Health and Health Care in Papua New Guinea

Warfare was endemic in almost all of PNG and a major cause of death before colonial rule. Malaria was endemic in coastal and island regions. The highlands were free of malaria, but the people suffered from serious respiratory diseases. Malnutrition was endemic in some regions, and in others there was seasonal or occasional famine. Traditional care included potions made from plants, and magic and careful nursing, especially of male children. In the 19th century Europeans and other foreigners, such as Polynesians, who accompanied them, introduced tuberculosis, dysentery, syphilis and gonorrhoea, smallpox, measles and whooping cough. Amongst Europeans measles was mostly a disease of childhood with relatively low mortality. In Melanesia it caused epidemics with a high death rate among adults as well as children. The worst killer among the new diseases was a virulent form of bacillary dysentery. Missionaries taught hygienic practices and dispensed simple Western medicines. The medical services of the colonial Administrations were largely restricted to attempts to prevent the entry of infectious diseases through quarantine measures, prevention and control of dysentery epidemics among laborers, and attempts to understand and prevent diseases amongst laborers caused by dietary deficiences.

From the end of World War II to Independence, the Australian government, in a marked change from prewar policies, spent large sums of money on health services in the Territory of Papua and New Guinea. That the money was spent wisely was largely the work of the Director of Health, Dr John Gunther. The Department of Health mounted campaigns against tuberculosis and malaria. Up-to-date hospitals, staffed by white doctors and nurses, were built in the larger towns. A network of medical aid posts was established in villages and medical and paramedical officers were sent on patrol into rural regions. Melanesians were trained as nurses and as village aid post workers. These latter, forerunners of the more famous Chinese “bare-foot doctors”, were trained to recognize symptoms of diseases that could be cured by the newly introduced antibiotic drugs, and to use them in treatment. Some PNGans were trained at the Central Medical College in Suva. In 1958, the Papuan Medical College was founded. In 1971, the College became the Faculty of Medicine at UPNG.

At Independence in 1975 health services were provided by both the government and the churches. There were hospitals in all main towns. Health centers and sub-centers catered for communities up to 20,000 people, and aid posts for communities under 5,000 people. Four-fifths of health services were provided by the paraprofessionals who staffed Aid Posts. The local community was expected to provide the land and building and a house for the aid post orderly.

The rapid increase in population, and the retrenchment or resignation of most overseas trained doctors, made it difficult to maintain services at the 1975 level. After 1977 primary health services became the responsibility of provincial health departments. Many aid posts and small hospitals continued to be run by the churches. The national Department of Health provided teaching, base hospitals and pharmaceutical supplies. In 1987 the Churches Medical Council warned that health services were deteriorating rapidly in rural areas and many aid posts had ceased to function because of a shortage of staff, equipment and medical supplies.

In 1990 there were 19 hospitals, 195 health centers, 227 sub-centers and 1,752 aid posts. Seventy percent of the population did not have access to safe drinking water. The infant mortality rate was 56 per 1,000 live births. Life expectancy at birth was estimated at 54.9 years. In the 1993 budget, the K117.9 million allocated to health care represented 8.5 percent of total budget expenditure. In 1992 the most prevalent diseases were malaria, respiratory and gastric infections, malnutrition and sexually transmitted diseases. Death and injury from criminal activity and tribal warfare were increasing. Many people, in both towns and villages, continued to use a combination of traditional and Western remedies.

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