The perils of pregnancy in Papua New Guinea

Only 56% of PNG women in labour are seen by a health worker (credit: Annelie Edsmyr)

According to the UN’s Population Fund, Papua New Guinea has one of the highest maternal mortality rates in the world with around 1,300 women dying every year from pregnancy related problems. Given the findings in their latest ‘State of the World Population Report’, we explore how MAF is saving women’s lives in remotest PNG.

Did you know that out of every 100,000 live births, 192 babies die in PNG? In the UK, the figure is 10.

With only 56% of PNG women in labour attended to by a skilled health worker, no wonder the death rate is so high. Only 30% of PNG’s population has access to the full range of affordable healthcare services whenever they need them, wherever they are compared to 88% of the UK (source: UNFPA State of the World Population Report 2024).

Rural PNG is full of rugged mountains and jungles (credit: Joy Suarkia & Jonny Watson)

Samarie’s story

On 22 March 2024, mother-of-one Samarie gives birth to twins at home – a grass hut in remote Mengamanau Village in the middle of the jungle on a steep mountain.

Mengamanau is located in PNG’s Enga Province characterised by rugged mountains and high-altitude valleys. The area doesn’t have any roads.

The boy named ‘Jared’ and the girl ‘Sanda’ meaning ‘perfume’ came into the world without the help of a health worker, electricity or running water.

From Mengamanau, Enga’s Kompiam District Hospital is a seven-day hike through the jungle via many rivers, but some are simply too dangerous to cross.

By air, the whole journey takes just 15 minutes.

Samarie’s plan was to give birth at her nearest basic health clinic in Mengau on the other side of the River Yuat, but rainy season (December to March) scuppered her plan.

A week of relentless rain had swollen the river to dangerously high levels meaning that she would have to navigate a precarious rope-bridge over raging water rather than be taken by canoe to get to the other side – the usual transport during dryer months.

There are no fixed bridges to cross over into Mengau.

Heavily pregnant and vulnerable, she contemplated the kilometre-wide raging river, but underwater currents had already claimed the lives of many before her.

She had two choices – cross the river and risk death, or deliver at home without any medical supervision and risk death.

Samarie gave birth at home. Sanda was born successfully, but Jared was still attached to the placenta, which hadn’t come out yet.

Samarie and her babies needed urgent medical attention, but with intermittent, poor mobile phone coverage caused by bad weather, her family couldn’t call Kompiam District Hospital for help.

Community health worker Terence Baiang explains how extreme isolation can kill patients in remote areas:

‘Sometimes the bridge is washed away during rainy season, so they have to wait for the rain to stop and water levels to drop to rebuild.

‘People with curable disease, pregnant women with complications who cannot access medical care during that period are left to die.

‘Almost 80% of pregnant women develop infections after delivery due to no proper medical care.’

Terence Baiang – community heath worker in Enga Province & MAF partner

MAF is the only way for many villagers to access healthcare (credit: J Suarkia & J Watson)

MAF is the only way

For community health workers like Terence in Mengau, their hands are tied. With a raging river between them and an absence of basic infrastructure, he couldn’t be there to help Samarie deliver her babies.

All he could do was encourage her community in Mengamanau to cut the grass of their airstrip in preparation for MAF to make a safe landing.

Despite the intermittent network, Terence eventually got through to the MAF agent on the other side of the river and connected him with a doctor at Kompiam District Hospital.

As soon as the MAF agent had mobile phone coverage, he was able to call MAF’s headquarters in Mount Hagen and request a medevac.

On 25 March, three days after giving birth, Samarie, Sanda and Jared were medevacked to Kompiam District Hospital. The flight took 15 minutes.

80% of postnatal deaths in PNG are caused by sepsis

Jared (top) had sepsis. Sanda (bottom) was faring much better (credit: Camy Thomas)

Samarie and Jared are unconscious on arrival. They have contracted sepsis and are presenting with fever. Samarie has lost a lot of blood and needs a blood transfusion. Jared cannot breathe by himself and needs a ventilator.

The umbilical cord is still attached to Samarie and Jared and has become infected. Her community were too afraid to cut it fearing it would disappear inside her body.

Samarie is resuscitated and put on intravenous fluids. Both she and Jared are given antibiotics.

The family are treated by Dr Ray Feluwa who says that 80% of postnatal deaths in Papua New Guinea are caused by sepsis closely followed by bleeding to death.

Sanda survives, but infection overwhelms Jared. He dies two days later.

At first Samarie doesn’t produce enough milk to breastfeed Sanda, so nurses feed her instead.

Samarie nurses Sanda – both are getting stronger every day (credit: Camy Thomas)

Samarie is getting better, but her heart is broken. She is no stranger to heartache – Jared is her third baby not to survive.

On 27 March, Jared is buried in a cardboard box coffin covered with banana leaves in the grounds of Kompiam District Hospital.

5-day-old Jared is buried in the grounds of Kompiam Hospital (credit: Camy Thomas)

No more 3-day canoe rides for Fiyak’s expectant mothers

When Fiyak Airstrip in northern PNG’s Sandaun Province was out of action for six-and-a-half years, the only way a pregnant woman could access healthcare was via a three-day canoe ride on the River May.

Reopened Fiyak Airstrip is literally a lifeline (credit: Joy Suarkia & Jonny Watson)

Like Mengamanau, Fiyak doesn’t have any roads and like Samarie, Siani was faced with a tough choice when she was expecting – risk the perilous journey or risk childbirth at home without any medical assistance. Unsurprisingly, Siani was scared:

‘It’s a frightening experience for a mother to travel three days by canoe just to deliver her baby at the health centre. So many of us choose to have our babies at home where we are comfortable, but then unassisted delivery also leads to the loss of life.’

Siani – Fiyak Village resident, Sandaun Province & MAF beneficiary

Siani: 3 days in a canoe when pregnant is ‘frightening’ (credit: J Suarkia & J Watson)

Without plane access, many women and their babies lost their lives en-route to the clinic or ended up giving birth inside the canoe or on the banks of the River May.

For others choosing to give birth at home without any medical assistance, many of them ran into complications.

Community leader Jeff Kukilim looks back on the hardship his community faced:

‘Our health centre was greatly affected because medical supplies couldn’t be delivered and there were no medevacs for patients who were critically ill or injured.’

But since repairing and re-opening the airstrip in January, making it safe for MAF to land, healthcare in this isolated community has been transformed.

Once again, MAF makes it possible for medical staff and lifesaving supplies to reach Fiyak by plane and for expectant mothers and critically ill patients to be medevacked safely to hospital in good time.

The flight from Telefomin District Hospital to Fiyak only takes 15 minutes. To walk, takes a week!

Healthcare in isolated Fiyak has been transformed (credit: Joy Suarkia & Jonny Watson)

Some pregnant women climb mountains for healthcare

Thanks to MAF’s two-year partnership with New Zealand Government and PNG’s Provincial Health Authority, access to healthcare in the Eastern Highlands has significantly improved.

Medical supplies at Goroka destined for Boikoa & Sindeni via MAF (credit: Kowara Bell)

Instead of remote villagers spending hours climbing mountains and traversing rivers to access healthcare, MAF planes now deliver health workers and medical supplies to isolated communities via short flights.

It’s made all the difference to Boikoa Village says local resident Rosa:

‘Many pregnant women from my village were forced to walk for hours or were carried over two or three rivers or up one or two mountains just to reach the nearest clinic in neighbouring Sindeni Village for proper medical care or supplies.

‘Many have lost their lives from Boikoa en-route to Sindeni due to no access to health workers or adequate medical supplies in Boikoa. Thank you MAF and the
New Zealand Government for bringing in medics as well as providing us with medical supplies.’

Rosa – Boikoa Village resident in Eastern Highlands & MAF beneficiary

Residents wait for medical supplies in Sindeni Village (credit: Kowara Bell)

Locals take the medical supplies to Sindeni Clinic (credit: Kowara Bell)

Thanks to the partnership, pregnant women are now treated locally in Boikoa, so they no longer have to embark on such a drastic journey.

To date, the MAF, New Zealand Government and PNG Provincial Health Authority collaboration has flown some 1,300 health professionals via 500 flights to over 150 communities reaching some 110,000 people across the provinces of Enga, Sandaun, Eastern Highlands, East Sepik, Gulf, Hela, Jiwaka, Madang, Morobe, Chimbu, Southern Highlands and Western Province.

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