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Fighting TB in remote Papua New Guinea

Story by Mandy Glass. Photos by David Moore & Annelie Edsmyr

”If we couldn’t see, diagnose, and bring these children back for treatment, it is likely the disease would have progressed on and may have eventually led to their deaths,” reflects Dr Rebecca Williams when realising that their initial suspicion of a TB diagnosis was correct and Mia and Masi had received surgery and were started on a treatment.

Malaumanda is a village in the border area of East Sepik Province and Enga, with around 300 people plus children living around the airstrip/station but with a few hundred more living in the catchment area of the airstrip, about 30- 120 minutes walking distance. It’s a very remote area, surrounded by very big mountains and steep valleys.

To travel out to Wewak would take about 3 days walking through the jungle, followed by 3 days on a motor canoe. There are no other villages nearby to Malaumanda within one or even two days walking distance. There’s no mobile phone coverage in the village, people hike 4 hours to a nearby mountain to catch a signal.

There’s a small aid post in the village, monitored by two village health volunteers one hour a day, Monday to Saturday. Daina and Didimus are helping the community with what they can during the week on a volunteer basis. The village gets the chance for more professional clinics and medical treatment 2-4 times a year when MAF flies a medical team from the Kompiam hospital in to do 1-3 days of clinics.

During these patrol days, Daina and Didimus help translate the local language when the doctors examine the patients; and at the same time the two receive hands on training from the doctors.

Dr Rebecca Williams, who led the patrol at the end of June, is Medical Superintendent at the Kompiam District Hospital under Enga Baptist Health Services. Joining her was Dr David Moore (from the UK, working with Ethnos360 and currently based at Kompiam) who did most of the examinations under Dr Rebecca’s supervision to get more experience in the area of rural health and medical needs.

Lucy Jack and Jessica Kandan, Community Health Workers from Kompiam, were also part of the team focussing on immunisations and health awareness for the adults.

During the clinic hours, Dr Rebecca and Dr David attended to almost 50 patients, men, women and children. Two pregnant women were checked up with ultrasound. Most cases seen were generalized fungal infection of skin, Osteoarthritis, and suspected TB cases.

Those people with the suspicion of TB were highly encouraged to find their way to Kompiam as soon as possible for further examination and testing, and consequently treatment. On the flight out, two young girls and their care giver found space on the plane. A young man, probably around 20 years, followed ten days later on a different MAF flight.

Dr Rebecca shared:

Mia and Masi, age 5 and 8, were seen by us during clinic in Malaumanda, and had a positive family history of TB (their father had been treated for pulmonary TB in Wewak some years ago). Their mother brought them in to see us as the older girl Masi had a swelling on her neck that had per- sisted for several months. On examination and with the positive family history of TB, it was highly likely that she had TB of the lymph nodes.

We then asked for her to bring in all her other children so we could screen them also. The younger sister Mia also has similar neck swellings suggestive of TB lymph nodes. Their mother was advised to bring the two girls to Kompiam so we could do a biopsy and run the samples through gene X-pert, prior to starting them on TB medications.

When we returned on the 24th June back to Kompiam, we brought these two girls along with their guardian. The next day we did a biopsy of the lymph nodes, which came back positive for TB and they commenced with TB medications immediately.

They will remain in Kompiam for 2 months of TB treatment before going back to Malaumanda where they will continue their treatment for another 4 months. If we couldn’t see, diagnose, and bring these children back for treatment, it is likely the disease would have progressed on and may have eventually led to their deaths. We also know that there must be some people in the community with active TB, as TB bacilli is only spread in people who have pulmonary TB i.e. a cough and children typically contract TB from adults rather than other children.”



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