Saulo Honorobo was a teenager when he first met his wife.
For 30 years he and Marggeret built a life together. They moved homes, they had two children, Marggeret started a small business and Saulo became a community leader.
Then a tumour started to grow on Marggeret’s face.
If Saulo and Marggeret had been born in another country, their story would likely have been different.
But in Papua New Guinea, there is currently no radiotherapy available for people who have cancer.
“The doctor discussed that the only way she will survive is she has to go to have that radiation therapy overseas,” Mr Honorobo said.
The country’s only radiation machine has been out of action for more than two years.
The International Atomic Energy Agency has offered to supply the radioactive sources needed to get the machine back up and running, but before it can do that, the PNG Government has to pass legislation to meet nuclear safety regulations.
So Saulo Honorobo watched as the tumour grew, disfiguring his beloved wife.
They considered selling the family home to try to get some of the money they needed.
“[From] January for six months it started to grow, so we started to ask if [the doctor] could do a referral letter so that we could sell the property and ask for donations and take her to the place where she can get [radiotherapy],” Mr Honorobo said.
But Marggeret died first.
That memory brings the stoic Saulo Honorobo to tears.
“Life has become very tough,” he said.
“I’ve got two children, she’s the only one that looked after them, not me, but I am the only one taking care of them now.
“I don’t need anyone to look after them.”
He has vowed to stay in the city of Lae where they have been living, rather than return to his home village, so that his children can study.
“My son is a bright student in secondary school now, he is grade nine now, a good bright student and my daughter will do her elementary school,” he said.
Like being a gardener ‘but they haven’t given you a spade’
At the National Cancer Clinic at the Angau Hospital in Lae, where Marggeret spent some of her final days, Alfred Mel moves through the wards with great ease and familiarity.
The young doctor stops regularly to chat with visiting family members and still manages to make patients laugh, despite the grim circumstances they all find themselves in.
But when questioned about the lack of radiation facilities, there is a sense of helplessness.
“I tell my patients it’s like being a gardener and being told to go to the garden, but they haven’t given you a spade,” he said.
“You know that you can plant the stuff and make it grow, but if you don’t have the spade, who’s going to break the soil?”
Radiotherapy is one of the most common and effective forms of cancer treatment, especially for cervical, throat and mouth cancers, some of the most common forms of the disease in PNG.
The cancer clinic feels more like a palliative care ward.
Early diagnosis is also a major problem in PNG.
Education campaigns are underway to try to ensure people seek help before the cancer is too advanced, but for a country where many people live in remote villages, it is difficult.
Dr Mel said it was especially hard when patients were in the early stages and should have a good chance of beating the disease.
“It’s terribly frustrating and it makes coming to work difficult,” he said.
“It makes talking to patients even more difficult because a lot of my job now is telling patients, if I had this, it would be different.”
He knows that most of his patients will not be able to afford to travel overseas for treatment.
“For 85 per cent of the population, the absence of treatment in country means that they will die, that’s the sad reality of it,” he said.
100 patients sent home to die in a year
In one of the wards, Dr Mel stops to speak to Philomina Isac.
She sits up in her bed and smiles. She has four children and cervical cancer.
“Most of the patients I came with, most of them died,” she said.
“I am the only one now, all the men and women already left us.
“I am here, I say God is helping me.”
Doctors are doing what they can, giving chemotherapy when radiotherapy, or a combination of the two, would be better.
Ms Isac is receiving chemotherapy and is trying to stay positive.
“I don’t want to think too much about it, I want to live each day as they come,” she said.
“Plenty of people thought of dying and they died.
“I get afraid of thinking too much, that maybe I might take my own life just from thinking too much, I am just at peace and waiting.”
John Clarke from local charity, the Cancer Relief Society, said a lack of action from the Government was killing people.
“Last year alone there were 101 patients who had to be turned away because they couldn’t be given cancer treatment,” he said.
Ms Isac is hoping things change.
“I want to say that if the Government can help quickly, please they must try, because the lives of people — it’s like, you close your eyes and wake up, one dies,” she said.
“You close your eyes and wake up, one dies.
“So, I want the Government to help, I pray all the time that God will help us one day.”
Developing countries carry the burden of cancer deaths
The PNG Health Minister Sir Puka Temu has conceded it has taken too long to pass the legislation required to allow the radioactive sources to be brought in so the radiotherapy machine can be used again.
“Over the last three years, commerce and industry, health and now defence has come in as well,” he said,
“We’ve basically concluded those consultations and then we should be able to have the bill passed.”
The legislation has been approved by cabinet and will now be voted on in Parliament.
“We are addressing the cancer issue — it has been a difficult five years,” Sir Puka said.
By 2030, the World Health Organisation expects that 70 per cent of all cancer deaths will be in developing countries.
The stagnant radiation machine is not the only problem facing PNG when it comes to cancer treatment.
On the morning we visit the hospital, four patients have already been turned away because of a shortage of chemotherapy drugs.
The vast majority of the chemotherapy drugs the hospital does have were purchased and supplied by the Cancer Relief Society, not the health department.
The country is also struggling to recruit a radiation oncologist.
Despite this, Dr Mel, who is a clinical oncology registrar, said he could operate the radiation machine until an oncologist was found.
Dr Mel said he would like to see more funding for cancer treatment, but knew that other areas of health like HIV/AIDs and tuberculosis were also in desperate need of financial help.
Health spending was cut by 2 per cent in real terms in last year’s budget, but Sir Puka said that was manageable and denied the health system was in crisis.
The current cancer unit in Lae is being upgraded with assistance from the Australian Government and the health minister said the PNG Government was also planning to build a new cancer treatment centre in Port Moresby.
“If things go well towards the end of this year, we should have the two centres,” he said.
“We are looking at newer anti-cancer instruments, like a linear accelerator, to provide better therapy for our cancer sufferers.”
But that will likely be too late for patients like Philomina Isac.