulous people who were seeing photographs and print for the first time in their lives. I was uncomfortably aware that our mere presence was a catalyst for change in the society which I would have preferred not to happen. But if the people chose to modernise was it perhaps wrong to want to keep them in a museum?
We were alarmed to learn that none of our carriers had ever ventured further than Bimin along the route. They did not know the way and were frightened to proceed as they would be in enemy territory. Luckily we met Memkenya, a Bimin man, who was prepared to guide us from Bimin via various other villages and eventually back to Oksapmin so our carriers agreed to continue. Memkenya was an older man with very thin legs and an emaciated body but he was strong and able to carry one of our rucksacks with ease. He wore a khaki peaked cap on his head, a skirt of large black feathers covered his backside and he was otherwise naked apart from a penis gourd and some cane hoops around his waist. Memkenya proudly explained that the cap showed that he had been a luluai or government representative before the arrival of the kiap in Oksapmin.
We continued walking through beautiful rainforest and sometimes open country on this high plateau on a narrow track from Bimin to the small village of Kunana and the following day we saw a magnificent gorge between Kunana and Duban. We crossed raging rapids scrabbling on dangerous bridges made of slippery fallen treetrunks. We traversed sheer mountain sides on tiny paths with vertical drops and waded through many muddy streams.
The population density was low and we walked for hours without meeting people. The villages were generally a day’s walk apart providing plenty of space between traditional enemies and enough land for hunting, gathering and growing food. In the villages we were welcomed by people wanting to sell us vegetables and showing us to the “haus kiap” to sleep for the night. Memkenya knew the route which was fortunate because at times there was no path to be seen and at other times a choice of several uncharted tracks. We stayed overnight at villages called Kweptana and Gowgitamin.
This was one of the most remote places in the world and at times it was hard to believe that we English suburban kids were really here and hiking through such beauty and in such an alien culture. At times our carriers would run ahead and out of sight in the dense vegetation. We had no chance of keeping up. The weather was hot and the going arduous. Would we ever see them and our rucksacs again? Would we be lost in the jungle with no one to guide us? Would we die up here? But then we would round a bend and find them sitting on a fallen tree waiting for us smiling and calling.
We westerners had to stop for our three meals a day but these wiry little people seemed to need little food even though they were carrying our rucksacks. In the evening they would have a small meal of sweet potato but little or nothing else all day. We discussed how they could manage with such a small food intake. There was a theory then current about possible nitrogen fixing bacteria in their guts which might enable amino acids to be synthesised in the gut and thus reduce dietary protein requirement. Another theory suggested that natural selection had resulted in the survival of individuals with a genetic makeup which allowed them to need little nourishment. The genes resulting in people with higher nutritional needs would have died out.
One afternoon after arriving at Kunana, our destination for the day we met an impressive man. Handsome and taller than average at around five feet, he was muscular, proud and charismatic. He was a fight leader and a village big man. He wore a possum on his head with a long white feather attached and a red headband with a pigtusk in the middle. He had an impressive insect proboscis pointing forward in his nose piercing and a fine dogtooth necklace . Of course he wore his penis gourd. We sat with him and from a pouch he wore around his neck he took out a mouth harp like a jew’s harp made of wood and began to play. You had to sit close to him to hear his tune as the volume was quiet.The music was rhythmic and melodic with a repetitive riff followed by improvised embellishments. This was modern jazz played by a stoneage fight leader who had never left his homelands or heard a radio. It was a moving experience to hear such wonderful music in such a remote place.
These people spoke their tribal language, one of the seven hundred or so in Papua New Guinea. Only a few of them spoke Pidgin English and none we met spoke English. I tried to learn a few words. I learned the words for “the man goes to the garden” and then learned the word for “dog.” I then tried to say “the dog goes to the garden” by substituting the word for dog in the sentence in place of the word for man. This caused hoots of hilarity. What I had said was complete nonsense as the word for “to go” and the word for “garden” differ in the case of a man being the subject or an animal being the subject in the sentence.
When my nutritionist wife asked whether a certain type of leaf could be eaten, the women laughed uproariously. This was akin to aliens from outer space asking us if toilet paper could be eaten.
From Kunana we walked to Dunan with magnificent views across the Bok gorge. We had completely stunning views of the Strickland gorge.
On the way we met a very thin old man standing outside his hut and clutching his belly looking very sorry for himself. I found a large lump in his abdomen and other than giving him a few painkillers there was nothing I could do and there was no health care facility within many days walk. I suggested he should be taken to Oksapmin and then flown to Wewak hospital but this seemed an impossible undertaking given terrain and the fear of leaving their territory that these people had.
On the fourth day of our walk we stopped in a small one roomed haus kiap for the night. We were taken to a small singsing held to ward off evil spirits following a funeral. Before going out we had fixed a tarpaulin to the underside of the leaky roof as it had already started raining. Returning from the sing sing in heavy rain we lay in bed listening to the water dripping through the roof. Half an hour later an almighty scream roused us as we dozed off. The tarpaulin had collapsed under the weight of a large puddle of rain water it had collected, soaking my brother and his girlfriend. The rest of us were unable to contain ourselves and giggled hysterically.
On our final day our carriers took us to their home village and told us they would cook us a celebration meal, a mumu. Taro and pandanus nuts were prepared and wrapped in banana leaves. They built a large fire on which they heated a pile of stones until they were white hot. The stones were then lifted between two sticks and put into a hole in the ground and the food wrapped in banana leaves was put on top of the stones. The hole was then covered with soil and the food left for several hours to cook. When cooked the taro was kneaded into a base rather like a pizza base and then covered in the bright red pandanus sauce. The process took several hours and we were ravenous when the enormous delicious looking pizza like dish was ready. But we had to conceal our disappointment when we tasted the meal and found it was almost completely tasteless.
Eventually we walked into Oksapmin and flew back to Wewak three by three. I loved what I had seen and didn’t want it to change. I knew this was hopelessly simplistic and paternalistic. They had land, space and community and strong traditions, no deadlines and no bureaucracy. But they had no health care or education, no running water and no conveniences or comforts and they had fear of evil spirits and danger from their enemies. Given the choice these people would probably opt for the safer and more comfortable lifestyle which I enjoyed.
In my Wewak garden that evening I, my brother Phil and our friend Rick danced in penis gourds and brandished spears.
I shouted my warcry,
“Keep out twentieth century. Leave these people to their lives.”

In 1970 a medical degree was a passport. A key to many doors. Medicine was, scarily, scarcely regulated. A doctor’s freedom to practice as he or she saw fit was sacrosanct and it was assumed that would be in patients’ best interests. Medical negligence and medical litigation were terms rarely if ever heard. Bureaucracy although already invented was, in retrospect, in it’s infancy. The National Health Service had not been reorganised - not even once.
After passing finals I was required to spend a year in hospital practice as a junior houseman, nominally under supervision, and then was free to practice in whatever field or place would employ me. Doctors were in short supply so there was ample choice.
One evening at the end of my houseman year in Newcastle upon Tyne, standing next to me at the bar of the Medical Institute a genial elderly doctor sipped his malt whisky. He was a general practitioner as it transpired, with a practice just around the corner from my home. I overheard him saying to his drinking partner that he needed a holiday but couldn’t find a locum.
“I’ll do your locum for you” I said flippantly, and introduced myself.
“Fine, start on Monday morning” said Dr Black.
I was concerned for the doctor and his patients at his casual way of appointing staff so I asked him whether he would need some evidence that I was qualified and suitable for the job.
“Oh I suppose I should” he said, “what are the green and black tablets?”
“Librium” I said, naming the ubiquitous tranquilliser of the time.
“That’s all you need to know. The job’s yours” he laughed.
On Monday morning in a side street I found Dr Black’s neglected brass plate on a scruffy brown door next to a small sweet shop. I climbed the steep stairs to the surgery. You had to be fit to be a patient in this practice. In the large dingy waiting room twenty or thirty people sat and behind her desk was small, plump, white haired Mrs McTaggart the receptionist. She was a friendly, motherly woman and showed me into the small shabby consulting room which contained a large oak desk and chair and two hard backed upright chairs. There was no toilet, wash basin, or examination couch.
Pale green peeling paint swung towards me as my first patient entered through the squeaky door. I had a sensation of adventure into the unknown. This was to be my first clinical encounter outside the protected environment of the large Victorian hospital building with mile long corridors and Florence Nightingale wards, which had been my training ground. This felt very different from working in the hospital. I felt exposed. Would I be able to deal with the problem with no advice from a registrar or consultant? No nurses. No equipment. Just me and the patient and this room. I ventured outside to ask Mrs McTaggart for the patient’s records.
“Oh Dr Black doesn’t really bother with those” she said. “He knows all of his patients. But there is some correspondence in that cardboard box over there under the table”.
The people I met were friendly, respectful, sometimes deferential and unquestioning of my ability. I was the doctor after all so I had the answers. Most patients wanted repeat prescriptions - black and green tablets or more of the purple tonic that had no active ingredient but made them feel so much better. The little white lie, now obsolete, since full information, honesty and informed consent robbed the placebo of its effectiveness.
I thought I was learning general practice quite quickly. I took a brief history from each patient and made notes as I had been taught in medical school. I even tried to prod or peer at the problem part of the body without the benefit of an examination couch or getting the patient to undress. I suppose I was spending five to ten minutes with each patient. After a couple of hours I realised that the waiting room was still full and that some people had already been waiting for two hours. At morning coffee time Mrs McTaggart was looking a little anxious so I asked her how Dr Black could cope with such a large number of patients in a session.
“Well” she said “He comes into the waiting room in the morning and counts how many people are waiting. Say there are thirty, he says to them, “there’s thirty of you and I’m here for an hour so that makes two minutes each.”
I was beginning to suspect that this type of general practice was not the pinnacle of quality that I, still young and idealistic, aspired to. But I soon discovered that his patients adored Dr Black.
“He’s a wonderful, kind Doctor” they would say, “If he thinks there’s anything at all wrong with you he sends you straight to the hospital”.
This was the kind of GP we young hospital doctors, perhaps arrogantly, used to despair of. The type who wouldn’t take any responsibility and clogged up the hospital system with unnecessary “rubbish”. Yet here I was seeing it from the other side of the hospital doors and the patients loved and valued him.

“Locum GP for three months wanted for the small town of Towawa, Saskatchewan, Canada” said the ad in the BMJ.
“Good pay and all expenses paid”.
I sent off a letter of application and a few days later the phone went at six in the morning.
“It’s Bill Jiaomeng and I want you to come as soon as possible. I need a holiday.” said the voice in English with a strong French accent. It appeared that appointment procedures in Canada were no more rigorous than in Newcastle but that is where the similarities to my previous post ended.
A few days later as I flew across the Atlantic at someone else’s expense, well dressed and with a smart new briefcase, I felt, self importantly, that I must have something special to offer. I spent a night in Montreal which seemed a very suave modern city. Next day I caught the internal flight to Regina in Saskatchewan where Dr Bill Jiaomeng was waiting for me. He was an enormously fat Chinese man who had spent his early life in Mauritius and later moved to the UK. He and his young family now lived in the sticks in Canada. I later learned that he spent most afternoons on the phone to his stockbroker. He wined and dined me before we drove the two hundred miles of Saskatchewan prairie and parkland in his large Buick. Towawa was a small Canadian “town” with a population of five hundred and another fifteen hundred farming people living in the surrounding area. A village in reality, it had one street with a few stores and a few scattered wooden or fibro houses. The next day Bill handed over to me his house, his cars, his premises, the small hospital and then he was gone. Perhaps I had overstepped the mark this time. I had been qualified eighteen months and now I was in the back of beyond in charge of a hospital and the only doctor for two thousand people was me! The nearest other doctor was fifty miles away and if I wanted to send someone to hospital it was a two hundred mile drive or in an emergency a flight.
This was indeed a new experience for me. Next morning as I walked down the wooden sidewalk past the stores, the bar, sherrif’s office and the funeral parlour, to the doctor’s office I felt I was in a movie set for a western film.
“Hi Doc” said the cowboy as he got out of his truck at the hardware store.
After doing the ward round with matron in hotpants in the modern twelve bedded hospital, I spent a few hours seeing patients in the well equipped doctor’s office with an efficient appointment system, an examination room and a smart nurse receptionist.
That night, my first night on call in Canada was the night of the graduation ball at the local high school. At three in the morning I received a call to go to an automobile accident on the highway. Two kids were killed and two were injured, one with a fractured pelvis and multiple other injuries. I certified the dead and resuscitated the living before an ambulance took them the 200 miles to Regina hospital. I was in the deep end but fortunately that was the worst disaster I had to deal with in Canada. Finding that I was coping, I was gaining confidence and thoroughly enjoying being a proper family doctor in the old fashioned sense. I delivered a baby, set many fractures, sutured lacerations, did minor surgery and saw many people with general medical illnesses. I reduced a dislocated knee joint, a very rare injury and fitted intrauterine devices (which I had even been trained to do). I began to feel that I was a competent doctor. When I had my first patient with appendicitis I had to call Dr O’Leary from Greenfield, fifty miles away as two doctors were needed for major surgery.
“Do you want to do the operation or the anaesthetic?” he asked.
Never having done either before, this brought home to me how theoretical and lacking in practical experience my training had been. I opted for the anaesthetic. The operation was successful and what’s more the patient survived.
I heard about the GP in a nearby town who enjoyed appendicectomies and the accompanying fee. Anyone he saw with bellyache had their appendix taken out. When there were no more appendices in the area he moved into the next state and started the task of removing the population’s vestigial organs and filling his own coffers.
This was proving an epic teach yourself practical medicine experience for me with the local population as my learning material. As far as I know I did no harm and the patients and nurses seemed to like me. Even though I was inadequately prepared for what I was doing, I felt justified because I was the only doc in town. If I didn’t do it no one else could.
After the appendicectomy, I suggested a drink back at Jiameng’s.
“Yes. let’s drink Jiameng’s whisky” said Dr O’Leary, a garrulous Irishman who seemed good humoured enough. I hadn’t yet discovered that he was on the wagon and that I was about to start him on a binge of drunkenness which was to last for months. Over the next few weeks I received many calls from Dr O’Leary’s secretary asking me to cover his practice as “Dr O’Leary was “unwell” that afternoon”. I met him several times and discovered that his good nature was intermittent and that he also had black moods and a biting wit at times.
Once a week I drove in Jiaomeng’s Buick to the next little town to do a clinic. This really was the wild west. Farmers and cowboys and their families would drop in to see me with their complaints. These people were old fashioned and stoical and showed huge respect for the doc. I also had the privelege of visiting some people in their homes.
I and my twenty six year old wife were invited to homes for barbecues. We spent weekend afternoons at the lake, boating and swimming in hot summer weather. We spent one unforgettable evening at the home of an eccentric German veterinarian, Baron von Hagen, who clicked his heels and saluted when we met. He kept an index card system with details of everyone he met. His wife was away and after dinner he put on soft music and insisted on dancing cheek to cheek with my wife while I sipped schnapps and plotted how to escape from what I feared was an ex nazi war criminal.
I thought this was a grand life. My wife had the use of Jiaomeng’s second car, a convertible, Dodge. She was invited to play tennis and socialise with the local ladies - a mixed blessing for her. She learned of the high suicide rate of doctors’ wives in these small prairie towns, presumably related to boredom and social isolation. She soon talked me out of any ideas of this way of life in the longer term. She had her own career to develop and was not the type to be a professional “doctor’s wife”. She was writing a book and was happy to spend a summer working here but the Canadian winters were hard with snow and ice for six months. After three months in Towawa and a short stint working for Dr O’Leary we left Canada to tour the USA.
My appetite for novelty was stimulated and shortly afterwards I travelled to the other side of the world to Papua New Guinea.
The door to an even more exotic experience was opening.

It was seven o clock in the morning on the seventh day of the seventh month of ninenteen seventy one. In the cool early hours of the morning thousands of local village people had made the arduous climb through the forest to the summit of Mount Turu in the Sepik District of Papua New Guinea (PNG). At the summit were two concrete triangulation posts which years earlier had been placed there by an American geographical survey team. The villagers were all paid up members of the Peli Association, a cargo cult. They believed that at this auspicious time, they should remove the Americans’ concrete posts and the mountain would open and disgorge for the membership masses of cargo, a term for manufactured western goods, and money. Crops would flourish where they had recently failed, birds of paradise would return in plenty and the members would be rich.
The big man of the area, Mathias Yaliwan was the leader of the Peli Association. Yaliwan had been preaching for many years that Peli members would be rewarded on this date when the mountain would open and be full of cargo. To become a member entailed buying “shares bilong Jesus Christ”. The cult grew to huge proportions and eventually most people in the area joined. Even educated local people, though sceptical bought shares, not wanting to risk missing out. The disappointed members were not refunded their subscriptions and thousands of dollars were unaccounted for. Yaliwan, who was quite possibly a sincere man later became a member of the national parliament.
Of course there were those who realised the impossibility of the prediction. The European expatriates were worried that they would be accused of conspiring with God and Jesus Christ to prevent the local people from getting their cargo so they themselves could profit. This concern proved unnecessary. Some of the Europeans understood that uniquely complex cross cultural dynamics had led to this bizarre situation. However some redneck Australian administrators and businessmen considered the local people to be lazy “bush kanakas” who wanted something for nothing by subscribing to this corrupt organisation rather than working hard.
What was the background to the social aberration of cargo cults? The people of PNG had been more or less isolated from the rest of the world for thousands of years until contact with Europeans started in the late nineteenth and early twentieth century. Then Christian evangelical missionaries started to arrive, but for years made contact with only a tiny minority of the people. Tribal warfare made travel impossible for most people and many had no contact with the outside world except for neighbouring tribes, who were often dangerous enemies, until the mid twentieth century or later. In the 1970’s I met tribes whose first contact with outsiders had been seven years earlier.
After World War one a League of Nations declaration made PNG a protectorate of Britain who delegated the role to Australia. In the first half of the twentieth century most people still lived a stone age traditional village life of subsistence agriculture and hunting. Their homes were built of wood and palm leaves. The men hunted with bows and arrows and spears and used stone axes to chop down trees while the women worked in the vegetable gardens using wooden tools. Neither the wheel nor flights for arrows had been invented.
Gradually a few imported axes, saucepans and the like were acquired from missionaries or bought from trade stores.
Later a Westminster style national government was introduced to govern the country of 700 tribes with 700 languages, most of whom were living literally in the stone age.
In Melanesian societies status was gained through giving and the big men tended to be those who were able to give most. Melanesians believed that their ancestors spoke to them in dreams and could come back to life bringing gifts. Some came to believe that missionaries and other white people were reincarnations of their ancestors.
The missionaries of course taught that the people should believe in the Christian God and thatJesus Christ was the son of God and that traditional pagan icons should be destroyed. Christianity was difficult to reconcile with traditional religions, which consisted of ancestor worship and belief in spirits which had to be placated in order to ensure good harvests and safety from enemies.
Soon after the white people came to live amongst the Papua New Guineans, enormous ships and planes started to arrive disgorging amazing cargo such as radios, cars, refrigerators, beer, and many other things which had never before been seen. These were out of context and the people had no concept of how they could be produced by humans. The goods were destined for the white people and never for the local black people. Some of the local people put two and two together and began to believe that the goods were sent to the white Christians by God and that if they became Christian they too would receive shiploads of cargo. When the goods failed to arrive for the black people, some began to believe this was a conspiracy by the whites. But some local leaders developed large followings when they predicted that the ancestors would send ships and planes with goods for the local people. These beliefs were known as cargo cults.

The superimposition of a twentieth century western culture on a stone age society produced a situation ripe for misunderstandings at an interpersonal level and also at a national level. In his autobiography “Ten thousand years in a lifetime” the then minister for health the late Sir Albert Maori Kiki graphically described the immense personal cultural conflicts and difficulties in his transformation from a child in a stone age village, through missionary school, training in Fiji as a health worker and finally becoming a Westminster style politician and a cabinet minister.
During the three years I spent as a doctor in Papua New Guinea in the 1970’s I often encountered situations in which I had made unconscious assumptions based on my western background only to discover that the people I was relating to had a very different way of viewing the same event.
At the end of a day of hospital clinics and wardrounds, Joseph, a hospital porter who had been friendly with me said he wanted to talk. I invited him for a beer and we sat in my tropical garden under the Frangipani tree, the gentle waves of the South Pacific breaking on the coral reef a few yards away. We chatted in New Guinea pidgin and after a few polite preliminaries he asked me what money really was and where it came from.
“Long wonem yupela Europeans kisim dispela mani na yupela inap baim planti cago na mipela kisim liklik mani tasol?”
How was it that I and other Europeans were able to get plenty of money and buy goods, whilst the New Guineans only got a small amount of money. He wanted me to explain the source of the coins and notes so that he could obtain more for himself.
I tried to explain that money had no intrinsic value but was merely a token paid for services, that my skills as a doctor were rarer and more in demand by the government than his as a porter and so I was paid more money and could obtain more expensive cargo. As I explained I became acutely aware of the limits of my own understanding of economics.
Joseph listened politely and asked questions. After I had explained as clearly as I could he said that this was a very interesting story but now would I give him the true explanation of where the white people got money from. Clearly he believed that the whites had secrets we were unwilling to divulge thus preventing the local people from obtaining wealth. He had no concept of factories producing goods or mints producing coins. Money and goods were given to the white people probably by God or gods and ancestors sending them to the country by ship.

Each morning I would stroll along the breezy point of land projecting into the south pacific and which was the grounds of Wewak Hospital. The basic wood-built hospital was well maintained by the Australian administration and supplies and equipment were adequate. The nursing staff were mostly Papua New Guineans but matron in charge was Australian. The four doctors were, like me, expatriates.
One morning I arrived on the ward to do the rounds. By chance I went into a side room and found a desperately ill old man lying in the bed. I hadn’t been told about this tribesman who spoke no pidgin or any language in common with the hospital staff. I started emergency resuscitation.
When I asked how long he had been in the ward and was told he had been there for about three days and had received no treatment I became rather angry and incredulous. How could it be that a very ill man in hospital was not seen by a doctor for three days and received no treatment? Moreover it seemed that this would have continued had I not entered the room by chance.
The old man died and I tried to discover what had happened. Gradually I understood from Isaac, the charge nurse, that the man was from a tribe which was a traditional enemy of the tribes of most of the nursing staff. There was a feeling that it would be no bad thing if the man were to die. This event was pivotal in my awareness that my own, often unconscious assumptions, did not always hold true in another society.

Today it is recognised that even severe dehydration in children can be safely treated with rehydration by mouth using the correct electrolyte solution. In the 1970’s dehydrated children were treated with an intravenous infusion and there was great emphasis on the correct amount of fluid to avoid under or over hydration. Often the intravenous needles for the infusion would become displaced from the vein and need to be replaced. Every evening in the children’s gastroenteritis ward in Port Moresby we had a ward round to ensure that the night nurses understood the treatment for each child.
One morning I came to the ward and found that the young nurse who had been on duty overnight had placed the displaced needles not into the children’s veins but had run the fluid into the mattresses rather than into the children’s veins.
I was completely puzzled by this apparently strange behaviour. It became clear that the Papua New Guinean nurse had misunderstood me the European doctor. I had emphasised the importance of the level of the fluid in the infusion bottle, assuming that it was obvious the fluid needed to go into the child. Unable to resite the needles correctly into the veins, she was satisfied to get the fluid to the correct mark in the bottle by whatever means. This seems impossible to us with all our assumptions about medical treatment and our background of a western education but it reflects a completely different cultural background.

A middle aged man who had his initial treatment for pulmonary tuberculosis in hospital improved, stopped coughing blood and was stronger. I advised him to go back to his remote village for his eighteen month course of treatment to be completed at the local health aidpost.
A few months later he returned to hospital complaining that he was again coughing blood. X rays confirmed that the disease was producing new cavities in his lungs and sputum microscopy showed that many tubercle bacilli were again present. His treatment card showed that all the right boxes were ticked three times each week indicating to me that he had received all his treatment. My initial thought was that his TB had become resistant to the drugs, a problem which was starting to emerge in the early 1970’s but was rare in the Sepik district of Papua New Guinea.
On further enquiry I discovered that although the man had been to the aidpost three times a week and the aidpost worker had ticked the boxes, no treatment had been given. It seemed that the aidpost had run out of the medicine and the orderly had not been to town to collect more. Later when I discussed it with the aidpost orderly I discovered that he thought the most important thing was to tick the boxes to show that the patient had attended even though the medicine was not given. Maybe there are some lessons for the UK’s health service where important government targets can be met by massaging waiting lists even though no more patients are treated.

Although we westerners do not understand all the causes of diseases we have an underlying assumption that they have a biological or a psychological basis. When I went to Papua New Guinea as a 26 year old doctor I was unprepared for the beliefs about illness held by the people who would be my patients.
All disease was believed to be caused by poisoning or “sanguma” either by angry spirits or by enemies. If it was found that the sanguma was caused by an enemy then revenge would be appropriate especially if the person died of their illness. One night in a village next to the Sepik river, I sat up all night with the village people in the “haus tambaran” or spirit house. A child had died following an illness. The people were gathered in the haus tambaran and the elders and important people were engaged in heated debate, singing, shouting, crying and wailing all night while they tried to determine which spirit or which enemies had been responsible.
Often one could tell the location of a patient’s symptoms by numerous small cuts or scars over the area. The traditional doctor had cut the skin with a sharp stone or a knife to let out the spirits causing the illness. If this did not work the patient would come to the hospital to try western treatment. Sometimes I was very frustrated after my treatment was starting to be effective when the patient would one day disappear. I was told that because they had started to improve they had gone back to the village for the village doctor to complete treatment using their traditional methods.
I believe that the presumption that others are thinking in the same way as oneself, whether within one’s own cultural group or in another, leads to conflict, either interpersonal or on a larger scale. Perhaps awareness of differences in thought processes would avoid some of the horrific problems caused by misunderstanding.

The Javanese train was comfortable enough. The open windows allowed the hot humid breeze to provide some relief from the stifling tropical heat. Pungent smoke from the coal fired steam engine occasionally drifted in through the window and every now and then the blowing of the whistle brought memories of travelling in England by steam train not too many years earlier. At each small station hawkers got onto the train selling food and drink, and an assortment of amputees exhibiting their stumps, sadfaced ragged women with small children, cripples and other needy people would get on and parade through the carriages begging for money before getting off at the next station to return home on a later train in the opposite direction.
After travelling for several hours we decided to try our luck at the next station. We had no idea what the town would be like but wanted a different experience from big cities and from the major sights described in our guidebook and to see what life was like in an ordinary Indonesian town.
The small platform was not busy but two Europeans with small backpacks were an unusual sight and we were immediately surrounded by an inquisitive group of young men and children. “What is your name? Where are you from? What is your religion?” These were the usual questions that we were growing tired of answering after several weeks in Indonesia. We had learned to say we were Christian as the answer “no religion” was interpreted as meaning communist, a dangerous answer as only a few years earlier hundreds of thousands of communists had been massacred by Suharto’s government. We asked for directions to the nearest hotel but were informed that there was no hotel or guesthouse in town. One young man who spoke English offered us accommodation in his parents’ comfortable home and we agreed, relieved to have a bed for the night.
The small town was similar to many others we had passed through on trains and buses. There was a bustling main street with numerous small open fronted shops and stalls selling sarongs, batiks and other textiles, hardware, tropical fruits and vegetables, meat of both familiar and strange animals. There were crowded buses with people on the rooves and hanging out of doors and windows. Horses and carts and bullock carts transported people and goods. The ubiquitous pedal rickshaws were the main transport for short journeys in town.
Our horse and cart drove us past cottage industries where people made the necessities of life. Tofu was made by traditional methods in mud floored huts by cigarette smoking men with filthy hands. Women sitting on a concrete floor treated fabrics with wax to make beautiful multicoloured batiks. Liquor was produced by a lethal looking process using assorted tubes, spheres and distillation cylinders. Brass gongs for gamelan orchestras were made in an intensely hot, primitive foundry where molten metal was manipulated by men in shorts and open toed sandals. There was a clayworks where roofing tiles were fired.
That evening, we learned, was to be a festival. By six o clock the town was a throng of activity. The main town square was covered in small open stalls where we feasted on spicy kebabs, peanut sate, rice and noodles fried in large woks, and coconut cakes, all washed down with locally made arak.
In a small temple the mellow gongs and drums of a Javanese gamelan orchestra played quiet, mesmerising music using an unfamiliar scale. The character of this gamelan was so different from the rousing raucous gamelan orchestras we had recently heard in villages and temples in Bali.
We were led down dusty backstreets and into a square lined by single storey wooden houses. A noisy excited circle of people babbled, shouted, exclaimed and gasped in bahassa Indonesia. I could understand only the occasional word. Around the square the usual assortment of food stalls sizzled and spat and emitted a heady mixture of mouthwatering aromas of spicy frying food. In the centre of the crowd was an arena some ten metres across. Men in traditional finery squatted on their haunches around the perimeter of the arena chatting and laughing loudly. They were short wiry swarthy characters with fine moustaches who had clearly seen years of work in the hot sun in the rice paddies and probably some years in the Indonesian army in East Timor or Irian Jaya or some other area of Javanese colonisation. But on this night they were stars, competitors rivalling each other for the championship. They wore turbans and fine batik sarongs. Each man had several small wicker cages and in each strutted and bristled a potential champion fighting cock. Two men squatted at opposite sides of the arena, each holding his best bird and thrusting it towards his opponent, taunting and provoking, while his bird became more and more angry and adrenalised: eager to pounce on his enemy. At last the birds were released and flew at each other amidst squawks of anger. Wings were spread, feathers flying, beaks pecking, and legs lashing. Suddenly there was a piercing avian scream, blood was spurting and one bird fell to the ground, lanced by the razor sharp silver spurs attached to the legs of the victor. Wagers were settled, hands were shaken, the owner of the winning bird was surrounded by backslapping admirers and was paid his winnings and then it was time for the next two competitors.
Later in the evening we were taken to the edge of the town and into the rice paddies. In the fading light we walked on a patchwork of raised earth pathways between the sunken and partially submerged fields of young rice plants. An occasional farmer was working late with his buffalo drawn plough. Women worked waist deep in the warm water planting and weeding. After a couple of miles, hidden in the paddies, we came to a raised area of dry land. Here was an arena some twenty metres in diameter with a stockade of thatched palm leaves. A crowd of spectators in holiday mood and dressed in their best batiks and sarongs chattered excitedly. An announcer with a microphone shouted unintelligibly. Our host told us that what we were about to see was illegal and had to take place away from the town and at night. A small trapdoor was opened and into the arena trotted a small bemused looking wild boar. Then another trapdoor at the other side of the arena was opened and three lean hungry yapping terriers emerged. After running around aimlessly for a minute or two they started to attack the boar who gamely fought the dogs off. The small dogs were not able to slaughter the pig quickly but persistently nipped and bit at the increasingly distraught boar. After half an hour the dogs tired and were replaced by three more yapping hungry terriers. While this torture was carried on, the audience chatted pleasantly and occasionally cheered when some particularly skilful tactic was tried.

On the train to Djakarta the following day we reflected that the previous night’s activities may have seemed cruel but only twenty years earlier my wife’s grandfather was still involved in illegal cock fighting in England and badger baiting with small dogs was still practiced in some South Yorkshire towns. Bull fighting continued in Spain and fox hunting in the UK was still legal. Cruelty to animals for human entertainment is a widespread phenomenen.

The first of January 1973. New year’s day and I woke with a feeling of keen anticipation. Every day I was learning new and fascinating aspects of the unique environment I was living in and I looked forward to a new year of discovery.
I had the day off work so thought “let’s go for a picnic.” Five degrees south of the equator there is no contradiction in a picnic on new year’s day.

I was twenty six years old and was revelling in what was happening to me. Only six weeks earlier I had arrived in the large open sided hangar which was Port Moresby’s airport and encountered sounds, smells and sights which were completely unfamiliar to me.

Papua New Guinea. I towered above the lively excited crowd, many of whom wore traditional dress. Women carried their babies and their loads on their backs in string bags called bilums, suspended from their head by a long carrying strap. Men and women had bright red mouths stained by chewing betel nuts with white lime powder and mustard sticks. People shouted excitedly in Motu and in Pidgin - Balus i kam pinis long Australia - The plane has arrived from Australia. Short, stocky Melanesian highlanders dressed with leaves over their backsides known as arse grass and carrying their umbrellas, looked uneasy in this modern environment. There were tall, blue black Bukus from Bougainville and elegant Polynesian islanders with red hibiscus flowers in their hair. There were beautiful people from New Britain with their fair skin and blonde hair and graceful Papuans from Hanuabada. There were groups of Australian expatriate businessmen and public servants in shorts and long socks meeting colleagues and families from Brisbane. A uniquely vibrant arrival hall.

I was working in Port Moresby Hospital as a paediatric registrar under the inspirational guidance of Dr John Biddulph.

My learning curve was a vertical straight line. In six weeks I had looked after children with malaria in all it’s manifestations like cerebral malaria and blackwater fever, I had treated children with kwashiorkor, marasmus, tuberculosis, leprosy, severe dehydration, meningitis, severe measles, hookworms, roundworms, anaemia, encephalitis, pigbel, nephropathies, filariasis, neonatal tetanus, and the list could go on and on.
I had learned the crucial importance for babies of breast feeding and the disaster that bottle feeding can be in unhygenic circumstances.
I had learned to communicate in basic Motu and Pidgin English but as there were more than seven hundred languages in the country there were patients who could communicate with no one in the hospital. I had learned that other people may have a very different perception from mine, that a nurse from one tribe may not always have the best interests at heart for a patient from an enemy tribe. I had found that many people believed that all illness was caused by poisoning by enemies or by angry spirits.
Coastal people would be miserable if they didn’t have sago to eat whereas highlanders must have their sweet potatoes. I knew how to treat snake bites, stone fish stings, arrow wounds, spear wounds, pig tusk injuries and shark bites. I knew the signs that a witchdoctor had previously treated the patient. I had learned to accept that a patient from out of town would have several guardians sleeping under the bed or in the hospital grounds.

Papua New Guinea was largely unknown territory at that time - that is unknown to Europeans. A million highlanders had been “discovered” by westerners only forty years earlier. Many areas had not yet been explored by Europeans. Cannabalism and headhunting were probably still practised in remote areas but Port Moresby the capital was developing. Driving through the town to the hospital I was moved by the beauty of the turquoise blue Coral Sea, the white coral sand beaches, the colourful people. But there were squatter settlements, and poverty and serious crime was already becoming a problem.
I had been warned that although most of the people were friendly and peaceful there were rascals who would rob and rape and that one needed to be careful about where one went and how one behaved.

My young wife, Jacquie, had arrived from England to this amazing place only a few days before Christmas. I suggested a drive and a picnic on my day off in my newly acquired but battered and well travelled Holden estate. There were few roads but I had been told that Brown River was a good picnic spot about twenty miles away. As we drove through the steaming tropical jungle along a dirt road we met the sounds of parrots and strange tropical birds. Huge cassowaries the size of ostriches strutted their stuff. We passed small traditional thatch villages where friendly people waved and offered drinks of coconut water. We felt excited and slightly nervous, as this was our first encounter with such exotic surroundings.

After driving for an hour or so through this stunning tropical newness we knew we must be approaching Brown River. Rounding a bend in the road there was a slight descent and the wide muddy river was in sight. There were still a few hundred yards to drive when we became aware of a blood curdling yodelling sound of many voices. Then running up the road towards us from the river was an approaching army of a hundred armed warriors, their bodies smeared in mud from the river. They carried spears and axes and bottles of beer. They were fast approaching and my heart was fast sinking. We were vulnerable in this tropical jungle and were about to be massacred by a warparty of cannabalistic headhunters. We hadn’t seen another car or another westerner since we left the capital. There was no help. I reversed the car with my right foot flat on the floor, desperately looking for somewhere to turn so we could escape.

But it was too late, the crazed war party was upon us. We were surrounded. They were shouting and screaming war chants and waving their weapons threateningly. Their eyes were glazed and bloodshot from the combined effects of alcohol and betel nut. They were smearing the car and the windows in mud, completely blotting the view through the windscreen. They were banging on the metal with their fists and shouting all the time. We were totally at their mercy.
Intense fear was now another new experience to cap all the others I had encountered in recent weeks.

But no windows were smashed with those axes. The car wasn’t being damaged, only smeared. Some of the men were smiling and laughing.

Suddenly it dawned on me.
Perhaps - this wasn’t quite as bad as I had feared.
The words they were shouting.
Happy new year! Happy new year!

I was dismayed when Ryan was brought back to the hospital in relapse again.
I was a trainee paediatrician, a registrar, recently returned to the UK from Papua New Guinea. I felt that some of the agressive medical treatment that was given to children with life threatening illnesses was pointless, unkind and unwise.
Young Ryan had suffered bravely from leukaemia for the last thirteen months. He had spent at least half of that time in the children’s ward and the ward staff all knew him and his family very well.
The small pale twelve year old child was completely bald from the effects of chemotherapy. His arms were scarred from numerous intravenous infusions. He was psychologically damaged, just accepting that the trauma of painful procedures and separations from his family was his lot in life.  His illness had separated him from his friends and disrupted his life in school in the London suburb which was his home. The adults around him didn’t know how to talk to him about the things that were really important and the child didn’t ask. Why was he having all these painful injections and yet he was still ill? What exactly did his illness mean? Was he going to die? What was death like?
Ryan’s parents, good people, everyday people, were not prepared for the way their lives had developed. Like most parents they had never contemplated the possibility that after marrying and having children their lives might be devastated by illness, and perhaps even more by the treatment. Decisions about treatment were made by others and they did not have the information or opportunity to question the decisions or to consider disagreeing with them. But they knew that things were not going well. Their little boy was having nightmares. He was miserable and cried a lot at home. He was unwell and listless. He didn’t want to play with his brother or his friends.
They dreaded him going into hospital. He would be hurt physically and he would be so distressed and unhappy. But they considered this was all necessary and in Ryan’s interests because this was what the doctors recommended and because they hoped his disease could be cured. They couldn’t face the dreadful prospect of losing their beautiful child. It seemed unreal and so unfair.
They had their lives to get on with. Trevor, Ryan’s father had to continue working as an electrician or the family would fall into debt. Shirley, his mother, continued with her part time job and looking after Sean, Ryans’s eight year old brother. No one really had time to consider what was the effect on Sean of Ryan’s illness and the huge amount of parental time and attention it demanded.
There was no counselling or discussion with the family about these things. The consultant haematologist and the staff on the leukaemia unit were expert in applying the most up to date treatment. But no one had a holisitic caring role to consider and advise whether all the treatment which was medically possible was likely to do good in the long run. The hospital team knew that Ryan would die soon from his illness but there was no discussion amongst the consultants and nurses, let alone his family, about the pros and cons of continuing active treatment to the end. It was the formula for leukaemia in relapse and therefore it was applied.
After several more days of painful drips, injections, bone marrow tests, lumbar punctures and misery, Ryan died. Trevor and Shirley were grief stricken. Sean his brother didn’t show much emotion. The nurses who had spent so much time with Ryan were distraught and some went to the funeral.
I felt confused. I didn’t share these emotions. This was a tragedy for Ryan’s family but not for me. I wanted to help them but did not feel the pain which they were suffering. I could switch off and I went home and had an enjoyable evening as any other evening.
For some months I had felt that the treatment Ryan was getting was futile and cruel but as a trainee I was not in a position to take the decisions. When he died I felt relief that the young child would not have to go through any more trauma.
In Papua New Guinea, at the age of twenty seven years, I had been one of five doctors for a population of two hundred and fifty thousand people. In London the same population had at least five hundred doctors. In Papua New Guinea I had seen many many people die of illnesses which could have easily been treated successfully if the infrastructure had been available. In the hospital there the doctors and nurses were used to the sadness of child deaths which were an every day event. The infant mortality rate was high and families were used to tragically losing their children.
I could not rationalise that such intensive and probably futile effort had gone into trying to save Ryan’s life when people I knew were not even getting basic health care. Ryan’s death was terribly sad but why should it command so much grief when life in other places seemed so cheap? I could not come to terms with these paradoxes.
Why should I feel more sad about the death of one child in London than one child in Papua New Guinea? I could not afford to be emotionally involved in every death that I had witnessed in Papua New Guinea or I would have been swamped and emotionally paralysed.
Was one life in London so much more important than a hundred lives a few hours flight away? Not to me. In Papua New Guinea death was accepted as an inevitable part of life. In London it seemed to me that death was not acceptable and that any quality of life, no matter how tortured was deemed to be preferable to death. I didn’t agree. Was I callous and uncaring because I wasn’t distraught about Ryan’s death? I  had no answers to these apparent contradictions but I felt aware of double standards and moral imbalance.
I was in culture shock and wasn’t prepared for life and work in London.

I booked my ticket back to Papua New Guinea.

The names and details in this article are fictitious.

A week ago our medical team was chased away from the village near the coast. Angry, dangerous looking men threatened us with spears and bows and arrows.

Later when tempers had calmed some of the team carefully approached the village again.
The villagers were angry and frightened because they thought we were a family planning team entering their compound. In 1985 some of our Kenyan people believed that family planning teams would kill or steal babies and small children. Many men didn’t want to use birth control anyway. They liked to have several wives and wanted plenty of children to look after them in their old age.
When we explained that we were a medical research team, not a family planning clinic, the village leaders agreed to listen to what the team leaders had to say and arrangements were made to return the next day with the full team.

The following morning, early, before the sun was too hot, the truck was loaded up with specimen pots, blood taking equipment, weighing scales, height measuring stadiometers, medicines, examination couches and all the other gear for the clinic. The doctors from England, the enthusiastic paediatrician, the fierce parasitologist, the trim nutritionist, and the African technicians and nurses all piled in. We crossed the Kilifi river on the trusty old ferry, bought freshly roasted cashew nuts from the riverside vendors, and the long drive up the coast road began.

This time when we arrived in the village although the reception wasn’t exactly friendly we were not threatened.  The day was hot and dry and the drive had been dusty. After we drank some coconut water the white paediatrician stood up under a large shady mango tree. The elders, men and women, sat quietly in a group on the ground under another tree at a safe distance of ten or fifteen yards. An excited group of younger women sat separately. A few older children played around the mud and wattle houses but the young children and babies were kept safely out of the way.
The white doctor speaking in very bad Swahili went through the ritual he had learned. Jambo. Habari. Salamat. The elders nodded.
Then through the lips of the interpreter he said that we wanted to help the people by finding out more about malaria, schistosomiasis and the other diseases that affected them and we hoped to find better treatments and vaccines. But first we needed to know more about which diseases were the main problems in the area and so we needed to examine the people and take specimens of blood, urine and faeces. He said we would see any sick people in the village and give them treatment.

After some heated discussion amongst the elders the big man of the village stood up to speak and the interpreter translated for the foreigners. Politely he welcomed the team to the village and apologised for the previous day’s attack. He said that the elders were interested in what the doctor had said but that there had been no mention of their main health problem which was that many of their babies were born with plastic teeth. The village people were very worried about this. The government was doing nothing about it and the local medicine men were removing plastic teeth from most of the babies in the area. This was done in the early months otherwise the babies became sick at around six months of age with diarrhoea and vomiting and many died. The villagers wanted to know why this was happening and what could be done to prevent the problem.

The foreign doctor was puzzled but we local health workers of course knew that village doctors were removing milk or deciduous teeth from under the babies’ gums saying they were plastic teeth. We thought this belief had started some years earlier in Uganda and had spread. People did not understand that it was normal for babies to have unerupted teeth under the gums. They believed that infant teeth started to grow only at the time they appeared through the gums.
Many babies had severe infections or bleeding after the operation and some died.
Of course the real explanation for the many babies who died at about six months of age was gastroenteritis caused by bottle feeding which was often introduced at that age. The foreign doctors and we African health workers said these teeth were normal and not the cause of the babies’ illnesses but the villagers of course didn’t believe us.

Three days later I was walking along the village road in the morning with my baby Margaret, feeling very scared. The rest of the team drove past and when they saw me they stopped the truck and said “Hey Nurse Elizabeth where are you going with your baby?” I was ashamed and didn’t tell them where I was going. But I could tell they knew. Well of course we all knew that the plastic teeth epidemic was based on a myth. We health workers taught that all the time. But I knew that most of the team had had their babies’ teeth removed to be on the safe side, just in case the medicine men were right. I was terrified that my baby would get sick after the operation. But what else could I do? I couldn’t afford to take any chances. If she died at six months and I hadn’t had those teeth removed, I could never have forgiven myself.