White Spirit

It is barely nine o’clock and already the Solomon Islands’ sun beats down on our backs as we climb the gentle hill to Atoifi Adventist Hospital. The wharf-side dawn market has wound to a close and locals sprawl under the trees nearby, hoping to find buyers for the bananas, raw peanuts and inkori that did not sell that morning. As we pass, the men greet my husband, Paul. They ignore me, his property, lest the attention offend him. It took me days to stop smiling my greetings, to stop expecting a grin in return.

By the time we reach the shade of the humble clutch of hospital buildings our shirts are wet through. Noel, a Philippine expat and the only doctor in the hospital, is late. We sink onto the slatted benches outside the shell of a building that houses the male ward and watch the swallows swoop on the grassy hillside. Their sleek, black bodies dart to the ground and skim the grass before wheeling into the sky. Back down the hill, before the backdrop of palm trees and, farther, the gleaming bay, the small figure of the doctor is making his way up the red dirt track from his house at the end of the village.

We have been here for less than a fortnight but news travels fast and most locals have heard about the two Australian “doctors”. In truth we are medical students, here to learn what the profession is really about. I have imagined myself working here since I started medicine.

An old woman we have never seen before approaches Paul, her weathered skin the colour of coffee against the blue ink of tattoos that identify her tribe. Her face splits into a smile, her gapped teeth grey. She presses a bunch of bananas into his lap, smiling, pressing. As Paul watches her, bewildered, Noel arrives.

“She wants to give them to you,” says the doctor, in accented English. He is dressed in freshly ironed shorts and a polo shirt, his stethoscope slung around his neck. Paul looks to him for some kind of explanation but in his soft-spoken manner he does nothing but shrug. Another cryptic smile to decipher.

Paul takes the bananas. We follow Noel on his rounds of the hospital, in and out of the main wards—separate buildings, each with twenty beds lining a long room. The male ward has a scattering of patients: pneumonia, malaria, wrist fracture, more malaria. One man seems to have an arrhythmia, but the paper for the ECG machine ran out weeks ago so we have no way of confirming. Faces press against the wooden slats of the glassless windows as people from the bush or nearby villages look for entertainment before the long walk home after market.

In the female ward is a thin, old woman with scabs and ulcers on her limbs. Her straight, short hair is dark and ragged around her face, her sparse teeth blotched with black. She answers the doctor’s halting pidgin in a few sharp words of Kwaio, the local dialect. We fetch a student nurse, one of those training here under a handful of fully qualified nurses. She stands beside the doctor in her crisp uniform and translates sketchily, giggling. Somehow, shuffling through this three-language waltz, Noel comes to a conclusion and orders one of the few blood tests available in Atoifi: a haemoglobin count for anaemia.

The doctor shows us an x-ray of another woman’s spine. Her bones are nothing more than the faintest, ghostly wisps; the rural communities of Malaita, one of the six main islands in the Solomon group, have no dairy animals. A Western woman lugging heavy root vegetables in sacks hanging from her head would have bones as strong as an ox. I think of the vegans who would envy this diet as “natural”.

The patient, face twisted in pain, lies on a thin mattress wearing a long denim skirt hitched up over her breasts like a strapless dress. In the absence of a surgeon who can operate on her spine, Noel gives her a painkiller that Australians buy in supermarkets. It won’t help. Her daughter, or sister, lounges on an empty bed. The mattress has been removed to discourage locals from sleeping there. The younger woman beats a hand-woven fan, tugging at the neck of her faded Hollywood t-shirt. From the sacks at her bare feet she offers the patient a plump, green banana, the sweet type with lightly pink flesh.

That afternoon, a nursing student brings Noel the results of the haemoglobin test. The patient has half the healthy level of red blood cells; she needs a transfusion. Walking back between the buildings to see her, we are stopped by a barefoot man in grimy shorts, singlet and baseball cap. He confronts the doctor, speaking quickly and loudly. I understand nothing of the conversation.

“He knows that his wife needs blood,” the doctor explains when the man has gone. “But he refuses to find family members to donate unless the hospital pays them money.”

It only takes the distance back to the ward to make my decision. It’s an easy one. With such paltry access to equipment and medications, the medicine here is minimalist. We see so much and do so little. Here, finally, I can make a difference.

“I want to donate blood,” I tell Noel. “I’m O-negative.” In Australia I donate every three months. My blood type, common to 9 per cent of the population, is safe to give to anyone. I’m a “universal donor”.

Noel is incredulous. “Are you sure?” he asks. “Only if you want to. You really don’t have to.”

“I know. I’d like to.” It takes a few minutes to assure him. I’m not sure why my suggestion is so remarkable. I feel embarrassed, as though with the best intentions I’ve offered to run naked through the village.

In the evening the doctor’s wife, Jinjin, cooks for us.

“I hear you are going to donate blood,” she says. Her voice is delicate, singsong in its Philippine inflections. She is also a doctor and originally worked with her husband in the hospital. She stopped when a patient died after nurses refused to respect the orders of a woman. Jinjin is remarkably without bitterness as she flits about the kitchen, a pan of simmering fern leaves on the stove. Looking at her, my dream of working here wavers.

“You are very brave,” she tells me.

“Am I?” I ask, surprised. “I’ve donated lots of times. I don’t mind, really.”

Why am I being questioned again? Images of filthy, virus-laden needles plunging into my arm flood my mind. I suspect the only reason for the low rate of HIV in the Solomons is the absence of formal testing. Maybe my naive magnanimity is really just foolhardiness.

Jinjin wipes her hands on her skirt. “No, you are brave. More brave than me!” She laughs brightly.

The tender, young fern fronds are served with bush-lime juice and sugar. They keep a faint crunch and taste like earth and herbs through the sour dressing. I’m still going through with it.

Just down from the only store in the village—a window through which you can buy oil, salt, canned tuna and, occasionally, toilet paper—is the hospital laboratory. I climb onto the vinyl mattress and try to ignore the stained sheets beneath me as the technician, a local who supplements his income selling carvings, sets a retort stand on the floor. He washes his hands at the grimy sink and dons gloves he pulls clean from a box. The needle and tubing come from a sterile pack. I am somewhat reassured.

As the point of the needle hovers over my skin he looks up. “We’re out of local, I’m sorry.”

I shrug. “That’s fine.” I’ve never given blood using local anaesthetic.

He is relieved. “We don’t use it, normally,” he says. “But because you are a white person, I thought …” He trails off and finishes placing the needle.

The blood runs quickly from my arm; the bore of the needle is large and the room is so hot that my veins are gorged to shed heat. The technician squats beside the retort stand and rocks the bag of dark-brick liquid to mix the blood with the chemicals that keep it fluid. I wonder how much the bag-rocking machines at the Blood Bank are worth.

When the bag is full the technician brings me my reward: two cans of tuna, the standard payment for giving blood. Pressing a wad of reasonably clean cotton-wool to the wound, I tell him to keep the fish. I ask if blood shortage is a common problem. He says yes; sometimes he donates himself and sometimes he uses his own money to pay relatives of patients. He names a sum that is more than a day’s wages for a nurse. He tells me I have done a very good thing.

The donation is more tiring than usual. The heat, I imagine. Lying under the mosquito net in our flat that evening, I watch the geckos chase each other, sinuous, across the walls. They are vague shapes through the haze of netting, chittering like parrots. When they settle, the rats rouse to scuttle behind the walls. I’ve seen them—smaller, softer than at home, with oversized ears like two coins.

In the morning I walk up the hill to find the doctor. One of the women who cleans for the village is hanging disposable plastic aprons on a line to dry. Noel has the patient with an arrhythmia hooked up to a three-lead heart monitor. The lone trace on the small screen is a poor approximation of a full ECG, certainly not clear enough for a diagnosis.

The three of us see outpatients in a room at the front of the hospital. It houses the second-hand ultrasound machine, so the hospital’s one air-conditioner runs here twenty-four hours a day to protect the equipment. The cool is a relief from the damp heat of outdoors and the suffocating air in our flat, where the lone fan only works until the village generator is shut off each evening.

The first patient has pain in her ear. I borrow the otoscope from the nurses’ room and peer inside. I have a Godzilla moment; through the lens, the cockroach in her ear looks the size of a horse. We carefully extract the bug, wiping each broken, bloody fragment from the forceps with a tissue. One of the nursing students, sitting on a bench under the window and swinging her legs, jumps down and runs over to see. The patient winces silently and ignores the celebration.

When the corridor of patients has emptied I ask Noel about the transfusion.

“We had to stop it,” he says, leading the way back to the wards.

“Why?” My blood type should not have caused a reaction.

“She was short of breath. Agitated,” says Noel.

“A transfusion reaction?” I can’t keep the confusion out of my tone.

We stop in the doorway of the female ward and he lowers his voice. He explains that he doesn’t think it was a reaction. She knew it was my blood and she didn’t want it. He seems tired.

White blood, I think to myself, gazing at the anaemic woman’s skeletal form. I picture a needle in her scabbed arm, the tube between her vein and the bag running a poisonous red—picture her as she feels the spreading cool of the infusion and imagines her rich, angry spirit blurring and corroding. My hands clench with indignation.

The intrusion of Western medical care has been tentatively embraced. The bush people, who arrive in nothing but loincloths, are clothed by the hospital but strip out of these garments as they climb back into the kilometre-high mountains. They leave them bundled under the ferns so as not to bring tainted, foreign things into their settlements. The fabric rots in the humidity. The only material that weathers the jungle is the plastic packaging of forbidden medication left in the pockets.

Taboos hold a special power. The first major wave of converts to Christianity occurred in the 1920s, when whites seeking retribution against defiant indigenous taxpayers invaded the island’s interior. Some locals sought refuge in Christian coastal villages. They huddled in huts on the sand, clean males alongside menstruating females and women with post-partum discharge. After months of this life, the transgressions of ritual law were so deep and destructive that it was easier to come into the arms of Christ than appease the disrespected ancestors. The people in this hospital are a mosaic of local and foreign beliefs.

I feel a complex mix of emotion. I came here to see the gift of health on the frontier. What I have seen is so much strangled medicine: Band-Aids for broken bones, devastating disease left to fester for want of a few coloured pills. Despite the risks of the donation, I had wanted to make a tangible difference. Now, when I cannot undo my gift, I have been rejected. My white, foreign spirit has been refused. I think of Paul’s bananas and struggle to balance the scales. My already wavering dream thins beyond reach and I am, privately, secretly, appalled at myself.

Noel bargains with the woman’s husband, who finally agrees to make the six-hour hike through the jungle to recruit family members to donate blood. The doctor has promised him money

That afternoon a woman walks out of the bush with a baby whose red cell count is critically low. The naked infant lies in her arms, eyes unfocused. It is light as a bird.

Noel sags at the prospect of another struggle for donors. I don’t know if the mother—young, haggard, her golden hair a wiry halo—feels the heavy hand of her ancestors as strongly. I cannot donate again for another three months. Perhaps, after all, I should have waited.