A long road to deliver services: Outreach in Papua New Guinea

The National Orthotics and Prosthetics Service (NOPS) in Papua New Guinea have been out on outreach again, visiting three towns in remote Northern PNG – Aitape, Wewak and Maprik.

Almah, in NOPS uniform and using a lower limb prosthesis, sits on a bench under a verandah with three other people who are all using walking aids and/or prosthetic lower limbs. All are smiling for the camera.

Outreach is essential

It has been over four years since NOPS last visited Aitape and more since they have visited Wewak and Maprik, due to a lack of funding and human resources. This meant that the team was faced with huge demand for their services on arrival.

NOPS delivered services to 40 clients over three weeks, with many more clients still waiting to be seen or waiting for follow up appointments. The first week of the trip was spent in Aitape, working with the Father Antonine Prosthetics and Orthotics (FAPO) Centre.

The FAPO Centre was first established in the early 1980’s by the Franciscan Missionaries. Late Father Leo Leoni (ofm) identified a need for prosthetic limbs for people with Leprosy who required amputations. The establishment of the centre reduced the need for people in Aitape and surrounding towns to travel to Lae, which was a full day away by trip by boat. After being struck by a tsunami in 1998, the need for prosthetic services in Aitape increased, as many families were displaced, homes destroyed and many sustained serious injuries.

A map of Papua New Guinea showing the distances between Aitape, Wewak, Maprik, Madang and Lae. The distance between these stretch over the north coast of the main island.

Supporting existing staff

In 2017, the Cambodia School of Prosthetics & Orthotics offered a scholarship to FAPO. Barbara Raire, a local school teacher for inclusive education at FAPO, was nominated to study prosthetics. Barbara returned after completing her studies in March 2020 and has been working at the FAPO Centre since.

Barbara is the only prosthetist in Aitape. The remoteness and a lack of internet access in the area compounded the professional isolation Barbara experienced. She could not access the support she needed as a recently graduated health professional. This outreach trip provided an opportunity for NOPS to not only provide outreach services to clients, but to also give some incredibly valuable professional support to Barbara.

Almah and Barbara are wearing service uniforms and NOPS branded face masks. They are talking to and examining the arms of a client who is sitting on a tall bench. The client's right arm is missing from the elbow joint down.

Challenges of accessing services

The FAPO Centre faces many challenges when delivering services. These include problems with procurement of essential materials needed to fabricate prosthetics, lack of internet and phone access for clients and personnel, and challenges for people travelling to the service. Many clients live along the coastline and must travel by boat to the centre, which is quite expensive, or they may be forced to walk miles to reach a road and access transport services that are also expensive.

When visiting Aitape, NOPS delivered services to Monica. Monica had an infection on her foot that led to an amputation of her lower left leg. Monica travelled from Lumi, a nearby town, to receive services in Aitape. Her trip to Aitape costs 150 Papua New Guinean Kina (around $60AUD) one way. To be able to afford the trip, she stays with her sister in Aitape and sells fruit at the local market. Upon arrival, Monica was delighted to receive services from NOPS, and looks forward to living her life with the support of her prosthetic limb.

Monica sitting on a porch with her right leg crossed over her prosthetic left leg, smiling.

Reaching more people

After Aitape, NOPS travelled to both Wewak and Maprik by road. Accessing prosthetic and orthotic services is also difficult for those in Wewak and Maprik. Currently, people who have had amputations in Wewak are referred to Lae, which is a full day trip by boat onto Madang and 6 hours by road, or a 45 minute flight. Hospitals do not have the capacity to cover travel costs, and clients must fund their own travel.

According to one of the Doctors at Wewak Hospital, the amputation rate in Wewak has been increasing. This coincides with the rising prevalence of diabetes and diabetes-related complications, which has been a trend all over PNG and the Pacific. The need for greater diabetes prevention and management activities in PNG has been raised with us by NOPS, and is an area we are looking to support with future programmes.

Inside a home, Almah sits across from a woman and is making a cast of her residual lower limb. A man is behind them taking a photo on his phone.

Looking to the future

While the NOPS team did amazing work and saw so many people in a short time span, there are still people waiting for services and follow up. This trip highlighted the need for more decentralised rehabilitation services outside of major cities in PNG. As a result of this outreach trip, NOPS has worked with Wewak Hospital to establish a position for a prosthetist to begin working at Wewak Hospital and a NOPS officer will be moving from Lae to Wewak in the new year. Longer term planning has begun between NOPS and Wewak Hospital to set up a NOPS clinic in Wewak.

Thank you to Aussie Breadtags for Wheelchairs for helping fund this outreach trip. Their assistance supports NOPS to deliver a more sustainable model of service delivery to clients in need of prosthetics and orthotics, wheelchairs and walking aids.

Outreach also gives NOPS the opportunity to raise awareness about the services they deliver, which many people in rural and regional places are often unaware of. It also creates an opportunity for NOPS staff to meet with representatives of provincial hospitals, to develop their capacity to deliver rehabilitation and assistive technology services.

Outside under a verandah, Barbara takes a cast of a man's residual limb.

We look forward to supporting NOPS strengthen and decentralise their services in Wewak and throughout the other 15 provinces in Papua New Guinea in the future. See the work as it happens on our Facebook page, and help it happen by donating to Motivation Australia today!

Motivation Australia would also like to acknowledge the valuable contribution of the Australian NGO Cooperation Program (ANCP) to this project.