“The [existing] services are not really getting to the people who are living in the inland upper areas and there are diseases such as leprosy, filariasis, yaws and TB which are not being detected for many reasons including this.” Team member Mr. Patterson Merengas, Kavieng District Health Manager.
My second ADI patrol was to the large island of Lavongai (also called New Hanover), which is located north-west of the main island of New Ireland. This patrol ran more smoothly than the first one, although it was often difficult to navigate the boats between villages and across shallow reefs. However, there was no running out of fuel in the dark this time!
Over three weeks I visited six rural health centres – none of which had received a doctor’s visit for many years – and treated 509 patients. Pre-screening was performed by local staff to ensure I only saw people with the most serious illness or difficult diagnosis, for example, two previously undiagnosed cases of leprosy.
I also gave staff clinical training on topics they requested, which ranged from hepatitis to heart attacks and there were lively question and answer sessions about other clinical issues. During patient consultations I also gave staff one-on-one training on good history taking and examination, diagnoses, investigations and treatment.
Our team consisted of seven provincial and district health staff, which included the Kavieng District Health Manager Mr. Patterson Merengas, a health information officer and disease control officer, and dental staff. The team gave community health talks on healthy environment, TB, leprosy, yaws and maternal-child health. The dental therapists did check-ups for over 1,000 students, and treated 82 general patients of whom 60 required extractions.
We saw many cases of TB, but a lot more skin infections. Some patients presented with huge tropical ulcers which can last for months. Others presented with yaws which is caused by bacteria similar to syphilis. If left untreated, the sufferer can develop painful bone infections long after the skin lesion has healed. Yaws is spread by flies and linked to poor hygiene and sanitation.
It rained a lot on this patrol and the ground became very muddy. The mosquitoes multiplied happily, along with the flies. Two of the important diseases we saw are spread by mosquitoes – malaria and filariasis (elephantiasis). We saw several young patients who had ended up with epilepsy following a childhood attack of cerebral malaria or meningitis.
The villages were difficult to access, which is one of the biggest problems of providing health care in this area. Unlike the Konoagil area in southern New Ireland where all the villages are on the coast, some of the Lavongai villages are up to a day’s walk inland on steep, muddy tracks. This obviously makes it difficult for sick people to get to the health centres or for health staff to reach these villages on patrol.
Again, I marvelled at how dedicated the health workers are to stay and provide a service in such challenging places.