Straddling the global and local challenge of TB
By Maree Nutt, CEO RESULTS, International Australia
In the space of less than a week, (four and a half days to be exact) I travelled firstly to Canberra, then to Saibai in the Torres Strait with UN Secretary General’s Special Envoy on Tuberculosis (TB), Dr. Eric Goosby. Our journey to bring greater prominence to, and understanding of, TB took us from the halls of Parliament House Canberra; meeting ministers, shadow ministers and senior departmental officials, to Australian territories in the Torres Strait, just a few kilometres from Papua New Guinea (PNG) and home to one of the world’s hot spots for TB and drug resistant TB (DR-TB).
Throughout, our task has been to demonstrate why Australia should be taking on a leadership role in addressing TB in the region. And the simple answer is that we sit in the Asia Pacific where 60% of the 10 million cases of TB identified globally in 2015 were and, where our own northern border meets PNG in a unique way.
While many Australian’s may be unaware of the global fight to end TB, our government has already demonstrated its commitment, through its support of the Global Fund to fight AIDS, TB and Malaria, TB program funding to PNG, and TB related medical research. In fact, while we were in Canberra, Foreign Minister Julie Bishop announced a $20 million contribution to the World Bank’s Emergency Tuberculosis Project in PNG.
The importance of the situation and it’s complexity is brought into focus when our charter flight reaches the Australian Island of Saibai, in the Torres Strait, off the tip of far north Queensland. Travelling as a guest of the Hon Warren Entsch MP the Federal Member for this region (and co chair of the Australian TB Caucus) we got to see why he is so passionate about the issue of TB – it’s very much a part of his electorate. Here we saw first hand a health clinic run by Queensland Health. Because of an arrangement that dates back to PNG’s independence in 1975, there are 13 ‘Treaty Villages’ in the Western Province just across the water on the PNG mainland with free access to Australian Torres Strait Islands for traditional fishing and food gathering. Up until a few years ago this also resulted in Treaty Village residents understandably choosing Australia’s far superior medical care for TB and other conditions.
The Australian Government’s recent aid strategy has been to strengthen the the PNG health system – largely focussing on TB hotspots like Daru (an island of 15,000+ situated just off PNGs Western province). This is the long term view which with proper funding and support will have a positive long-term impact. Whilst progress is being made, more time will be needed to build a strong and sustainable response to TB ensuring widespread screening, treatment access and treatment completed.
In the short term, people still some across from the treaty villages by boat.The modest health clinic on Saibai open seven days a week does not turn them away from immediate and one off interventions but for long term and more seriously ill patients there are two stark choices, which I saw first-hand.
For a PNG national with clinical signs and symptoms of TB they are returned to PNG and linked with Daru hospital. To get there requires boat transport (sometimes expensive or irregular) or through the Inloc Ranger program. If their symptoms so severe that there is concern they would not survive the wait or the trip to Daru, then they will likely be transported to Cairns hospital – knowing that culturally this presents problems where they are removed from their family and context for an extended period while they are put in isolation and receive treatment.
In Daru there has been a strong investment of in recent years by the Australian Government with a 200 bed hospital and 20-30 patients for TB. The program is also supported by a medical team through the Burnet Institute working alongside PNG health department officials.
Things are getting better in Daru with TB treatment completion rates increasing from 40% to 97% in the last 5 years. However, there is still a long way to go and to to build and strengthen support and programs outside the hotspots of Daru and Port Moresby which is where Australia and our leadership role around TB is so important. Australia’s current TB funding package to PNG of $60m over seven years concludes in 2017, and RESULTS has been advocating for several months for its renewal. Newly committed funds, like those announced by Minister Bishop on June 1 will support additional international expertise and finance for treatment and prevention services in communities across PNG, and help to strengthen PNG’s health system (including lab testing and technical/managerial training for health workers).
Still, more more funding will be needed for PNG and other countries in our region with high burdens of TB. These funds will need to come from both donor governments and domestic health budgets.
Australia has already shown its commitment to addressing TB. Now is the time for us to step up and play a leadership role to address TB in our region. Because TB is an airborne infection and respects no borders, no one country can hope to eliminate this ancient disease alone.