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A Piece of My Mind
January 20, 1999

Underlying Cause

Author Affiliations

Edited by Roxanne K. Young, Associate Editor.

JAMA. 1999;281(3):215-216. doi:10.1001/jama.281.3.215

Dusk. It descends suddenly, decisively, in the tropics, a silent, cosmic curfew delimiting day and its labor from darkness and its repose. As certain in the hospital as in the village, sunset signals a respite from rounds and operating rooms. So why the commotion as we arrive at the door of Tari District Hospital? An entire Huli clan, always colorful but now also uncommonly concerned, is clamoring for . . . what?

Dawn. It had come clear and cool to Papua New Guinea on the 13th anniversary of its independence—at least in the Southern Highlands. Leaving the other two physicians at the hospital in the Tari Valley below, I had greeted this dawn in the mountain rain forest at 8200 feet. We had gone, half a dozen Huli and expatriate friends and I, hoping to sight the elusive bird-of-paradise. Clouds and fog shrouded the valley of the Huli 3000 feet below. One of 700 distinct tribes/languages in this southwest Pacific Melanesian island nation, the Huli, hesitant to demand independence before it was granted by Australia, now are eager for the annual celebration. We seven knew that in the morning mist below, 30,000 Hulis were donning their magnificent traditional headdresses and cous-cous skins. Home to a million Melanesians, the Highlands of Papua New Guinea were not "discovered" until the 1930s; only after World War II were they extensively explored by outsiders. Despite unparalleled "progress" since, there persists a primordial pride in clan identity—and the clan warfare that preserves that identity. As a young general practitioner I, with my family, had spent a thousand days in Papua New Guinea before its actual day of independence in September 1975, when our youngest daughter was born there. We stayed another thousand days after independence. We learned. We saw our Melanesian colleagues give birth to a new nation, delivered in peace, with a primal potential for prosperity. A decade later I had returned, this time to Tari, a thousand-soul "government village," 100 "Highland Highway" miles from our prior home at Enga Hospital.