How Australia & the US gave away the people of West Papua

21st century so very far away: PNG’s tragedy of remoteness

On a Sepik tributaryGEORGE KUIAS

SO here I was at Mirsey health sub-centre in the Ambunti area of the upper Sepik. There was no oxygen, the hydrocortisone and salbutamol had run out and even the manual foot pump for nebulising the patient was malfunctioning.

Martin, my patient, was developing severe shortness of breath and was cyanosed due to lack of oxygen. Even the antibiotics had not helped. He was restless and gasping for air.

I tried to resuscitate him but failed. He needed anti-asthma drugs to revive him. The only option was to refer him to Boram hospital in Wewak - 14 hours by dinghy along the main Sepik River and then by ambulance to Wewak.

After sorting out the fuel and the boat operator we trundled off following a tributary of the Sepik. Due to low water levels and submarine tree stumps, we could not travel at speed.

At seven o’clock in the night my patient Martin told me to stop and turn back to the health centre. I hesitated. My aim was to save his life.

On our way, he had made several attempts to jump overboard but was held back by his guardian. Martins’ voice had become very weak and then he slipped into unconsciousness. His eyes turned upwards, saliva and mucus drained from his nose and mouth and he died in our arms inside the dinghy. Unfortunately I had lost my patient.

As I lowered my head, I thought to myself that Martin should not have died if only the medical kits had arrived on time and all the necessary drugs were in stock.

People could argue that it’s the responsibility of the officer in charge to make sure the kits are there and the stocks are maintained and the life-saving equipment is in place.

But this is all sweet talk from people in comfortable chairs. It’s tough managing complex cases in remote settings where there are poor or no roads or long water journeys. The town is far away and so are the people responsible for maintaining the liens of supply.

There are other factors. Will patients assent to be referred when they are told the medical and other fees? Do they have wantoks in town who can support them?

Some people refuse to be referred because of these reasons and accept death as normal. But down deep in their hearts they feel the pain. Parents accepting the death of their children, a husband can the death of his beloved wife, children accepting the death of parents.

This is a continuing tragedy happening in many parts of remote Papua New Guinea.


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George Kuias

Thank you Rhonda for the comment on Facebook Sepik Forum.

We would argue to that extent but as the person on the ground at that time I would have done what you suggested.

Bear in mind that there are other issues interlinked. Thank you for your comments and suggestions.

George Kuias

Thank you, Maureen, the deceased was the front man of the contractor that was contracted to build the staff houses funded under the Save the Children (SCF) Fund in that health facility. Unfortunately he was an asthmatic so it happened the way it did.

Barbara Short

A comment from Rhonda K. on the Sepik Forum -

These circumstances surrounding the death of this patient are very unfortunate but there are learning issues which we can learn from.
We can either keep complaining about the Government services or lack thereof or we can do something about it.

First of all if there are no basic drugs available and which can not be procured then shut the clinic down rather than giving a false sense of security that patients can be treated there. Once you do that the District Health Manager will wake up and start doing his job because if you keep working with little or no resources not only are you jeopardizing yourself as a health professional but also the patients life.

Secondly there should be public health awareness in the communities where the clinics catchment area is as to what the clinic can and cannot provide so that people who are as in this case asthmatics can relocate closer to a health center which can assist them. And also people will need to start taking better care of themselves (primary health care).

Thirdly if the Government is not providing the resources then you have to start charging fees in order to purchase the medicines yourself. Or kick off a fundraiser to enable you to purchase the medicines.

And in any event get out there and start talking to people who might be able to assist.

Paul Oates

Maureen, I understand the frustration felt when you and many others feel when they look at the state of public health in PNG and how it has been allowed to lapse into such a deplorable state.

Programs like public health cannot be managed on a piecemeal basis but must be managed nationwide otherwise the funds and staff become localised and there is no commonality of approach or accountability.

The issue is very clear. PNG people continue to lament about their lack of government services but still keep electing those politicians who cannot or will not behave in a responsible manner.

As Des Martin correctly points out, even with the limited resources available in the time of the Australian administration, the level of medical service was provided free to the PNG people in rural areas was far better than it is now.

What should be happening is that PNG people look to fixing the disease rather than continually concentrating about the symptoms. All that happens at the moment is that those responsible are laughing all the way to their overseas bank accounts and leaving their own people to suffer.

If there wasn't such a material expectation on the part of voters to have elected officials to provide 'gris moni and kago' to get elected and stay in the job, perhaps those who would or could manage the budget and programs might be allowed to actually manage successfully?

There are however a few PNG leaders who are saying and doing the right things. Why aren't these leaders being actively supported and encouraged by everyone else? Why are those who are responsible for the lack of services continually allowed to get away with it?

No one ever said that something worthwhile was ever easy to obtain yet such appears to be the expectation of the many every five years.

Maureen Wari

This story, the way it is told (and I am sure is how it happened) is traumatising even for me as a reader.

My comment is to those who are able to or who are authorized by virtues of powers and who can make a difference.

This losing of a life is so tragic. I again am sure that there are stories like this in all provinces of PNG.

Instead of sick people looking for medical services whether it is three hours on high seas or 14 hours by dinghy on a main river, can medical services go to the people?

I know an NGO Christian group by the name of YWAM that has been taking medical services to the Bamu people in remote Western Province and Gulf and are extending to a couple of new places.

How about each Governor of each Province give them some money to take medicine to our far flung places?

I am seeing results with their programmes than our big vision.

On that same note check out the churches and NGOs doing similar things all over PNG.

Give them a boost to help our people in very remote areas.

George Kuias

Thank you everyone for commenting. This is just one of many experiences that I have encountered over the the ten years in remote West New Britain and East Sepik provinces.

Ian Fraser

Disjointed funding indeed. That's what the MPs' slush funds are: a decision to act individually rather than collectively, as big men rather than as a government.

When people vote for government, rather than big men, maybe they will get it...not that I know of a way to make that happen!

Jimmy Awagl

Many festivals for hours of fun and entertainment and, after the recent crocodile festival at Ambunti, Wewak and Melanesian arts festival, we hear of this tragedy.

The nature of the incident calls for Sepik MPs and District Administrators to consider services in the remote places to provide reliable and convenient services.

The money for the festival is too much compared with chartering a plane for a good Samaritan to fly to desperately ill people.

John Kaupa Kamasua

In this age in PNG if one cares to look, there are ironies, then there are ironies of ironies; one of them is the predicament faced by people in remote and rural areas in relation to basic health and medical attention.

The country is seemingly flushed with cash (?) so that Electoral MPs now have K10 million each to spend under their DSIP each year, and Council Presidents have K500, 000 to spend on projects in their LLGs. There's a lot of money to spend on some health and education program.

Time to do a bit more realigning of efforts of private sector, donor agencies, community initiatives and what can be done through the government established mechanisms.

Right now it appears there are too many disjointed projects and programs each trying out different approaches and with different agendas.(Just a food for thought).

Des Martin

George Kuias' post is so sad and his patient's death a tragedy.

Looking back to those far away days when I was the ADO Kiap at Ambunti 1960-63, I had a liklik dokta medical assistant whose small hospital provided excellent medical facilities to local people and medivac by air to base hospital in Wewak for those needing advanced treatment.

Seems that things have gone down hill a bit since then.

John Kaupa Kamasua

Yes Paul, Minister Malabag was in Melbourne for the World AIDS Conference recently and was very animated during his speech on EMTV but I was not overly convinced.

Paul Oates

Calling Health Minister Malabag,....

Hello Minister...... Do you remember that scheme for the reputable purchasing and guaranteed distribution of medicines that was paid for by Australia that you and your government insisted on throwing out in favour of a vastly more expensive BPP scheme that reputedly produced massive kickbacks?...

You know... that's the contract you broke your own tended rules to force your countrymen and women to suffer under..

Hello Minister.. (tap, tap) the line appears to have gone dead...

Yep! (sigh) People sure have short memories...

David Kasei Wapar

May God bless those who serve with the heart!

Kela Kapkora Sil Bolkin

This cannot happen in the Sepik where the Chiefs and the Sukundumis rule.

So the story tells us that the leaders have decided to build castles in Wewak town, go off to foreign lands for medicals; buy assets and shares as if they were peanuts; award themselves ego inflating titles like Chiefs, Sirs, Sukundumis and so on.

While others decide to open their bums to the Asians as reported by the late bank robber, engrossing in the underworld and leave the people in this plight.

Caesar burnt Rome and watched it burning from his balcony and was thrilled when he saw women and children running for their lives. A similar tale in the Sepik.

Shame! Shame!

Barbara Short

I placed this article on the Sepik Region DD Forum on Facebook and there are some good responses -

Have seen the same in the outback; hinterlands of East Sepik.. where government's services, government workers, are seen after every five years.. that's during the time of the elections.. its all really really sad when you yourself see it.. even schools in some places are non exsistant.. no aid posts.. no central health centers .. these people believe in ancestral things.. yet the government of today boast of economic growth and all that .. and talk about the front face of the country and forget the back page.. that's how incapable of how the government and the provincial members have neglected them and even cannot do anything about it.. all they want is flashy cars, hotel rooms.. and you name it.. while our very people die of curable diseases.. may Martin's soul rest in eternal peace..

Comment Amburk Alloy 8:57am Aug 20

I feel... may late Martin rest in peace, with the Living Being, God Almighty. Knowing there is hope practically, yet cannot be provided at this circumstance, is hurting. I have witnessed many along Sepik River, and did my best to save those I can. But still it is unbearable knowing that there is cure available but cannot be delivered or reached in time.
Diane Liriope 8:43am Aug 20

My heart breaks for this patient. This is a preventable death.
How tragic in this day and age and with a govt that claims success with its free health policy.
Send this post to PM and HEALTH MINISTER so they can see the realities of life in rural PNG.

Barbara Short

The Sepik region is full of isolated places like this. But thousands of people live there. recently they help a Crocodile Festival at Ambunti and it is said that 10,000 river people attended. But does anybody in PNG know about it. I doubt it.

But here, in a place that was once famous for its headhunting 100 years ago, there is now a thriving community where people can come together safely and respect each other.

But, as you say, the government way over in Moresby, hasn't got a clue. We tried to stop the government from allowing the wrong people to look after supplying medicines to the out-stations. We knew this sort of thing was bound to happen.

I just pray, Martin, has gone to a better place.

Leonard Roka

A vast land area and poor government strategies to develop this country has led to the suffering of the people.

But that's your calling - to serve.

Jimmy Awagl

Quite challenging and you used your initiative to save life but the tragedy happened to convey a dynamic message to the authority and people concern to address such demanding issues.

You are too brave and genuine to take the risk I applaud your effort to save one.

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