The morning of departure had come. My bags were piled up by the door; I had chosen the food to take with me to Amselhafen; I had given away some of my clothes to Eliza, the haus meri; I had even written about house-related topics that might be of interest to any future occupants, from how to charge the solar power system, to the oddities of the plumbing, to the voracious appetites of the ants that live behind the cutlery drawer. I was ready. It was 07:30, nominally the time the boat leaves, but this is PNG, there was plenty of time for a cup of tea.

A slight rustle at the door announced the arrival of the board chairman. To knock loudly seems to be against the New Guinean culture, with the result that many a time people have waited at the front door for ages without me realising that they were there. I invited the chairman in to join Eliza and I for a farewell drink and he gladly accepted. I was so engrossed in tea-making that I did not hear the further rustling that signalled the arrival of the nurses. Luckily PNG ears are far sharper than mine and Eliza let them in.

The nurses entered hesitantly, almost too afraid to cross the threshold of the Big House. It was the first time that any of them had been inside and for them it seemed to be an experience akin to me being invited inside Buckingham Palace. (When I tell you that I am treated like royalty here I mean that quite literally, with all the advantages and disadvantages that this relationship entails.) The nurses had come to present me with a bilum, the traditional token of thanks and farewell. They had woven one in the Silsil fashion, which involves using fibres stripped from the long, fleshy leaves of a local plant which are dried and then dyed magenta and purple. To cement the bilum’s status as a ceremonial gift, a stick had been placed inside to fan it out and fresh flowers had been woven into the tassels. It was a princely gift indeed.

24 hours later I was packing away the bilum into a bag to be left in Madang. I had just about got everything prepared when Sussi, the guesthouse manageress, reappeared to let me know that she had called a PMV to take me to Lae. Unfortunately she had called it far too early and it was only a quarter full. If I had known what was to come I would have asked the driver to return later but at that stage I had not fully appreciated the process of filling the bus.

PMVs going on long journeys will only depart once they are completely full. To fill the bus the driver does not merely wait at the PMV stop, he drives around, with the bos cru (boss crew, ie: conductor) hanging out the side of the bus shouting the destination, “Laelaelae! Laelaelae!” This behaviour sounds reasonable until you realise that the circles are about 25 metres in diameter and there are three or four other buses making exactly the same circuit. At times they are pretty much nose-to-tail. Strangely there is no animosity between them nor attempts to poach each others passengers. Occasionally the driver would get bored, or perhaps dizzy, and break off to drive around town but quite frequently his route would take him down several roads almost completely devoid of any pedestrians. On these trips the bos cru would optimistically call out to people crossing in front of the bus, as if someone would suddenly decide to take a 7 hour bus ride on a whim.

There is one final twist to the process: the bos cru will often fill up the bus with his wantoks (friends, clan members) so that it looks like it is full and thus nearly ready to go. This attracts customers, because no-one wants to drive in circles for ages if they can avoid it. However, when the genuine passengers get on the wantoks get off. I wasn’t aware of this at first and couldn’t understand why the bus always had two empty seats, no matter how many passengers we picked up. The bus is filled agonisingly slowly by this method.*

By the time we had been circling for three hours I was almost at exploding point. I had expected some delay in filling the bus but not three whole hours and we still were not full. Thankfully I managed to drift off to sleep and when I awoke we were speeding out of Madang. Only to stop 10 minutes later for a break at the closest out-of-town market. I dissipated some of my agitation by wondering aimlessly through the stalls. Quite unusually some of them were selling pre-cooked meat and fish. I found this discovery diverting enough to occupy me until it was time to go back to the bus and back to sleep.

The next time I awoke we were in the mountains with the engine sounding close to breaking point. We were inching up an impossibly steep road and for a while it looked like we would not make it. The driver was clearly accustomed to driving these roads, however, and he started driving in zigzags across the whole width of the road to flatten the gradient enough to permit the bus to keep moving. Eventually we made it to the summit, only to hurtle down a precipitous downhill and then to be faced with yet another equally steep incline. The Romans, I thought, would have approved of these roads: no concession to geographic obstacles, just the straightest route possible.

To relive the tension the bos cru started telling a series of stories which soon had all the passengers shrieking with laughter. I drifted in and out of sleep, waking at intervals to find us crawling up another hill or speeding down another descent. Sometimes we would pass vehicles broken down by the side of the road but we never stopped to help. You never know if it might be staged by raskols who want to rob passers-by. On one occasion we passed a huge container lorry lying on its side at the base of a hill with scores of people sitting on top of it. I wondered how they would right it again, they would need a crane with a pretty powerful engine to get it there in the first place.**

Shortly after the stricken truck we came to the crest of the final hill and the great Ramu Plains, flanked by majestic mountain ranges, spread out ahead of us. An involuntary, “Ayo-o-o!” (Pidgin for wow) escaped my lips, causing my neighbour to chuckle. From that moment there was no possibility of sleep and I sat pressed up against the window in rapturous contemplation as we descended into the valley and started our long journey across its floor, past sugar cane and oil palm plantations, past the scruffy town of Ramu and its tired inhabitants, past mills and isolated little huts and past slanted columns of smoke billowing from the burning fields. All against the background of glorious mountains; some crenelated, soft and verdant, as if they had been covered in a layer of green velvet, and others distant, craggy and blue, promising hidden adventure.

The plains took an age to cross but when the driver turned on the radio I knew that Lae must be close and indeed shortly afterwards milestones appeared, indicating that Lae was only 30 miles away. The final stretch of road was measured out by markets and shops named after their proximity to Lae – 10-Mile Market, 8-Mile Motors and so on – and with each mile my excitement was mounting. Nine hours in a bus is more than enough for anyone. However, my excitement was premature: I had not anticipated the oddities of the drop-off procedure.

Most PMVs in PNG will take you directly to your door, with the exception of short-route town buses, and so it was with this bus. I decided to follow the route the driver took on my Lonely Planet map of Lae to try and give myself an idea of how the city was put together. To my utter despair the driver took the most illogical route imaginable; several times we were tantalsingly close to the Lutheran Guesthouse, only to turn around and drive back to within a block of where we had dropped off a previous passenger. After an hour of eddying around it was finally my time to be released. Freedom has never tasted so sweet.

The day and a half that I spent in Lae was more than enough. In colonial times it was known as The Garden City and indeed there still remains a sign proclaiming this by the side of a shorefront road. Ironically this is surrounded by rubble and detritus washed out of the litter-choken harbour but these piles of rubbish are almost ubiquitous in the town that locals now jokingly refer to as Pothole City. The roads here are so awful that drivers frequently mount the central reservations to avoid gaping craters and the trucks are contantly surrounded by clouds of dust which become strangely picturesque around sunset.

Notwithstanding the photogenic Lae traffic, I was glad to be disembarking at Amselhafen on a balmy Thursday afternoon to be greeted by Dr Matthias and his wife, Angela. My pleasure only increased when I discovered that there was no space in the cab of the pick up so I would have to balance on the tailgate as we sped down the unsealed roads from the wharf. Give me sun, some scenery and the chance to sit in the back of a pick-up and I am immediately transported to the seventh heaven.

Amselhafen turned out to be my idea of paradise: mountains, jungle, caves and rivers. What more could anyone want? However, these delights and the joy of exploring them by foot and outrigger canoe were all but eclipsed by the relief at finally finding someone with whom I could fully discuss my Eichel experiences. Matthias and I chatted about the various aspects of medicine in PNG almost non-stop throughout dinner preparation and consumption. I had just finished describing the cardiac arrest of the week before when the phone rang and Matthias left to answer it. He came back about a thirty seconds later. “That was hospital. A patient has come into the outpatient department with a cardiac arrest. How’s that for a coincidence?”

We reached the hospital about five minutes later to find a man even younger than my Eichel patient lying on a trolley. He had come from an island in the vicinity of Amselhafen and had been ill for a few days before the health worker had finally decided to bring him over. Despite the fact that they had radioed ahead from the ship, the ambulance had not been waiting for them at the wharf and they had been obliged to wait for an hour and a half for a PMV to take them to the hospital. The patient had died five minutes before they had arrived. This resuscitation attempt was even more futile than the last and after about ten minutes we stopped.

The family were the sole occupants of the dimly-lit waiting room and I watched Matthias as he emerged from behind the curtain to deliver much the same speech as I had started the week before. The wife looked numb with shock and her only response was to clutch her sleeping baby ever tighter to her chest. The silence was broken by the father’s high-pitched wail, a thin, sharp sound that cut me to the quick. Strangely, despite all the pain and suffering I have seen here, it was the first time I’d heard a New Guinean cry spontaneously.

We walked back to the truck and drove home in silence. Above us thousands of stars glimmered in the indigo sky and around us the jungle was alive with chorus of a million insect voices singing their nightly song. One day all this will be gone; the stars blotted out by the glare of street-lights, the trees felled to make way for tarmacked roads and the chirping insects drowned out by televisions, radios and the siren of an ambulance racing a critically ill man to hospital in time to save his life.

*Nevertheless my experience tells me that there must be some advantage to this method which outweighs the waste of fuel. There is always a good reason that people do things and whilst it is sometimes tempting just to dismiss things as stupid it is only because one hasn’t fully understood the thought processes of the locals.

**Obviously such cranes things exist because the container and lorry had disappeared a week later.