Why does it cost K15,000 to treat one snakebite?

Editorial

The decision to charge K15,000 for one snakebike anti-venom treatment at the country’s referral hospital is a slap in the face for ordinary Papua New Guineans.
That notice is part of an inter-office memo signed by Port Moresby General Hospital chief executive Dr Umesh Gupta advising the finance manager, clinical coordinators and revenue clerks that user-fees for higher speciality services will be effective from August 14.
The service fee for snakebite anti-venom is the highest at K15,000; then the fee for thrombolytic therapy is K1000, dental OPG X-rays  K500, 128 Slice Contrast CT scans (with injectable contrast) K500 and 1.5 T MRI scanner  K500 and flowcytometry K200.
The memo explains that the fees are calculated to recover the “very high maintenance contract costs and consumables for these new and tertiary care services”, while primary health care continues to be free.
Gupta says each vial of anti-venom costs K13,500, which – according to him – is the cheapest available on the market.
It is unfair that PMGH is seeking full-cost recovery from patients.
Gupta says the health department has not been supplying hospital with anti-venom for a year.
This notice does not help anyone in any way. What it does is that it pushes families of snakebike victims away from coming forward for help.
The memo explains that the fees can be waived for those who cannot afford it, but that still is not comforting.
We have been following the remarkable work of the Charles Campbell Toxinology Centre (CCTC) in Port Moresby.
The centre has provided hundreds of vials of anti-venom to patients at PMGH, and at no time have they ever charged any fee.
The CCTC is a partnership between the School of Medicine and Health Sciences (SMHS) at the University of Papua New Guinea, and the Global Snakebite Initiative.
They work in collaboration with the Australian Venom Research Unit (AVRU), Department of Pharmacology and Therapeutics, University of Melbourne, the Instituto Clodomiro Picado at the Universidad de Costa Rica, and with other international research institutions.
They are based in the SMHS in Port Moresby and operate a clinical and preclinical research laboratory and animal house.
They also operate the snakebite clinic within the Emergency Department at Port Moresby General Hospital, and a mobile intensive care ambulance service specifically set up to enable specialist medical teams to safely retrieve the most seriously ill snakebite victims from outlying rural areas in Central.
Their collaboration with the Australian Venom Research Unit and the Instituto Clodomiro Picado has led to the development of a new anti-venom for treating snakebite in PNG.
They are working with several other institutions who have partnered with us to improve our understanding of PNG’s venomous snakes and their venoms.
If this is the scenario, then we are baffled as to why PMGH
has to go far to order the anti-venom medicine instead of consulting with CCTC to find an amicable solution to the crises of shortage.
Unless the PMGH decision is reversed it will turn back the clock on increasingly positive health-seeking behaviours that have seen snakebite patient numbers rise to between 300 and 400
cases a year, but at the same time seen case fatality drop to record lows since their clinic in the emergency department opened in 2013.
It will make people opt to stay in their communities and rely on traditional treatments that are both unsafe and ineffective.
This can only lead to an increase in snakebite deaths.
CCTC says they will continue to provide the anti-venoms they have to the hospital at no cost whatsoever.
The new government must immediately release funds to support the operation of the hospital and the supply of life-saving services and medicines, including anti-venoms.

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