Monday, November 26, 2012

Drug-resistant tuberculosis in PNG and Torres Strait islands

A Treaty Protection Zone allows Papua New Guinea inhabitants and Australian nationals to mix freely on the outer Torres Strait islands. Cam Pervan

Most Australians hear only periodic news items about outbreaks of tuberculosis, but globally the disease remains a top killer. And the emergence of drug-resistant strains pose a major challenge to tuberculosis control programs.
One recent news story documented the life of a young woman from Daru Island who has become a medical refugee in Cairns after contracting a highly drug-resistant form of tuberculosis, known as XDR-TB (extensively drug resistant TB).
Such personal stories (of which there are many) emphasise the human tragedy interwoven with health challenges at multiple levels. They also capture anxiety about the possibility that multi-drug resistant (MDR) forms of tuberculosis may spread and pose a risk to the Australian population.

Arbitrary borders

A Treaty Protection Zone allows Papua New Guinea inhabitants and Australian nationals to mix freely on the outer Torres Strait islands. And due to the difficulty of health-care access as well as a poorly functional tuberculosis control program, Papua New Guinea nationals in the adjacent South Fly district frequently used Torres Strait Island services to access Australian care.
During 2012, the Queensland government shut down health clinics on Boigu and Saibai islands and returned 92 PNG nationals from Cairns to Daru Island for completion of their tuberculosis treatment. Amid concern that these patients were unlikely to receive adequate treatment support, the Federal Government committed $8.5 million via AusAid to improve services at the regional hospital on Daru Island and to support tuberculosis services throughout the Western Province (including the South Fly district) between 2011 and 2015.
The impact of the initial “Stop TB in the Western Province” program is yet to be scrutinised.

A local focus

Ensuring access to high-quality services within Papua New Guinea is the preferred and most effective intervention to assist local communities. It will also reduce their need to seek health care in Australia.
Ironically, the visible epidemic is likely to get worse before getting better, since better functioning diagnostic systems will identify MDR- and extremely drug-resistant (XDR)-TB cases that previously went undetected. This may seem alarming, but it allows for better assessment of the problem and should facilitate improved patient care and better protective strategies.
In reality, health-care services are poorly functional throughout Papua New Guinea and careful consideration should be given to the most cost-effective and sustainable strategies. The situation requires a strong and coordinated cross-border approach that includes all parts of the Australian government to work with central and provincial administrations in Papua New Guinea.
Unfortunately, this important issue has become a political ball being kicked around between the federal and state governments and between political parties.

Australia and tuberculosis

Thankfully, the intended closure of Queensland’s Tuberculosis Control Centre, which would have been a disaster at this crucial time, has been narrowly averted. This should enable the continuation of vital surveillance and control functions within Queensland and the provision of guidance and support to Papua New Guinea colleagues on Daru Island and in the South Fly district.
In general, excellent socioeconomic conditions and effective infection control measures within Australia reduce the risk of local tuberculosis outbreaks. But poor and marginalised populations are at risk, as are immune-compromised people and the rapidly growing portion of the population that is of an advanced age.
Immune senescence associated with old age is a well-characterised risk factor and several tuberculosis outbreaks have taken place in aged-care facilities. The introduction of highly drug-resistant tuberculosis into any of these vulnerable communities would pose a major challenge, since treatment requires two years of multiple drugs that have numerous side effects.

Finding the way forward

Recent evidence suggests that MDR-TB, contrary to previous belief, is often highly transmissible and protection against infections that spread via the air (such as measles and tuberculosis) is notoriously difficult.
Given the health challenges posed at multiple levels and the complexity of the issues involved, careful and objective assessment should guide the assignment of clear roles and responsibilities to the Papua New Guinea and Australian governments involved, as well as to international health agencies.
AusAID has published an expert report on the tuberculosis control situation in the Western Province, and the World Health Organization (WHO) is conducting an independent review of the same.
Insight from these fact-finding missions is vital for understanding the complexities of the situation and ensuring bipartisan support for workable solutions.

Authors

Disclosure Statement

Warwick Britton receives funding from the NHMRC.
Ben Marais and Tania Sorrell do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.

The Conversation provides independent analysis and commentary from academics and researchers.
We are funded by CSIRO, Melbourne, Monash, RMIT, UTS, UWA, Canberra, CDU, Deakin, Flinders, Griffith, La Trobe, Murdoch, QUT, Swinburne, UniSA, UTAS, UWS and VU.

Sunday, November 25, 2012

Manus refugee facility faces power threat

By Eoin Blackwell,

AAP Papua New Guinea Correspondent

Manus Island landowners have threatened to shut down power after the arrival of asylum seekers. Source: AAP

LANDOWNERS on Papua New Guinea's Manus Island have threatened to shut down electricity to parts of the province, less than a week after Australia's first batch of asylum seekers arrived.

The 19 Sri Lankan and Iranian asylum seekers, including four children, were flown to Manus on Wednesday.
They are currently being housed in "G camp" within the temporary tent facility on Lombrum naval base, the same site as the Howard-era detention facility.
Now known as "Newtown" to locals and the G4S security guards running the site, the facility will house up to 600 asylum seekers in the coming months.
Local MP Ronnie Knight says landowner groups on Saturday threatened to shut down power to parts of the province over demands for compensation from Australia to use the site.
"I had to break the news to them that they were not going to get what they want," Mr Knight said.
"They did not take it well. I told them I would do my best to see they get something.
"(If they cut the power) the people of Manus will rise up and chase them out."
The facility itself is powered by four large generators and is not expected to be affected by loss of power to Manus proper.
The Australian and PNG governments have sent a joint task force to Manus to assess what infrastructure projects need assistance, while the Australian High Commission has said it cannot hand out money to landowner groups.
A group involved in blockading Manus airport on November 12 gave the PNG government a two-week deadline to meet with them.
That deadline ends on Tuesday.
The PNG government has sent 64 mobile riot-squad police to Manus, a move Mr Knight said should keep the landowners from following through on their most recent threat.
The landowners, who represent as many as five different clans around Lombrum, were angered after it was announced controversial security firm G4S was given contracts to run the site.
Since Australia announced in August it planned to send asylum seekers to the island the groups have separately made demands for compensation totalling $45 million, security contracts for running the site as well as building contracts.
"I want development and funds so I can start my business," said John Lou, who leads the Lombrum clan living just outside the base.
He says he will not resort to aggressive action such as blockading goods and services to the facility, but he is considering legal action.
"The PNG government didn't give us a chance to get in on this project," he said.
It is unclear when the next batch of asylum seekers are due to arrive on Manus.
The Australian government announced in August that it would process asylum seekers on offshore facilities in Nauru and Manus Island.
Nauru eventually will have space for 1500 people.
AAP and PNG'S The Post Courier were denied access to the site on Friday by G4S and PNG Immigration, who told reporters they were following orders from Canberra.

A true gentleman

By MAURICE PRATLEY exclusive to this blog

Do you ever get the feeling that someone you meet is somewhat different than most of us? Someone who shows a character that stands out. I met a person who interested me greatly because of this. It was the first Governor-General of PNG, Sir John Guise.

Independence declaration on September 16, 1975, by Sir John Guise

We were invited to a meeting of the Lae Branch of the PNG Accountants organisation. I forget what Sir John spoke about but my subject was accounting for plantations, a much needed subject within the country. (This is a story within itself.) Sir John and I did not really speak with each other but offered cursory hellos. After the meeting, I received a phone call from the person arranging our transport back to Lae airport the next morning advising of an alteration to these arrangements. I was also asked to advise Sir John of these changes. I contacted Sir John at dinner that night when he walked into the dining room. He then joined me at my table.

We talked about general matters for a start but then we went on to the subject of the 'old days'. Sir John explained how life was when he was growing up. He mentioned the separation between local people and the temporary administrators. There were many restrictions in those days for 'locals' and he commented on these without any show of emotion but just talked about how things were. About access to the stores like Burns Philp, Steamships and suchlike; the restriction on alcohol; admission to clubs and, generally, the segregation within the country. I listened enthralled. This was a life I did not know much about but had me thinking why. We talked til well after midnight before we called it a day. On the way out I mentioned to Sir John that he should write an autobiography about his life and the country as it stood. His reply was that nobody would be interested. Not interested?!! Not interested! My reply was that I was sure people would be especially those in future years.

We met on several more occasions when he visited my office in Port Moresby. He had a family association with a trade store and he had arrived with a shoe box full of receipts. He needed them sorted out for a tax return. He came not in a suit or such but in a pair of shorts, a t-shirt and some thongs. He presented no airs and gave no indication of his past life. He was perfectly natural. He came several times after but, I suspect, mainly for a chat.

In my eyes, Sir John was a true gentleman. He, as mentioned, presented no airs, was particularly polite, was soft spoken and was considerate. Consideration of others is, I believe, a cornerstone of civilization. He was, of course, a politician and may be seen in other people's eyes as somewhat different from what I mention. This is understandable. But still I will see him in the way I describe.

Today's buai pekpek in Port Moresby

By MALUM NALU

After three weeks in the huge, but clean, Taipei in Taiwan, it's back to Port Moresby and its buai pekpek.
I guess some things will never change!

Excuse of a "children's playground" at Hohola

By MALUM NALU

Our children deserve better than this rundown and filthy playground at Hohola!
Walking through the playground today with my kids made me feel so sad for my kids, the kids of Port Moresby, and the kids of Papua New Guinea.

Australian man charged with fraud in PNG

AAP

An Australian man has been arrested and charged with fraud by Papua New Guinea's anti corruption taskforce.

Leonard Patrick Capon, 68, was arrested and charged after allegedly misappropriating 1,485,085 million kina ($A668,400) paid in 2010 to his company, Rural Development Services Ltd, for a mini-hydro power project in Hela province in PNG's Highlands.
Authorities allege that project was never delivered and the funds were allegedly diverted to expenses unrelated to the purposes of the payment.
Task Force Sweep Chairman Sam Koim told PNG's The National newspaper that Mr Capon was arrested and charged with misappropriation and released on K10,000 ($A4635) bail.
Task Force Sweep recently revealed it had registered 174 complaints about corruption, with just some of the cases involving amounts totalling 2.162 billion kina ($A1 billion).
Of the 174 complaints, 52 cases have been investigated.

Child health is improving in PNG, and it’s all about the people

Report from Australian Agency for International Development

Published on 20 Nov 2012 — View Original

By Professor Trevor Duke, Centre for International Child Health, University of Melbourne

I have seen many improvements in child health in Papua New Guinea in the 15 years that I have been working with the health system there, led by committed young paediatricians who have designed and implemented a national plan for child health.
As a member of the National Child Health Advisory Committee and the Paediatric Society, I was part of a review held in September to assess whether this plan is on track. At that meeting, leaders in child health presented strong evidence of progress in the most challenging of problems.
Immunisation is one of the most cost-effective ways to save lives. For vaccines to reach every district, the Health Department has identified the 20 lowest-performing and most isolated areas and completed a stocktake of childhood immunisations, services and vaccine supplies. AusAID has provided $1 million to implement the Reaching Every District initiative in concert with support from WHO and UNICEF. The Health Department is also partnering with AusAID, WHO and UNICEF to provide mass vaccination across the whole country, against measles and polio. With revitalised services for the hardest to reach, this is already making a difference.
The Haemophilus influenzae vaccine against pneumonia and meningitis was introduced successfully in 2008, and the pneumococcal vaccine is to be introduced in 2014. The Health Department is also active in prevention of pneumonia through improving nutrition (including breastfeeding), reducing indoor air pollution, encouraging hand-washing and early treatment. Treatment programs that introduced oxygen therapy have seen a 35 per cent reduction in death from pneumonia. Pneumonia, diarrhoea and neonatal conditions are the major causes of hospitalisation and child deaths in PNG.
Neonatal health is a continuing priority; while child and infant mortality has fallen in the last decade, neonatal mortality remains static at 28-30 per 1000 live births. As part of an effort to implement better standards of neonatal care, the health department has assessed five hospitals in the Highlands district and established a model for quality district-level services.
Malaria is no longer one of the top three causes of hospital admission for children due to the widespread use of insecticide-treated bed nets. The health department acknowledges that maintaining this program beyond the Global Fund to Fight AIDS, Tuberculosis and Malaria will be a challenge.
With support from the Clinton Health Access Initiative, rural clinics are now HIV testing, counselling and treatment centres. Effective programs to prevent transmission of HIV from parents to children have seen the rate of infection to newborns from mothers who have HIV falling from 30 per cent in 2007 to 15 per cent in 2012, meaning many fewer children are born with HIV.
Tuberculosis treatment through a fixed-dose combination of medications has been introduced nationally; however, access to medication in health centres is currently inadequate. Major policy changes were recommended from this meeting.
Information about common causes of hospital admissions and deaths has improved over the last three years with the introduction of a new reporting system. During this period, 36,000 admissions from 15 hospitals have been documented in detail. This information will assist the Health Department to prioritise clinical and public health programs and to track future progress in child health.
A dedicated and trained health workforce has achieved improvements in child health but more training facilities for child health nurses and community health workers are needed to provide sufficient numbers. AusAID is helping to develop a skilled health workforce. They have provided invaluable support to the University of PNG School of Medicine and Health Sciences for a decade, and are providing scholarships to support the training of nurses, midwives and community health workers.
Many challenges need to be addressed in the coming years. Long-term development depends on national coordination of programs and services for child health, implementing programs and services in all provinces, a good understanding by provincial health officials, and monitoring the scale and quality of implementation. Maternal health is a large determinant of child survival, and there is much to do to reduce maternal deaths and improve family planning. Increased investment in maternal and child health, matching the growing wealth of the country, is an urgent priority. Factors outside the health sector, particularly education, agriculture and environmental health will be major determinants of long-term progress.
Child health in PNG is in good hands. We hope the economic opportunities of the next decade will put much greater resources into improving children’s health, and that a more equitable spread of opportunity will enable parents to better care for their children.

About the author: Professor Trevor Duke
Professor Trevor Duke is the Director of the Centre for International Child Health, University of Melbourne, and Adjunct Professor of Child Health, School of Medicine & Health Sciences, University of PNG.
The Centre for International Child Health receives funding from AusAID through Compass: Women’s and Children’s Health Knowledge Hub. Compass is a partnership between the Burnet Institute, Menzies School of Health Research and the Centre for International Child Health, University of Melbourne.