Preparing baby kits in PNG

PNG’s rocketing birthrate and high maternal mortality is making Obstetrics a high priority for this nearby nation’s medical system. Dr Nathan Kesteven visited Port Moresby General Hospital to meet staff and mothers…

Although Papua New Guinea is our nearest neighbour most Australians would have no idea that it has one of the higher maternal and infant mortality rates in the world. In Australia our maternal mortality rate (per 100,000 live births) is 6, in PNG it is 215!

The most common causes are post partum haemorrhage and infection - both related to poor access to birth support structures. In Australia less than 1% of women birth without trained staff present, in PNG that figure is probably around 55% (according to the Pacific Island Regional Development Goals, 2004). This means that most women birth without access to the basic and essential needs that prevent death and serious morbidity, outcomes that we in Australia very rarely see.

Recently I spent 10 days in the Port Moresby General Hospital (PMGH) observing how obstetrics is practised in PNG, at least in a hospital setting. PNG has a population growth rate of around 3% - this means that within 20 years the population will have doubled. This high level was reflected at PMGH - 40 births a day - that equates to 15,000 a year. By comparison, Lismore Base recorded 1155 births in 2016.

The labour ward is a large room divided in half with 12 cubicles on either side with curtains for privacy. There are 2-3 doctors on per shift, with around 4-5 midwives caring for the women who come in.

A range of local artists contributed works for the new Lismore Base Hospital Paediatric Unit that was officially opened on 8 September. Pictured with NSW Health Minister Brad Hazzard (rear) and State MP for Lismore Thomas George (right) were (l-r) Joanna Kambourian, Erica Gully, Beki Davies, Jeremy Austin, Jeni Binns, Dougal Binns, Malcom Austin, and Anne-Marie Mason. At the front is Dr Sniggle of the Clown Doctors.Other artists (not pictured) were Justin Livingston and Rachel Stone.

With features such as bright play areas, a parents’ lounge and an adolescent retreat, Lismore Base Hospital’s new Paediatric Unit focuses on creating a visually appealing environment to complement its acknowledged high level of clinical care.

The unit, opened by visiting NSW Health Minister Brad Hazzard on Friday 8 September, is part of LBH’s remarkable redevelopment in the past few years.

Helping celebrate the latest milestone was Lismore MP Thomas George, who will step down before the next state election in March 2019. There is no doubt he will be going out on a high note, with the once-outdated facility rapidly becoming a state-of-the-art referral hospital.

And don't tell me what to do
Don't tell me what to say
And please, when I go round with you
Don't put me on display 'cause

You don't own me
Don't try to change me in any way
You don't own me
Don't tie me down 'cause I'd never stay

You Don’t Own Me 1963, Lesley Gore

Vaccination for Contrarians

The Social Services Legislation Amendment (No Jab, No Pay) Bill of 2015 has brought about an increase in childhood vaccination rates around the country and also on the North Coast. The essence of the Amendment was to remove conscientious objection to vaccination as an exemption from the requirement of children to be fully age appropriate vaccinated to be eligible for child care subsidies and Family Tax Benefit A.

Vaccination rates have risen to 93% nationally and are approaching the 95% level recommended for herd immunity. All Primary Health Networks (PHNs) reported rates of greater than 90%. However, rates can vary widely within PHNs and in this issue we report  on the 1867 North Coast kids who are unimmunised. Recent Department of Health Data have shown shown that less than 50% of Mullumbimby two year olds are fully vaccinated; the lowest in the country.

To improve the levels and to counter last year’s anti-vaccination film, Vaxxed: From Cover-Up to Catastrophe, the Department of Health has launched a 5.5 million dollar campaign targeting areas of low vaccination.

Dr Jane Barker

By definition chronic diseases are diseases we cannot cure and at best can attempt to control symptoms and delay complications and progress. The care of patients with chronic diseases is consuming increasing general practice hours. They contribute to 60% of deaths globally and this figure is increasing on an international scale. It has been estimated that if the current trend persists, diabetes alone could consume the entire health care budget of western nations.

While much of our population lives longer they do not necessarily live with optimal health, being limited by their physicality, their pain, the psychological reaction to their problems and by current management itself.
Finding ways to effectively and efficiently prevent, manage and potentially cure these diseases is the challenge for the new generation of clinicians.

Blue Crowned Motmot bird

Think again if you imagine this Central American nation to be another lawless hellhole awash in drugs.The people of Costa Rica (‘Rich Coast’), known as ‘Ticos’, live by the code of Pura Vida, an infectious mixture of “no worries” and “stay cool”, which results in a cohesive society full of optimism.

It has had public schools for all since the 1880s, free healthcare and civilised labour laws, major drivers of this wonderful place.
My wife, my sister-in-law and I joined nine others on a two-week tour through the country with our guide Xander and his trusty sidekick Pappy piloting the bus. For those readers of a certain age, these two were very reminiscent of Pancho and the Cisco Kid.

San Jose the capital sits in the elevated Central Valley surrounded by active volcanoes. After the spectacular flight in, we found the main road into the city was being repaired so our taxi driver took us by the ‘scenic’ route, a bit daunting, with dusty shanties and much barbed wire.