Sailing into uncharted waters

    THE Kula Spirit, a private boat clinic, and family planning organisation Spacim Pikinini-PNG have been conducting a medical outreach programme in parts of Milne Bay: Normanby, Esa’ala and Ferguson. They have focused on  Bomada aid post, Esa’ala health centre, Dobu aid post, Boduya health centre, Ulisalolo sub-health centre, Mapamoiwa health centre and Igwageda aid post.
    The team included Wendy Stein, St Barnabas nursing students, women’s rep Rosa Dennis and Sophie Pascoe, and their work included:
  •  Training St Barnabas nursing students and local health workers in family planning implant insertion on women.
  •  Training St Barnabas nursing students in community engagement skills and running family planning meetings.
  •  Training St Barnabas nursing students to do eye tests and provide reading glasses; and
  •  Conducting need assessments at rural health facilities and provide supplies and equipment.

    On July 31 the group visited Bomada aid post in Taulu village. The aid post services about 1600 people from nearby wards. They worked with community health worker Brigit Silowai.
    The aid post needed a host of medical supplies including antibiotics, pain relief medication, malaria treatment medication, rapid diagnostic test (RDT) kits, plasters and bandages, which they provided as required and available. The team also ran training with the CHW on the medicines provided. In addition, patients with asthma, anaemia and tinea were also treated.
    The aid post refers most deliveries to Esa’ala, but the child health worker has delivered two babies this year. While the team was in Taulu village, a mother went into labour and needed to travel to Esa’ala health centre. The Kula Spirit dispatched a dinghy and a team at 7:30am and helped the mother get to Esa’ala.
    The team ran two community sessions on family planning. Women who received implants at Esa’ala health centre were also concerned that the wrong expiry dates had been written in their medical books.
    The nursing students were also trained on how to perform eye assessments. They did 40 eye tests and provided reading glasses. The health chairman emphasised the difficulties people faced with accessing health care in the village and he asked that the outreach programme be done regularly.

    On August 1,  the team visited Esa’ala health centre. It is the main referral centre for the area. During the needs assessment, staff advised that they required malaria treatment drugs, RDT kits, antibiotics, pain relief drugs and anti-nausea medication. The centre was provided with medicines as required and available, but the lack of RDT kits and malaria treatment remains a serious problem.

    On August 4,   the team visited Ulisalolo sub-health centre and worked with the child health workers. The facility does around eight deliveries a month and staff conduct family planning clinics every Wednesday where only pills and injections are prescribed.
    The team again ran through community engagement on implants with the staff and provided each with an information booklet so they can conduct the awareness programme themselves in the villages.
    Ulisalolo has transport problems. Every time they buy a dinghy, it is stolen. Dinghies are now hired to transfer patients although having enough fuel for the trip is still a problem.
    The team had to medevac a patient who was admitted August 1 for PV bleeding, excessive vomiting, high temparature, headache, chest pain and numbness in the limbs. The staff suspected she had an ovarian cyst but were unable to diagnose her without an ultrasound. As the patient was not responding to treatment, a doctor at Alotau Provincial Hospital was consulted and the patient was medevaced to East Cape where she was then taken by ambulance to Alotau for further diagnosis and treatment.

    The Dobu aid post has been facing serious drug shortages. They needed antibiotics, malaria treatment, RDT kits, pain relief and iron tablets. As there were no RDT kits, the staff had  been treating malaria symptomatically and giving patients antibiotics, and if they didn’t respond to the antibiotics, malaria was suspected and they were  sent to Esa’ala.
    The delayed diagnosis and the likelihood mistreatment is dangerous and a  waste of medicine that is already in short supply.
    Dobu aid post performs supervisory deliveries at the rate of about three a  month.
    However, the aid post does not have a delivery bed and the staff are untrained to deal in breach deliveries. The labour ward has no lighting and births that occur at nights are difficult.
    The aid post does not have sterilisation equipment and delivery instruments are soaked in providence before use. The dispensary holds one box of misoprostol tablets for the treatment stomach or duodenal ulcers.
    The tablets expired in 2015 but continue to be used because there is nothing else there. The aid post does not have a vaccine fridge, so staff from Esa’ala are supposed to do vaccinations for new born babies after they are delivered in Dobu, which is a small island off the coast of the mainland.
    This poses a problem, as health staff from Esa ala often cannot make the nine-kilometre trip, resulting in mothers and babies being sent home without the immunisation.
    The medical team ran two community engagement sessions on family planning and provided individual advice to women seeking more information on implants.
    About 20 women on the island are on family planning injection but the aid post is running short of supply.
    The Dobu aid post received a box of medical equipment that was donated from Australia earlier in the year but the staff did not know how to use it. Members of the Kula Spirit team trained them on the use the infrared thermometer.  An aerosol delivery system was also donated but because the aid post does not have electricity it cannot be used.
    In addition, a pulse oximeter was donated by them the medical boat  team and staff trained to use it.
    The team conducted 95 eye assessments and provided reading glasses. This number included students with reading difficulties who were referred by their teachers.
    The Kula Spirit team recommended immediate follow up action. It pointed out that:

  •  All facilities require drugs and medical equipment, in particular antibiotics, pain relief, RDT kits and malaria treatment.
  •  A memorandum needs to be sent out advising all staff to write the correct date in which implants will expire. The date should be five years after the implant is inserted, not the “to be inserted by” date on the implant packet.
  •  A review of the baby bundle system needs to be undertaken to evaluate the policy on providing baby bundles to all supervised deliveries regardless of spacing or attendance to prenatal clinics.