Ideally, in a hospital setting, a health worker looking after a critically ill patients is always part of a “team“. The size of this team and it’s sophistication will depend on the hospital size/level and the resources available. At Port Moresby General Hospital the team may consist of Medical students, RMOs, registrar, specialist consultants, nurses. In a hospital in Australia, the team will be bigger, with many other specialist, allied health worker and social workers, etc. looking after the patients. The clinical management of each patient is discussed within a team and across teams in order to provide what is regarded the best treatment for the patients. Unfortunately many hospitals, health centre and aid posts are severely understaffed and resources and some are closed.
Private GPs in urban areas also work in small team and often find themselves operating as a one-person team.
Many PNG health workers, working outside the hospital setting frequently face situations where they are the only ones making critical decisions about the clinical management of seriously ill patients. In addition to this professional isolation there are limited resources: pathology, radio-imaging, therapeutics and transportation.
In these situations, having clear clinical management protocols can assist health worker immensly in dealing with the tough situations they face. These protocal must be easy to understand and follow, they must be evidence based
with as much local input as possible. This will encourage local research. These standard treatment protocal must provide options to the health worker about what course to take in a given clinical as well as the environment and level of health care facility and available resource.
Every PNG health worker knows about the Paediatric Standard treatment book “The Blue Book”
and the Obstetrics and Gynaecology Standard treatment book “The Red Book”.
The availability of these two pocket handbooks have, in my opinion saved thousands of life and are warm glowing light houses of hope in an otherwise rough, uncertain, scarry sea of clinical medicine in PNG.
From my experience working as a GP in Port Moresby, having these books on my desk, gives much professional comfort when an ill child or woman presents. They are like a readily available collegue to seek a second opinion from, or a drug dosage or fluid regime. In the abscence of that “team” they are a very worthy substitue, and give a certain sense of certainty in my clinical management of patients.
I believe there is also an official PNG Standards treatment book for adult medicine “The Green Book”. I have not seen this book for a while, and to my understanding it has not been updated for many years. This Green book needs to be updated with updated clinical management of common and important cases in Adult Medicine, like Acute Coronary Syndromes, Severe malaria and other infectious diseases, diabetes and other endocrine diseases and various others. I cannot emphesis enough the importance of these Standard treatment handbooks for the “standardisation” of our treatment.