On 23 June 2012, Papua New Guinea voters, including 87% from rural districts, began the difficult travail (on average a two hour walk across rugged mountains and dense rainforest) to confirm their vote for Papua New Guinea’s political future. One significant item on the electoral agenda is the vital need to restructure the nation’s fractured, inefficient healthcare system to improve quality of life for seven million struggling people. If this election manages to alter PNG’s political landscape, it could prove an incredibly momentous occasion for the majority of PNG citizens, 37% of whom live under the poverty line. A fact that is both horrifying and angering.
87 percent of the population live in isolated villages in 22 provinces and 89 districts, each with vast differences in language and culture. These rural areas do not have access to timely health service delivery due to deficient, deteriorating transport infrastructure.
These logistical factors cripple an under-resourced medical supply system. For example, an estimated 40 percent of rural health facilities, including first-line providers like aid posts, are not maintained, restocked or serviced due to inadequate government funding. Many communities lack essential services such as vaccinations, emergency surgeries, prenatal care, labour and delivery services. This fact would be absolutely unacceptable in a Brisbane hospital. Herein lies the essential dilemma – why are there people in the world that don’t have the same access to health services as I do living in a country less than 5 hours flight away?
Insidious corruption, ineffective management and poor coordination cripple public health services that fail to meet the needs of local people.
PNG’s healthcare problems are underscored by a widespread lack of hygiene.
With an estimated 40% of the population lacking sustainable access to improved sanitation, infectious waterborne diseases such as cholera and typhoid are significant threats. Major causes of morbidity and mortality in PNG include communicable diseases such malaria and diarrhoeal diseases, both of which can be attributed to lack of sanitation.
With two to three percent of its adult population affected by HIV, PNG is in the grip of an acquired immunodeficiency syndrome (AIDS) epidemic and accounts for seventy percent of Asia Pacific’s HIV cases. PNG’s struggle exhibits characteristics of Africa’s AIDS/HIV epidemic.
For example, those most probable to contract the disease, such as urban workers, live in denial, and the largely heterosexual transmission leaves women (a disempowered minority in PNG) particularly susceptible. Mothers often inadvertently transmit the disease to their children through pregnancy, labour, delivery or breastfeeding. The consequences are evident in the grim statistics – maternal mortality is increasing in PNG, while the under-five infant mortality rate continues to be one of the highest in the region, with 733 per 100,000 live births resulting in premature death. To put this into perspective, the equivalent figure in Australia is about eight.
Most frighteningly, inadequate public education means that social stigmas surrounding AIDS largely undercut attempts to minimise its spread. However, brave efforts from a few young women like twenty-three year old Orange Samilo, who faced ignorance and distrust from her community when she broke news about her AIDS infection, is slowly breaking ground.
PNG’s health system also lacks the technology and facilities to effectively treat chronic lifestyle-related diseases like diabetes, heart disease and cancer, which are on the rise in urban centres.
As a result of PNG’s abrupt transition from thousands of years in subsistence agriculture to participation in a global economy inundated with Western-influenced commodities, urban Papua New Guineans suffer a wide range of chronic lifestyle problems, including obesity, because their modern consumption habits fail to meet nutritional needs set up by evolution.
PNG suffers recurring tribal violence. Deeply-entrenched socio-cultural and language differences between tribes hinder attempts to establish peaceful negotiations.
In rural areas, certain tribes dominate public services, including health clinics, allowing them to deny health services to enemy clans. This ignites open warfare and encourages clans to destroy health facilities, creating an unstable environment for nurses and doctors.
There are many challenges that Papua New Guinea faces into the future with its healthcare but many organisations and local communities are already investing their time and energy to improve the conditions many face.
But one crucial question remains, what lies ahead for Papua New Guinea?