Hi there. Time for another post I think. I’ve slowly been drawn into the health sector through having two med students stay and with Melanie having organised events for National Health week. I’ve got a couple of friends down at the local hospital as well, so am getting a bit of exposure to the issues they are grappling with here.
Papua New Guinea is facing some significant challenges. According to a recent evaluation of national progress across key indicators, governance and law and order are performing badly and getting worse. Health has had an average performance, and the trend since 2000 for primary health care is for further deterioration.
I personally experienced proof of this when I visited two medical centres on Buka Island (there are three levels of service – aid posts, medical centres and hospitals). A medical centre is a pretty basic operation, providing basic treatment and child delivery services. No doctors amongst the staff; a Health Executive Officer role plays both an administrative and slightly more than a nurse but much less than a doctor role. The HEO is supported by three nurses and three to four ‘health care’workers (I don’t know what they do, something along the lines of family planning etc). I have to say, it was pretty rough. The table for giving birth is literally that – a table, plus two posts for the stirrups. The only bed available in the first medical centre had some collapsed cardboard boxes in place of a mattress. It was also meant to be powered but the contractor nicked the generator when he wasn’t fully paid out.
According to the statistics (which are publicly available), a health provider can expect to be short of vital drugs for 5 out of 12 months of the year. This includes drug treatment for pneumonia, malaria, tuberculosis and dysentery, the typical illnesses bringing patients in from the villages. Both centres I visited had a dedicated room for drug storage, each with four shelves on four walls. The total amount of drugs and bandages stored in those rooms would barely have filled just one school bag. I couldn’t believe it. Neither could my friend Dr Vilosi, who I am helping to plan an inspection tour of all medical centres and aid posts in Bougainville. According to Dr Vilosi, it hasn’t been this bad since the war.
And then there is the maternal death rate. I can’t quote the rate here, since I don’t have the precise figure, but it is alarmingly high, and according to the government, amongst the highest in the world. This rate is measured by deaths per 100,000 live births, but it is also useful to measure the number of deliveries supervised by a qualified attendant. The war did a lot of damage here, as services were shut down, forcing mothers to give birth unattended in villages and at worst, in the bush.
The good news is that, with the resumption of services, it is possible for most births to be supervised now. Should there be complications, however, it can be difficult to get qualified advice on what to do. Let me share a story. An expectant mother in central Bougainville had complications when the baby became obstructed. With contractions this put the future mother in a lot of pain. The HEO (trained in this area, but no expert) in the local medical centre misdiagnosed the problem and gave her a drug which increased the contractions. Now the life of both the mother and the unborn child were at risk.
At this point you are probably hoping that a trip to the local hospital was arranged. With no ambulance and no private vehicle, the family were forced to raise $1000 kina to hire a vehicle and bring her to Buka. This caused further delays and placed added stress on the mother. Thankfully her family was able to raise the funds and she was safely delivered to Buka passage, where she was put on a boat to cross the channel.
Although the channel only takes about three minutes to cross, and the hospital is about two blocks from the landing site, treatment was out of reach. By this point the mother had endured six days of contractions, contractions which had increased due to an incorrect diagnosis at the health centre. That proved too much; both mother and the unborn child died on the boat, five minutes from the hospital and the treatment that could have saved them both.
Heavy stuff, sorry. The good news is that we are hoping to organise a Health Summit here to try and address the issues. All the top dogs are behind it, and by the time you read this I should have met with the CEO and Director of Health and the ball should be rolling. Will let you know how it goes, if of course anything does happen!
Ka kite ano,