Accepted Paper:

Non-compliant patients or poor health systems: TB control in PNG  

Author:

Susan Hemer (University of Adelaide)

Paper short abstract:

This paper explores the debates occurring around the high levels of tuberculosis (TB) infection in Papua New Guinea. On the one hand there are questions about what makes a ‘good’ patient. On the other hand, some analyses squarely target broader social issues as the reason for high rates of TB.

Paper long abstract:

This paper explores the debates occurring around the high levels of tuberculosis (TB) infection in Papua New Guinea through the lens of what is understood to be good and appropriate practice. Current research suggests that PNG has one of the highest rates of TB infection in the world, where it is one of the leading causes of hospital admission and mortality. This has sparked new efforts at control through donor funding, new management protocols, and infrastructural spending. In the current context Australia is providing ongoing and increasing support to the TB control program, particularly in the border Provinces of Western and Gulf Province. As part of these efforts, various agents are debating the key causes and concerns in the field of TB control. On the one hand there are questions about what makes a 'good' patient: individual patients are categorised often as 'non-compliant' or 'defaulters' by Papua New Guinean medical personnel when they do not adhere to treatment protocols. 'Cultural beliefs' have also been raised within PNG as a barrier to effective treatment and individual patient compliance. On the other hand, some analyses squarely target broader social issues as the reason for high rates of TB , such as poverty, vulnerable people and weakened health systems. In light of these analyses, PNG is being cast as a 'dangerous' neighbour—both the movement of people across the PNG border into Australia, and the poor PNG health system are being characterised as 'threats' to Australia; raising questions about the ethics of treating PNG citizens in Australia or further supporting their TB control program.

Panel Med05
Disease and goodness