Final day in Goroka

It was the first day back at work after the long weekend and we were making plans for the day – the hope was to get out to a Rural Community Health Post and have a meeting with the EHPHA Executive team.

My job in the morning was to get Schola’s (Infection Control Nurse) computer working so that the Access data base that had been created for her could work and we could download the driver for her printer. She has no internet connection in her basement office, I was not able to hotspot, so the plan was to take her computer up to the IT lab and connect to the only room with Ethernet connections. Arthur is in charge of IT (he was running late). There is only one line into the hospital, so all the offices are running off the same service. This was eventually done and at the end of the day I went back to get things sorted (at 6pm) – as it turns out her computer has a file corruption, so Arthur will need reinstall the whole system – I hope that this does not take longer than a week. Then scholar should be able to input data into the data base and into a spreadsheet to share Hand Hygiene audits with the Executive.

My phone was ringing and Marie and Leslie were just beginning our meeting with the Executive; Dr. Joseph Apa, CEO (anaesthetist);  Mr. Kidron Gimiseve, EO to the CEO; Dr. Kendaura (General Physician) Director of Curative Health Services; Dr Max Manape, Director of Public Health (this includes all Rural Health). The meeting was very productive and positive. There was recognition of the important role that the Highlands Foundation has had in the hospital since 2004. The organisation is very well respected and Marie is known and very highly regarded by all levels of staff.

It is a good time to have reconnected with the area. The new hospital has been built, bringing new specialist to the area; there is a new Model of Care Policy being rolled out;  and new Community Health Posts (CHP) are being built. The executive was keen for us to reengage and felt that our resources were best suited to Public/Rural Health Services. We introduced the Health Worker Kit project and the team was very receptive.

They noted that often resources provided to the hospital and health centres went missing and it was difficult to keep an inventory of items, so if Health Workers were given their own equipment they would take pride and take ownership of that equipment. It was decided that a goal would be to equip the Community Health workers and Midwives working at the CHP. When each centre is opened, the staff would be presented with a kit. The goal is to build 72 centres with 3 staff. That would be 216 packs.

We discussed the importance of incentivising staff to take ownership of their equipment and centres. Dr. Manape thought it would be great if THF could sponsor an award program for the best performing rural hospital (there are 8) and the best performing staff member in each region. The details of this are to be clarified, but this sound like a great opportunity for THF to invest in the valuable human resources in Public Health by supporting them in their practice. This year they sponsored the team from the best performing Health centre to attend a medical symposium.

If this project is successful, the plan would be to roll it out further. The idea is that this program can be a pilot for the country. The executive understand that they will need to keep records and monitor the success of the project.

We were then into the back of a land cruiser and off for a rural visit to Jafa Community Health Post (2 hours drive down the National Hwy). The country side is beautiful; green mountains, tropical temperate forest the then clear into savannah grass lands. Villages are scattered all the way along. People are selling veggies from their small plots at roadside plots. Jafa is in Kainantu District which is next to Goroka District. The houses are a little different as are the layouts of their garden plots. We slowly climbed and as we did the air became cooler. The highway is riddled with pot holes bigger than people and areas of unsealed dust roads. People are walking along the sides of the road the whole way, children returning home from school and villagers carrying their wares. It was a long and uncomfortable journey – demonstrating the challenges of getting people to general hospitals quickly.

After a bumpy journey (navigated very well by our driver Danny) along the Highway and up a final dirt track (of a few kms) we arrived at an impressive looking building perched on the crest of a hill. The centre is currently run by two Community Health Workers from the village of Jafa, George and Lizen (husband and wife).  They live on site with two of their children, whilst the older board at school in Goroka. The location was chosen to allow for access from mainly five local villages. The walk in is still an average one to two hours, cars are dime a dozen. It is then a 30 minute drive to the Kainantu District hospital or two hours to Goroka General.

The centre is large; a delivery suit, maternity ward (3 beds), emergency room, two consult rooms and an education room. It was intended to work as a mini hospital, but it is obvious that the centre is very large to be run by two community health workers. The equipment is technical and unfortunately they do not have the skills to use much of it. Marie was able to explain/turn on the resus cot. We made attempts to set up the steriliser, but they will need to have skilled staff come to the centre and support them. This is now another project for us: to make sure that the staff who work in these centres are supported and given the technical skills to use the facilities that have been provided. If we are going to support the workers with their own Health Worker Kit, it is important that they are supported by the local system to utilise the resources that are provided.

George and Lizen are on call 24/7. They tend to see most patients in the morning, maybe 20-30 a day. They run anti-natal classes on Tuesday mornings. They have found that the women who come to classes come to birth at the centre. They have birthed 9 babies – all have been strong and none have required interventions. They encourage the fathers to attend the births to support their wives. This is then followed by family planning and parenting programs. They feel that the fathers are more receptive to family planning after they see their wives birth their children. Especially the younger fathers. This approach benefits the whole community. Lizen did say that women who come from further away villages often come alone (or with another family member) for they need someone at home to look after the farm and other children.

It was a valuable experience to visit the centre. They are still waiting for the midwife to come who will also live at the centre. They will be more senior and be able to support the CHW. They need help with keeping the centre clean – louver windows are open and dust continually comes in. there are cupboards all everywhere, but everything sits on the benches. They need support with organisation, cleaning rosters, inventory etc. This centre is such a step up from the aid posts where they have worked before, so different to any building they have seen before that the processes to run such a place simply don’t exist in their lives. This has been an obvious gap in implementation of these new facilities. They are so advanced to anything before that there is culturally no experience that can prepare them to be responsible for such a place. Even simple cleaning of surfaces that we do so naturally, is not a part of their daily routine at home, because they don’t have surfaces and very few cupboards. They are great at keeping floors clean, but dusting just doesn’t exists.

On Wednesday morning we had a very quick tour of the new hospital. It is amazingly decked at – it looks like a hospital! Sturdy new hospital beds, wards that look like our hospitals (but unfortunately open cubicles, separated by curtains, so looks more like emergency), top of the line equipment. The labour ward does have 3 private delivery rooms, with 9 open beds and a theatre for performing C-sections. It is huge compared to what they have now. It was disappointing to see that many women will still not have much private space to move around through labour, but you still cannot say it is not an improvement.

The challenge now is to get the staff in and the hospital active and have systems in place to look after the space. There is still a need to purchase consumables and set up the space.

 I write this from Port Moresby – sitting overlooking the airport and The Stanley ranges drinking delicious PNG coffee.