Dr Ishani Kaluthotage Reports From The Frontline In PNG: What does a positive COVID test result mean? It usually means you instruct the patient to isolate for 14 days, minimise further spread, allow for thorough contact tracing and ensure appropriate medical care is given.
But when you are in a very remote village in Western Province with limited access to food, roads, flights, healthcare, PPE – what are you meant to do when a positive case is detected?
How are you meant to tell someone to self isolate when they live in a small hut with 20 other family members? How do you tell them not to go outside when they need to go out to their gardens or markets to make some form of living to survive? How do you close a school and leave children stranded because they are days walk away from their homes? How do you initiate contact tracing when most people don’t own a phone and they move from the village to their bush-camps?
In Papua New Guinea (PNG), vaccinating against COVID has been the main priority as part of the National Covid Response. Most of PNG does not have the capacity or resources to treat or test for COVID cases. Given the lack of medical supplies and healthcare workers, there has been a big push to prevent the spread of COVID19 by vaccinating communities. Contact tracing was not a priority in their COVID response plan. Only 23% of the provinces in PNG have trained rapid response teams for contact tracing and quarantining.
There was limited COVID19 testing conducted in Western Province earlier this year. Most villagers believed COVID19 would not reach their villages given how remote they were. However, this month we were requested by the Provincial Health Authority to take 20 Rapid Diagnostic Test Kits to Mougulu on patrol. There had been a recent outbreak in Kiunga which meant nearby villages were at risk. Being so close to the West Papua border means there may have already been transmission of COVID19 even before this Kiunga outbreak. So when we had a patient with respiratory tract symptoms and a good travel history, we decided to do a nasal pharyngeal swab. This was the first ever COVID rapid diagnostic test we had done. It came back positive.
A week before we left to Mougulu, another surveillance team had detected two positive cases in other areas of PNG. Given lack of confidentiality in small villages, some of the positive cases were thrown out of their homes and also threatened with violence by other villagers. After hearing this I was worried our RDT tests were going to cause more harm than benefit. We had to ensure testing was done in confidence.
Once positive cases were detected, we notified the Provincial Health Authority and urgently requested for more PPE, vaccines and RDTS to be sent over. We had to explain to the patient what his diagnosis was and also the importance of self isolating. We also provided them with masks and soap. We worked with the local health care workers in the clinic and discussed triaging at risk patients of COVID19.
Minimising spread of COVID19 in a remote village is very difficult. Many villagers heard rumours that “the sickness” had arrived in their village. As a consequence, we saw more villagers coming to the clinic to receive their COVID vaccine. The best things we can do in these environments is promote vaccination awareness and advise those who test positive to isolate as best as they can given the environment.
Dr. Ishani Kaluthotage is a medical doctor passionate about global health and humanitarian medicine. Dr. Kaluthotage is a volunteer Doctor with Australian Doctors International and on patrol in PNG. Currently she is also completing her Masters of Public Health and Tropical Medicine and Rural Generalist training. She has developed a strong relationship with PNG as a volunteer doctor and as a medical educator through Queensland Rural Medical Education and Kiunga Hospital, Western Province. She has experience in health care and promotion, human trafficking and sustainable development projects in Sri Lanka, Nepal, India, Tanzania, and Papua New Guinea. She represented Australia in the Lowy Institute’s Australia-PNG Emerging Leaders Dialogue in 2019 with the goal of strengthening the relationship between the two neighbouring countries. She is also the Australian-Papua New Guinea Liaison Officer for “Project Yumi – Bush Dokta” – an NGO improving access to health care and resources in rural and remote PNG. Her passion lies in health policy and minimising health inequalities in low resourced environments within the Indo-Pacific region.
Australian Doctors International is the only NGO to work exclusively in Papua New Guinea.