Friday, April 28, 2006

Lae Hospital

Angau Hospital is the main hospital in Lae – PNG’s second city – and services the surrounding region. The visit began with a briefing from the hospital’s newly appointed Director (second week in the job) who spoke frankly about the challenges the hospital was facing.

These challenges became rather more apparent when we were split into group to tour the wards. Whilst others went to view the neo-natal and psychiatric wards, our small group went to the Soroptimist funded Women and Children’s Clinic. From the accounts I heard on the other wards, this seems to be the bright spot in a hospital that is, literally, falling down around the patients.

The Clinic treats and counsels women and children who are the victims of domestic violence. The hospital provides that space and supplies for its operation while the rest of the funding – for staff and other overheads – come from the Soroptimist NGO. As well as treating the injuries and trauma that are the result of the violence, the clinic is actively engaged in prevention. They have trained and supported 40 volunteers (half of which are men) to go out to communities to provide information and workshops about alternative ways of dealing with anger/frustration etc and demonstrating to women that violence and rape are not acceptable and they can get help.

The clinic is also working closely with the local police in Lae to make sure that complaints are followed through on and perpetrators are punished.

About 1000 women have visited the clinic in the last two and a half years.

The other groups in the delegation found the rest of the hospital in serious decline. The buildings have been severely affected by termites causing crumbling walls and floors. Much of the equipment is broken and languishing in corridors, and supplies are sporadic.

Its hard to imagine how all this seems to the people – some of whom walk for days – when they bring their sick loved-ones for treatment. But, in many cases, this run-down hospital is the best available and the only option.

More to come

It was hard to capture everything we saw in PNG in the few short entries I managed while we were in country.

Retrospectively I will try and cover what else we covered during the week.

The field blog also seems to have generated a good following, so rather than go into hiatus whilst we find our next field writer, we will continue to update it with NZAID related news and information.

Thursday, April 13, 2006

School Visit

After a few hours rest to recover from a 4 am start, our programme in Lae began with a visit to the local secondary school. It was quite uplifting spending time with so many bright and hopeful young students, although the teachers were very frank about the problems with budget the school faces. The school was built in the 60s and seems to have little maintenance since – there are now almost 400 students and just 9 teachers. The teachers, like all the people we meet working in the health and education sectors, are tremendously pragmatic and dedicated in the face of difficulties that must be quite overwhelming.

The parent of the children pay fees - 1200 kina (about $750 NZ) for boarders – a cost which would be prohibitive for many living in PNG, but the children do seem to be getting a good quality education. Many of the students we talked to had already decided on what they would study at University – law, medicine and journalism were the most popular. All of the students were articulate, confident and spoke easily about their experiences with the delegation.

One aspect of the visit that was concerning was the absence of education around HIV/AIDS and safe sex issues. PNG is a very conservative country and these are not topics that are easily discussed, especially in a school setting. The head teacher mentioned his desire to introduce teaching around these areas, but felt it was unlikely that this would be supported by the parents. There is also not coordinated sexual and reproductive health modules in the national curriculum which the school teach.

This definitely brought home to me, and the other members of the delegation, how great the need for comprehensive and integrated planning is needed in terms of the HIV/AIDS issues. Our meeting with the various UN agencies on Monday emphasized this and outlined where and how this was happening – and how NZ can continue to support this work. The big question remains – will the results happen in time for the generation of kids we met today?

Wednesday, April 12, 2006

Arriving in Lae

This morning we arrived in the province of Morobe and are staying in PNG’s second city Lae. Like Port Moresby, Lae is struggling under the effects of a growing population, crime, HIV/AIDS and struggling public services.

On the schedule are visits to the local secondary school, the main hospital and the Markham Valley.

What everyone in the delegation is taking on board is the complexity of the issues facing PNG. There is layer upon layer of problems and possible solutions. What worked in Africa in terms of HIV/AIDS cannot be facsimiled to PNG – the diversity of culture, language, religion, custom seem to doom off-the-shelf solutions to failure.

Hospital Visit

I’m a bit hospital phobic at the best of times, so I have to confess that the two hospital visits we have done over the last two days have been difficult, upsetting and inspiring all at once.

Yesterday we were lucky enough to spend the afternoon with Dame Carol Kidu, PNG’s first woman Cabinet Minister and a staunch campaigner on HIV/AIDS issues.

Dame Carol took us to Port Moresby General the main, and only, hospital in the city. We were briefed by staff running the hospitals Sexually Transmitted Infection clinic which is where most people come to be tested and treated for HIV. The clinic has funding for the Global Aids Fund to provide anti retro viral drug treatment for those who fulfil the WHO criteria for treatment – supply of drugs is often raised as an issue here, but at this clinic the problem was finding the people to treat, there is so much shame and stigma attached to the disease that only one-third of the drugs available are being used.

The difficulties in the health sector and the burden HIV/AIDS is placing on an already dysfunctional system was more than obvious when we visited our next stop, a general ward at Port Moresby General. Feeling very much like voyeurs rather the helpful foreigners we were led into a ward of 63 beds, all full, and many occupied by patients with illnesses contributed to by HIV/AIDS.

For 63 very ill patients there were two junior doctors and two nurses. The nurses generally work 24 hours shifts and many just run-away when they cannot cope with the hours and conditions. On a stifling day the ceiling fans were not operating because the hospital cannot afford to pay the power bill.

It is through these situations that the need for leadership and reform in the health sector is so important – and why donor funding and support is much needed. New Zealand’s funding to the Sector Wide Approach in health seems a small drip in very large ocean when you see the results of the broken systems; but the goals of the programme seem to be exactly what is needed and it seems the results cannot come quickly enough.

Tuesday, April 11, 2006

Poro Support

The programme for this trip is fairly action-packed so finding time to write the blogs is an exercise in logistics itself and I am behind already!

Day one (yesterday) was spent visiting projects with NZ connections.

The second stop was the Save The Children Poro Support Project which provides a refuge and training place for Port Moresby’s sex-workers. The project focuses on providing information and training to new and established sex-workers and covers a range of topics including HIV/AIDS, safe-sex and self-defence.

The workers are often the victims of violence and have also faced discrimination from the Police and other groups – the project is helping build the raltionship between sex-workers and the police and volunteers from the project conduct ‘patrol’ of the areas known to be ‘hot-spots’ to keep an eye on the workers and monitor the numbers in each area.

The visit was a really positive introduction of how small NGO/community run project can make a difference to people who face significant challenges.

All the group spent a lot of time talking with the workers who were using the facilities and many had stories about violence, living on the streets and friends who had died as a result of HIV/AIDS.

Approximately 800 people are using the centre each month and the staff show such commitment and compassion for their project, it is easy to see why its considered such a success story.

Monday, April 10, 2006

Starting Point

Via Wellington, Auckland and then Brisbane the FPAID/NZAID study tour arrived in Port Moresby, capital city of Papau New Guinea.

Through briefings by the New Zealand Aids Council, NZAID, FPAID, WHO and the NZ High Commission in PNG the 17 of us now have a good level of background to begin our visit with.

The statistics we have been given show just what a serious and complex issue health in PNG is:
  • PNG is 1.7 times bigger than New Zealand

  • Population is 6 million – of which 82% live in rural areas

  • A high fertility rate of 4.3 births per woman
In many ways we have to take all the statistics we receive with a grain of salt and realize that they are probably on the conservative side. In a country as vast as PNG, with no roading network and 800 different dialect – gathering accurate information is a major challenge.

When it comes to HIV/AIDS the statistics are even more difficult to gather as there is much social stigma attached to the disease. The statistics that are available paint a pretty grim picture: 60,000 infections or a prevalence of 1.8% HIV deaths per year – 3,300.

The newly arrived World Health Organisation representative in Port Moresby told us that the HIV/AIDS situation in PNG is now akin to the situation in Sub-Saharan Africa – where prevelance rates are up to 30% - this is in comparision to Asian countries, such as Indonesia and Thailand where infection rates rose steeply but have now peaked and are on the decline.

As with Africa the disease is being spread mainly through heterosexual sex and women have over-represented in statistics – this is thought to be because of three factors:
  • Common for men to have many sexual partners

  • Prevalence of other sexually transmitted infections which make, women especially more vulnerable to contracting HIV

  • Lack of treatment available
Over the last 10 years the health system in PNG has basically collapsed. A lot of money has remained unspent in the central department whilst rural hospitals/community health centres have run-out of money, medicine and people.

Its hard to take-in all of this and wonder what can a country like New Zealand do to help – the problems seem so big. Our programme of $13 million could easily seem like a small drop in an enourmous bucket. The bright spot in all the information we have received is that it does seem New Zealand's funding to PNG is going exactly where it needs to go.

As lead donor in the Health sector New Zealand has taken the initiative and led a Sector Wide Approach (SWap) to strengthen the ability of the National Department of Health to meet the health needs of PNG. It is clear that there is some momentum for change now and the NDOH is seen as reform model for other PNG public departments to follow – but its going to take a long time and there are many bridges to cross.

Today all this background will be put in context when we start our field visits – which include a range of HIV/AIDS and other health project.