Interview Doctor Wandy from Agats' health centre

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. MSF set up a referral system for life saving emergencies, using a radio network to refer patients to the closest health centre by boat. In Agats clinic, MSF trained the health staff in complicated pregnancies, deliveries and also in the sterilisation of medical equipment, safe blood transfusions and blood screening. MSF rehabilitated the operating theatre, donated surgical equipment and provided training in waste management and universal precautions.

Obstetrician Doctor Wandy worked in the hospital in the city of Timika (Papua) before he joined the Agats health centre. He describes how collaboration with MSF has helped improve the 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, 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. The staff lacked basic skills, things like maintenance of equipment, 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 health care and surgery in this remote setting?

Logistic of course is a real challenge. The villages are remote and we need to access them by boat. And for serious cases, which require referral to a bigger hospital in Timika the main city, then it's even more complicated

We also have a wide range of other issues. We have no electricity until 6 pm 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 together with the Ministry of Health has set up a referral system in the villages.  What's the situation like in terms of access to health care?

It's a radio system that allows the local health posts to contact the puskesmas in Agats so we can send a boat ambulance. The system is in place and there has been some very positive progress. We have 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. There's been some improvement but it remains challenging. For example the nurses and midwives who are supposed to be stationed in the villages are not local. They find it very hard to remain in remote villages without any facilities and 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. Before the staff didn't have the equipment to screen blood.  In the past in emergency cases was 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 few chances 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 speedboats or even plane when it's possible but it's expensive and can take a long time. The planes don't fly every day; it depends on the weather.  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.