November 14, 2014

The tuberculosis (TB) prevalence in Papua New Guinea (PNG) is among the highest in the world, prompting Doctors Without Borders/Médecins Sans Frontières (MSF) to launch a response to reach the most-affected communities.

Assessing the Needs

After analyzing where the greatest needs are, MSF decided to focus on the Gulf Province. This region, which includes many remote communities with limited access to health care, is estimated to have very high rates of TB and possibly a worrisome rise in drug-resistant TB.

MSF and the local health authorities started by implementing a separate TB clinic with proper infection control and patient flows. “When MSF arrived in Kerema in mid-2014, we found that infection control in the hospital was completely out of control,” said MSF project coordinator Cyrus Paye.

The team then set to work on rehabilitating services in the Kerema general hospital with new laboratory equipment, including the GeneXpert diagnostic machine, to cut delays in TB test results from weeks to just two hours. “The objective is to improve considerably the diagnostic capacity in order to be able to start treatment very quickly,” said Benjamin Gaudin, MSF head of mission.

A new TB ward is also currently under construction. When complete it will have 18 inpatient beds, which will allow for the separation of TB patients from the rest of the hospitalized patients for better infection control.

The next phase of the activity would be to decentralize TB services—however, geographical conditions pose a formidable barrier

Access is a Challenge

The project’s progress has been significantly hampered by the poor condition of the roads. After months of rain, the dirt roads between Kerema and PNG’s capital Port Moresby have turned to deep clay mud in many areas, leading to delays in construction at the hospital.

It is also difficult to reach remote communities and health centers. While some villages could be reached by water, boat travel is not safe due to frequently treacherous conditions on the Coral Sea and the presence of large saltwater crocodiles in the rivers, along with deadly snakes in the jungle. The local community is still mourning the loss of a child killed by a 4-meter crocodile in May 2014 near Kerema.

Innovative Technology Helps to Bridge the Gap

The difficulties in accessing the remote communities outside Kerema forced the MSF team to come up with innovative solutions. Working with the US company Matternet, MSF trialed the use of small quadcopter unmanned aerial vehicles (UAVs) to transport sputum samples from patients with suspected TB from remote health centers to Kerema general hospital for testing, and will explore the possibility of transporting results and treatments back.

Currently, the UAVs are capable of traveling at up to about 40 miles per hour, with a maximum range of about 20 miles carrying a light payload in favorable conditions. However, it is predicted that their range will increase rapidly in the coming years as new lighter and longer-lasting batteries are developed. The UAVs can be launched and piloted via smartphone, so that non-technical staff can operate them without assistance.

While there is still fine-tuning of the UAV system to be done during the trial phase, initial signs indicate that this may be a useful method of connecting remote health centers to otherwise inaccessible hospitals in the future.

Setting a Benchmark for Effective TB Care

Once the Gulf Province project is running at full capacity, MSF plans to expand the program to the national capital district of Port Moresby in 2015. The goal is to support PNG’s health authorities in solidifying an effective model or models of care in Kerema that can be replicated in other areas of the country.

 “We work closely with the authorities and stay in line with the national strategy,” said Gaudin. “Our objective over five years is to create a TB program that is replicable and sustainable.”

MSF has worked in Papua New Guinea since 2009. MSF’s current projects include a Family & Sexual Violence (FSV) programme in Tari, and the National Capital District, and a TB project in the Gulf Province. Previous projects have included a FSV project in Lae, and a maternal & child health project in Bougainville.

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