Returning to Bougainville's neglected south after a decade-long absence
Since April this year, a small MSF team has been working in Buin Health Centre in southern Bougainville. Ten years after the signing of the peace agreement following what has become known as the ‘Bougainville Crisis’, the situation in terms of access to healthcare remains dire.
The crisis, a civil war beginning in 1988 and lasting ten years, caused the deaths and displacement of tens of thousands of people, and also left the region’s infrastructure in tatters. Health services were severely limited, and today there is only one functioning hospital for a population of around 200,000.
Although relatively peaceful now, and despite rebuilding efforts that have taken place since the end of the conflict, the southern area of the island continues to be neglected and access to quality healthcare for the population poses substantial issues.
“If the people living in Buin need to go to a hospital, they have six hours to travel, if they are lucky. Sometimes it can take anywhere up to ten hours or more. The only hospital is in the north, on Buka Island, and to get there, it’s necessary to cross about 15 rivers and travel on roads which are not in good condition,” said Patricia Convent, Head of Mission for Médecins Sans Frontières. “There are only ten qualified doctors in the whole of Bougainville, and eight of them are in Buka. People who cannot get to this area easily are therefore left without adequate medical assistance. In an area where malaria is endemic, and where maternal mortality rates are some of the highest in the Asia Pacific region, we saw that we needed to come back.”
MSF is currently the only international NGO based permanently in this remote southern region of Bougainville. In Buin Health centre, the MSF team is working alongside the Division of Health to rehabilitate the facility, and to provide medical assistance in the outpatient, inpatient and maternity departments and laboratory, as well as improving the quality of antenatal and postnatal care. The team also works to improve the hygiene situation in the health centre, through the provision of clean water and better waste management. Due to the lack of qualified medical staff throughout Bougainville, staff training across all departments will also be a core component of the work.
The state of care for pregnant women will be one of the biggest priorities for MSF in Buin. In May, for example, approximately one in four pregnant women was classified as an emergency case.
“We received one woman from a nearby village, who was having seizures during her labour,” said Convent. “She delivered a stillborn baby and stayed two days in a coma. We are so thankful that the woman survived, but without adequate intervention, she would certainly have died. Complications arising during delivery are common in this region, mainly because of the distances women have to travel to get to a clinic.
“For this reason, we are going to be developing a ‘maternity waiting home’ so women can plan to be close to the health centre before they go into labour, instead of having to travel the long distances that they normally would. In June, we had two women who delivered on their way to the health centre, simply because they could not make it in time.”
Since teams began work in April, the number of patients coming to the health centre has increased significantly. In May alone, the medical team saw 741 patients, compared to 1,110 patients in the first three months of the year.
“These figures reflect the need for our return to Bougainville,” noted Convent. “We’ve been told by a lot of patients that they remember us from previous years, and they are happy to have us here working alongside the Division of Health to improve the healthcare situation.”
As part of its intervention in Bougainville, MSF intends to further evaluate the local health needs by conducting assessments throughout other areas in the southern region, and adapt the program to meet these needs accordingly. The team will be looking at how diseases such as tuberculosis are managed in the region, and whether the organisation can offer assistance in addressing these issues.
MSF will also maintain the capacity to respond to medical emergencies in the region, such as disease outbreaks and natural disasters. Already this year, teams were able to assist in responding to Bougainville’s first ever cholera outbreak. The outbreak, confined to Buka Island, saw 521 cases in eight weeks. MSF worked alongside the local health authorities for six weeks, setting up a ten bed cholera treatment centre and two posts to provide oral rehydration salts in Lemanmanu, one and half hours' drive north of Buka Town.
MSF first began working in Bougainville in 1992. After an intervention of approximately six months , teams returned following the Bougainville Crisis from 1998 until 2001. Following assessments carried out in 2010 which found considerable gaps in the healthcare system, the decision was made to return in 2011. In May and June, teams have carried out 1576 outpatient consultations, admitted 153 patients to the inpatient department, and delivered 48 babies.
Elsewhere in Papua New Guinea, MSF is also working In the city of Lae in Morobe province, and Tari, in the Southern Highlands province. Teams are providing care for the medical and psychological consequences of sexual and domestic violence, and also carry out trauma surgery.