PNG: Building up TB care in Gulf Province

Quick Summary

• MSF has been treating tuberculosis in Gulf province, Papua New Guinea, since 2014.
• Australian field worker Jeff Fischer oversaw the construction of a new medical unit in the town of Malalaua, east of Kerema, building a structure with an infection-controlled environment and more space to treat patients.
• The project allowed MSF to establish good relationships with tradesmen and labourers in the local community.

MSF runs its tuberculosis (TB) program in two locations in Papua New Guinea (PNG) – one in Port Moresby with outreach activities to surrounding districts, and one in Kerema, Gulf province, which is 260 km west of Port Moresby. Outreach activities from Kerema are very difficult due to the remoteness of villages, challenging terrain and limited transport options to these villages. There are no roads to the more isolated locations and the MSF boat enables access to a couple of outreach centres along the coast. Local 'treatment supporters' support MSF activities by following the wellbeing of patients living close to their house.

Follow-up of patients receiving treatment is critical and one of the main concerns of the medical team. Treatment for a patient with TB involves a medication course of at least six months, and once started the patient must complete the full course – otherwise drug-sensitive patients risk becoming drug-resistant, requiring a longer treatment of more expensive medication. While patients defaulting on their treatment is a huge problem for our teams, we are working hard to increase treatment adherence. Having decentralised care helps bring treatment closer to our patients.

MSF has invested many resources in infrastructure in Kerema: a pharmacy, logistics store, fuel store and a 10-bedroom international staff guest house were built in 2015. Back then, the medical team still operated in a small hut and tent which had been placed in a hurry to at least improve the medical conditions temporarily. Later that year, I managed the construction of an 18-bed inpatient department to provide better care for drug-resistant TB and extensively drug-resistant TB patients.

I then returned to PNG as a construction manager in Kerema in 2017 for a nine-month assignment. I was responsible for the implementation of construction projects which included a 70m2 extension to the international staff guest house and two six-bedroom houses for the Papuan staff, with the aim of providing extra accommodation to support the settlement of staff, as it is difficult to source experienced staff to treat TB in this region. I also oversaw the construction of a 124m2 basic medical unit in Malalaua (a small town 65km east of Kerema). The purpose of this new medical unit was to create an adequate infection-controlled environment for the medical team, as well as provide more space for patients than the previous structure.

The construction of the medical unit was put out to tender, but the quotes were very high, so after a lot of research we decided to buy a 'kit house' designed to meet MSF standards. I employed local tradesmen and labourers and supervised the construction myself.

This turned out to be a very satisfying project: the unit was constructed on time, to a high standard, and good relationships were established with the local community. The local tradesmen learned new skills and techniques and of course, benefited from their wages. I lived in a dormitory with some of my construction team five days a week and returned to the Kerema international staff house for weekends. It was a great opportunity for cultural exchange and to make friends.

The Kerema guest house extension was designed and built by MSF. I employed four tradesmen from Kerema and I supervised the work. The two six-bedroom houses were contracted to a registered building company and only required my daily inspections.

The lengthy time it took to order and receive the supply of materials, hardware and tools for these jobs was a challenge. This was partially solved by ensuring we did thorough forward planning for what was required, including purchasing and supply schedules. We also needed to ensure stringent security protocols were established and followed.

Building major additions to MSF's health facilities and accommodation was very satisfying, but the bonus was the friendships I made with many of the local people. My time in Kerema was an extremely rewarding experience.

Four years ago, TB became the joint lead as the world’s deadliest infectious disease – neck and neck with HIV/AIDS. In PNG, the epidemic is such that the government has declared a state of emergency in several provinces. With an estimated 30,000 new cases in 2016, expanding and improving TB care in PNG is an uphill battle.MSF is providing TB diagnosis and treatment in two of these provinces: Gulf province and National Capital district, in conjunction with the Ministry of Health.