Cancer treatment issue in PNG

MY name is Peter Bire and I am the only national radiation therapist trained overseas (Melbourne) and I have worked in radiotherapy and oncology centres in Australia (Melbourne, Canberra, Townsville) and in Canada (London Regional Cancer Centre) for a total of over eight years.
I have also worked at Angau Hospital in Lae in the early 80s until Dr John Niblett left and everything closed down.
Radiation therapists are people who actually plan and deliver the radiation dose prescribed by the radiation oncologist (physician).
I feel that I have to speak out because I cannot stand the misinformation and wrong advice the Government has been receiving all these time causing this unnecessary delay for the availability of radiotherapy services for our people.
For a start, I believe the postponement or delay in re-establishing the cobalt and radiotherapy due to non-availability of a local radiation Act or regulatory framework in the last three years was not statutorily necessary and has cost our people’s lives.
These laws are necessary because PNG only became a member of the International Atomic Energy Agency (IAEA) in 2012 but this should not have technically or legally stopped our radiotherapy services from operation because IAEA could have assisted us in transporting the 2cm cobalt-60 radioactive source from Canada easily using their system or through Australia’s until we have our own laws in place.
Putting cobalt-60 machine aside, we could have imported linear accelerator machines which is just a bigger x-ray machine, not radioactive and so does not need a new law to import.
However, my main concern is the staff capacity to plan and operate the machine to deliver the treatment. Health and HIV/AIDS Minister Elias Kapavore’s announcement that an Indian Radiation Oncologist was recruited and is on his way will not solve the problem, even if he arrived tomorrow.
Radiation therapy or radiotherapy is a precise treatment which must be planned and delivered accurately and requires no room for error because radiation can be deadly if the incorrect dose and wrong parts of the body are irradiated.
A radiation oncologists job is to perform the physician function (diagnosing and approving the treatment plan) and the job of delivering the actual treatment lies with the radiation therapist who carries out the radiation oncologists’ treatment plan just like what nurses do for other medical conditions. The radiation therapist will place the patient under the treatment machine (cobalt-60 or linear accelerator) and gives the dose of radiation over a period of up to six weeks for curative treatment regimens.
Therefore, radiation oncologists or doctors need radiation therapists and vice versa.
We have local radiation therapists trained at Unitech and are on standby at Lae but my opinion is that their technical capacity needs reassessment and they need to go for more on-the-job attachments overseas to give us the assurance.
The cobalt machine at Angau cannot be used in its current state if its half-life or strength has decreased because this would amount to errors in treatment (long treatment times, patient movements, increased scattered radiation etc).
Lastly, regarding the regulations, I don’t think it is absolutely necessary for a lawyer to draft this radiation safety regulations as this can also be done by the people who work in the industry at a lower cost, as there’s so much similar regulations around we could easily modify and adopt or even adopting IAEA’s regulations.
I also don’t think that this laws and regulations should be place under NISIT (Trade & Commerce Ministry) as the custodian of these laws because NISIT currently has its own problems with accreditation so the Government should have set up a specific authority to perform these radiation safety and control responsibilities.
My concluding point here is that we would need the following minimum cadre of health workers in any radiotherapy unit to achieve the treatment outcomes desired, i.e. Radiation oncologists, radiation therapists, biomedical technicians, radiation physicists.
We would also need other staff such as nurses, dietitians, social workers and other medical staff as total cancer treatment is a multidisciplinary approach.
The question is that do we have the above staff? The much awaited radiation oncologist from India might arrive tomorrow but absolutely nothing will happen and the Government still has to pay him his salary. Do we want this to happen? For Port Moresby General Hospital Cancer Unit, they would also need the similar staffing requirements.
We can have the machines or technology such as the diagnostic machines (PETT Scan, CAT Scan, Cat Lab, diagnostic lab etc.) but we must also have the treatment machines (cobalt-60, linear accelerator, cardiac surgery lab etc.) and lastly and most importantly the human beings to operate the machines besides the doctors, in the case of radiotherapy we need people such as myself who are called “radiation therapists”.
Without radiation therapists, just as radiation oncologists, no radiation treatment.
If other people want to contact me for further discussion on this issue my email is [email protected]

Peter K Bire
Radiation Therapist