Covid has reached my hospital in Papua New Guinea – people could soon be dying in the parking lot

At Port Moresby General Hospital, about 20% of women presenting in labour have symptoms of Covid-19. Of these, about one-third (four to five women a day) test positive.

We get the test results back about two to three hours after we take the swabs, so often by the time the woman is delivering her baby it is too late to transfer her to the Covid isolation ward for the birth and staff have attended to her and been exposed to the virus, without being able to don the appropriate level of PPE and practice other precautionary measures to protect themselves.

Since mid-February, the rise in Covid cases in PNG has been exponential. Even with our low rates of testing our total numbers have gone from 1,000 to 2,300 in the past month and deaths from 10 to 25 in the same period.

We now see that about 10 of our nursing and medical staff are becoming Covid positive every week, and the number is rising along with the community numbers. Positive staff are put off work until they test negative some weeks later. To date we have lost 30% of our maternity department workforce.

Our midwifery protocols stipulate that one midwife should not have more than four women in labour to care for; however now we find that we sometimes only have two midwives on duty for our labor ward of 30 beds – all of which are typically full at any one time. Doctors are now filling in to provide a significant part of the midwifery care, especially on the night shift, but three of our 20 doctors have also tested positive this month.

My concern is that we will reach a point in the near future where we will have insufficient staff to keep the doors open. If we get to this point, what will happen to the more than 50 women who present for pregnancy care every day? Some may make it home again with their severe pre-eclampsia or life-threatening bleeding or to give birth, while others may end up dying in the hospital car park.

The Port Moresby General Hospital (PMGH) is the only hospital in the capital of PNG that offers maternity care for public patients. The service is basically free, and most of the time we are able to provide basic care for the 20,000 women who are admitted to our service each year without any additional cost to them.

Over the past 50 years, in the 92-93% of women who are booked for pregnancy care in our city’s antenatal clinics, we have managed to achieve the lowest level of perinatal (babies) death of any public maternity in the low-to-middle-income world (18-19/1000) while having possibly the lowest caesarean section rate of any large public maternity in the world (5-6%).

In the rest of PNG only about 50% of the country’s (mainly rural) pregnant women are able to access pregnancy and birthing care. This results in PNG having some of the highest national maternal and perinatal death statistics in the world. Port Moresby General Hospital has a track record to be proud of, but it is all possibly about to end – because the Covid-19 epidemic has finally reached PNG.

The same scenario is playing out in the general part of Port Moresby General Hospital. The Covid isolation ward has been full for the past week; now we have taken over one of the medical wards to be an additional Covid ward. In addition, each part of the hospital has a small isolation area for Covid positive cases that are admitted with other problems and then found to be positive in the course of their admission. All of these are mostly full as well.

When the general hospital staff reach levels where the emergency department is unable to maintain the service, then its doors will close as well. Then we will have people who have car accidents, knife wounds, TB, typhoid etc. dying in the main car park, or being sent home to their fate.

We need a vaccine urgently, but by the time it reaches us it could be too late to save the health service of Port Moresby.