Papua New Guinea: Government "inaction" fuels cholera spread

News and Press Release
Originally published
MADANG, 15 December 2009 (IRIN) - Government inaction is contributing to the spread of cholera in Papua New Guinea (PNG), health workers say.

Since the first case in northern Morabe Province in July, more than 1,000 have been reported in the Pacific island nation, fuelled largely by poor sanitation practices and an acute lack of access to potable water.

According to the UN Development Programme (UNDP), approximately 58 percent of the country's six million-plus inhabitants do not have access to safe drinking water.

"It's spreading and the government is doing nothing," Sibauk Bieb, operations coordinator for the government's cholera task force in Madang, one of four provinces now affected, told IRIN.

"If they don't take action soon, more people are going to die," he said.

Of the 1,356 cases to date, 608 have occurred in the provinces of Madang, 462 in Morabe, 281 in East Sepik and five in the Eastern Highlands Province, reported the World Health Organization (WHO), with at least 35 confirmed deaths.

"There are many remote areas so there could be cases and related deaths we are unaware of," Eigel Sorenson, WHO country representative in the capital Port Moresby, added.

Funding delays

In September the government declared a public health emergency and committed more than US$4 million to combating the disease - none of which has been released, leaving local health authorities and NGOs struggling to cope.

A hastily prepared cheque for more $1 million later bounced.

"Despite the approvals, funds are not moving from Waigani [the PNG seat of government] and cholera is spreading at very alarming rates across the country and the latest province to be struck is East Sepik," PNG Health Minister, Sasa Ziba, was quoted in the press as saying.

Outside the Madang general hospital, evidence of that spread is already visible. Patients continue to arrive at the hospital's 10-bed cholera treatment centre (CTC), hastily erected in November by Médecins Sans Frontières (MSF), which has become a key player in stemming the disease's spread where the government has failed.

Inside the quarantine tent, Willie Kagoe, 47, of Banara village, 160km from Madang, struggles to sit upright in bed, his gaunt appearance testament to the disease's impact. Severely dehydrated, he has lost almost 10kg in just over a week.

A disease on the move

"What we need now is an aggressive response to help plan and prepare and mitigate the mortality," Vanessa Cramond, medical coordinator for MSF warned.

Since the first case in Morabe and a subsequent outbreak in Lae, the provincial capital, the disease has travelled westward by road along the coastline, with outbreaks now in both Madang and East Sepik provinces, as well as the country's Eastern Highlands.

Added to that is its movement now by water down the Sepik River - PNG's second-largest and a primary source of water for both drinking and washing.

"We found cholera in the water in more than one location and the bacterial results were very high," Daniel Bleed, an epidemiologist with WHO in Port Moresby, noted.

And with the Christmas season fast approaching, as thousands prepare to return home, mainly by air as many villages are inaccessible by road, the disease could likely become airborne if it has not already.

"It's just dumb luck cholera hasn't made it to the capital yet," said one aid worker. "Maybe then the government will stand up and take notice."

Most deaths reported have occurred in and around the village of Wasu in Marobe and Kambaranba in East Sepik, where access to healthcare is limited, while mortality rates in the cities of Lae and Madang have been kept in check due to people's proximity to health services and early preparedness.

But should the disease spread to the interior, the impact could be much worse.

"If cholera makes its way to the highlands, it will be a disaster," Bieb said. "This is where most of the population lives and where our health and water infrastructure is weakest," he said, noting that cholera would be a nationwide problem in the next 12 months.

Yet despite the urgency, the government has yet to respond, while public outcry intensified last week when the government purchased a multi-million dollar jet, at a time when NGOs working in the area, including Oxfam, are struggling to cope with limited resources, and government health workers working at CTCs in the affected area have yet to receive their salaries.

"It's a disgrace. A national disgrace," Bieb insisted. "And yes, you can quote me on that."