Papua New Guinea

young dancers in serafuna
Children who performed a traditional dance in Serafuna, Papua New Guinea (Hepatitis B Free, July 2013)

Papua New Guinea (PNG) is Australia’s closest neighbour, coming within 3.7km of the closest border. However, while Australia is ranked 2nd out of 177 countries on the UNDP Human Development Index (2015), PNG is ranked 158th. Despite its abundant natural resources and more than three decades of political independence, the majority of its population live below the poverty line. 87% of the population live in rural areas, often in remote communities with very limited road access. The fact that PNG is one of the most diverse countries in the world – geographically, biologically, linguistically, and culturally – also creates unique challenges for healthcare delivery.

Hepatitis B is endemic in PNG, affecting an estimated 8% of the population. Government support systems are in place: hepatitis B birth dose and triple dose are included in the national immunisation programme, and a policy to vaccinate all health care workers from hepatitis B was established in 2013. However, these initiatives do not assist the large number of people already living with chronic hepatitis. For these people, at risk of developing liver cancer or failure and death, there are limited testing and treatment options.

Map of papua new guinea [Source: free world maps]
Map of Papua New Guinea [Source: Free World Maps]
Hepatitis B Free in PNG

The work of Hepatitis B Free in PNG began in 2013. Since then, more than 7600 vaccines and 7781 medical consultations have been given. These include pentavalent, hepatitis B, tetanus, and measles, mumps and rubella (MMR), in accordance with the national immunisation policy. Our focus has been on delivering healthcare in isolated areas without access to timely immunisation due to challenging terrain, distance from health services, and a low health care worker to population ratio. In 2013, we worked in the Oro Province, such as Itokama and surrounding villages, as well as Kokoda and Popondetta. In 2015, we continued to work at 3 clinics at Popondetta and 3 village clinics (Gajot, Tahama and Itokama).

In all of the communities we service, there is a dire need for improvement in healthcare delivery. In Itokama for example, there is no running water, no electricity and no plumbing. The entire community is served by two health care workers who have undergone a two-year diploma training course. Ezekial, one of the health care workers, completed his two-year diploma more than 20 years ago and has had very little further training since then. There is no formal, regular, ongoing educational up-skilling programme for these invaluable healthcarers. Medical supplies for the community are provided for by provincial medical stores in Popondetta, to which roads are unsafe in the wet season.

Our approach is to undertake sustained, close work with existing systems and staff, whilst passing on key skills and training. In the Barai Villages, we partnered with tribal leaders and community health workers to deliver immunisation and medical outreach. Close partnership and logistical support from health staff of New Britain Palm Oil has greatly facilitated our work in Popondetta and surrounding health posts. As a small and mobile team, we have been able to offer vaccinations such as the hepatitis B birth dose. It was not uncommon to see many mothers travelling for days carrying their pikini (children), sometimes in colourful weaved billum bags, to be immunised at our clinics.

Identifying further healthcare needs whilst on the ground, our team of medical specialists have also undertaken work beyond the administration of hepatitis B vaccinations. For example, in 2015, our optometrist provided 554 eye examinations and distributed 191 eyeglasses. Formal in-service training for health workers in Popondetta about appropriate antibiotic usage was led by our pharmacist. We have also supported two local students over one semester of their nursing education in Port Moresby as a crucial investment in their communities.

Where to from here?

There is much to be done to further our work in medical outreach and education. We hope to continue to support health workers at clinics in Popondetta and nearby villages, and to disseminate educational materials and provide training for health care workers. Logistic planning is underway to set up water tanks at Itokama health clinics, providing invaluable access to clean water and better sanitation. In future trips, we hope to continue to explore avenues to support other isolated communities in the Oro Province.