Realities of remoteness

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When people refer to Papua New Guinea (PNG), so often the word remote is used to describe the diverse, rugged nation but throughout my fairly significant travels I have never been to anywhere quite so disconnected, with so little infrastructure and I think it is quite hard to imagine what remote means when we have convenience at the press of a button and a shop just around the corner. Remote means no road, no ambulances, no power, no water and no real services accessible for a very, very long way; seclusion at its most isolated. And this is how around 85% of PNG’s 7 million population lives.

In PNG a woman dies from pregnancy related causes every six hours.

There is no one answer for the poor healthcare in PNG but remoteness is probably the biggest cause of some of the major medical issues. Maternal mortality for example, being days away from a hospital means that women have to give birth at home with no experienced healthcare professionals to help them. In PNG a woman dies from pregnancy related causes every six hours. 98% of these deaths would have been prevented with better and swifter access to quality healthcare. In four hospitals in PNG nurses are now being trained to become qualified midwives. There are health workers in PNG, albeit a very low ratio for the population with 4.6 registered nurses per 10,000 population, but most prefer to live and work in the towns so these remote communities do not have the services that they need.

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The big health concerns in PNG are care for pregnant women, malaria, sexually transmitted disease, malnutrition and the biggest of all, violence. All of these areas are key focuses for aid organisations with incredible work being done in each area but there is still more action to be taken and awareness to be raised.

DSC_0270Lack of resources is a major problem, particularly in the provision of diagnostic testing; such as CT scanning, ultrasound scanning and blood tests; in addition there can be no stock of expensive yet vital medicine such as snake antivenins. Matt Reeves, Medical Student from Australia reflects on the six weeks where he worked at Modilon hospital in Madang: “While I was at the hospital there was a five bed Intensive Care Unit (ICU) which sat empty because there was no money to keep it open, and young sick people who would really, really benefit from the high level care that could have been provided in an ICU went to wards and passed away.”

On countless occasions I heard from my health worker colleagues that there was no water at the hospital and on some occasions no power. This makes it exceptionally difficult to treat patients with doctors washing their hands with bottled water or carried in buckets from the rain tank or some other source. Once I sat in the labour ward and watched a rat scuttle by. It puts a very different perspective on cleanliness and hygiene in a health setting when viewed from this context. I was also astounded to hear that drugs long out of use in the UK were being used to treat patients. I certainly never imagined that the dedicated health care staff would be working with such barriers to treating patients effectively. Sometimes quite basic drugs and supplies are unavailable.

“While I was at the hospital there was a five bed Intensive Care Unit (ICU) which sat empty because there was no money to keep it open.”

For women the picture really is very bleak. Women’s status in PNG society is much lower than men’s and there is great gender inequality. Women are often powerless to make decisions about their own health so this can impact on family planning options that would reduce high numbers of pregnancies so close together. There are also some cultural taboos surrounding blood and body fluids that deem them to be harmful, particularly to men, which can mean that help may not be forthcoming in an emergency situation. And this is before a woman has even made the long journey to a health centre.

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The most dangerous journey a person makes in PNG is probably that of being brought into the world.  In PNG 5000-6000 new born babies die a year, mostly from prematurity, low birth weight, birth asphyxia and infections; most die in the first three days of life.

In PNG a newborn baby dies every 90 minutes.

DSC_0262Despite all this the hospitals are staffed in the most part with compassionate and dedicated staff doing the best that they can with the limited resources available. And there are positive things happening, Voluntary Services Overseas has a highly skilled health worker supporting the obstetrics department, the family sexual violence team is having a major impact in Madang and Mendi and there are some huge projects about to begin including one to revise the national nursing curriculum. The World Health Organisations nursing and midwifery team working across PNG is doing incredible work training new midwives. In 2014 they have trained about 70 midwives from many Provinces. The Institute of Medical Research is also making great progress in anti-malarial drug development as well as distributing bed nets and making sure prophylactic medication is available. This is just the tip of the iceberg of the life changing work that is happening on a daily basis in this remote part of the Pacific.

We really are so lucky to have the free health service that we do in the UK. Next time you complain about how long you have to wait to see your GP just think for a moment.

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