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

Shortage of Pathologists in Papua New Guinea Contributing to Long Turn-Around-Time for Cancer Diagnosis

I was invited by PNG Air this week for the Pinktober Cancer Awareness information session.

PNG Air, one of the major third level airlines in PNG organised the event to allow their employees to be informed about cancer as a disease as well as challenges in PNG and what they can do access cancer prevention services currently offered in Port Moresby.

I gave an overview of what cancer is and focused on the two major cancers affecting women in PNG – breast and cervical cancer. Over 90% of the attendees were female employees. It would have been good to have more men in there as well. But I am hoping for another session to talk about common cancers affecting men in PNG. I think this area is a neglected area.

The session was organised by Sr Dorish Palangat and Team from the Health, Environment and Safety department – an all female team! Hats off to you ladies and job well done! Congratulations.

The session ended with a Q&A session and topped it off with morning tea.

png-air

Photo of me with the organizers. And Thank you ladies.

And in the news. Click on the links below to see as reported by NBC PNG.

 

Next, we hope to have a session information on men’s cancer.

Posted in Health, Medical Training

ePathPG: A Telepathology Initiative to Overcome Shortage of Pathologists in PNG & Access To Specialists Globally!

What started for me as a passion in photography and work using a microscope as a trainee pathologist has given birth to “ePathPG”.

Telepathology is an emerging field in pathology and is only going to grow with advances in the kind of technology used. Telepathology has the potential to close geographical gaps, access to specialists globally and offer diagnostic service to countries like PNG still struggling to produce adequate number of specialist doctors to serve the ever growing population. I first wrote about it here in 2007 on this blog. Other articles are here, here,  also here. Some more articles here,  and here. My articles were also referenced by an online magazine “Hospital and Health Care Management”. 

ePathPG is a digital image management system that a we have developed. We originally meant to use the “Path” to mean Pathology but I think “Pathway” also makes sense. Because ePathPG has applications in other areas of telemedicine including teleradiology, dermatology, cytology and general practice where a digital image is needed to make a diagnosis.

Version 1.0 of ePathPG is now live online and we are doing a validation trial. We are using an Olympus BX41 digital microscope to capture the images from the glass slides but the cost of purchasing such a system would be expensive making our project unsaleable nationally. So we are also exploring the option of capturing the images using smartphones with smartphone optics adapter. The second option is much cheaper, there is very good 3G and 4G mobile coverage in PNG making our project scale-able!

Posted in Uncategorized

The Pen is Mightier than the Sword or Bullet!

Following the aftermath of what transpired between protesting UPNG Students and PNG Police, the international community has condemned the shooting of students.

There is also overwhelming support in PNG for the students as evidenced by postings on other social media outlets. Bruce Horick, who is a former UPNG student, after reading in the news of what happened, he put pen on paper and wrote this poem. The poem was published online by PNGLoop.

I Fight For You Too by Bruce Horick.

I fight for you too

My brother in blue

Cold metal in your hand

For your future too I stand

I bleed for you too

Friend in combat shoes

That our kids may grow strong

And joy will be their song

I die for you too

Comrade in sky hue

As you aim death towards me

I’m fighting to set you free

I mourn for you too

My wantok trutru

You follow orders from above

Mine’s from patriotic love

I plead for you too

Brother cop, yes you

Our leaders have misled us

And stepped us into the dust

Would you stand with me too?

My blood in navy blue

Reach out and hold my hand

And let us take back our land

Posted in Uncategorized

Breaking News! Confrontation between Police and Students at the University of Papua New Guinea

There has been a confrontation between students studying at the University of Papua New Guinea and PNG Police.

After a month long student protest by the students (they boycotted classes for nearly 2 months now) against Prime Minister Peter Oneil over allegations of corruption, the students decided to stage a protest march this morning.

The planned protest turned nasty when the PNG Police opened fire with guns. Reports and pictures posted on other social media say 4 students have been wounded and 1 student is feared dead!

Go to PNG Blogs for posts by students and the public.

 

 

Posted in Uncategorized

Cancer fight in Papua New Guinea: A Case of Horse before the Cart?

Recently there has been so much coverage in mainstream news outlets and social media regarding cancer treatment or rather the lack of it (treatment options) in PNG.

Much of these increase in media coverage has been spear-headed by the PNG cancer foundation. Numerous medical symposiums and conferences have been held regarding this very issue in PNG over the last 20 years.

Women Doctors Association of PNG has also been in the news regarding this agenda as well.

A recently held workshop in Port Moresby on cancer treatment spear-headed by PNG NDOH (I stand to be corrected on this) with attendance by various development partners where discussions were held on what treatment options are available for cancer patients in PNG. Particularly I am told via the grapevine that much of the discussions were on radiotherapy! (BTW PNG does not have laws to import radioactive substances I am informed).

But what blows my mind away is here are the major stakeholders in PNG involved in the fight against cancer talking about treatment but not an utter on DIAGNOSIS! Aren’t you suppose to diagnose cancer first, characterize it and know its biological behavior THEN look at treatment options to obtain a much more favorable outcome?

How can you treat if you do not know what you are treating? Shotgun treatment? And hope for the best?

Cancer diagnostic infrastructure and technical know-how has to be improved first or hand-in-hand with development of treatment options! Currently there are 7 specialist pathologists involved in cancer diagnosis for PNG – current estimate is 8 million people? And all of whom are working in Port Moresby and thousands of tissue/organ specimens are received each year from around the country for histopathological diagnosis (diagnosis by examining tissues obtained by biopsy or surgery).

People in PNG seem to think that you just do a biopsy or collect some blood in a tube and send it to the “Lab” and somehow the sample is put into a machine that automatically tells you what kind of cancer you have. And they wonder why results take so long so they go on the social media to vent their frustrations. The PNG public need to be informed how cancer prevention and treatment occurs. You need specialist doctors to make the correct diagnosis using the tissue from a biopsy or blood (in the case of leukemia) to report back the specific diagnosis. THEN you can treat correctly.

How can you expect a quick result from the lab (for cancer diagnosis) when a team of 10 people are trying to process specimens coming from a country of 8 million people. Do the maths! By simple logic, it will dawn even to the high school student that you need more people and other similar laboratories to share the workload so results are given out faster to patients/surgeons/gynaecologists.

Surgeons and gynecologists in PNG also give public the perception that by examining someone (looking, hearing the story and physically checking) they can make the diagnosis of cancer right away!  PNG public need to be informed that there are many different types of cancer and treatment is not the same. Not all mouth cancer or cervical cancers are the same. Not all leukaemia are the same. Treatment is tailored to the specific cancer. Surgeons and gynaeocologists in PNG please do not fool the PNG public. Inform them that the sample you obtain is sent to the laboratory and a specialist doctor called a PATHOLOGIST will examine it make the confirmatory diagnosis.

PNG NDOH including development partners and other stakeholders involved in cancer work in PNG really need to look at cancer diagnostics before talking treatment. This means looking at PNG’s pathology services including specialist pathologists, medical laboratory scientists and necessary laboratory equipment and infrastructure to diagnose the different types of cancers accurately before talking about how to treat.

The PNG cancer treatment (radiotherapy unit) is in Lae (treatment is ancient in terms of current practice) and the main cancer diagnostic services (Histopathology services) are in Port Moresby (PMGH) and these two cities are not linked by road. What a financial and social nightmare for cancer patients. By this very fact, cancer patients in PNG are already disadvantaged! So in PNG you get diagnosed in one city and fly to another city (where there is no social support) to get treatment. What plans are in place to change this status?

I have not heard or read anything about plans to establish histopathology services for cancer diagnosis in Lae. What is the PNG NDOH plan to establish cancer diagnostic services? Including development of specialists and scientists to make accurate diagnosis? Treatment involves giving radiotherapy and cancer drugs. How can you give the correct cancer drugs if you have no clue as to what type of cancer you are dealing with?

I am convinced (as a trainee pathologist) that stakeholders involved in cancer fight in PNG have put the horse before the cart.

We need to develop and build the capacity to diagnose cancer accurately before treating.

 

 

Posted in Uncategorized

Recognizing Scientists in Papua New Guinea

Lately there has been a rapid increase in the establishment of organisations or programs by PNG government trying to promote business growth in PNG. There has also been an increase in organisations specifically for women in PNG such as Women in business or Women in Science and Technology and the like. These are well intended and should be promoted and must continue to be promoted.

However, there has not been much publicity in the recognition or specific programs to promote science, research and technology in PNG. With the recent establishment of the Science Research and Technology Office under the office of the higher education, it is hoped the current situation will change. I know there are silent achievers in this country but science, research and technology growth as not been seriously addressed by the government or the industry that recruits science and technology graduates in PNG. There has been no public programs to promote science and technology to encourage more students to take up these as career pathways.

The lack of government funding for start up companies as a result from scientific research in PNG is well known. Of course PNG has other major pressing socio-economic issues to deal with but it is  well know from history that any innovation  or discovering leading to start up an industry starts from years of scientific research. It is truly then I think we can progress in our mindsets and be politically independent to some extent.

As for my own scientific organisation, the PNG Medical Society has grown too big to be managed effectively (my opinion only). It is only once a year that medical scientists come together. But the meetings are so big (>1000 attendees) that focus is on established researchers that young scientists are forgotten. However, having said these, I also think the medical scientists themselves are not promoting their work and encouraging others. Some are doing in a small way, but I think there is a need for larger public programs directed at promoting science and technology to the general public. For example, how about a specific government or scientific societies award event/night with media coverage!

I have decided that I may contribute my bit in promoting science, research and technology in PNG and have started a new blog niuginikuru.wordpress.com. The vision of the blog is to feature and profile PNG scientists, technologists and researchers and their work as a way to promote science and technology in PNG. Niugini kuru is pidgin for “new guinea brain” and I am hoping niuginikuru.wordpress.com will showcase some of PNG’s top scientific brains.

 

 

 

Posted in Uncategorized