Mount Hagen Provincial Hospital

Background: Community Health Workers (CHWs) in Western highlands Province were given a 6-month CHW upskilling training to enable them to provide essential maternal-newborn care, do timely referral of high risk clients and refer emergencies to hospital. Five trainings were conducted over the five year period. Forty seven (47) CHWs were upskilled over that five year period.
 
 Aim: To evaluate the effectiveness of the CHW Upskilling Training during 2012 – 2016.
 
 Methods: A post-training assessment was conducted by direct observations of the CHWs and the Officer in Charges (OICs) at their workplaces. Assessors observed the application of knowledge and skills and determined if there were improvements in the health facilities. Purposeful discussions were carried out to elicit qualitative feedback from CHWs OICs of the health facilities.
 
 Findings: The findings were impressive. The organisation of health facilities improved with specific schedules made for priority reproductive and maternal health services. The recording of maternal and newborn care services indicated great improvement. The ANC, family planning and labour ward registers indicated the kinds of services provided including management of life-threatening conditions. Records show reduced maternal and newborn deaths. Records also show reduced unnecessary referrals.
 
 Conclusions: The CHW Up skilling Training Program is an effective intervention to improve reproductive health and maternal-newborn services in remote areas of Papua New Guinea, particularly where there are no midwives, or higher category health care providers. It has contributed to improved maternal-newborn survival.
 
 Recommendations: The evaluation recommends that the CHW Upskilling Training should reach more CHWs to fill in gaps in health facilities where there are no midwives or doctor. In Papua New Guinea, the CHWs Upskilling program in maternal and newborn care is recommended for all CHWs.

The World Health Organization has recommended that testing for high-risk human papillomavirus (HPV) (hrHPV) infection be incorporated into cervical screening programs in all settings worldwide. In many high-burden, low-income countries, it will not be feasible to achieve high cervical screening coverage using hrHPV assays that require clinician-collected samples. We conducted the first evaluation of self-collected vaginal specimens compared with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. Women aged 30 to 54 years attending two well-woman clinics in Papua New Guinea were invited to participate and provided self-collected vaginal and clinician-collected cervical cytobrush specimens. Both specimen types were tested at the point of care by using the Xpert HPV test. Women were given their cervical test result the same day. Those with a positive hrHPV test and positive examination upon visual inspection of the cervix with acetic acid were offered same-day cervical cryotherapy. A total of 1,005 women were enrolled, with 124 (12.3%; 95% confidence interval [CI], 10.3%, 14.4%) being positive for any hrHPV infection. There was a 99.4% overall percent agreement (OPA) between vaginal and cervical tests for HPV-16 (95% CI, 98.9%, 99.9%), a 98.5% OPA for HPV-18/45 (95% CI, 97.7%, 99.3%), a 94.4% OPA for other hrHPV infections (95% CI, 92.9%, 95.9%), and a 93.4% OPA for all hrHPV types combined (95% CI, 91.8%, 95.0%). Self-collected vaginal specimens had excellent agreement with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. This approach provides for the first time an opportunity to incorporate point-of-care hrHPV testing into clinical cervical screening algorithms in high-burden, low-income settings.

Bush thoracotomy is a procedure performed by traditional medicine men to let out blood and pus from the chest. It has a significant complication rate and 60 cases presenting to the major hospital in Papua New Guinea are analysed over a 2-year period. The complications were empyema (40), osteomyelitis of the rib (2), wound infection (2), pneumothorax (1), neuralgia (1) and chest pain (4). All cases were further complicated by underlying pulmonary infection and often by delay in presentation. Fifteen cases were seen in the first year (1983-84) and forty-five in the second (1984-85). A more aggressive surgical approach was adopted in the second year (21 thoracotomies with 17 decortications compared with 1 thoracoplasty in the first year). However, this course of events was accompanied by an increase in mortality from 0 to 5. Although there were a number of contributory factors, lesser surgical procedures, such as open pleural drainage, are recommended for the sicker patients.

Ocular trauma is a significant cause of blindness in Papua New Guinea (PNG). This study was done to determine the pattern and rates of ocular and adnexal injuries so as to determine the size and extent of the problem. A retrospective study of 4157 cases presenting with ocular trauma in three regions of PNG was carried out. The data were analysed with respect to the age, sex, province, type and cause of injury, time interval between injury and presentation to the hospital and the final visual outcome after treatment. Ocular trauma rates in PNG were alarmingly high (39.1 per 100,000). The commonest cause of injury in the younger age group was due to lime. Alcohol-related violence and fights resulted in injuries in the adult age group. Most of the injuries were grievous and 60.7% of patients were left with a visual acuity of less than 6/60 in the injured eye. In addition, 78.7% of the patients were under 30 years of age. Ocular injuries in PNG are an important cause of visual disability. Some specific injuries, such as those due to lime in children, can easily be prevented by health education.