Uritai Village, Kerema District, Gulf Province
The following abstract is from an article written by professor C W Watson, Bandungat School of Business and Management, Bandung Institute of Technology (ITB), and emeritus professor at School of Anthropology and Conservation, University of Kent, UK.
(When Prof. Jim Yong-kim was recently appointed head of the World Bank, several eyebrows were raised: Why was this man, Obama’s candidate for the job, chosen? He had no qualifications in economics or finance. His PhD is in social anthropology and he is a medical doctor.
How could he possibly be qualified for the job? One answer that was quickly forthcoming from Gillian Tett, a managing editor of the Financial Times, was that Kim “has tried to blend the seemingly opposed worlds of science and social science. His development work, for example, examined tuberculosis and Aids, both through the prism of germs and biology, but also the cultural and economic interactions of the poor. This type of research is called medical anthropology.” (Tett, Financial Times 31 March p. 6)
The point that she — and US President Barack Obama — are making is that however much money is poured into development and however sophisticated your mathematical models are, unless that development is grounded in a real understanding of the circumstances of the everyday lives of the poor then development policy will have very little chance of success. To devise appropriate policies with a chance of success before you commence you must know a lot about “the cultural and economic interactions of the poor”.
The word “poor” here is used with a Western – Free market democracy perspective, where one’s value is based on materialist possessions. When one looks closely at the lives in a traditional village setting this definition of “poor” can easily be debunked.
In a way our small team are amateur medical anthropologists and though we are far from knowing the full story and the solutions to what is an inherently a complex situation, we did at least make it to our destination of interest.
We hopped on the PMV and felt the pain on our back-sides, we have crossed the rivers, and swamplands to arrive here to see and hear for ourselves first-hand the state of the one of many similarly debilitated Health Centres in the country – The Kukipi Health Centre, Kerema District, Gulf Province.
Having undertaken this journey we now have a more intimate understanding of what is required in terms of appropriate infrastructure, facilities and services and we can make an authentic and more meaningful contribution to discussions and work that is required to be undertaken to improve the situation and ultimately the quality of life of the local (not necessarily poor) people of this area.
FIG: Showing the Hiritano Highway, Kukipi Health Centre, Malalaua Station and Kerema town.
In the making of health policies and implementing them it is critical that the voices of people like the officer in charge (OIC) of The Kukipi Health Centre (KHC), Health Extension Officer (HEO) – Ms. Yaukota Mawasi are heard.
So in keeping with this, today Yaukota spoke freely and shared with us her experiences as she showed us around KHC with hope that someone would listen, that someone would reach out and help her small team of herself and 3 Community Health Workers (CHW) to do the work they have chosen to do and are getting paid to do and improve the health services in the area.
We heard of her difficulties in trying to maintain operations with little supervision from the provincial health headquarters, we heard of her hardship and that of the people she serves.
We also heard some positive stories, like that fact that there is virtually no malnutrition (neither over-nourishment nor under-nourishment) at all to be found in the area. Overnourishment is a growing problem in the “richer” countries and is having a huge impact on the quality of lives in these poor living in rich countries.
This balanced nutrition can be attributed to the advantages the rich traditional life had to offer. There is an abundance of natural, unprocessed food many of which, with their high-fibre low saturated- fat content offer a natural protection against many of the “lifestyle diseases” being seen in increasing numbers in the more urbanized areas.
Yaukota spoke with hope that with partnerships with other individuals and organization, that soon the people will have access to better health services.
The centres serves about 2300 people in the area surrounding Uritai Village which is located in Kerema District the open Member of Parliament of which is Hon. Mr. Richard Meneani and incidentally is also the place in which the young now Sir Mekere Morauta started off his primary education to later become one of Papua New Guinea’s Prime Miniters great leader’s
Fig: Sir Mekere Morauta
MP for Kerema District – Hon. Richard Mendani
Fig: Kukipi Health Centre – A man being treated with IV Fluids on the verandah due to lack of in patients facilties.
Kukipi Health Centre – Building and Facilities
The story of the KHC so far is one of an unfortunate place and people who have been forgotten in a country which after a brief period of post-political independence euphoria, has struggled, for whatever reason, to deliver to the very people whom the nation state is in existence for and is in existence because of.
However, the story of Kukipi Health Centre is not unique. The same can be retold throughout Papua New Guinea. While the politicians and bureaucrats hold their meetings in expensive hotels many a times with some well-meaning some not so well-meaning international Aid consultants, such Health Centres and Aid posts throughout the country remains as they are, debilitated and deteriorating by the day, many without any form of maintenance whatsoever since pre-1975.
Yet despite the building deteriorating beyond a level fit for human inhabitation, people like Ms. Yaukota Mawasi and other inspirational people like her continue to hang on, doing what they can with what they have and where they are in their attempts to meet the healthcare needs of the people they have chosen to serve.
Fig: Ms. Yaukota showing the team around the debilitated Kukipi Health Centre.
The KHC building itself was built pre-independence (1975) during the colonial era when Papua and New Guinea were still two separate territories of Australia.
From the stories we heard and what we observed today, there is a long way to go before the KHC operates at a standard that is sufficient to meet the needs of the people.
First and foremost there needs to be a total facelift of the building and facilities. The existing building needs to be demolished and rebuilt. There should be an outpatient general practice area with an acute treatment and daycare area, a proper drug dispensary area, a minor theater, a small laboratory using appropriate point of care equipment for basic routine tests and off course a well-equipped inpatient ward with all necessary fittings.
Secondly the medical supplies procurement needs to be optimize to ensure continuity of services without overstocking and wastage of supplies. An evaluation of the disease prevalence in the area, will allow tailoring the drugs and consumables supply and inventory appropriate to the local disease epidemiology.
Thirdly, the system of referrals needs to be strengthened. This means concurrent improvement of the bigger provincial health centres in the area which KHC comes under and the Gulf Provincial Hospital – Kerema General Hospital.
Fourthly an effective system of financial accountability whereby, the kina cost of the overall health services can be recorded, and simple regular reports generated so they can be visualized and the impact of a healthy population can be quantified and hence have a feedback loop to justify the costs and determining adjustments if required.
The bigger picture – the referral system and avoidance of working in silos.
When we embark on this sort of exercise to improve the health of a certain population whether in the rural or urban area, we must be cognizant of the fact the a health system is inherently complex and projects focusing on one facility alone, while noble and welcomed, must also articulate well with the existing overall regional health system.
Dialogue must be had with the next referral health centre which ideally must be more equipped and serve as the next referral point for patients from KHC (which at this point is cannot be called “functioning”). This will off course need to involve appropriate stake holders, Local Level Government (LLG) councilors and leaders, and the appropriate provincial and national government administrative officers.
For now our immediate focus is and will be on Kukipi Health Centre. We want to build it up to a level that is fit to serve its purpose of providing primary health services to the estimated 2300 people of the area.
Fig: The cement foundations of what apparently used to be the inpatient ward (pre-1975), 20 metres away from the main existing building still remains.
The above figure is a remnants and reminder of how it used to be. It hints of the plans the then pre-independence administration had for expansion and development of the health and social wellbeing for the people.
Some Papua New Guineans today talk of Australia, especially Australia’s administration of the then Papua and New Guinea territories – pre-independence during the colonial era as a stain in the growing “National consciousness”, however, these remnants signifies that the then administration did have genuine and sincerely plans to improve the lives of the people of this land.
Some of the methods used were not conventional but when humans are involved in any endeavor, human behavior – good and bad will surface, perhaps some of the bad behaviors and experience have made up the stain which I mention and we tend not to see the good things that existed and contributed positively towards the emerging national consciousness.
In general, I believe without a doubt that the intentions were in general, good and the feeling of comradary and “mateship” (a much loved Australian phrase) was in fact genuine and mutual between the Australians and the indigenous people of the now Papua New Guinea.
The chance for self-determination is one of the strongest arguments for the drive behind political independence, but in terms of quality of life, where and how it matters most? Are the majority of Papua New Guineans better off now because of political independence? Will they be better off in the long run as a result of independence? Un-answerable questions perhaps, but if I was to give an answer, the idealist and artist in me would say:
“YES our people will be better off, and the process starts now and is in our hands. As citizens of this wonderfully diverse land we must take the driver’s seat in determining the history we want to create and tell our children. A history that we’ll co-created together; retaining what is good about our rich traditional culture and lifestyle and articulating it intelligently and optimally with the modern world into which we are aspiring to become a part of.
We must see democracy, the political system and ideology which we find ourselves adopting as a country, as a dynamic and forever-changing stream that we can and must control. A stream from which flows a better history, a better past, a better story to tell our children.
Note that I speak not of the future, as for me it is not a reachable destination; it is beyond our control and reach. The future is a gift from Eternity that only becomes tangibly ours, and that we have the privilege to experience only in the NOW.
In this stream, we the people, well informed and standing shoulder to shoulder, make up the gravity that allows the waters of change to flow. We must realize the power of our gravity in co-creating history, in creating better stories which can be told with fondness to our children and in turn they can retell even better stories to theirs”.
But perhaps it is time to stop asking these questions, let bygones be bygones, let the waters flow under the bridge and from NOW onwards, let’s pool our resources and translate ideologies to practicality and tangible change for our people. Let us, in partnership, start building!