ADELAIDE - My first outstation posting in Papua New Guinea was to Baimuru Patrol Post in the Gulf Province.
In 1970 the station boasted a grass airstrip, a native materials office, a small collection of houses and miscellaneous outbuildings.
There was also a rickety wharf decked with Marsden matting left over from World War II.
The two main businesses at Baimuru were a sawmill (owned, I think, by Steamships Trading Company) and the Gulf Hotel, the latter establishment mostly frequented by local people (including the two resident kiaps) plus the occasional visitor.
The pub was connected to the government compound by the only road.
It was almost exactly one mile long and, provided it had not rained too much, the station’s one and only Toyota Land Cruiser could negotiate it without too much difficulty.
In bad weather, a dinghy could be used to get to the pub, although the journey back to the station in the dark could be a bit fraught.
Health services were provided by Drs Peter and Lyn Calvert who worked out of Kapuna Hospital which, as near as I can recall, could be reached in about 45 minutes in an outboard powered dinghy or canoe.
The hospital was, and remains, the main provider of medical and nursing services for some 30,000 people who live in and around Baimuru and Kikori.
By Australian standards, it is an astonishingly primitive facility. Australians would struggle to recognise it as a hospital, except perhaps as an historic exhibit of something that existed in the remote colonial past.
Its wards are made of locally milled timber, each with a rusty corrugated iron roof. Ventilation is provided by shutters which are opened and closed according to the weather.
It is a very long time since I saw inside one of those wards, but my recollection is that they were pretty basic facilities, lined with hard wooden trestle beds with only woven grass matting to serve as a mattress.
Despite the chronic lack of resources, the Calverts and their successors have saved countless lives and eased the pain and suffering of huge numbers of patients.
The doctors and nurses who work at Kapuna are doing what I regard as heroic work under very adverse circumstances.
After Papua New Guinea, I spent much of my career as chief executive of South Australia’s largest regional hospital at Mount Gambier and, later, a 300 bed metropolitan teaching hospital (the Repatriation General Hospital).
And whilst at Mount Gambier I presided over the construction of a new 120 bed hospital which boasted all the major facilities, services and technologies you would expect to find in a modern Australian hospital.
In 1997 this medium sized regional hospital cost $A30 million (K72 million) to build and around $15 million (K36 million) a year to operate.
The contrast between the hospitals I managed in South Australia and Kapuna is very stark.
This was brought home to me rather forcefully a few days ago when I visited the new Royal Adelaide Hospital, which the locals call the “nRAH” (pronounced “en rar”).
I had neither seen nor been in the hospital before. I live on the southern fringes of Adelaide and so rarely go into the Central Business District.
My knowledge of the nRAH therefore was restricted to what I had learned through the occasional TV report or newspaper article.
Despite my extensive background in hospitals, it came as a considerable shock to me to discover the enormous scale of a modern, international standard, 800 bed teaching hospital.
It is a gigantic building and no expense has been spared to ensure it is truly impressive.
The grand main entrance boasts vast areas of elegant ceramic tiles and what look suspiciously like genuine marble pillars. Light floods in through various windows and strategically placed, plant filled atria.
In the background, a volunteer was expertly playing soothing classical music on a baby grand piano. This apparently is a regular feature intended, so I am told, to promote an atmosphere of calm and serenity amongst sometimes anxious patients and relatives.
Finding your way around requires a map plus the assistance of helpful volunteers who have learned to unerringly navigate the hospital’s several kilometres of labyrinthine corridors.
My wife and I found our way to the Nuclear Medicine Department wherein was located the hospital’s most impressive and expensive piece of modern technology – a positron emission tomography (PET) machine.
I understand that this machine cost around $A10 million (K24 million) to acquire. Heaven only knows how much it costs to operate each year, but several million dollars seems a likely total. Its main purpose is to examine soft tissue (as distinct from bones) to locate and identify various problems, notably cancerous tumours.
I could not help but reflect upon the cost of what I was seeing.
The nRAH cost $A2.3 billion (K5.5 billion) to build and requires at least $A1.2 billion (K2.9 billion) a year to operate. It is the largest single government organisation in the state and currently is the most modern hospital in the Southern Hemisphere.
It struck me forcefully that the nRAH costs twice as much to operate each year than the entire PNG health system, which was allocated a miserly K1.5 billion in the 2019 national budget for PNG’s nine million people.
I find this very troubling.
While I am grateful to have access to the knowledge, expertise, technology and services available at the nRAH, I remain keenly aware that the people of PNG have nothing remotely like it to meet their health needs.
Instead, they are mostly reliant upon the heroic efforts of a comparative handful of people such as those working at Kapuna, most of whom are obliged to work on a shoe string budget.
While it would be unrealistic to imagine that something like the nRAH could be built or operated in PNG, it is not unrealistic to suppose that something like Mount Gambier Hospital could located in the major regional centres of PNG.
The fact that this is not the case speaks volumes both about the gross imbalance in available resources across the world as well as the dreadful failure of successive PNG governments to meet even the basic health needs of the population.
The provision of basic health services is not rocket science and does not require much more than a comparatively modest range of services, drugs and equipment.
PET scanners and other sophisticated and expensive technologies would add little value compared to the availability of a range of effective drugs, high use consumable items like sutures and dressings and, most importantly, people trained to use them effectively.
In the colonial era, the people we called aid post orderlies had low levels of training and little in the way of drugs or equipment, yet they provided a remarkably effective health service, especially if they were part of a well supported system.
Unless I am mistaken, the aid post orderly system either is no more or has become largely dysfunctional.
Experience shows that countries without a modern and effective health system cannot create and support a genuinely modern economy.
The nRAH reflects a determination by successive governments to ensure that my small and comparatively poor state (by Australian standards at least) has a health system that can and will continue to support a truly vibrant economy and society.
In a way, the health system is a bell wether indicator of a country’s underlying socio-economic status and its prospects more broadly.
By this metric, it seems that PNG is not now, nor in the foreseeable future ever likely to be, able to create and sustain a modern economy.
The serious failure by successive PNG governments to remedy the many deficiencies in the national hospital system has led to a tragic waste of lives, talent and resources.
This is both sad and a great shame.
It is my fervent hope that the PNG government can and will make the effort required to create the health system their people both need and deserve.