Planning your elective - Papua New Guinea

Stephen Ford and Mark Wilson discuss the people, culture, medical problems, and contacts in Papua New Guinea

Geography and people
Papua New Guinea's variety belies its small population. Ethnically, it is a transition zone between the Pacific, Australasia, and the Indonesian archipelago. This amazing fusion produced around 800 different ethnic groups, each with their own language. The ethnic groups are known as wantok ("one talk"), and wantok forms a major part in the formation of personal and corporate identity. Geographically, the country is also highly varied, with some of the highest mountains in Asia, mighty rivers, swamps, humid coasts, and tropical islands.

The major cities of Port Moresby and Lae are unattractive and have significant crime problems. Girls should take particular care if alone. Some of the larger highland cities are also going the same way, although yearly festivals (sing-sings) are a cultural delight. Papua New Guinea is also noted for its diving, having beautiful coral and many maritime wrecks from the second world war in shallow waters.

Remarkably, Papua New Guinea is alone in Asia in being a Christian country by constitution, and Christianity permeates every aspect of national life. Eighty five per cent of the population describe themselves as Christian, church attendance is high, and Christianity plays a major part in national life.

Getting there
Electives can be arranged through the University of Papua New Guinea or local health care providers. These are often run by churches and staffed by nationals and foreign volunteers.

Visas (£7) are available from the High Commission in London. (Mine took less than a week to arrive.) Two types are available: a general tourist visa, allowing 60 days' stay, or a special elective visa of negotiable duration.

Travelling to Papua New Guinea is somewhat arduous--expect a long journey. No direct flights from London are available, though international flights to Port Moresby arrive from Manila, Singapore, and Cairns. I flew to Port Moresby via Tokyo and Cairns for £840. Internal flights from Port Moresby are necessary as no roads lead out of the city. The cost of these soon adds up, although Air Niugini offer a 25% discount for students with an internationally recognised student identity card.

Vaccinations for diptheria, tetanus, hepatitis A and B, typhoid, and Japanese encephalitis are recommended. Malarial prophylaxis (mefloquine or doxycycline) is essential, as malaria is endemic.

Health and the health care system
Although Papua New Guinea is economically a middle ranking country--in 1998 the gross domestic product was $900(£642)--on a variety of social indicators, including health, its performance is comparable to many developing countries. Communicable diseases form the bulk of the disease burden in the country, particularly in rural areas where malnutrition is widespread. Non-insulin dependent diabetes mellitus and hypertension are rapidly increasing and the nation's love of rugby and tendency to build houses on stilts keeps orthopaedics a busy specialty.

Trauma and violence are common in some areas for several reasons. The liberal use of alcohol and marijuana, the common practice of wife beating, and the culture of "payback" (where one clan will attack another in return for grievances towards them) are some causes.

Papua New Guinea provides plentiful evidence for the efficacy of low tech and public health interventions in improving health. Basic sanitation projects, such as pit toilets, have contributed to a substantial reduction in the infant mortality rate, while village based obstetric programmes have slashed maternal mortality rates.

Much health care is provided by the older churches (Lutherans, Anglicans, and Catholics mainly) and voluntary organisations. The sense of vocation and duty that Christianity induces allows the church to fill vacancies in unpopular places that the government cannot.

Village health attendants (VHAs) and village birth attendants (VBAs) provide very basic health care. VHAs are villagers trained to recognise conditions requiring referral, and taught skills, such as bandaging, and health promotion. VBAs are village women trained to supervise low risk deliveries in village settings. They can also refer patients to health centres for observation, delivery, and postnatal contraception. VBAs are remarkable because many of them are illiterate and trained using diagrams and pictures. The introduction of these posts has led to a dramatic reduction in maternal mortality. ^{1 2}

Further up the chain of referral are aid post orderlies (APOs), healthcare workers trained to deal with minor complaints and injuries, with the capacity to refer to health centres or subcentres. Aid posts exist in most villages of any size and ensure that the vast majority of the population receives at least some form of health care. Doctors and nurses staff primary health care centres, and hospitals exist in provincial capitals and major cities.

There is a medical faculty in the University of Papua New Guinea and even a Papua New Guinea Medical Journal, which is worth reading before arriving.

Stephen Ford, fourth year medical student, University of Liverpool
Email: md0u7141@liv.ac.uk

Mark Wilson is author of, The Medics Guide to Work and Electives Around the World
Email: mark@medicstravel.com


studentBMJ 2001;09:305-356 September ISSN 0966-6494

1. Biddulph J. Maternal mortality--a continuing tragedy. Papua New Guinea Medical Journal 1993; 36:1-3.
2. Edwards K. Maternal survival and village delivery. Papua New Guinea Medical Journal 1992; 35:79-83.