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In 1998, six years after graduating as a medical doctor, Ian Garbett took a decisive step. He joined the international voluntary charity Voluntary Service Overseas (VSO) and went to work in Papua New Guinea (PNG). For Garbett it was the start of a love affair. “I was touched by the country, by the landscape, by the people — and deeply moved by their health needs,” he says. “It was a transforming experience.”
Garbett, who was born in Birmingham and educated in Liverpool, UK, spent two years working as a general practitioner in the rural areas around Mount Hagen, in the Northern Highlands of PNG. He says the people there are very poor — mostly subsistence farmers. But their patience and courage in the face of the country's healthcare shortages was inspirational. In particular, the fate of those battling late stage cancer affected him profoundly. Garbett found himself abandoning the professional distance acquired during his medical training, and becoming emotionally involved in the lives of his patients and their families. “I made a vow then to work towards improving conditions for these people,” he says, “to make accessible, effective health care available to all people affected by cancer in Papua New Guinea.”
Independent since 1975, PNG's cancer facilities limped along until 1998 when the country's single ageing radiotherapy machine broke down irreparably. The expatriate doctors who had kept the oncology services ticking over returned to their home countries and an acute shortage of trained staff meant that the prospect for those with cancer was dire indeed. Today, cancer is a massive problem. According to The Hidden Burden, Cancer in PNG, a report produced by the PNG government in 2002, this low-income country of six million is facing up to 15,000 new cancer cases a year and as many as 12,750 deaths, making it one of the world's highest per capita cancer rates.
Of all cancers, that of the cervix is by far the biggest killer of women in PNG. This is particularly tragic because this form of cancer can be prevented with screening or successfully treated if diagnosed early. In men, the commonest form is oral cancer. Cancer of the liver is also widespread, although lessening due to an extensive Hepatitis B vaccination campaign in children.
Today, with the country now enjoying a period of political stability, the government has turned its attention to developing and implementing an effective, sustainable national cancer control plan. To this end, a taskforce was created in November 2007. A new MDS Nordion cobalt radiotherapy machine will become operational later this year and the newly-appointed Health Minister, Sasa Zibe, wants to speed up training programmes for urgently needed health professionals. At the moment, for example, there is just one pathologist working in the entire country.
Ian Garbett has signed a three year contract to work at the medical school attached to the General Hospital in the capital, Port Moresby. His focus will be on teaching and research, but Garbett is also committed to helping PNG build the cancer prevention and treatment services its people deserve. “I'd like to set up a community-based HPV vaccination programme for young women, as well as a screening service to tackle the widespread problem of cervical cancer,” he says. “I'm thinking of a small scale project in a rural setting, where local people will learn to take ownership of their healthcare, and one which, hopefully, will serve as a model for others around the country.”
In a country where poverty, illiteracy and limited resources result in extreme disadvantages in healthcare, Ian Garbett's plan is ambitious and far-reaching. But the doctor has the energy and determination to carry his plan forward. “I am an advocate for change,” he says. “I feel passionately about this. There are other very committed individuals working in cancer care in PNG. Together we will make it work.”
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