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.

Posted in Health | Tagged , , ,

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.


Posted in Medical Training | Tagged , , ,

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



Posted in Medical Training | Tagged , , , | 10 Comments

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.

Posted in Health | Tagged | 11 Comments

Dangers of Prescription Drugs for Seniors

Article by guest blogger Tara Heath.


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.


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.


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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