The Impact of ADI’s Health Patrols

New Ireland Child Health Care with ADI

A summary of Dr Tim Baird’s personal reflection on his volunteer placement:

Having returned from working as a volunteer doctor with Australian Doctors International (ADI) in Papua New Guinea’s New Ireland Province (NIP), I can look back with fond memories of a life-altering journey. It was an incredible and challenging job, a completely unique world of medicine, and a wonderful cultural and personal experience.

As a ‘city dweller’ and, relatively, junior doctor, the volunteer stint in Papua New Guinea (PNG) was always going to be a challenge, both medically and socially. After four years of hospital based practice in Brisbane, Australia and, subsequently, successfully completing a Diploma in Tropical Medicine in the United Kingdom, I was fortunate enough to be given a medical aid posting with ADI. The job description involved leading a small group of PNG health professionals on various health patrols throughout NIP with a focus on upskilling rural health workers and delivering primary health care to areas with minimal health access and basic medical resources.

The team consisted of various health staff including dentists, physiotherapists, maternity and child health nurses, eye nurses, HIV and STI officers, TB officers, and various administration officials. I was also lucky enough to have my partner work with the team as a clinical nurse for two of the six months I spent in PNG. She provided the team with invaluable expertise and support.

Throughout my placement our patrol team members provided their particular specialised health service to the remote communities of NIP whilst also collecting data and formulating reports that will hopefully lead to an improvement in the medical resources and infrastructure of each area. Our team was predominantly based in a small, picturesque town named Kavieng, and from there we arranged the logistics of each patrol, including the team members, the itinerary, the food, the transport, the accommodation, and any medical equipment that could be utilised and distributed during the patrol visits.

The medicine in these remote areas was not only eye opening, but served to provide me with a vastly different clinical mindset and understanding towards best patient care across multiple areas of medicine. I had the opportunity to examine and treat patients with diseases that virtually don’t exist in Australia including Malaria, Tuberculosis, Leprosy, Filariasis, and Yaws. Moreover, most days provided the team with unique medical challenges that would often mean the difference between someone living or dying in these rural villages. Whether it be a sick infant that needed long distance transfer by boat across rough seas, a pregnant mother needing to urgently deliver in a village health centre with no running water, a young adult presenting with their arm hacked off by a bush knife, or, a group of children presenting with measles from a village where there was no functional immunisation program – every day provided separate challenges that I will certainly never forget.

There is one particular case that stands out in my mind, not because of the patient’s disease, but because of the nature of the situation and the resultant outcome. It is certainly something my partner, Samantha, and I will always remember. The case involved a two-week old baby that weighed less than two kilograms on a small island named Emirau. The infant had been presented to the small health centre with sepsis and was in severe respiratory distress.

The newborn had been delivered in a nearby village and was severely malnourished due to poor feeding since birth. Simply put, the baby was in urgent need of oxygen, intravenous antibiotics, and increased nutrition. The baby would not survive if we could not provide these to her. There was one small health centre on the island with one health staff member, no oxygen, and severe shortages in other basic medical supplies. The nearest district hospital that had these basic resources was a six-hour ‘banana boat’ ride away across open seas. To make matters worse, the health centre’s boat was non-operational with virtually no accessible fuel on the island either.

The only option to save the child’s life was to arrange transfer to Kavieng Hospital. Between myself, the one sole local health staff, and Samantha, we managed to get an intra-osseous line in the baby’s tibia to allow us to give fluids and antibiotics, and place a nasogastric tube in-situ in which we could give enteral feeds through, and thus hopefully keep the baby alive.

The next step was to try and figure out how we could get the baby off the island. We sent word out across the island’s numerous villages to try and arrange a boat and skipper for transfer of the mother and baby to Kavieng the next morning. We, the ADI team, would assist by providing fuel to the boat on its arrival and would try and stabilise the newborn enough for her to survive the long journey. Due to these messages being sent out across the island, the night became one to remember. Many people resided to the fact that the child would probably not survive the evening and came to say their goodbyes at the health centre. Others tried, frantically, to arrange for the required boat and skipper in case the child pulled through.

Unbelievably, with our interim management, the child managed to survive the night and a functional banana boat and skipper were arranged to depart the island for Kavieng at sunrise. As planned, our ADI team assisted with the fuel that was needed for the journey as well as providing a health staff member to monitor and treat the baby during the open water journey.

Two ‘intravenous poles’ made out of sticks were attached to the small boat and the intra-osseous line and nasogastric tube were fastened in place with fluids and antibiotics running for the six-hour journey. The baby, the mother and grandmother, our health staff member, the skipper, and even a critically ill tuberculosis patient, were sent on their way in less than ideal sea conditions. The community on the island gathered on the beach to wish the baby a safe journey and to say their prayers.

The community assisting with loading the patient onto the boat to Kavieng Hospital

Later that evening we got radio word from Kavieng that the baby had survived the trip across the ocean and remained in a stable condition at the district hospital with access to an oxygen supply and a far better chance of survival ahead. That evening the island held a traditional celebratory thank you dinner for the ADI team with many humbling speeches given and an incredible promise from the chief elder of the island – if the baby survived she would be renamed Samantha (after my wonderfully caring and capable partner).

Two weeks later, after the completion of our patrol and our return to Kavieng, Sam and I visited the hospital to check up on the status of the baby. She was still an inpatient but was looking much fatter and happier than our last meeting. She was off oxygen, alert and smiling, and feeding well. She was being nursed by a loving and extremely grateful mother and grandmother, and, now had a new name – ‘Samantha’.

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