By Leon Elia
In a remote Papua New Guinea village, Elizabeth, a 38 year old woman and her husband Isa were expecting their fifth child. Elizabeth’s labour began at 5:00 pm Wednesday, with the nearest health centre two days sailing time away. Two untrained village midwives, Jemma and Josephine, were in attendance. After a 12 hour labour, Elizabeth gave birth to a healthy, crying baby, but the placenta hadn’t come out. Jemma hurried to get the most experienced nurse in the village, Julian, who pulled the umbilical cord, breaking it and leaving the placenta trapped inside. A tear appeared on Isa’s face. It was now 8:00 am, and Elizabeth was bleeding heavily. Isa and Elizabeth borrowed a motorised dinghy to get to the health clinic, arriving at 3.00 pm, ten hours after the birth. The community health worker tried, but was unable to help. Elizabeth had been bleeding the whole time. They gave her Ergometrine, a drug to try and stop the bleeding, plus paracetamol. They lay her down in the mothers’ waiting house. There was no Pethidine. No saline solution. No I.V. equipment. The radio was broken. They couldn’t ask for help. Her pulse was 40. Isa sat with her through the night as she breastfed the baby. Elizabeth passed away at 5:00 am.
This could be a story told by health workers in remote communities in any developing nation on the planet. Dr Barry Kirby relayed this story at the National Press Club’s address on Wednesday 7th May. Dr Kirby was a carpenter working in Papua New Guinea on a housing project in the 90’s when he found a pregnant woman on the side of the road and drove her to a health clinic. Unfortunately, when he returned the next day her bed was empty, the room smelling of diluted bleach. This was the trigger to come back to Australia to complete a degree in obstetrics. Dr Kirby returned to PNG in 2000, at 50 years of age with $50 in his pocket.
In 2006 the PNG maternal mortality ratio (MMR) was 755/100,000. In Australia it is 7-8/100,000 births. As women in PNG give birth 5-6 times, one in 30 women will die giving birth.
Due to a lack of training, drugs, equipment and the stigma of poverty; Elizabeth’s story is common among developing countries. PNG is a fiercely patriarchal society, where women are reluctant to have a male health worker present at the birth. These factors, along with remoteness and a lack of education mean women are reluctant to get professional help.
With the aid of research, Dr Kirby formed The Hands of Rescue Foundation aiming to get women in trouble to clinics like the Flying Doctor Service does in remote Australian communities. Trouble securing an air fleet meant they would have to encourage women to get to the clinics. They needed more women to train and join the staff. Their own baby bonus was introduced. For every child born in a health centre over the number the year before, 20 Kina was given to the facility. In one health centre alone, the staff received k1420 (A$710). There are now 16 facilities.
In 2012, a baby bundle was introduced to further encourage women to the facilities. The bundles included a number of items such as clothes for mother and child, bedding, mosquito nets, sanitary products, condoms and toiletries. At about A$25 a thousand is about the cost of a car.
To accommodate more mothers, there has been housing built with electricity and water supplies. Sehulea Health Centre serves a population of 6310. In the ten month period prior to the introduction of the support program the centre had 58 supervised deliveries. This grew to 141 supervised deliveries in 2012, an increase of 141%. There have been 15 recorded complications with one recorded death since the program commenced. Indications are that 35 women had births in the village since the introduction of the program.
The dangers of giving birth in PNG are not going to disappear like magic through Dr Kirby’s work, but with the right targeting now would be a good time to continue the current level of foreign aid.