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Fight continues unabated in Daru – a world TB hot spot

People-with-suspected-TB-Mabuduan-Health-Centre (DFAT)
People with suspected TB await further tests at the Mabuduan Health Centre, Western Province

STAFF REPORTER | The World Bank

DARU - “Hurry up and come! The health workers are here!” With the help of an enthusiastic community member and a megaphone, the tuberculosis screening team announce their arrival in Bamu, a small community on Daru island in Papua New Guinea’s Western Province.

Within minutes, community members emerge from homes, gardens and fields to make their way towards the makeshift clinic. By the time the first people take their seats at the registration desk, the team is already hard at work preparing for another day in the fight against TB.

They are there with a clear mission: to screen as many people as possible, educate the community about the disease and link suspected cases directly to treatment services.

Health workers begin taking details. Weight and height are recorded. Counsellors run consultations to combat stigma and dispel fears around x-rays and a potentially positive result. Then one-by-one, each visitor enters the mobile screening van, where an x-ray and thermal image provides on-the-spot diagnosis of possible TB infection.

The challenge is immense. In 2016, the World Health Organisation (WHO) recommended that the entire population of Daru be screened because of alarmingly high rates of tuberculosis, especially the even harder to beat multi-drug resistant tuberculosis.

Health services on this island in the remote south-west corner of PNG have struggled to cope with TB for many years, compounded by the challenging terrain that makes it difficult for people to travel to the central hospital for diagnosis and treatment.

To combat this challenge, the TB van – a custom-built, all-terrain, mobile x-ray screening vehicle, complete with a giant photograph of PNG’s most famous rugby player, Ase Boas, and the slogan ‘let’s kick TB out of PNG’ – hit the road with the mission to test the entire population of Daru for TB.

“In Daru the hospital is quite far and most of the people are not going to the hospital until they are really sick,” said Natalie Fimbuvu, the x-ray technician on board the van. “We help them by providing services at their doorstep.”

Natalie is a vital part of the 10-person health team that has so far screened around 6,500 people across Daru in a little under a year. Natalie calmly and expertly guides each and every person through the two-minute x-ray process inside the van.

“It’s the first time many of these people have had an x-ray, so many are nervous,” she says. “I’m looking for abnormalities in the chest region, especially the lungs. For a normal x-ray it’s usually black – both lungs – but if there are white patches in between the lungs, then there’s an abnormality there.”

After a screening, Natalie provides a score out of 100 for each person that rates the likelihood of infection. Low-score patients are free to go without further action, but those with a higher score are required to produce a saliva sample for further analysis.

If a TB infection is identified, patients immediately begin an intensive treatment program at the hospital, followed by the dedicated TB treatment sites close to their homes.

“We live a bit of a distance away from the clinic,” says Simona Vanaria, a Bamu resident. “Sometimes when we are sick, we are scared to come to the hospital. [But] I’m happy that I came with all my family to check and the results are negative.”

Sandra Wanakrah, WHO’s coordinator for TB screening in Daru, is working alongside Natalie. She says there is a strong camaraderie among the team: that this is important, life-saving work.

“We know it’s a big fight but if we can all stand together and do as much as possible, to the best of our potential, I’m sure we can do it. We can kick TB out of PNG,” says Sandra.

Comments

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Julian Counsel

What they need is a 40-50 ft shallow draft aluminium barge with diesels and jet drives. It should have small cabins, genset backup and space to store a vehicle so, when they arrive at river locations, they can drive off and back on.

The vehicle needs to be an all terrain 4WD and the barge ramp the extended type.

I can be contacted to help design but I do not have money just the idea from many years of travelling through Western Province rivers and coastal areas.

Philip Fitzpatrick

Daru is about 1,500 hectares in size. You can walk to most parts in a very short time. The airport is smack in the middle at the highest points (3 metres).

The 'corners' are settlements of different people from the mainland. Bamu River people from the mainland live at Bamu Corner, for instance.

I agree with you Peter. A boat would be a much better proposition. With a boat they could get to the mainland and some of the islands where TB is probably also rife.

Peter Sandery

Perhaps I am becoming senile, but from my recollections of Daru island, no part of the island is too far from the Daru Hospital and the topography of the island is that of a typical estuarine island, rather low lying with a bit of a rise, which apparently was sinking, upon which the comms tower was built.

I think when the writer talks about "Bamu", he probably means "Bamu Corner", which is one of the many corners of the town in which transients and not so transients from other parts of the Western Province reside.

The real Bamu is of course on the mainland. In my humble opinion, the anti-TB campaign would be far better off with a decent boat than a truck.

However, I stand to be corrected by my betters!
_________

I believe you are one of the 'betters', Peter - KJ

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