Thanks, Boys...NOW MEN.

I like our discussions!

With a good system and training, I guess, people like Aurther Somare would not
jet down to Brisbane for what he is seeking right now. Late Bill Skate should
have died in his beloved Port Morsesby. Iambakey, Siaguru and Kilage would not
have died here. Sir Julius then, now Sir Michael who now frequents Brisbane for
medical checks would have their own specialists and facilities to be at peace in
PNG.

Would you all agree that you would not want to die away from your belowed family
and land that had made you someone this far? I would rather die in my family's
hands in my own bed, in my own town. Appreciate the best my fellow citizens can
offer and encourage the young to achieve the highest for my people...and put
money where my reality is.

IT BECOMES A VERY FAMILIAR CYCLE:

BORN AND BRED IN PNG, RAISE TO PROMINANCE IN PNG, DIED IN AUSTRALIA, COFFIN BOX
TO PNG.

BORN AND BRED IN PNG, RAISE TO PROMINANCE IN PNG, DIED IN AUSTRALIA, COFFIN BOX
TO PNG.

Discussions like this would help stop above and make us feel real independent.

I will give you this case to synthesis: Dr Miam and I looked after Sir Julius
Chan in PMGH - ICU under Prof Kevau with Arhythmia soon after he was overtaken
in Namatanai open by Lin Stucky. Prof prepared him for Brisbane...and the very
afternoon he asked. " If I have to go, let me walk out of the aeroplane, not
escorted and not monitered. If I have to die, let me die in Lady Chan's arms
here in PMGH". We ceased evacuation plan and he was discharged after 5/7
amiodarone. He presented the staff with 20 small cakes with a "Thank you card"
on his discharge. Eventhough, the aeroplane that medivac people in PNG to
Australia belongs to him! I have a photo of him on the day of discharge. He
also warned me that he never pose for friendly photos but this would be
exeptional, since he really did see some Trust in Prof Kevau, Ben Miam and
myself at the time. I will have it posted sometime.

This has been inspiring, one man cannot change the tide...(please note, I am not
into talking people up)


keep talking

Cheers

JT






All we get

>>> pojaroo@... 08/14/06 6:27 pm >>>
Hi all,

I wanted to bring this topic up months ago but didn't but I am glad it has
surface and we are discussing it. I hope that we can do something about it as a
group.

Ganzee I Like the growing tree analague and I think it pretty much hits it on
the nail - You talked about the school being the tree and the need to add -
compost/fertilizer and pruning some branches here and there, watering the tree
and it will grow into that healthy plant that we want - after all it is this
very tree that will bear fruit to those Juicy fruits that our country need and
what we are talking about - Doctor, Healthcare professionals who will in the end
be the driving force behind the "system".

Just to take that analague a bit further and to relate it directly to our
Medical School I have this to add.

Any tree, needs a good base, a good root system in order to hold the tree up
so it can grow a bare fruit - The base/root here for any medical school in which
everything else is built on are the BASIC MEDICAL SCIENCE - I don't believe that
any of you learned people will argue with that, these are the pillars of any
medical school:

ANATOMY
BIOCHEMISTRY
PHYSIOLOGY
PUBLIC HEALTH

There needs to be a qualified professor in each of these position to provide
the acedemic leadership and foster the appropriate environment for learning.

With the root firmly in place, the middle trunk can have a steady base on
which it can stand strong and grow - The trunk here are the pathological
sciences:

MICROBIOLOGY
HISTOLOGY
HAEMATOLOGY
CLINICAL CHEMISTRY

Then we have the branches of CLINCAL SCIENCES

MEDICINE
SURGERY
OBSTETRICS AND GYNAECOLOGY
PAEDIATRICS
ANAESTHESIOLOG


When we have a good root system, a strong trunk branches, we can then add on
the, leaves, flowers and finally and not the least we can bear fruit to those
juicy, delicious, nutritious, fruits that our country need oh so much - Health
Care Workers.

Research and public health and education would probably come in as the strong
outer bark of the tree that covers the whole tree, making it even stronger.
Once we have all these in place, we can add the fertilizer, compost "MONEY" and
we have one healthy tree. The fruit beared will offcoarse go to feeding our
people, but some may be for export to overseas countrys as an exportable good,
bringing in income to the country.

So at present how does OUR TREE compare to this ideal picture above.

I will talk for my department only ie Patholgy, (the trunk of the tree using
above analogue).

We only have one - Histologist

NO - MICROBILOGIST
NO - CLINICAL BIOCHEMIST
NO - HAEMATOLOGIST

We desparately need to fill these position. On a personal not - I'm doing
Clinical Biochemistry at the moment and after getting as much as I can here(with
or without a fellowship, hopefully with if I can) I'll be back to add to this
trunk, I am sure Rodney and others may share this same sentiments.

Modern Medicine was not practice by our ancesters so to learn we have to be
overseas to learn and bring back the new knowledge to share and apply to our
need and situation. Unfortunatle it is not carving a canoe we are talking about
here, otherwise mi bai askim lapun papa lo ples lo sowin me.

Having said that, while some of us are overseas - whether training or running
away, someone needs to hold the fort for the interim. And it just may have to
be these good overseas doctor who we are so very lucky to have, and mind you I
am sure the likes of Dr. Temple, Prof Chung, Prof AMoa can get much better pay
somewhere else if they wanted - and they can get a job anywhere they want.

My closing thoughts here: The school must break away from UPNG, we must
become automonous to do as we please with the funding that we get - either from
the government or from the donars. There is no dought that to run a medical
school anywhere in the world is an expensive exercise, there is no way around
that fact. The longer we remain with the UPNG the more we spiral into oblivion
- MARK MY WORDS ON THAT GUYS. So we as a group should explore the possibility
of making this eventuate --by this I mean - find out all the facts, do the
feasibilty study, find out what needs to be done - eg legislation, WHO
requirement etc and hopefully have a GOOD HARVAST OF FRUIT!!


"Lets do some thing instead of being another NATO Group!!!!"

CHEERS YOU ALL!!!!





gunzeegawin <gawinsg@...> wrote:
Hello olgeta,
Pheeew! Just completed a hectic two and half weeks of 'Night Shift' and
decided to check on you guys. And, hmmm, very interesting issues you had been
discussing. Issues I would say are the core of why we are doing what we are
doing (or, maybe why we prefer to run away from?).
It appears to me that we are not all together on issues concerning our Health
SYstem, and that is great. It makes our discussions more healthy and finally we
all can draw good conclussions from these discussions.
I am going to break my discussion into three parts. I will give my opinion on
the current health services delivery system, the issue of new Medical School,
and touch on a topic Eric Ungil brought up sometime back; HEO Training.
1. Health Service Delivery.
In the 70s and the 80s, I believe more than 95% of the Aid posts were
operational. As a primary school kid in one of the remotest part of the Morobe
province where my dad was a Primary School teacher, I used observe this
dedicated staff (APO) work 6 days a week, except Sundays. He ensured he had
enough supplies for the population. He made regular patrols around nearby
villages and the school to give health Talks and do immunizations. Cases
complicated to him were referred to a nearby sub-health centre which was fully
staffed with a Nursing Officer as the OIC, about a full day's walk from the Aid
Post and School. More complicated cases were transferred to a Health Centre
headed by a HEO. There seem to be enough supply of drugs, referral system was
effective the staff were very dedicated and enthusiastic about what they were
doing. Sadly, when I went back in 2002 Christmas holiday, the Aidpost appeared
to be unmanned for more than 3 to 4 years as one would make out from the
tall shrubs and moulds on the walls of the buildings. The cobwebs were all over
the building. There had been no APO since 1990, the locals told me. The
sub-health centre had been upgraded to a Health Centre, but was still
functioning as the sub-Health Centre and even worse than before. The staff
morale was very very low. They had an ambulance (10 seater Toyota Landcruiser)
which was used by the HEO in charge as his private family transport (in fact
they had driven for 10 hours down to the coast to do marketing when I went
there). The drug storeroom was 3/4 empty, and they had no kerosene to sterilize
the equipments. Something happened, and the well mapped out health delivery
system just fell apart.
I agree with Sioni and Rodney regarding this. Both of their comments are true
and justified although they themselves may think otherwise.There was a
well-mapped out health system delivery back then with effective health service
delivery. Currently, only the skeleton is left of what was an effective health
service delivery, similar to what happened to the dinasours.
Sioni's comments on the health system delivery and the need to improve the
system is commendable. True, we may not be able to implement a totally new
system but improve on the old system. Say identify where we went wrong and start
rectifying those areas. Maybe we had been doing that for the last 11 years and
are going nowhere? The system really IS NOT WORKING.
One thing I know is that they cut back on a number of CHW training schools
because they could not afford to fund them. The only CHW training schools now
currently operating in the country are mission run as they rely 100% on the CHWs
to manage their health services (Aid Posts) out in the remote areas. The
government attempted to put the Nursing Officers to Aid Posts but it back fired,
especially in the remote areas. There is a big difference when it comes to
health service delivery by the missions and the government.
So how do we correct the system? While we try to identify the areas of failure
in the system to improve the health service delivery, we might as well look at
adding sinews and muscles and blood vessels and nerves, etc, to the skeleton and
give it life. One such area is staff morale. The health staff morale at the
moment is very low. Identify the factors that will raise morale in the work
force. Instilling threat and intimidation will not improve a low morale in the
workforce.
One factor that contributes to low staff morale is the chronic 'nil stock' of
medical drugs and equipment. Financial support is another factor.

2. Medical School.
We do not need a new medical school. No. More resources should be put into the
current medical school. There are few reasons why I say this.

Taurama campus should be established into a separate University, say Taurama
School of Medicine, a campus separate from the Waigani Campus. Make more funding
available to fully equip this medical school to train more doctors. As it is
now, the campus is under the University of Papua New Guinea, and is not getting
enough funding as it requires as most of the money is absorbed by the main
campus. (This information is from my discussion with then Dean, Prof Sapuri in
2005). It does not make sense when the current medical school is struggling to
adequately equip itself and produce its quota, while there is talk of a new
mwdical school somewhere.
Although Divine Wood University is a private institution, it recieves more
than half of its budget annually from the National Government's annual budget to
the national government run institutions. Creating another medical school
obviously stretches the budget a little bit more. Do we have the money to do
this when we still cannot solve the health personnels' demands for pay rise and
improved conditions, adequately supply and keep up to date the pharmaceutical
supplies, create positions for our specialist doctors and keep our doctors in
the country?
Do we have the money to employ more doctors? Interesting.
What are we aiming to achieve with increased medical schools? Is it a band
aid approach to the failing health service delivery? Can't we learn from the
missionaries? Why are they able to deliver effective health services with very
limited funding and pharmaceutical supplies compared to the government
organisations? I believe there is a big lesson here we are too proud to stoop
that low and learn from. Do they have doctors? Very few. But they do 100 %
better than the government in delivery of the health service to the people.
let us get out of relying on donors, people. Pleeaaasseee, I beg you. Let us
get on our own two feet and feed ourselves. Setting a medical school to be
funded by donors, my karanas. We still have not learnt from the mistakes we have
made so far.
Rather then putting the composed to base of the tree, watering it and pruning
the dead branches so that we can have a better harvest come next season, we
prefer to plant a new tree, hoping that the old tree will manage to survive in
those harsh Port Moresby environment. What is the guarantee that the new tree
will be well looked after in 11 years time?
No. I for one do agree with Poyap. I think we do not need another medical
school but improve the current one.
Well this is just me thinking, cause the plan is already out and ready for
execution. I will either bow in same and eat the humble pie in 11 years time
keep my head up and say, "I did say this would happen."

3. HEO TRAINING.
I am going to make my honest opinion here.
HEO training was a quick-fix solution during the colonial days to train
someone who was not a nurse nor a doctor but would function as a clinician and
an administrator. Come Independence, and people in authority thought it would be
a great idea to keep them. And it was a great move. They had contributed
immensely in the absence of doctors
With the training of doctors, HEOs were trained to manage Health Centres.
Their medical knowledge are no better than nursing officers, but they are
trained better in administration. I had been involved in their residency
training and and worked with them and I know.
Making them to do degree in HEO, I do not see the logic here. Obtaining a
degree does not make them better or near a doctor, they are still in their
position they were before. Despite the change in qualification, pay and
conditions and positions do not change. They will be hard done by making them do
5 - 6 years of degree programme only to find themselves no better then the HEOs
who passed out with diplomas earlier on.
This is what I suggest they would consider.

Those who do well in their diploma are offered to further their career in
Medicine.
Those who are averge can go on to major in administration. there is a lot of
need for good managers and in health, a manager with a health background,
although is not necessary, is a bonus. In this regard, the Divine Word
University should consider taking them in its Hospital Management Degree
programmes.
This I believe will be fair on them. 'Fair dinkum' we say in Aussie. If you
train them well, you must be prepared to look after them well. I doubt our
Government is in a position to that considering the current trend.

Folks your say,
Gunzee.
Ps. Sioni, I should reply your email soon. Sorry for the delay.




-- In pngdoctors-general@yahoogroups.com, sioni sialis <ssialis56@...> wrote:
>
> Rodney, maybe not so much a new system but an improved system. But it is clear
that our health system is not working and I do not believe that we have a well
mapped out system. If it is a good system then we should have seen improvements
in the indicator health statistics.
>
> When building a system we need the standards, we need procedures we need
policies for overall governance. The system if well built will take care of the
hanger's- on and the 3-hour lunch employees and so forth.
>
> You see when you talk about reprimanding someone for the chronic absenteeism
etc...it doesn't happen, because there isn't a system that is working to take
care of this type of things....one can claim that it is there, but we all know
it is not.
>
> And just from this example, it should be clear that things are not working.
You see right after independence everything was centralised that is all
decisions were made from Waigani. For example, if you finished medical school
and your residency period then you were sent where Waigani says you should go.
So if headquarters decided that you were to go to Telefomin then that is where
you go.
>
> I think it was through the 80's that the the "decentralisation" ideology was
surfacing, and that meant that districts and provinces were the implementing arm
and made decisions and the Headquarters in Waigani just made the plans. You see
there came a time where there was no coordination between the two and health
workers did not know which to follow - a confused workforce will definitely
result in bad things.
>
> Provinces and districts were making their own plan and Waigani was making
their own. Two different groups with two different plans to improve health.
>
> Hence there has been two different systems. Retrospectively the intial one was
working, but maybe it is not so appropriate now. The "new" system is plain and
clear not working. Furthermore, I do not believe that putting just "good people"
will work. But maybe putting "good people which can also improve the system",
might just work.
>
> Just recently if you may have seen the classifieds in the newspaper, you would
have seen an advertisement by AusAid with an advertisement for a Health Advisor
to AusAid.
>
> There was a committee that was put into place to assess the health system was
working or rather if there was implementation of the health plan. This meeting
was held in 2004, and the outcome of the meeting was that there was no
implementation of the health plans goals and objectives.
>
> It is apparent that there are numerous stakeholders in the form of donor
agencies that are willing to committ money to improving the health system. But
as you may see there needs to be a functioning system in place that ensures good
use of the funds and that improvements are sustainable. This is the angle AusAid
is coming from by trying to get a link with a Health Advisor with the Department
of Health and the stakeholders.
>
> Hence, our system is not working, no matter how old it is.....it is not
working. But trying to improve will be difficult. If our government is not
improving the economy a great deal then how do we expect the health system to
improve.
>
> I guess that is enough of my nonsense.
>
> Lukim
>
> Sioni
>
>
>
> rodney itaki londari2000@... wrote:
> Sio, I am sorry but I have to disagree with you that
> we need a 'new' system. I am satisfied that PNG has
> well mapped put health service delivery system.
>
> What we need is to MAKE THE SYSTEM FUCTION!! as the
> way it was intended for in the first place!
>
> We all know it is the PEOPLE that make the system
> actually function. What is needed is to change work
> ethics (eg earn your paycheck honestly by doing your
> hrs), attitutes (NO 3 hrs lunch breaks) and change of
> behavor among public servants aimed at making the
> public service delivery machinery actually work (eg
> introduce legislations to punish public servants who
> take unathourised leaves, chronic absentees etc).
>
> Let's talk about MAKING the system work. There is no
> perfect system in the world. Any system is as good as
> the people in it.
>
> cheers
>
> ri
> --- sioni sialis ssialis56@... wrote:
>
> > Hello Olgeta,
> >
> > And congratulations to Dr. Kindin and another
> > success story for Dr. Kindin, his family his people,
> > us as his colleagues and the country as a whole.
> >
> >
> >
> >
> > I don't believe we can't afford a medical school;
> > it's how the institution accesses the funds from
> > donor agencies. If there was to be a medical school
> > in Madang, I believe it can be done. DWU has enough
> > of a reputation to easily access these funds.
> >
> > The issue is... PNG needs to improve the health
> > system. When we can do that then another medical
> > school should be built. If we can not improve the
> > Infant Mortality rate and Maternal Mortality Rate
> > since the 1980's, then another medical school should
> > wait.
> >
> > We need a health system that can implement the
> > National Health Plan 2000 - 2010.
> >
> > I'm worried that the political committment will be
> > behind this new medical school, because it looks
> > good. And for the blind people it will look like
> > development. But the political committment should be
> > behind building a Health Service that works. Because
> > as it is now.......the system has failed and needs a
> > major overhaul; oil change, filter change etc. Maybe
> > if the engine has ceased than a new engine has to
> > replace the old for better performance and
> > reliability.
> >
> > Lukim na tingim independence is around the corner.
> > How old are we (PNG)now???......31yrs........so
> > 11years ago our health statistics was the same as
> > now, that we are at 31. Will we have any improvement
> > when we are 41 or by then our country's health
> > system will have a massive coronary.
> >
> > We need improvement and we need to start now to
> > improve; we need the basic health services in the
> > rural areas that are open, with reliable workers
> > that do not run away to Port Moresby and continued
> > to get paid. We need to provide the basic service to
> > the people.
> >
> > Maybe when independence comes by, we can reflect
> > and ask ourselves what we have done to improve the
> > health system? What have we done to improve the
> > country?
> >
> > Truthfully.....I put my head down in shame because
> > I do not feel I have contributed as I should. But
> > I'll take a step at a time to be proactive.
> >
> > Have a good one everyone, and hope you prepare
> > well for the coming independence.
> >
> > Sioni
> >
> >
> >
> > Poyap James Rooney pojaroo@... wrote:
> >
> >
> > Hello Everybody,
> >
> > Good to here from you all. Sio, Welcome back!, was
> > wondering when we
> > were going to here from you again. Willie, I suggest
> > you call the
> > PNGMS directly and talk to someone there to clear
> > things up, no use
> > being in the dark.. I've got the presidents number
> > in my diary there
> > somewhere, if you don't have it let us know and
> > we'll give it to you
> > so you can call. Hope all is going well with
> > everything that
> > everyone is doing. Before i say anything about
> > anything, I would
> > like to reiterate again..CONGRATULATIONS TO DR.
> > KINDIN ONGUGLO for
> > achieving a great milestone for himself and for PNG
> > "FRACP!!!", those
> > five letters represent a lot of hard work, sacrifice
> > and commitment,
> > it truley is an inspiration that we all should
> > acknowledge. WELL
> > DONE KINDIN!!!!! Well done!! Well done!
> >
> > .......
> >
> > ....
> > ..
> > .
> > Medical School in PNG,, guys why do you all want to
> > kid yourselves
> > for ,,, GET real, WE cannot afford ANOTHER Medical
> > school and we
> > should not even think about starting another school
> > until we we get
> > this one to the status that it desrves!!!!! Rodney,
> > Willie and Sio I
> > and disgraced with you guys even contemplating
> > another M3ed School in
> > PNG what the hell are you guys thinking, are you
> > guys loosing touch
> > eith reality or what.........truely, I cannot
> > beilieve you guy...
> > PNG cannot afforad another <Med school and we should
> > not even think
> > about starting another..... ,....
> >
> > What are the fact with this so called Medical School
> > in Madang -- Can
> > we have the facts before we go on any further on
> > this topic because
> > as far as I am concerned the on institute of
> > Medicine that I want to
> > put my time and energy into is at TAURAMA, behind
> > PMGH, otherwise,
> > forget it!!!
> >
> > WAKE UP GUYS, STOP DREAMING, AND GET
> > REALLLLLL!!!!!!!
> >
> > Cheers
> > Poyap
> >
> >
> >
> >
> >
> >
> > ---------------------------------
> > Stay in the know. Pulse on the new Yahoo.com. Check
> > it out.
>
>
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