The challenges of tuberculosis in Papua New Guinea

msf.org | March 23, 2018

Three years ago, tuberculosis (TB) became the joint lead as the world’s deadliest infectious disease - neck and neck with HIV/AIDS.
In Papua New Guinea (PNG), the epidemic is such that the government has declared a state of emergency in several provinces.

Giakila was diagnosed with drug-resistant TB at Gerehu Hospital, Port Moresby, where MSF supports TB treatment and diagnosis.

With an estimated 30,000 new cases in 2016, expanding and improving TB care in PNG is an uphill battle.
Médecins Sans Frontières (MSF) is providing TB diagnosis and treatment in two of these provinces: Gulf Province and National Capital District, in conjunction with the Ministry of Health.

Extreme geography

In Gulf Province MSF’s teams are based in Kerema – a town seven hours’ drive from the capital, Port Moresby, and literally at the end of the road.
Further west, there are no roads and extremely limited access to healthcare and other services.
Patients travel for hours or even days to reach our clinics, using a combination of dinghies, cars and walking.
Transport can be prohibitively expensive – around 100 kina (40 US dollars) for a few hours in a dinghy.
It’s not only the extreme geography that is challenging.
In the remote villages around Kerema, access to education is limited.
The low health literacy of some patients means they were never explained essential facts about TB, including the fact it is infectious, or that it passes through the air. Many people across the country still believe TB is an effect of witchcraft.
These geographical and cultural barriers contribute to one of MSF’s biggest challenges – ensuring that patients adhere to TB treatment.
TB is not a simple chest infection.
It’s an insidious infection with very hard-to-kill bacteria.
 Successfully treating TB takes at least six months, using a combination of various antibiotics.
Some patients develop drug-resistant TB: when the bacteria mutates to resist the drugs because they are not taken in the necessary amounts, intervals or combinations.
 For these patients treatment takes up to two years, including daily injections in the early stages.
 Patients often encounter serious side effects such as nausea, nerve damage and deafness.
Sticking to TB treatment is critical not only to cure individual patients, but also to reduce the risk of drug resistance developing in the community.
 Patients who develop drug resistance can infect others with these strong and deadlier strains.
 If this happens on a larger scale, the epidemic will claim more lives and become even harder to manage.

Improving adherence

While patients defaulting on their treatment is a huge problem for our teams, we’re working hard to increase treatment adherence.
All patients are provided with counselling and education to improve their understanding of the disease and to follow up their treatment.
 By embedding an anthropologist in our medical operations, we also try to increase our understanding of the local context and improve treatment adherence.
We have decentralised our care to bring treatment closer to patients.
 In Gulf Province teams travel for hours, often by boat and road, to visit health posts in small villages for regular consultations. We also provide transport to help patients reach care, as well as run a network of community health workers and treatment supporters who visit patients at home.
In Port Moresby, the outreach team provides home visits for patients with difficulties accessing their clinic or adhering to treatment, in an effort to reduce the still-high rate of patients ‘lost to follow up’.

Enhancing TB management

In many low-income settings, TB continues to be diagnosed as it was a century ago: sputum samples are examined under a microscope for signs of the tuberculosis bacillus.
The most reliable test of this type takes two months.
In many countries, this is complicated further by the lack of laboratories equipped for TB diagnosis, meaning samples need to be sent to a capital city, or even overseas. For these reasons the disease often goes undiagnosed, or far later than it should. In much of PNG, this remains the case.
In recent years TB diagnoses were revolutionised by a device called the GeneXpert, which can test for the presence of bacteria in less than two hours.
(It can also test for resistance to the TB drug rifampicin - meaning it can help diagnose drug-resistant TB.)
MSF uses GeneXpert in both Gulf Province and Port Moresby.
This means patients can be diagnosed and begin treatment far quicker.
 In 2017, our teams started 2,100 people on TB treatment in both projects.

UNICEF lifesaving supplies reach Papua New Guinea to help children and families hardest hit by earthquakes

unicef.org.au | March 23, 2018

UNICEF has this week delivered 23 metric tons of relief supplies to Papua New Guinea, including tents and tarpaulins, water purification tablets, hygiene kits, blankets and learning kits as part of ongoing efforts to help children and families who were hardest hit by recent earthquakes.

Barbara, 8, lost her elder sister and her cousin when a boulder struck their house. She has been living in difficult conditions at the makeshift camp with her father, Iso Putap, since 27 Feburary. © UNICEF/PNG-2018/JamesMepham

On February 26, a massive earthquake of 7.5 magnitude hit four provinces of Papua New Guinea, followed by another two major earthquakes and nearly 100 aftershocks.
More than 100 people were killed, with many more injured in landslides and collapsing houses.
The PNG Government estimates 270,000 people are in need of urgent assistance, including 125,000 children.
“Children’s lives are in danger,” said Karen Allen, UNICEF Representative for PNG. “With limited access to basic necessities, families are struggling to survive in crowded shelters, or to rebuild homes and food gardens.”
To date, UNICEF has already delivered 12,000 packets of therapeutic food and enough vaccines to protect 31,700 children against the increasing risk of disease outbreak and malnutrition.
Papua New Guinea already had low vaccination coverage and the world’s fourth highest rate of chronically malnourished children.
 UNICEF is working with the PNG Government and partners to ensure humanitarian supplies are distributed to affected communities as quickly as possible. Access to remote and isolated villages remains a huge challenge across vast and rugged terrain. UNICEF needs AU$17 million (US$14.6 million) to provide humanitarian assistance to children and families affected by the earthquake over the next nine months.
This will help provide clean water, sanitation and hygiene in temporary shelters, psycho-social support in safe places, vaccinations and malnutrition treatment, and support for children to return to school.
“The relief supplies that have been delivered today by UNICEF are part of the overall support by the Government of PNG, the United Nations System, the Governments of Australia and New Zealand, other humanitarian partners, and the private sector, to the affected people of PNG,” said Mr. Gianluca Rampolla, the UN Resident Coordinator in PNG.
“We have been working together since the onset of the disaster to help those most in need, and will continue to do so.” 

Only 37 per cent of people have access to clean water in Papua New Guinea

 by Anne Gulland, telegraph.co.uk
March 21, 2018

People in Cape Town are forced to queue for water as a drought has led to the government warning that the city's taps may soon run dry

Captain Eric Aliawi of HeliSolutions supervising water bottles for delivery to earthquake victims at Mori Airport.-Picture by MALUM NALU

Access to clean, safe drinking water is seen as one of the most important ways to improve a nation’s health but a report shows that for nearly a billion people, this is far from reality.
The charity Water Aid estimates that around 844 million people around the world have to make at least a 30-minute round trip to get clean, safe water or are forced to drink from unprotected sources or directly from rivers or lakes, almost certainly risking their health.
Drinking and bathing in dirty water leads to a host of health problems such as diarrhoeal disease, which kills 289,000 children every year, skin infections and illnesses such as trachoma, a painful eye condition which can lead to blindness.
The report from Water Aid ranks countries in terms of access with Eritrea at the bottom of the list, with just 19 per cent of its population having access to a clean water supply.
This is followed by Papua New Guinea, where just 37 per cent have the most basic access and Uganda where just 38  per cent of the population have safe drinking water.
 India has the largest number of people lacking access to clean water, with more than 163 million people without even the most basic water supply.
India faces great strains on its water supply: falling groundwater levels, drought and demand from industry.
However, the country has also made great strides in recent years - with 300m people gaining access to clean water since 2000. Last year the government committed to providing clean water to 90 per cent of rural households by 2022.
The report also looks at how countries have changed over time and, despite its ongoing problems, Afghanistan has made the most progress.
In 2015 63 per cent of the population had access to clean water, compared to 27 per cent in 2000.
Yemen has also made great improvements over the same period - from 43 per cent in 2000 to 70 per cent in 2015 - however, the report warns that the civil war ravaging the country will damage this progress.
The report also highlights the inequalities within countries - in Nigeria for example only 30 per cent of the poorest people have access to clean water, compared to 89 per cent of the richest.
The situation is similar in Mali - just 45 per cent of the poorest people have clean water, compared to 93 per cent of the richest.
The report highlights the issue of water security around the world: Cape Town, one of the world’s most popular tourist destinations has warned that its taps may run dry this year and its residents have been forced to queue at pipes for water.
Jonathan Farr, senior policy analyst for water security and climate change at Water Aid, said water had to become a political priority.
"If the investment, political will and capability is there we see huge changes in a very short space of time.
" In sub-Saharan Africa there are 407m people who don't have access to clean water.
"These countries have a lot of potential but we need to see it becoming a political priority like it has in Cape Town," he said.
But he warned that water security was becoming an issue for developed nations as well.
"There are threats such as climate change and lifestyle changes such as industrialisation which have a huge impact on water supply.
"Even in global cities like Cape Town water is in jeopardy - and Beijing and London have also had problems," he said. 

PNG Earthquake Response Logistics Situation Update (21 March 2018)

reliefweb.int
March 21, 2018

01. LOGISTICS OPERATIONAL UPDATES

The Australian Defence Force, (ADF) is considering requests for assistance, using the Hercules C-130J, for ad-hoc rotations between Port Moresby/Mt Hagen and Moro, into early next week.

The RAAF C-130J at Moro Airport last Saturday.-Picture by MALUM NALU

 Request for Assistance (RFA), must be submitted for requests to be considered, and the Australian DFAT has requested agency distribution plans for their consideration when making a decision on the acceptance of the task.
Oil Search Limited (OSL) has granted the use of their Moro facility as a logistics hub for operations to the earthquake affected areas that are only accessible via helicopter.
 This offer is conditional upon having a humanitarian logistics officer present as the focal point, as they transition the response to humanitarian partners.
OSL wrote to the Office of the Emergency Controller outlining the scope of their support.
While many access roads are being re-established, last-mile transport to locations only reachable via helicopter continues to be a major constraint for the response.
The Logistics Working Group is working on identifying commercial options to ensure that remote communities can be reached, however it needs the cooperation of the cluster leads to identify those communities.

AIR TRANSPORT

ADF’s 3 Chinooks Helicopters, currently in Mt Hagen, are fully tasked and are not accepting further requests for airlift until their departure back to Australia, scheduled in the next few days.
Oil Search Limited has two Bell Helicopters stationed in Moro, which can be requested for airlift to affected areas on cost-recovery basis.
Mission Aviation Fellowship also has a number of available air assets - Twin Otter - on cost-recovery basis.

LAND TRANSPORT

PNGDF truck assets have been requested by the Office of the Controller for use in the response around Hela and Southern Highlands.

 SEA AND RIVER TRANSPORT

Lae’s port is fully functional, with a yard for storage, and it is the recommended port of arrival for humanitarian cargo.
The road connecting Lae to Mt Hagen and Mendi is currently passable.
Options for river / barge movement via the Kikori river, and from Port Moresby to Lae, are also being looked into as an additional transportation options for goods bound to earthquake-affected areas and between major entry point of arrivals for humanitarian cargo.

Papua New Guinea: Highlands Earthquake Situation Report No. 4 (as of 21 March 2018)

reliefweb.int
 March 21, 2018

This report is produced by the National Disaster Centre, the Office of the Resident Coordinator and the United Nations Coordination and Assessment (UNDAC) Team in collaboration with humanitarian partners.
 It was issued by the Disaster Management Team Secretariat.
It covers the period from 18 March to 21 March 2018.
The next report will be issued on or around 27 March 2018.

Background

According to IOM’s Displacement Tracking Matrix (DTM), 6,444 households (34,153 people) are displaced in 39 communities and informal care centers.
Almost 65 per cent of health facilities in Hela and Southern Highlands provinces are damaged and 32 per cent remain closed.
To date, 87 villages have been reached with food supplies in Hela, Southern Highlands and Western provinces.
Around 1,300 shelter and non-food items have been distributed in Southern Highlands and Hela provinces.
All airports in the affected regions are open except for Huya and Komo airfields, which are only open to helicopters.
The roads from Mt. Hagen to Tari and Tari to Mendi remain open.
Nipa to Magarima and Tari and Komo roads are partially accessible.
The road from Mendi to Moro remains closed.

270,000 people in need of assistance

87 villages reached with food

34,153 displaced people in 39 communities and care centers

269 schools in five LLGs (Hela) are damaged

Situation Overview

The National Disaster Centre (NDC) estimates that around 544,000 people have been affected in five provinces and that more than 270,000 people are in immediate need of assistance.
Over 125,000 are children, of which 55,000 children are under the age of five.
Displacement Tracking Matrix (DTM) teams completed assessments confirming that 6,444 households (34,153 people) are displaced in 39 communities and informal care centers.
Current figures estimate that 10,000 houses have been damaged and need immediate shelter assistance.
In Hela Province, of the 31 health facilities (not including aid posts) 90 per cent have been damaged to some extent.
In Southern Highlands Province, of the 46 facilities (not including aid posts) 45 per cent have been damaged.
Significant gaps remain in sanitation and hygiene support, including hygiene messaging, for affected areas.
According to Education Management Information System (EMIS) data on schools and number of students in the seven most affected LLGs, over 34,000 school children are enrolled in 368 schools, of which more than 23,000 children are in the five most affected LLGs of Hela.
 Reports from the SMS Blast/RapidPro among school inspectors and some teachers identified that 269 of 439 schools in five LLGs in Hela are damaged.
Provision and maintenance of water tanks, sanitation facilities, school buildings, learning materials and canvas for temporary shelter are the most pressing needs.
In Southern Highlands, 42 schools have submitted damage reports to the Department of Education.
The buildings of the Department of Education in both the provinces are badly damaged and most staff have not returned to work.
The toll-free trauma and crisis counselling hotline continues to receive calls from the affected areas.
Calls cover issues, such as fear of aftershocks, people needing assistance but have not been reached, distress due to loss of property, concern for relatives and general confusion about the cause of the earthquake.
Rumors and fear still have a huge influence on what people believe and how they can recover.
All airports in the affected regions are open except for Huya airstrip (Southern Highlands) and Komo airfield (Hela) which are only open to helicopters.
 The roads to Mt Hagen to Tari and Tari to Mendi remain open; there are reports on increasing traffic on these roads.
The road from Nipa to Magarima and onward to Tari and Komo is only partially accessible and the road between Mendi and Moro remains closed.

Oil Search sees Gobe plant operational this week after PNG quake

epmag.com
March 20, 2018

SYDNEY—Australia’s Oil Search Ltd. said on March 20 that it expects its Gobe processing plant and oil export pipeline in Papua New Guinea to be operational later this week, after a deadly earthquake hit last month.
Oil Search said the Gobe facility and its export pipeline were largely undamaged in the magnitude 7.5 quake that struck on Feb 26.
The company said its condensate handling facilities, part of the giant PNG LNG project, were also ready to receive PNG LNG condensate once production at the Hides gas conditioning plant comes back on stream.
The Hides plant was shut down after the quake by operator ExxonMobil, which said earlier this month the PNG LNG project would be shut for about eight weeks for inspections and repairs.
Oil Search said it expects its central processing facility at Kutubu, another oil and gas field, to be “progressively restored from late March,” while its Moran oil and gas field would take longer.
“The Agogo processing facility and the Moran 4, 6, 9 well pad, which are in the area most impacted by the earthquake, will require some repairs before production from the Moran field can recommence,” Oil Search said in a statement, without giving a repair timeline.
At least 100 people were killed when the powerful quake hit the remote and rugged highlands three weeks ago, triggering landslides that buried villages and destroyed infrastructure.

Health facilities devastated by PNG quake

reliefweb.int
March 21, 2018

21 MARCH 2018, PORT MORESBY - A third of all health facilities have closed in Hela and Southern Highlands provinces as a result of the Papua New Guinea earthquake.
On 26 February, a 7.5 magnitude earthquake struck Papua New Guinea, triggering landslides, affecting water sources and wiping out houses, health facilities, people and crops.
More than 190 aftershocks have been recorded, according to the United States Geological Survey, including one as recently as 20 March.
Results of a joint National Department of Health (NDOH) and World Health Organisation (WHO) assessment show that 25 out of 77 health facilities in the two worst-affected provinces are no longer functioning.
The total number of closed facilities is potentially higher, as data from eight health centres remains unavailable due to access constraints.
“This disruption to health service provision comes at a time when people are most in need of care,” said Dr Luo Dapeng, WHO Representative to Papua New Guinea.
 “As aftershocks continue, affected communities are dealing with injuries and psychological trauma.
"We’re also worried about potential outbreaks of epidemic-prone diseases.
"We must move swiftly to restore health services.”
Overcrowding in informal camps and a lack of access to clean drinking water and sanitation increase the risk of disease outbreaks.
Vaccination coverage was low prior to the earthquake and the country was already facing outbreaks of malaria, pertussis and measles.
Roads, rivers, airfields and bridges have been impacted by the earthquake in a part of the country prone to violence and insecurity.
Access to affected communities has therefore been extremely challenging.
“Responding to the health needs in Papua New Guinea is definitely not easy,” said Dr Luo.
“But we’re determined to find ways, alongside our partners, to deliver life-saving health services to even the hardest to reach communities.”
WHO is supporting the National Department of Health (NDOH), provincial health authorities and partners with information management, technical guidance and logistics.
As the Health Cluster lead agency, WHO plays an active role in coordinating the activities of 25 health partners in order to align efforts, fill gaps, avoid duplication and ensure that response efforts reach those most in need.
The organisation is also supporting the strengthening of disease surveillance and has pre-positioned medical supplies in preparation for potential outbreaks, including seven diarrhoeal disease kits and rapid diagnostic tests for dengue.