Psychiatry Disconnect and Social Crisis in Papua New Guinea

Poroli, my father's small brother facilitating slaughtered pigs for compensation payment at Pakura village, August 2020 (photo courtesy Kingsford Uriliwa)

1. INTRODUCTION

This article is updated from its original social medial post on the 21st of June 2020. A young man whose paranoid schizophrenia has fallen through the net has been on the run on a killing spree. Upon the loss of three innocent lives in a spin of four months, all four relatives of all victims and the culprit are left with a social crisis in the making in Papua New Guinea (PNG) society. Here I explore the disconnect of psychiatry services within the PNG public health system as the underlying determinant to an uncontrollable epidemic of social upheaval, conflict, and violence.

 2. PSYCHIATRY SERVICES IN PNG PUBLIC HEALTH SYSTEM AT A GLANCE

 Mental health legislation in PNG dates to the Insanity Ordinance of 1912. This was superseded by the Mental Disorders and Treatment Ordinance of 1960. The latter was annulled in 1997 and replaced with a subsidiary chapter (no. 226) of the Public Health Act known as the Public Health (Mental Disorders) Regulation*. This is the current mental health legislation in PNG, but a review of the legislation is underway to make it more relevant to the mental health needs of 21st-century PNG. That is associated with an increasing trend of demographic, health and nutrition transition associated with contemporary development changes*. A huge flush of local migration from rural to urban sectors inflicting a stress and shift in the mental health resilience of our population, especially among the young generation. To understand the psychiatry public health system, let us begin with a brief look into PNG's governance system.

2.1 PNG government system

PNG adopts a parliamentary democracy based on the Westminster system with independent legislature, executive and judiciary. Composed of 109 elected members from 89 open electorates and 22 provincial governors, parliamentary term lasts five years. National politics is characterized by a scattered and fragmented party system, high candidacy rates, high turnover of politicians at every election and frequent party switching by members of parliament*.  Although recognized as a successful democracy, poor governance from national to decentralized provincial and local level governments has been key determinant to PNG’s deteriorating social and economic development challenges*.

2.2 Decentralisation as development policy

The 1995 Organic Law on Provincial and Local Level Governments (OLPGLLG) was intended to ‘bring government closer to people’*. Apart from other ministries, rural health, basic education and law and order were decentralized. However, rather than strengthening the role of LLGs in decision-making, LLGs have been increasingly marginalized from planning and financial decision-making processes at both provincial and district levels. Political instability, corruption and lack of technical expertise have resulted in failed decentralized governance for development*.

2.3 Health system and service delivery

PNG National Department of Health (NDOH) system is established around primary health care principles to be responsive, effective, affordable, acceptable, and accessible to the majority people*. Health services are provided by government and church providers both of which are financed primarily from public sector funds. Under the OLPLLG, district and local governments are given responsibility to manage and support their health services, each level of government having different powers and functions in relation to health. However, due to other district and local government priorities, almost all rural health services in the country are underfunded*. Despite significant levels of official development assistance (ODA) grants; there is still shortage of health sector human resources development especially in rural sector and deteriorating health facility infrastructure.

2.4 Provincial Health Authorities

In 2007, under the leadership of the Minister for Health and HIV/AIDS, the PNG National Department of Health (NDoH) reinforced and revitalized its decentralized primary health care system by establishing the Provincial Health Authorities of PHA system throughout the country*. The central concept of the PHA system was to unify different health services and service providers by managing resources by the PHAs as a centralized entity. The PHAs therefore have been given more powers as a central agency and custodian of all health services, stakeholders, resources, and decision-making at the provincial level. This system has been proven to be successful than the initial decentralized primary health care system which was seen to be fractured and disconnected*.

2.5 Psychiatry services fallen through the net

The primary health care system managed by the PHAs comprise of curative, preventive, health promotion, laboratory services and community engagement programs. The PHAs vision and manage these activities through different participating stakeholders at levels of the primary health care system. While the provincial hospital is the main referral centre, the districts health centres, primary health units and community health units provide the most basic health services utilizing resources and personal at their own capacity. A huge, ignored gap in this system, from the initial decentralization to the PHAs, is the psychiatry arm of health care. Currently, there is only one psychiatric hospital, Laloki, which serves the entire country. Other major cities including Lae and Rabaul may have random mental health services. However, psychiatry preventive, curative and management services have fallen through the net.

Here, I have looked at the psychiatry service within PNG's public health system. The psychiatry management itself including the cultural epidemiology is a whole write up. In fact, some might find Graham Roberts* contribution useful as he thoroughly investigates the history of mental health services, the cultural ontology of mental health in 20th century PNG, and the gap in the public health system. 

3. SOCIAL CRISIS AND A CULTURAL FABRICS OF PEACEMAKING

Let me begin this section with a geographical, social, and cultural context of a typical PNG highlands society.

3.1 Hela Province

In May 2012, the PNG National Parliament passed a bill that Hela could become a province of its own. Hela therefore broke away from Southern Highlands Province (SHP) and formed a new province with its own administration, governance, public institutions, jurisdictions, and geographical borders. Oral History suggests that Hela was the grand ancestor who had four sons and a daughter from whom a nation was to emerge. Hela’s offspring sons were Huli, Opene, Yuna, Tuguba and sister Hewa. Traditional Hela Territory ranged from whole of Enga Province (Opene) (Mt Porgera specifically Kumbi Para, ipa Yambale where sacrifice to traditional gods took place) to Mt Tundaka (Sacrificial sacred area) to Lake Kutubu to Mt Bosavi to Mt Gigira to the Strickland gorges bordering western and West/East Sepik Provinces.Geographically, Hela and SHP cover the Central Range and Lagaip Valley in the north. The Tagali Valley runs through the centre. The south of the province includes limestone plateau, Lake Kutubu and the Hegigio, Mubi and Digimu Valleys as well as the dormant volcano, Mt. Bosavi. Incomes for most people are low, earned from the sale of coffee, food, and firewood. Small pockets of high incomes are earned from oil and gas operations; however, this is limited to the areas near these concerns. The Highlands Highway runs through the province from Imbonggu to Kopiago, and other roads go to Komo, Erave and Pangia. Remote areas in Komo Margarima and Nipa Kutubu, especially near Mt. Bosavi. Hela province is home to the current Exxon Mobil led PNG liquefied natural gas (PNGLNG) and the Oil Search Ltd petroleum project.

With a projected total population of 400,000, the new province is made of three district electorates including Tari Pori, Komo Magarima and Lake Kopiago Koroba. The National Research Institute of PNG district and provincial profile completed in 2010 record that Hela Province has total of 12 local level government electorates, and 253 council wards*. Hela province is known for patriarchy and rich traditional customs where man dominate decisions about social order, leadership, participation in development and sharing of resources and opportunities. These coupled with other institutional and political corruption, tribal fights, and infrastructure isolation is contribution to some of the worst social and human development indicators in the country.

3.2 Yuna Country

The Yuna, (Duna in Huli dialect) occupy the western end of Hela Province. Yuna is a culture, a people group, and a language spoken by a population of about 100,000 people. The Yuna lands extend from the headwaters of the Pori and Tumbudu Rivers in the south-east, through the river valleys to the Strickland River in the north-west, lying within the Koroba-Lake Kopiago district of the province. People in the Yuna territory live in family groups in hamlets spread through the Pori and Tumbudu valleys and clustered in the low-lying wetland area around Lake Kopiago (the Kopiago Basin). Other settled areas include the Aluni Valley, the Strickland Gorge area, and locations at the headwaters of the Logaiyu, Urei, and Wanika Rivers in the eastern region. Hamlets are subdivided into parish territories. Each parish has an esoteric history of its origin transmitted as an oral tradition among alien descended from the parish founder of founders. Residences and gardens are typically established in very high altitudes of 1600m. The territory covers the peaks in the mountain ranges that mark the extent of Yuna country to the south and north-east. With an average rainfall of 4500mm, the area is wet and dry and cold at nights. Frosts, droughts, and inundation are inevitable in these geographical conditions. Subsistence farming is the main source of livelihood. Sweet potato like in other parts of the highland’s region is main staple food while beans, pumpkin, peanuts and pandanus are also grown seasonally. Domesticated pigs are not only a source of protein. Pigs are social and economic wealth used for compensations, bride prices, ceremonials, and funerals.

Nicholas Modjeska did his doctoral thesis on the Yuna while based at Aluni village near the Lake Kopiago station and records beautifully about Yuna cosmological perspectives, landscape, oral history, production, reproduction, invasion, and the Yuna understanding of time and space. The Yuna country and society exists not only as a place located in space, but also as a place located in time. The Yuna have strong links, both cooperative and antagonistic, with several neighboring culture/language groups, especially the Yeru, Bogaia and the Huli. The Bogaia, Yeru, Hewa, Ok Tedi, Huli, Ipili, Strickland Plains peoples, including the Phebi, and at least some Papuan Plateau peoples further to the south (including speakers of Foe, Fasu, and languages of the Bosavi language family) are identified by the Yuna as having a common primordial origin with them as the Hela ingini (sons of Hela), who came to life in the Strickland Gorge.

The Yuna people had no direct contact with Europeans until the 1930s. Sturzenhofecker in her anthropological thesis records that first European invasion occurred in 1934, an unauthorised entry by the brothers Tom and Jack Fox searching for gold. Following the Fox brothers came Taylor and Black under the Australian Administration known as League of Nations Mandated Territory of New Guinea before the Second World War which then became United Nations Trust Territory. The pair were accompanied by a team of huge local carriers. They also ventured into search for gold. Taylor later establishing a small gold lease at Pogera which later became the Pogera Gold exploration owned by the Australian company Placer Dome and operated by the Pogera Joint Venture. Since then, was sporadic through the 1960s with missionaries through to 1975 when PNG gained its political independence. 

3.3 The 'Kiap' colonial system

In the twentieth century when PNG was under the Australian Administration, there were about 2000 'Kiaps' in PNG. Kiaps is a derivative of the Pidgin word 'Captain' which is originally derived from German 'Kapitan'. The Australian Kiaps were basically administrators with a holistic role. Which means Kiaps were barristers, governors, engineers, surveyors, medical officers, dentists, agricultural advisers, policemen, magistrates and more. Through the Kiap system of administration, local reliable and responsible men were appointed as 'Luluais to work with the Kiaps. The Luluais were the point of contact between their own people and the Kiaps.

However, Papua New Guineans were used to a free democratic society. Society was framed around customary mandates for gender roles, status, power distribution, leadership, conflict resolution and peace making. Social establishment has always been passed down from generation to generation. A system of clansman-ship, tribalism and hereditary status and leadership structure. Part of this social fabric has been a system of revenge, compensation, and tribal warfare. The people outright opposed the imposed collection of a small cash fee endorsed by the Kiaps. And this irritated the people making the role of the Luluais even harder. The Kiaps then found themselves overpowered within this juxtaposition of a primitive cultural fabric and an attempt on imposing a colonial rule and values that came with it.

3.4 Lei

I remember vividly, my mother preparing for the arrival of her sixth child. She gave me maternal responsibilities for my four younger siblings. Heavily pregnant and alone, she prepared firewood, food, and water. She headed to the usual birthing cave Randupi and disappeared for the whole evening into the night and two more weeks. The night, the days and the weeks seemed forever. After finishing six years of primary school and two years into high school, I had learnt very little about birthing. I knew mother was having a baby in the bush and living in the bush with her child, my sibling. There was no way I would tell my little ones or Nendege, as asking father about giving birth, sex of baby, how mother was doing etc. was breaking custom. I hoped and waited that she and our sibling were doing well. Eventually, Nendege came early one morning to tell us the good news. Our mother had received our baby brother from the tree gods. And they were living next door, in a little hut until such a time we could see them. When I was little and growing up with Nendege, I would be curious and ask her many questions in our long conversations into the nights. I would ask her where the beautiful babies came from. She would tell me that babies were gifts from the gods of the banana trees around our house. Only our mother just like any other mother was the only authorized person by these gods to collect our babies, our siblings. Father was a very sacred figure in all the birthing and collecting babies’ affairs. He would be away on long hunting or camping trips from the time mother would travel on the birthing journey until the puerperium had ended. This means father would be away for up to two months. This is part of the custom. If a woman faced complications during pregnancy, labour, or the puerperium, she would be expected to manage it all on her own. If she couldn’t manage it and led to the death of her baby or herself or them both, it would only be known by an elderly woman figure such as her mother who would be briefly assisting her.

Mother had us four girls and only one son. She was well pleased she had given birth to her second son. My mother was once again blessed with her last-born child who also turned out to be a boy when I was in college. In the Yuna culture, being able to give birth to more male children give a woman recognition. She gains honour and respect from her husband and her society. It brings honour and status for the family. It gives her husband pride and dignity. Mother was very proud especially at the birth of her second boy child, who was born after five of us. She held her baby as if this was her first child. This was her favourite child. We were not to see our baby brother for weeks until the umbilical cord had completely dried off. We waited. When the baby was about four weeks old, mother brought him out of our birthing haven, cave Randupi. She had called him Leneti, in English Leonard, we call him Lei. We welcomed our healthy sibling. We were complete, six children, two boys and four girls, at least at that time, before our last brother was born.

The boy Lei was favourite child of both our parents. He grew into a fine young man. By the time he was at the age of enrolling in primary school, our only primary school from which I had completed my six years of primary schooling had closed. The school had insufficient teachers. As a new school and with limited trained teachers from the village to remain in the school and teach, teachers were recruited from other urban, well-off centres. Since the road infrastructure was absent, there were no markets and stores where teachers could buy groceries and other basic needs for their families. The school itself had run short of supplies. This led to forced closure of the school. This meant that all my siblings after me had no school to attend to. Since they were close in age, they were all at school age, doing household and social obligations in the village instead of schooling.

By the time my mother had only given birth to my last baby brother after Lei, I returned to the village for holidays as a third-year general nursing student from Balimo College of General Nursing. I was thrilled to see my baby brother. I was also thrilled to see my siblings’ all grown teenagers. Sadly, none of them at school. They were all doing all the gardening, household, and baby-sitting duties. My two brothers were growing into fine young men. I quickly settled and found village roles to fulfill during my brief holidays and returned to college.

I realized that this holiday was very brief to connect with my six siblings. I hadn’t spent time growing together with them as I spent most of my childhood years with Nendege, then went onto primary school, then to high school and onto college. I felt like I had been given the golden opportunity, chosen out from my group. I quickly realized that each of my siblings played different roles, with their different personalities, attributes, and gifts. I felt proud. They were all beautiful and well mannered. They shared and cared for each other. They respected and obeyed their parents and each other and their friends. I loved our family dynamic and my family. But I was very sad. That none of them could be at school.

By the time I had returned to Balimo to complete my final year of nursing training, my parents had separated. It is a culturally acceptable practice that when a man dies leaving his wife, the remaining brothers have entitlement to take the widow as wife. If the deceased husband didn’t have a brother, an immediate cousin brother or someone close from the same clan would take the widow to wife. In this case, my dad’s cousin brother had passed away leaving two wives. So, my father wanted to take the second widow for himself. However, my mother didn’t approve of it. Hence, they had separated with an argument and my father moved out of the house and was living on his own. This meant that our mother was alone to raise all five children since my Nendege had also passed on.

There was something about Lei. He was very smart, outgoing, vocal and a risk taker. He had a no-nonsense personality. His leadership qualities, knowledge about the family genealogy, customs and rituals of the land soon outsmarted his older brother. He was growing up with a reputation among his peers and siblings. Although rest of us his siblings would only visit our father when our mother gave permission, Lei spent more time with his dad. Our father was a well-known butcher and hunter in our village. People from nearby parishes would submit their requests for our father to hunt for them in exchange of pigs, kina shells, clothes, and cash. In our village, my father has a huge land which extends from the vicinity of the main road all the way to Kialoro. Kialoro is about half a day on foot from Pakura village. Kialoro is very fertile with untouched natural rain forest and wildlife. This is the village impacted by the Oil search LTD Juha Suspect lines exploration. My father would often go hunting there for possums, cassowaries, echidnas, and tree kangaroos. He was expert hunter. He had two dogs who were his ultimate companions in these hunting trips. And not at any one time did they return empty handed. Hunting was a skill my father used to sustain our big family.

Lei soon learnt hunting skills from father. He also learnt dog training skills, genealogy histories, land boundaries and social rituals and obligations. Soon when he was into his late teenage years, father would have passed down everything a son should know about the land, custom and people down to Lei, his favourite son. With these inherited knowledge and skills and his own personal attributes, Lei soon became a well-known carpenter and architect. Lei was a natural talent. He was only an illiterate teenager with no formal education. However, he excelled in natural architectural skills and expertise. He also excelled in carpentry skills. Only when he was about 14 years old, he began designing and building houses for his own family. The rest of the community saw his talents and hired him with pigs, food, and valuable items so he could design and build their houses. He became a popular young man with talent and skill. He accumulated wealth for himself in the form of pigs, weapons, tools, and food supplies. He built a reputation. He had become famous and skilful. He was admired and liked by many. Addition to all these, Lei was the boy next door, an ordinary young man, doing his thing, growing up into manhood, into a good man. He was kind and selfless. He loved helping those that were disadvantaged, single mothers, orphans, and widows. He loved young men and boys and had so many peers. He made his parents proud.

By the time Lei was grounding himself, our last-born brother had moved to Tabubil on foot. He walked from our village across Strickland River and onto Teleformin and eventually Kiunga and Tabubil with other boys from the village. This journey on foot takes about two weeks minimum. Since there isn’t a school or any form of economic activity in the village, young men travel such risky journeys on foot searching for opportunities. Our second brother also moved to Port Moresby looking for opportunities. Our third born sister married and moved out of the house and moved in with her husband in the same village but marrying into a different clan. And our fourth born sister also moved to Port Moresby with her husband whom she met during her travels. As for me, since graduating from Balimo Nursing School, I immediately got a job at Kapuna Rural Hospital in Baimuru, Gulf Province as a registered nurse. I was working there for two years until I returned to the village and got married in 1997. I then left the village and got into different jobs, changed careers, had children, and travelled leaving home behind. This meant that we had one young sister left with our parents with Lei. Altogether three of our siblings were living in the village while four of us were elsewhere.

In early 2013, I received sad news from the village. My aunt, mother’s older sister had fallen ill with Typhoid Fever in the village. She had refused to allow her sons to take her on a stretcher to the nearest health centre, Kelabo, which is located about 10 kilometres from our village. She fell very ill and died. I was devastated. My aunt was a very humble woman. She was simple and cared less about anything. She found joy in making grass skirts for girls as she only had five sons and no daughters. She was humble and kind. Her husband was much older than her. He didn’t have relations or land when he migrated to our village after marrying her. So, she was a private person. I admired her simplicity. I mourned for her loss. But sadly, I couldn’t attend her funeral. By then our mother had lost almost all her family members, her dad, her mum, her sister, her brother. To our surprise, she was strong and grounded. She mourned when she had to, she didn’t allow herself to be broken. She prayed, encouraged other women, and led fellowship groups in her house with women. Soon she was the woman leader in her community. She built a little church in the mountains of Randupi, surrounded with beautiful rainforest and untouched natural beauty where all of us were born.

In 2016, we received news from the village that Lei was now getting married, and we had to make contributions towards his bride price. Culturally, it is an expected and accepted norm that the older siblings marry first before the younger ones. In the case of Lei, his older brother, the second born in the family was not married yet. Lei decided to marry first because he had influence in the village. He made name for himself. He was a leader in his own clan. He was well liked by many for his multiple natural talents. He decided that this day was the chosen day in his life to marry. He had several girlfriends. However, there was this one girl whom he was dating. The Papua New Guinea highlands custom of dating involves exchange of gifts. Girls would present their boyfriends with string-bags which they weaved themselves, sometimes they would present best garden food and wrist bands. Boys would gift their girlfriends with necklaces, money, and labour work to the girl’s family. So, Lei was seriously dating his girlfriend to marry her one day.

Lei married in August 2016 and had their first boy child into the end of their first year of marriage. When Lei's son was only a few weeks, there is a conflict between him and his wife's family which broke out into a big fight in the village. When Lei was bending down in complete ignorance, a group of over five of his wife's cousin brothers and distant relatives surrounded Lei and busted him up with sharp rocks, bush knives and hammer on his posterior head, neck, face, and hand. Lei was defenceless and fell unconscious to the ground. He recovered from a long concussion.

3.5 Schizophrenia

A few months into the incident, Lei began to be very confused and disorientated. His behaviour changed and couldn’t think or concentrate anymore. Slowly Lei’s family realized that his behaviour was deteriorating. Lei started becoming violent and resentment. By then our last-born brother took him to Tabubil in an attempt to seek medical attention. Lei became worst because there is no mental health Constitution in Tabubil. So, he was transferred to the Laloki Psychiatric Hospital in Port Moresby. He was admitted there for a few years and recovered from schizophrenia and was discharged with ongoing medical treatment. Lei had returned to the village in December 2018. Lei was well until the beginning of 2020 when his schizophrenia symptoms re-developed. Lei would go to old graveyards of dead relatives and dig up their skulls. He would take these corpse skulls and use them as his pillows. As we have seen, there is a gap in the mental health care system in the country where remote villages are especially far disadvantaged. As such Lei's paranoid and violent symptoms became out of control. He burnt down many properties, food gardens and domestic livestock. These violent symptoms lead to Lei committing the murder of three innocent men between February and June 2020. All three deaths are preventable if Lei had access to proper mental health care and treatment. I will write about how two of the murders took place in Port Moresby subsequent to Lei being released prematurely into the community.

3.6 Social crisis, compensation and peace-making

Soon after the first murder in the village, Pakura village was burnt to the ground. This is expected as a cultural pay back system. Lei himself sustained eight arrows which he managed to remove them himself and survived. Innocent women and children received intimidation and threats and fled for their lives into hiding places in caves and jungles. Compensation claims have been exhorted onto Lei's family in the thousands of cash and pigs, both killed and alive. The claims have been paid from June to September 2020. 

In the customary way, when a life has been intentionally taken, there is a custom for compensation. Local mediation team negotiate in between the victims’ relatives and the offenders’ kin on a compensation demand and is agreed and paid. Peace made. This means that the murder case doesn’t go pass any legal establishment. However, the way the claim is handed down has its own custom. It could be lawless destruction of property, threats, harassment, intimidation. There is a set amount, but claims exaggerate that to instil fear. Innocent kinship of the offender become targets for revenge. This is accepted by society as an inevitable occurrence therefore the entire clan of the offender lives in fear and often go into hiding. The victims’ kinship often refuses mediation decision handed down by local mediation team. This is usually the cause of tribal fights or murder of an innocent life.

The PNG Criminal code (Amendment) Act No 42 of 2015, Section 28, Amendments 3&4 concur that a person suffering from mental health issues cannot be tried but referred to a mental health institution. However, in Lei's case, the crisis has been managed through the customary way. The customary way doesn’t have exception for the insanity. Which means a crime resulting from insanity is no different to intentional crime, in this case murder. Hence the custom is uniform regardless. While the law is clear on insanity, the customary approach is decaying society. Mutual Understanding is lacking when innocent kinship of insane offenders is victimized, threatened intimidated to live up to threats, demands etc. Such is instilling emotional trauma and vulnerability. Furthermore, there is lawless destruction of property.

4. CONCLUSION

Lei is serving a life sentence in Bomana Correctional Services in the outskirts of Port Moresby. Cultural compensations have been paid in full to the relatives of the three men killed. A legal and common-sense system of equitable peace making is a long way off in the lens of a PNG cultural fabric. 

 

A typical compensation claim handed down by victims' bloodline to Lei's bloodline

A typical compensation claim handed down by victims' bloodline to Lei's bloodline

References (*see for example)

Pacific Islands Legal Information Institute (paclii.org)

Allen, M & Hasnain, Z 2010, ‘Power, pork and patronage: Decentralisation and the politicisation of the development budget in Papua New Guinea’, Commonwealth Journal of Local Governance, no. 6, pp. 7- 31, viewed 1 April 2012 (online: http://epress.lib.uts.edu.au/journals/index.php/cjlg/article/view/1617/1748).

Ausaid 2010, Papua New Guinea development challenges, viewed 4 May 2011 (http://www.ausaid.gov.au/default.cfm)

NRI 2010, PNG provincial and district profiles, viewed 5th January 2022 (www.nri.org.pg)

Reilly, B 2002, ‘Political engineering and party politics in Papua New Guinea’, Party Politics, vol. 8, no. 6, pp. 701 – 718, viewed 5 May 2011 (online: http://ppq.sagepub.com/)

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