“Em sik blo ples”, these are words sometimes uttered by healthcare workers if the cause of an illness cannot be found. Sometimes when healthcare workers don’t know the cause or they do not have the diagnostic capabilities to test and make a diagnosis, they resort to saying things like this – “em sik blo ples”. I think such actions by healthcare workers fuel and cement the belief in the supernatural causing sickness in people.

Healthcare workers in PNG are indirectly contributing and strengthening the belief in the supernatural causing sickness and diseases. For example Joe Blo has a head ache and presents to a health center for treatment. Joe Blo is seen by a nurse and given some panadol. Basic blood test for malaria is negative. So he is sent home with panadol. After a month he comes back and this time the head ache has gone worse. The nurse again assesses Joe Blo and there appear to be no obvious cause for the head ache. Malaria and dengue rapid tests are negative. So he is sent home with more panadol. After another 2 months Joe Blo is brought to the health facility in a state of coma and after few hours he dies. Without an obvious identifiable cause the nurse then tells the relatives that “em mas samting blo ples”. What if Joe Blo had a tumour that was causing the head ache? What if Jo Blo had a slow brain haemorrhage that was causing the head ache? What if Joe Blo had a head injury or trauma that he forgot to mention that caused a blood clot that was causing the head ache? We don’t know! Lack of training and poor diagnostic capabilities in hospitals and health centers are in some way contributing to the notion of “em samting blo ples”. This I think needs to change and the healthcare workforce in PNG can make a difference.

In this next example I put here a paragraph from “Sorcery, Christianity and the Decline of Medical Services”, by John Cox and Georgina Phillips (ANU E Press). The authors describe a scenario in Madang Hospital where Philips observed this example. Philips is an emergency physician providing training to PNG and other Pacific Island countries.

“One example concerns a middle-aged woman brought in to the ED in Madang Hospital by a male relative. She’d been brutally assaulted with a hammer and large piece of wood, and came shuffling in to the department led by her companion, her swollen face partially covered with a cloth. Once laid down on the resuscitation bed, the woman’s injuries could be inspected; multiple open wounds over her head and face were a result of the hammer attack, as well as deformed and swollen elbows on both arms, which had been deliberately smashed. The piece of wood had been used over her torso and back, which was already showing signs of severe swelling and bruising. As the ED nurse, ‘Meredith’, attended to her wounds, Phillips asked what had happened. ‘She’s been attacked because she is a sorcerer’ was the explanation, without any further detail. The explanation of the reasons or history behind the attack was not required or sought by the ED staff, and the patient’s history simply became ‘attacked because of sorcery’. This was repeated each time the patient was referred to within the department, or even altered to ‘the sorcerer who has been attacked’. After an X-ray had been done to diagnose the broken bones, Meredith proceeded to cut off all the woman’s hair in order to properly clean the scalp wounds. Phillips expressed sympathy for the patient, as Meredith reiterated that ‘she was a sorcerer’. In carrying out her duties as a nurse, Meredith treated the patient dutifully but was seemingly oblivious to any further effects of apparently reconfirming the label of ‘sorcerer’, which had been the cause of horrific injuries to the woman”.

This story illustrate another scenario where healthcare workers reaffirm and reconfirm the belief that spirits and curses are the cause of sickness and death in PNG.

Here is another example that I took from the same article above. This story is from the Solomon Islands.

“The 11-year-old schoolgirl had been rushed to the resuscitation room of the ED by her family in an agitated state. The junior doctor, ‘Kathy’, who was attending her described the girl’s initial presentation as ‘struggling’ and reported her yelling at one stage ‘Satan! Satan! Satan!’. Apparently the girl had gone to school in her normal, well state that morning, and suddenly became physically agitated and emotionally distressed with ‘yelling and struggling’. Family had been called to collect the girl and had secured transport to get her to hospital where upon arrival she was ushered into the resuscitation room by the ED nurses. Kathy was rapidly on hand and with the nurses’ help administered a dose of sedative medication by intramuscular injection. Nothing happened immediately, so the family continued to hold the struggling and distressed girl down on the ED bed so that another dose of commonly used sedative was injected. When asked what she thought was going on, Kathy’s immediate working diagnosis was ‘satanic possession’. ‘Could it be anything else?’ Phillips asked; a common technique she uses when teaching or supervising junior staff back in Australia to trigger more critical thinking about the clinical presentation. Kathy’s response was: ‘Not really. I know it’s difficult for outsiders to understand, but this is part of our belief system here in Solomon Islands. It’s quite a common occurrence. I mean, I should consider mental or organic illness, but I really think this is demon possession.’”.

In the above example, the doctor did not consider other causes of the abnormal behavior in line with her medical training. When doctors and nurses reconfirm the belief in the supernatural, it further consolidates the belief and it becomes very difficult to erase or remove from people’s mind and belief system. Persistent education and awareness over a long period of time can help change people’s mindset and belief.

The authors of the above article I shared think that decline in healthcare services; especially primary healthcare in rural PNG has also directly resulted in a decline in biomedical knowledge and authoritative advice to deal with issues such as sorcery so when health workers do not know the cause the issue is simply relegated to “sik blo ples”. I agree with their observation and reasoning. Another factor I have observed is that junior doctors pass through their careers without good supervision and training and can sometimes contribute to the “sik blo ples” issue.

The rise in sorcery related killings and violence in PNG is also in some way directly related to failure of biomedicine in PNG to address the root cause of sickness and death. Furthermore, I think the rise of sorcery related violence is a reflection of the increase in poverty and social inequality that is prevalent in PNG right now. When people accept that sickness and death is from the supernatural and not from organic causes that can be treated or prevented with modern medicine, they will not demand for better quality health services. Some politicians can take advantage of such situations and perpetuate the problem for political gain.