In the grounds of Buka General Hospital, dozens of women are waiting to be seen. They wait in the maternity ward, at the antenatal clinic, and in the outpatient clinic. 

They are waiting to be seen by Buka Hospital’s team of midwives and doctors, dedicated to saving the lives of women and babies in Bougainville. Despite the challenges the hospital faces with respect to supply and personnel shortages, the safest hands are those of trained health professionals. 

The Last Years of the Crisis

“I was new and I was scared,” recalls Sr Jillian of her first days with Buka General Hospital after graduating in nursing in Lae, 1997. “I returned to Bougainville in 1998 and when the team at the hospital heard there was a new nursing graduate in the area, they sent a boat to pick me up.”

Sr Jillian remembers of those later years of the Bougainville Crisis that there were far fewer patients than today. Most women gave birth in smaller health centres, or in the village, rather than risk traveling. Even after the Crisis, it took time for hospital admissions to increase.

“We used to get around one admission per week,” says Sr Jillian. “From 1999, we started to get more mothers coming in, as the Crisis was winding down.”

After achieving her qualifications in midwifery in 2000, Sr Jillian was the first midwife to be employed at Buka General Hospital after the Crisis. She says that so much has changed. 

Not only have patient numbers increased - to an estimated 120 women a month - so has the expertise of the workforce. 

“We used to see a lot of mothers die from sepsis, infections, or bleeding. Now, we have better active management of labour and access to drugs, such as magnesium sulfate.”

Now fearlessly announcing the benefits of healthcare in the streets, she is joined by several midwives who serve the women and babies of Bougainville.

From Tinputz to Buka

After graduating as a nurse in 2000, Sr Alice had been stationed in a labour ward. From this initial exposure to the experience of working with mothers and babies, she pursued qualifications in midwifery and completed her specialty in 2012. 

She moved to Buka from Tinputz and, like Sr Jillian, notes that the capacity of midwives, and the drugs and equipment available, has drastically improved in the past 20 years. However, she said that with increasing patient numbers, the workforce is stretched. 

“Unless the mother has a complication, we don’t really know the patients,” said Sr Alice. “We treat them, talk about family planning and that’s it.”

Faltering Supply

The hospital’s sexual and reproductive health services are undoubtedly strained under increasing demand. In Port Moresby General Hospital, the midwife to patient ratio is around 1:6. In Buka General Hospital, the ratio is 1:30. During our visit, just one bed in the maternity ward was free. 

This is a challenge for the midwives, who want to give personal, respectful care to all mothers. 

Meanwhile, supply of essential reproductive health commodities is inconsistent, with some shortages lasting a few weeks while the hospital sources medicines and other things, such as reagents for diagnostic machines, from mainland Papua New Guinea. The hospital does not currently have a functioning generator. In the two weeks preceding our visit, visiting consultant Dr Willie Trane completed a c-section via torchlight during a blackout. Both the mother and baby were safe, just one example of why mothers should deliver at a healthcare facility, no matter the facility’s limitations: when things go wrong trained professionals in an advanced care facility have far more options than are available at other centres, or in the village, and they have the skills to adapt to the circumstances.

But the patient to midwife ratio at Buka Hospital will continue to grow. Not only is the population growing, more women and their partners are recognising the benefits of giving birth with a skilled health professional, in a healthcare facility. Preventing common complications from pregnancy is a simple solution to alleviating the pressures on the midwifery workforce.

With fewer complications to respond to, midwives can give appropriate attention to all mothers. 

A New Focus on Family Planning

After completing her residency in Rabaul and Port Moresby, Dr Luke joined the team in Buka in July 2021. Together with Srs Alice and Jillian, she shares that almost every complication seen by the team could have been prevented with family planning. 

“We see a lot of teen pregnancy,” says Dr Luke. Teen pregnancy has been associated with increased risks of complications and, globally, complications from pregnancy and childbirth are the leading cause of death for adolescent girls, 15-19-years-old. 

Family planning includes contraceptives, like the pill, implants, injectables, or condoms, and reversible medical procedures, like a vasectomy. Making these options available to adolescents is critical to preventing teenage pregnancy and other high-risk pregnancies, enabling parents to make informed decisions on when to have children for the safest outcome for mothers and babies. 

“Family planning is very difficult to advocate for,” says Dr Luke. “We’ve done so much advocacy. But I don’t know how people take in information, how they process information.”

“It’s really difficult to talk to people about reality.”

For the women in the wards of Buka General Hospital, these conversations with healthcare professionals are happening. But for the many more women and girls around the province, these conversations are out of reach.

Improved conversations about family planning at the community level and during adolscence, especially with support of churches, is important for improving knowledge of modern contraception so that women and men can make an informed decision about their health, and the health of their families. 

UNFPA and Family Planning

Family planning is a key factor in reducing poverty.  In Papua New Guinea, UNFPA works with the National Department of Health and other partners to improve access to family planning services and information in hospitals, primarily through support to Family Support Centres. In partnership with the National Department of Education the organisation works to expand Comprehensive Sexuality Education through schools. We work with youth networks and promote peer education to advocate for family planning at the community level. In addition, UNFPA works with fellow UN agencies, such as UNAIDS, to promote condoms to not only address unwanted pregnancy, but to reduce the spread of HIV/AIDS and STIs. 

To strengthen the policy environment on family planning, UNFPA is supporting the development of a national family planning curriculum and provincial family planning implementation plans.