Shaded from the punishing midday sun, a group of around eight people sheltered under a large mango tree on the edge of Malalaua in Papua New Guinea’s Gulf Province. Among them was Moika, a slight mother of four children, pregnant with her fifth. She sat on the ground separate from the others gazing across an empty field, the construction work on the one road linking Port Moresby, 240 kilometres in the east, to Kerema, 70 kilometres in the west, the only activity to be seen.
Until recently the tree’s arbour was the unofficial waiting room of the town’s clinic where people from miles around could seek treatment for tuberculosis. A new TB out-patient building constructed by Médecins Sans Frontières has a small porch where Moika and others following up treatment TB can now wait if they want to. But old habits die hard and in Gulf Province where TB is rife and undergoing treatment and failing to complete is also all too common.
It has led to a worrying increase in cases of drug-resistant TB (DR-TB) that takes even more drugs to treat and longer to cure. From just two of 20 clinics in Gulf Province (only nine of which are functioning in a very basic capacity), Médecins Sans Frontières enrols around two patients per working day. Papua New Guinea is ranked 5th globally in terms of TB burden, but under-reporting may mean it could sit in an unenviable position at the top of that list. Moika has had TB for around five years and gone through periods of recovery and relapse numerous times. She almost lost her life in 2013, according to her husband Kaia, and now has DR-TB.
Together with Médecins Sans Frontières medical staff based in Kerema, community health workers like Atika, who comes from Malalaua, and treatment supporters like Howard Joe, a local network of education and support for people suffering from TB is being developed in an area that is remote, underserved by health facilities and hard to traverse with crocodile-infested rivers. The geographical challenges make it hard for both patients and Médecins Sans Frontières outreach teams. Having to travel for two days on a boat from the village of Kakoro to Malalaua at a cost of 100 kina ($30) meant Moika was initially unable to stick to the regimen of drugs and first period of injections. But with the help of the Médecins Sans Frontières community health network, and financial support to live close to the clinic, she is improving steadily.
When she arrived at the clinic six months ago with Kaia she weighed just 39 kilos, today she weighs 46 kilos. “I heard about Médecins Sans Frontières and was very happy,” said Kaia. “They are up to date and I liked how they talked to us. I was surprised.” Malalaua, is just one of two existing Médecins Sans Frontières supported TB outpatient clinics, but there are other ways Médecins Sans Frontières are having in impact. Every Friday Howard and other treatment supporters brings patients from miles around to the out-patient building – including his wife Cathy whose TB caused the lymph nodes in her neck to swell to a size larger than golf balls. She too, is now improving and sticking to her regimen of drugs. After her consultation, both Moika and Kaia left smiling, even though they won’t be able to move back to Kakoro for some time to continue her treatment. “I want people to be educated about TB,” said Kaia. “I want Médecins Sans Frontières to reach my village.”