Debate On Training of Medical Doctors in Papua New Guinea

One of the hot topics debated during the recent medical symposium in Goroka recently was on the training of medical doctors in PNG. The general opinion of recent and senior medical doctors present during one of the discussion session was that the quality of medical training was declining and that there was a need to review how doctors are training at the UPNG SMHS.

There were two major themes:

  1. The urgent to need to review the PBL curriculum and modify it to suit our settings in PNG.
  2. Urgent need for government intervention to improve infrastructure, increase staffing and improve staff salaries at the UPNG School of Medicine.

There were also newspaper reports of this issues as well.

Below is a letter to the editor of Post Courier from Sir Prof. Isi Kevau, Professor of Internal Medicine at UPNG SMHS in response to the one of the newspaper reports.

I was the student leader mentioned in Sir Kevau’s letter below that made the trip to New Castle in 1999.

I was asked to write a report back than (as a third year medical student). My recommendations back in 1999 was:

  • Modify the PBL curriculum to suite PNG setting i.e essentially years 2 & 3 to be solely dedicated to teaching Basic Medical Sciences using the traditional method of teaching.
  • PBL mode of teaching in years 4 & 5.
  • Review how students are selected i.e stick to science foundation as the entry pathway or increase quota of post-graduate students coming in.

This was based on my observation at New Castle that a large proportion of their medical student were first degree holders and I also saw that the PBL curriculum was a resource intensive curriculum (something we do not have a lot of in PNG).

Read below the letter.

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Quality of doctors rising – Prof Sir Isi Kevau
(Post Courier 12/09/14)

I take issue on the front-page article of your paper on Tuesday September 2, bearing the title “standards down” followed by the Editorial the next page; admittedly the Editorial was more positive.

The report was based on accusations made by three of my old students. They alleged that the School of Medicine & Health Sciences (SMHS), UPNG is churning out sub-standard graduates, that there is lack of qualified teaching staff and that the graduates will not be recognised as medical officers in other parts of the world.

I say that these accusations are unwarranted and certainly unprofessional. Further, to discriminate against one’s own siblings in the family of PNG doctors, is a sorry state of affair.

Amazingly, the call was made by doctors who graduated from the same institution when it was then the Faculty of Medicine, UPNG. It is worth mentioning that those senior doctors and the graduates they accuse of being sub-standard in quality have one thing in common — that is, they have been taught by the same academics and clinicians (including the author of this letter) in the same institution under the same rapidly decaying infrastructure.

The difference is the curriculum.

The traditional curriculum used at the Papuan Medical College later Faculty of Medicine, UPNG ran for 39 years (1960 to 1999). I was trained under this curriculum from 1969-1972 as the pioneer MBBS (Bachelor of Medicine, Bachelor of Surgery) student. For the last 14 years (2000 to the present time), the Problem-Based-Learning curriculum is used at the SMHS.

Why and how did we change? By the beginning of 1990s, new methods of learning and teaching were developed in other parts of the world. In 1998, the Faculty of Medicine, UPNG felt it appropriate that a curriculum review was necessary and that newer and innovative methods of learning needed to be explored.

From our searching, we discovered that McMasters University in Canada had developed an innovative curriculum-based on student-centred learning. Later we learnt that, closer to home at the University of Newcastle, NSW medical students were taught under Problem-Based-Learning (PBL) curriculum. The Faculty wanted to explore this path.

In 1999, a group of academics including the author of this letter, student leaders [ this part inserted (Dr Rodney Itaki was the student leader)] and the then Dean, Dr Francis Hombhanje, visited the University of Newcastle to know more about the curriculum and assess its applicability in PNG. The group presented its findings to the Faculty.

Approval was granted to use the new curriculum and with UPNG’s Council’s endorsement at the end of that year, the PBL curriculum was adopted. It was started in January 2000 to 2nd, 3rd and 4th year MBBS (Bachelor of Medicine, Bachelor of Surgery) students.

The first PBL medical graduates, 48 in number, came out in 2004. Since then we have graduated 481 medical doctors with MBBS, 25 clinical specialists with Master of Medicine.

I am very proud to reveal that two of the PBL graduates have completed their doctorate requirements and are about to graduate from Australian universities with PhDs. These are Dr Paul Pumuye, a young academic groomed at the SMHS in molecular biology and Dr Moses Laman who is based at the PNG Institute of Medical Research. Dr Pumuye’s PhD is from La Trobe University, Victoria and that of Dr Laman’s is University of Western Australia. Another two are going to Australia to embark on PhD studies.

During the Goroka Medical Symposium, two senior Australian doctors, Professor Frank Shann and Professor Trevor Duke, both based in Melbourne were very impressed by the quality of PNG medical graduates who presented top-quality papers based on clinical and scientific research they conducted.

I am very proud to be the teacher of PNG doctors who are graduates of both the traditional and the PBL curricula; they have all been very impressive. I say that expressing negative comments about our own medical siblings is counter-productive.

The way forward for all of us is to push the Government of the day to improve the 1960 infrastructure at the School of Medicine and Health Sciences, UPNG, Taurama Campus. Massive scaling-up of infrastructure, laboratory developments and staff numbers must occur immediately so that we can increase our MBBS intake from 60 students in 2nd Year to 100 students.

I am happy to learn that the Government since the 2014 Medical Symposium is taking steps and listening to our grievances. Let us remain united in the direction of increased student intake and more medical graduates from SMHS, UPNG.

Professor Sir Isi H.Kevau. Kt, CBE, MBBS (UPNG), MMed (UPNG), PhD (Syd), FRACP
Professor of Medicine & Former Executive Dean, SMHS, UPNG

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What is the link between Hallucinating & Suicide?

Hallucination and suicide have a strong relationship. People who hallucinate tend to die by suicide or attempt suicide. There is a strong genetic link and most people who hallucinate have a strong family history where family members have experienced similar symptoms.

Hallucination can be auditory where the sufferer will hear actual voices (not thoughts), visual where the person will see people who are not real or combination of both.

Hallucination is caused by many mental illnesses. It can be difficult to diagnose these disorders because many normal appearing people may suffer from hallucination due to some mental illnesses and live a normal life and behave normally.

People who suffer from mental illnesses that have hallucination symptoms have a difficulty interpreting reality. That is, it is difficult for them to tell the difference between what is real and what is the hallucination. Over a long period of time their world of reality and what is not become one if not diagnosed and treated.

 

How can hallucinations contribute to suicide?

Many people that hallucinate from mental disorders hear voices or see imaginary people who talk to them. These voices or imaginary people maybe telling uncomfortable things to them, demoralizing, threatening or even commanding or instructing them to do things. The sufferers have no control over this. Majority of sufferers do not act on these voices or carry out the commands from the imaginary people. However, some people will follow their commands or instructions and can die by suicide as a result of acting on the commands. The chances of dying by suicide or attempting suicide due to acting on commanding hallucinations (whether voices or people talking) are higher in young people. These voices or imaginary people are real to the sufferers. It is not a like a thought running through their head but rather like someone in the room and tells them to do something. The voices and the imaginary people can be very annoying and persistent and do not go away not matter how hard the sufferer tries to avoid them. It can only be controlled by medical assistance.

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Medical Research in PNG: Challenges & Opportunities

I am researching for a presentation I plan to give at the Menzies Research Institute, University of Tasmania in June and from my discussions with my peers and some seniors clinicians in PNG, I am getting the impression that lack of training in research techniques and methods is a major challenge for PNG medical researchers.

Another theme coming through is PNG doctors are overwhelmed with clinical patient care that time to think and plan research is lacking among many PNG clinicians.

Most PNG clinical doctors think PNGIMR should lead the way to promoting clinical medical research among PNG doctors. Promoting and making accessibility to PNGIMR’s various resources should also be easier for clinical researchers.

UPNG Medical School is another institution that can lead medical research.

Despite the many challenges, PNG is a gold mine for medical researchers and many young researchers can make a name for themselves in their field of interests as data is lacking in many areas, particularly tropical diseases. There is also a lot of opportunity for operational research among our many busy PNG  clinical doctors as well.

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Dangers of Prescription Drugs for Seniors

Article by guest blogger Tara Heath.

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The Dangers of Prescription Drugs for Seniors

Health issues are an unfortunate but common result of aging. For that reason, many seniors take prescription drugs on a regular basis, and some take several different prescription medications each day.

While all of the drugs prescribed by doctors are considered safe and approved for use, that doesn’t mean that they aren’t without risks. Combining prescription drugs may end up being even more problematic.

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Doctors Can Make Mistakes

According to Well, a New York Times-based blog, a recent study shows that about one in five seniors that takes part in Medicare is being prescribed a drug that health authorities have advised against giving to seniors because of potentially severe side effects. While this problem is particularly common in the Southern United States according to Well, the fact that even trusted doctors may not always make the correct decision when it comes to prescription drug choices is a bit concerning, and something all seniors should keep in mind.

If you’re taking prescription medication or caring for a senior that does, take the time to do the research on the medication and evaluate whether it’s appropriate for their age group. This type of information can easily be found online, but a conversation with a qualified pharmacist or an opinion from a different doctor can be helpful, as well.

Side Effects

Unfortunately, the risk of side effects is always present with prescription drugs, but these problems are easily compounded in seniors – especially those with several medical problems. While most doctors don’t prescribe medications that have more severe side effects for seniors, each individual reacts differently.

Some seniors may not fully understand the side effects of a drug before taking it, or may not be aware of the fact that a drug could be problematic because of a past health condition. The side effects of many prescription drugs are also made worse when combined with over-the-counter drugs – something many seniors don’t think about.

Combining prescription drugs and over-the-counter drugs also has the potential to lead to a variety of serious health problems, and all over-the-counter drugs should be approved by a doctor.

Seniors or anyone caring for an elderly individual should always talk with the person’s doctor about side effects and the individual’s medical history before starting a new prescription.

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Addiction Is a Real Concern

When most people think about prescription drug addiction, they aren’t thinking of seniors who are prescribed medicine by the doctors for short-term or chronic health problems. However, many of the drugs seniors take can be additive – even when they’re taken as recommended.

This is particularly true of opioid painkillers, drugs that affect the central nervous system to reduce anxiety and treat sleep disorders, and stimulants prescribed for anxiety and other problems like narcolepsy.

If you, a parent, or a loved one is prescribed any of these drugs, make sure the person taking the medication understands the risk of addiction and talks to their doctor about it.

Many seniors need prescription medications in order to stay healthy and function properly on a day-to-day basis, and for most, prescription drugs are incredibly beneficial, but that doesn’t mean seniors should simply take anything prescribed to them by their doctor without understanding the medication and doing research.

If you’re caring for an elderly family member or loved one, the task of researching medications and asking questions may fall to you. Take the time to check out any new prescription drugs or changes in medication when they occur to avoid as many complications down the road as possible.

Tara Heath is a freelance writer in Southern California. She knows how dangerous prescription medication can be and encourages those taking it daily to do their research first. As a health writer, she contributes to the Presidio Home Care blog.

 

 

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New Years Greetings! With a Bang! Serious Allegations Around Re PNGIMR. Reputation at Risk?

Hello Readers, and welcome to 2014.

I am introducing you to 2014 with a bang. Serious allegations of nepotism and mismanagement at the Papua New Guinea Institute of Medical Research aka PNGIMR as surface on the internet.

A blog that has been exposing widespread corruption in PNG www.pngexposed.wordpress.com has posted a blog with allegations that may have widespread ramifications within the PNG Medical Scientific community.

Read more about it here: http://pngexposed.wordpress.com/2014/01/18/nepotism-and-mismanagement-at-png-institute-of-medical-research/

 

 

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Precious Metals & Allows: How They Have Significantly Impacted the Metal Industry

Article by Guest Blogger – Gerald Jackson. The article below is by a guest blogger.

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Precious Metals and Alloys: How They Have Significantly Impacted the Medical Industry

The medical and dental industry relies on tools and instruments that are durable, reliable and can be machined to extremely precise measurements. Many of those instruments are used in life saving procedures where exact accuracy is needed. For instruments to work as they should and be able to perform the tasks they are designed for, precious metals and specific alloys are often used to manufacture them.

Gold, silver, platinum and palladium are the metals of choice for medical manufacturing companies. Because precious metals are often less substantial than steel or iron, other metals like copper, zinc or tin are added to them for stability and strength. The new alloys are stronger, more durable and will not corrode or rust like tools made out of iron or steel. Because of their unique composition, medical machining can be performed much easier, allowing for extreme accuracy and precision.

The impact precious metals and alloys have had on the medical industry is immeasurable. Instruments are not the only items made from these durable materials. Dental implants, cardiovascular implants and neurological stimulation devices are also made of high quality alloy-based precious metals. Drug-delivery systems and endoscopy devices also require the use of instruments made of special metals and alloys.

Medical machining of devices allows them to be manufactured to exact specifications. Being able to do so allows doctors to implant devices made of these metals into extremely tight spaces within the body. The ability to perform medical procedures that involve micro technology would not be possible without the use of instruments and devices made from these materials. The precise nature of many medical procedures requires physicians to use medical instruments that have been machined to 1/1000th of an inch, in some cases.

One of the main benefits of using precious metals and alloys is that they do not corrode or break down if implanted within the body. Metal screws, plates, pins, dental implants and neurological simulators are meant to remain within the body for long periods of time, constantly being exposed to heat and moisture. Because of how they are made and the types of metals used in the manufacturing process, these devices are capable of performing quite well within their intended environment.

Medical instruments that are manufactured by medical machining techniques are designed to be used during specific procedures must also be extremely accurate. The use of metals such as copper and zinc to stabilize and strengthen precious, weaker metals allows them to be used in operations where delicate precision and firm pressure are needed so the physician can work freely and effectively. Clamps and sutures are just two surgical tools that have been greatly improved with the use of precious metals and alloys.

The use of gold, silver and other precious metals also reduces the risk of allergic reaction or rejection by tissues within the body. Objects implanted or used within the body for long periods of time can be “rejected” by the body. When this happens, the immune system recognizes the implant as an intruder and begins to attack it causing pain, inflammation and other physical symptoms. By using precious metals to manufacture these devices, the risk of rejection and subsequent infection is dramatically reduced.

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I publish articles from time to time from guest bloggers. Email me if interested.

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Tackling Tuberculosis in Papua New Guinea: Guest Blogger Article.

The article below was from a guest blogger – Claire Holt.

Tackling Tuberculosis in Papua New Guinea

 For twenty years the World Health Organisation (WHO) has recognised tuberculosis (TB) as a renewed threat to global health. Progress had been made in stabilising numbers affected by the disease with vaccines and targeted treatment, but the emergence of new drug-resistant strains of mycobacterium tuberculosis and shortages of medication has meant a decline in the effectiveness of treatments. This has been particularly devastating for health in Papua New Guinea (PNG), which now has the highest rate of TB in the Pacific region with around 15,000 cases, registered annually of which 3,500 prove fatal.

 TB is prevalent in the environment and can be transmitted through tainted food and water or by inhalation of droplets produced by an infected person’s coughs or sneezes. TB is highly contagious so that even breathing air close to a person carrying the bacteria can put you at risk. Only 10% of people infected will develop the disease. Eating a healthy diet and getting enough sleep and exercise can help to build immunity and guard against the severity of its effect as well as play an important role in recovery, but poor living conditions increases the risk of developing TB and hampers recovery, and underfunded care systems result in increased fatalities.

 Treatment problems

 A cure of even the common forms of TB involves four different antibiotics and six months of treatment. The symptoms usually clear up quickly although the disease is still present. This means that close supervision of patients is necessary, particularly as side-effects can damage the liver or eyesight. In PNG it is common for patients to receive only partial treatment, which means a relapse is more likely and the bacteria may mutate into a new strain of drug resistant TB (XDR-TB) or multiple drug resistant TB (MDR-TB). New drugs used against MDR-TB may be less effective, require a longer course of treatment or be more toxic to the patient and more expensive, further straining an underfunded health system. The control of tuberculosis worldwide requires early diagnosis, effective medication and completion of a patient’s course of treatment.

 The view from Australia

 The prevalence of TB in Australia is low, with numbers at about 12,000 annually, 85% of which occur among people born overseas. The percentage of MDR-TB cases is stable at about 2%. Numbers of cases transmitted within Australia is low. However, the disease is able to spread south from PNG across the Torres Straits, with symptoms developing only months or even years after the patient has settled in Australia. In 2011 Australia increased its support for PNG’s fight against TB to the tune of $1.1 million. In October 2013 Australia’s Burnet Institute, an NGO dedicated to improving the health of poor and vulnerable communities, launched its Stop TB campaign. The institute’s infectious diseases expert Dr Emma McBryde had spent two weeks in PNG’s western province assessing the TB situation. She said: ‘Not only were there vast numbers of tuberculosis specific beds in every hospital but almost every bed in every hospital was taken up by patients who had TB or were suspected to have TB or were likely to have TB.’

 The HIV/AIDS and addiction problems

 Many TB patients contract the disease as a result of reduced immunity due to HIV/AIDS, which has increased in PNG over recent years despite progress in HIV/AIDS treatment – to a large extent because of the country’s diverse geography and culture and its communication and transportation problems. However, this trend has showed signs of stabilizing and declining in the last 5 years. High levels of casual sexual activity, alcohol and drug use, and the difficulty of educating the population about preventing the spread of HIV have made its containment difficult. The risk of contracting TB increases in people who consume alcohol in quantities above 40g per day, or if they have an addiction problem, either to alcohol or other recreational and illicit drugs, which is a major problem in PNG. TB and other infectious diseases including HIV/AIDS are particularly prevalent among addicts who inject drugs, although there is no evidence that injection drugs users exists in PNG. There is now also the problem of increasing acquired HIV Drug resistance, which alongside the growing problem of MDR-TB creates a picture of disease in the country that only greater investment in the health and education services will begin to solve.

 The challenge for the future

 Supply, transportation and communications are still major problems. The Burnet Institute’s Dr Emma McBryde said: ‘Occasionally people will turn up to a clinic to be told there are no drugs available. There are other challenges as well. People might live in a rural community but their treatment service might only be a short distance away by our terms, but if they have to use a long boat to get there and that costs money, and takes a long time, then it’s very hard to access healthcare.’

According to the PNG National Department of Health, one person dies from TB in PNG every two hours. The increasing incidence of MDR-TB makes the challenge of combating the TB problem even more pressing. The WHO 2013 update on the global response to the problem of MDR-TB shows that its 2009 targets for patients enrolled on courses of treatment fell short in 2011 by about 80,000 and that projections based on the current figure still fall short, with an ever-widening gap between 2009 and current projections. However, it does say that ‘48% of patients with MDR-TB enrolled on treatment in 2009 were reported to have been successfully treated.’

 New facilities

 In July 2013 a new TB ward with 22 beds was opened at Daru General Hospital with financial support from the Australian government to provide ‘targeted assistance to help the PNG government address TB in the Western Province.’ This is the first isolation ward in PNG that complies with international standards for the care of patients with infectious diseases, with 6 isolation rooms for patients with infectious TB and accommodation and washing facilities for careers. The Australian government also pledged over $30 million for the support of health services in PNG, including specialist TB doctors and nurses, community health training, a sea ambulance, laboratory diagnosis, the upgrading of Daru Hospital and Mabaduan Health Centre and improvements to Western Province primary health care.

The new facilities were opened by the PNG Hon Minister for Health and HIV, The Hon Michael Malabag MP, with Australia’s Parliamentary Secretary for Pacific Island affairs, Senator The Hon Matt Thistlewaite, who said: ‘This is the approach Australia supports and it is saving lives. Data from Daru Hospital shows that mortality rates from multi-drug resistant TB fell from 25% to 5% between 2011 and 2012.’

 

This blog publishes articles from guest bloggers from time to time.

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