In the district of Asmat in Papua, MSF has been working in partnership with the Ministry of Health to improve the quality of care for over two years. Using a radio network to refer patients to the closest health centre by speed boat ambulances, MSF has set up a referral system for life-saving emergencies.
Obstetrician Doctor Wandy worked in the hospital in the city of Timika (Papua) before he joined the Agats health centre.
Doctor Wandy examines a pregnant woman in the Agats health centre, Paupua
Photo by Wishnu Aditya
How has collaboration with MSF helped to improve care provided to patients in this remote setting?
MSF began setting up the emergency referral system two years ago and in July 2007, they rehabilitated the operating theatre and donated surgery equipment. We’ve had several interventions since, mainly caesareans, hernias and appendectomies. It really made a difference, not only the operating theatre, but also the training given to local staff. When I joined this puskesmas in March 2007, most of the staff assisting me had little experience in surgery. They lacked basic skills - things like maintenance of equipment and inventory. The equipment used to get rusty or they couldn’t find it when they needed it. Now the staff understand what to do and can sterilise material properly.
What kind of challenges do you face here providing healthcare and surgery?
Logistics, of course, is a real challenge. The villages are remote and we need to get to them by boat. And for serious cases, which require referral to a bigger hospital in Timika the main city, it’s even more complicated
We also have a wide range of other issues. We have no electricity until 6pm and then we have to use a generator. Not that long ago I was just about to begin a caesarean on a patient when the generator broke down and we ended up in the dark. I called MSF who helped me with their own generator to continue surgery.
Another difficulty is that most of the population is illiterate and few are used to western medicines. When you ask a woman how long she has been pregnant, most of the time she has no idea. Time is a different concept for them.
MSF and the Ministry of Health have set up a referral system in the villages. What’s the healthcare situation like?
The radio system allows local health posts to contact the puskesmas in Agats so we can send a speed boat ambulance. Since the system has been in place there has been very positive progress. We also implemented a network of voluntary health workers in the villages, who have been trained by MSF and there are also local health posts in the villages. This has led to some improvement but remains challenging. For example, the nurses and midwives who are supposed to be stationed in the villages are not local and find it hard to stay in such remote places. Many often stay in Agats instead.
MSF has trained the staff on safe blood transfusions and blood screening - why is this important?
Here at the clinic many mothers have anaemia, they are at high risk of haemorrhage and need blood transfusions. Previously, the staff didn’t have the equipment to screen blood. In the past, emergency cases were very risky but the only other choice was to refer the patient to hospital in Timika, which meant a long and dangerous boat trip. If it were a serious case, the patient would have a low chance of survival. I used to work in the clinic in Timika and I had women who had haemorrhaged to death during the two-day trip on a traditional boat. Now, we use speed boats or even a plane when possible.
Being able to give a safe blood transfusion here is critical even if it can sometimes take two days before we get a donor with the right blood type. Since MSF trained lab technicians in blood screening and safe blood transfusions, we don’t need to refer patients who need a transfusion to Timika anymore.