ANZCA Bulletin June 2011 - Australian and New Zealand College of ...

Teaching in
Papua New Guinea
If you mention Papua New Guinea (PNG)
to most Australians and New Zealanders
it conjures images of coconut-lined
beaches, lush rainforests or the rugged
rainforests of the highlands made
famous by World War II battles in
the Owen Stanley Ranges. However
it is its very diversity of ecology and
ruggedness of geography that makes
provision of healthcare in PNG so
difficult. Half of the almost 7 million
population live in traditional rural
village settings. According to the World
Health Organization almost 10 per
cent of children die before the age of
five years. One in 25 women now die in
childbirth. This is on par with sub-
Saharan Africa and Afghanistan.
Despite being richly endowed
with natural resources, poverty is
widespread and reflected in the health
sector. Annual health expenditure in
PNG is only 3.1 per cent of GDP, or $US50
per capita, as opposed to the regional
average that is more than 10 times that
amount and in Australia 40 times as
much. There are severe staff shortages
with only nine consultant anaesthetists
for the entire country.
Anaesthetic services in PNG are
mostly provided by anaesthetic
scientific officers (ASOs) who are
non-physician anaesthetists who have
completed a one-year diploma course
offered by the University of Papua
New Guinea. For medical graduates
the University of Papua New Guinea
also offers a one-year Diploma In
Anaesthesia (DA) and a four-year
Masters in Medicine (MMed) which is
closest to the College training program.
Since the mid 1990s ANZCA has had
an extended interest in the development
of anaesthesia in Papua New Guinea.
ANZCA has committed to assisting
the education and training of ASOs
(Diploma of Anaesthetic Science) and
anaesthetic registrar training (DA
and MMed) by supporting a Fellow to
undertake lectures and workshops with
the local students.
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ANZCA Bulletin June 2011
Early in February this year I was
fortunate enough to be asked by
Dr Michael Cooper to undertake an
intensive one-week teaching trip to Port
Moresby. The teaching program for this
trip consisted of three days teaching the
anaesthetic scientific officers, two days
with the anaesthetic registrars and one
day with the MMed candidates who were
preparing for their final examinations.
Given the limited time for teaching
and the significant problems with
infrastructure, equipment and
monitoring, the teaching was focused
primarily on safety, pre-operative
assessment, common surgical problems
and airways. Lectures were held in the
mornings and hands on sessions in the
operating theatres in the afternoon to
provide some air-conditioned reprieve
from the humidity and allow the
students to apply what they learnt in
the morning.
All the students were provided with
comprehensive course notes on USB
sticks along with a number of electronic
textbooks and hard copies of some of the
more popular anaesthetic handbooks.
Despite the challenges faced by the
local physicians and ASOs in providing
anaesthetic services to their local
community, I was at all times impressed
by their enthusiasm, professionalism
and compassion for the patients they
served. The ongoing support of ANZCA
and the Overseas Aid Committee is
critical to the growth of the profession
in the region. Furthermore such work
is essential if the College is to stay true
to its mission statement: “To serve the
community by fostering safety and
quality patient care in anaesthesia,
intensive care and pain medicine”.
Finally I would like to thank the
ANZCA Council for their commitment
to aid in the region, Dr Michael Cooper
(Children’s Hospital Westmead) for his
encouragement, wisdom and expertise,
Dr Robert Woog (Royal Prince Alfred
Hospital) for providing leave from
my regular work commitments, and
Baxter and Abbott Pharmaceuticals
for donations of USB memory sticks to
provide e-textbooks and course notes
for the participants.
Dr Michael Stone BMedSc MB BS(Hons)
M Med(Pain) PGDipEcho FANZCA
Consultant Anaesthetist
St Vincents Hospital, NSW and
Royal Prince Alfred Hospital, NSW
References:
Cooper M. and Morriss W. ANZCA Bulletin,
June 2010, p56-57.
World Health Organization. Papua New
Guinea: health profile. Last update April 4,
2011. www.who.int/countries/png/en/
Above clockwise from top left: Port Moresby
General Hospital; The Diploma of Anaesthetic
Sciences course students, from left: Israel
Lebani, Jerry Duni, Norman Kambo, Elani
Namel, Rachael Toniu, Tom Wapulo, Jenny
Muli, Homeless Manitore, Justus Jack and
Mafi Asipeli; Anaesthetic scientific officers
confirming the correct placement of the tube
by symmetrical inflation of the lungs and
manual pressure check of the pilot tube; A
quick stroll around the wards of the hospital
quickly initiates the inexperienced as to some
of the challenges face by the local doctors;
One of the students trying to troubleshoot
a deliberately faulty anaesthetic circuit.