More posts for doctors needed

Letters

I REFER to the news item last week in which Prime Minister Peter O’Neill informs us that Cuban doctors are coming to assist us in the health sector in PNG.
Last month, I was invited to be external examiner for the first examinations of the Timor-Leste University and national teaching hospital in Dili.
This gave me an opportunity to see once again the experience of another Pacific country which has taken many Cuban doctors into their health service over the past 15 years.
My recent visit confirmed that the problems associated with having Cuban doctors in the health system are still present.
If anything, the problems are now exacerbated because there are now trained Timor-Leste doctors who can do the job.
The presence of the Cubans in the system makes change and reaching a consensus on best management protocols for the local circumstances difficult.
In the maternity section of Dili national teaching hospital, there are four Timorese specialists (two trained in PNG at the School of Medical Health Sciences), two Cubans, a Chinese and a Nepali.
There are a total of eight obstetrician/gynaecologists (ObGyn) (women’s health) specialists.
The patient load at Dili is about 5000 births per year.
There is a low case load of gynaecology.
At Port Moresby General Hospital (PMGH), we have three times the above case load (i.e close to 14,000 women deliver in the PMGH labour ward each year).
We have a very high case load of complex gynaecology to deal with.
We have only six full-time ObGyn specialists.
At the same time, we have a perinatal mortality rate (the number of babies born dead or which die in the first week of life) that is less than half the Dili hospital rate.
In 2017, there were 36 maternal deaths in Dili and in PMGH only 15.
The conclusion is that we produce much better results with less resources.
One of the main problems in Dili is that the Cubans cannot speak any of the Timor-Leste national languages (or English), and write in the patient’s charts in Spanish (which the nurses cannot understand).
The Chinese doctor’s English is also poor, and she does not speak any Timor language.
The Cubans prefer to manage patients as they were taught to do so in Cuba (irrespective of whether the protocol they are following is appropriate for the Timor circumstances).
Similarly, the Chinese doctors tries to do it the Chinese way when she is on duty.
The local Timorese head of department does not seem to have the authority to demand that patients are managed according to the best protocols.
These are protocols that have been worked out from international evidence and adapted for the local setting.
In short, there is daily chaos: nurses are confused, young Timorese trainee doctors are confused, and of course the patients suffer and outcomes (as can only be expected under the circumstances) are poor.
We do not need any further element of chaos in our health systems in PNG.
We already struggle on a daily basis with the chaos of shortage of medicine and essential materials to do our work.
Introducing doctors who cannot speak any of the PNG national languages to our health system, and also have not been trained in the way it is best to handle problems in our setting, will only lead to worse outcomes at hospital level.
In addition, we already have sufficient PNG specialists trained in most branches of medicine and surgery.
Indeed, today there are no vacant specialist posts left in the country for paediatricians and surgeons.
By the end of this year, there will be no vacant posts lefts for obstetricians either.
What the Government needs to do is to create more paid posts for new specialist graduates who will be attaining their specialist qualifications at the end of this year.
For the rural districts of the country, there are very few paid Government positions for medical officers available.
A group of about 40 doctors will complete their intern (practical training) at the end of May this year.
There are not 40 rural vacancies for them to go to.
The Government needs to create more posts for PNG doctors to work in rural areas – not bring in Cubans to take the few posts there are available.

Prof Glen Mola

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