PNG Health Clinics – Challenges and Road Blocks
FHI360 (formerly Family Health International) PNG Country Office, in collaboration with HOPE Worldwide PNG Country Office, jointly supports two community health centers in the National Capital District of Port Moresby—Lawes Road and Nine Mile Urban Clinics. In addition, FHI360 also supports Id Inad Clinic, a healthcare facility within Modilon General Hospital in the northern province of Madang. All of these healthcare clinics specialize in care and treatment of clients with sexually transmitted infections, HIV/AIDS, and opportunistic infections such as pneumocystis carinii pneumonia and pulmonary tuberculosis. Because of the nature of these health conditions, part of their services is also geared towards care and counseling of gender based violence, sexual violence, rape victims, as well as family planning counseling and referral.
At the beginning of my fellowship, clinic staff in Port Moresby thought that I was here to see clients, perform physical examinations, prescribe treatments and medications, and arrange for follow-up visits for re-evaluation. I knew from the very beginning that the scope of my responsibility and duty were within the boundaries of technical advisement and expert consultancy to assist in building and strengthening clinical staff capacity and expertise. It is perfectly clear and I am totally aware that I will not be practicing clinically since I do not have the license in PNG to do so. Therefore, I made it perfectly clear and transparent after my initial clinic orientation that I would observe staff during clinical counseling, physical assessments, and clinical procedures; keep notes, check records, and then recommend clinical practice enhancements.
I have since observed and identified many situations that can be modified to align with good clinical practice. For example, healthcare in PNG strongly emphasizes the need for privacy and confidentiality of all clients and patients and this impressed even more in the sexual health clinics due to the nature and sensitivity of the cases. One of the early record keeping audits I did was to check for signed and dated confidentiality agreements in staff files as well as medical records. The clinics are compliant in this regard. However, there are times when this does not necessarily translate into clinical practice. For instance, medical charts and records at Lawes Road Clinic are all stacked and filed on top of and underneath the receptionist’s desk at the front. This way, the receptionist can easily look for a client’s medical record before getting seen by the clinicians. The charts however are not secured properly in a locked cabinet and are easily within reach of anyone who wishes to retrieve medical records when the receptionist is not at her desk. At Nine Mile Clinic, the overt problem is the physical space. The STI examination room is a simple and small room where two clients can be seen simultaneously in the two desk offices inside. Usually, both the male and female STI nurses screen the clients before treatment prescription or further clinical investigation with the supervising physician. There is no division between the two desk office and the proximity is very close that one can patient/nurse can hear what the other pair is talking about. The premise of confidentiality is not at all present in this situation. In return, clients are usually triaged to determine who needs physical examination the most, since there is only one room and one examination table. Most of the other clients are seen, assessed, and treated based on medical history and interview. Clients who need to have a vaginal or penile examination are asked to wait until most clients are seen to prevent backlog.
I recently attended the bi-annual Quality Assurance / Quality Improvement initiative participated by FHI360, HOPE Worldwide, and the National Department of Health. In so doing, all stakeholders are aware of the many achievements the clinics have done in many years, as well as the present challenges and barricades they are experiencing. The last one that we did before the fiscal year end took place during the first week of August. During that visit, both the medical chart problem at Lawes Road and confidentiality issue at Nine Mile were mentioned. There are other issues identified in both clinical and administrative areas as well. At the present time, while everyone is waiting for the official result of the visit, interventions are being tabled and brainstormed.
As a Pfizer Global Health Fellow, it is important for me to internalize and appreciate the fact that the clinicians that I am working with are competent and intelligent medical professionals. Unfortunately, they are caught within a healthcare system where medical equipments, necessities, and infrastructure are often lacking. In a place where one has to prioritize procurement of materials, waiting for quite some time before it arrives or delivered is not unheard of. In the interim, it is also all too common to just do without. After all, the show must still go on.