PHOTO Jo Chandler writes: "What we found in Daru Hospital were conditions beyond the worst I had seen in hospitals in Kinshasa, hitherto my baseline for as-bad-as-it-gets."
While largely curable, tuberculosis is caused by the most infectious bacteria in human history and now ranks alongside the human immunodeficiency virus as a leading cause of death worldwide. This World Tuberculosis Day, award-winning journalist Jo Chandler recounts her investigation into the small Papua New Guinean Island of Daru, where she witnessed an outbreak of epidemic proportions.
In June 2011, ABC Radio carried a story about a man from Western Province in Papua New Guinea (PNG) who had put his sick 14-year-old daughter in a dinghy and paddled her the short distance between one of the worst health systems in the world and one of the best.
After arriving on an Australian island in Torres Strait, the girl was airlifted to Cairns Base Hospital where she died of tuberculosis (TB). The father was diagnosed with the same disease and treated. He was then told that he would have to take his daughter’s body back to PNG in his dinghy. A public appeal by Queensland MP Warren Entsch raised enough money to fly them both home with some dignity.
The report was sparse, but its desperate undercurrent stuck with me. I was then a reporter for The Age in Melbourne. An occasional foreign correspondent, I had a reasonable understanding of TB and its powerful resurgence as a consequence of the HIV and AIDS epidemic in Africa. I had visited TB wards and HIV clinics in Mozambique, Democratic Republic of Congo and Malawi. People living with HIV are around 30 times as likely as others to develop tuberculosis.
What was the story in PNG? Research soon revealed that specialists in PNG and Australia were deeply concerned about what they feared had the makings of an epidemic. Curiously, it appeared to be largely unhooked from the HIV epidemic. Co-infection rates were – certainly compared to sub-Saharan Africa – comparatively low.
Daru, just off the PNG coast and close to Australian waters, was by all accounts the epicentre of this outbreak. So I added Daru to my itinerary for a forthcoming field research trip for The Age.
What we found in Daru Hospital in August 2011 were conditions beyond the worst I had seen in hospitals in Kinshasa, hitherto my baseline for as-bad-as-it-gets. The broken-down hospital was overflowing with patients. They spilled from the beds onto the floors, into corridors, outside on the wide verandahs, under the mango trees.
Vital equipment was broken, drug supplies had run out, infection control was non-existent. There were no doctors on the wards and nurses were stretched beyond their limits. It later emerged that several contracted TB during this period.
“Each morning, the sick are turned too quickly out of 90 beds to accommodate the next wave,” I reported in The Age. Many came from the town settlements where thousands pour in from villages along the Fly River delta to get access to health, education and other services, or because drought, seawater inundations or the tailings from the Ok Tedi mine upstream have wiped out their crops. The patients included two little girls with TB meningitis, the infection having damaged their brains. Felina was seven months old, and her young parents kept vigil with a Bible and prayers. Next to her was Christina, six years old but weighing just eight kilograms. Her mother washed her in a shallow plastic dish on the floor. Christina's eyes were wide and vacant. The infection had profoundly damaged her brain. Christina did not survive.
In the settlements, where it is not unusual to find shanty houses with more than 30 residents, I saw what happens when children disabled by TB survive. I met Soba, a mother cradling her four-year-old son, Sawai. He had a beautiful smile but withered legs he couldn’t use. He was too big to carry, but Soba had no choice but to haul him over the mudflats as she went about her business of getting food, water and firewood for her family.
In November 2012 I passed through Daru again and found that while conditions in the hospital had improved, thanks to investment by the Australian Government, the dimensions of the TB situation were growing.
GeneXpert machines, a relatively new tool which can quickly diagnose strains of TB, had revealed that instances of drug-resistant TB were, in the words of the head of WHO’s PNG chief at the time, “off the charts” in Western Province and neighbouring Gulf Province. By November 2015, an international meeting convened by the PNG Government and WHO officials in Port Moresby appealed for an urgent response, describing the cost of inaction as “catastrophic”. Still, not much happened.
In April 2016 I returned to Daru, reporting for ABC Radio National. There were still nowhere near enough beds, healthcare staff or outreach programs to meet the needs of diagnosed patients, let alone discover those people incubating and unwittingly spreading disease. Doctors told of cases where children were living in households with parents diagnosed with TB, including drug-resistant strains, but those children had not been tested or treated because of a lack of resources. It was almost inevitable that they would contract the disease.
The failures were many and complex: a weak, overburdened and poorly resourced health system; a free-falling national economy; complex local and regional politics; lumbering international health bureaucracies. And at the bottom of it all, growing communities of closely packed, poorly nourished people – the very conditions in which Mycobacterium tuberculosis thrives.
I’ve reflected on the story of Daru over the years because it highlights the casualties of TB, and testifies to the complexities of the disease. This is not merely a health issue. It is a combination of social, political, economic, commercial and diplomatic factors, all of them conspiring to give this wily bacteria its enduring, diabolical power.
Finally, I must declare a personal interest. At some point during that first visit to Daru in 2011, maybe in the hospital, maybe visiting the close communities of the settlements, I breathed in a drug-resistant strain of Mycobacterium tuberculosis.
I had the luck to be born into one of the world’s best health systems and received treatment over an 18-month period, worth more than $200,000. This report is dedicated to the millions of people who share my diagnosis every year, but not my privilege.
This is an extract from ChildFund Australia’s report Tuberculosis: The cruel scourge for children in Papua New Guinea, authored by Jo Chandler.
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