Goilala: Paradise lost to TB

SUSAN MERRELL
PAUL, originally from the remote Goilala district in the Central Province, is pursuing a promising career in finance in PNG’s capital. He’s reaping the rewards of his considerable scholastic achievements both in second¬ary and tertiary institutions, where he shone.
“He was a brilliant stu¬dent,” explained Father Brian Cahill, head of the Catholic Diocese of Bereina that runs the school in Tapini, the main town.
For Paul, the future should be bright – but there’s a pos¬sible dark shadow – not over his head but on his lungs. If found to be lurking there, it has the potential to stop one of PNG’s best and brightest in his tracks. It already has once.
Seven years ago, when Paul was still in high school, he contracted tuberculosis (TB). Sent home with two months supply of drugs, he was told to return when they ran out for the next two months sup¬ply – TB needs six months of drug therapy.
Paul reacted positively to the drugs and soon he returned to school. Although he found taking 11 pills a day (his daily dose) cumbersome, he did this diligently until they ran out.
But after two months, feel¬ing better and fed up with swallowing so many pills, he didn’t return for further treatment. He became a ‘de¬faulter’.
Defaulters run the risk of having the disease lying dor¬mant in their bodies’ maybe to recur at a later date.
Defaulting is responsible for the disease becoming resistant to drug therapy and becoming the Multi-Drug-Resistant Tu¬berculosis (MDRTB) strain.
When TB becomes resistant to drugs, being highly infec¬tious, it has the potential to cause a global pandemic that world health organisations fear.
If anyone had cared to moni¬tor Paul’s progress things may have been different. They didn’t.
Paul was too young to shoulder the responsibility of this disease alone.
To Goilala
People from the remote Goilala district in the Central Province have a fearsome reputation in PNG. Many Papua New Guineans have never travelled there and many would be reluctant to do so.
So when the Goilala Federa¬tion Inc. through their Presi¬dent Thomas Eme, invited me to visit Tapini, on hearing of my upcoming fellowship to the International Lung Con¬ference in Kuala Lumpur, it was probably just as well that I was ignorant of the accepted wisdom.
If I had succumbed to popular mythology, I may have missed out on visiting a breathtakingly beautiful part of PNG and never had the pleasure of meeting the warm, kind-hearted people of Goilala. From personal expe¬rience, I can’t imagine from where Goilalans get such a reputation for ferocity.
The mostly dirt road that we travelled is steep and treacherous. Our packed-to-the-gunnels, four-wheel drive rarely making it out of second gear – many avalanches needed clearing before we’d reach Tapini
“You’re going to see some sights today,” said Goilalan, Leontine Javia, Health secre¬tary of the Catholic Diocese of Bereina, as we left Port Moresby.
And I did.
The scenery’s so mesmeris¬ing that it holds your gaze even as you try to avert your eyes from the terror of being perched on the edge of a precipice – where we often found ourselves
That this beautiful, remote, majestic district could harbour anything sinister beggars be¬lief – but it does. Tuberculosis is decimating the population.
The Devil within
In Tapini, in the early hours of the morning, they queued for their TB treatment. There were more than a dozen pa-tients: that’s a long queue for a small town.
Kope, two months old, snug in his bilum, surveyed a world that was still new to him. This beautiful baby boy with eyes so big that you could melt into them had, in his short life, only known suf¬fering. He has TB too. His mother died of it.
This highly infectious dis¬ease, when working in tandem with the high incidence of HIV/AIDS that is also preva¬lent in Goilala, is particularly lethal:
“They contract HIV/AIDS,” said Father Brian, “but it is TB that kills them.”
Poor nutrition further exac¬erbates the local susceptibility to the disease – sources of protein are few.
In a district of just a few thousand people, the medi¬cal centre atTapini has on its books an average of 40 new cases of tuberculosis a year and further cases (up to 13 in recent years) of retreatment through previous default orreoccurrence.
If those statistics are fright¬ening, they’re just the tip of the iceberg due to the fact that, of the 15 government aid posts in the district, none are operational – all closed down. Many were treating TB patients who have now defaulted increasing the likeli¬hood of the MDRTB strain’s occurrence.
Now, in the remote vil¬lages people die quietly and anonymously when unable to travel, often long distances, to Tapini.
The PNG government’s re¬sponse is to keep on the gov¬ernment payroll ‘Managers’ in Port Moresby who draw salaries for overseeing aid posts that are closed: To look like they’re doing something rather than actually doing it.
Government administra¬tion offices in Tapini are also unmanned.LeontineJavia says that the health services of Tapini have not received “one toea” of DSIP funds in her living memory. It is why the Catholic Church has stepped into the breach and now run 85% the medical facilities in the district. “We just couldn’t sit back and watch people die,” said Father Brian.
But die they do – the facili¬ties at Tapini often run out of drugs and are operating with no diagnostic equipment – relying on observation and more than a little faith.
Abraham, the “small bro” of Goilala Foundation’s, Anthony Morant, was in grade seven at Tapini High school when he lost his life to the disease earlier this year. Abraham had been dux of his community school – what a tragic waste?
Yet, in spite of his grief, or maybe because of it, Anthony moved heaven and earth to facilitate my visit. Goilala hasn’t given up on itself even if the government has given up on Goilala.
Many harbour high hopes that the new district MP Daniel Mona will prove to be different to his predecessors – some are more sceptical.
Father Brian happily posed with the new MP and his PNG Party leader Belden Namah for the obligatory photographs when the two helicoptered into Tapini recently.
“I listened, but I’ve heard it all before,” he told me…and he has, over a 14 year period.
“PNG Party. Party for change,” is the slogan of the party to which the new MP belongs.” That’s good, because the governmental ne¬glect of Goilala needs change: aid posts need reopening, the clinic in Tapini is in dire need of diagnostic equipment and that’s just for starters. But…
…back to Paul
Paul has ambitions to go to Australia to do a post-gradu¬ate degree – there’s no doubt he’d qualify academically but on the immigration form to enter Australia are two ques¬tions: Do you have a criminal record? And Do you have tuberculosis?
To the second question Paul’s honest answer would currently have to be “I don’t know.”
Paul is in the throes of re-diagnosis – to date all seems well.
PNG needs the next genera¬tion of young men like Paul – it needed Abraham -TB has taken enough of them.