Health services in Papua New Guinea have declined in number, quality and funding since Independence (1975, when the Australian administration officially withdrew). This includes the training of medical staff, the number of points at which you can access health care (whether it be in the form of a visiting midwife; an aid post; a doctor; a hospital) and the availability and cost of medicine.
Between 80-85% of the population lives in rural areas, and survives on subsistence farming: they grow what they eat. For a villager, a hospital might be several days’ walk away – or a boat ride and walk away, etc etc. To combat this, each province has numerous aid posts: places where there is supposed to be someone with some form of medical training (i.e. nurse), hopefully radio access to someone with more training for advice (i.e. a doctor) and some basic medicines. But the aid posts have been closing down. Funding was not provided for the upkeep of buildings. Staff had inadequate medical training, occasional visits from trained doctors or nurses ceased, medicine was limited and old. Some – fortunately – still operate, and operate well. But overall this is not the case.
There aren’t many hospitals, and some have closed due to lack of funding and staff, and/or security. Hospitals don’t always have doctors, and they aren’t always open. If without doctors, nurses did have radio access to a doctor for advice – but this has stopped (in the cases I know of). Hospitals aren’t always safe places; there can be tension relating to treatment of certain patients when there is a local tribal war, for instance; in an area where critical infrastructure is weak, staff can be at risk of physical attack and abuse. Staff morale in many hospitals is low. All hospitals have trouble stocking medicines. (Case in point: a nearby hospital: open only from 8am-4pm; without a doctor; staffed only by nurses; several nurses reported being raped; medicine cabinet often consists of little stronger than aspirin.)
In Goroka, we do have a hospital – and last year its first maternity ward opened (this was because of an Australian team of nurses who “adopted” the hospital; they fundraise for it here and back in Aussie; they come up once a year and do 2 weeks volunteer work there).
But there has been a move away from hospitals in the last 2 decades. They remain out of reach for a lot of people. If you’re seriously sick (imagine a breach birth), you don’t want to/are unable to walk for hours, for a day, or for days to get there. The boat or PMV (public motor vehicle) ride might also not be an option – perhaps the sea is too rough for a pregnant woman, maybe roads are impassable at that time (mud slide, broken bridge etc), maybe you’ve been cut by a bushknife and are bleeding and there simply isn’t time for the long journey. Maybe the discomfort of travel makes it impossible, and/or because it costs money.
Plus, getting to hospital, waiting to be seen by a staff member, being seen and told what medicine is needed – you might then be told that you have to buy the medicine yourself because the hospital can’t afford to buy it. This has been happening in Goroka (in a case reported on in the media, to a child with leukaemia). This is medicine that is not subsidised, and costs over one hundred kina – something few can afford. This means that patients usually just have to begin the trip back home, without any medicine. Their illness gets worse, and maybe they die.
And so we arrive at another issue: the reputation of hospitals, or peoples’ attitudes towards them. Given the lack of staff, lack of medicines, lack of proper training – well, people die in hospital. And so the hospital is known as a place you go to and die. Hence, a significant number of people will avoid going to hospital for treatment – or simply won’t consider it as an option. It’s not hard to understand: if someone you know is seriously ill, has a painful journey to and from hospital, comes back and takes a few aspirin* and then dies anyway – well why bother going? Maybe if you simply rest at home and avoid the hospital you will be ok.
This is coupled with a growth in use of traditional medicines – which is partly a positive change (accessible and affordable), but given that the market for trad medicine is totally unregulated, has also resulted in a lot of scams (“miracle water” from a spring somewhere in PNG is marketed seriously as a cure for cancer and AIDS).
The rate of infant mortality has risen significantly in the past twenty years, and is amongst the highest in the region. Life expectancy remains amongst the lowest in the region (a little above 50 years). HIV/AIDS remains a disaster area – but that’s a story all of its own.
I present to you a dire picture of a state in crisis. And yet – it’s just life. Heath care is vitally important, and some situations here are so bad that they are unacceptable and need to be fought about. But: Living here for over a year now has subtly but profoundly changed my understanding of life, and of the world, and how to conceptualise it. People are lively and active and hard working. And they love and have families and dreams, and they learn and strive and try. It’s the best we can do.
(*Aspirin: common cure-all; buy individual tablets at the market; a workmate who had typhoid trusted that a few aspirin would make it go away)
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