I sat on the lee of a hill gazing through the swaying pandanas at the milky white surf far below and marveled at how living in a run down shack on an island devoid of electricity, paved roads and “civilization” could feel so free. Life was as it should be. Tanna, the primitive Mitchneresque South Pacific island, was my home for seven months in 1995. After soaking up the afterglow of a fiery sun sinking into a lazy tropical ocean, I nestled under my mosquito net and began to sleep the sleep of a bush doctor, one eye always attuned to the fact that any second my dream could become a nightmare. From my bed I could gaze out across a field at our rough and tumble hospital. At any moment a lantern might come swinging across this field, attached to a nurse who had the task of beckoning me to another jungle emergency. Tonight it came. “Dokta” the nurse whispered almost apologizing as she stood at my door, “Man, he no good.” Tonight’s man in question was Esau, a man in his 20’s, as fit as a cheetah, muscular as a moose and sporting the fat of an anorexic ant. But he indeed had become “no good”. He was moribund. His abdomen was grossly distended and obstructed and he was about to die of some horrid tropical illness, perhaps the typhoid that had recently ravaged a remote part of the island. I explained to the village chief that Esau would most assuredly die unless he underwent urgent surgery. Of course, he was so sick that he might also die on the operating table. The chief and villagers took several hours to decide on whether to allow surgery. I wasn’t sure of what could be done on the operating table, but my Canadian training told me that I just couldn’t let him die. I must do something.
Once they finally acquiesced, I rushed him into the makeshift operating room, anesthetized him with a shot of ketamine and made a two-foot incision into his rock hard abdomen. I worked desperately. My attention on this massively swollen and friable bowel was occasionally distracted by a piercing THWACK!, as the nurse every so often would snap a towel at a fly that had settled on the surgical site. So much for sterile technique. So engrossed I had become on what I was doing that I was astonished to look up at one point and see that several villagers had softly slipped into the operating room! Two men had crawled under the operating table, their hands reaching up under the drapes to hold Esau’s hand. They wanted to reassure him that he was part of a community where people knew when he was sick and cared if he died. “More gaz dokta?” came the inquiry from the chief who was standing at the head of the table, fiddling with the oxygen valves. I glanced around at 20 or so ill-clad barefoot villagers crouching or sitting reverently on the floor. This is bush medicine, pure and simple. More like the bush leagues the way I was operating.
Had this patient been in a tertiary care hospital in any “civilized” country, he possibly would have lived. Had he been operated on by a surgeon, rather than a simple GP who usually treats sore knees and acne, he may have survived. I felt, watching Esau take his last breath, that my reputation among the Ni-Vanuatu men and women would be in tatters. Disconsolate and saddened, I felt tears join the 90 minutes of sweat that had pooled on my cheeks and mask. Then the chief turned to me and asked if he could offer a prayer. Without waiting for a reply, he began. “Thank you God, for letting us be here tonight to see the doctor work hard to help our man. We saw with our eyes what you wanted. Thank you for this doctor. We know that this is kustom.” Kustom meant that it was simply meant to be. Within minutes the villagers had Esau’s body wrapped up and with intense wailing they carried him out of the hospital compound and disappeared into the dark mist of a jungle night.
As I stumbled back across the field toward my mosquito net, I paused to sit at the lee of the hill, now dark but awaiting the morning light’s unveiling of another calm tropical vista. I thought about kustom. Kustom. I realized that tomorrow would bring another lantern and the next night yet another. My nights would come to resemble a teen patio party, filled with lanterns, anxious moments of truth and truthful moments of angst. Some nights would find me skipping back to bed, thrilled with success of a victory over disease and death. Other nights I’d be wishing I was back in Canada, treating simple problems with a host of specialists to help with the tougher ones. And as I sat and watched for the first glimpse of dawn, the reassurance came that here in this forgotten corner of the world kustom was a good thing. Life was as it should be.