In addition to the care delivered directly in the communities, we also carry out consultations at three health centres.
We spend two days a week in Malalaua in the Gulf region.
Local buses are sporadic and each boat trip costs more than our patients can afford.
Transport support is, therefore, part of the package of services that we offer to ensure quality care for patients throughout their tuberculosis (TB) treatment, which lasts at least six months.
Humanitarian work reminds me every day that we are not all born with the same opportunities
We start the day with a team briefing before the consultations begin, in order to divide tasks and take note of the day’s appointments, while the patients wait under the shelter of a big mango tree.
The team consists of different health professionals. Patients meet them one after the other.
There’s a community health worker for weight monitoring and sputum collection; a doctor for the evaluation of side-effects, evolution of the disease and treatment prescription; a health promotion officer for the assessment of treatment adherence and psychosocial support; and, finally, another community health worker who provides the medication.
A cry for help
Immediately, I am confronted by the situation of one of our former patients, Teresa, a 36-year-old woman who also has HIV.
TB is the most common opportunistic disease in patients with HIV because their immune systems have been compromised by the virus.
Teresa’s father and sister took her to the health centre this morning to ask for help.
Since finishing her MSF care four months ago, Teresa can no longer afford the bus fare to go to the clinic for follow-up treatment.
Her condition has deteriorated to the point that she is now unable to walk and can hardly eat or drink as she is suffering from terrible diarrhoea.
I find Teresa prostrated on the ground. Huge eyes consume her face, she’s 30kg at the most with oozing wounds all over her body, quickly covered with flies.
I had already noticed how flies know how to recognise bodies where death approaches…
An ethical dilemma
Teresa is no longer our patient but we finally manage to negotiate her admission to the nearby health centre, which is able to administer antiretroviral drugs to treat her HIV.
Unfortunately, we are all too often confronted with this problem for our patients with HIV.
At the end of the TB treatment, during which we also take care of their antiretroviral treatment, their condition deteriorates again because they can't continue to take their medication.
The clinic for HIV patients depends on Papua New Guinea’s Ministry of Health and does not have the means to pay for patients’ transportation costs. This leads to people stopping their treatment and, in the long term, dying prematurely.
This is a hard reality to accept.
Later, I will learn that Teresa has died. I had almost forgotten what it meant to die in poverty.
The fight against tuberculosis cannot be limited to hospitals or health centres – it must also come from within communities
Humanitarian work reminds me every day that we are not all born with the same opportunities.
Doing my part to combat this inequality is my way of fighting the sadness, disgust and sense of helplessness that inspires me to volunteer with MSF.
Back to work
My thoughts are interrupted by the project administrator who joins me on my rounds. This is payday for community carers who are our intermediaries with patients.
In particular, they are responsible for delivering daily treatment to the most frail or isolated patients in order to ensure their recovery.
Coming from the same community, they can also bring people with the signs and symptoms of TB to get tested, and organise health promotion activities to inform their community members about TB and fight against it.
Breaking down the stigma
Despite this, there is still stigma attached to TB and many patients experience discrimination.
Every month, we hold an interview with each community carer to make sure they are performing the tasks assigned to them.
We also give them a little money to encourage them to continue.
The fight against tuberculosis cannot be limited to hospitals or health centres – it must also come from within communities.
That's why MSF is trying hard to involve community leaders in this fight because only this way can we stop the epidemic.
I then rejoin the team for the end of the consultations and after four hours of meeting with patients, it's time to head back to base, 1.5 hours’ drive away.