Papua New Guinea lies on Australia’s doorstep. I have visited twice now and will be returning later this year. Increasingly I find myself thinking about PNG and her people, especially those that I have met and talked with and briefly shared life with. Beth, a young mother, and her newborn son, Enwah are two of these people. Enwah, like many babies in PNG began his fight for life very early.
My time in PNG was spent with a medical ship that takes health professionals to remote areas along the southern and eastern coast where basic medical care is not easily accessible to most people. PNG is mountainous and covered by thick jungle. In the Gulf Province and Fly River system in the west, most people travel by dugout canoe along the intertwining river systems. Roads are few and far between and often in poor condition. With 88% of people living in rural areas and health facilities sparsely distributed throughout the country, most people with a serious health problem will not have the chance to be treated in a hospital.
In 2011, I was part of the primary health care team on the ship. This was my first journey to PNG. The ship sailed 27 hours from Port Moresby to the Western Province where we anchored off Daru, the capital. Each day we would travel by zodiac (inflatable motor boat) from the ship to a village or settlement where we would set up our clinic for the day. Our role included seeing and treating people for a variety of medical conditions, vaccinations and health education.
The last two days of clinics were to be spent at a village named Abam, well up the Oriomo River. The only way to reach this village was via the river. Floating debris had to be skirted carefully to avoid catching the propeller and resulted in many a disappointed attempt to spot a crocodile! Along the way we passed dense jungle, traditional villages and smiling families in dugout canoes. The people of this area hunt, fish, harvest sago and grow vegetables, much as their ancestors have done for centuries past.
We received a warm welcome from the villagers who helped us unload our gear and mount the steep banks. They gave us the use of their school house for the clinics, a two storey building made from traditional materials and surrounded by lush green lawns. There were dirt floors, blackboards and desks with benches made from planks of rough wood. Most of our patients presented with conditions seen frequently in Australian general practice – respiratory infections, diarrhoea and musculoskeletal problems. However in PNG, a flu-like illness could easily be malaria or a chronic cough, tuberculosis.
On our final afternoon, riotous laughter drifted through the school house windows as some of our team played with the children on the lawn, turning skipping ropes and blowing bubbles. Not long after, I was called to see Beth and her newborn baby, Enwah, only 10 days old. Enwah nestled in a colourful blanket, crying weakly, skin taut across his tiny skull, with the wizened appearance of marasmus. Beth and her parents had left their village, further up the river at 5am that morning, having heard about the visiting medical team. We settled Beth into the storeroom with our team leader, Jennifer. I advised them on how to express some breast milk and syringe feed the baby. While Jennifer helped Beth to feed Enwah, she told us her story.
Beth had been attending high school in Daru, capital of the Western Province, but became pregnant at age 19 and returned home to live with her parents. She worked hard and ate little on the advice of her mother in the hope she would have a small baby and easier delivery. Beth received no antenatal care. Eight months into her pregnancy, Beth became ill with a fever and went into premature labour. She delivered a baby boy, Enwah. After a few days, he became ill and stopped feeding at the breast. Beth tried to spoon feed him for the next six days; however Enwah took very little orally and continued to grow weaker. Enwah had now been ill for six days and had not fed for 24 hours. He was severely dehydrated and malnourished. Beth and her parents were distressed about Enwah’s condition. The nearest healthcare facility was in Daru. Their only mode of transport was dugout canoe. It would take nearly two days to make the journey to Daru, paddling day and night.
After discussion with Beth and her family, it was decided that mother and baby would return with us to Daru for transfer to the hospital. Beth’s parents would follow in their canoe. This journey would take 1 ½ days in dugout canoe from Abam. The same trip would only take one hour in the zodiac. We prayed for Enwah as we set out for Daru.
Jennifer accompanied Beth and Enwah to the hospital and visited them the next morning to check on their progress before our departure for Port Moresby. The doctor’s initial attempts to insert a drip into Enwah’s collapsed veins were unsuccessful. Overnight, he developed vomiting and diarrhoea and continued to be syringe fed with breast milk. Eventually an intravenous line was inserted. By morning, he was crying more strongly. It seemed as if Enwah had turned a corner and the doctor was more hopeful of a positive outcome. I believe Enwah would have died if unable to get to the hospital. Another day, he would not have had this chance.
Maternal mortality rates in PNG are among the highest in the Pacific at 250/100 000 live births1, compared with 8/100 000 live births in Australia2 (2009). Child mortality is also high in the under 5 age group at 68/1000 live births1 compared with 5/1000 live births in Australia2 (2009). It is not my aim here to address solutions to this problem, simply to share the story of Beth and Enwah, who for me have personalised the challenge of delivering health care to remote communities. After our return, Jennifer tried to find out what had happened to Enwah. The only information we were able to find out was that they weren’t at the hospital anymore. We don’t know what the final outcome for Enwah was, only that he was given a chance that day that normally would not have been available to him or his family.
- Global Health Observatory, World Health Organisation. Papua New Guinea – health profile (2009).
- Global Health Observatory, World Health Organisation. Australia – health profile (2009).