Papua New Guinea: Return to Neglected Bougainville

Today, a decade after a peace agreement was signed, there is only one functioning hospital for a population of around 200,000. 

After a 10-year absence, Doctors Without Borders/Médecins Sans Frontières (MSF), has returned to the Autonomous Region of Bougainville, a collection of islands off the eastern coast of Papua New Guinea, to assist in delivering much-needed health care in the remote southern region of Buin. Since April 2011, a small MSF team has been working in Buin Health Center.

Access to health care in Bougainville is extremely limited. A 10-year civil war between secessionists and the Papua New Guinea government caused the deaths and displacement of tens of thousands of people, and left the region’s infrastructure in tatters. Today, a decade after a peace agreement was signed, there is only one functioning hospital for a population of around 200,000. 

Although relatively peaceful, and despite rebuilding efforts since the end of the conflict, the southern area of Bougainville continues to be neglected and access to quality health care for the population poses substantial issues.

“If the people living in Buin need to go to a hospital, they have six hours to travel, if they are lucky,” said Patricia Convent, MSF’s head of mission. “Sometimes it can take anywhere up to 10 hours or more. The only hospital is in the north, on Buka Island, and to get there, it’s necessary to cross about 15 rivers and travel on roads which are not in good condition.”

There are 10 qualified doctors for the entire population of Bougainville, and eight of them are in Buka. People who cannot get to this area are left without adequate medical assistance. “In an area where malaria is endemic, and where maternal mortality rates are some of the highest in the Asia Pacific region, we saw that we needed to come back,” said Convent.

MSF Plans To Improve Treatment and Training Across the Board, With A Focus on Obstetrics

MSF is currently the only international non-governmental organization (NGO) based permanently in the remote southern region of Bougainville. In Buin Health Center, the MSF team is working alongside the Division of Health to rehabilitate the facility and to provide medical assistance in the outpatient, inpatient, and maternity departments, and in the laboratory.

The team is working to improve the quality of antenatal and postnatal care, and is providing clean water and better waste management to improve hygiene. Training staff across all departments will be a core component of MSF’s work in Bougainville, due to the lack of qualified medical staff in the region.

Care for pregnant women will be one of MSF’s highest priorities in Buin. In May, approximately one in four pregnant women was classified as an emergency case.

“We received one woman from a nearby village, who was having seizures during her labor,” said Convent. “She delivered a stillborn baby and stayed two days in a coma. We are so thankful that the woman survived, but without adequate intervention, she would certainly have died. Complications arising during delivery are common in this region, mainly because of the distances women have to travel to get to a clinic. For this reason, we are going to be developing a maternity waiting home so women can plan to be close to the health center before they go into labor, instead of having to travel the long distances that they normally would. In June, we had two women who delivered on their way to the health center, simply because they could not make it in time.”

Since teams began work in April, the number of patients coming to the health center has increased significantly. In May alone, the medical team saw 741 patients, compared to 1,110 patients in the first three months of the year. “We’ve been told by a lot of patients that they remember us from previous years, and they are happy to have us here working alongside the Division of Health to improve the health care situation,” Convent said.

Evaluation of Needs And Flexibility to Respond to Emergencies Will Continue

MSF plans to further evaluate the local health needs by conducting assessments throughout other areas in the southern region, and to adapt the program to meet these needs. The team will be looking at how diseases such as tuberculosis are managed in the region, and whether MSF can improve care.

MSF will also maintain the capacity to respond to medical emergencies in the region, such as disease outbreaks and natural disasters. Earlier this year, teams responded to Bougainville’s first ever cholera outbreak, which was confined to Buka Island and affected 521 people over eight weeks. MSF worked alongside the local health authorities for six weeks, setting up a 10-bed cholera treatment center and two health posts to provide rehydration salts in Lemanmanu, a 90-minute drive north of Buka town.

 MSF first began working in Bougainville in 1992. After an intervention of approximately six months, teams returned following the conflict  from 1998 until 2001. After assessments carried out in 2010 that found considerable gaps in the healthcare system, MSF made the decision to return in 2011. In May and June, teams have carried out 1,576 outpatient consultations, admitted 153 patients to the inpatient department, and delivered 48 babies.

Elsewhere in Papua New Guinea, MSF is also working In the city of Lae in Morobe Province, and Tari, in the Southern Highlands Province. Teams are providing care for the medical and psychological consequences of sexual and domestic violence, and also carry out trauma surgery.