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Women dying in filthy, overcrowded and understaffed hospitals
Sydney Morning Herald - September 7, 2009
Even PNG's Health Minister says its system is 'bloody useless', reports Jo Chandler.
The stream of blood running down the concrete path to the maternity wing of Papua New Guinea's main referral and teaching hospital tells the story.
It is easy to imagine the urgent response that would await a pregnant, hemorrhaging woman arriving in any Australian hospital. Harder to envisage the reality greeting this unknown woman, just a couple of hours' flight away, in PNG.
Pushing through the doors of the Port Moresby General Hospital, she takes her chances in the overcrowded, understaffed, dilapidated women's wing. But the 12,000 pregnant women who find their way here each year are among the luckiest in the country.
The floors are crowded with women waiting and babies because there are not enough beds. They sometimes deliver on the floor because of a lack of staff and beds. The vinyl mattresses where they labour are worn through, soiled foam bursting through the cracks. The toilet is a bucket by the bed. But at least they have access to doctors and midwives – albeit in chronically short supply – and lifesaving drugs. Many more of their sisters labour unaided at home. Of PNG's 200,000 births a year – and the figure is rising dramatically – 120,000 are unsupervised.
"Those 120,000 are taking their chances in a dirty house, on a dirt floor, with no skilled attendants, no equipment, no capacity to get somewhere if something bad happens. And they die," said Dr Glen Mola, professor of obstetrics and gynaecology at Port Moresby General Hospital.
The consequences are starkly laid out in the latest national figures analysing the country's maternal death rate, which doubled in the decade to 2006 – rising to 733 per 100,000 live births. The equivalent figure in Australia is about eight, unless you are indigenous; then it is 21.5.
Most of these women bleed to death or die from infections after delivery. Most of them were considered low-risk pregnancies.
At Port Moresby Hospital, overworked midwives and doctors ensure most women and babies survive. But it is a constant struggle – always more patients, but no more staff.
The deaths of mothers tell a story of an even broader tragedy, Dr Mola said. "Maternal mortality is the most sensitive indicator of the functionality of the total health-care system. And the care system outside the towns and provincial centres has virtually collapsed."
The PNG Health Minister, Sasa Zibe, was equally succinct in a recent summary of the crisis, describing the system as "bloody useless", and vowing to rebuild it from the floor up.
The man charged with restructuring the system, Health Department secretary Dr Clement Malau, said PNG's fragile systems are deteriorating for a range of reasons. A collision of culture, ethnic complexity, rapid modernisation, governance and geography have all contributed to the crisis, he said. "We are a people in transition" from the traditional to the modern.
Dr Mola, who has lived and practised in PNG his whole life, has strong views on what has gone wrong in the health system and what it might take to fix it. He attributes much of the blame to a shift to decentralised management of government departments in the mid-1990s. Areas such as health and agriculture, requiring specialist knowledge, suffered badly when they were put into the hands of political appointees without "the slightest interest or any expertise in managing a health service".
A critical shortage in midwives is also a key factor. Since nursing education moved into universities in 2000, not a single graduate has emerged with the skills to gain registration as a midwife. Meanwhile, the previous generation is retiring.
The system was further weakened by cultural factors. The lack of status of women. The power of clan loyalties, which keeps people in jobs even when they consistently fail to show up. Then comes the weight of population growth.
In the same 10 years that maternal deaths have doubled, Australia has poured more than $476 million into the PNG health system. Some of it has helped, but "hundreds of millions are being wasted – I've watched it over 30 years," Dr Mola said.
His criticisms echo a report released last month by AusAID tracking the effectiveness of development in the Pacific. It concluded that the region is seriously off track in achieving critical targets on hunger, poverty, health, education, shelter and security by 2015. The report argued for a new development framework to prioritise and co-ordinate programs.
Dr Molan said it was easy to forget there are many people doing amazing things within the fractured system – holding things together through sheer force of will and personality. "But it's very disappointing," he said, to consider that with centralised, expert management, all those AusAID millions could have built one of the best health services in the developing world.
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