South Sea Gold: Chapter Twenty-four

Tom and Matt found Dr. Rao later that morning and asked for an interview. They explained their involvement with the families and with Owego Island. Dr. Rao recognized the public health implications. "You say the pipe line broke that carries mine waste to the sea, and the waste contains cyanide?"

Matt nodded. "And I saw children playing in the mud created by the spill."

"These three?"

"I don't think so; not that day at least. But the mud was there for more than a week before the pipe was finally fixed."

"Interesting. Now let's see if we can close the final gap in the chain."

That afternoon, Dr. Rao visited the children again. Tom had described his wife's brief association with Palli and Lisa as their school teacher. The doctor invited her to be his interpreter when he talked with the children individually, while their mothers waited outside the examining room.

After first questioning Palli about her island home and her family to put her at ease, Dr. Rao turned the conversation to what she liked to to do with Lisa and Timothy. It turned out that she and Lisa were close friends, but that they played with Timothy only occasionally. "He's a boy," she explained.

"And what do boys do that you don't like?"

"Sometimes he chases us, or pushes us when we're playing."

"Does he hurt you?"

"Not really, but he's bigger and thinks he can boss us around."

Palli was a talkative little girl, and could describe her village very well. One story, further along in their conversation, caught Dr. Rao's special attention.

"There's this big pipe that's broken, see, and it's made a mess on the road. Lisa and I had sticks and were scratching a path through the mud so the water could go to the ditch. Timothy came along and told us we were doing it wrong, and we told him to go away, and he pushed us in the mud, and that made us angry, and we splashed mud back at him, and it hit him in the face!" She giggled at the memory.

"And then what?" Dr. Rao encouraged.

"Well, he pushed us down again and tried to make us drink some of the muddy water, but we got away and ran! He chased us and we ran hard and he never caught us. But we were all worn out."

The doctor turned to Kim and said, "Tell your husband, I think we may have found the missing link in the story."

They went on to interview the other two, and the mothers as well, and found nothing to contradict Palli's story, except for Timothy's mother, who angrily denied that her son would ever behave like that. She emphasized it with a spit of betel juice, and in her irritation missed the spittoon.

Dr. Rao summed it up the next morning, presenting the three children's cases to all the senior medical students in their informal weekly clinical pathology conference. "Sometimes the cause of the sudden crisis in konzo remains a mystery, but most doctors who deal with it think that stress plays a part. For example, its appearance after a woman's childbirth. In our cases here, we have a chronic diet of manioc, sometimes carelessly prepared, and then the sudden addition of exposure to a new cyanide source from the pool of pipeline waste, together with the stress of a childhood fight-and-flight event.

"There is not much value in trying to assign blame for this unfortunate tragedy of three children partially disabled for life, except to learn from it." Dr. Rao was silent for a moment, thinking.

"Better schooling for this generation will make it possible for future mothers to prepare their family's food more wisely. . . .A better health-care system will provide therapy in home districts without the need to travel all the way to Port Moresby. And, although cyanide is apparently the best way to extract gold from its ore, better enforcement of mine safety laws could prevent fouling the surrounding community with toxic waste. You young doctors must never forget that the practice of medicine does not end with the diagnosis. Nor even with treatment."

The students pondered this silently for perhaps a minute. Dr. Rao sensed more questions coming, and waited. "Yes?" he said, as one of them half-raised her hand.

"About a better health-care system; we have our own medical school now, and a few districts have a hospital with an X-ray machine and a laboratory. But . . ." she struggled to express her question, "I am going back to a small town after I finish my studies. Many people I see will have to walk for a day or more to reach even my small clinic. What is 'a better health-care system' going to mean out in the districts?"

Dr. Rao nodded understandingly. "How do we get along in the districts, far from the X-ray, and laboratory, and consultants, is that it? You will be surprised when you realize how much equipment you already have. It starts with your own mind, which comes equipped with many 'applications'―ears with which to listen to your patient's story, eyes with which to see, a sense of curiosity with which to put together all that you see, hear, smell, feel. A stethoscope is not an extra necklace, you know, but a tool to listen to the heart, the bowel sounds, the breathing, and the baby within the mother's belly.

"You will not have a completely equipped lab in your clinic, but science has supplied you nowadays with some tools in the form of test-strips, with which you can detect not only the presence of malaria, but its type, at the bedside with a finger prick. Other test-strips to tell you whether the urine is infected, or the kidneys are failing, or whether the patient is diabetic. Used wisely, such tests should cost only one or two Kina. You don't need a laboratory to alert you to blood loss, or liver failure. Use the senses that God gave you. And always keep in touch with new developments. Subscribe to at least one good medical journal, and attend a medical conference every year or two."

T