- Australian Doctors International

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Northern
exposure
After the tough arena of state politics, Dr Peter Macdonald
is using his negotiating skills to bring primary health care
to remote parts of Papua New Guinea. A group of volunteer
doctors is helping him tackle the appalling state of health
just beyond our border, and more volunteers are needed,
as HEATHER WISEMAN reports.
I
It’s a place where eyes and limbs
are still lost to leprosy. It has the
world’s highest rate of elephantiasis.
Babies born there are 10 times
as likely to die in their first year
as those born in Australia, yet it’s
just 150km from the Australian
mainland.
“In Papua New Guinea, health
is in a crisis,” says Dr Peter
Macdonald, a GP who is president of Australian Doctors
International (ADI), an organisation bringing primary care to
remote parts of PNG.
“All the indicators are
appalling, from infant mortality
20
| Australian Rural Doctor | June 2011
through to maternal mortality.
Malaria is rife. TB is out of
control and HIV is the highest
rate in the Pacific.”
Dr Macdonald is chipping
away at the base of this colossal
problem.
The former state government
politician relies on a special breed
of GP to help him; the kind who
can fix a broken generator,
distinguish between lepromatour
and paucibacillary leprosy, cross
rickety bridges and doesn’t mind
sleeping rough.
Usually, they’re GPs who have
worked in remote Aboriginal
communities or studied tropical
medicine – and often they’re
women.
“Probably 75% of our doctors
are women,” Dr Macdonald says.
“I can’t tell you why that is.”
After four months working
across the Torres Strait, volunteers return a few kilos lighter,
with riveting stories and a disdain
for sago.
ADI is a not-for-profit medicalaid organisation which, despite
its title, focuses exclusively on
PNG.
Eight directors, including Dr
Macdonald, made personal
contributions to kick-start it nine
Continued page 22
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ADI volunteer Dr Denise Wild
transporting a patient in the
Western Province.
June 2011 | Australian Rural Doctor |
All photos courtesy of ADI
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Continued from page 20
Rewarding but confronting:
Melbourne GP plans next trip
r Denise Wild vividly recalls the emotional impact of
watching a young woman walk away to die.
The woman, in her mid-20s, had end-stage renal failure and
was dehydrated and uremic, having spent 12 hours travelling
by boat to access care.
“We threw around options, like transferring her to a major
hospital, but she chose to go back to her village and we knew
that’s where she would die. She didn’t want any more intervention,” Dr Wild says.
“We come from a system where we put all our resources into
managing patients, so that was a confronting situation for me.
“It hit home, that so many young people are faced with
these chronic conditions that could be managed with good
access to medical care.”
Dr Wild and her husband, Marco Sartori, a carpenter, spent
three-and-a-half months working in Western Province last year.
She went to PNG as a medical student in 1995 and decided
then she would return when she had better skills. In 2008 she
studied a diploma of tropical medicine in the UK, which gave
her “the extra push to get out there and do it”.
Dr Wild, who works in a group practice in the Melbourne,
has done many locums in rural WA and far north Queensland.
“I worked in Aboriginal communities, which was really
helpful for setting me up to work in remote parts of PNG,”
she says.
On patrols, her team usually stayed in a small house with a
priest or nun.
“We were sleeping in basic houses, like tin sheds, on camping mats. It was a bit rough, but we are hikers and campers so
it wasn’t a huge deal,” she says. “But the food got to us. Sago
is the most boring food I’ve ever encountered.”
Dr Wild says she’ll work in PNG again. “I think I’m still
recovering, so I’m not sure when that would be,” she says. “It
will be rewarding to see the work ADI has done that has been
continued.”
D
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| Australian Rural Doctor | June 2011
years ago, before receiving support
from Rotary, Ok Tedi Mining and
Roche.
At the time of going to press,
ADI had not received any government funding, but Dr Macdonald
was optimistic it would soon
achieve AusAID accreditation and
receive $150,000 for each of five
years.
Dr Macdonald’s interest in PNG
was sparked after he was contacted
by a Catholic bishop who was concerned about the welfare of 10,000
West Papuan refugees who had
fled Indonesian authorities.
In January 2002, Dr Macdonald
visited and saw the desperate need
to improve health services across
the province.
He signed a partnership agreement with the Diocese of DaruKiunga, the most effective health
services provider in the region, and
with the provincial government.
“To work in any developing
country you need a local partner
to make things happen,” Dr
Macdonald says.
Earlier this year, he travelled to
Port Moresby to sign an
agreement with former PNG
prime minster Sir Julius Chan,
who is now governor of New
Ireland Province.
Despite a population of about
200,000, the province has no doctors dedicated to primary care.
The agreement will allow ADI to
provide health services to 62 rural
clinics.
ADI deploys health managers,
as well as GPs. The “doctor-supervised integrated health patrols”
head out for four weeks at a time,
treating patients, providing health
education and training clinic staff.
Dr Macdonald says that over
the years, the organisation realised
there was a lack of good management in the health centres.
“If we’re going to leave a lasting
benefit, management of the health
centres is crucial,” he says.
While clinic staff are now better
at getting medical supplies and
monitoring cold chains, corruption at all levels of government
draws from limited funds directed
to health.
Dr Macdonald says PNG governments are indifferent to the
appalling state of the country’s
health services.
Above (left): a child with grille, a common skin condition in the Western Province, and
(right), leprosy is highly treatable but needs 6-12 months of continuous medication.
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Former MP drawn
to trouble spots
Dr Peter Macdonald says his experience as a
state and local politician has helped him
achieve what he has for ADI.
The former mayor of Manly Council, who still
serves as a councillor, says his profile in
Sydney’s northern suburbs had helped open
doors to fundraising and sponsorship successes.
“When negotiating with authorities and
senior officials in Port Moresby or going to
Canberra and negotiating with AusAID, those
skills that come from years in political spheres
are helpful for sure,” he says.
Dr Macdonald, a GP anaesthetist, was born
in Scotland and moved to Australia in 1972. In
2007 his passion for politics was declining and
he yearned to push himself further, clinically.
Since then, he has spent 4-5 months a year
doing locums in the NT, in challenging communities such as Wadeye.
“I thought, ‘This will put me outside my
comfort zone’. And it does, really. Clinically the
demands and responsibilities are very high
compared with having worked mainly in general
practice settings in the city.”
His commitment to PNG remains strong, but
his focus there is on logistics, developing busi-
“We’re very careful
to try to work within
the current system.
Doctors might carry
starter packs, but
we have to remedy
proper supply lines.”
DR PETER
MACDONALD
d
Dr Peter Macdonald ... his political experience has served him well in Papua New Guinea.
ness plans, action plans and patrol plans and
having them endorsed and supported by local
authorities.
His lobbying efforts have extended to highlighting what impact he thinks PNG’s TB crisis
will have in Australia, as patients with drugresistant TB travel seeking health services.
“Many health facilities have no
power, no water, no fridges, so
there are no cold chains and staff
morale is at rock bottom because
they don’t very often get paid.
“We are constantly badgering
provincial and local governments
to bring about an improvement.”
When ADI discovered cases of
leprosy in remote areas of Western
Province, provincial and national
departments of health denied the
disease existed.
Finally they admitted it but then
it took up to two years to get leprosy medications released from
Port Moresby.
“It will come into northern Queensland.
Already there is evidence of that happening,”
he says.
“It’s a no-brainer. The Australian Government
should be improving health services in the
southern region of PNG, opposite the tip of
Cape York, to stem that flow.”
Doctors had to submit forms to
Port Moresby requesting medication for each patient. “It’s incredibly bureaucratic, with tragic
results,” Dr Macdonald says.
The same problem works
against the effective treatment of
TB, but addressing the issue isn’t
as simple as ensuring that doctors
take medication with them.
When doctors are visiting
remote areas every 3-6 months,
they need to ensure the supply of
medication will continue after
they’ve gone, or risk non-compliance and disease resistance.
“We’re very careful to try to
Continued next page
June 2011 | Australian Rural Doctor |
23
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Jack of all trades
work within the current system,”
Dr Macdonald says.
“Doctors might carry starter
packs, but we have to remedy
proper supply lines.”
He says that while ADI is now
getting regular supplies of leprosy
drugs into Western Province’s
Middle Fly region, it is not having
the same success with TB, largely
because treatment requires 3-4
drugs and effective contact tracing.
“TB is proving to be a real struggle,” Dr Macdonald says. “I’ve
talked to AusAID and asked them
to assist in their representations at
a higher level.”
One of ADI’s great successes is a
public health program that has
distributed about 55,000 bed nets.
In just one year, the long-life nets,
impregnated with insecticide,
resulted in a 46% decrease in
malaria cases presenting at one
hospital in Western Province’s
One wonders what the locals were thinking as they
watched Dr Marg Purcell drive, in reverse, around
and around their village.
In her usual self-reliant style, she’d decided she
needed to master reversing a trailer without jackknifing, as no one else in her team could do it.
Having been to PNG four times with ADI, Dr
Purcell (picture right) has fixed generators and temperamental 4WDs, and taught her boatman to drive.
“He used to sit in the middle of the road. I’d keep
saying ‘It’s not a river, move to the left,” she says.
Dr Purcell, a GP who is a senior medical officer at
Mareeba Hospital, near Cairns, has worked for many
years in Indigenous health care and isolated communities.
She has entertaining diary entries from her time
in PNG, including a boat trip in which her travelling
companions relied on her new canoe paddle to
bludgeon a cassowary about the head.
“I was, of course, horrified, but realised my privileged Western, vegetarian sensitivities had no place
in this jungle where people see wildlife for the protein it is,” she says.
Dr Purcell was disturbed to meet a 16-year-old
girl with Hodgkin’s lymphoma who was admitted to
a hospital in Port Moresby, but sent home,
untreated. Her discharge summary read “drugs not
given as none available”.
“If the country can’t manage to treat a
16-year-old with a curable problem in its biggest
hospital, then it’s no wonder others try sorcery for
a cure,” Dr Purcell says.
Another great frustration was obtaining medication for people with TB or leprosy.
“I used to say, well Plan A didn’t work. We’ll get
to P and we’ll give up, shall we? You’ve got to work
with whatever you can.”
Dr Purcell met her husband, Neil, on an early trip
to PNG. Neil, an electrician, was working with
Australian Volunteers International.
She says anyone thinking of working for ADI
needs to be patient, have a sense of adventure, and
have a strong background in primary health care.
“Those used to a lot of machines and high-tech
equipment would be sorely disappointed,” she says.
Continued page 26
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24
| Australian Rural Doctor | June 2011
Work For Us
Search for vacancies or send an online
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Let us hel
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ADI volunteer
Dr Verena
Doolabh.
Continued from page 24
northern region. It’s often a long
haul just to get the nets to the
communities: they are flown to
region, then transferred by boat,
driven in 4WD and then lugged by
volunteers trekking through dense
jungle.
ADI ensures the effort isn’t
wasted, teaching villagers about the
difference the nets will make and
how to use and care for them.
Despite the differences ADI is
making on the ground, one of its
greatest challenges is getting its
workers’ visas processed.
“It can take six months of sheer
obstinacy
in
government
departments in Port Moresby.
They’re great paper shufflers,” Dr
Macdonald says.
“This is why most aid agencies
will not operate in PNG. It’s too
difficult. You wouldn’t expect the
red carpet, but you’d expect them
to open the door and let us in.”
•
How to get
involved
D
octors don’t need procedural skills to work for
ADI in Papua New Guinea .
ADI president Dr Peter Macdonald says the
organisation needs people with general practice
skills, along with some knowledge of four basic
infectious diseases: TB, malaria, leprosy and
filariasis (elephantiasis).
He says most ADI doctors have worked in the
NT, in remote parts of WA or Queensland.
Doctors apply through the ADI website. Dr
Macdonald and two volunteers assess applications
and candidates are interviewed by a panel.
Volunteers need to commit for a minimum tour
of three months but have the option to stay six
months and go back several times. On tours, they
do patrols to remote areas for 3-4 weeks, have a
week off, and then go on patrol again.
Doctors essentially work as volunteers, although
they’re paid $1000 a month to cover a few bills at
home. ADI covers the cost of flights, accommodation, insurance, vaccinations, food and transport.
Challenge
yourself.
ADI’s doctors work closely with health
managers, who improve the way local health
clinics are run.
While health managers typically have nursing
backgrounds and have worked in small hospitals,
Dr Macdonald says general practice managers
would be well equipped for these roles.
While parts of PNG are known to be dangerous,
ADI is careful to ensure its volunteers are safe.
“The rascals who cause problems in terms of
the bigger cities aren’t in Western Province or
New Ireland Province,” Dr Macdonald says.
Recruiting Primary
Health Care Professionals
Northern Territory Health Workforce (NTHW) provides
recruitment, retention and support services to GPs and health
organisations across the Northern Territory (NT) of Australia.
As a unit of General Practice Network NT, we have the
benefit of being linked to an organisation that leads and
coordinates a Territory-wide Primary Health Care network
with the objective of improving health service delivery and
health outcomes in the Northern Territory.
We provide more than a ‘recruitment service’ to ensure
that both GPs and our health services and practices are
fully supported.
www.gpnnt.org.au
Blaze31552
Change
lives.
To find out more about primary health
careers in the Northern Territory,
contact the NT Health Workforce team on
(08) 8982 1000 or [email protected]
GPNNT acknowledges the financial assistance provided by the Australian Government Department of Health and Ageing.
26
| Australian Rural Doctor | June 2011