It was the loneliest of births for Papua New Guinea woman Gile Sayiyong, trapped in a remote village deep in the mountainous jungle of Morobe province, unable to reach medical assistance because of tribal fighting.
Ms Sayiyong gave birth to triplets with no nurse or midwife on the 12th of July. Her children were dangerously underweight, yet she couldn't reach the nearest medical centre because of the fighting further down the valley. Two warring parties had destroyed a footbridge, trapping Ms Sayiyong in Bulu village.
Unable to get medical care, Ms Sayiyong relied on a complex helicopter evacuation, something which would not have been possible had her triplets been born a few years earlier.
"Late in the evening we received information that triplets had been born in Bulu village," said Jurgen Ruh, chief executive of Lae-based Manolos Aviation, Papua New Guinea's first and so far only medical helicopter service.
This woman was in a remote area without even a midwife. She gave birth, unsupervised. She delivered, and saw three babies. All the information we had in the absence of any medical staff was that the babies were very small and needed to come into a nursery.
For Mr Ruh and his orange helicopter, embarking into the rugged, isolated, and densely forested mountains of upper Morobe province would be no easy feat, especially last Wednesday.
At first light, Mr Ruh lifted off from Lae, the provincial capital and PNG's second largest city, for Bulu, normally a 20-minute flight, he said. But a thick fog had filled the valley and heavy rain was cascading down its walls, making access to the village nigh on impossible.
"I followed up the river very close to the surface, but as I got further in the rain got heavier and the clouds got thicker," explained Mr Ruh nonchalantly.
"I turned around and tried to get over the top and see if I could go down into the village; I tried to go from the north, I tried to go from the east. Then, three hours later, the fog had lifted slightly and I was able to come under the cloud into the village and retrieve the patients."
Gile Sayiyong arrives at Lae Heliport carrying her babies in a bilum. Photo: Supplied/Niugini Heliworks
"The mother was able to walk onto the aircraft unassisted and her mother and her husband came onto the aircraft as well. The babies were in a small bilum - a small bag which you hang over your head - and [the triplets] were, beyond expectation, quite healthy. But the most crucial aspect was the smallest of the babies, which I don't think would have even been one kilogram," said Mr Ruh.
The mother and triplets made it to hospital in Lae, where they remain under observation, but are otherwise doing well, he said.
The dramatic rescue of Ms Sayiyong made local newspapers and was widely discussed on social media forums in Papua New Guinea, but for Mr Ruh, who started the Morobe medical helicopter service in 2009, it was a pretty standard workday. In fact, on the day of our interview, he said he had to perform another medivac for a child who was born feet first, then he had to ferry supplies for a school before he was free.
Just a pilot and a stretcher
Manolos Aviation started in Morobe in 2009 with the most basic of service. "It was just a pilot and a stretcher," he said. That year, Mr Ruh's service rescued about 50 people, but that number has steadily increased each year since then, aided by the expansion of mobile phone coverage in remote areas.
Janet Kum's placenta remained inside her for four days before she was able to be transported to hospital. Photo: Supplied/Niugini Heliworks
Mr Ruh said the introduction of a medical helicopter had had remarkable effects in Morobe, with the province now one of PNG's highest performing districts in terms of healthcare coverage and survival rates - a country where accessing the most basic of care is often a challenge in itself.
In January, the service launched a second helicopter and expanded into neighbouring Milne Bay and Oro provinces. It was at the launch of the Milne Bay service, Mr Ruh said, that he really saw the extent to which health workers would go in trying to save a person's life.
"The health workers would often go from the health centre into villages, treat a patient, then put the patient perhaps on a speed boat, go across rough waters to try and arrive in Alotau [capital of Milne Bay] a day, maybe two days later only to see that the patient may have expired on the way. Then they would go back to the villages and do the same thing again."
"Now, with the service available in Milne Bay province, from the time a health worker calls for help it's perhaps an hour before the patient arrives in Alotau Hospital."
But operating Papua New Guinea's only medical helicopter service isn't without its challenges.
Not for the faint-hearted
Mr Ruh said finding pilots was often difficult, as the country's rugged, inhospitable terrain and climate made the country's flying conditions some of the most difficult in the world.
"Twenty minutes from here in Lae and you're already at 13,000 feet; you've got the seasonal weather - we're currently in the rainy season - but there are a lot of challenges here," he said.
"We had a pilot arrive from South Africa two months ago to fly with us. That pilot saw the terrain and weather for two weeks and basically said, 'sorry this is not for me'. The pilot was not used to having mountain-after-mountain with wind, rain, fog and cloud, and having all those conditions change so quickly."
Helicopter pilot Jurgen Ruh holds the baby of a medivac patient alongside the mother and hospital staff. Photo: Supplied/Niugini Heliworks
"Basically, I conduct a medivac and then hope to get paid later," said Mr Ruh. "Sometimes it takes up to a year to get paid, so it is a struggle. I could make further and further improvements if payments would come a little faster.
In six years, the advances Papua New Guinea's first medical helicopter service has made into three provinces are immense. But Mr Ruh isn't content, casting his sight on further expansion.
"I plan to expand into the Highlands soon and my ultimate goal would be to be able to reach any village in Papua New Guinea within two hours notice."
