Hi James (PJR)

I have been on and off, however I am also aware of guys like yourself and
Willie, Timmy plus most of our members keep th PNGDOCTORS.COM going. keep up the
good work.

Those thoughts you had on Preventive Health is just the right stuff for all
doctors and health professionals of today for tomorrow. As you can see here in
Australia, well established Primary Health Care: Quite simply - Clear water,
Clean Air, Clean food and basically soil free homes solved most of primary
Health issues.
The notion of prevention is better than cure is hold right here. A step higher
than this is immunisation and public health notices, phamplets, and health
Policies /Laws. Education and more of it is what is needed in our situation and
I do not think we (in PNG) had enough of it yet. There need to be relentless
approach to it and a great need to sustain such approach is long over due.

Again good to discuss...I totally agree with you points.

Proper housing and population control, throw in education is what PNG citizen
need in the next decade or Professor Mola will continue to live to say " I told
you so 10 years ago"

Cheers.

JT


>>> Poyap James Rooney <pojaroo@...> 10/07/07 5:15 pm >>>
Thanks guys for the thought provoking exchanges, this is no dought as many of
the other issues we discuss, ongoing. While offcourse they will not results in
immediate fruitation(if theres a word), it is importatnt to discuss these
issues, get different perspectives and experiment with our different thoughts
and ideas, no doubt a few amongst us will inevitably be in decision making
positions and we must remember that our decisions will go to impact millions of
people...(not to get too "grandiously delusioned").

I just want to go on a different but related track.

This idea of prioritising public funds towards prevention as the best option
for our country seems to be hard for our policy makers and ourselves at the
frontline as service providers to grasp. This difficulty, in my opinion stems
from the fact that the benefits of greater spendings on primary health care and
prevention, though on the whole greatly outweigh those of spending on tertiary
health care on a cost benefit ratio, are not as obvious and dramatic as they are
in the latter. This is an example of how emotions of individuals in decision
making positions can influence the making and implimenting of policies
impacting the lives of millions, not necessarily in a positive way. Emotions
have their place, don't take me wrong, ..(the advocates of EQ), but they should
not impede on rational, sound decision making.

Another personal experience/example if I may.

Last week, I got a letter from the Stonington City Council, in fact it was
addressed to my baby daughter (her first letter), wishing her a happy birthday
and reminding "her" that her next medical checkup and immunisation was due.
This was a reminder to me as a parent (even as a medic) that these shots were
important and I should take her in for immunisation to prevent these diseases.
This exercise costed me nothing and the Australian Government (I'm guessing) no
more than $100.00 (cost of letter, immunisation, labour etc.).

What effects did I actually see? - a small scar on the side of her arm. What
we don't see as a result of this preventative exercise is the potential costs -
financial, time, emotional that could have occured had she not get immunised and
come down with one of these diseases, as we see on a daily basis and becoming
more prevalent in PNG - measles outbreaks, hep B outbreaks, TB etc.

On the other side of the coin, is the provision (or lack) of tertiary health,
the effects of which are much more dramatically and immediately seen. For
example, A kid from Tatana village is diagnosed with measles at PMGH A/E, A look
at her immunisation schedule revealed that she had not recieved any measles
vaccination, she is kept for observations and sent home. Three days later she
develops a serious complications (SSPE) and re-presents - she needed ventilatory
support but unforunately, all the ventilators at PMGH were used up by snakebite
victims. The family had to manually ventilate the poor girl whom later passed
away due to other complications arising from the crude way in which she was
ventilated. If you asked this family what the government should be doing more,
they would most probably answer - "Buy more ventilators" not "make sure
prevention and immunisation programs are improved" which would have prevented
her from getting measles in the first place and
subsequently needing the ventilator machine and dying ..

We make decisions on a daily basis based on what we see and feel at that time.
These decisions are for our immediate survival. However when decisions have to
be made about health policies that will impact the whole country, they need to
be based on what we know based on well established scientific facts - not
merely on what we see and feel.

"Prevention is better than cure, prevention is better than cure, prevention is
better than cure" Every PNG should recite this a hundred times each morning
upon waking and retiring at night to imbed this in our brains.....

Having said that, I am not advocating total funding starvation of our tertiary
health system, rather a greater leaning of public health expenditure towards
primary rather then tertiary. Again the provision of tertiary health should be
left predominantly to the private sector as discussed......

I think a live, living example of what I am trying to elude to is in Prof Mola
- A strong advocator if not the strongest of public health measures especially
in population control, yet in his field providing arguably the best private
tertiary health facility in PNG.

Cheers
poyap
Tim Haina <png_hausboi@...> wrote:
While I am sceptical of the proposed K1 per fortnight scheme I would
be absolutely thrilled to be proved wrong. A pilot study as you
propose would be the most sensible way to go. The issues that will
need to be addressed will be:
1. Identification of the individuals paying
2. Collection of monies and fiscal accountability
3. Who will ultimately recieve the monies and how will it be disbursed
4. How do you verify that someone has paid or not.

At the district or village level things may be easily done however on
the national stage identification and verification will be an issue
and may demand a system similar to the EFTPOS system that is in place.

I do agree that PNG is developing and there is access to relevant
telecommunications/ electronic infrastructure however one must
realise that the setup costs are going to be significant as will be
the maintenance costs.

Who then do we involve in this dialogue to seriously consider the
practicality of our suggestions and to take it to the next stage
which is to consider the options; do a strengths and weakness
analysis and then an economic viability study.

Can we afford to invest in this kind of infrastructure and what will
be sacrificed for this investment (eg : public health prevention
programs, dialysis unit setup, training program funding etc ...).

Cheers;

Tim

PS: Private work being done through the public system is plain fraud
and a discredit to our medical fraternity as well as against the code
of ethics and should be condemned by all. This is a medical board
issue and if you are aware of this practice going on it should be
reported so appropriate disciplinary measures taken.

--- In pngdoctors-general@yahoogroups.com, mol william
<w_mol2003@...> wrote:
>
>
> Another problem, I see in the Public health services, is
> that there is no fair system of charging hospital fees,
> (the total cost of a particluar health service). There is
> usually the standard outpatient fee, admission fee etc.
>
> Dr. Jack Mulu made a very detailed presentation about
> estimating the cost of a particular health services basing
> at one of the Provincial hospitals, last symposium (2006),
> surgery meeting. Such studies could be the backbone of a
> proper hospital management.
>
> Apart from that many private practitioners are using the
> public health facilities to make their own money. There
> seems to be no rules about paying the public hospital,
> regarding the facilities they use. Even Drs working for
> the Health Dept are doing private practice under the
> public infrastructure. Now, this is where honesty comes
> in.
>
> All these may contribute to further deterioration of our
> public hospitals.
>
> By deterioration I mean, the simple, obvious things like:
>
> 1. Poor maintenance of infrastructure
> -Blockade of sewage & plumbing system
> -Painting & maintenance of building etc.
>
> 2. Lack of facilities
> -Not enough beds, wheelchairs, basic surgical
> instruments etc.
>
> 3. Shortage of basic drugs & consumables
>
> To summarise I think the following needs to be done:
>
> 1. Strict regulations regarding private practioners using
> public facillities and/or private practice within the
> public system
>
> 2. Imposing fair hospital fees to patients considering the
> services they receive (This is where the user fee policy
> or the idea I have suggested may come in)
>
> Guys, I think this is the root of the problem and it needs
> to be addressed seriously. Atleast we have to maintain our
> infrastructure & facilities & get our basic supplies going
> consistently every year before we can think of expanding
> on it.
>
> Finally, we need reliable, honest & dedicated staff in all
> sections of the public hospitals, otherwise a well
> designed system or plan would never workout.
>
> Thanks for reading!
>
>
> William
>
>
>
>
>
>
>
>
> --------------------------------------
> Easy + Joy + Powerful = Yahoo! Bookmarks x Toolbar
> http://pr.mail.yahoo.co.jp/toolbar/
>






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