Calling on investors.

We want to grow our clinic and medical diagnostic technologies supplies business and are looking for investors that share our passion to provide an uncompromising primary health service that adds to the bottom line by growing and establishing a chain of more affordable yet high quality primary health care and a quality Pathology service.

If you are reading this and think you may want to invest into something, an idea, a vision that can see a vast improvement in people’s lives in PNG through a private entity that contact us and let initiate a dialogue.

We are absolutely confident that we have to right formula for the type of primary healthcare service people deserve at the right cost.

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Korobosea Medical Clinic – Business Profile.

Business Address:

Sec 84, Lot 22, Doreen Place, Korobosea, NCD, Papua New Guinea Ph: 73304080, 72450527


Postal Address:

PO Box 1238, Waterfront,

Konedobu, NCD, Papua New Guinea

Contact person: Dr. Poyap J Rooney

Our logo:

The area that is now the suburb of Korobosea was an area that the traditional Motu-Koitabu land owners used to forage around for eggs of the flightless bird they called ‘Koro’. ‘Bosea’ is the word for basket, because the nest of the Koro bird resembled a basket.

South Pacific Diagnostic Technologies Ltd (SPDT Ltd) was established to venture into the diagnostic technology supply industry in PNG.  Our early market research showed that the market was held by a handful of mostly foreign owned, locally registered companies.

We felt that we could have competitive advantage through proper user need assessment and sourcing out the most appropriate available diagnostic technology in the market to suit PNG’s low resource setting without compromising quality.

Currently we have a well-established relationship with 2 major internationally reputable manufacturers of diagnostic equipment.

Alere (Now Abbot)

We have been the authorised distributor of several point of care (POC) test analyser for Alere since 2014. (See below).  We have sold several of these analyser to our PNG customers who continue to order test consumables from us. While these orders quantities have been low we are confident that we will see increase in sales in the nexts few months to years as more and more healthcare provider see that benefit of having these tests available.

NB: Alere has only recently in Novemeber 2017 been acquired by Addott diagnostics.

H3 Diagnostic and YHLO

More recently, in early 2017 we sign our second major distributorship agreement with H3 diagnostic, an Australian-based company that represents the manufacture of various analysers that have entered the market and seeing strong growth internationally (see below).

So far we have not yet sold any YHLO products however we do use their UNION Immunoanalyser at our primary healthcare facility, Korobosea Medical Clinic and Laboratory Services.  The UNION analyser has allowed us to expand our testing capabilities and because we are ordering directly from the manufacturers we are able to offer these tests at a competitive price compared to our competitors.


  1. The epoc blood analyser.

A robust hand held analyser (reader) and computer designed to give laboratory quality results for blood gas, electrolytes, creatinine, lactate and glucose (and other calculated parameters) at the point of care using compact tests card that incorporate all necessary reagents and stored at room temperature..

11 critical tests on a single card                  

pH          pO2        K+           Cl-           Lac          Hct

pCO2     Na+        Ca++      Glu         Crea

Calculated values                             

AGap     cHCO3 –                BE(ecf) cSO2      eGFR

AGapK cTCO2   BE(b)     cHgb      eGFR-a            

A1729 v2 Alere epoc Training Presentation_Page_01    

2. Triage MeterPro analyser

The Alere Triage MeterPro is utilised in thousands of healthcare facilities worldwide. With a variety of individual tests and panels, the Triage system provides rapid results at the point of care, supporting accelerated treatment decisions.

Lab Quality at POC Speed

  • Built-in Quality Controls
  • Lot-specific assay calibration
  • QC material available
  • Operator ID and QC lockouts
  • Ability to run batch testing
  • Whole blood, plasma or


These test are essential for the proper evaluation of critically ill patients presenting to emergency.  Both the epoc and the triage meterPro analysers allow doctors caring for these patients to perform these important blood test and have results ready in less than 15 minutes, which helps them make quick potential lifesaving treatment decisions.

3. The Afinion AS100 Analyzer provides valuable near patient testing for today’s busy healthcare professionals who understand the value of knowing now. The Alere Afinion Test System utilises the latest technology and provides a simple, fast and reliable method to bring more to your in-office evaluations.

  • Muliple analytes on one system – HbA1c,
  • Lipid Panel, ACR and CRP
  • 3 minute HbA1c
  • 5 minute Albumin/Creatinine Ratio (ACR)
  • Short test time provides the opportunity for

more timely treatment changes

  • Easy sample collection and operation, minimal training required
  • Reliable, laboratory-quality results






More details about the above analysers can be found on the enclosed brochures and on the Alere website on


4 The YHLO Union automated enzyme linked immunosorbent assay (ELISA).

In early 2017 we entered an agreement with H3 DIAGNOSTICS, an Australian company that represents the Chinese diagnostic manufacturing company YHLO.

South Pacific Diagnostic Technologies ltd is now the official sub distributor of YHLO diagnostic products in PNG.

The main analyser from YHLO that we are using at our pathology laboratory is the YHLO UNION Immunoanalyser.

The UNION analyser takes an old testing principle, i.e the ELISA, and puts it on an automated platform making it easier to perform ELISA testing in small to medium size laboratory. The cost per test is affordable and the analyser itself is robust and has low maintenance requirements.



5. Hemocue 201 Hb point of care analyser

Uncompromising Accuracy

Providing lab accuracy and ease of use, the HemoCue ® Hb 201+ system has become a standard in Hb point-of-care testing. Healthcare providers around the world rely on the immediate results so they can make the right decisions when they need them most — right at the point of care.

hemocue 201.jpg


6. The Innovative Difference for Faster Care

With groundbreaking technology, the HemoCue WBC DIFF makes it possible to get not only lab-accurate white blood cell counts but also five -part differentials at the point of care. In just five minutes, you have accurate counts for neutrophils,  lymphocytes, monocytes, eosinophils and basophils. Fitting seamlessly into a variety of clinical applications and even remote field clinics, the benefits are clear.

Immediate WBC DIFF counts can mean the difference between waiting and taking action at the point of care — helping you move from assessment to treatment within minutes rather than hours or days.

5 diff.jpg



5diff size.jpg

Primary Healthcare and Pathology testing services.

In 2016 we opened our small community-based primary healthcare and pathology testing facility, Korobosea Medical Clinic.   We are located short distances away from Port Moresby General Hospital, and two other major PNG Hospitals.




We offer general practice (GP) services which includes the facilitation of consultation by our our specialist associates admission to Hospital if required.  Currently Dr Rooney is seeing patients by appointments only mainly after 4pm, during weekdays and on Saturday mornings.

The fact that we order directly from manufacturers means that we can offer our tests at very competitive prices. We believe our services will create much needed competition in an otherwise small private healthcare and pathology testing market.  This can only be of benefit to the people of PNG.

Primary Healthcare services:

Specialist consultation and referral for elective cases.

We enjoy a good collegial working relationship with several hospital-based, specialist medical doctors who consult patient at the clinic and also can arrange hospital admission if required.

Occupational Health.

We believe a healthy workforce will be a productive one. We offer several health programs for organisations who have made the health of their workers a priority.  We can give seminars at business houses and even conduct health checks either onsite or at the clinic.  We believe this area of occupational health will grow when the PNG economy starts to pick up again.

 Aviation Medicine

Rooney has a post graduate diploma in aviation medicine and is awaiting appointment as a Designated Aviation Medical Examiner (DAME) by the civil aviation safety authority (CASA). Once DAME status has been given we can start marketing of services for pilots and other aviation industry personnel who require regular medical examination for the license renewal.

Chronic disease management:

Chronic diseases are medical conditions that a person will have for the rest of their lives. This group of diseases include – Diabetes, High blood pressure, high blood cholesterol, asthma, chronic obstructive airway disease, and many others.

Chronic diseases require a different approach to acute sicknesses that a patient may have for short periods of time onle.  For example in diabetes the promotion of self care and the education of patients about their own condition is very important so that they can also participate in their own care.

Many times with chronic disease a multidisciplinary approach is needed and it is important that the referral on communication between the different health professionals involved in a person’s condition is coordinated so that care is as efficiant and effective as possible.

Electronic patient medical records Papua New Guinea

Most of our records, medical, financial and inventory are on a computer network with a dedicated server and is backup on a regular basis.  The software program we use is called Patient Manager Advanced (PMA) from the European-based software publishing company called VeriKal.  We are also the authorised distributor of this and other software produced by VertiKal in PNG.

This system allows our front desk staff to schedule appointments and reminders, send messages from the software via mobile SMS or email.  This has been a very worthwhile investment as we have found it very useful.


More information can be found on here however if you purchase from us you will get a 30% discount for the very useful software.

Building and environment


The clinic itself is very comfortable with a reception and waiting room to fit 10 people comfortably.  It has a central coffee table with assorted magazines and other interesting reading material and a television. The doctors room is fully kitted for a primary healthcare setting and emergency resuscitation equipment should a patients develops an emergency after arriving.  The pathology area is located towards the back of the clinic and contains all our laboratory analysers and equipment.

Nia in lab.jpg


pris in front.jpg




Car parking and outdoor waiting areas

We have a secure car parking area to fit 3 cars and a separate emergency ambulance bay. Clients also have the option to use the outdoor waiting area should they wish. This area is furnished with seats and tables, vegetation and a small water fountain and has plenty of shade.  It has a designated smoking and chewing area.


Future plans.

We have grown steadily over the last few years and have consolidated our relationship with our suppliers, agents and our customers and clients.  We are continuously working at improving our systems and the quality of the services we provide.

We are hopeful that the next 5 years will see even more steady growth and expansion of our services.

We are passionate about what we do and have a genuine desired to see the improvement of the health status of our individual clients as well as the wider community.

We have already contributed to the training and professional development of the numerous employees we have seen pass through and we hope to formalised our training and partnership with the bigger hospitals and the University of PNG so that we can contribute more in the future to the development of the different cadre of health professional in the country.

We also plan to explore the potential of developing relationship with rural health facilities as part of our social responsibility and our desire to see the improvement in health even in rural based communities.  This is something that has always been part of our vision.  We have already started preliminary discussions with a couple of rural communities and hope to develop a working relationship soon.

We recently landed another sale of the epoc and the triage Meterpro analyser to Gerehu Hospital and see this as a major achievement as we anticipate that they will utilise these two analyser more for the benefit of their patients.

We know that these two analysers are the best and most appropriate analysers for emergency departments, intensive care units and operating theatres throughout the country and hope to see its uptake in the coming years.

Our pathology testing capabilities

HbA1c K75
Urine Albumin: creatinine ratio K75
Lipid profile K85
C- reactive protein K75
Troponin I K75
Creatinine (eGFR) K75
Electrolytes (Na+, Cl-, K+) K75
Full blood examination K75
Total PSA K75
Thyroid Function  
TSH K125
fT4 K125
Serum VitB12 K175
Serum Folate K175
Ferritin K75
Vitamin D 25-OH K75
Malaria (RDT) K25
Dengue N2 antigen (RDT) K55
Dengue IgM K55
Dengue IgG K55
Microscopy +/- gram stain K75
HIV – Ig/Ag combo (Alere) K75
Syphilis K75
HepBsAg K75
CA125 K75
CA15.3 K75
CA19.9 K75
FSH K125
hCG K125
PRL K125
AMH K225
Anti-TG-IgG K175
Anti-MPO-IgG K175
Anti-TPO-IgG K175
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A review of the diagnosis and management of peripheral neuropathy in type 2 diabetes.

The prevalence of diabetes worldwide has risen tremendously over the last few decades and parallels the rise in obesity and sedentary lifestyle that is now widespread in our modern society.

*CD Mathers and D Loncar (2006) as cited by the WHO (2017), state that ‘the number of people with diabetes worldwide has risen from 108 million in 1980 to 422 million in 2014’. Unfortunately diabetes prevalence has been rising more rapidly in middle- and low-income countries, countries that have least capacity to deal with the many problems associated with diabetes.

In Papua New Guinea (PNG) for instance, according to the International Diabetes Federation (IDF) out of the estimated 3,952,000 adults 12.9% of them are living with diabetes.  This equates to about 507,900 adults with diabetes, *IDF (2017).

This is a staggering increase from the mere 0.2% prevalence reported in very early studies in PNG. In the early 1960s, Hingston and Prince found ‘no cases of diabetes in 407 adults in the Hula district of Central Province and only 2 of the 1057 adult subjects tested in four suburban communities in Port Moresby (PNG’s Capital City) had diabetes’ *Hingston and Prince (1962) as cited by G D Ogle (2001).  .

Long term, uncontrolled diabetes leads to a number of complications that cause morbidity and early loss of lives. These complications can be divided into macrovascular and microvascular complications.

Macrovascular complications include coronary artery disease, peripheral vascular disease and cerebrovascular disease while the microvascular complications include retinopathy, diabetic kidney disease (formally termed diabetic nephropathy) and diabetic neuropathy.

There are number of factors at play in the pathogenesis of microvascular complications of diabetes.  The underlying common factor seems to be chronic hyperglycemia which leads to hyperglycemia inside various tissue cells which absorbs glucose through insulin independent mechanisms. Intracellular hyperglycemia in these tissues triggers various other pathological processes that ultimately leads to dysfunctional vascular epithelial function which further leads to the development of other pathological process, *K Vithian and S Hurel (2010).

Diabetic neuropathy are a group of microvascular complications of diabetes that affect the nerves and the following classification of diabetic neuropathy is based on a modification of the classification proposed by PK Thomas by J G Llewelyn (2003).

Classification of Diabetic Neuropathy

  • Generalised neuropathy
    • – hyperglycaemic neuropathy
    • – symmetric distal polyneuropathy with/without autonomic neuropathy
    • – acute painful sensory neuropathy variants
  • Focal and multifocal neuropathy
    • –cranial neuropathies
    • –focal limb neuropathies
    • –thoracolumbar radiculoneuropathy
    • –lumbosacral radiculoplexus neuropathy (Bruns-Garland syndrome)

This report is focused diabetic peripheral neuropathy (DPN) which is the most common type of diabetic neuropathy. The pain that can arise from DPN ‘can be one of the most distressing and debilitating of all the complications of diabetes’ AJM Boulton (2005).  Therefore for a general practitioner who cares for people with diabetes it is an important condition to be familiar with and confident in diagnosing and managing.


From an international consensus meeting attended by various professional from ‘diabetologists, neurologists, primary care physicians, podiatrists and diabetes specialist nurses’ AJM Boulton et al (1998) as cited by AJM Boulton (2005) define diabetic peripheral neuropathy as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes”

This definition highlights that in people with diabetes the patient’s clinician, before making the diagnosis DPN must exclude other causes (which we shall discuss briefly later) of signs and/or symptoms of peripheral nerve dysfunction.

DPN can be divided into acute sensory neuropathy and chronic symmetrical sensorimotor neuropathy which is the most common form of DPN, AJM Boulton (2005).

In daily clinical practice a confident diagnosis of chronic symmetrical sensorimotor neuropathy can be made by the use of one of several approaches using well-validated questionnaires and clinical examination tools.

One such approach includes the use of Michigan Neuropathic Screen Instrument (MNSI) (Fig1) coupled with quantitative neurological examinations and if required a nerve conduction study (NCS) can be done however in most cases a NCS is not essential, AJM Boulton (2005).

Another useful approach that can be easily and quickly performed in a clinical practice setting employs the use of a modified Neuropathy Disability Score (MNDS), (Fig 2.). According to E L Feldman (1994) this approach consists of firstly a clinical neurological examination followed by routine nerve conduction measurements including vibratory threshold perception, pain, and light touch which were assessed with a 128 Hz tuning fork, a pin, and a 10-g filament, respectively.


The maximum score using the MNDS is 10 while a score of 6 or above has been shown to increase the risk of insensate foot ulcerations.

According to EL Feldman et al (1996) as cited by Porte D, S S Robert, Ellenberg M and Rifkin H (1997) in the 5th Edition of Ellenberg and Rifkin’s Diabetes Mellitus (1996), some common and easily excludable causes of peripheral neuropathy other than diabetes include but not limited to:

  • VitB12 and of Folic acid deficiency
  • Hypothyroidism
  • Chronic alcoholism
  • Systemic Lupus Erythematosus (SLE)
  • Paraneoplastic syndrome (especially due to small cell carcinoma of the lung)
  • Dysproteinemias and paraproteinemias
  • Amyoloidosis
  • Gullen Barre’s Syndrome
  • Sarcoidosis
  • Heavy metals (lead, mercury, arsenic)

It is prudent to exclude these other causes of peripheral neuropathy and in general a:

Good history taking (alcohol, family history of neuropathy, drug history, etc) and a few basic blood tests such as: Vitamin B12 and folate values serum protein electrophoresis, antinuclear antibodies (ANA), extractable nuclear antigen (ENA) double stranded DNA (dsDNA) , rheumatoid factor (RF), Thyroid function test (TFT), full blood count (FBC), erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP), Urea, and electrolytes creatinine (UECs) and liver function tests (LFTs) should be enough to secure diabetes peripheral neuropathy and exclude other serious and most treatable causes, J G Llewelyn (2003).

Once the diagnosis of diabetic peripheral neuropathy is confidently made and other more sinister causes of PN ruled out the appropriate management can then be provided and treatment response be monitored using the same tools described above.

Firstly the patient needs to be educated on his or her the diagnosis and they should be advise about the various treatment options available.  They should also be advised about the need for monitoring their response to treatment and reassured that with proper treatment they will experience improvement in their symptoms.

A number of pharmacological agents have been shown to be effective in the treatment of painful DPN and the most common ones used include:

  • tricyclic agents like amitriptyline at dosages of 25 to 150 mg daily and Imipramide at dosages of 25 to 150 mg daily.
  • Selective serotonin reuptake inhibitors (SSRI) like Paroxitene at a dose of 40 mg daily and citalopram at a dose of 40mg daily.
  • Anticonvulsants like Gabapentine at dosages of 900 to 1800 mg daily, Pregabalin at dosages of 160 to 600mg daily, Lamotrigine at dosages of 200 to 400mg daily and carbamezapine up to 800mgs daily.

The anticonvulsants have the best side effect profile out of these pharmalogical agents, AJM Boulton (2005)

The two landmark studies in type 1 diabetes mellitus and type 2 diabetes mellitus, the Diabetes Control and Complications Trial (DCCT) DM, Nathan et al (1993) and the United Kingdom Prospective Diabetes Study (UKPDS) Group (1998) respectively, both demonstrated that the intensive management of blood glucose led to a huge reduction in the incidence of microvascular complications

Newer pharmacological agents that have been shown to be effective yet requiring more research especially on their side effect profile include local anaesthetic arrhythmic agents in particular mexiletine, STM Krishnan et al 2004 as cited by AJM Boulton (2005), NMDA receptor antagonist, C N Sang (2002) and the opioids analgesics tramadol ‘has been confirmed to be efficacious in a randomized, controlled trial, and a follow-up study suggests that it can be used safely for up to 6 months of sustained pain relief’ Y Harati (2002) as cited by AJM Boulton (2005).

Together with the use of the above agents the usual advise about well fitting footware and care when walking to avoid injury to the feet must be given as well as general advise about exercise and healthy living.

The involvement of other health professional as part of a multidisciplinary team is also available.  In a patient with DPN who is identified to be at an increased risk of foot ulceration should be referred to a podiatrist for specialized foot care.

In Papua New Guinea most of the pharmacological agents listed above are available but unfortunately relatively expensive and in general are not accessible to the vast majority of the estimated 507,900 adults with diabetes whom are not covered by any form of medical insurance.  Furthermore the quality of diabetes care is greatly hindered by the lack of qualified professionals with an interest in diabetes and a limited resources.  As an example as of the date of writing this report, HbA1c an indispensable test in diabetes care is still not available at Port Moresby General Hospital and at private health facilities the cost of this test is on average around K150 ($45 USD), a price that is simply out of the question for the average Papua New Guinean.  With this sort of situation one can imagine the huge burden that is suffered by people living with diabetes in PNG and calls for urgent action by the relevant authorities.


Fig 1: MNSl questionnaire. Ref: E L Feldman (1994)


Fig 2 Modified Neuropathy Disability Score (MNDS),  E L Feldman (1994)


AJM Boulton (2005), ‘Management of Diabetic Peripheral Neuropathy’, CLINICAL DIABETES • Volume 23, Number 1, 2005, available at:, accessed: 10/12/2017

CD Mathers and D Loncar, ‘Projections of global mortality and burden of disease from 2002 to 2030’, PLoS Med, 2006, 3(11):e442. Available at: , accessed: 09/12/2017

K Vithian and Steven Hurel (2010), ‘Microvascular complications: pathophysiology and management’, Clinical Medicine, 2010, Vol 10, No 5: 505–9

International Diabetes Federation (IDF) (2017), ‘IDF Western Pacific members’, available at: , accessed: 9/12/2017

G D Ogle (2001), ‘Type 2 diabetes mellitus in Papua New Guinea – an historical perspective’, PNG Med J 2001 Sep-Dec; 44(3-4):81-87, available at:, accessed: 9/12/2017

UK Prospective Diabetes Study (UKPDS) Group (1998), ‘Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)’, The Lancet, Volume 352, No. 9131, p837–853, 12 September 1998, available at: accessed: 9/12/2017

DM Nathan et al, (1993), ‘The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus’, N Engl J Med. 1993 Sep 30;329 (14):977-86, available at:, accessed: 9/12/2017

J G Llewelyn (2003), ‘THE DIABETIC NEUROPATHIES: TYPES, DIAGNOSIS AND MANAGEMENT’ J Neurol Neurosurg Psychiatry2003;74 (Suppl II):ii15–ii19, available at:, accessed: 9/12/2017

Porte D, S S Robert, Ellenberg M and Rifkin H (1997), Ellenberg & Rifkin’s Diabetes Mellitus, 5th Edn, , USA: McGraw-Hill Professional Publishing, 1997

E L Feldman (1994), ‘A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Dianetic Neuropathy’ DIABETES CARE, VOLUME 17, NUMBER 11, NOVEMBER 1994

C N Sang (2002), ‘Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: efficacy and dose-response trials’. Anesthesiology 96:1053–1061, 2002

American Diabetes Association (ADA) and American Academy of Neurology (AAN) (1988),

‘CONSENSUS STATEMENT, Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy’ DIABETES CARE, VOL. 11, NO. 7, JULY/AUGUST 1988



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The solutions to obesity, diabetes and their many associated problems can only come from ourselves!

Obesity is defined by WHO ‘as abnormal or excessive fat accumulation that presents a risk to health’ (WHO 2017). Several parameters have been proposed as means of defining, grading levels of and communicating obesity and its severity.  In this article the body mass index (BMI) will be used to define and grade obesity.  The BMI is calculated by the following relatively straight forward formula:

BMI = (Weight in kilograms) ÷ {Height (in metres)}²  (Evidence for BMI as good for now)Ref

Other anthropometric parameters used and have been shown to be as effective as BMI include, waist circumference (WC), Hip to waist (circumference) ratio.  In a large Japanese study the level of adiposity as measure by the dexa scan was use as a measure of obesity.

While there are variations in the actual quantitative definition of obesity, a field of ongoing study, ‘the BMI is a good indicator of overall adiposity’, Hu F. (2008) as quoted by Whitlock G et al (2009).  The BMI is the most widely studied parameter in terms of its correlation with ‘risk to health’ and is currently accepted and used by major international bodies involved in developing evidence based clinical practice guidelines for the management of obesity and obesity related co-morbidities.

Whitlock G et al (2009), in a large study published in Lancet, showed strong evidence that:

BMI is in itself a strong predictor of overall mortality both above and below the   apparent optimum of about 22·5–25 kg/m². The progressive excess mortality      above this range was due mainly to vascular disease and is probably largely causal.           At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is      reduced by 8–10 years (which is comparable with the effects of smoking) 

Overweight and obesity according to the World Health Organisation (W.H.O.): are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. This form of malnutrition (over nutrition) was once considered a problem only in high income countries, however today is dramatically on the rise in low- and middle-income countries, particularly in urban settings. (WHO 2017)

Like many other low to middle income countries the dramatic rise in the prevalence of obesity, seen in Port Moresby and other urban centres in PNG has been brought about by two fundamental changes in society. Firstly, the rapid shift from a traditional, more physically active lifestyle to one that is in general comparably sedentary and secondly, this change in the general level of physical activity in the population has been coupled with a parallel shift in the average diet from a traditional one that is composed of high fibre, unprocessed, low glycaemic foods to one with more processed foods, lower in fibre and higher in saturated fats (mainly animal derived fats).

Modernity and how we are developing is truly a double edged sword, a sword that may be cutting deeper in a way that is detrimental to society rather than in a way that is improving society.  The costs of dealing with obesity and its associated problems is huge, both financially and emotional to the individual, families and the country as a whole. For example the numbers of people turning up to our ill-equipped hospitals with heart attacks, strokes and as a result of acute and chronic complications of obesity and diabetes has risen and will continue to rise in parallel to the rise in obesity. There are not too many people reading this that has not had their lives affected by an obesity or diabetes related condition.  As a young country we have lost and will continue to lose many precious citizens many years before their time.

The situation is grim; there is no rosier way of putting it.  The best way to stem this disastrous trend lies firstly in accepting this grimness, and then coming to terms with the fact that the solutions can only come from us. By putting in place strategies that are simple, immediately doable at an individual and community level yet so fundamental in nature it will encourage a shift towards a much healthier lifestyle on a societal level.


  1. WHO (2017), Obesity, available at, accessed: 13/01/17


  1. Whitlock G, Lewington S, Sherlike P – Prospective Studies Collaboration (2009), ‘Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies’ Lancet, 373: 1083–96 
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Cardiovascular risk assessment prior to commencing moderate to high intensity exercise

The P.N.G government in recent times has devoted billions into the construction of huge sporting venues with the aim of promoting sports and exercise in the community.  This is commendable however in Port Moresby as is the case in all the major urban areas in PNG there is still a very limited number of affordable and family safe venues for people to participate in structured or unstructured exercise.

Exercise has always been recognised as something that is good for health.  Two major studies give overwhelming evidence that exercise is good for both the prevention of diabetes and the optimising of blood glucose levels in people with diabetes.

In the Finnish diabetes prevention study  Jaana Lindström et al (2003) showed that people who participated in an intensive lifestyle intervention program involving exercise and diet show significantly better outcomes in terms of anthropometric measures (body mass index, waist circumference and central abdominal obesity), diabetes incidence and also in the biochemical parameters like blood glucose and lipids level.

The US diabetes prevention program (DPP) also showed similar benefits of exercise, National Institute of health (2008):

The DPP’s results indicate that millions of high-risk people can delay or avoid                         developing type 2 diabetes by losing weight through regular physical activity and                   a diet low in fat and calories. Weight loss and physical activity lower the risk of                       diabetes by improving the body’s ability to use insulin and process glucose.

For someone wishing to embark on an exercise program that is more intense then say brisk walking it is recommended they they undergo a health check by a suitably qualified health care practitioner.  This assessment is important to identify any pre-existing condition that may cause harm or at worse be fatal if they are not identified and appropriate precautions taken.

Mitigating the risk of heart attacks.

One issue that is of particular concern and should be assessed in high risk individuals is the risk of having a heart attack during moderate to high intensity exercise.

Heart attacks are caused by the narrowing and eventual blocking of the coronary arteries, the arteries that supply oxygen and nutrients to the heart muscle. Major risk factors for this narrowing and blockage include: cigarette smoking, high blood pressure, diabetes and high cholesterol.  These risk factors are termed modifiable risk factors because they can be modified in order to reduce their contribution to the overall risk.  Exercise along with a healthy diet and when indicated specific medication has been shown to be effective in reducing these modifiable risk factors.

A number of very well validated cardiovascular risk calculator tools have been developed that can allow the determination of an individual’s risk of developing a heart attack over the next 10 years.  By plugging in the individual’s value for blood pressure, total and HDL cholesterol, their sex and whether or not they have diabetes or whether or not they smoke, a percentage risk of developing a heart attack in the next 10 years can be determined.

An example of this is the Australian absolute cardiovascular disease calculator that can be found here

The individual may already have a pre-existing narrowed coronary artery the extent of which determine the symptoms and risk of having a heart attack.  If a pre-existing narrowing of coronary artery is left undetected (through an appropriate health assessment) and that person commences a medium to high intensity exercise program it may precipitate a heart attack.

One way of determining whether a person has narrowing of their coronary arteries is by doing an exercise stress test.  An exercise stress test involves connecting a patient to an electrocardiogram (ECG) while they perform some physical exercise of progressively increasing intensity either on a treadmill or an exercise bike.  The patients is monitored for signs and symptoms of cardiac ischemia (low oxygen delivery to the heart) and changes in the ECG that suggest ischemia.  If the person shows changes in his or her ECG during the test they have narrowing of their coronary arteries and it is recommended for them to undergo further more invasive test to assess the severity of this narrowing.

The exercise stress test does not need to be done on every person who wishes to commence an exercise program, this would be too costly and subject people to unnecessary testing.

The American Diabetes Association recommends that an individual should have an exercise stress test to identify an underlying coronary artery occlusion if their 10 year cardiovascular risk is greater or equal to 10% or 1% per year using the

In Papua New Guinea even this relatively simple test,  (the ECG stress test) is not readily available and therefore in a patient who has a 10 year cardiovascular risk of equal to or greater than 10% I will always suggest light to moderate exercise, like regular  brisk walking, until they undergo an exercise stress test after which they can undertake exercise of higher intensity if the stress test turns out negative

To the best of my knowledge only the Port Moresby General Hospital and the Pacific International Hospital are the only two health facilities that do exercise stress testing.

My recommendation would be for every adult (especially those living in urban areas) to have a cardiovascular risk assessment every 1 to 2 years and if indicated from this initial assessment they should undergo a stress test.



  1. National Institute of health (2008), ‘Diabetes Prevention Program (DPP)’ available at, accessed 16/02/2017.
  2. Jaana Lindström et al (2003), ‘The Finnish Diabetes Prevention Study (DPS) Lifestyle intervention and 3-year results on diet and physical activity’ DIABETES CARE, VOLUME 26, NUMBER 12, DECEMBER 2003.
  3. Sheri R. Colberg (2010), ‘Exercise and Type 2 Diabetes – The American College of Sports Medicine and the American Diabetes Association: joint position statement’ Diabetes Care 2010 Dec; 33(12): e147-e167


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Recently I found a word to described feelings of tension that I get all the time and that word is cognitive dissonance!

While sitting there contemplating the meaning of this old psychology term (newly discovered by me), I decided to stand up! and scribble one of my thoughts on the whiteboard in the hope that at least some of my thoughts, through my words may at least follow and reach the PNG Prime Minister, Hon. Peter O’neil and his delegates to Cuba.

And since I am not yet super-organised administratively I decided to cut this corner short and upload the pic…


Thoughts from PNG to Cuba 22nd November 16


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A journey of a thousand mile begins with a single step – what is the immediate things the Government of PNG (GoPNG) should do about diabetes?

In countries with more developed economies the generally accepted wisdom is that it is more cost beneficial overall to invest resources (MONEY) into preventing or at least delaying the long term complications of diabetes rather than facing the huge costs of treating people who will eventually develop (earlier than if they were properly managed through well known and validated treatment) the long-term devastating complications of .diabetes which includes:
• Adult blindness
• Early heart attacks
• Strokes
• Chronic kidney disease
• Leg amputations and
• Nerve problems

According to the very large study recently published in the Lancet journal, NCD Risk Factor Collaboration (2016)

The burden of diabetes, both in terms of prevalence and number of adults affected,                has increased faster in low-income and middle-income countries than in high-                      income countries.

Diabetes has increased most dramatically in Pacific island nations and in the Middle              East and North Africa region, which now have the highest diabetes levels in the                      world. In Polynesia and Micronesia, where prevalence is highest, more than one in                five adults have diabetes. In Nauru and American Samoa, the number is nearly one                in every three men and women. NCD Risk Factor Collaboration (2016).

One of the principle investigator in this study, Professor Majid Ezzati and as cited by Wighton K (2016) stated that “…the data (from the study) reveals that the disease has reached levels that can bankrupt some countries’ health systems”.

These findings should be extremely concerning to all Papua New Guineans.

The smaller island nations mentioned above have small populations and therefore are able to collect, collate and have these data available for planning purposes. For us in PNG, to the best of my knowledge, we do not have a national database for diabetes and my guess is that any figures that is out there in the international diabetes literature is a gross underestimation of what the real situation is.

Despite these alarming numbers and our knowledge of them, it seems to me that there is a total lack of enthusiasm from the PNG Government to allocate the appropriate level of funding to develop the type of infrastructure and expertise that will be required to curb this tsunami of diabetes and lifestyle illness that can, if we ignore it, in affect severely pull us back as a nation. Undermining whatever gains we may have achieved in our short history
The country’s largest tertiary hospital, Port Moresby General Hospital (PMGH) which also serves as the teaching hospital for the University of Papua New Guinea has perhaps the busiest diabetes clinic in the country. This clinic runs every Tuesday and is led by Dr. Loyde Ipai.

Despite being severely under-resourced, Dr. Ipai and his team and doing the best with what they have and have managed to at least keep the clinic going till now. BUT THEY NEED MORE GOVERNMENT SUPPORT

The 1st Step

As an immediate measure our government must move as swiftly as possible to ensure that the PMGH diabetes clinic is well equipped, both with the appropriate point of care diagnostic and diabetes monitoring equipment and also invest into increasing the number of personnel with appropriate expertise. So apart from doctors specialising in or with a special interest in diabetes we also need more diabetes educators, podiatrists (health professionals who take care of feet), optometrists, counselors, dieticians and others who will form a chronic health care team that has the patient in the centre.

The idea would be to create a PNG Diabetes Centre of Clinical Excellence at PMGH which can also serve to provide training to people from other centres throughout PNG so that similar sites can begin to proliferate throughout the country.

While the benefits of having such a centre established would be immense and immediately visible and measurable, it must be appreciated by people and organisations who may want to be a part of such development that this is not a straight forward job and as much as possible the drivers of such a concept must aim to integrate into and synergise with the existing health facilities and medical education institutions.

The details of how this “Diabetes Centre of Clinical Excellence” may look like and operate is out of the scope of this article but my hope is that this important 1st step is taken.
How ready and willing is the GoPNG to take this first step?

From my perspective, as a strong advocate for improvement of diabetes care in PNG if I were asked to assess the government’s readiness to make changes to improve the provision of care to our diabetic patients I would say we are at a “pre-contemplative” stage, i.e the GoPNG is not even contemplating making any real investments into curbing this big problem. My fear is that the level of devastation caused by the long term complications of diabetes in the general population will reach tragic proportions at before the government start contemplating making investments as a reactionary approach. I hope my pessimism is wrong.


1) NCD Risk Factor Collaboration (2016), “Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4•4 million participants”, Lancet; 387: 1513–30

2) Wighton K (2016) , Imperial College London, available at, accessed on 22/11/2016

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