GOROKA GENERAL HOSPITAL
PAEDIATRIC Department

PAPUA NEW GUINEA DELEGATION TO THAILAND

Paediatric HIV care, Community Network and Paediatric HIV Quality Improvement Program

Just recently in October 2009, I returned from a trip to Thailand where I along with my team mates were able to observe first hand the Paediatric Programme in Bangkok and at the Chiang Rai Regional Hospital.

Forward

The first HIV case in PNG was diagnosed in an adult in 1987.After the first case of HIV was detected in 1987, the number of HIV infections has increased drastically. In 2004, Papua New Guinea became the fourth country in the Asia-Pacific region to declare a generalized HIV&AIDS epidemic. As of 2008, it has the highest HIV prevalence in the Asia-Pacific region at 1.5%. Cases of HIV from Papua New Guinea in turn constitute an increasing proportion of the total cases detected in the Pacific-from 21% of all cases in 1984-1989, to over 98% in 2005-2007. This upwards trend is expected to continue in coming years. (NACS, 2008)

Paediatric HIV has been a long overlooked area of the National HIV Program, although childhood HIV is a preventable disease. The neglect has been particularly due to the focus of the National Aids Council and NDOH on the adult population by promoting preventative aspect of HIV by promoting Abstinence, Faithfulness and the use of Condom. This is more directed to the adult population. The prevention of HIV from passing from an infected adult female to the unborn child through administration of anti-retroviral drug has not been promoted as much by NACS and NDOH as a major preventative option to the unborn child.

Because of the lack of knowledge and experience of care givers and policy makers, Paediatric HIV programs failed to prevent vertical transmission (PMTCT), find and treat children infected with HIV with the consequence that morbidity and mortality for HIV infected children has been very high.

The study tour visit to Thailand to view the health system structure, the Paediatric HIV program coupled with the discussions held with the Paediatric HIV Program implementers has really helped us the PNG contingent to view our own deficiencies and we feel that now we are in a better position to improve our own PMTCT and HIV / ART programs for the children infected with HIV.

We would like to thank the following individuals and organizations for contributing significantly to the study tour: the World Health Organization (PNG) for sponsoring the trip, NDOH Secretary and HIV/STI Team for finding faith in the team and selecting us and the Thailand Ministry of Public Health – United States Center for Disease Control Collaboration (TUC) for organizing the logistics. We also would like to extend our gratitude to the TUC staff especially Dr. Rangsima Lolekha, Ms. Thananda Naiwatanakul and Ms. Worawan Faikratok for their undivided commitment and support to help us understand the concept of PMTCT and Paediatric HIV / ART programs in Thailand. We also really appreciated the discussions we had with the doctors of the respective regional, provincial and community hospitals. Professor Kulkanya and Dr Rawiwan Hansudewechakul of Siriraj Hospital and Pan Hospital respectively were very inspirational.

The experience has motivated all of us to have a positive view on childhood HIV programs. Depending on the circumstances all of us have decided to report to the respective organizations our activity in 6 months time.

Figure 1: The PNG Participants

Participants (from left to right):

1. Dr. Mary Bagita (Obstetrician & Gynaecologist PMGH: In charge of PPTCT in PMGH)
2. Team Leader Dr. Harry Poka (Paediatrician Kundiawa: Paediatric Tuberculosis focal person for PNG)
3. Dr. Paul Wari (Paediatric Registrar Goroka Base: In collaboration with Clinton Foundation/Paediatrician, oversees the Paediatric portion of the PPTCT program in Goroka)
4. Sr. Veronica Kalebe (Paediatric Nurse employed by the Clinton Foundation and works at the PMGH Paediatric unit specifically manages the HIV infected children)
5. Mrs. Esther Kawang ( Health Extension officer at the Angau Memorial Hospital)
6. Sr. Wendy Kunal Aiwa (Antenatal Clinic Nurse of PMGH and employed by the Clinton Foundation: practices PPTCT in the antenatal clinic and labour ward)

Purpose of the Training

1. To learn about a community-based Paediatric HIV treatment and care network model in Thailand
2. To learn Paediatric HIV quality improvement program HIVQUAL-T Model in Thailand.
3. To visit Paediatric HIV treatment and care clinic and discuss with Paediatric infectious disease physicians in Thailand
4. To discuss and plan for adapting the Paediatric HIV care community network and Paediatric HIV quality improvement program in PNG.

Travel and Transportation

The participants (see figure 1) congregated at the Port Moresby Jackson’s International Airport on the 3rd of October 2009. After a short briefing with Ms Doris Kedea of WHO (PNG) at 1400 hrs, we checked in for Air Niugini direct flight to Manila. We arrived in Manila International Airport safely. After customs clearance we seek the WHO Help Desk in the airport. From there, the WHO van picked us up and transferred us to the Euro Apartments were we spent the night. On the 4th of October the next day at 0800hrs we were picked up by the WHO van and transferred to the manila International Airport. We board the Philippines Airlines flight to Bangkok International Airport. The Windsor Hotel shuttle bus transferred us to the hotel.

The travel within Thailand to the different sites of training was very well organized and timely. All in all our travel was uneventful thanks to the WHO (PNG) and especially the Thailand based CDC (South East Asian Headquarters) logistic officer.

Study Fellowship Program Component

Our study fellowship tour consisted of two parts:

The first part was based in Bangkok Metropolitan Area

1. TUC: Overview of pediatric HIV care community program / quality program
2. Visit to Bamrasnaradura Hospital, the National Infectious Disease Hospital of Thailand.
3. Visit to Paediatric HIV Clinic at the Siriraj Hospital
4. Site visit to Klong Luang Community Hospital

The second part was based at Chiang Rai, the northern most region of Thailand

1. Site visit to Chiang Rai Regional Hospital. This hospital has a very effective Paediatric HIV Care Community Network and Paediatric HIV Quality Improvement Program and is in-fact the leader in the HIVQUAL-T program in the Western Pacific Region
2. Site visit to the Pan Community Hospital.
3. Site visit to a Health Centre

Siriraj Hospital which is an hour’s drive from Bangkok CBD. This hospital is a University Hospital and is the biggest in Thailand, it has 72 buildings (See figure 2: Siriraj Hospital building complex as indicated by the box). Since it was built by the King of Thailand it is also called the “Hospital of the Kingdom.” It has 2,500 beds, of which 350 beds is allocated for pediatrics.

At the Siriraj Hospital we had a very informative and stimulating session with Professor Kulkanya who highlighted four effective strategies to Prevent Mother to Child Transmission which were:

1. Pregnant HIV mothers should be administered ART in addition to OI prophylaxis
2. ART should be administered to the neonate for PEP. More ART treatment is needed if mother received less treatment
3. Elective caesarean section and
4. No Breast feeding (but if needed, exclusive BF is helpful. Here we learnt that the Thailand Government provides formulae feeds for free to all babies of HIV infected babies. Thus the practice was all expose babies are put on formulae feeds as well as co-trimoxazole prophylaxis from birth.)

Figure 3 – Map of Thailand

From Siriraj Hospital we departed to the Bangkok International Airport and Boarded a flight to Chiang Rai (see figure 3 courtesy of Dr Rawiwan Hansudewechakul) the Northern Most Region of Thailand. Our Hotel Van took us from the Chiang Rai International Airport to the Wangcome Hotel.

On Wednesday the 7th of October, the third day of our visit, we were fortunate to visit the Chiang Rai Regional Hospital. This hospital under the leadership of Paediatrician Dr Rawiwan Hansudewechakul has a very effective and efficient community network system for Paediatric HIV care. Their Paediatric HIV activities are oriented towards improving the adherence to the ART. The hospital is taking the lead in this program. The processes of establishing a well functioning Paediatric HIV program with a good ART adherence rate of 95% and above were basically the following:

1. The hospital adopts best practice in the area of PMTCT and Paediatric HIV
2. Good leadership (Dr Rawiwan herself)
3. Make the system work by drafting policies and guidelines according to the recent available research updates
4. Attitude to work is highly maintained in the team. Workers have good work ethics; they all have a good heart.
5. Hospital mobilizes its staff to form a Paediatric HIV team that consisted of the following
6. Nurses: take history, prepare all documents / records of HIV infected children
7. Pharmacist: provide medicine, check adherence
8. Paediatrician: physical check up, prescribes ARV and medicines for OI
9. NGO / PLHA: do home visits, does pill counts etc

Each of the above staff has specific responsibilities clearly spelt out and they perform their job really well as such there is sharing of workload and everyone enjoys their job.

Once the hospital based PMTCT and Paediatric HIV program organization, structure , policies and procedures are up and running well, then the hospital goes to the next level which is to bring in the health workers from health centers and rural hospitals (known as community hospitals) into the hospital and conduct on-the-job training for them in a day. These community hospital staff feels motivated and have ownership of the programs. After the on-the-job training the Chiang Rai Regional Hospital then refers the Paediatric HIV patients back to the community hospital for follow up and continuation of care is maintained.

These above activities has enabled very good adherence rate (see figure 4 courtesy of Dr Rawiwan Hansudewechakul). Due to their effective PMTCT program which was started in 1997, the vertical transmission rate in PMTCT at the Chiang Rai Hospital has been zero for the past two years (see figure 5 courtesy of Dr Rawiwan Hansudewechakul).

On the 8th of October 2009 we were privileged to visit the Pan Community Hospital in Chiang Rai (equivalent to a rural hospital in PNG). The pediatric HIV care and pediatric HIVQUAL – T are embraced and applied very well.

Several things that stand out were;

1. There is a very good relationship between the Paediatric HIV team (PLHA, NGO, Nurses, doctors, pharmacist, and dentist) of the community hospital with the Chiang Rai Regional Hospital Paediatric HIV team.
2. The regional hospital closely supervises and monitors the pediatric HIV care and pediatric HIVQUAL – T program in the community hospital.
3. The staffs in the community hospital are committed and have a very good work ethics.
4. The administration of the community hospital really supports the program

We than returned to Bangkok, where we debriefed and are now in the process of submitting our report to the WHO/NDOH HIV Team

I would like to thank the NDOH Team for selecting me , WHO for sponsoring the trip and GGH CEO Dr Apa, a/DMS Dr Kendaura and my supervisor Dr Mauta (Paediatrician) for releasing me for this study tour.

Dr Paul WARI
Paediatric Registrar -Participant.

9-13 August, 2009

BALI INTERNATIONAL CONVENTION CENTRE (BICC)
NUSA DUA, BALI,
INDONESIA.

THEME: ‘Empowering People, Strengthening Networks’.

The trip was a worthwhile and educational exposure for the whole team that went and participated in the plenary, oral, poster presentations, satellite meetings, and skills building workshop, symposia, Asia Pacific village and the Congress field trips.

The team consisted of Dr Apa, Dr Frank, Dr Wari, Dr Mondurafa and Mr Wai. We were accommodated at the beautiful Grand Hyatt hotel and our travel allowance was used to cover for our meals, transportation and emergency use as was in the case of the three of us that lost our baggage (Drs Frank and Wari and Mr Wai).

THE BALI 09 TEAM

(From  L to R) –Mr Wai , Dr Apa , Dr Mondurafa , Tour guide and Dr Wari. Dr Frank was taking the photo.

The meeting began with an opening at Lotus Pond; Garuda Wisnu Kencana Cultural park proceeded by a dinner. The President of Indonesia officially opened the congress.

The five days were divided into a combined Plenary session from 0845 to 1030 hours than community forums from 1045 to 1915 hours at night. The days were generally very busy for us running in between the different sessions that were of interest.

We attended sessions that covered areas in Political commitment for HIV programmes, PPTCT programmes , HIV/AIDS planning sessions , Clinical updates of HIV, HIV/AIDS programmes in resource poor settings, and responses of both governments and NGO’s in combating HIV/AIDS in the region.

It was very difficult to attend all the sessions as they were all important and very educational.

We were not able to take the field trips as they coincided with our presentations.

The group presented a poster presentation on the Self help projects being undertaken by the Clinton Foundation and the Compassionate care in PPTCT leads to retention in Paediatrics. Our Clinton Colleagues from Port Moresby spoke on the PMGH PPTCT experience and the Early infant diagnosis in PNG as well as the ART data management system in PNG.

Key lessons learnt at the Congress were:

1. Good PPTCT programme can lead to reduced HIV in the population
2. Data management is very vital in assessing how programmes are going and for patient management and care.
3. People of all groups such as gays , lesbians, homosexuals, drug users, PLWHA, commercial sex workers, clinicians ,scientists, politicians, administrative groups , pathologists, radiologists must work together to combat the illness.
4. There is a new vaccine being trialed in Thailand.
5. Goroka’s protocols are that of those which have been proven to work
6. We need to understand the epidemic and strengthen prevention efforts.
7. Strengthening partnership for treatment, care and support.
8. HIV/AIDS in Context: Understanding and addressing Socio-Cultural, Economic and political determinants
9. Leadership and broadening the response.

RECOMMENDATION:

1. Strengthen our PPTCT programme in Goroka.
2. Keep very good data and manage it accordingly.
3. Learn to work with all stakeholders in the community.
4. Empowering our staff to do research and present in country and internationally.
5. Keep abreast with the latest clinical management through our association with Clinton Foundation.
6. Keeping management aware of benefits of such gatherings.
   Implementing what we as a group have picked up in areas of clinical and management.

We would like to thank the Clinton Foundation for sponsoring the trip.

For the Bali Team.

Dr Paul WARI
Paediatric Registrar.

GOROKA GENERAL HOSPITAL

RURAL OUTREACH CLINICAL PROGRAM

OFFICE OF THE a/COORDINATOR

Part of the campsite; in the forefront are the pit latrines.

Report of Special Clinical Campout – Korofegu, Bena

From 5^th – 11^th November 2009

BACKGROUND

The Seventh-Day Adventist Church hosted its national women’s convention from the 5th-11th November 2009 at Korofegu, Benabena, Eastern Highlands Province. People started flocking into the camping venue as early as 2nd November 2009 from throughout Papua New Guinea. The program was supposed to have been conducted in early October 2009 but deferred to the said date due to an instruction from Provincial Taskforce on Disease Control and Epidemic due to the recent outbreak of Cholera, Dysentery and Influenza. More than 17,000 delegates attended and participated in this convention/gathering. The hospital responded to the organizers request for medical assistance in terms of manpower and logistics, with blessings from the Provincial Taskforce on Disease Control and Epidemic in its deliberation on Thursday 29th October 2009. The Rural Clinical Outreach Office was thus delegated this task to coordinate this health operation within this period.

AIMS / OBJECTIVES OF THIS HEALTH OPERATION:

1. To provide Curative Health care on site, to reduce morbidity and prevent mortality, and ultimately to prevent as much as possible morbidity and logistics/capacity burden on Goroka General Hospital and Eastern Highlands Province:

Activities
- sick patients to be reviewed immediately and treated on site.
- very sick or critically ill patients to be evacuated to Goroka General Hospital (Port Moresby and/or overseas medical evacuation to be borne by the church, however, hospital officers will escort if required).

2. To encourage Promotive Health:

Activities
- tent settings, mess/kitchen facilities, pit latrines, waste disposal pits, water supply within the camping grounds etc as well as local food stalls and markets to be inspected on a daily basis and advise concerned stakeholders to maintain infection control measures especially in regard to recent cholera, flu and dysentery outbreaks as well as other water and/or food borne diseases.
- active surveillance to be implemented and if there is an outbreak concerned stakeholders will be notified immediately.

3. To disseminate information on Preventive Health:

Activities
- Pamphlets, posters, information booklets etc to be provided as giveaways on all public health diseases, conditions and issues.
- Presentations, Talks, Discussions etc to be carried out if opportunity is given in this gathering.

CATEGORY OF HEALTH WORKERS THAT PARTICIPATED

* Doctors : 2
* Physiotherapists : 6
* Dental Officers : 2
* Nursing Officers/CHWs : 22
* Eye Nurses : 2
* Clinton/MAC officers : 12
* Anaesthetic Officers : 2
* Laboratory Technicians : 1
* Pharmacists : 2
* Drivers : 2

Total Staffs: 53

And of course we had several dedicated volunteers from the church who participated especially in the evenings and nights.

Rosters for the respective divisions were formulated and the staffs were scheduled for duties accordingly. We had almost 15 staffs during the day, and about 5 during the evenings and night shifts.

A one hour staff briefing was done on Tuesday 3rd November 2009; rural outreach protocols on work standard ethics and especially infection control measures was emphasized, as most of the partaking staffs were not rural outreach team members.

LOGISTICS / PHARMACEUTICALS

Vehicles

: 2 hospital ten-seaters utilised for drop off and pick up of hospital staffs
: 1 private open-back landcruiser stationed 24 hours with private driver for medical evacuations only

Pharmaceuticals

: oxygen cylinders x 2 (one portable and one large with its accessories)
: Dental Officers, MAC & Clinton officers, Physiotherapists, Ophthalmology Nurses, Anaesthetists, and Laboratory Technician came in with their own gear for patient diagnosis and management.
: K2600.00 cheque given to Goroka General Hospital by organising committee of this program; basic pharmaceuticals worth K2900.00 supplied (see attachment from Hospital Pharmacist, Mr Malcolm Sabak)

Clinic Setting

: well-set traditional building with kunai-thatched roof; rooms for staffs, dispensary, outpatients, and inpatients. Separate extension/confinement for staffs outside for breaks. The Clinic was connected with treated water supply and genset electricity which was occasionally going off. Toilet/Shower facilities is 5 minutes walking distance (sick patients should take longer than that)
: Infection Control – sharps were discarded in standard sharps container for incineration at Goroka General Hospital

OVERVIEW OF THE CAMPSITE

Venue partitioned into 10 divisions according to the SDA Church’s 10 national divisions. Well over 17,000 people attended this church gathering from throughout Papua New Guinea.

Housing

: tents accommodating 2-3 persons (some more than that depending on capacity)
: 12 round kunai houses (10 for respective church regions, and 2 for guests)

Water Supply

: piped into 7 Tuffa tanks from about a kilometre away; chlorinated and distributed into respective sections via another 7 Tuffa tanks. This treated water supply was used for both drinking and bathing; the bathing area was further down the nearby stream (5 minutes walking distance), whilst drinking taps were scattered throughout the site

Toilet

: about 100 human-dug toilet pits covered with concrete slab cover, a latch and ventilation vent via a bamboo pipe. Some of the toilets were quickly filled and had to be dug again by a back-hoe excavator during the week

Kitchen

: 4 well – set kitchen but open-air for serving which was prone to dust and flies; cooking done with gas cookers, and boiling water was self-served via electric heaters; there was a separate building for storage of food

Food Stalls

: From observation, no cooked foods were sold in the stalls/markets; the locals had adhered to the advice given

It was practically difficult to monitor sanitation and hygiene practices and to do daily inspections of water, toilet, kitchen and food stalls; request was made verbally to Mr Opa Kairu – Coordinator of Provincial Health Disease Outbreak Team for manpower (health inspectors) in this area of duty, but the response was negative. Therefore day to day monitoring was not effectively carried out as we were busy in clinical duties.

PATIENTS SEEN AND TREATED AT THE CLINIC

A total of 1048 patients were seen and treated by 53 participating staffs, as depicted in Table 1 and Table 2. There were 870 females as expected (83 %), and 63 sick children (6 %).

There were more medical cases (34 %) followed by eye (26 %), dental (~12 %), and so forth. The ‘Others’ patient category consists of Voluntary Counseling and Testing patients (52), as well as ENT and skin cases (14); All VCTs were nonreactive or negative.

Medical and Paediatric cases were mainly Upper Respiratory Tract Infections, Uncomplicated Malarias, Arthragias, Myalgias and non-specific headaches; only few had chest infections; there were only 3 diarrhoea cases which were treated as climate/weather and stress-related, and do not fulfill the case definition of Cholera.

The Surgical morbidity were mostly strain or sprain, followed by minor cuts and abscesses; the operations performed were suturing of a mother who had deep scalp laceration who was hit by a falling iron tent pole, whilst the other 2 patients were removal of foreign bodies from legs.

For Dental cases, mostly extractions were done, followed by dressings, fillings and dentures; dentures were done at the Hospital.

For the Ophthalmology cases, most were due to refractive errors that required glasses; affordable reading glasses were given to the patients on the site after their problems were identified; a few cataracts and pterygium were referred for surgical operations but unfortunately the operations had to be cancelled as the Ophthalmologist was on his way to Australia.

Gynaecology patients were mostly PIDs, with few menstrual disorders; we had 5 patients coming in for their depo injections as part of family planning.

Physiotherapy cases were mainly athralgias and myalgias.

Of the 17 patients referred, 5 were emergencies (acute appendicitis, pyomyositis, threatened abortion, trigeminal neuralgia and infected plantar wart), and 12 were dental cases requiring dentures, filling, and specialized extractions.

Apart from the execution of clinical duties, health education was also presented every day on health issues concerning Cholera, HIV/AIDS etc.

CONCLUSION/ACKNOWLEDGEMENT

The clinical health program undertaken by Goroka General Hospital was crucial and timely, as there were no constraints of resources on the hospital during this peak period, and also for disease control especially in regard to the recent cholera, dysentery and influenza outbreaks.

The Chief Executive Officer of Goroka General Hospital, Dr Joseph Apa, and The Director of Eastern Highlands Provincial Health & Taskforce Chairman of Disease Control and Epidemic, Mr Ben Haili, are hereby acknowledged for their approval for this exercise, which is ultimately for the wellbeing of our people.

All staffs who took part in this program are thanked for making Eastern Highlands Province a healthy place to thrive.

And finally the SDA Church is thanked for setting the standard in outdoor camp meetings.

Report compiled by:

Dr Beron T Kongona
a/Coordinator Rural Outreach Clinical Program
(17th November 2009)

A slideshow of the photos taken out at Korefegu can be viewed below

[Show as slideshow]

Lucy was my mentor and companion during my visit and I thank her for her friendship and for sharing so much of the ‘ways of doing things in Goroka’. The group photo is of the Monash Goroka Alumni and in the meeting we had there was so much energy and enthusiasm with each person talking about what they have been doing in their nursing career since studying at Monash and their hopes for the future. We spent time talking about research and nursing leadership and how it is up to us as individuals, within the organisation, to make a difference in the care we provide and to help others to reach out and to do the best possible. There are many examples of good practice, in health care delivery, within the hospital. The request for further undergraduate programs was taken to the Head of School and the Dean of the Faculty of Medicine, Nursing and Health Science and we are forming a committee to look at how and when we could implement such a program again.

Working with all the staff was for me enjoyable…I aimed to have them tell me of their good work and achievements and how they do so despite a poverty in essential resources. They were able to recognise that even though there are limitations in equipment and qualified staff, it is still possible to create culturally appropriate and sensitive care for unwell people and their families and to be person centred.

Diane and Simone also achieved their aims, to provide antenatal care and to be with birthing women, to work with the local midwives and to maintain high standards of care. Care that would meet the Australian Nursing and Midwifery Council standards of practice. What was important in this for me, was to see how these students translated their skills in a new and challenging culture,  in practice, in environment and among people who understand and speak a different language and experience a different lifestyle.

We received a wonderful welcome by all we met, those in the hospital and people in the streets and markets. Sonia  always kept us safe and ensured that we were able to experience wonderful opportunities such as a local wedding and a lunch with friends, sometimes we spent many hours at night talking, talking, talking about everything! As only friends can do. In what we were experiencing, sharing our thoughts, telling stories, and writing our journals, Sonia was always supportive. Thankyou ever so much. Thankyou also to Dr Jo and your many colleagues who made us welcome too and for the provision of vehicles and drivers to ensure we were able to get out to the health centres, to shop for provisions to give to the birthing women, to the markets to buy fresh produce.

Many people shared their plans and hopes for a bright new hospital, and we wish you well on this quest. But in the meantime we send you our best wishes and our thoughts, and thank everyone for what can only be described as a remarkable experience with remarkable people.

Kind regards

Dr Kay McCauley-Elsom
Senior Lecturer
Bachelor of Midwifery Coordinator
School of Nursing and Midwifery
Monash University

November, 2008

The Goroka General Hospital staffs were privileged to undergo the public service induction training. For some they had been working for more than ten years, while for others they had been working for only a year. The trainees included doctors, nurses, administrative staff, allied health staff and the hospital maintenance staff. All in all there was 120 staff from the hospital that attended the 2 weeks induction. The first batch of 60 in the first week and the second batch of 60 the following week.

The facilitators were from the National Department of Health as well as from the Institute of Public Administration in Port Moresby.

Topics covered in the course were:

1. Orientation to the Public Service
2. Orientation to the agency (Central and line Departments)
3. Orientation to the Agency ( Provincial)
4. Orientation to the job.

The public service in PNG is often termed as ineffective or disorientated and I believe as a participant that this is because many public servants have not been inducted or due to the fact that there has not been any refresher courses for older public servants on the code of ethics, the Public Service ‘General Orders’ and lack of general quality supervision from supervisors at all levels.

With many more of these Inductions planned for other provinces and the PSWDI sponsored development of ten Basic Modules to help public servants to develop their core competencies in their jobs, the Public Service culture can be revolutionized.

A big thank you to the Management of Goroka General Hospital for releasing its staff and funding and also the NDOH/PNGIPA for facilitating and co funding the Induction.

We all hope that there can be a cultural change in Productivity and efficiency in our hospital now that we have been educated and inducted.

Finally, ‘an EDUCATED Public Service is an EFFECTIVE Public Service’.

Dr Paul WARI
Participant.

As most of you would be aware Goroka General Hospital has it’s own website (http://www.ggh.org.pg/) – a first for a PNG Public Hospital. A website is the perfect medium for sharing news, articles and other items of interest with the outside world.

We are currently seeking news items and photos from Hospital staff with the view to publishing these to our website. The form and content of your stories can be wide and varied – here are some ideas that will hopefully generate some interest and response from Hospital Staff:

• Conferences and workshops you have attended or facilitated.
• Rural visits including photos.
• Current projects (eg: Oxygen Plant, Housing relocation etc…)
• An introduction of your Department/Section/Team.
• A success story (eg: funding, study scholarship, accomplishment etc…)
• Personal Staff profile.

We look forward to receiving your stories and news items and if published your name will be noted as the author of the article. Also, if you are needing access to a digital camera to add some colour to your story we are more than happy to assist.

Yours sincerely,
Manager IM&T
GGH

Email: info@ggh.org.pg

Story by Sally Keat, Matthew Tate and Alex Bown (Visiting medical students from Sheffield Medical School, England)

We are Sally Keat, Matthew Tate and Alex Bown, three fourth-year medical students from the University of Sheffield in the north of England. Our elective period allows us to experience medicine in a different health care setting; as all of us had long been interested in visiting Papua New Guinea, we jumped at this opportunity. Goroka General Hospital was the natural choice when we were looking at where to spend our elective as it is one of the foremost hospitals in PNG and we had heard very positive things from previous visiting students.

During our time at GGH we rotated through the various departments: adult medicine, paediatrics, labour ward, ophthalmology and the Michael Alpers clinic. Each department made us feel very welcome and the staff were unfailingly friendly, helpful, and enthusiastic for us to get involved.

Our first impressions of the hospital were that it was obviously very different to the hospitals we were used to at home. Despite the limited resources however, we were immediately impressed by the staff´s ability to deliver efficient and effective health care to the populatin of Eastern Highlands province. In the UK, doctors are increasingly reliant on expensive and complex tests and investigations. Doctors here must rely heavily on their own clinical judgement, and so excellent practical skills are vital. We shared the frustration of the staff that simple investigations (such as X-ray and routine blood tests) were sometimes not available, but the healthcare team worked tirelessly to minimise the effect of this on patient care.

Part of the reason we wanted to come to PNG was expose ourselves to a very different disease spectrum and gain experience in the management of problems that we see only very rarely at home. The main burden on the healthcare system in PNG is infectious disease rather than the lifestyle diseases (such as heart disease and diabetes) that we commonly see at home. The main problems we have encountered have been tuberculosis (often advanced and involving multiple body systems), HIV, typhoid, malaria, pneumonia and diarrhoeal illness. Although we don´t see a great deal of these problems at home, they form a huge burden of disease globally and are very important to have experienced and have a good understanding of.

Each of us has had the opportunity to improve our own set of clinical skills by working alongside the doctors on the wards and in A&E. As well as gaining lots of experience of day-to-day ward work that will be invaluable when we start work as junior doctors next year, we were also very lucky to have had training and been supervised performing a number of procedures that are not usually taught at this stage in our training in the UK.
We were able to see cutting-edge cataract surgery in the ophthalmology department which is not available anywhere else in PNG, and for which some patients had travelled hundreds of miles.

Although understaffed, the highly-skilled doctors and midwives on labour ward provided a very high standard of care for expectant mothers.

The Michael Alpers clinic is working in conjunction with the Clinton Foundation to implement high quality HIV care and provide education to the community about HIV/AIDS as well as sexual health issues.

The doctors on the adult medicine and paediatric wards have to be true generalists to deal with any medical presentation, which they do expertly.

Although Goroka can be a frustrating place to work, with limited resources, it is also a highly rewarding place to work. We would like to thank all the medical staff for allowing us to get involved and taking time out of their busy days to teach us. We would also like to thank all of the administration staff who have helped to make our stay so enjoyable and productive.

We not only learnt a huge amount during our time in Goroka, we were also able to spend time in an amazing country, one which we all hope to return to in the not-so-distant future.