For theatre staff, the most precious drug in Buka.

When the theatre drug safe has nothing in it bar a packet of tea, you know you are in an unusual operating theatre. When I volunteered for a fortnight in October 2001 with AusAID in Bougainville, which lies between the Papua New Guinea mainland and the Solomon Islands, I knew I'd have to resurrect my Third World anaesthesia skills. One can come to terms with halothane anaesthetics and a single syringe — the real test is the tea in the drug safe. For the record, that packet of tea made the best "cuppa" I'd had in a long time. You put several spoonfuls of tea into a strainer and run hot water from the urn through the strainer until your cup has the desired strength. Two tablespoons lasted all day. It worked — thus passing the acid test of all Third World medicine.

Faced with a 13-month-old little boy up for three hours of bilateral talipes surgery, I racked my brains: what was the best way to gas him? First World anaesthesia was precluded by the absence of any endotracheal tubes smaller than 5 mm. Anyway, the ventilator didn't work. So I gave the kiddie a knockout premed and snuck up on him with the halothane. Just a few seconds before his Mum and I fell asleep the kid succumbed and I stuck in a laryngeal mask. He breathed himself to sleep for three hours and the surgeon had no complaints. It's a bit like the old air force adage, "Any landing you walk away from is a good landing".

Over the years, I've done lots of tours of "good works" — from trips with the Flying Obstetric Service out of Roma, Queensland (about 500 km west of Brisbane), to those with the Forward Surgical Troop with INTERFET in East Timor in 1999. Nothing has given me the satisfaction of "a job well done" as much as this AusAID tour, and I recommend it to others unreservedly. Our orthopaedic team left Buka knowing there were half a dozen kids walking around the place who couldn't otherwise have done so. How does that compare with the list of arthroscopies that is my usual bread-and-butter?

The Bougainvilleans are trying desperately to put behind them the '89 to '99 "crisis" — their term — when a move to secession left a potentially well-off country devastated by war and pollution (eg, from heavy metal run-off from abandoned mines). Conversations with the intelligentsia left me with the distinct feeling that their support lay with the Bougainville Revolutionary Army (BRA), although they would never admit it, and any conversation on the topic is conducted sotto voce.

I was one of a four-man team of orthopaedic specialists who, since the peace treaty of 1999 and supported by AusAID in partnership with the Royal Australasian College of Surgeons, have made an annual trek to Bougainville. Airfares and accommodation organised for us, we arrived without a hitch on Buka, the northernmost of the two main islands of Bougainville.

First, we had to separate the "VIPs" from the deserving cases. The surgeon had been here before — indeed, his father was a much-respected "expat" from the days before the crisis — and knew that the first patients to be seen in outpatients would be the important people in the village. The trick is to admit that they need surgery but put them off until the real work is done. We did this very effectively, finishing our 25 cases of the visit with three arthroscopies of knees (the postmaster, the bank manager, and the police chief). Interestingly, from a professional point of view, these last three patients had more postoperative pain than that experienced by all the (far more serious) cases put together. Education is obviously related to pain perception.

We were accommodated in a hotel at the opposite end of the village from the hospital. Getting from one to the other involved a long and sweaty walk each morning and evening, sometimes in the dark. A throwaway remark, by a fellow guest and expat, put things in perspective. When we asked whether the locals would harm us, he replied that they would rob us, but they wouldn't kill us or rape us (one of our team was a theatre sister) and, if they did, the village would be pretty cheesed off about it and would probably exercise payback on the perpetrators.

When AusAID teams weren't in Buka anaesthesia was reduced to its true role in the spectrum of medicine and was provided, perfectly adequately, by two "technical officers", who, as far as I could see, had been trained in the "recipe technique" (eg, "give two inches of the big syringe and about half of the little syringe"). They provided a service that would be envied in many Australian public hospitals: they never argued with the surgeon, and nine times out of ten the patient went to sleep on demand and woke up afterwards. I discovered — the hard way — that a speedy recovery phase was in your own interest, as you recovered your own patients. If you weren't careful, then, when everyone else was drinking tea, you were still applying jaw support.

Our team of four knitted together quite quickly. Sister Mary-Lou — whose name, along with those of all the others in this story, has been changed . . . to protect me! — had never done anything like this before. She worked her feet off for 10 days but gave away her Third World inexperience by expressing disappointment when she found out that the only chemist's shop for a thousand miles did not stock self-tanning lotion, this amidst the second-blackest people on earth after Ugandans. She also let it slip, at the end of the trip, that probably nothing we used was truly sterile, as all the bundles were coming out of the steriliser still wet. If she'd told us this at the beginning, we would probably have gone home, but after two weeks we'd adopted a Bukanian attitude to sterility (ie, near enough is good enough). After all, if one can be "a little bit pregnant" then there's nothing wrong with "nearly sterile". A senior orthopaedic registrar joined us for part of the trip; an excellent fellow who worked very hard, saw things he'd only read about, and was imbued with the concept of pro bono work.

The resident doctors, nurses and other staff at the hospital were extremely hospitable to us, and my expressed interest in fly-fishing was rewarded with a social outing in one of the locally built "banana boats" — twenty-three feet of unbreakable fibreglass, with a seriously large outboard. However, as these men fished for the table rather than sport, I felt they found my efforts with a fly rod and "feathers-for-bait" amusing and inconsequential but were too polite to say so.

We spent the weekend in Arawa, the old provincial capital; getting there involved a painful 4-hour trip over dirt roads and tracks in a 4WD "troop carrier".

Arawa is now a burnt-out shell after the BRA razed it to the ground in 1989. However, a new hospital has arisen from the ashes thanks to Australian aid and, at the time of our visit, had been open for only six weeks. It had a staff of two: an Australian doctor, only four years out, and a nurse from New Zealand. The doctor was away in the highlands seeing patients, but had already done a laparotomy for stab wounds and a caesar. I read, with morbid fascination, his guide to anaesthesia that was pinned to the wall of the theatre. It enumerates a Plan A, then a Plan B (both simply lists drug doses and techniques for giving a very basic anaesthetic). For Plan C, it simply says: "There is no Plan C".

We shared accommodation (with hot showers) with several Kiwi policemen, who were there under an NZAid plan to set up an impartial police force. One of them, a young sergeant, described all the expats in Bougainville as either "mercenaries or misfits". Mature consideration revealed that, on social contact thus far, he was probably correct. However, we couldn't decide which group we fell into — one term was as pejorative as the other. Interestingly, several of the locals we met changed their attitude towards us when they clarified that we were not paid for our efforts and were not affiliated to any religious organisation (unless the RACS considers itself as such?).

Tom, the Buka hospital carpenter, had accompanied us to Arawa. He had offered his services as a guide and general factotum, having said that his family came from this area and that he would like to visit them. Over the weekend, it became clear that our friend and ever-helpful guide was actually persona non grata in the area over a past relationship involving the daughter of a prominent local leader.

Notwithstanding this social drama, Tom felt himself truly to be part of the team, joining the ward round of all the local "orthopaedic" patients rounded up for us to see during our visit. I might add, as a mere anaesthetist, that I thought his contribution to management was at least as sensible as the experts', and probably took more note of local exigencies. I've always maintained that orthopods were just carpenters with chrome-plated tools.

The most threatening few moments of my trip actually happened in Arawa rather than Buka, when the "Team Leader" (his words, not mine) Dr Bones sent me off to find beer to sustain us over our weekend there. Tom established that it wasn't available legally. But, he had an address. We set off in the ambulance with Sister Mary-Lou riding shotgun and soon found ourselves in a back street with unnumbered houses. Tom disappeared, coming back with the going price (remarkably reasonable in the circumstances). Then it was my turn to enter the house, without Tom but with 60 kina and a tachycardia. It did cross my mind that the speech of the locals involved in the transaction sounded unusually Australian, but at the time I was more involved in getting out with a case of local beer and both legs working. Back in Buka, I learnt that these locals were the sons of a Buka nurse who had given up everything to educate her boys in Australia. I was quite proud to think that an Aussie education had given these lads an honourable profession.

If you have a few weeks on your hands and can't stand the prospect of spending it on the links or the harbour, give a thought to volunteering your services to AusAid. It will not only broaden your horizons but also "reset your thermostat" as far as the truly important things in life are concerned. Now that I've retired from the black art of anaesthesia, these trips are the only thing I miss about "my old life".