This year marks another year for the PNG Medical Society hosting the annual Medial Symposium, this time in Madang Province. Timely and appropriately in Madang too since the Divine Word University has commenced its own MBBS program for doctor training in the midst of much controversy and debate within the PNG medical fraternity. The public has not been engaged as much as one would expect perhaps from a lack of insight into the running of an MBBS program. But I am sure a good number of middle class parents are happy with the news because they have an alternative to send their children to study medicine should they wish to.
I have been a keen participant at the annual scientific meetings from my medical student days while researching at the Sir Buri Kidu Heart Institute when conducting my research on betel nut chewing and effects on the cardiovascular system. And over the years I have noted a growing trend at the meetings that I think may hinder scientific and medical science progression in PNG. I have noted what can termed an “Academic Cartel”. This is similar to financial and drug cartels who promote and protect their interests and destroy others who stand in their way.
A handful of PNG academics and institutions appear to decide that a particular domain of health in PNG is worth researching or funding and over the years has become “their domain”. These “academic cartels’ also tend to promote their views on the subject matter while dismissing and make conscious efforts to propagate and promote their opinions. They have over time become to be known as the “experts” in PNG. Young PNG doctors and medical scientists are afraid to speak up in scientfic meetings and offer a differing opinion to these academic cartels’ research or opinions.
I also think that medical scientists from other countries who come to PNG to conduct medical research also strengthen the “academic cartels” by supporting the existing view in PNG rather than work with other young medical scientists in the various hospitals who would prefer to offer a differing opinion.
In my opinion this trend is worrying and the establishment of the second medical school in Madang at the Divine Word University is welcoming and offers a way for young medical scientists and academics to academically challenge the status quo within the medical science research community in PNG (in a positive way) and offer alternative routes and pathways to improving health in rural PNG. The news of another medical school to be established in Goroka at the University of Goroka is also welcoming and is in the right direction.
After more than 10 years of being declared Polio free by the WHO, the disease is back! And there are many other diseases that were once on the decline in PNG are now back and the number continue to increase each year. These re-emergence of diseases once thought to be decreasing is a direct reflection of the declining and now fragile public health service in PNG.
A rapidly increasing population (around 3% p.a) compounded by constraints in health resources has resulted in a decline in the quality of primary health care in PNG. I also think a major contributor to disease outbreak is the uncontrolled growth and unregulated growth of settlements in PNG creating the ‘urban poor’ population. When settlements spring up without planning for other support services such as water, sanitation and health service, diseases such as polio and other vaccine preventable diseases start to emerge. And that is what we are seeing in the urban PNG.
The focus of training for the health workforce therefore should be public health and primary health care. Much has been written about the resource constraints for the health service but this has to be fixed, focusing on resourcing urban clinics and rural health centers for the delivery of basic primary health care and public health services.
Every Papua New Guineans believe in sorcery and witchcraft, no matter how educated they are! And this is from experience. Do I believe in sorcery and witchcraft? Let’s just say I believe in Science.
Frankly, I believe the health sector in PNG and particularly the professional health organisations like the PNG Medical Society or the other professional specialist organisations are not doing anything to combat sorcery related killings and torture in PNG. In fact, health workers in PNG are partly to be blamed for what is happening. How do I do know?
Let’s face it, rural health services are non-existent in most parts of PNG. So when someone comes in very sick and the health care worker is not sure of the diagnosis, they commonly tell the relatives – “em samting blo ples” (meaning = it’s caused by black magic). This has been going on for many years in rural PNG, and even in major hospitals in PNG. I think the health care workers just gave up educating their patients on the cause of diseases, ie, the medical science of disease. And over time, this was accepted without question by illiterate and partially educated rural people and because it was coming from a professional health worker so it must be true! That black magic is real and it can cause disease in people. So overtime, people in rural PNG accept the status quo and don’t bother going to health centres for treatment (besides it may be closed 80% of the time! Because of corruption, lack of finance etc etc..).
With so much being reported in the main stream media and social media about sorcery related killings and torture in rural PNG, I have not heard or read about what health professionals in PNG have decided to do. The focus seems to be on legislature changes related to sorcery and witchcraft. And bring the perpetrators to justice. Yes that’s good. But what about on going education and awareness of diseases, what causes them and that disease conditions are preventable and treatable. I think this is an important long-term strategy to prevent sorcery and witchcraft related killings and torture in PNG.
Now to the role of forensic pathology in sorcery and witchcraft related killings and torture in PNG. The call to make sorcery and witchcraft related killings to undergo mandatory forensic autopsy must be supported by the wider healthcare sector in PNG. This will enhance the long-term strategy of educating and public health awareness among the people.
Since leaving academia and commencing in my new role as a GP with a private medical provider in Port Moresby, we have seen an increase flu-like illness, fevers and chills resembling malaria. What most people do not know is that Dengue is currently more commoner than malaria in Port Moresby.
Dengue is transmitted by the aedes mosquito species. They are quite easy to recognise. They are black and have a white stripe across their abdomen. Just Google “aedes”. There are different types of aedes mossy species but as long as you know the big name aedes is sufficient for Joe Blo and Jane Doe.
I have had patients coming in self diagnosed with malaria and tests comes back as dengue positive. On a side note, pharmacies in Port Moresby are still selling chloroquine when it was stopped by PNG NDoH sometime back! For the last 2 months, over 90% of the patients I see daily have presented with these symptoms.
Diseases such as dengue that have a vectors whose behaviours are directly determined by the environment tend to change with environmental change and it is no surprise that the rapid developmental changes in Port Moresby has resulted in a shift in vector behaviour directly changing disease pattern in the Nation’s Capital.
Dengue in Port Moresby is here to stay and the best prevention (and the cheapest) is preventing mosquito bites.
Telemedicine platform Doxy.me stand to make a huge impact in increasing access to doctors in rural PNG.
I have been writing and researching about telemedicine on my blog since 2007 and just today I Googled around looking for a free telemedicine platform and came across Doxy.me. (www.doxy.me). Its so easy to use and has a free version that even doctors in countries like PNG can use at very minimal cost. I believe that this platform will make a huge impact, in fact a giant leap in improving access to doctors in the developing world.
It is is only a matter of time before it takes off in countries like PNG where there are so few doctors and a very large rural population that is unable to have access to a doctor.
I predict once in use, community health workers, nurses or HEOs will use this service to schedule doctors consultation clinics and they will be able to manage patients without referring patients to major district hospitals where it can be expensive for rural patients.
Thank you creators of Doxy.me. I am already using it and enjoying it. This is what I was looking for!