Dr Bronwen Morrison

DoctorDr Bronwen Morrison
Location Kavieng New Ireland
Date June 2016

Multiple patrols

Sentral East, New Irelanc: February 2016
Anaemia

Kimadan is a busy maternity and general clinic with an estimated 374 births expected from the clinic catchment area in 2016. Training was provided by the ADI doctor for 13 staff on how to use the clinic’s new WHO Haemoglobin Colour Scale Testing Kit, provided by ADI, to diagnose anaemia. Kimadan Clinic has a Hemocue machine that can also test for anaemia, but regularly runs out of expensive batteries and testing strips, leaving the busy staff without an important resource. The WHO kit provides a low cost and simple way of accurately estimating a patient’s haemoglobin when other means of testing are unavailable. The kit is designed to diagnose anaemia when clinical symptoms and signs point to this, for example in chronic malaria or childhood malnutrition. It can also be used as a screening tool in pregnancy, enabling prevention of maternal deaths by post-partum haemorrhage through early detection and treatment of significant anaemia. Staff also participated in an interactive refresher session on neonatal resuscitation using ADI’s Neo-Natalie doll.

Tikana patrol: Piliwa Health Centre March 2016
Domestic Violence

Serah G is a wife and mother who lives on a small and beautiful coral island off the west coast of New Ireland. She presented to Piliwa Health Centre, 1.5 hours boat ride from her home, with a broken forearm after being hit with a wooden paddle by her husband. The injured arm was plastered, a home-made sling was devised for comfort, and the team delivered her home the next day. Education was also given to local health workers in dealing with this kind of injury, and local police contacted.

Sadly, Serah is not the only victim of domestic violence presenting for treatment during rural patrol. As in Australia, women and girls in New Ireland sometimes suffer at the hands of their close family, husband or father, and their children often witness or are also victims to this violence. After attending Child Protection Training delivered by ADI, the rural patrol team has decided to start including topics of domestic violence prevention and child protection in their community health talks, and are.

Serah G is a wife and mother who lives on a small and beautiful coral island off the west coast of New Ireland. She presented to Piliwa Health Centre, 1.5 hours boat ride from her home, with a broken forearm after being hit with a wooden paddle by her husband. The injured arm was plastered, a home-made sling was devised for comfort, and the team delivered her home the next day. Education was also given to local health workers in dealing with this kind of injury, and local police contacted.

Sadly, Serah is not the only victim of domestic violence presenting for treatment during rural patrol. As in Australia, women and girls in New Ireland sometimes suffer at the hands of their close family, husband or father, and their children often witness or are also victims to this violence. After attending Child Protection Training delivered by ADI, the rural patrol team has decided to start including topics of domestic violence prevention and child protection in their community health talks, and are developing appropriate materials in conjunction with Kavieng Hospital’s social worker, to start addressing this important issue in New Ireland’s rural communities.

Serah G and Dr Bron waiting for the boat at Piliwa, Djaul Island.

South Lovongai Patrol; Baungung AP April 2016
Family planning

Ngourvalus is a single mother, and just gave birth to her 3rd child at home. She is unremarkable in the New Hanover Island community in that more than 50% of births on the island take place away from delivery centres in unsafe conditions. Ngourvalus was lucky – the birth was uncomplicated for both her and her new daughter. She presented to the ADI Patrol Clinic wanting treatment for her baby’s mild conjunctivitis. Gwendoline had not had a baby check or immunisations. Dr Bron Morrison treated her eyes, did a thorough newborn and post-natal check, arranged for them to visit Metemana Health Centre for immunisations, and talked to Ngourvalus about family planning, an essential part of any post-natal consultation. Ngourvalus was interested! Sr Eileen, the team’s Family Planning Officer, then inserted Ngourvalus’s first contraceptive implant under the skin of her left inside upper arm using a local anaesthetic, after some careful counselling about possible changes to her menstrual cycle and other important information, such as the implant’s protective effect against certain cancers. The implant is the most effective reversible method available worldwide, and is slowly changing birthing patterns in New Ireland as its use becomes more widespread. The implant is key to effective spacing of children and control of fertility when desired family size is reached. And, as Sr Eileen says in her community education talks, population pressure on land within traditional communities is becoming intense, and causes conflict within family groups and dispossession from customary lands. By using the implant, a woman and her partner can decide if and when to have the next child, ensuring the family doesn’t outgrow its resources. The implant program was begun in NI by Specim Pikinini, then continued by AVI and Marie Stopes. Now Sr Eileen, a local health officer currently based with ADI, is continuing the established implant program during ADI patrol by training health workers to do insertions, giving community awareness talks on a range of women’s and baby health topics, and inserting implants where there is no health worker. On the recent South Lavongai patrol, she inserted close to 50 implants in 10 days in 7 communities and delivered education talks on family planning to 400+, correcting the usual misconceptions and rumours about the implant and championing its use.

SR Eileen inserting a contraceptive implant for Ngourvalus.

Tanir Patrol : Natong AP  May 2016
Desease Prevention

Parrots, bananas, mosquito nets and immunisations in remote Tanir.

This affectionate little boy with Down Syndrome presented to Natong Aid Post with pneumonia, a common childhood presentation in Anir. There have been no immunisations on this remote island group for over two years, due to difficulties with transportation and coordination of the “cold chain”, and so the youngest children have had no protection against a range of preventable childhood illnesses such as pneumonia. Thanks to a hire of the Governor’s fast boat, the MV Akalei, the ADI/PH Patrol team were able to visit Anir for the first time in 3 years, and to deliver much-needed immunisations to Babase Health Centre. The ADI Patrol does not normally carry out immunisations, due to the lack of an MCH midwife on patrol and immunisation program responsibility lying at sub-provincial level, but the Patrol tries to be responsive to the greatest health needs of New Ireland’s most isolated and vulnerable communities.

Health education is critical to communities understanding the causes and prevention of disease, and to healthy changes happening at the individual and household level. Maria Sabok, ADI/PH Patrol team’s infection control officer, tells of all the different uses she has seen mosquito nets put to. On Lavongai, men use mosquito nets for fishing. At Anir, people cover their banana trees with them to catch the brightly coloured Eclectus parrots that come to eat the bananas. Very few Tanir families were actually using the mosquito nets that had been distributed during previous public health programs for themselves and their children. Diversion of health supplies to inappropriate uses eventuates in chronic ill health, malnourishment and stunting of children, resulting in poor school attendance, low literacy rates, and reinforcement of the cycle of poverty. Tragically, it also results in maternal deaths, such as two recent maternal deaths in the last 6 months caused by antepartum and postpartum bleeding on Anir. Women with severe anaemia, due to repeated or chronic malaria and lack of family planning to enable spacing of births, have little chance of surviving a major bleed in pregnancy or childbirth. Babies are also born small and anaemic, and more susceptible to childhood infection.

Malaria was rife in Anir and Tanga when the ADI team arrived, but thanks to an emergency supply of anti-malarial medications through City Pharmacy in Kavieng, the team was able to treat 121 RDT-positive patients, two-thirds of these children, some with severe complications of malaria such as heart failure, during their 2 week visit to these island groups. Martha Lungunga, the team’s education officer, delivered health talks to hundreds of local adults and children on prevention of malaria and other common diseases. The team was also able to reach remote populations on the islands away from health centres, that local health staff are routinely unable to provide outreach for due to clinic boat fuel shortages. In addition, ADI provided Hb Colour Scales to health centres with training, to enable quick and inexpensive screening for anaemia during antenatal visits, and to prevent further maternal deaths.

 Naminar Patrol: Palie Health Centre – 4 June 2016
Bronchiolitis and Broken Bones: Emergency Transfer

This baby boy was admitted onto the children’s ward at Palie HC with fever and laboured breathing 3 days prior to the patrol’s arrival. Despite antibiotic treatment he got worse, and was in marked respiratory distress by the time he was reviewed by the team’s doctor. Bronchiolitis is caused by a respiratory virus and affects babies and very young children only. Most of the time it is a mild disease and babies recover quickly. However, in some infants the lung inflammation is severe, meaning that all their energy is used in taking the next breath. These babies often develop dehydration because they are too exhausted to breastfeed. The team assisted the local health staff to assess and treat the child with oxygen and intravenous fluids, and eventually decided to transfer him in the team’s car to Lihir Medical Centre, where he was put on artificial respiratory support until his lungs recovered.

The next day, a 12 year old boy was carried in by relatives after falling from a tall fruit tree and breaking his femur. The bone was protruding through the skin, causing a lot of pain. ADI was able to supply morphine for pain relief and advise on stabilising the patient for transfer to Lihir Medical Centre, 1 hour’s drive away on potholed roads, for surgical repair of the broken leg.