'Critical shortage' of rural doctors in PNG - doctor

Transcript

A group representing doctors in Papua New Guinea says there is a critical shortage of doctors in rural areas and the situation is becoming dire.

The Papua New Guinea Society of Rural and Remote Health president David Mills told Amelia Langford there is no hard data on the total number of doctors working in PNG, which complicates matters.

DAVID MILLS: We know roughly the numbers of doctors that are in the country. You don't have all the information because you do have some doctors coming in from overseas that are unregistered but normally those numbers are kept by the medical board who keeps the statistics on registered practitioners but unfortunately the medical board itself has struggled over recent years so we don't even have good centralised data on the total number of doctors but let's say we work with that data that is available we can get a rough idea as to the number of doctors in PNG and from there we just go from district to district and work out, you know, how much of the population basically doesn't actually have access to basic services. So we know that the situation is fairly dire but we don't have very accurate hard data on the total numbers.

AMELIA LANGFORD: And the majority of districts don't actually have a doctor?

DM: Oh yeah, goodness yeah, the vast majority. I mean, it is 89 districts in PNG and those districts range in the populace that they contain of course but you know can be anywhere from 30,000 in a small district up to 80 or even 100,000 and the vast majority of those have no resident medical doctors present.

AL: So does that mean that some people are not getting the treatment that they might need?

DM: Well, yeah for those of us who live here in PNG it is unfortunately common knowledge that the vast bulk of the population doesn't have access to meaningful health services and that can mean even the most basic medicine, antimalarials, or antibiotics, there are just no health workers present in the rural places and for a place like PNG, where 80 percent of the population live in these truly remote areas that is truly a disaster - it is not just an inconvenience.

AL: It the problem that the jobs are not on offer or is it just difficult to get these doctors to serve in remote areas?

DM: Yeah, the latter unfortunately. The jobs are there but there are a whole string of reasons as to why they don't go. But generally speaking it is a case of actually attracting doctors to work in these places.

AL: Because what sort of conditions would doctors be facing in those areas?

DM: Well, it is not just a question of pay. In fact, pay is probably one of the smaller issues. It is the whole gamut of for example, what sort of hospital will they find? When they go to this area is there going to be power? Is there going to a laboratory or an X-ray facility. Is there going to be an operating theatre where they actually do some of the things they have been trained to do? And then there are also considerations like you know road [conditions]. Another very big issue is whether there is going to be schooling for their children and so it is a bit of a systematic problem rather than just simply no doctor. Having said that, I think the issues are a bit deeper than that.  

Probably those of us who work in the field would say that it is more to do with a cultural issue, by that I mean a medical cultural issue. PNG trains 45 doctors a year so that in itself is a problem because we have nearly eight million people now and 45 doctors a year is clearly nowhere near enough compared to say like New Zealand or Australia where you'd have one doctor for every 800 people - here we are looking at tens of thousands of people without doctors so there needs to be a very large increase in the number of doctors that are trained. However, when those doctors do graduate the vast majority of them unfortunately are still wanting to pursue careers in specialist urban practice so become surgeons, or gynecologists, or pediatricians and ply their trade in town and that is a big problem of course because if you live in town and work in town you will only ever see a very small percentage of the population. And what we really need to be training is generalists, rural generalists, who have the skills to be able to manage district hospitals. And unfortunately what has happened in PNG over the past two or three decades is that the medical culture has moved more towards training specialists and away from generalists and we are paying the price for that at the moment unfortunately.

AL: So in your opinion what needs to be done here? What should the health department be doing?

DM: Well, I think slowly people are coming around to address these issues. To be perfectly honest, I think for a long time they didn't really know what they could do - they knew there was a problem but really didn't see a way forward and there have been some positive changes in the last five or six years. We now have a specialist training programme that trains doctors for rural practice and that has been very important because you don't want doctors to be feeling like if they work in rural areas they are somehow second class or they are not as educated or talented or skilled or knowledgeable as their peers who work in town. And so there is this sort of peer acceptance thing that we have had to address and so commencing a fully-fledged specialist programme that trains doctors for rural practice has been a really important step forward and that programme is gaining quite a bit of attention from donor funding and increasingly from the department. So we need the department to really now get behind that programme in a big way with funding and with support. There are going to need to be other creative things addressed like for example when a doctor does decide to come to a bush place you know what are we going to do about schooling for their children? And there are going to need to be incentives that we don't give to other doctors - you are really going to need to load up, I suppose, on other incentives.

However David Mills says he is optimistic about the situation as there are some very committed young Papua New Guinean doctors who are working in rural parts of the country and making a difference.