Without a road or airstrip, the only way for medicines to get to the health centre are for them to be carried from the Ramu Highway. Jakob goes to town and collects the medicines from the provincial health office transit store. He uses the user fees from the health centre to pay for a PMV to carry the medicines to the roadside – a small market stall on the side of the highway above a community school. Just behind the market stall at the head of the track inland lives Samuel, whose father is from Begasin, but who settled on his mother’s land near the highway in order to be able to establish a road building business. Samuel lets Jakob store the medicine on his porch while he returns to the health centre and calls out for volunteers to come and pick the medicine up. Each village takes a turn to do the collection.

On arrival at the highway, the women empty the large boxes out into their bilums, which they carry on their heads. Young men carry smaller boxes on their shoulders. One person’s load can be up to 40kgs. Carrying the medicines is painful work, but people are not paid for it. Instead, I am told, it is community work. Sometimes, Jakob gives carriers paracetamol or amoxycillan in exchange for carrying the medicines. Sometimes, if he sees them carrying the medicines, he doesn’t charge them when they come to the health centre. But if there is conflict with the health centre staff, the community will refusal to carry the medicines. Similarly, if the health centre staff feel under threat, they simply close their doors; a sign that the exchange relationship has broken down.