First impressions of Papua New Guinea tend towards the idyllic – flying over islands and atolls of white beach and emerald water, across green rolling hills backed by thickly-forested mountains. Then the people themselves, open and generous, not just full of smiles but easily reduced to giggling, as I learned on my bumpy local flight from Port Moresby to Lae where I was to visit a family support centre run by the humanitarian aid organisation Médecins Sans Frontières (MSF).
There, my romantic idyll was abruptly shattered. The first patient I saw arrive was a woman with three deep blows of a bushknife to the back of her head and her lip and right cheek close to being severed from the rest of her face. She had had a quarrel with the second wife of her husband, she claimed. Really, just a quarrel. For an organisation well-versed in the violent consequences of warfare, this sort of violence from within the family came as a shock.
Even more astonishing was that this woman was not a once-in-a-month case, but an every-day patient in the industrial city of Lae. Later in the afternoon in the waiting room at Lae, I noticed two women sitting next to each other, both with right arms bandaged and hung in a sling of white gauze. It was momentarily comical, until an MSF doctor explained that they were both suffering from snapped forearms having defended their heads from the blow of a pipe or a club or whatever weapon might have been handy.
MSF has a similar project in Tari, in the country’s beautiful isolated highlands and such cases of brutality within the family are just as common. I am sickened and baffled because I have never seen anything like it, not even in my imagination. Up in the mountains, MSF’s project coordinator told me that she recently interrupted a man beating his wife. The battered woman was sobbing loudly while the family’s children played happily only a few feet away as if even raised voices were nothing to be distressed about.
I also heard about one of our own staff who delivered a machete chop to his daughter’s head inside our hospital grounds, because the girl had disobeyed him. When he was dismissed, he appeared not to understand why he was being punished – so normal was his act! These and so many other stories haunt the team of doctors and nurses working at the centres, not only because of their gruesome and disturbing detail but because there is nothing in our individual or collective experience that makes sense of this domestic violence.
Only five years ago MSF was debating whether it could justify its intervention in violence not related to armed conflict. Mostly, the answer was no. It was suggested that domestic or social violence was a phenomenon completely distinct from the political violence of armed conflict, and that MSF’s role existed only in the latter sphere. I was attached to MSF’s Humanitarian Affairs Department at the time, and we began to break down that false distinction by shifting the focus away from the perpetrators or causes of the violence, and towards the direct medical consequences on people. It certainly seems like a no-brainer.
Yet I have to acknowledge that there are some very pragmatic challenges that also pushed MSF away from going to places like Papua New Guinea to help victims of social violence. This is not war in Papua New Guinea, nor is it a crisis with boundaries, like an epidemic, that will come to a natural end. Rather, people in PNG face (and generate themselves) crisis-level violence on an everyday basis, to the point where it appears as a cultural norm. The violence is like poverty in need of long-term systemic change, rather than an emergency response.
MSF struggles in such settings, because there is no logical time for withdrawing, and because there are no soldiers or militia but husbands, wives, sisters and brothers. The surrounding poverty makes it even more difficult for MSF. There are no government doctors in the Tari district hospital and MSF’s team is pulled, literally by the arm, into wards full of infectious diseases, maternal child health problems, and people who are desperate for a loved one to be treated. Supplies and staff are unavailable. Yet what else can they do?
When I arrived in Tari I found a team exhausted, breaking all the MSF rules by ignoring the project strictures which is to deal with surgery and family violence only. Yet they are acting sans frontieres and making the only choice possible.
The problems of domestic violence requires a different set of strategies for MSF. It is difficult enough to advocate against attacks on civilians during combat, or for a government to grant us access to refugees. But here in PNG, do we outsiders push for a change in culture? Do we enter into the political dynamics of bride-price, which appear to give men the feeling that their wives are their property, to “bash up” alarmingly frequently?
Here is another example of the difficulties: in many countries, we provide a Medical Report to victims of sexual violence that can be used as proof of what happened. They’re often the only way for a rape survivor can be believed and receive some recompense for her injuries. Yet, these reports are used in PNG as testimony in a traditional compensation system that is itself the source of so much violence. The extended family or ‘wontok’ of the victim demands to be paid for the injury against one of its own, a process that can swiftly erupt into yet more violent clashes. Worse still, in at least one case, we fear that our report was used to justify beating a perpetrator into a vegetative state.
In their content and in the challenges they confront, the projects in Lae and Tari are groundbreaking for a humanitarian medical organisation such as MSF. It’s exciting to see MSF pushing itself. We provide the sort of vital treatment and psycho-social counselling for victims of violence that do not exist elsewhere (there are a lot of education and prevention efforts focussed on sexual violence, but few resources devoted to caring for the victims). We will hopefully use the experiences we gain in Lae and Tari to catalyse change, to push for similar family service centres to be opened in other hospitals, and maybe even to cast more light on the phenomenal violence.