They die of tuberculosis – disease on rampage in PNG

SUSAN MERRELL

AT THE HEALTH CENTRE in the township of Tapini there were more than a dozen patients suffering from tuberculosis waiting for treatment: that's a long queue for a small town.

Kope, two months old, surveyed a world that was still new to him.  This beautiful baby boy with eyes so big that you could melt into them had, in his short life, only known suffering.  He has TB.  His mother died of it.

Tapini is the main town of the district of Goilala in Papua New Guinea's Central Province.  It's just 124 kilometres from the capital city of Port Moresby, as the crow flies, but the journey takes over six hours by road – a four-wheel drive is an absolute necessity -The road is often blocked by avalanches.

One can also fly into Tapini - but that's not for the faint-hearted either.  Nestled in a small valley, take offs and landings from the grass airstrip that bisects the town are fraught owing to the mountains rising up from the end of the runway between which the pilot must steer a treacherous path. 

Nevertheless, it's a trip well worth taking if only to witness the breathtaking scenery of this beautiful remote region.  In Goilala life is lived in much the same manner that it has been lived for centuries. To all intents and purposes Goilala is a land that time forgot.

But it’s not only time that has forgotten Goilala. 

Goilala is hardly on the radar of the PNG government either - especially when it comes to basic services.  There is no central electricity supply in the district for instance.

And while there were up to 15 government aid posts  – all but one have been closed due to lack of funding and the fate of the last remaining one hangs by a thread

There are no roads. Public transport is non existent. The government administration offices in Tapini are unmanned.

In Tapini, the Catholic Mission runs the district's school and sole health centre.

The Central Province has just one medical doctor to service 200,000 people.

But if PNG is described as a gold mine floating on a sea of gas and oil, the Goilala district also has its share of mineral wealth.  Goilala is host to the Tokuluma gold mine that produces 80,000 ounces of gold a year.

The mine is owned by Petromin - a PNG state owned enterprise and the mine is a handy source of government revenue – not that much trickles down to Goilalans.

However, Goilalans do reap the adverse consequences - The mine discharges 230,000 tonnes of its toxic detritus (known as tailings) into the river system.  There is also substantial toxic run off from its waste dumps. 

These riverine tailings have poisoned the river system - previously a source of drinking water. Discharged heavy metals such as Arsenic has also killed off a valuable source of protein for the villagers - fish.

Toxic run off has also seeped into the soil polluting the surrounding land and finding its way into underground water supplies – accessed by the people from wells. Now, in some affected villages women need to walk for 4 hours to collect drinking water.

Ironically, 25% of the land area where the Tokuluma mine operates has been declared an area of ecological fragility.

Goilalans are in the unenviable position where their traditional life has been compromised by modernity in the form of industry but they receive scant benefits. 

Poverty is rife.  The diseases of poverty thrive, unchecked – another legacy of the modern world.

Tuberculosis, known to be one of the principle diseases of poverty, is rampant. There's little to stop its rampage and much that aids its onslaught - such as the high incidence of HIV/AIDS – the two diseases working in tandem is a particularly lethal combination

Sister Marina, the town's midwife says that for every ten expectant mothers that she tests at least one or two will test positive to HIV.  In the main the men refuse to be tested. 

"They contract HIV/AIDS," said Father Brian Cahill, head of the Catholic Mission "but it is TB that kills them."

Poor nutrition further exacerbates the local susceptibility to the disease – sources of protein are few - less since the Tokuluma mine killed the river fish.

In a district of just a few thousand people, the medical centre at Tapini has on its books an average of 40 new cases of tuberculosis a year and further cases (up to 13 in recent years) of retreatment through previous default or reoccurrence.

If those statistics are frightening, they're just the tip of the iceberg because with the government aid posts closed, now, in the remote villages people die quietly and anonymously.

In the villages with little recourse to scientific diagnosis they blame sorcery and they rely on sorcery for the cure. It doesn't work - they die. 

Those who don't die, some of which had started treatment but discontinued when aid posts were closed or when the trip to Tapini became too hard are in danger of developing the multi-drug-resistant strain.

The fact that the clinic in Tapini also runs out of drug supplies on a regular basis also increases the risk of MDRTB too.

In a recent report in Australian newspapers it was disclosed that there have been 6 confirmed cases of Extensively Drug Resisant TB (XDRTB) in another province of Papua New Guinea – the impoverished Western Province. XDRTB is known to have a low cure rate and a high death rate. 

The situation was highlighted to the Australian authorities when a sufferer from Papua New Guinea flew to Australia on a holiday visa.  She is currently in hospital in Australia – her treatment is expected to last 2 years and cost $500,000 - $1,000,000. It is feared that within 5 years this disease will spread to the general population of Australia.

Tuberculosis needs to be stopped - eradicated at the source.  Yet, with no diagnostic equipment in Goilala, the question is:  how many cases of this frightening strain of TB are lurking undiagnosed?

The question is how?  In a country where 50% of the governmental budget each year is lost to corruption – perpetrated by public servants working in concert with politicians - it leaves little available for basic government services – including and especially health.

I wonder whether the corrupt of Papua New Guinea realise the human implications of what they do.

Well I do - They killed Kope's mum.

Comments

[Paulus Ripa]

Susan - Your article highlights the dysfunctional state of health services in PNG.

Since decentralisation in the 80s, health functions were decentralised to provinces and districts and much of rural health services have disappeared or become defunct.

We used to do outreach services from Port Moresby General Hospital but that has since lapsed so we practice in an isolated island in the middle of NCD.

All we can do is take the patients referred to us and treat them and then send them home hoping they can continue to take treatment.

All family members ideally should be screened for TB but that does not happen because of travel logistics.

At the moment the TB authorities since moving to combination therapy (all TB medicines in one preparation) have decided to only supply health centres who are certified DOTS (directly observed treatment) centres.

This means most centres do not have TB drug supplies and patients often run out (increasing the risk of drug resistance).

The whole TB program needs a revamp in this country and the PNG Paediatric Society has during the recent symposium put together a set of proposals to forward to the Health Department to address these issues.

There is the added dimension of so many organisations and NGOs etc pushing their own sectarian agendas that the health department is inundated to the point of paralysis when the central theme should be to strengthen the whole health service rather than concentrate solely on midwives or HIV or TB.

Each province needs to be supported to strengthen their health services and links between hospitals and peripheral services so that services can be maintained. In that regard Central Province has been a very neglected province.

We could look at providing paediatric visits to Goilala to support TB diagnosis and treatment there (since you are putting in an x-ray machine ) from PMGH if we can sort out the logistics.

[Susan Merrell]

Subsequent to my trip to Goilala, I have managed to secure the clinic at Tapini the donation of an X-ray machine from a radiological practice in Melbourne.

We still need a donation of computer equipment to work it. The radiologists are working on this.

There have also been people approached to provide some of the other peripherals like freight, air fares, hotel rooms training, maintenance and installation. Things are proceeding slowly.

This article is the transcript of a video presentation I did for a lung disease conference I will be attending in KL in the middle of the month.

As the drug company Lilly provided my fellowship to the conference, I am hoping that I may be able to convince their MDRTB foundatiIon to come up with what we're missing.

The video presentation is on my Facebook wall - and I can be contacted on Susan.merrell@bigpond.com. Excuse any typos, I'm using my phone.

[Peter Kranz]

Forgive my cynicism, but it seems Australia is in a hurry to push the TB patients back to PNG, close down the Torres clinics, and claim they are building up first class TB treatment facilities in Daru.

As Susan describes, the problem is much bigger and more widespread than this piddling effort in Daru.

Out of sight, out of mind?

Not as long as this website is bloody around!

[Paul Oates]

What’s needed here is the equivalent of a General Templer. He was the bloke who was appointed to take over the Malayan emergency after the Administrator was ambushed and shot. I read long ago a report of his first day on the job and it went smething like this:

‘The General sighed and opening the bottom draw of his desk, put his feet into it and lifted the telephone handset.

‘Hullo’ he said. ‘Is that the Head of the Public Works Department?’

When he was assured it was, he asked: “Can you hear me alright? Is the phone working OK?’

Again he was assured it was.

‘Well’ roared the General, ‘Where’s that bloody barbed wire I ordered 3 hours ago?’

[Trevor Freestone.]

TB is developing into a super bug as was described on a recent 4 Corners program on the ABC.

A bug that may soon have no cure and is going to be devastating throughout the Western Province of PNG, the Torres Straits, Northern Australia, South East Asia and indeed the whole world.

AusAID is patting itself on the back claiming that it is providing 8 million dollars towards treatment and research into TB in Papua New Guinea.

Sounds grea!? Hardly! This aid is spread over four years. Over the next four years AusAID's budget for PNG is $1,800 million and only $8 million has been earmarked for research and treatment of TB.

Surely Daru Hospital and other hospitals in this area not only need to be upgraded and staffed with highly qualified specialists but huge sums of money needs to be poured into research.

New hospitals need to be built not closed down and AusAID should be leading the charge by donating a realistic amount of aid into this problem.

A new research facility in PNG would also be a huge step forward into finding how to stop the spread of TB throughout PNG and Australia.

The government of Australia needs to take a hard look at Ausaid for it seems to be an organisation completely out of touch with reality. Bob Carr should be far more involved in how aid is used in PNG and a few visits would not go astray.

A few stays in rural villages instead of five star hotels would be a real learning experience for him. Bob don't forget to take your TB shots before going although from what Four Corners tells us these won't be of much use soon.

[Kevin O'Regan]

Barbara and Susan, this is becoming so common in all remote areas. Barbar's last sentence says it all but get it in the Australian newspapers and to Queensland's health attention... only last week Dr Jeannette Young of Queensland Health assured us we are being alarmist. I have seen first hand what this scourge can do... patients start off the first month of treatment and then because of lack of drugs consequent months do not get followed up. TB is heading to become the single biggest killer in PNG yet the authorities and health officials in Nth Queensland play down the issue... so desperatly sad and needless..

[Mrs Barbara Short]

Someone needs to give all PNG MPs a copy of this sad story. A copy could also be pinned to the noticeboards in all the Government Department offices in Moresby.
Hope it will also appear in the Post Courier and The National and I hope Bob Carr gets to read it.
I hope lots of things....