“There are brave women and girls out there in the villages that can be doctors”
Dr Paula Zzefrio is an obstetrician gynecologist in New Ireland. She’s one of the only doctors trained in complex deliveries for a province with a population of more than 800,000. She’s recently completed her training in Port Moresby and has returned home to deliver antenatal care in challenging conditions with scarce resources.
Paula faces many barriers in supporting women’s health in her province, but says some of the biggest obstacles are the land and sea.
“The terrain of the province is elongated and the island has limited transport,” she says. “This makes it hard for women just to get to health centers.”
Beyond the transport issues and physical barriers, Paula says there are deeper socio-economic reasons women don’t get care.
“They are unable to come to the clinic because they don’t have the money to get there,” Paula says.
“They are unable to come to the clinic because they don’t have the money to get there,” Paula says.
She says it’s important to be aware of the family dynamic when talking about sexual and reproductive health in a patriarchal community.
“Understanding social issues between the husband and the wife is crucial to quality care,'' she says. “I’ve had times where the husband does not want the woman to get treatment and he will sometimes stand right behind me.”
Paula says she has felt menaced but not physically threatened by husbands observing the consultations.
I’ve had times where the husband does not want the woman to get treatment and he will sometimes stand right behind me.”
“Papua New Guinea has a significant problem with gender-based violence,” she says. “When women come in, we give them the medical care they need and at the same time they are engaged in all the hospital services.”
Paula says even when they do notice signs of physical abuse, the reality is that most cases never get reported to police.
“At the end of the day women make the choice whether or not to report the case or not,” Paula says.
Although she’s seen some very severe cases of domestic violence, Paula says there’s a cultural pressure to return to the husband.
“In my experience when they go back home,” Paula says, “they are with the husband, then they get back together and the case is never pursued in a court of law.”
Paula says that some men still consider their wives as their property because they paid a bride price, which gave them ‘ownership’ and prerogative to use violence.
“I’ve heard men say, ‘I paid this amount of money and this gives me the right to do so!’”
“I’ve heard men say, ‘I paid this amount of money and this gives me the right to do so!’”
This heightened awareness about how to spot signs of violence is changing the way health workers are trained and how they follow up and refer cases of concern.
“We often see women suffer from domestic violence with the typical presentations of injuries caused by abuse,” Paula says. “They might get treated but then symptoms don't go away. She might start Antibiotics treatment and then it reappears. That’s a red flag for us asking about a problem.”
Despite the scale of the problem of gender based violence and women’s health issues in the country, Paula says it is typically inadequately funded in the government budgets
“Women's Health is not always the number one priority,” Paula says. “It’s about where women's health issues fall on the list of priorities in terms of government spending.”
“Women's Health is not always the number one priority.”
Paula says it is difficult to push for funding when budgets across the country are limited.
“The country is struggling with debts from international loans,” she says. “So they cut the budget for hospitals and that has affected all the units throughout the country.”
She says this lack of resources has created a culture of sharing information and supplies between health partners.
“We have seen some progress in creating more partnerships,” she says. “There are more discussions, collaborations, visibility, coordination and planning.”
Paula says this culture of better planning can save lives. Building relationships between colleagues and health centers saves time when there’s an urgent case.
“When midwives are calling from wherever in the remote area where they are they are stationed,” she says “at least they know who they're talking to and the call will not be put through to the switchboard.”
Even though Papua New Guinea has limited internet coverage for rural areas, tech innovations in the hands of health workers are starting to make a difference.
“The government has given midwives and nurses mobile tablets to better share patient data,” she says. “I think communication tools have played an important role in reducing maternal mortality.”
“The son gets an education while the girl stays back at home.”
Paula says that the focus on boys' health and education has created a major imbalance in gender outcomes across the country.
“The son gets an education while the girl stays back at home,” Paula says. “But slowly girls are getting educated, slowly things are changing.”
Paula says there is strong opposition to sexual and reproductive health services, both from traditional leaders and religious groups.
She says there are many Roman Catholics in New Ireland and it creates difficulties when trying to coordinate unified health messages.
“We have a lot of Health Centers and hospitals that are run by the Catholic Church.”
“In the Catholic faith, the use of Family Planning treatments is big trouble,” she says. “We have a lot of Health Centers and hospitals that are run by the Catholic Church.”
For Paula, she’s aware that being a woman doctor is helping break the barriers in her home.
“The response from women having a woman doctor in the province and a gynecologist in the province has been a really good thing,” she says.
“The response from women having a woman doctor in the province and a gynecologist in the province has been a really good thing,” she says.
Paula says the women are able to connect and share more easily because she speaks their language and there are fewer taboos in addressing sensitive subjects like menstrual hygiene or contraception.
While Paula is encouraged to see the progress in New Ireland, she says there is still a long way to go to ensure women and girls can reach their potential.
“I've seen brilliant friends and classmates forced to drop out of the medical program just because the families couldn't afford the school fees.”
“I've seen brilliant friends and classmates forced to drop out of the medical program just because the families couldn't afford the school fees,” she says.
Paula appreciates the comprehensive family support needed to help a girl realize her dream of being a doctor in Papua New Guinea. She’s encouraging to young girls with the same dream, but knows it will take a wider cultural shift as well.
“There are brave women and girls out there in the villages and remote communities that can be doctors or engineers,” she says. “But only if the society also encourages them to pursue their education and career.”