A Pandemic Experience

28 January 2021

Dr Gayathri (Gaya) Jayasinghe, FRANZCOG trainee

After spending 6 months volunteering in Papua New Guinea, I can easily say it is one of the most beautiful and fascinating counties I have ever been to. Despite being home to only 8 million people it is the most culturally and linguistically diverse (greater than 800 languages) country on the planet.
With the assistance of the NSW Regional Committee Travelling Scholarship, I was able to volunteer at Port Moresby General Hospital (PMGH), which is the only public tertiary hospital in the capital of Papua New Guinea. It serves as both the university teaching hospital and the national referral hospital for the country.
Last year alone over 14 500 babies were delivered in PMGH with a MMR of 105/100 000. This equates to around 15 women each year, with leading causes of death being related to sepsis and haemorrhage with confounding factors such as HIV and TB worsening outcomes. PMGH also provides an essential Gynaecological service to the country. There is a plethora of fascinating and unusual gynaecological cases, with significant opportunities to up-skill in surgical technique and experience under the supervision of very talented gynaecological surgeons.
During my time in PMGH the day always started with a departmental meeting, which was based on the foundations of teaching, collaboration, and clinical reflection. These meetings became particularly valuable as the impacts of the Covid -19 pandemic became more prominent. Enabling the department to respond quickly to changes implemented by the government and hospital administration whilst responding to the concerns of the health workers within the maternity department.
The health services of Papua New Guinea are already very stretched. There are significant challenges related to geographical isolation, diverse cultures and customs, as well as a lack of resources, resulting in an underfunded and resource limited system. When the Covid 19 pandemic was announced, the country went into a state of emergency lockdown and several essential outreach health services were prematurely suspended. A poignant and tragic example of the consequences of this was the case of a young primigravida who was not referred to PMGH despite having elevated blood pressures, due to fears surrounding the pandemic. When she eventually presented for care she had severe preeclampsia and went blind.  Despite having an emergency caesarean section her child passed away. I am sure that in rural centres where women are dependent on outreach health centres for antenatal care, contraception and delivery care, there will have been other such tragic examples.

Thankfully essential health services have begun to re-open, as Papau New Guinea transitions into a “new normal” in the context of the Covid Pandemic. However, the collateral effects of this were still being felt even in my last two weeks in PMGH, where two young women died from complications related to Eclampsia over the course of one weekend. Dealing with adverse outcomes in Papua New Guinea was challenging and I often felt guilty at how hard I found it to cope with the gruelling 36-hour on call shifts. The doctors I worked with in Papua New Guinea gave new meaning to the words ‘commitment’ and ‘resilience’!
Despite dealing with significant limitations in funding and resources (at times performing caesarean sections without electricity or light, labour ward shifts with no running water, and frequently running out of essential equipment such as gloves, sutures, and gauze) they were able to keep perinatal and maternal morbidity and mortality outcomes relatively low. This was maintained due to well thought out procedures and protocols (appropriate for the setting, resources, and cultural limitations) as well as through a commitment to clinical excellence through frequent audits, morbidity and mortality meetings and self-reflection. It was by far the most challenging experience I have ever done, but in many ways, the most rewarding. I will never forget the brave and gracious women I cared for, and the stunning beach sunsets capped off by sipping on fresh coconut or an SP Lager.
I would like to make a special acknowledgement of Professor Glen Mola who mentored me during my time in PMGH, and all the dedicated residents, registrars, midwives, and consultants who became my friends and inspired me.

Despite the close proximity to and close relationship with Australia, women and children in Papua New Guinea (PNG) experience unacceptably high rates of death, illness and disease during pregnancy, birth and the postpartum period (a woman in PNG is 80 times more likely to die in childbirth than a woman in Australia, and every year 5,000 babies die in PNG in the first month of life).
The COVID-19 pandemic presents the serious risk of worsening these outcomes both directly and indirectly as essential services are reorientated to contain the disease and care for those affected. Routine maternity care including antenatal care and facility -based births are quickly being side-lined posing added risks to women and newborns.
You can help improve the quality of care in PNG for women during pregnancy and childbirth, particularly in light of this global crisis. Your donation can a have considerable impact on the health and wellbeing of women now and into the future, not only in PNG but across Australia and the Pacific. Donate.

Dr Gaya Jayasinghe receives her award from RANZCOG President Dr Vijay Roach



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