Proposal for evaluating the operational feasibility and acceptability of Citofem ®, a liquid based cytology test for cervical cancer screening when using Telecytology as an alternative method for smear reporting in the absence of a hospital based pathologist to improve Pap smear result turn-around-time: A Possible Game Changer in the fight against Cervical Cancer in Papua New Guinea.


Cervical cancer is the most common form of cancer in women in Papua New Guinea (Vallely et al 2011). The 2012 Australian Institute of Health and Welfare  report on cervical screening showed a declining trend in the new cases of cervical cancer in women aged 20-69 from the years 1982 to 2007 (AIHW 2012). The same trend was also seen in the mortality rates (AIHW 2012). These trends have been attributed to the national cervical cancer screening program using the Pap test introduced in 1991 (Vallely et al 2011). It is now established that high risk serotypes of Human Papilloma Virus (HPV) infection directly leads to the development of cervical cancer and efforts are also now targeting this virus (Ray and Ryan 2011). Analysis of early results of the use of the HPV vaccine in young women in Australia is promising (Brotherton et al 2011).

Current national efforts in Papua New Guinea (PNG) to control cervical cancer include, adhoc Pap test and the ‘see and treat’ approach based on visual inspection of the cervix with acetic acid plus cryotherapy (Vallely et al 2011). The introduction of the HPV vaccine in PNG is now being discussed (Vallely et al 2011). A national cervical screening using the Pap test has not been adopted in PNG because of inadequate laboratory infrastructure, shortage of cytotechnicians and cytopathologists, limited funding and difficulty in comprehensive clinic follow-up (Vallely et al 2011). Although a Pap test-based screening initiative was established in 1999 by a non-government charity organization the follow-up rate for high-grade epithelial abnormality has been between 30-50% (Vallely et al 2011). In an editorial titled “Achieving control of cervical cancer in Papua New Guinea: what are the research and program priorities?” published in the 2011 issue of the PNG Medical Journal, it was highlighted that research was need to “establish the performance, acceptability and operational feasibility of alternative approaches to cervical cancer screening and treatment of precancerous lesions” (Vallely et al 2011).  Advances in cytology diagnostics and information communication technology offer innovative solutions to the challenges of a national cervical screening program in PNG.

This pilot project proposes to evaluate the operational feasibility and acceptability of Citofem ®a liquid based cytology (LBC) test for use in cervical screening. Although LBC perform interchangeably with conventional cytology (Whitlock et al 2011), its main advantage is reduced rate of inadequate results compared to conventional cytology (Vega et al 2010). Smears from cellular material obtained using Citofem ® create a monolayer of cells on a single plane without debris, mucus or inflammatory cells (Vega et al 2010) making it easier to digitized the glass slide compared to smears made using conventional cytology method (Thrall et al 2011). Telecytology, a component of telepathology, is the interpretation of cytology material at a distance via the internet using digital images (Thrall et al 2011) and offers an alternative to the shortage pathologist in PNG. Because cytology material is difficult to image relative to histology, telecytology has been limited in its clinical applications (Thrall et al 2011). Conventional cytology material frequently contains significant elements of three-dimensionality and cellular material is widely and randomly distributed across glass slides (Thrall et al 20111). Liquid based cytology has the advantage of creating a single layer of cells making imaging easier. Lee and others evaluated the use of telecytology as a tool for quality assurance programs in screening cervical smears and found it to be reproducible and accurate compared to conventional microscopy (Lee et al 2003). These recent advances should prompt us to re-examine the use of cervical screening in PNG and evaluate an alternative cytology test in combination with recent advances in telepathology.

Problem Statement

Cervical cancer is the leading cancer among women in PNG. The role of cervical cancer screening using the Pap smear test has been proven in developed countries that have a publically funded cervical cancer screening program. National cervical cancer screening program has been difficult to implement in developing countries because of various challenges, the major ones being inadequate clinical follow-up, limited funding and inadequate laboratory infrastructure including shortage of pathologists. The Conventional method of cervical sample collection, processing and reporting using the Pap smear test has its limitations. Liquid based cytology (LBC) is proving to overcome these limitations although its costs are higher. Telepathology offers a short to medium term solution to the shortage of pathologists in developing countries. This pilot project will evaluate the feasibility, acceptability and operational requirements of a LBC for cervical screening and telecytology for reporting in two hospitals in PNG.

Aims of Proposed Project

  • Evaluate operational feasibility and acceptability of the LBC cytology test for cervical cancer screening at PMGH and Popondetta General Hospital.
  • Evaluate operational feasibility and acceptability of a telecytology service specific for cervical cancer screening at PMGH and Popondetta General Hospital.

Objectives of the proposed project

  • Determine and document operational requirements and acceptability of the LBC test.
  • Determine and document operational and infrastructure requirements for a telepathology service for cervical cancer screening.
  • Determine the costs of the LBC for cervical cancer screening.
  • Determine the costs of a telecytology service for cervical cancer screening.

Significance of the proposed project

Pap test for cervical cancer screening has a proven benefit. But use of this test for cervical screening in a national publically funded cervical smear program in PNG has been limited due to a number of factors. The major limiting factors have been inadequate laboratory infrastructure, inadequate number of pathologists and high rates of loss for clinical follow-up for abnormal smears. The Pap test also has limitations inherent with the test such as high rate of inadequate smear results which results in increase repeat test rates. Liquid based cytology test has fewer inadequate smear results. In addition cervical cell smears from LBC have less debris, inflammatory cells and mucous making reporting easier. Smears from LBC can also be easily digitized and produce clearer image, a feature that is not possible with smears from conventional Pap test. Because the smears can be photographed easily and digitized, the images can be sent via internet to a pathologist geographically located elsewhere for viewing and reporting hence improving result turnaround time. It also allows increased number of number of smears to be reported by distributing workload to many participating pathologists.

The results of this pilot project will determine the laboratory infrastructure, technical capability and other operational requirements for a LBC test for cervical screening. Such information will also be important for laboratory managers and medical directors who plan to introduce this test into their hospitals. This pilot project will also determine the hardware, software and other infrastructure requirements for establishing a telecytology unit within a hospital and provide baseline data for further research into telepathology in PNG and its role in cervical cancer screening. It is hoped that data from the pilot project will be the basis for follow-up studies exploring the application of telepathology/telecytology not only for cervical cancer diagnosis and prevention in PNG but for other diseases of that require cytology for screening or diagnosis such as breast cancer and tuberculous lymphadenitis.

Literature Review

Population based cervical smear screening has contributed to the decline in morbidity and mortality from cervical cancer in developed countries. The commonly used screening test for cervical screening is the Pap test or Pap smear test. Recently the development and introduction of the Human Papiloma Virus (HPV) vaccine is proving to be effective and will play a major role in the prevention of cervical cancer. And for developing countries such as PNG (Papua New Guinea) considering preventative strategies against cervical cancer, the HPV vaccine may be a cost-effective solution. This is because a population based cervical screening program has been evaluated and thought not to be cost-effective. Other factors such as inadequate laboratory infrastructure, shortage of cytotechnicians and pathologist and inability to clinically follow-up abnormal smear results has also limited a national cervical screening program in PNG.

The conventional Pap test involves the collection of ectocervical and endocervical cells using a wooden spatula or brush and transferring the cells onto a glass slide by making a smear. The glass smear is then fixed with 70% alcohol. The remainder of the cellular material on the sampling device is discarded. The fixed smears are later transported to the laboratory, stained with specific stains and the glass slides are viewed by a pathologist using a microscope and reported. Sample collection in a liquid based cytology test (LBC) is similar to the Pap test but the collection brush has a removable head that is placed in its entirety with sampled cellular material into a container with a fixing solution. This ensures all sampled cellular material is obtained and dispersed in the fixing solution for processing later in the laboratory. At the laboratory, sampled cells are concentrated and obtained selectively using either filters or centrifugation. Inflammatory cells, mucus or cellular debris are also eliminated in this process. The resulting smear slide is clearer containing a monolayer of cells and less or no debris making slide reading easier for the pathologist. The creation of the monolayer of cells also makes it easier for the slide to be photographed and digitized, a feature not possible with cervical smear slides made from conventional Pap test. In terms of diagnostic capability for detecting abnormal cells, the conventional Pap test and LBC test appear to perform equally. However, the LBC test has less repeat and inadequate test results, a feature common with the Pap test. This is an obvious added benefit for patients although it may cost more for the LBC test.

Liquid based cytology test for cervical screening is now being used in the United States, England, Scotland and New Zealand although it has not been accepted for public funding in the national cervical screening program in Australia. Combining telecytology with LBC test for cervical cancer screening is being evaluated and there is increasing evidence to support this approach where there is shortage of pathologists. Reading concordance between telecytology and conventional microscopy for cervical screening is about the same as well although this requires proper training and a good quality assurance program. Screening for HPV can be done with the left over sample from LBC also. These added advantage of LBC and developments in telepathology should prompt us to re-evaluate our position on the use of a population based cervical cancer screening program in PNG for the prevention of cervical cancer. The challenge of clinical follow-up for abnormal test results also needs re-visiting and innovative options need exploring, for example use of mobile phones for alerting patients using automated text messaging solutions. Introduction of the HPV vaccine appears to be way forward for PNG and this option is currently being discussed but it will also require proper planning and funding to incorporate it into the national PNG vaccine guidelines. As a pre-requisite for HPV introduction, epidemiological surveys on HPV stain prevalence also needs to be determined and the LBC sampling method has the advantage of adjunct HPV testing using the sample. Numerous studies have demonstrated that HPV testing is more sensitive than cytology but with reduced specificity. But when coupled with reflex cytology on positive HPV results, there is increased detection rate of CIN3 and CIN 2. This may result in increased referrals for coloposcopy or biopsy procedures. Therefore the net effect of primary HPV testing will need to be determined. Limitations to the use of a population based cervical smear program, including challenges in clinical follow-up in PNG have been documented but recent diagnostic and technological advances such as telepathology should prompt us to re-visit and explore application of these advances in cervical cancer prevention strategies.

Citofem ® is a liquid based cytology test kit used in screening for the presence of atypical cervical cells for the prevention of cervical cancer. After endocervical and ectocervical cells are obtained using the Rovers ® Cervex-Brush ® combi, the handle is disconnected and the head inserted into the preservative Citofem ® cell preservative fluid vial. The vial is later transported to the laboratory for further processing. No sample is discarded allowing for 100% of sampled cells to be analysed and adjunct tests to be done on the sample. Citofem ® can also be utilized for non-gynaecological samples such as sputum, aspirate fluid, urine and cerebrospinal fluid. Compared to other LBC such as ThinPrep ® and SurePath ®, Citofem ® does not require additional expensive laboratory equipment or reagents for sample processing. After staining the cells are fixed with a resin, Culiq ®, that ensures high optical quality and eliminates use of Xylene and cover clips. Although numerous studies have compared LBC to conventional cytology, there is limited data evaluating the performance of Citofem ® against other LBC tests commercially available. When Citofem ® is compared to conventional Pap test, Citofem ® has a slight advantage over Pap test at a comparable cost indicating non-superiority of Citofem ®. Citofem ® also has the advantage of adjunct or co-testing for HPV without further processing of the collected sample, a step required in other LBC tests. All these make Ciofem ® a suitable LBC test for cervical screening for developing countries considering LBC tests in cervical cancer prevention strategies.

Telecytology is a component of telepathology and can be defined as the digitization of cytology images and transmission of these images via a telecommunication network to a remote viewing location for diagnosis, storage or education. Establishing a telepathology unit will require considerable financial investment. A cost-benefit analysis will have to be done in a feasibility study before a final infrastructure investment decision can be made. Experiences from other countries such as China and Japan shows telepathology can be a medium term solution for histopathological diagnostic limitations. The long-term solution for PNG will always be to have hospital based pathologist but this will not be possible in the foreseeable future.  If a telecytology unit is set up for cervical screening, other diagnostic services will have to be incorporated into this service so that establishing such a unit is cost-effective. For example, using a telecytology-based cervical screening program as the platform, other diagnostic services from fine needle aspiration biopsies will need to be considered such as for probable tuberculous lymph node or breast lumps for investigating breast cancer. A major limitation on the routine use of telecytology in clinical diagnosis has been its low diagnostic accuracy which is affected by field selection (sampling error) and inadequate magnification. These challenges can now be overcome with whole slide digitization systems and a pathologist trained in the use of this technology. With appropriate training and a good quality assurance program, accurate diagnosis and reproducibility can be achieved with telecytology systems.


  1. Crouch-Chivers PR. A review of cancer in Papua New Guinea.PNG Med J2010; 53(1-2): 48-53.
  2. Mea VD, Mencarelli R (ed). Proceedings of the 11th european congress on telepathology and 5th international congress on virtual microscopy. Diagnostic Pathology 2013; 8(Suppl 1): S1-S45.
  3. Australian Institute of Health and Welfare. Cervical screening in Australia 2009–2010. Australian Institute of Health and Welfare. Report number: 67, 2012.
  4. Cancer Council Australia. National cancer prevention policy: cervical cancer. Cancer Council Australia. 2013.
  5. Brotherton JML, Masha Fridman M, May CL, Chappell G ,Marion Saville AM, Gertig DM. Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study. The Lancet 2011; 377(9783): 2085-2092.
  6. Vallely A, Mola GDL, Kaldor JM. Achieving control of cervical cancer in Papua New Guinea: what are the research and program priorities?. PNG Med J 2011; 54(3-4): 83-90.
  7. Moss SM, Gray A, Marteau T, Legood R, Henstock E, Maissi E. Evaluation of HPV/LBC: cervical screening pilot studies. Report to the department of health. Cancer Screening Evaluation Unit, Institute of Cancer Research; Health Economics Research Centre, University of Oxford; Psychology and Genetics Research Group King’s College. 2004.
  8. Rai G, Ryan C. Epidemiological surveillance of human papillomavirus prevalence and type distribution in Papua New Guinea: the selection of an appropriate laboratory tool. PNG Med J2011; 54(3-4): 132-138.
  9. Karnon J, Peters J, Platt J, Chillcott J, McGoogan E, Brewer N. Liquid-based cytology in cervical screening: an updated rapid and systemic review and economic analysis. Health Technology Assessment 2004; 8(20): 1-4.
  10. Whitlock EP, Vesco KK, Eder M, Lin JS, Senger CA, Burda BU. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the US Preventive Services Task Force. Annals of Internal Medicine 2011; 155(10): 687-697.
  11. Ronco G, Confortini M, Maccallini V, Naldoni C, Segnan N, Sideri M, Zappa M, Zorzi M, Calvia M, Giorgi Rossi P. Health technology assessment report. Use of liquid-based cytology for cervical cancer precursors screening. Epidemiol Prev 2012; 36 (5 Suppl 2): e1-e33.
  12. Cox JT. Liquid-based cytology: evaluation of effectiveness, cost-effectiveness, and application to present practice. J Natl Compr Canc Netw 2004; 2(6): 597-611.
  13. Vega GM, Gonzaga RM, González JV, Wíscovitch R, Puente SP, PuenteJP.. Papp smear vs liquid based cytology (CITOFEM ®) Praeventio Laboratory, San Jose, Casta Rica from 2003 to 2009.Iberoamerican University, UNIBE, Medical Faculty Magazine2010; 2(1): 1-8.
  14. Lee SE, Kim IS, Choi JS, Yeom BW, Kim HK, Han JH, Lee MS, Leong ASY. Accuracy and Reproducibility of Telecytology Diagnosis of Cervical Smears.A Tool for Quality Assurance Programs.  Am J Clin Pathol 2003; 119: 356-360.
  15. Thrall M, Pantanowitz L, Khalbuss W. Telecytology: Clinical applications, current challenges, and future benefits. J Pathol Inform 2011; 2: 51.
  16. Colombari R, Mencarelli R, Gasparetto A, Cogo C, Rizzo A. Telepathology in cervical and breast cancer screening programmes. Diagnostic Pathology 2013; 8(Suppl 1): S28.
  17. Kldiashvili E, Schrader T. Reproducibility of telecytology diagnosis of cervical smears in a quality assurance program: the Georgian experience. Telemed J E Health 2011; 17(7): 565-568.
  18. Aminisani N, Armstrong BK, Canfell K. Uptake of liquid-based cytology as an adjunct to conventional cytology for cervical screening in NSW, Australia: a cross-sectional and population-based cohort analysis. BMC Public Health 2013; 13: 1196.
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Kumul Game Changers: Creating Generation NEXT in PNG!

I had this idea when studying in Japan in 2005 but everywhere I looked and searched, all I received was negativity. Even PNG National Department of Health analysed this idea and said it was too expensive and not worth the investment.

Now I get a change to make an impact with this idea thanks to Kumul Foundation and Kumul Game Changers.

Next week in I get to attend a 2 day workshop facilitated by world-renowned trainer Henrik Sheel. And I get to refine my idea and pitch to a panel of investors.

I really believe the idea I have can make a real impact and save many lives in PNG. I just need a chance to show how it works. And I know it will work!!

I am halfway there. The next few weeks would be a very steep learning curve, adrenaline rush emotional roller-coaster for me.

Will keep you all posted on this blog.

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Problem Based Learning at UPNG SMHS: An Urgent Need For Review

I just came back from the Australasian Institute of Anatomical Sciences conference in Hobart, Tasmania, Australia (2014 conference) where I presented a paper titled: “Challenges of teaching anatomical pathology in Papua New Guinea; current challenges & the future”. 

My paper discussed the history of problem based learning curriculum introduction at the UPNG medical school and the impact it has on how anatomical pathology is taught to medical students. I then went on to discuss challenges we are having such as deteriorating infrastructure and lack of resources for effective teaching. And I proposed a way forward for us and that is to use digital images available on the internet and virtual pathology resources.

There were a lot of papers presented at the conference. And one of the things that was very clear to me was that the it seems to me the mode of teaching in medical schools around the world is coming around in full circle. What do I mean?

Traditionally medical students were taught in medical schools via lectures, tutorials and practical classes. And the basic sciences were a big part. Anatomy in particular involved dissection of cadavers. Then there was a shift in teaching philosophy started in Canada at the MacMaster University where the shift changed to self-directed learning or Problem Based Learning as it is commonly known. At this year’s AIAS conference I realised medical schools in Australia are reverting back to the “old” way of teaching or having a hybrid of the two. In fact there is mounting research data that suggests that there is no difference in the outcome comparing the “old” way of teaching medical students and the PBL way of teaching medical students.

What does all this mean for UPNG Medical School? There have been numerous calls to review the PBL curriclum. And there have been a lot of discussion on the perception (real or otherwise) that basic medical sciences are not taught effectively to medical students. There was a review of the curriculum recently in Port Moresby. And one of the main themes that rose was that the basic medical sciences are not being effectively taught! Now this is coming from lecturers at the medical schools! Does this mean we have to change back to the “old” way of teaching?

My view is that we need to have a hybrid, of the “old” and PBL way. I have always maintained that PBL curriculum is a resource intensive way of teaching medical students. There are of course other factors involved but primarily I think it needs more resources..lecturers, tutors, resources for self-directed learning etc..

I think UPNG Medical School need to seriously consider having a hybrid system and not purely PBL because we have not been able to fund the implementation of this curriculum effectively over the last 10 years since it was introduced. There are many senior academics who will disagree with me but we have to admit PBL is not working effectively for us and we need to change it in a big way. I do not see the medical school having adequate lecturers and tutors let alone the resources in the foreseeable future to change things around.

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University of Papua New Guinea School of Medicine & Health Sciences: “To Be Or Not To Be Stand Alone University? That Is The Question”.

Should the School of Medicine & Health Sciences (SMHS) of the University of Papua New Guinea be a stand alone university?

Why ask this question?

The SMHS is on life support. It is struggling to survive, let alone do its functions effectively. The main issue here is funding. Adequate funding to improve infrastructure, improve staff remuneration packages, improve staff numbers. These things have not been addressed over many years by successive governments and now the SMHS is struggling. A recent World Bank report on the PNG health workforce showed PNG has an aging health workforce. PNG’s health training institutions are not producing enough to meet the growing needs of the population. UPNG SMHS is one such training institution. I believe if SMHS become a stand alone university, it will be able to attract adequate funds on its own. Currently, SMHS is competing for the same funds that rest of the schools within UPNG are also demanding. Mind you, they also need funding. Other schools within UPNG may have they own strategies, but for SMHS, we must be stand alone university.

If Vudal and Goroka can become stand alone university, why can’t SMHS? SMHS has the administration and curriculum in place. We need only to the change the legislation to make this happen!

Status Quo of SMHS

Currently, SMHS is competing for the same funds as other schools to run its programs annually. SMHS currently runs the medical degree program (its flagship program), nursing, medical imaging, pharmacy and medical laboratory sciences. Within each of these strands, there are various divisions which are further divided into disciplines. Take medicine for example. Medicine has: Division of basic medical sciences (anatomy, physiology, biochemistry and pharmacology disciplines), Division of Pathology (Chemical pathology, anatomical pathology, medical microbiology, haemotalogy, immunology disciplines) and Division of Clinical Sciences (Medicine, Surgery, Pediatrics, Obstetrics and Gynaecology, Anesthesiology disciplines) and Public Health Division (with its own disciplines). And on top of these you add nursing, medical imaging, pharmacy etc. And we are all competing for funds from national government through UPNG to operate every year. SMHS can not continue to operate in this manner. Change must take place.

SMHS has also not been given the national prominence it derserves in national building. It has been silently suffering and trying its very best.

Why the change?

SMHS stand alone university will send a clear message that this institution is vital for national building and is the national institution to consult on health training matters. The government must give the recognition it deserves.

There are various nursing, community health workers schools and other cardre of health worker training institutions being established in PNG. A stand alone SMHS university will set the minimum training standards and curriculum requirements. Its simply not possible to do under the current status quo. We can not expect the Ministry of higher education, science and technology to do this. A university must be mandated by the government to do this and assist the ministry.

Funding. A stand alone university with change of legislation will ensure direct funding from national government. SMHS do not have to fight for limited number of cake pieces with other schools within UPNG. A stand alone university will also attract direct research grants.

The future

If SMHS continue to be part of UPNG as a school, the problems its facing (infrastructure, staffing, etc) will not be solved. SMHS need to cut its umbilical cord and stand on its own two feet.


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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.


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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