Saturday, July 4, 2009

Brisbane Day 2: A Zoo in Pictures

This morning we had reservations for "Brekkie with the Characters" at the Australia Zoo, the one of the late Steve Irwin. After waking up at the time we meant to be leaving, we made good time north to the Zoo itself. In the dash, we managed to forget that this is winter here, and thus we might want our jackets. Live and learn, I supposed.

Breakfast was a good time, though, despite the shivering (and the stares of the locals who thought we were nuts for walking about in the "freezing" weather). We made friends with Squirt the whale, Floyd the pink elephant, Khan the tiger and BW the croc. Games were played, breakfast was eaten, and no one froze to death. Afterwards, we stopped into one of the gift shops for jackets and found a couple that were not going to cost us too much money.

Afterwards, we fed the farmyard animals (goats and sheep) before watching Terri, Bindi and Robert Irwin feed decidedly more dangerous animals. The whole croc show was facinating. They had several varieties of birds flying around the Crocoseam for the first half, some of which must have been flying at 40-50 mph. Then the real show started as they brought in one of the crocodiles and introduced us. The handlers were so enthusiastic, it seems Steve's legacy will live on for quite a while yet.

Next up were the Koalas. They taught us about them and then walked around, holding one and let everyone pet them. This zoo is the most hands-on approach to zoos I have ever seen. Nearly every animal could be touched, many included in the price of admission. Those that aren't included tend to be the ones a bit more dangerous, like the tigers. That said, you can pay for a walk with them or a photo shoot. (Since this also includes the necessary insurance for such encounters, I can understand it. And had Miriam not been with us, we would have been sorely tempted to pay the money they were asking for to walk with a tiger or a cheetah.)

Speaking of hands-on, next up was "Roo Heaven". We went through some double-doored gates and then into an open enclosure. Inside, kangaroos and walabies roamed about. You could purchase "Roo food" for $1 AUD and feed them. They were quite friendly creatures. The enclosure also had some fenced areas that were "No humans" zones, so the animals could get away if they needed time and space. But most seemed very friendly (though not all of them were hungry).

Miriam got a pony ride on the way back to one of the more exciting zoo-activities I've done: feeding the elephants. Twice a day, the queue interested people up, free of charge, in specific locations. They bring the elephants up to the edge of their pen, put a mat where we should stand, hand us a bit of fruit and... The elephants just taking it right from us. Miriam was a little worried about those long noses, but she did want to keep going back to feed them until they ran out of food. The morning lines were huge, so we skipped it at the time. The afternoon ones, however, we could just go from the front to the back. We probably fed them 6-8 times at least, among the three elephants there.

Then it was off to see the red pandas, the tigers, and more koalas and kangaroos. Then, on the way out, we find a small playground, tucked in a corner. Two khaki-clothed kids are running around it, from some guys in blue security uniforms. Yes, it was Bindi and Robert Irwin, relaxing after a day of shows. It was refreshing to see that they get some time to be just kids. Miriam played a bit with them and they posed for us with her for a picture. All in all, a very good day and far more engaging than I thought a day at the zoo was going to be.

Friday, July 3, 2009

Brisbane Day 1

All the baskets cleared Australian customs without a hurdle.  My two specimens I'm carrying for pathology did not, however; they're on a shelf at the Brisbane airport awaiting my return.  It's all right - now I don't have to worry about Miriam thinking the jars are toys. 

Picked up an Australian cell phone, which has a ridiculous number of minutes because of this curious "cap" system for prepaid cell phones, so Matt is using it for Twitter messages.  I don't know what international SMS rates are, but if anyone wants to try sending one I'll happily provide the info.
If we wait 6 months, we can unlock it from the Vodaphone network for $25 AUD and then we'll be able to use it wherever the dual-band phones will still work (primarily Australia and Europe, it seems).

We spent today on the Sunshine Coast (after dragging ourselves out of bed and getting a slow start) at the Buderim Ginger Factory, which is a cute little ginger-themed park. 
 We didn't go to the Bee Exhibit or tour the factory itself, but we did ride on "Overboard", which is an awful lot like "It's a Small World" with a gingerbread man as the protagonist, and we took the little train tour, that talked about the history and the buildings of the ginger industry in Queensland. 
And we had ice cream, which made Miriam happy.  She's eating a cone with mango on top and ginger-pomegranate on the bottom scoop there.  It's going to be a few days before I can think about ginger rationally again.

She also likes carousels.

Wednesday, July 1, 2009

We're Leavin' on a jet plane

Packed and ready to go - Miriam is eating cereal and the last of the pineapple out of plastic bowls, the trash is emptied.  The house is more or less devoid of our stuff. 
Today's trip is from Mount Hagen to Port Moresby, and then Port Moresby to Brisbane.  We'll have a few hours in Moresby before facing Australian customs with our woven baskets (sprayed with bug spray, frozen for at least 24 hours, and banged on the table to remove bugs) and miscellaneous other New Guinean souvenirs.  And then we'll be spending the next four nights in Scarborough, just north of Brisbane.  We have a busy few days booked there.

I meant to write something about leaving yesterday, but I was so exhausted by packing all day that it never got done.  Perhaps it will still come, eventually.  It's been bittersweet the last few days.

Monday, June 29, 2009

A different world: On call

We're out of oral flucloxacillin again - apparently it was a brief and glorious week of in-stock.  We're also out of cloxacillin and dicloxacillin.  A month ago, I don't think I even knew such drugs existed, let alone that you could sort of interchange them.  I know because I got called at 7:30 PM with this information.  "Are they already on Cipro?  Bactrim?  Oh, this is Surgery ward?  Call Dr. Taiye."  Jim told me not to take calls from D ward - that's Taiye's job, he's the resident.  It felt good, mostly because if you're already on Cipro, chloramphenicol, and Bactrim, then I don't know what else to substitute for flucloxacillin.

The ER nurse called me - baby with vomiting and diarrhea.  I gave him orders for IV, admission, and antibiotics.   Came up later on to see a woman with massive ascites from hepatorenal syndrome who'd just delivered a baby and had a hemoglobin of 6.  Nursing was concerned because she was short of breath, oh and, Doctor?  She refused to have any IV fluids.  Called Becky on that one, got Erin.  She approved of my plan A, which did not involve a paracentesis at 9pm.  Got hit with two more gastroenteritis babies and then a man who fainted after his wife's delivery (blood pressure 85/45, pulse 50, carried into ER).  I will note that the nurse told me to head on out, he could handle fainting.  They handle a lot of things here that in the States would require a physician.  It's quite nice.  I only get called when they need my specialized skills.  It took less getting used to than I would have thought; I know a lot of nurses back home who probably don't need me to tell them what to do 95% of the time, and I don't mind saying it.

Miriam requires Audio Adrenaline on the iPod now to go to sleep.  My little rock and roll baby.  She's been quite a handful at bedtimes these days, up and down a lot.  I think the different environment really gets to her.

Back over to B ward to see the lady with hepatorenal syndrome twice more last night - low blood pressures, worsening pain.  Wishing that there were a nephrologist or a GI doc or an ICU or something that I could punt to.  Finally, I called the lab guy in from home at 4 in the morning to give a unit of blood.  And they haven't called me back yet to tell me she died, so I guess it was the right thing to do.

Last Call: Halfway done

Three days on "A" ward - pediatrics.  Came in this morning and someone cleaned house over the weekend; at one point last week we had at least ten floor beds occupied - this morning started with five.  And my first patient was this smiling cutie - Anita.
Anita has primary pulmonary tuberculosis and is finally well enough to go from the inpatient ward to the TB house.  This is backwards - folks with TB start in the hospital and when they're no longer desperately ill, they go to the TB house until they're done with the daily medications, since the PNG requirement is directly observed therapy for at least the first month to 2 months.  She's feeling great and full of beans, and tolerating her streptomycin regimen quite well.  It's just a little too far for her to come to the hospital to get her medicine every day.
Anita's mother tried to have a conversation with me in tok pisin, and I sort of stumbled through it.  We managed the basics, like 'where are you from' and 'I'm a doctor for moms and babies in America'.  It was fun, and she was such a nice woman.  I printed a copy of this picture out for her and brought it to the TB ward, and she hugged me. 

Like most days here, it went sort of uphill and downhill from there.  There were less kids on the floor, but it was still 11 before we finished rounding on the ward, and then one of Susan's little ones decided to try to die.  Successfully, unfortunately, despite suction and CPR and 2 rounds of adrenaline.  He'd been working on it all morning, with sats in the 50-75% range and some kind of illness we couldn't beat - platelet counts of 1 and 2, white counts not much higher.  Maybe TB.  Maybe something else entirely.  We'll never know.
We took lunch after that; it was close enough to noon that nobody minded.  Came back and saw patients from 1 to 5:30 PM.

I sent my first five or six patients to Xray for chest films; one of them was a man with no cough but shortness of breath for the last few months.  He also had back pain.  He'd been treated with prednisone and amoxicillin (they spell it amoxycillin here) and salbutamol, but hadn't really improved, and I didn't think the air on his right side was moving very well at all, so I wasn't really surprised when he came back with a big right-sided lobar consolidation.  Off we went to ultrasound, with Steph's assistance, and produced some very nice images of a loculated pleural effusion that looked a whole lot like it might be TB.
At home, this is when I might have called the pulmonologist.  Here, we sent him over to the ER and got out the thoracocentesis kit, and I pulled off 180 mL's of straw-colored pulmonary fluid with a big syringe.  Then he got dizzy, so we stopped.   Follow up Xray looked good, and lab confirmed a probable TB effusion, so he'll be starting TB medications tomorrow.

While we were in the ER, one of Becky's patients apparently rapidly metabolized his Valium.  We use ketamine and valium for our conscious sedation procedures (I&D, minor surgery, D&C, that sort of thing) - it's a fast-acting dissociative anesthetic (related to PCP) that doesn't suppress respirations.  The downside is that when it wears off, it induces hallucinations.  Vivid hallucinations.  Most of the time, this can be avoided by co-administering a benzodiazepine such as Valium with it - our usual practice is to always co-administer these in adults.  Apparently, this particular patient didn't get enough Valium, because he was lying on his ER table with five men holding him down - one on each limb - thrashing and screaming in the midst of some kind of religious ecstasy.  "JESUS!  JEEEEEESUS!"  He nearly thrashed himself and his handlers off the table, almost kicked out a window, and then calmed down a bit after a few more milligrams of Valium IV (two men on the arm, Becky with the needle ready).  After that, there was no more thrashing, just the preaching.  "Do YOU! Have a Heavenly Passport?!"  Finally, one of the security guards answered one of his questions: "Do you know JESUS?!"  "Yes."  "That's the right answer, praise JEEEESUS!"  And he settled down.
Mental note: Never skimp on the Valium.

Little Jesicka, to the left, is my other unfortunate chest X-ray patient from the day, and her story isn't nearly as entertaining.  She's eight months old and has been treated several times for recurrent shortness of breath and coughing up blood.  I couldn't tell if anyone had ever done any X-rays on her before; it seems almost inconceivable that they had because of what our X-ray showed.  And there isn't always a machine available - even in Mount Hagen - and the notes are generally sparse.  One note mentioned her features (which I kindly referred to as 'slightly dysmorphic'; they wrote 'mongoloid?') - the wide set eyes, slightly low ears, turned-down mouth and large tongue.  She doesn't quite look like a Down Syndrome baby.  But nobody, anywhere, mentioned her abdominal exam.
My note is sketchy; just-the-facts.  100% on room air, respiratory rate 60-70 breaths/minute, liver margin palpable at 1 cm below costal margin; very large spleen.  It doesn't adequately portray my request for Susan-the-pediatrician to "please come check this baby out" or her frowning face as she palpated the firm mass on little Jesicka's left side.  Feels rounded.  Start with a chest X-ray.
Chest X-ray - here, a babygram; we use all the film we take - gave us more questions than answers.  Why is her heart round and why is the border so hazy?  Why is her stomach displaced?  What are those curious shadows over her spleen and left side?  Why is her right hemidiaphragm elevated?  And are those little round things in her lungs vessels, or something far more sinister?  Something is desperately wrong with this child's physiology.  Susan nodded at me.  Everyone had to look at "the strangest baby X-ray ever".  Nobody knew what it meant, but everyone agreed: it was time for an ultrasound.
I didn't have the heart to charge 12 more kina for something that I was sure was going to be bad news.  Furthermore, they were longwe patients who I was going to have to refer back to Mount Hagen for management, so I just called it a followup ultrasound on the chest X-ray and went for it without billing.
I laid the probe on her belly and scanned what I expected to find: liver, right kidney, bowel gas, and then awholebunchoffluid where no fluid should be.  I tried to make sense of it, but couldn't; big cystic things full of fluid and debris without reference point, and Susan wasn't in her room.  So I asked Scott to come in - showed him the X-ray, told him the story, and he frowned. 
A few minutes later, ultrasound probe in hand, he was staring at the screen with the same solemn expression.  That's not a spleen.  Did you find a left kidney?  I shook my head.  I think this is it.  We found her spleen, tucked up under her ribs, but half or more of her belly was occupied by what, under his guidance, revealed itself to be a multicystic structure with solid components.  Maybe a nephroblastoma?  I don't know.  I thought they were solid.  Neither did Jim, or Susan, but we all agreed on one thing: that has to come out.  And then I had to explain it to Jesicka's mother, who thought maybe her little one just had pneumonia before we laid hands on her.  I told her that sometimes this is cancer, and that I needed her to see a surgeon in Mount Hagen, that Dr. Jim thought there was someone there who would do the surgery.  She nodded.  "Jesus."  It was an invocation.  We prayed - for strength, for guidance, for the right surgeon's hands to be guided to the right place.  Wednesday is surgery clinic day in Mount Hagen, so I wrote my referral note and gave it to her, told her to be there early in the morning.  And I pray that someone there will look at it and understand.

Wilms' Tumor, or nephroblastoma, is the most common abdominal tumor in early childhood.  A little research indicates to me that there is, in fact, a cystic variant (multilocular cystic nephroma) which looks on CT scan sort of what I imagine this kidney would look like, if there were a CT scanner in range.  In the US, with nephrectomy and radiation therapy and chemotherapy, it has an 85-90% survival rate in Stage IV disease (assuming those really are lung metastases).  I don't know here; I'll have to look at the Cancer Treatment in PNG book tomorrow.  It's associated with several genetic syndromes, none of which quite exactly match Jesicka's abnormalities.
It frustrates me that I won't know the outcome; but I'm going to choose to believe that God does great and wonderful things, and that someday Jesicka will be just another PNG woman who only happens to have one kidney.   What else can you do?
I will call to mind the deeds of the Lord;
   I will remember your wonders of old.
I will meditate on all your work,
   and muse on your mighty deeds.
Your way, O God, is holy.
   What god is so great as our God?
You are the God who works wonders;
   you have displayed your might among the peoples.
With your strong arm you redeemed your people,
   the descendants of Jacob and Joseph.

Sunday, June 28, 2009

Village Church Visiting

Over at my study blog, I have some comments on our recent trip to a village church - cross-posting here.

This Sunday, we went to the village of Banin (we think that's the spelling) for worship. Pricilla, one of the clerks and translators for the hospital had invited Nykki and us out for worship. It was a sort (5-10 minute) drive down the highway to the village, only past a couple large potholes. The village was a collection of small houses, similar in construction to the church in the picture. (Roofs are either tin or thatched, but the walls were all a weaved siding.) We were greeted by the pastor and several others when we arrived, about 10-15 minutes early for the service.

Church began with the ringing of the "bell": an old, empty tank of the sort one might store pressurized gases. The service was led by Pricilla, who led us through some worship songs. A pair of other women in the church played guitar. Actually, most of the congregation was female, perhaps a half-dozen men, plus a few young boys being the only men present. (And they apparently asked if I wanted to preach.)

The church had posters and signs all along the walls. Some were from the Church of the Nazarene denomination, some were sign ups and schedules for who was doing what during worship, and others were home-made signs.

The music was vaguely familiar. There were more Tok Pisin songs here than at the church just off station, though there were a number of English songs as well. The songs also seemed to blend a number of familiar tunes into one song. One such song went from the chorus of "Power in the Blood of Jesus" to the chorus of the "Battle Hymn of the Republic" (with a few words changed). (It's also possible that I'm forgetting how some of the old hymns go.)

They had a time when they would share memorized scripture verses. One member would get up, give the citation. The congregation would repeat it. Then they would give the verse a line a time, the congregation repeating each line after them.(I'm not sure if this is particular to here, but I know I've not seen adults memorizing Scripture for a while when it wasn't part of a class.)

Other than those few things, it reminded me a lot of US worship. It seemed, perhaps, more communal, but a lot of that may also be that the whole village seemed to show up for worship, barring a few of the younger kids.Churches here are very local, each village having one of its own. And usually only one, as decisions tend to be group led. Thus, the village decides to join the church all at once. (See the baptism with 16+ people being baptized.)

The culture is very tribe-based, so there has been some dividing done on denominational lines. Most of the churches I've seen around here as we drove from one place to another were Nazarene. A few others exist: there's a Catholic mission up the hill next to us and a Lutheran church down one of the roads. But that said, most of this "tribe" around here seem to be Nazarene. Some of the literature around here seems to comment about how this may help continue tribal divisions, rather than try to bring the tribes more together.

I will say that everyone seems to be overly welcoming of guests into their church or tribe. If someone is an invited guest, a lot of the suspicion and mistrust seem to vanish. I've seen this when we go to church services and to the singsing the day before. Since Jonathan (our wasman, "watchman" or "guide") was with us and was part of one of the tribes in the singsing, we were welcome with open arms. I'm not sure how they would have greeted us had we just shown up. I know that Mt Hagen seemed particularly less welcoming, though that may be city verses village/town dynamics.

Anyway, before the service started, one of the women (I think Pricilla's aunt, but family relationships get blurred in villages, as everyone a certain age is a mama or papa) gave Nykki and Miriam each a meriblos, one of the traditional dresses. (Traditional at least since contact with Western cultures.) And as we were leaving, they gave us all the fruit off the altar (enough to fill to the brim a reusable shopping bag). The other missionaries tell me they do this every time one of them visit one of the small village churches. In all, a very rewarding experience.

Saturday, June 27, 2009

Picture Post: The Sing-Sing

Steph got the car today so we could go out and see some of the actual sing-sing.  We packed up, loaded up the Tracker with Steph and Jonathan, Matt and Miriam and I, and set out down the road toward the river to see the goings-on.  It was much busier today than it had been on Wednesday; truckloads of people being toted up and down a one-lane partially-gravelled road that apparently used to be the Highlands Highway.  It was quite an adventure in itself, rocking precariously on the side of the road as another vehicle scraped by literally inches away sometimes, but one we weathered well.  And the views were incredible.
At the place where we'd seen the dance rehearsal before, there were only a few scattered vendors and some folks sitting around, but two women were dressed except for their paint.  They had beautiful headdresses, shell necklaces, and tree-kangaroo pelts on their chests.  Jonathan had been given the charge of our printed out sing sing rehearsal pictures, and he distributed them to people so they could take them home.  Then we rattled on down the road - and down and down and down. 

Jonathan proved to be an excellent tour guide, directing us to the sights that were worth seeing - a structure built of bamboo and vegetables (which the locals were happy to pose on) that I suspect was for the actual exchange of cows later on, but nobody seemed quite clear on why they'd built the thing.  I do know that it was something else to see a man in ceremonial garb and a flower-encrusted hat posing with fruit in classical style. 
There were a number of beautiful floral decorations tied to the trees around this spot; the natural loveliness of the land is something its inhabitants know how to take advantage of.  Decorating with fresh flowers takes on a whole new meaning.  

Everywhere we got out of the Tracker people crowded around.  We spent the first five minutes at any location shaking hands and exchanging greetings, letting women pinch Miriam's cheeks and rub her legs (someone always picked her up, and bless her adventurous spirit she was willing to be carried by total strangers), introducing ourselves and nodding that yes, we were going to take some pictures.  I've been hugged and squeezed and shown around by more women whose names I don't even know today than, I think, ever before.  It's a very friendly culture - and the fact that we came and wanted to know what was going on was a source of some evident pride.  We stayed at a few little stops, enjoying the scenery.

Eventually, when one lane was more like three-quarters of a lane, we came to a field where the cows were grazing, just next to the primary school and basketball court (there's one in every village, I think).  There was a stream where some of the folks were bathing (no pictures), and a swarm of pikinini who brought us a cassowary-feather hat to try on and posed for pictures.  They seemed very interested in everything we were doing, and wanted to show off the cows.  Miriam wasn't so certain about the cows, but she did get on fairly well with the children. 

We turned around, then, and headed back up toward the general area where the sing-sing participants were gathering.  Along the way, we encountered a lotu just getting out, so we climbed down a steep incline toward the river and watched the baptism.  The pastor was very glad to have our attendance, even if Miriam did steal a tomato from the garden, and told us to come by later after the women had finished parceling out the meal, so we could have some of it.  We thanked him graciously and continued on.
According to Jonathan, most of the Christians don't take part in the dressing up and dancing for a sing-sing.  He doesn't find there's any biblical prohibition regarding it - they just don't.  And in this little village it was fairly tranquil, with women preparing food and no bird-of-paradise feathers to be found.

We came back up to the little village where we'd watched the painting on Wednesday and encountered the girls from up the road, now with face paint - and several other folks all garbed up - and then we hiked a few hundred yards up the road to where all the shouting was taking place.  There was a big circle of dancers all shaking their as-gras (I don't make these words up) and shouting something which Jonathan told us meant "We're going to get the cows" in tok ples.  Their dance was something like a big group shuffle with plenty of hip shaking, which does exciting things to the as-gras, which is a giant tuft of leaves strapped on behind.  It's a chaos of color and sound.  Very exciting.

One man asked us to e-mail him a picture of himself - he was a student - so I got some good poses from him with his axe.  Once upon a time, the axes were stone, but the waitskins came and brought steel with them, and now the axes are bought at stores.  His headdress is an excellent example of decorating with pigeon breasts and bird-of-paradise feathers; there's a kina shell at his neck, and you can see pig's tusks on his necklace. 
The loincloth in front also has meaning: each region has a different kind of coloring.  We saw some women in long white fringey ones, as well as the Western Highlands black and white stripes.  The Hagen folks had a different look as well.

We drove up to Jonathan's house, then, and stopped along the way at the village - the pastor had our food in plastic bags and wrapped in banana leaves to keep it warm - to pick up lunch.  There was chicken and pork, cooking bananas (which are fairly bland and not at all sweet), and plenty of kaokao, all still warm from the stone-and-earthen ovens.  Each of the four of us had our own individual plastic grocery bag of food, all jumbled together, and they provided four cans of soda as well.  We ate with our fingers, out of the plastic bags, and were glad for the wet-wipes to clean up with first.  Miriam mostly ate chicken and the cooking bananas, while the rest of us enjoyed our kaokao and meat.  The leftovers went to Jonathan to save.  He also had a tree-kangaroo in a cage, and got it out for us to see after we ate. 

Refreshed, we headed to one of the meeting-up places.  An old man greeted us, stalking up and down the pathway and yelling something I couldn't quite make out.  There was a group of women in everyday clothing with as-gras and face paint and decorated headdresses dancing and chanting, and when one of them noticed my camera there was a flurry of lining up and turning.  The dance got more interesting as everyone tried to make sure that my camera could see them.   They stayed mostly in a circle.  And then, beyond them, there was a group of men.  When I got over there they were mostly just standing around, but the camera does seem to bring out the best in people, so everyone wanted to make sure they were seen in the picture.

And then someone broke out the Coke.  There's something about watching a bunch of half-naked men in traditional garb and feather headdresses all swigging Coca-Cola that gave us the giggles.  I can't blame them for wanting a drink - today was hot, bright and sunny without a drop of rain or hint of clouds; a lot of people were carrying umbrellas to protect against the tropical sunshine and I got a little dizzy from the heat and the dehydration once or twice myself.  So we watched them drink their Coke, and then someone in one row started shaking his hips so the shells clattered together, and someone else stamped his feet, and the next thing we knew they were dancing and chanting once again, following a corkscrew pattern through the crowds (when a bunch of men come stomping at you, you move) like so many well-armed honeybees.

They danced, and the women danced, and there was a lot of singing and shouting that, after a while, starts to reach down into some primal place inside and make you want to dance and chant too, but we were heading back to the Tracker, since Miriam was getting pretty tired by this point - and then along the way we came across the adorable little guy on the right.  He can't be more than two or three at the most, but he was holding on to a broad-leafed plant as if he owned the place, all dressed up in traditional garb, with his little pot belly hanging over his loincloth and paint and all.  The man watching over him and the kids who were with him were just thrilled that we wanted to take his picture, but from his expression I'm not certain he liked the idea much.  He stood for us anyway, though.

We were about to leave again and had actually gotten back to the Tracker, when there was a great deal of shouting coming from down the road, so we stopped and waited - and a whole group of folks from earlier came charging up the road, dancing and shouting, followed by the marching men with whistles who'd been putting on paint on Wednesday.  There was nothing for it but to sit back and watch the scenery, since they were turning into the little clearing where we'd parked.  Steph moved the Tracker out of their dance floor, and two groups of dancing men circulated for a while - long enough for the men and women we'd just seen to come down and join them in one big dancing, shouting, singing, noisy sequence.  There was as-gras waving and feet stamping and feathers bobbing, and the crowds were shouting along.  According to Jonathan, it was more of the same: "We're going to get the cows."

At one point, I found myself directly in the line of march, as the groups formed up and moved out back to the main road, so I scrambled up a little hillock with some sure-footed children and watched the excitement pass by with one eye glued to my camera.  Everyone was very intent on their dancing and shouting - and there's something quite intimidating about a line of dancers with spears and axes coming straight at you.  I wasn't quite sure if they'd move if I didn't, so I got out of the way.

We'd gotten the Tracker a hundred feet down the road, in the wake of the crowd following the dancers, when there was more shouting and singing, so we pulled over and I climbed out with my camera.  An old man met me at the back door, and shook my hand, and asked if I was going to take pictures.  I'm glad for my rudimentary tok pisin because it lets me understand old men - and so I told him that yes, I was going to take pictures, and he told me there was a line of dancers coming.  I noticed.  And when I got around to the front, it was Brother Robert and the dancing men from Wednesday coming down the road all painted and decorated, so we got to see them again.  You'l notice their loincloths are a different print than some of the others - apparently, that's the Hagen cloth. 

Once they'd passed (by now there was a string of five separate dancing groups, each with its own accompanying crowd, all shouting something different and heading down to (we presume) the place of the cow exchange, the road was finally clear.  With Miriam dozing in the Tracker and the rest of us exhausted from sun and heat and the primal excitement of the whole thing, we headed back home to nap.