by Mike Steketee
Doctors and nurses are gathered around an operating table conducting an emergency caesarean at the general hospital in Popondetta, a 25-minute flight north over the Owen Stanley Range from Port Moresby.
It could be a scene in any Australian hospital, until you look around. The operating area is a small recovery room next to the real operating theatre, where the ceiling has collapsed. On one side, nothing more than a curtain divides the area from the sluice room where medical waste is kept and instruments and gowns are washed.
The building was last condemned by health authorities in 2005 and before that in 2002. The sterilising equipment was out of action for almost four months last year after rats chewed through the cables, meaning instruments, gowns and bandages had to be sent to Port Moresby.
The surgical ward is in a ‘‘temporary’’ tin shed put up in 1992 after the previous building burnt down. The ceiling is so low that fans cannot be installed to provide relief from the tropical heat. Air conditioning is an unaffordable luxury. Patients with broken limbs have been put into a makeshift form of traction – filled water bottles tied to legs and arms and hanging over the edge of beds.
Australians are used to long waits inside emergency departments. Here scores of people are queuing outside, sometimes all day, for their chance just to make it into the hospital. A nurse is triaging the most urgent cases on the verandah. In the maternity ‘‘ward’’ – actually a small, crowded room – space has been found on a bench in the corner for an abandoned new born baby found wrapped in banana leaves in a vegetable patch. The nurses are hopeful he’ll make it.
Hope is one of the few things in plentiful supply at this hospital. Dr Gunzee Gawin, the chief executive, maintains a cheery demeanour, despite conceding that his job is ‘‘very challenging’’. Perhaps that is because he saw what was possible when he worked as an obstetrician at Sunshine Hospital in suburban Melbourne in 2006 and 2007. There are plans on the wall for the hospital redevelopment, which is due to be completed in 2017. But that has to be tempered against the reality that the work scheduled to start in 2011 has yet to begin and the hospital is still waiting for the replacement of the temporary wards built 22 years ago.
We used to know a great deal about Papua New Guinea. After all, as a colony it was Australia’s responsibility and generations of our teachers, soldiers and bureaucrats lived and worked there. With a population of 7.2m and rising rapidly, it will demand our attention again in the future – and not just as a dumping ground for asylum seekers.
In the meantime, since independence in 1975, PNG has slipped from 77th to 156th for sub- Saharan Africa – on the United Nations Human Development index, which compares measures such as life expectancy, education, health and income between countries. Australia ranks second. According to the World Health Organisation, our nearest neighbour had nearly
18,000 cases of malaria for every 100,000 people in 2011 – 4 ½ times the world average.
Tuberculosis was running at 534 cases per 100,000 population– more than three times the global average. Men die on average at 61 and women at 65 – 20 years younger than in Australia. According to a 2010 WHO report, ‘‘the health system has become increasingly dysfunctional and unable to cope with routine tasks’’.
Popondetta Hospital saw about 40,000 patients last year, with 5000 of them admitted. This with 16 doctors – just four of them specialists – and one nurse per ward on each shift. This year patient numbers are running at double that rate – mainly due to the introduction of the new national government policy for free health care. In theory, following this week’s budget in Canberra, that makes PNG’s health policy more generous than Australia’s. The trouble is that the government is giving Popondetta hospital less than half the money it received last year from patient fees.
The supply of drugs is irregular, with the hospital periodically running out completely – sometimes for months at a time. Oro Community Development Project, an Australian-PNG charity that supports the hospital, as well as a local school, helps fill the gaps by supplying medicines and equipment.
On a national basis, the challenges looks overwhelming. Corruption is endemic in PNG, on a large and small scale. The stories are legion, from a government purchase of an extension cord billed at 370,000 kina ($149,000) to politicians helping themselves to tens of millions. Papua New Guinea ranks 144th out of 177 countries on Transparency International’s corruption perception index, based on expert and business surveys on corruption in the public sector.
Gary Juffa was elected Governor of Oro province, of which Popondetta is the capital, in 2012 and sits on the cross benches of the national parliament. An outspoken and articulate leader, he said in a speech last month in the presence of Prime Minister Peter O’Neill that the administration in Oro province ‘‘has grown into a giant organisation that employs anyone at will and whim and does as it pleases with the people’s funds, diverting it to this or that dubious claim or scheme or scam. Prime Minister, the entire province is dotted with unfinished projects that were mere scams to begin with, merely concocted to steal people’s money.’’
Local employers and charities try to make up for some of the government neglect. The Fred Hollows Foundation treats between 70 and 100 patients a week in PNG, mainly for cataracts and other growths on the eye. But hundreds more go blind. Back at Popondetta Hospital, a donated incubator for premature babies lay unused for five years until an OCDP doctor volunteering his services told staff how it operated. Gawin says nine premature babies were born at the hospital last year and all survived. ‘‘Previously, those less than 34 weeks would not make it,’’ he adds. Now babies born as early as six months can be saved.
As the Hollows Foundation’s Maarten Van De Reep puts it, ‘‘Just because we are not solving the problem in its entirety straight away doesn’t mean it’s not worth doing.’’
Mike Steketee is a freelance journalist who travelled to PNG as a member of a team from the Oro Community Development Project.