It’s barely a whisper when 14-year-old Patricia Oome speaks, and her movements are laboured as she struggles to find a comfortable position on her bed.
A room full of children shouldn’t be this quiet, but like many admitted to the paediatric ward of the Port Moresby General Hospital (PMGH), Patricia is weak from severe malnutrition – a result of often eating just one meal a day as her family feels the financial strain of having seven children.
She also has tuberculosis, a disease rare in Australia but which has one of the highest prevalence rates in the world in Papua New Guinea, where about 7000 children are infected each year.
Tuberculosis is preventable and curable, yet it is one of PNG’s leading causes of death.
“It’s Africa on our doorstep,” says Dr Katie Allen, the MP for Higgins who had a successful career as a paediatrician at the Royal Children’s Hospital in Melbourne before entering politics in the May election.
“I think Australians are not quite aware of how our nearest neighbour – we’re part of the Pacific family – is in need of our support,” Allen said while visiting the ward on a cross-party parliamentary delegation to see projects supported by the Australian government.
As Australia’s closest neighbour, PNG’s health security is a shared concern.
It’s only a 95-minute flight from the capital, Port Moresby, to Cairns, and when Queensland Senator Nita Green asks how far PNG is from Australia’s most northerly inhabited island, Boigu Island, an official from PNG’s National Department for Health replies: “If they shouted on one island, they could hear it on the other.”
PNG is Australia’s largest aid recipient at $607.5 million – almost half of the entire budget for the Pacific – with the emphasis on partnerships to improve healthcare and education.
Some of that aid money goes to the Child TB project at PMGH, which started in mid-2016.
A few beds down from Patricia is 13-year-old Sylvester Begama, who was admitted in 2017 “gasping for air”, pediatric ward senior nurse Wama Murray remembers. “He was very, very malnourished. He couldn’t walk.”
His treatment included a high-nutrient and energy milk formula designed specifically to treat severe malnutrition. After nearly two years in hospital, Sylvester beams when he says he has just one week until he’s discharged.
The concern, though, is what will happen once he stops receiving treatment. Murray acknowledges the challenges facing patients after they are discharged – the financial difficulties many families face are one of the main reasons for poor nutrition.
One of the causes identified for the high rates of tuberculosis in PNG is patients not completing their antibiotic treatment. To prevent this, they have clinics where nurses make sure patients take their medication.
Every morning, rain or shine, since April this year, Racheal Uwona and her daughter have made the short walk to one such clinic to receive their TB treatment. A nurse methodically cracks open the various blister packs and ticks off the medication they are about to receive – 11 pills for Racheal and eight pills for seven-year-old Linda.
Linda doesn’t even hesitate as she swallows all the pills in one go. They have been visiting the clinic for the past four months and they are expecting treatment to continue for at least another 20 months.
Taking healthcare to the hills
The undulating mountains of the Highlands region are beautiful but also emblematic of the challenges facing the delivery of healthcare in remote regions.
The parliamentary delegation – Labor’s Nita Green and Josh Burns, Centre Alliance senator Rex Patrick and Liberals Katie Allen, Hollie Hughes and Dave Sharma – travelled from Goroka to Kainantu to visit a community health outpost. Escorted by security guards in a four-wheel-drive convoy, the 80-kilometre journey took more than two hours.
The leader of the delegation, Save the Children Australia chief Paul Ronalds, is forced to jump out of a Land Cruiser at one stage to shepherd bemused children on their way to school away from the vehicle as its wheels spin in thick mud.
Some of these remote communities have healthcare come to them.
A modern clinic on the back of a truck sits like an oasis at the side of the Highlands Highway on the outskirts of the Western Highlands town of Mount Hagen, with mothers bringing their babies to get their vaccinations.
The free maternal and child healthcare service is what Douglas Apeng and his organisation Susu Mamas does, one of the success stories of PNG and Australian government partnership funds.
For Ruth Ismile, it means her month-old son, Carlvert, can receive his tetanus vaccination for free and without them having to make the journey into town.
With malnutrition and stunted growth in children endemic to PNG, one of the main objectives of Susu Mamas is promoting breastfeeding, and Apeng takes great pride in promoting a family-friendly workplace.
“As an organisation we walk the talk – when our staff have delivered their babies, they bring their children to work and breastfeed,” he says. There is also transport provided to take children of staff to school.
Bernadette Ove, the principal of Jubilee Catholic Secondary School in Port Moresby, remembers a time when girls would face disparities in education.
“A lot of parents did not really value a girl’s education, that’s why the majority of the women who would be about my age, in my sixties, did not receive that kind of an education that would have really prepared us very well,” she says.
School fees were prohibitive and when forced to choose, parents would often pick sons over daughters to receive an education. Ove says that is changing now and she is seeing higher numbers of female enrolments.
In 2012 the PNG government introduced the Tuition Fee Free policy, removing one barrier to education for those from a lower socioeconomic background.
Getting the students into schools is one thing, but there is also a need to improve the quality of early education and to support teachers with professional development in teaching literacy and numeracy.
A survey by Save The Children’s Rapidly Improving Standards in Education (RISE) program of 253 schools in Eastern Highlands province found that only 12 per cent of schools had electricity, 7 per cent had a library and 55 per cent of children could not identify any words in English, one of the country’s national languages (although Tok Pisin is the language most widely spoken).
The RISE program, supported by the Australian and PNG governments, aims to improve the quality of schooling and address some of the gender inequity facing girls by supporting them to stay in school.
Ove is hopeful that improving education for the girls of PNG will lead to a brighter future for the country: “I’d like to see more women coming out, being able to represent the people and being able to make decisions together alongside their male counterparts.”
Pathways from gender-based violence
From a young age, Jacqui Joseph was always aware of the challenges facing girls growing up in Port Moresby. If it’s not being robbed on the way to school, it is the constant fear of being touched inappropriately during the bus ride there.
Today, she is the CEO of Equal Playing Field, an organisation that uses sport to promote gender equality and prevent violence against women. Their programs have boys and girls taking part in mixed-gender sporting competitions, with educational sessions on respect and relationships.
Joseph said setting boundaries is a topic they cover: “In a sporting field you see boundaries, they are very clear, the white lines, the referee will tell you, the markers are there, but in a relationship are they that clear? Boundaries in relationships are not that clear.”
A 2015 report from the Overseas Development Institute paints an appalling picture for gender-based violence in the country, with 41 per cent of men admitting to having raped someone and estimates of over two-thirds of women suffering some form of physical or sexual violence in their lifetime.
Last year Angelyn Amos was beaten by her partner of five years until she passed out. He had cheated on her and she wanted to walk away from the “emotionally abusive and controlling relationship”.
When she regained consciousness from the beating she jumped from the verandah of her home, injuring herself, and fled in desperation to her mother’s place.
“At the time I wanted to just kill myself, I didn’t want to go back to that environment,” Amos said.
Bel isi, a case management centre operated by Femili PNG, a non-government organisation supported by Australia, assigned her a case worker who helped her get a protection order and prepare court documentation, allowing Amos to go back to work and get her life back on track.
Amos reflects on the many challenges facing the women of PNG, from the basics of safety to gaining leadership positions.
There is not a single woman in the country’s current parliament and there have only been seven since PNG gained independence from Australia in 1975.
“I have met incredible Papua New Guinea women who are doing amazing things, they are leaders in their own right but their stories are not being told,” Amos says. “Once people start taking in that women can take up these kinds of positions and these kinds of roles in other areas, that will translate into women in politics and women in parliament.”
After seeing Australia’s aid programs firsthand, first-term MP Katie Allen acknowledges the complexities but is optimistic.
“It’s always easy to give up hope and not to keep trying. I personally think there is a sense of change in the population demographics but also a sense of change in attitudes … I think we will see rapid development happening in a very transformative way.”
Alex Ellinghausen travelled as a guest of Save the Children Australia. The trip was funded by the Bill and Melinda Gates Foundation.
Alex Ellinghausen is The Sydney Morning Herald and The Age Canberra bureau photographer