Burden on the system

Normal, Weekender

SIOBHAIN RYAN reports on the strain on the Torres Strait Islands’ health system from an influx of Papua New Guineans

Torres Strait Regional Authority chairman John Kris has warned that indigenous communities were left dangerously exposed to disease by the 30,000 unrestricted movements last year across the Queensland and PNG borders.
Support for new protection measures was “absolutely critical and not negotiable’’, he says in a submission to a new federal parliamentary inquiry into the health of the Pacific region.
“We propose that screening of PNG visitors and Australian visitors happens before PNG nationals are cleared to visit communities on both sides of the border.
“Australian and Queensland governments must wear any responsibility, cost and compensation to Torres Strait communities if an outbreak occurs if no screening of visitors continues to take place.’’
Under the Torres Strait Treaty, traditional inhabitants of PNG’s impoverished Western Province and Queensland’s Torres Strait can cross the border for cultural activities without visas or passports.
But sick or injured PNG nationals in need of health care also make the journey, accounting for 2000 crossings a year into the Torres Strait and increasing workloads at clinics already struggling with their own indigenous health crisis.
“We need to see up to a 50 per cent reduction in presentations over the next four years of PNG nationals. Torres Strait has its own health issues that it must address, therefore cross-border efforts need to complement this, not further burden it,’’ the TSRA submission says.
The north Queensland-PNG border is the lower end of a pathway for emerging infectious diseases extending from Asia through West Papua, PNG and into Australia via the Torres Strait.
Japanese encephalitis, dengue, the Asian tiger mosquito and multi-drug resistant tuberculosis have all travelled this corridor to enter Australia.
James Cook University associate professor Darren Russell, a past president of the Australian Federation of AIDS Organisation, fears that HIV-AIDS could be the next to exploit the porous border.
The number of Papua New Guineans living with AIDS has risen from 10,000 in 2001 to 54,000 in 2007.
“It’s likely that the remoteness of the PNG border region has helped protect people, but we know that there’s a significant HIV problem in Daru, which is the district capital of South Fly district, so it really is just a matter of time,’’ Russell says.
“The other thing to realise, of course, is that while we’re focusing on the people of PNG, people in the Torres Strait actually move quite a lot, too. They visit Cairns, Townsville, Darwin and other cities in Australia, and there’s no reason they won’t contract HIV just as anyone else can if they travel and have sex away from home.’’
One recent study into genital herpes, which can increase HIV infection risks and worsen the prognosis of people with the virus, has identified rates in Cape York’s Aboriginal and Torres Strait Islander populations among the world’s highest.
The paper, under wraps while awaiting peer review and publication, found 58.4 per cent of the 270 indigenous adults tested were positive to herpes simplex type 2, which causes genital herpes, almost five times the rate in the general Australian population.
The federal budget acknowledged the cross-border risks by committing $13.8 million over four years to a Torres Strait protection strategy. Most of the money will go towards upgrading Saibai clinic to cope with the dual workloads of local chronic disease and PNG communicable ones.
Canberra also has put to PNG a proposal to allow health professionals to cross between the two countries as freely as their traditional people do. But its focus has been on boosting its neighbour’s resources to handle its own health problems rather than pursuing the TSRA’s call to tighten borders, screen visitors or cap their use of Queensland clinic services.
Russell says there is little point pre-screening PNG nationals when few services exist on their side of the border to follow up the health problems identified.
“The only way to reduce the demand would be to improve services on the PNG side,’’ he says. Until that happens, pressure to boost the capacity of Australian health services to handle the flow of PNG nationals and spread of communicable diseases will continue to mount.
Russell says it is not just Torres Strait clinics that are ill-equipped to deal with HIV’s inevitable spread.
Cairns Base Hospital lacks even the capacity to test the immune function or T-cell count of people with HIV.
Its reliance on Brisbane to analyse samples adds so much transit time that Torres Strait residents with HIV must go to Cairns to give blood if it is to reach the Queensland capital within the tight 24-hour window for testing.  – The Australian