ADI is working in partnership with New Ireland Provincial Health, and so our patrol team included 10 provincial and district health workers who conducted complementary services such as community health education whilst I treated patients and trained local staff.
Konoagil: TB and malaria rife
Over three weeks, I saw many patients with TB symptoms – weight loss, chronic cough and coughing up blood. Unfortunately, many of them had not gone for TB testing as it is too far and too expensive to travel to a hospital. In the meantime they continue to spread TB. There is currently no effective TB DOTS program in the province.
One of the recommendations from our patrol is that a staff member from each health centre be trained up to do sputum microscopy for TB. In fact, the Provincial Director of Health has already made plans to send a laboratory technician around the area to test TB suspects, based on what we found.
We also saw many patients with filariasis (elephantiasis), so the District Health Manager is now planning to start mass drug treatment in this area, similiar to the program ADI ran in the Nomad/Mougulu region of Western Province in 2003-2008.
Malaria is very common in New Ireland – officially 44.7% of the population is infected – and I saw many people with huge spleens and anaemia from recurrent attacks of malaria. Sadly, I also saw a few children who had become partly paralysed after an attack of cerebral malaria and several who had developed epilepsy after cerebral malaria or meningitis.
Puk Puk: first doctor in a decade
Our first stop, Puk Puk, means “crocodile”. Once the news was out that a doctor was around, an overwhelming 138 patients turned up – no doctor had been there for over 10 years! The local nurse Tom and his two health workers helped translate. During patient consultations I discussed diagnosis and treatment and reinforced good history taking and examination to provide some on-site clinical training.
Lamassa: rough seas and a wrecked health centre
Lamassa has a catchment population of 2,700 people. It’s even more remote than Puk Puk and the health centre is extremely run down. The local nurse Andrew has worked alone for the past four years as no one is willing to fill the vacant second position.
There’s only one chair in the whole clinic and no running water as 11 years ago a “king tide” swept through Lamassa, wrecking the water tanks and generator which have never been mended.
There’s no communication either as the radio mouthpiece has been broken for four years, and no clinic boat as two years ago it got wrecked on a reef when Andrew was taking a patient with a retained placenta to hospital.
Upon leaving we were very fortunate to escape unscathed when our boat ran out of fuel in the dark. Due to rough seas and tricky landings, Konoagil has suffered a high number of boat accidents and shipwrecks in the past.
Manga: health centre very clean and well organised
Manga has a catchment population of over 4,000 people. The health centre is run by the Catholic Mission and it’s very clean and well organised. There are two clean water tanks to drink from, clean pit toilets for staff and patients, and a working refrigerator and adequate stock of vaccines.
The nurses provide a very good service for the community and see about 50 outpatients a day. They screened my patients so that I saw only the more serious cases and those that the nurses were not sure how to manage. This gave me a bit more time to spend on each patient and also time to prepare a teaching session on a topic they requested, “How to suspect TB”. In addition, I conducted some case-based teaching on TB, appendicitis, oral cancers and asthma.
Silur: a hotbed of tropical yaws and hepatitis
Silur has a catchment population of 3,000. Particular health issues and cases of note included filariasis, yaws (a tropical skin disease which if left untreated can destroy bone and tissue), hepatitis, poor hygiene, two cases of children partially paralysed after having had cerebral malaria and many TB suspects. Despite this, Joyce and the health worker Karl (who has been here 25 years) do a great job.
I was keen to visit nearby Morokon village because it’s the hotbed of yaws and home of the hepatitis sufferers. And because its aid post is currently closed due to a lack of staff housing. Unfortunately, I was unable to go because the boat landing there is difficult, stony and the seabed falls away quickly.
Admiration goes both ways
The communities were very appreciative that we had come. We were twice honoured with a pig feast, which was tender and delicious (and well cooked thank goodness!) and prepared in a mumu (an oven made of hot stones).
I built up a great admiration for the local nurses and health workers. They do an amazing job, working in isolation – and sometimes dangerous conditions – with very little support. They were all so pleased that a doctor had come at last and they could get me to see patients whom they were concerned about.
AFMW is proud to bring you reports from Dr Liz Scott on her experiences in New Ireland with Australian Doctors International. For more information about opportunities for doctors to volunteer to work in PNG please visit the ADI website.