Investment In Preventive Public Health Programs In Local Communities Will Reduce PNG’S Disease Burden By More Than 50%!

I don’t think buying more sophisticated diagnostic equipment or the availability of very strong antibiotics will reduce our disease burden. Having more doctors or nurses will not help directly either. Sure, these things may but it’s like catching overflowing water in a bucket by having more dishes on the side to capture the over flow. What we need to do is fix the tap that’s running freely!

What has happened to Preventive health activities in our communities and villages? Things like general cleanliness, proper latrines, access to clean drinking water, oral hygiene, enforcing our public health laws in towns and suburbs, creating health Programs for the ever growing squatter settlements and you can think of some more.

I find PNG people to be generally  unaware of of health issues when it comes cleanliness in Communities. Or are they just ignorant. They want to be paid for doing an activity. Why can’t people just do it for the benefit of the local community?

People have been brain washed by the cash economy. Middle class craving for lifestyles they can’t afford. Village people want to make a fast Kina, legally or illegally. All at the expense of their health or the communities’.

So what will it take to change this self destructive behavior?

The answer is obvious. Public Health Programs embedded into our hospital services, school curriculum, work place health Programs, in villages and communities. And these activities require money and trained people.

Now comes issue of health funding and management. I will leave that issue for a different post.

A greater challenge that only require sweat and time is community mobilization to promote and sustain good Public Health behavior. Leave a comment on how you think this can be done.

Posted in Uncategorized | Leave a comment

Leukemia & Lymphoma classification at PMGH: what do we do when we can’t reach global standards?

I failed my specialist training in 2016 and decided to take a year off in 2017 to write and publish some of my work in medical journals. My interest is in Pathology, the science of studying diseases and I have a special interest in hematopathology, a subspecialty that concentrate in diseases of the blood (leukemia and lymphoma).

Supported by my supervisors at PMGH I was fortunate to secure a training fellowship for 8 weeks at Maryland Medical Center, Baltimore, USA. I have been here for 5 weeks and got 3 more weeks before I return. I am supported by the American Society for Hematopathology (ASH).

All leukemias and lymphomas are classified after diagnosis. The classification systems have changed over the years, the current global system is the WHO system. But PMGH is still using outdated classification systems which are regarded in most settings to be obsolete. But we have no choice really! We can not classify these diseases without doing very specialized testing​, which I might add are very expensive. So where does that leave us?

WHO system of classification of blood cancers it seems assumes that all hospitals providing Hematopathology services have these tests or plan to have these tests. But the reality is far from the truth.

So that leaves PMGH to continue with using outdated systems? I guess we must. This is probably the same situation in most low to middle income counties.

So what do we do? I think we should strive to reach the standards​ set before us. We might not get there in 5 or 10 or maybe 20 years. We may not even reach there in my lifetime. But we must make a start.

 

Posted in Uncategorized | Leave a comment

Primary Health Care Remains and Should Be Priority for PNG.

A friend of mine recently asked me why Cancer services are non existent in PNG. He had to know because his mother-in-law was diagnosed with stage 4 cervical cancer and the family decided to try services in the Philippines. He was paying a good amount of money out from his pocket.

So I did a bit of research and showed him that cancer accounts for less than 10% of the total disease burden in PNG.

What constitutes the other 90%?

Infections diseases constitutes about 60% and trauma takes about 20% of the pie. The rest is divided between other life style diseases.

So given the adhoc cash flow within PNG NDOH, most of the funding is for communicable diseases.

So I explained that in terms​ of funding and prioritising, cancer services is at the bottom of priorities. He kind of got the picture but was still very unhappy. And we went into the usual conversation about corruption, kick-backs, bribery, nepotism and the list goes on, things we are all too familiar in PNG.

So he asked, “what do ordinary Pngeans do now if one of our loved ones is diagnosed with cancer?” I told him, my honest opinion is nothing. All we can do is not to think cure but quality of life and end of life care. Dying is part of being born and living.

I think doctors caring for cancer patients in PNG should see the big picture and train in palliative and end of life care. We will continue to see increase in disease burden but resources will remain limited. Our focus should be now on preventing and use every opportunity at the primary health care level to spread this message to help change behavior and promote healthy lifestyle.

 

 

 

 

Posted in Uncategorized | Leave a comment

Cancer Screening Is Key To Preventing Deaths From Cancer!

With so much being written in main stream media and discussions on social media on cancer treatment in PNG, I think the PNG public need to be informed and be made aware.

Cancer comes in many forms!

There are tissue cancers – mouth cancer, breast cancer, cervical cancer, prostate cancer etc. And there are blood cancers – the different leukemias, lymphomas etc. Screening, diagnosis and treatment therefore is not the same. One form of treatment therefore does not apply to all types of cancers.

Cancer generally has no cure!

Even in the best of centers in the World, late cancer when diagnosed has no cure. Patients may survive for 5 years or more on treatment but eventually they all lose the battle. That is the first thing PNG public need to know. This fact is hard to swallow but that is a fact based on current treatment modalities and research evidence available.

PNG has no cancer treatment equipment or drugs!

Forget the Lae Cancer treatment centre. Equipment is outdated. Need to be changed. Chemotherapy drugs are used in combinations, like a cocktail. The ones we are using are not the best and most times one or two drugs are always out of stock.

PNG has very limited cancer specialists!

This is public domain knowledge. Humans operate machines, machines don’t work by themselves.

Surgeons can not cure cancer on their own! Cancer treatment requires team of specialists in different aspects of cancer treatment.

PNG public have been led to believe that surgeons will cure you of cancer. Once operated upon and cancer removed, you are cured. FALSE! Don’t be fooled to believe that surgery is the way. It is not. Surgeons also need to advocate this fact and call for capacity building.

Screening is the key in preventing deaths. Early detection saves lives!

This is a proven medical fact backed up by medical evidence. Early detection saves lives! Screening is the key.

Public health interventions prevents most cancers long term!

Public health interventions such as life style changes, cancer hazards identification at work place (occupational health interventions) and appropriate laws to ensure industries in PNG conform to laws preventing the public from being exposed to cancer causing agents will reduce cancer numbers in the long term.

 

Posted in Health | Tagged ,

PNG Medical & Health Sciences University to be established!

I first wrote about a stand alone PNG National Medical University in November 2014. You can read the post here.

After 2 years, the PNG government has approved its establishment. Read about it here.

The concept has been around for some time and discussed in various meetings within the UPNG SMHS but never went beyond the meeting rooms. The proposal needed a sponsor to spear head its submission navigating the maze and labyrinth of PNG politics.

The National Doctors Association, spear-headed by its President, Dr James Naipao and team took up the challenge.

And now the first meeting has been held and the Department of Higher Education Science and Technology will oversee its establishment.

We are hoping this new university will improve the quality of health worker training in PNG – community health workers to specialist medical officers. It is also hoped that the new establishment will also attract and retain PNG medical graduates to take up academic posts.

 

Posted in Health, Uncategorized

Crowd funding campaign to support ePathPG: a telepathology cancer diagnosis in Papua New Guinea.

My friend Ian Garbett has initiated a crowd funding campaign to support ePathPG.

Visit the campaign site to donate.

Ian aims to raise £2000.

https://www.justgiving.com/crowdfunding/i-garbett?utm_source=Facebook&utm_medium=Yimbyprojectpage&utm_content=i-garbett&utm_campaign=projectpage-share-owner&utm_term=Gzz2xmKN3

 

Posted in Health, Information communication technology, IT

PNG Health Workforce in Crisis: A Call to Action October 2011

The World Bank made a comprehensive report in 2011 regarding PNG’s health workforce and the need for action.

Five years on and nothing seemed to have been done. No action!

Below is a synopsis of that report: Source: http://www.worldbank.org/en/news/feature/2013/04/26/papua-new-guinea-health-workforce-crisis-a-call-to-action

  • Papua New Guinea faces a health workforce supply crisis arising from:

(i)    the current severely constrained training system for new health workforce cadres;

(ii)    the rapid aging of the existing workforce – over half of the current health workforce will retire within a decade;

(iii)   the expanding demand for services over the next 10 to 20 years due to sustained increase of the population.

  • The National Headcount Survey in 2009 shows that the size of the health workforce financed by the public sector has grown from 10,791 in 1998 to 13,063 in 2009. Since 2004, however, the pace of growth has slowed down markedly. The number of nurses, for example, dropped from 3,980 in 2004 to 3,618 in 2009.
  • To respond to the health workforce crisis, the PNG government’s needs to deal with:

(i)    the immediate supply-side crisis (quantity);

(ii)    the qualitative side, including preservice and in-service training (especially for emergency obstetric care for existing staff);

(iii)   incentives to ensure staff are able to be deployed where needed, particularly in rural areas which is home to 80 percent of the population.

  • Armed with information of supply and demand, the report provides five scenarios to draw out the implications for each health cadre and for all service delivery staff, including affordability. The five scenarios vary from no change in existing supply capacity to four alternative scenarios with supply adjusted to meet the postulated demand.
  • The scenario most recommended envisages a new mix of direct service-delivery staff, which is not only affordable but also responds to the demand requirements for staff from the health system while leaving space in the recurrent health budget to boost quality. This scenario is driven by: (i) the growth in the resource envelope likely to be available for health and service-delivery staff; and (ii) the feasibility and speed with which preservice training can be ramped up to meet the demands of workforce attrition and the needs of a growing population.

Download full report png-health-work-force-in-crisis-call-to-action

There is discussion on hiring doctors from Cuba as well as sending PNG students to study medicine in Cuba, when UPNG Medical School is calling for more funding to revitalize aging infrastructure and build new ones to increase student intake and recruit more lecturers. Hiring doctors from Cuba (or sending PNG students to study medicine overseas) or anywhere else was not one of the recommendations in this report.

The proposed trip to Cuba (the second one, the first was when Sir Peter Barter was the Health Minister) appears to be another overseas trip with no foreseeable tangible benefit to the long term solutions of addressing health workforce in PNG (and waste of taxpayers’ money).

 

Posted in Uncategorized