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Health system melts - & not just in Australia

| With Philip Fitzpatrick, Chris Overland,
    Bernard Corden and Lindsay F Bond

“An emerging public health crisis has already hit our nation. A promising nation lost in paradise with bad politicians and a weak bureaucratic system and institutions that can’t turn the tide around after 46 years of independence” - Jerry Kuri Mandara (Twitter @KuriJMandara)

NOOSA – Yesterday the ABC’s Papua New Guinea correspondent Natalie Whiting, in conjunction with her colleague, producer and journalist Bethanie Harriman, published an evocative but brutal article.

It was based on the fact that PNG’s entire health system is collapsing - overstretched staff, no money, limited medical supplies, a population in desperate circumstances with out of control Covid and the constant, unforgiving burden of other disease.

The beauty of the story, which you can link to here, lies in the writers’ clever weaving of the health crisis with the predicament of the stoical and unfortunate villager Robin Balo, brought down by a solitary arrow.

What happens to him then makes for an enthralling piece of journalism as Robin is subjected to the full force of a shocking chain of events.

It is a story that brings shame on the governments of both PNG and the country where it has most frequently looked for guidance, Australia.

Both governments have shown a monumental incompetence over very many years in protecting PNG’s health system: PNG has failed a primary duty of government to keep its people safe; Australia has failed because an adjacent nation, whose performance profoundly affects Australia in many respects, is weak and vulnerable.

Two stories in PNG Attitude – Friday’s on the ambitious cooperation goals agreed by China and the Solomon Islands, and yesterday’s about Bougainville’s decision to reopen the Panguna mine (a K30 billion exercise) – point to just how exposed PNG is to newly expansionist China.

In this article, four Australian writers well known to PNG Attitude readers, tell of their own experiences with PNG’s appalling health care system, including Chris Overland who astutely perceives that “the Chinese might step into the breach before us”.

That is neither an outrageous nor eccentric thought. Indeed, today it looks more likely than not.


Philip Fitzpatrick

It was 2014 and the resupply order for the hospital at Awaba, on the Aramia River in Western Province, had been constantly ignored by the authorities for two years.

The orders included just about everything you could think of from antivenin for snakebite through to spare parts for the hospital refrigerator that had broken down and couldn’t be repaired.

The frustrated matron was at her wit’s end with ‘making do’ when she pleaded with me to try to kick free the logjam.

So I decided to personally take copies of the orders with me to Health Department headquarters in Port Moresby.

After a lot of yelling and pointing and some cash under the table, I was able to secure about one-third of the supplies and put them aboard a plane to the hospital.

The remaining two-thirds of these basic supplies just weren’t in stock – not even in the national capital.

Working in mining exploration camps and later undertaking social mapping studies all over PNG, it was a common occurrence to come across abandoned aid posts established under the colonial Administration.

It was also common to come across health personnel – medical assistants and nurses – who had continued to work without pay or supplies, supported as best they could by the local people.

All the big mining companies in this remote but resource-rich corner of PNG had well equipped medical facilities with trained personnel but many, like Exxon and Chevron, had a policy of refusing to allow villagers into their clinics or hospitals.

There was a sad case where an Oil Search security guard sought help for his baby daughter who was very sick with malaria at Lake Kutubu. He was turned away and his daughter died. I can tell you it did nothing for morale at the camp.

While working in Western Province we talked one of the companies into building a new aid post which a retired nurse in the area said she would voluntarily staff.

Jackson et al - Where there is no doctor coverBut when the company left the nurse couldn’t get further supplies and the facility closed.

One useful thing I did in these trying circumstances was purchase and distribute copies of the excellent publication, ‘Where there is no doctor’.

It contains heaps of useful information along the lines of ‘how to remove your own appendix’. It’s still available and there’s a link here if you’re interested.


Chris Overland

At Mendi Hospital in 1999, I witnessed scenes similar to those described by Bernard Corden (below) and referenced in Nat and Bethanie’s article.

The nurses in emergency were working with bugger all equipment managing presentations ranging from births going wrong to spear and shotgun wounds.

The hospital had no working equipment - no autoclaves, no oxygen concentrators, no IVAC pumps to deliver antibiotics, pain relievers and similar fluids. There’s wasn’t much of anything else either.

The food was cooked in two cut-down 44 gallon drums in a lean-to annex.

Back in Australia I persuaded the board of the hospital of which I was CEO to pay for our chief biomedical technician to spend four weeks in PNG.

During this time he worked with Mendi Hospital’s only biomedical technician to repair every piece of equipment and get it working. He called in favours with suppliers all over Australia to get this done.

Our board, now fully aware of the desperate need of such hospitals, subsequently released him for three months each year to do the same sort of work in Fiji, Tonga, Vanuatu and, of course, PNG, this time funded by various aid agencies.

The PNG Department of Health was useless. The hospital employees had not been paid for many months and were living on gifts and donations.

My friend and former colleague David Vorst is currently the CEO at Mount Hagen and he says the situation has not materially changed.

Only the dogged commitment of the staff to keep working prevents the total collapse of the system. It is shocking and it is a disgrace.

The best solution is for Australia to simply take control of the entire system on the basis that it will fund it if the PNG government gets out of the road.

Of course, the Chinese might step into the breach before us. They have plenty of capacity and it would be an easy win for them in the contest to win hearts and minds in PNG. Personally, I would cheer them on if they did.


Bernard Corden

Within a month of my arrival in Lae in April 2006, an employee from a logistics company working outside our factory late one Friday afternoon fell several metres from a ladder to the road.

He cracked his head on the concrete gutter and was quickly bundled into a utility and taken to the Angau Memorial Hospital.

The next morning I drove to the hospital to check on his condition.

He was on life support and his grieving family were surrounding the bedside as I approached.

I was stopped urgently by a doctor and thought I had inadvertently breached some cultural protocol.

But the doctor was frantically pointing to the floor where I was about to step to reach the bed.

There was a gaping hole encircled by rotten floorboards infested by termites.

The victim never regained consciousness and my introduction to the PNG health system had begun.

A couple of years later, in 2009, I vividly recall taking a young Papua New Guinean to Angau’s emergency department during the silent hours of an early Saturday morning.

He had been attacked in the Eriku settlement by a man wielding a broken beer bottle and was covered in blood which was pouring from the gaping wound in his head.

After receiving a frantic call from one of our security guards, I picked him up at the company gatehouse near Lae wharf.

The hospital’s emergency department was like a scene from Bedlam and the floor of the waiting room was dense with the sick and injured and wailing relatives.

I was stepped gingerly through the bodies on the floor looking for medical personnel.

Then I spotted the beleaguered duty doctor, his only identification the stethoscope hanging from his neck.

He quickly rallied a nurse and they eventually stemmed the flow of blood and stitched the wound. The patient was as stoic as they were noble.

As dawn broke over Lae, I was assured he did not need to stay at the hospital so took him back to my accommodation block where he was able to shower and I gave him a change of clothes and breakfast.

His family were beside themselves with relief and joy when I drove him to their settlement 20 kilometres along the Highlands Highway.


Lindsay F Bond

Thanks to Natalie Whiting and Bethanie Harriman on ABC news last night, Australians saw a report of the present day to day reality of PNG health service provisioning.

There is insufficiency in that delivery, and absolute absence of needed equipment and medications.

Covid-19 hardly gets a mention, the emergence of cases having already inundated communities and medical staff.

My own experience at Oro Bay in 2005 was of a hospital in such dire need that tears whelmed as I recalled our two children born there in 1969 and 1971.

That hospital was, in 2012, largely rebuilt and equipped by providence of humanitarian folk in Australia (inclusive of religious groups and more broadly in the community, all support by and in cooperation with the PNG government.

So, as this example shows, things can be improved where goodwill gives rise to participation and cooperation.

At Kabwum there are matters difficult to comprehend and harder to accept, that after many months its demolished health centre has gone to make way for a new facility but has so far only had the slab poured.

I hope that the contractor is active and able to achieve construction objectives.

We hope the PNG government (not only the Health Department) is also awake, aware, arranging auspiciously, and likewise assisting achievement of the objective.


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Chips Mackellar

The Chinese could help out easily if they wanted to. The Chinese Navy has a Hospital Ship named the Peace Ark, part of the Chinese South Sea Fleet. It was built in 2008. 14,000 tons, equipped with 300 hospital beds, 20 ICU units, 8 operating theatres, with instant telecommunication connection to Chinese shore based medical specialists. It also has an air ambulance, a French built Aerospatiale Super Frelon, the world's fastest helicopter capable of carrying 27 passengers or 15 stretchers. The Peace Ark has visited PNG before, being part of the logistical support contingent for the Chinese delegation to the 2018 APEC Conference held that year at Port Moresby. The ship has already paid medical visits to the Caribbean Islands, the Seychelles, and Bangladesh, so with a little bit of encouragement, the Chinese Embassy in PNG might arrange for the Peace Ark to visit PNG again, this time to solve some of PNG's most critical medical problems. In the absence of any other large scale international medical aid assistance, it is worth a try.

Harry Topham

Good idea Phil as there is obviously no votes in the health portfolio for most aspiring politicians to consider this issue when preparing their spiel for the next game of electioneering.

However like most good ideas it probably would get bogged down as the two parties negotiate the fine print as to Rules of Engagement and of course the necessary largess required for approval as redundancy payments for current Health employees would be required.

About Lindsay's comment - Some years back when visiting Kandrian I had a call to come to the old sub district office.

When I approached the front desk there was a sign, 'No interviews unless appointment made with Secretary', and a printed arrow pointing downward to an empty chair.

Great idea but unfortunately there was no Secretary nor had there been for several years. Shades of Heller’s Catch 22, in particular his chapter in which Major Major had a similar approach to avoiding confrontation with a sign over his door reading, 'When I am out I’m in when I’m in I’m out'.
What a shambles.

Philip Fitzpatrick

So it essentially goes back to the impossible task of pulling 800 plus tribes and their thousands of assorted clans into something that resembles a united nation.

That the average Papua New Guinean's loyalties lie first and foremost with their clan and not their nation a dysfunctional system of governance and all its problems like corruption and indifferent incompetence has emerged and entrenched itself.

There is no solution to something like that. Only time, a very long time, might change it.

So perhaps, as Chris suggests, the government should get out of the way and allow Australia or China (not the US heaven forbid) to step in and run the show.

Stephen Charteris

I promised myself that I would not put pen to parchment on this discussion. I am sure we have been here before and there are no easy answers.

I cannot bag a place whose people are close to my heart so instead I will relate a story about a place that exits in a galaxy far, far away. Queue the voice of Morgan Freeman.

From our Milky Way galaxy, it does appear as though the whole edifice of the government of Galactica along with much of the public service is rotten with corruption to the core.

However, the view from their side of the worm hole would suggest the matter, like Heisenberg’ s uncertainty principle, is rather more complex.

Experience by intergalactic “development assistance specialists” who have been flitting back and forth across the fabric of space time on the Starship Canberra, has revealed that tackling corruption, from a Milky Way point of view is about as useful as an Elon Musk robotic submarine at an arse kicking party.

A closer look reveals the issue is rooted in Galactica culture. Criminality and opportunism are most certainly involved but the underlying factors are not. It seems to boil down on Galactica to how far the idea of the common good extends or what constitutes Galactican society.

Ask almost any Galactican, who lives near a derelict school or abandoned health clinic to describe the issue as they see it.

You are invariably told that their member of the Galactica parliament does nothing to help them and the same applies to most if not all Galactica public servants.

But interestingly there really isn’t any expectation that this outcome could or would have been different.

You see neither the Galatica MP nor the public servants share anything in common with our speaker. Apparently, they don’t have same clan obligations, share the same language, culture, land or consider themselves to be part of the same planet.

For the MP and public servant, the notion of service tends to be a little closer to home.

Of course, the visitor from the Milky Way delights in describing utopia on Australis. Where public officials, whether elected or appointed are in positions of trust and legally bound by codes of conduct and ethics to serve everyone equally without fear or favour in the interests of the common good. (Queue gales of uncontrollable laughter)

Once our interviewee is able to compose him/her/itself, we are told that on Galactica MPs and PS are obligated to the Galacticans who cut copra or harvested coffee to pay their charges school fees and now look to their successful prodigy for a handsome return on that investment.

And inevitably this leads to Galactica parliamentarians and public servants, once the overlords of one hundred or so people now comfortably ensconced in the Australis system enter into dubious associations with bounty hunters and businessmen from the far side of the galaxy and approve shonky procurement practices to look after Galactica No. 1 without a hint of shame or remorse for those without services.

Something we all agree would be quite unthinkable on Milky Way Australis.

This invariably results with Galactican agencies becoming stacked with, well Galacticans, from different parts of the galaxy, each of whom represent the interests of a tiny group but who are nonetheless happy to blab on about services for all to a captivated audience from the Milky Way.

And contrary to expectations they remain a “protected species” despite clear evidence of serious wrongdoing for light years.

But wait there is more. Remarkably, it is when you observe that this interesting hybridisation of the Australis system has been duplicated across all levels of the Galactica government administration that you begin to understand why Galactican basic services have collapsed.

And therein lies the strange tale of Galactica opportunism and lack of vision that pervades the political and public service system.

A situation described by a late, but very much respected Galactica Prime Minister as “systematic and systemic.” He may possibly have added it is also deeply parochial, cultural, personal and it isn’t going away.

May the force be with you.

Bernard Corden

"The National Health Service and the Welfare State have come to be used as interchangeable terms, and in the mouths of some people as terms of reproach.

"Why this is so it is not difficult to understand, if you view everything from the angle of a strictly individualistic competitive society.

"A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society" - Aneurin Bevan.

Along with the late Tony Benn, Bevan always managed to empty the parliamentary tea rooms during question time.

Lindsay F Bond

At Tufi around 2014, the sign on the Health Centre door advised the consultancy hours were 9am to 12 noon.

Compliance was requested including for pregnancy. There was a water shortage also, a normality at Tufi.

Credit where it is due, however, with respect to an election coming on.

Responding to the flooding events in Oro Province in November 2007, among the last actions of an Australian government, Alexander Downer initiated a relief measure to go to PNG, and Governor Gary Juffa found the mechanism for release to intended purpose and four strategic bridges were constructed to replace those lost in the floods.

At least, that's my recall of events, and if longwinded, so too was the process.

Dr John Christie

When treating a cancer that has spread, only aggressive treatment has any hope of cure.

Radical surgery first to cut out the rot of cancer followed by months and years of monitoring and treatment as relapses occur.

No attempt has been made to address the real issue in PNG - the corruption cancer that has spread from the top to virtually all levels of government and often private industry.

Many words spoken but no action.

A whole of nation approach is required - not just fix the National Health Department which will never be achieved in isolation to the rest of government.

Unless a PNG citizen in the form of a Lee Kuan Yew appears, PNG is destined to continue to descend into ever greater chaos and pain and lose sovereign status.

The only other real hope is through education and that is where Australia should, in the main, be putting aid funding, principally through direct assistance.

Unfortunately a Band-Aid on a cancer only hides the inevitable outcome.

John Greenshields

In 2017 I saw a sign on the aid post at Guasopa, Woodlark island, 'No medicine, only Panadol'.

I agree with Chris Overland. Australia should offer to fund and manage both the health and education systems, as long as PNG politicians get out of the way.

We’d be criticized by a few 'nationalists' as neo-colonials, but I’d guess 95% of PNG citizens would welcome it.
If the Chinese come and do the same, no such criticism…[”we’ve been oppressed too”] ... just more of their creeping takeover of PNG.

But there’s an election on, so there’s nobody in charge to make such a decision…

Members too busy spending their K1 million DSIP grants earmarked for 'health’ on getting re-elected. Tee-shirts, cartons of beer, cash, Toyotas…. What a shambles. What a disaster.

What about some real 'Pacific Step-up,' Mr Morrison?

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