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Curative medicine and public health

Year: 1993
Setting: Chevron hospital in Papua New Guinea
Position: Chief medical officer

I have been working in Papua New Guinea for one month and I will stay there for two years as chief medical officer for Chevron. I am in charge of the hospital and four clinics, but also for implementing the public health program that I created for about 10,000 villagers in the Kutubu area. At the hospital, I begin to see patterns emerge for diseases stemming from the villages in the Southern Highlands province under my responsibility.

As in similar situations that I have encountered in Africa and South America, the main reasons for consultation are, in decreasing order of frequency: infectious diseases, gastrointestinal disorders, skin diseases and trauma. In the last category, I am confronted for the first time with injuries resulting from bows and arrows (weapons that are sometimes used in tribal fights over land, money, etc.).

The demands on the medical staff are intense. There are frequent emergencies at night and they put a strain on health-care providers. I would like to know more about the origin of the diseases and injuries we treat, but no stats are readily available. Therefore, I decide to work with corporate software technicians to create an electronic medical record system that will give us objective data to help alleviate the workload at the hospital while also increasing the quality of care. There are snags along the way, but we overcome each of them and in a few months the system is operational.

At the end of the first month, we start analyzing the data that we gathered. Now we know the villages where malaria and gastrointestinal disorders are more prevalent, for example. This will be extremely useful for the public health program. My motto for its implementation is: timely, targeted and temporary (with transfer of leadership to local authorities). We determine the implementation priorities as follows: mosquito nets, clean water tanks, latrines, garbage disposal pits and mass treatment for worms. The time frame is a two-year period. Immediately, we observe dramatic results such as: lower morbidity and mortality rates; decreased number of emergencies and total volume of villager consultations; less stress on the medical staff and better quality of care. This is particularly interesting for costly chopper medevacs.

With the money saved, I create CME programs that train the clinical staff on emergencies related to trauma and obstetrics as well as performing lab tests, and another program that enhances the efficiency of the health extension officers and aid post officers who are stationed throughout the area. The courses are provided in different hospitals in PNG and overseas. I also supply the aid post officers with boards that can be used in evacuating patients with spine injuries, watches to measure pulse rates, thermometers, blood pressure cuffs, solar-battery-powered radios and protocols for emergencies. Our enhanced cooperation with provincial and central governments has ensured a regular and updated basic drug supply to local pharmacies.

Lesson for the doctor: In developing countries it becomes more obvious that curative medicine and public health are two faces of the same coin. Try to work at both levels for better results.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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