Dr Merrilee Frankish

DoctorDr Merrilee Frankish
LocationNew Ireland
Date2012

Good stories exist 

ADI’s first patrol for 2012 went without a hitch thanks to hard work and brilliant teamwork, leading Merrilee to surmise: “There are good news stories too in this country.”

Working alongside local staff, she saw 70 patients and conducted interactive obstetric teaching: “The look of abject horror on the HEO’s face when I said we were going to the Labour Ward and I would pretend to be a patient was priceless.”

During patrols Merrilee thrilled locals with her rudimentary Tok Pisin, learnt 30 years ago as a medical student in PNG, and slowly re-learnt to “let things happen when they are meant to – not when I think they should!”

Mining the economic epicentre

“[T]he local communities generally enjoy a better level of primary health care than those visited during ADI’s other patrols.”

Nimamar Local Level Government (LLG) area in north-east New Ireland is based around tropical Lihir Island, which has the enormous and highly illuminated Newcrest gold mine as its economic epicentre. Lihir Medical Centre (which is funded by Newcrest and operated by the private company International SOS) is located near the mine and acts as a secondary referral hospital for Lihir and surrounding islands.

It has full inpatient, outpatient, pathology, dental, antenatal and radiology services. In fact, it acts as a little slice of Australia, providing back up for referrals, drug supplies as needed, outreach GP clinic and immunisation clinics.

Because of this, the local communities generally enjoy a better level of primary health care than those visited during ADI’s other patrols. Also, as many are employed by the mine, they often bypass their local health centre and go straight to Lihir paying their own way.

Palie Health Centre

“The HEO is outstanding […] however, staff are desperate for basic water supply, lighting and equipment.”

Our first stop was Palie Health Centre, which serves a catchment population of almost 6,000 people. It’s well supported with weekly visits and telephone advice from the GP at Lihir Medical Centre and an outstanding HEO who is hardworking, clever and dedicated. However, staff are desperate for basic water supply, lighting and equipment.

This area suffers extremely high rates and poor management of malaria and TB. Both programs were recently taken over by private bodies, Population Services International and World Vision respectively, so there are still teething problems. The new malaria testing and treatment is simple and highly effective and will be a boon once adopted in its entirety. Diarrhoeal diseases are also very common as pigs roam free and hygiene is not appropriate.

During my time there I saw patients and conducted ward rounds (using my rudimentary tok pisin). I treated a five-year-old boy with a cleft lip and palate and referred him for surgery – it’s anticipated that Lihir Sustainable will help with costs. At the request of the HEO, I undertook the supervision and teaching of a woman requiring an iron infusion. The woman was from the Highlands visiting relatives and had caught severe malaria, as she had no previous immunity (kind of like me!) She was adamant she would never return to the lowlands where “there is too much sickness”; she could be right.

“This is adult education: drills, scenarios and […] the staff were excited,
involved and will hopefully remember at least some strategies.”

I also carried out some lively interactive clinical scenarios involving me being a pregnant woman giving birth to a baby with stuck shoulder. A baby had recently died from this condition, so we were able to practice using drills, correct management and support for the baby.

PNG’s infant mortality rate is 52/1000 live births – by comparison, Australia has 4/1000 and the Solomon Island’s 30/1000. The stated aim for PNG is to decrease this rate to 20/1000. Seventy percent of deaths occur in the 48 hours around delivery time. PNG’s maternal mortality rate is the highest in the Asia-Pacific region, with a lifetime risk of maternal death of 1 in 94 (Australia has 1 in 7,400). Sixty percent of maternal deaths are related to infection and post-partum haemorrhage.

It is my desire to play a tiny part in helping to reduce these figures during my six months here. The PNG National Department of Health recently released a new Obstetric Handbook, which most health workers don’t know about, so I am teaching directly from this book.

We also practised resuscitation on a drink bottle as a model for a baby. The HEO was very perplexed – saying “but it doesn’t have a mouth”. “Pretend please,” I said. The staff became very involved and we learnt how to deal with various emergencies with the current equipment (or lack of) in the actual health centres. We explored many other areas including breech and bleeding after the baby is born – talking about some newer methods.

This is adult education, not just didactic lectures: drills, scenarios and as a PNG person stated, the staff were excited, involved and will hopefully remember at least some strategies. As a result of this feedback, ADI is pricing some practice models/dummies we can leave in the larger health centres and a mini one I can take on patrol.

Masahet Health Centre

“Delivering a baby by torch light […] is just plain awful and dangerous.”

We then travelled by banana boat to Masahet Island and later Mali Island, which are both great examples of healthy islands despite a high prevalence of malaria and TB. I had the opportunity to walk around the entire island and visit the villages, which are beautiful with fences, gardens, community spirit and flowers. The local people obviously take great pride in themselves and their surroundings.

Masahet Sub Health Centre serves a catchment population of 878 people. The staff are lovely and their accommodation was recently upgraded. Regrettably in all the health centres visited there was no power, no running water, no bathing facilities and no lighting. Delivering a baby by torch light (held by the one qualified staff member) is just plain awful and dangerous. Again, most patients take themselves directly to LMC, paying their own way.

“No one likes to use [malaria] bed nets, as they are hot and get eaten by rats.”

Each day I was there I diagnosed five cases of malaria. No one likes to use bed nets, as they are hot and get eaten by rats. It is a sad fact that some very talented scientists from the PNG IMR researching alternatives to nets have been lost at sea, their boat found empty and thought to have been taken by pirates.

There is total disorganisation of the TB program. One of my patients included an auntie with relapse TB who lived with a mother who had just given birth at home. The mother came in with her sick baby requiring im penicillin; her son had large cervical lymph nodes which looked tuberculous. There had been no contact tracing.

I advised that all the household contacts should go to Lihir Medical Centre for sputum and CXR. The mother had no money as she had no husband and the health centre did not have funds for transport either. I emphasised that it was urgent that they attend and that the money needed to be found from somewhere. There is just no contact tracing being carried out.

Tireless teamwork

“My family think it is particularly amusing that I am spending long periods of time driving on potholed roads and on the open sea in boats. These are not things I relished in Australia – but is all part of the experience isn’t it?”

To return to Kavieng, we travelled across the open sea by banana boat to Kavieng. This was actually quite fun; I shall become a convert to the sea. Everyone but me used their life jacket as a cushion and I did make sure the EPIRB was on my person. The next morning we drove the five challenging hours back to Kavieng. My family think it is particularly amusing that I am spending long periods of time driving on potholed roads and on the open sea in boats. These are not things I relished in Australia – but is all part of the experience isn’t it?

However, our wonderful tireless flexible team consulted over 400 sets of teeth and 300 sets of eyes (selling over 160 pairs of glasses for 30-60 kina/$13-26 each), gave numerous health promotion talks, offered advice on malaria and TB treatment, sanitation and water supply, assessed all the structural facilities, and generally provided support to the hardworking cheerful dedicated staff we encountered. In turn we shall report on the improvements needed in each health centre.

“Below the surface [of this slice of paradise] are treatable, preventable disease conditions affecting children, adults, tourist resorts and expats alike.”

I am truly enjoying and feeling privileged by my experiences in this slice of paradise. The sea is so blue, clear and breathtaking. Below the surface, however, are treatable, preventable disease conditions affecting children, adults, tourist resorts and expats alike. They are treatable and have been virtually eliminated in Australia, except for TB amongst our own very socially disadvantaged peoples in far north Queensland.

ADI’s presence here is warmly welcomed in whichever office I enter, thanks to our wonderful previous doctors and ADI’s management team of Peter, George, Delene and others. Hopefully the clarity, preciseness and relevance of our reporting, our onsite health centre teaching and medical actions will lead to a decline of these conditions of social inequality.