Warren Entsch (Leichhardt, Liberal Party) Share this | Link to this | Hansard source

I rise today to speak on this motion because this is a motion that is literally a matter of life and death. It is a desperate call for help on behalf of the people of Papua New Guinea's Western Province, the people of the Torres Strait and the people of the Northern Australian mainland, all of whom may be affected by the recent decision to withdraw tuberculosis services from the northern part of our country. The government has made a decision to provide short-term funding of $631,000 to clinics on Saibi Island and Boigu Island. These clinics are only about three kilometres from the mainland of Papua New Guinea. This funding is to be a frontline, if you like, to identify and treat tuberculosis in the population in the Western Province of Papua New Guinea. They have also committed a further $1.1 million to work on Daru hospital. This decision clearly demonstrates an absolute lack of understanding about these grave and critical issues. Quite frankly, this short-term funding is going to do absolutely nothing to ameliorate the problems that we have in that area; if anything, it is only going to make it worse.

I say that not in isolation, because my position is much supported by Australia's leading tuberculosis experts, who themselves have labelled the announcement as very misguided. They have said that the decision will result in unnecessary deaths of Papua New Guinea nationals and will inevitably spread the tuberculosis across the international border into Australia. Tuberculosis experts—such as Dr Julian Waring; Professor Ian Wronski from James Cook University; Dr Graham Simpson, who is one of our frontline fighters on tuberculosis in the region; and Dr Konstantinos—all insist that it is in Australia's self-interest to protect our citizens from exposure to this virulent and debilitating disease. Furthermore, they believe that the recent closure of tuberculosis clinics in the Torres Strait Islands diverges alarmingly from our self-interest. My principal concern is that, if the treatment of tuberculosis patients in the Western Province, especially those with the multi-drug-resistant tuberculosis, MDR-TB, ceases, that MDR strain will proliferate and migrate into Australian territory.

If you have any doubt at all about the competency of the Daru hospital to support this, I will refer to an article from the Papua New Guinea Post-Courier of 20 September this year. This front-page article, in this leading Papua New Guinea newspaper, starts:

After 36 years of independence, one town has nothing to show for.

The once peaceful town of Daru in Western province is on the verge of collapsing and the impact is being felt around this vast province.

There is no government presence with Governor Bob Danaya operating in Port Moresby because his official residence is rundown and has been taken over by squatters …

The local magistrate has fled the province because the jail has been closed for seven years and he has nothing to do.

Convicted criminals are roaming the streets with ordinary citizens on good behaviour bonds and that has sent fears to the community.

It goes on to say:

Most doctors of the Daru general hospital have also deserted with the last one leaving last Wednesday while the acting Chief Executive Officer Dr Amos Lano is in Port Moresby on private business.

Administrator Goinau on Sunday admitted the serious nature of the situation.

…   …   …

The Daru hospital has no drugs and the three buildings funded under AusAID and the South Fly District Services Improvement Program (DSIP) are incomplete.

… Hospital staff say all they have were chloroquine—

for treating malaria—

and panadol but they have now also run out of the latter.

So they do not even have panadol in the hospital.

Mr. Goinau said drug was a problem in all hospitals in the country and Daru was no exception.

So that is the sort of place we are talking about putting $1.1 million to stem the problem.

This is a major concern. The statistics show that Indigenous Australians in my electorate in the Torres Strait and in Cape York are eight times more likely to become infected with tuberculosis, and of course there will be corresponding increases in rates of hospitalisation due to this disease. If the MDR TB develops into an even more severe strain of the bacterium, which is the extensively drug resistant strain of TB, the population of Northern Australia will be burdened with a disease that is effectively untreatable.

If you have a look at what is happening in Papua New Guinea at the moment, the care of patients in the Western Province is a major issue. The PNG government's National Health Plan 2011-2020 depicts a trend of deteriorating health indicators and inadequate and inaccessible health services. And the health statistics tell a woeful tale: eight percent of children will die before their fifth birthday. Tuberculosis now consumes 13 per cent of all hospital bed days and is the cause of 11 per cent of deaths in the Western Province, and currently more people are contracting tuberculosis than are being affected by HIV. If left untreated, any person infected with tuberculosis or any potential lung infection will infect another 10 to 15 persons each and every year of their life. The other alarming thing is that 30 per cent of tuberculosis cases reported are in the age group from birth to 14 years.

A recent incident I was involved in highlights the gravity of the situation. I was asked to assist Mr Petru Aniba, a resident of Kadawa village, on the mainland of PNG's Western Province, about 45 kilometres from Daru. He had travelled to Daru and then embarked on an 8½ hour sea journey in a futile attempt to save his 14-year-old daughter, who was gravely ill with advanced tuberculosis. She got to Saibai and then down to Cairns but unfortunately she passed away. And there was a hell of an effort made by some incredibly generous people who raised money to allow Mr Aniba to take his daughter back home and give her a decent burial—4½ months after she had passed away.

Surely any reasonable person would ask why a father desperate to save the life of his dying daughter would embark on an 8½ hour open sea journey, bypassing Daru, if adequate medical facilities had been available in Daru. And therein lies the problem. We have to take responsibility for this. We have to make sure that we have our medical experts involved in this. I certainly support the concept of Australian development aid in PNG being incorporated into strengthening the government's health institutions, but it should not be done in the face of continued failure.

With respect to tuberculosis, we must admit that PNG cannot provide the health services that are desperately needed to combat this disease and we need to look at doing it ourselves. I think what is needed immediately is for the federal government to continue to appropriately fund the Boigu and Saibai island clinics. In the longer term, we need to build capacity for healthcare provision by directly funding aid posts strategically placed in villages in the Western Province. These aid posts need to be operated under Australian supervision and would be able to minimise, treat, diagnose and monitor tuberculosis in their catchment areas. One of the problems is supplying this support in widely scattered Western Province villages. Recently I have become aware of the YWAM medical ship that sails out of Townsville, MV Pacific Link, which has an outstanding record of providing a whole broad range of services. I think that, with the appropriate level of funding, that could be used as a front-line service in this Western Province area, referring on patients for further treatment. I think new ideas such as this need to be seriously considered.

Desperate people will continue to come to Australia for treatment and, with them, will come the very real threat of a tuberculosis outbreak in this country. An appropriate cross-border health solution will not occur by throwing good money after bad. A resolution will only eventuate if the government ensures its decisions are considered, compassionate, innovative and informed. In paragraph (5) of my motion I first of all urge the government to immediately consult with the front-line medical experts in this field to develop a long-term strategy that will deliver effective health outcomes to the region and minimise the number of inevitable deaths from this dreadful affliction. I plead with the government to treat this matter with the utmost urgency.

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

I commend the Chief Opposition Whip on his heartfelt contribution. The question is that the motion be agreed to.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I thank the Chief Opposition Whip for bringing this important motion to the parliament, a motion that is quite close to my heart and to that of the member for Kingston and that of the member for Hindmarsh, as in the last parliament we visited PNG, in particular Saibai Island. We were all members of the House of Representatives Standing Committee on Health and Ageing that put together the report on regional health issues jointly affecting Australia and the Pacific. So we saw firsthand the issues on Saibai Island, including what it was like at Daru Hospital, as we spoke to the doctors that were working in the hospital and the patients in it. We visited the Torres Strait Islands, going to islands that had never been visited by anyone from Australia and that had not even been visited by their own political representatives beforehand.

Mr Entsch interjecting—

I understand the Chief Opposition Whip may be very passionate about this. He wants me to name the islands. I can, as I have them here, but I do not want to waste my contribution to the debate by naming islands. I suggest that he has a look at the report that was brought down following that, as there is a lot of useful information in it that may help him when he is formulating some of his ideas.

When we visited Saibai Island we met with the elders and we went to the health clinic. We felt a strong feeling of resistance from those island elders to people coming across the Torres Strait to use that clinic. They saw that as a health hazard. Those at the health clinic itself talked about the dilemma of treating people from PNG when they were funded to treat the people of the Torres Strait Islands. So it is important to note, when we are talking about Saibai Island, that it is not necessarily the wishes of the people on the island that they undertake the treatment of people from just across the Torres Strait, those some eight kilometres from where they are or half an hour's trip away in a banana boat. The approach the government has adopted will empower the PNG people to be able to deliver their own health services. We do not want to just provide assistance to the few people who can make it to Saibai Island in a boat; we want to provide ongoing assistance to all people in PNG. As I said, we visited Daru Hospital. I am disappointed that the Chief Government Whip is opposed to giving money to Daru Hospital to upgrade its facilities and provide better services to the people in the Western Province. He highlighted the fact that there is a shortage of drugs. Isn't the issue assisting PNG to be able to have the drugs in Daru Hospital to be able to treat all the people who go to the hospital rather than treating just the few people who make it across the Torres Strait?

It is a really important issue. In those hospitals I saw many people suffering from multiresistant TB. They were in beds beside mothers who had just given birth. They were there with people who were suffering from malaria. The big issues are assisting that hospital to become a functional hospital with proper infection controls in place and ensuring that the hospital has the drugs. It is also about making sure that the communities we visited in the Torres Strait also have the health infrastructure that they need. All people, not just the one or two who make it across, have the right to have that sort of care.

This government—and it started under Prime Minister Rudd and has continued under Prime Minister Gillard—gave the strong message that Australia intended to engage with the Pacific in a way that had not happened in the past. That started with the Port Moresby declaration, which symbolised a new era of cooperation between Australia and the Pacific. It also started a new era of giving significant funds to that country to be able to improve its own health infrastructure.

The member opposite mentioned that the government is helping the PNG government to develop its health plan. That is really positive. That is a way that Australia can make a real difference. If we can help them put in place a health plan that will ensure these drugs are delivered and that will ensure those island communities that we visited actually have drugs and the right sort of infrastructure in place then we will really be making a long-term difference. Providing drugs to the few people who can make it across the Torres Strait to the clinics on the other side will not make a difference in the long term and that is not even popular with the people who live there.

I suggest the member opposite not just read the newspaper reports of what is happening in Daru but hop on a plane and have a look. If he visited some of the areas we visited, he would see the real issues. It is not just about reading it in the paper; it is about going and talking to people in those communities. It is about learning what they want. We do not need to adopt a paternalistic approach where we tell them what they need; it is about actually making real reform in the health system. I see that the member opposite finds that amusing. But I do not. I think it is really important that we make a big difference in those people's lives, that we do not just treat a few people but look at changing the way health services are delivered in PNG.

When the Howard government was in power, they were not giving money. They were not offering the assistance that has been offered since the Labor government has come to power. For instance, there has been $133 million and $72 million to PNG for health services. This is about the future and changing the way things are done. It is not about providing handouts; it is about building capacity. I suggest that the member opposite looks at ways that he can contribute to that in a positive way. (Time expired)

Warren Entsch (Leichhardt, Liberal Party) Share this | Link to this | Hansard source

I am speaking next. Andrew Laming has deferred to me.

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

An honourable member is only able to speak a second time in a debate in the event that leave is granted and no other member stands.

Warren Entsch (Leichhardt, Liberal Party) Share this | Link to this | Hansard source

I seek leave to speak next.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, I do not give leave for the Chief Opposition Whip to speak a second time.

Leave not granted.

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

It is a pleasure to be here in the committee today at such short notice to speak on the motion brought forward by the member for Leichardt, and I see some fellow members and ex-fellow members of the Health and Ageing committee on the opposite side. I must admit I was not on the trip to PNG, but I was on the trip to Thursday Island and visited Saibai Island, and I heard the previous member for Shortland talking about our experience on that trip. I remember quite clearly visiting the clinic. The woman who ran the clinic was the Western Australian, from Rockingham in the member for Brand's seat. It was very enlightening to hear about some of the experiences that they had had with the PNG nationals who had crossed the two- or three-kilometre stretch of water to get to the clinic.

As an example to highlight the problems with underfunding and under-resourcing of these clinics, one particular PNG national had been trying for four months to get into the clinic on Saibai Island. Eventually, on the day he had his scheduled visit, he collapsed in the waiting room. They revived him and sent him down to Thursday Island the next day for treatment, where he died. He had been waiting for four months to get in and due to lack of resources and funding he could not. He died, and the cause of death was HIV and tuberculosis.

In the 2009 Committee on Health and Ageing report into the health in the South Pacific, it was stated that tuberculosis is an infection primarily in the lungs caused by a bacterium called Mycobacterium tuberculosis. It is spread from person to person by breathing infected air during close contact. The most common symptoms of TB are fatigue, fever, weight loss, coughing and night sweats. The diagnosis of TB involves skin tests, chest X-rays and sputum analysis. TB can remain in an inactive or dormant state for years without causing symptoms or spreading to other people. When the immune system of a patient with dormant TB is weakened, the TB can become active or reactive and cause infection in the lungs or other parts of the body. As such, people with HIV-AIDS are at a high risk of developing the disease due to lower immunity, which is what I just spoke about—the gentleman who died and who had tuberculosis and HIV.

TB is a leading cause of death worldwide and, although rates in Australia are thankfully very low, there are signs that the disease may be making a comeback in developed countries, with the recent outbreak in the UK a case in point. With the considerable movements of people between the Top End of Australia and the South Pacific, many of which have been part of the culture for many years, this is an area that we must be mindful of and cannot neglect.

That is why I rise today to support the motion brought forward by my friend and colleague the member for Leichhardt and condemn both the federal and Queensland governments for indicating that they will terminate the tuberculosis clinics on Saibai and Boigu islands. These clinics provide vital tuberculosis surveillance and clinical care for Papua New Guinean nationals and reduce the risk of the emergence of drug-resistant strains of tuberculosis. By taking this course of action, the federal government is showing a lack of understanding of the issues at stake, and this is why the member for Leichhardt also has the support of Australia's leading TB experts in the motion he brings before the House today.

TB is a global health problem in which Australia has a responsibility and the capacity to make a difference. Australia has been successful in treating TB at home, and we have low levels of TB. Despite this good record, the federal and Queensland governments should not have assumed that, because we have been successful in keeping levels low, it will continue. Australians are not immune to future outbreaks of TB, and the Australian and Queensland governments must have appropriate policies in place to deal with this reality. According to Edith Cowan University reports, there were 1,142 new cases of TB notified in 2006, with 969, or 85 per cent, of these for people born outside Australia. Most of Australia's TB cases come from overseas, and the risk of TB spreading from PNG to Australia needs to be managed.

I also note that those at greater risk of contracting TB are Indigenous Australians. These clinics, which the government is indicating it will close, play an important role in preventing transmission to Australia through early detection and treatment and are a huge benefit to the local community. If TB does spread to Queensland from PNG, it is the Indigenous populations of the north who will experience the most harm. Even more worrisome is that, according to the Australian Medical Association, multidrug-resistant strains of TB—MDR-TB—are active in the Western Province of Papua New Guinea and are now spreading to the Torres Strait Islands and Australia.

With the close proximity of PNG to Australian territory, efforts to control TB are essential to ensure that it does not become a problem in Northern Queensland. In the worst-case scenario, the more severe strain of TB could spread to Northern Queensland, with the population burdened with a strain of TB that is effectively untreatable. A prudent government would be acting on this threat to ensure Australians are protected. I am afraid the closing of these clinics in Saibai and Boigu islands indicates the opposite of this approach.

The government has taken the decision to transfer responsibility for treating TB patients to the Western Province of PNG. This is despite reports that the health system in PNG lacks the capacity to provide such care. The government of PNG's National Health Plan 2011-2020 depicts a trend of deteriorating health indicators and inadequate and inaccessible health services. The number of health facilities in PNG is declining, and the quality of service is deteriorating. As at 2010, the population of the Western Province was 212,109 people and was purportedly served by 5.4 doctors per 100,000. This figure is probably optimistic, as in 2008 there were only four doctors on the island. Furthermore, between 2003 and 2008 the number of rural health staff declined in health services. There has been a reduction in equipment and supplies such as refrigeration and treatment manuals; retrieval systems in emergency situations are effectively nonexistent; and communication systems are poor. Procurement and distribution of medical supplies, including immunisation for measles, triple-antigen IPV and basic medical supplies, have waned. PNG has displayed an inadequate ability to prevent the spread of preventable diseases, and the government is reckless to assume the health services provided by the Western Province will overcome this decline. The federal and Queensland governments must admit that PNG cannot provide the health services that are desperately needed to combat this disease. In order to continue to fight the spread of TB in PNG and to protect the Top End from the risk of its spread, the government must continue to appropriately fund the Boigu and Saibai clinics. We support calls on the federal government to immediately provide long-term funding, through AusAID, to clinics that provide tuberculosis services to Papua New Guinea nationals and front-line health protection for Torres Strait Islander Australians.

Tuberculosis is not the only health issue facing this region. In 2009 the House of Representatives Standing committee on Health and Ageing conducted an inquiry into health issues jointly affecting Australia and the South Pacific, which involved a parliamentary committee delegation to Papua New Guinea and the Solomon Islands, which, unfortunately, I could not attend.

Ms Rishworth interjecting—

I did see the photos of the member for Kingston in that report and she looked as though she was struggling in the heat up there. From this delegation we heard evidence of the great challenges facing Papua New Guinea. As was recorded in the report, Professor Le Mesurier spoke of the high incidence of eye conditions in the Pacific. He referred to the approximately 800,000 people in the Pacific who are blind and an additional 250,000 people with severe vision impairment. Maternal mortality is another problem in the region and a worsening problem in Papua New Guinea, with government sources suggesting the maternal mortality rate has increased to 733 for every 100,000 live births. Compare this to a rate of seven deaths per 100,000 live births in the UK, according to 2002 UNICEF figures, and six in Australia, according to the World Health Organisation. PNG's rate is the second highest in the Asia-Pacific region, after Afghanistan.

Other preventable diseases, such as gastroenteritis and diarrhoea, as well as increased levels of bacterial infections, including severe skin infections, are caused by poor access to safe drinking water and basic sanitation. These diseases can often kill. In August 2009 there was a severe outbreak of cholera in Morobe Province in Papua New Guinea, with some 300 reported cases and 20 deaths.

It is imperative that we maintain the funding for the clinics on Saibai and Boigu islands so that they can keep up the fight against these diseases and assist the PNG nationals who come across and seek treatment, because it is obvious that the people in Papua New Guinea do not have the ability at the moment to contain their disease levels.

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to rise today to talk about the very important issue of TB and the spread of TB. It is a very complex issue and there is no easy solution. The complexity of it is perhaps missed a little in the motion. The member for Leichardt has very good intentions. I know he represents the area and I know, having been up there, people have said that they have seen him a lot—certainly in his previous term, and I am sure that that has not changed. However, the motion itself, while recognising this is a very important problem, probably misses some of the complexity around this issue.

I was very privileged, as has been mentioned previously, to travel to see both the Torres Strait Islands—and in fact visit the Boigu and Saibai clinics—as well as travel to Daru to some of the treaty villages. There are a number of challenges in PNG, and some of them have been mentioned, including the challenge of making sure people receive medication. In our discussions at the Daru health clinic, one of the issues that came up was ensuring that people do get their medication and continue taking it.

TB has become drug resistant because, while people get the drugs, they do not finish taking them. Ensuring that people finish their courses of TB medication is so desperately important. My concern, if the only long-term way we treat TB is through these clinics in the Torres Strait, is this: how do these clinics monitor people taking these drugs?

How do they ensure that the course is finished? That is one of the reasons the WHO, the World Health Organisation, has said that it is really important to treat people with TB as closely as possible to where they live. If you treat people as closely as possible to where they live, you can ensure that they are not only taking the medication but they also complete the medication. That was one of the big issues that people were raising: we need to ensure that people are treated as closely as possible to where they live to ensure that they finish their course of medication and to ensure that monitoring is done, and certainly I would support the government.

I know that the motion does call for ongoing funding. I note that the government has given temporary funding, because we are not able to shut these clinics down overnight. However, I do not believe that two clinics in the Torres Strait islands are sufficient to combat TB. Really, it is a mere bandaid solution in terms of actually ensuring that we treat TB. Only a few people can access those villages. People are not meant to come over from PNG for health reasons, but of course a lot do and I can understand that doctors, when presented with a very difficult, very severe case of multidrug-resistant TB, want to treat those patients. But that is not an effective way. For an effective treatment of TB, everyone must be treated so that the disease is eliminated. Treating only a few people that are able to get across the Torres Strait, but may not finish their drug-resistant TB medication, does not actually address the real problem—addressing TB right throughout the Pacific region.

There are a lot of challenges, as has been noted by previous speakers. As I said, there is the completion of medication. There is also, obviously, access to medication, a massive issue, as is access to health professionals, of course. When we were there, there were certainly concerns that it was very difficult for Australian health professionals to collaborate with PNG health professionals because of the visa situation. Australian health professionals had to go through Port Moresby down to Daru and then to the Western Province.

However, I do not think that we should say that with these challenges—the issue of getting medication, the lack of facilities at Daru and the issues around access—we should just throw up our hands and say that therefore we will just have two clinics on Australian shores and just allow patients to come over, without actually saying what we are going to do. That is why I was very pleased that earlier this year, in September, the government introduced another round of investments. We have made a real commitment to addressing health issues in PNG and we have provided $13.8 million over four years for the Australian-PNG package of measures.

But, even more importantly, there is another $1.1 million of investment in PNG to provide for the recruitment of health staff to address the issues that they are facing to improve TB services at Daru Hospital; to outreach services to the villages along the South Fly coast; for the construction of a temporary isolation ward at Daru Hospital; for a pilot incentive scheme to improve patient compliance in completing courses of TB medication; for training laboratory staff on Daru in the diagnosis of TB and training community members to support TB treatment compliance in communities and for continuing to support increased laboratory diagnostic capacity. So rather than just saying that we will just keep doing things the way we have been, things that have not worked in keeping these two clinics open for those that can make it across, we need to actually combat the problems that have been identified and combat some of those limitations and address them. That is incredibly important.

I think that it is important to note that the treaty between the Torres Strait islands and Papua New Guinea treaty villages does not allow for people to come over with health concerns as the primary issue. I understand that health professionals are supported, but if the member for Leichhardt truly thought that people from PNG should be treated for TB in Australia then surely this motion would read that we amend the treaty. The member for Leichhardt should be honest and say to the people up there, 'I suggest we amend the treaty between the Torres Strait and Papua New Guinea to allow people to come over primarily for health reasons.' If he were serious about this and wanted Australia to be the first port of call for treating Papua New Guinean nationals with TB then he should ask for the treaty to be amended to allow this to happen, because the treaty does not actually allow this to happen.

We are not immediately closing these clinics. We are looking at temporary funding for these clinics to transition to a real long-term strategy. As I said, TB does not get eradicated by treating the few people from the treaty village who are able to come over here. Indeed, we need to treat it at its source. We need to address the issues about medication. I have noted there have been some successful handovers to TB clinics. PNG took responsibility for 21 multidrug resistant TB patients. We will continue to do that. It is very clear that, if we are going to do this business as usual in Saibai and Boigu, clinics are not the answer. They are not the simple solution. We need to do something different.

If the member for Leichhardt wants to amend the treaty, he should call for the treaty to be amended. I do not think that would be very popular in his constituency. I think making the treaty wider, not just for commerce purposes but for health purposes, would not be popular in his electorate. If he would like to see that happen then this motion should call for the treaty to be amended to allow PNG nationals to legally get health services in Australia. That would show he was fair dinkum about this. If that is what he would like to see, I encourage him to explain that to his electorate.

We are working with the PNG government to ensure we are following the guidelines of the World Health Organisation. We are looking at their guidelines about how best to treat TB in communities—that is, treat people close to their communities to ensure people are able to finish their course. We are providing funding. I mentioned the drug supply. There has also been money for a boat that will help provide health care to some of the more remote villages. There has been $740,000 to temporarily support the TB clinics as we move to a longer term solution. While I think everyone in this House wants to see this, this is a complex issue and we must address it in a complex way. (Time expired)

John Murphy (Reid, Australian Labor Party) Share this | Link to this | Hansard source

Is leave granted for the Chief Opposition Whip to speak again without closing the debate?

Leave not granted.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

It is a great tragedy that today's debate on tuberculosis in Papua New Guinea has not been bipartisan. The two sides of parliament could have worked together to look after severely ill tuberculosis patients from Papua New Guinea, who for years have been treated by the finest infectious diseases physicians from Queensland Health. They have been nickel and dimed by the combination of the Queensland Labor Premier, who was looking for a short answer with less dollars to spend, and the Prime Minister, who simply did not have the will and the commitment to find a solution.

To blame the treaty is one thing but to embark on a personal attack against the local member who knows these islands is nothing short of a disgrace. We all love and work hard for our constituents. None of us here would ever suggest that those on the other side do not do that. For the member for Shortland in this debate to accuse the federal member for Leichhardt of not having visited the islands concerned is very disappointing. The member for Shortland is so far away from the focus of this debate and has probably never even seen a desperate PNG national crossing by dugout canoe in the hope they can get a family member or a child treated by the world's No. 2 health system. It was heartless, if not completely disappointing. It is a disgrace to make comments like that in a debate like this because we had a chance to get this right, a chance to inject a relatively small amount of money into making sure that our biosurveillance remains intact and that people who on compassionate grounds need life-saving tuberculosis care can access it. Mr Deputy Speaker, it was neither you nor me who designed the fact that Australia is within two miles of Papua New Guinea, neither you nor me who is responsible for the fact that the world's 174th ranked health system abuts by just a narrow, narrow isthmus of water the No. 2 health system in the world. So we do have to adapt to the inevitable people movements—up to 50,000 of them a year—and the desperate, desperate attempts by PNG nationals to seek out tuberculosis care.

This is an endemic disease. This is one of the three great killers in the world. It is only two kilometres away from us here in Australia, in the Torres Strait. You would almost think that those on the other side do not recognise that Torres Strait Islanders are Australian citizens. I am sure that if we lived that close to the perils of TB we would be calling out to the law-makers of the day to find a way to ensure that the most simple task of distributing tuberculosis treatments to people who live along the Western Province coastline was possible. But alas it is not.

To inform this debate, one just needs to talk to people like Fred Gela, from the Torres Strait Island Regional Council, or—as the member for Leichardt has—Toshie Kris, the Chairperson of the TSRA, or even Ron Enosa. These are the people on Saibai who know exactly what it is like. It is a complete affront to come to a debate in the nation's heart, be it 2,000 or 3,000 kilometres away from the Torres Strait, to wipe away and ignore such eminent and informed figures in the Torres Strait Islands and to turn this debate into a naked, partisan breakdown where basically one blames the other for the suffering of PNG nationals.

There is plenty of precedent for overseas nationals receiving Australia's first-class care, and there are plenty of committed clinicians who are already delivering it. They already travel, at great expense to their own practices, to Saibai and Boigu with nursing support and with top-quality TB expertise to deliver the service. It is not a major distortion to PNG health services because that entire coastal belt of PNG—even Indonesia itself—is wracked with the endemicity of chronic TB.

The great challenge we have, if we are going to enter this clinical space, is that we have to do it right. We have to completely treat people, as has been mentioned earlier in this debate. The risk of extreme resistance or even partial resistance to our TB treatments simply presents Australian citizens with an even greater challenge—that is, with extremely resistant TB, resistant to all drugs known to mankind and the medical system, we face the risk that an Australian can be infected by TB and be utterly untreatable by all the technology, all of the antibiotics and all of the advanced drug families, the second-line treatments, known to the medical profession.

Let us go through the history of this dispute, because, only a year ago, things were going well. It makes you wonder: just what does a Labor government have to do to get in and spoil a perfectly functioning clinical arrangement serving about 30 serious TB patients each year, visiting those islands of Saibai and Boigu and at the same time maintaining the biosurveillance that is so important for the northern parts of Australia? Here goes. First of all, Premier Anna Bligh spent herself into deficit within an inch of her fiscal life. She hit $85 billion in debt and said: 'Who can we find that's small and vulnerable and doesn't vote for me? Let's pick some Papua New Guinean citizens. There's not much they can do if we cut off their medical care.' So off she went and wrote a letter to the Prime Minister.

You would have thought that the Prime Minister of this nation would have looked upon that challenge and said: 'This is clearly a simple resource issue. We have the skills. We have the capacity. We have the distribution networks. We have, after all, the health system, and we have half a billion dollars every year poured into Papua New Guinea, so surely we already have the will, the commitment and the historical precedent.' But, no, there was a breakdown. In the correspondence from early this year there was a subtle suggestion: 'No, we won't be opening the purse strings because we're running the economy just as badly in Canberra as you are in Brisbane.' No, that was not inserted in the letter, but it said that what was referred to as an external arrangement would be reached. That was code for dipping into the AusAID pot, because that was a little bit more generous at the time, and surely we could find some money in there to come up with an alternative. That was the sudden prospect that, after 25 years in this space, we could actually begin a Western Province TB program domiciled in Papua New Guinea in just three months. That is right: it was the Labor notion that we could train clinicians, distribute drugs, get DOTS going and have fieldworkers trained in TB in just three months. Do you know what was more important than all of that? What was more important for these two jurisdictions was to cut off the clinics that come from Cairns, take the best people up there and offer the clinical support.

The federal member for Leichhardt has personally met the families involved, like the PNG man who brought down his dying daughter only to see her, with cerebral TB, lose her life despite the best care available in Australia. He had to look after that gentleman and all the arrangements that had to follow. This became a personal commitment by the federal member for Leichhardt working with partners in Cairns because this TB issue is one that is real for Northern Australia. It may not be real if you come from Melbourne. It may not be real in this debate here today. But if you are up there on the frontier this is incredibly important. If you are representing Torres Strait Australians, who are Australian citizens, it is really important because they have the cultural connections and they travel for trade, for markets and for family connections. Unfortunately, with TB endemicity does come the risk to Australian citizens.

We did not set about turning this into a potent and toxic political divide today. What we really wanted was some agreement from the other side that we could take this issue up to the Main Committee and have general agreement, in a non-controversial way, that together we can talk to the providers of this care and find a better way to do it. Has anyone on the other side talked to Horn Island? Have they talked to the Torres Strait about other ways of looking after the severely ill instead of having to transport them to Cairns or further? There are more cost-effective ways to do it, but this whole clinical area has been abdicated by the two jurisdictions that are in question in this motion.

So to people like Fred Gela, Toshi Kris and Ron Enosa, I am compelled now to say, after this has completely broken down as a result of the appalling contribution from the member for Shortland, that we on this side of the chamber will not forget their needs. We know this is a complex issue, but we are not going to pretend that there is a TB program in PNG when there is not. Already this morning I am receiving communications from the infectious disease clinicians in Cairns saying that the same patients that they saw and handed over last month have not received their follow-up drugs in Papua New Guinea. No, they have not. For all the effort in the world and after a generation, there is still not the capacity anywhere in Papua New Guinea to look at a sputum sample and work out what treatment is needed for one of their own citizens. So don't pretend in this place that AusAID has the answers to this challenge in a month. In three years? Perhaps. It is a noble goal to set up a TB program to train the PNG locals to directly observe the taking of TB medications so as not to have people, as they do so compassionately, share their TB medications with family and friends, innocently believing that that will cure them as well when it simply makes matters worse.

We need education. We need coordinators who have real telephones and are able to communicate with carers in Daru, Port Moresby and Cairns. Most of all, we need mobility through the use of maritime vessels to ensure these services are provided right along all the villages. But what we need more than anything is an injection of reality into this debate. It will not be done overnight. It is ridiculous to kill off the clinics and then talk about solutions. Worst of all, and most duplicitous, is to have these two jurisdictions squirting out press releases reassuring everyone that it will be okay in Papua New Guinea when anyone who has spent more than five minutes studying TB or more than five minutes on one of those islands knows it is a far more complex proposition. The intent of this motion from the member for Leichhardt was to raise this issue publicly and to garner the support of the government, something that I am very disappointed to say has not been achieved.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on this motion, as other members have before me, and I thank the member for Leichhardt for bringing such an important motion to this House. It is important when we look at diseases across the world and especially in the Pacific, the South Pacific, the Torres Strait and PNG to appreciate that countries have borders but diseases and illnesses do not. They do not stop at borders and if they are not contained they can spread across borders, including into Australia.

A couple of years ago I had the opportunity as Chair of the House of Representatives Standing Committee on Health and Ageing to visit PNG, Daru Island, the Solomon Islands and Saibai Island. We had an inquiry into health issues in the Pacific that affect Australia, and the aid that we give. Having seen the work that Australia has been doing over there when I led the committee on its visits during that inquiry, I thank the member for Leichhardt for the opportunity to speak on this motion today as I have a very strong interest in these issues. Bringing all this to the attention of the House is very important. However, having said all that, I cannot support this motion because I do not agree that the Australian government deserves censure for the way in which we have been assisting the people of Papua New Guinea, or PNG nationals, to access health care.

The Australian government is doing a great deal of work and spending many millions of taxpayer dollars tackling the economic and social costs, the mortality and morbidity caused by tuberculosis in PNG. That is reflected in the fact that in 2010-2011 alone, the Australian government provided $43 million to help strengthen PNG's health service across the country. That is a big help to the population of Papua New Guinea. Certainly, when we were there visiting health clinics and hospitals in regional communities, such as Daru, the people were very grateful for the assistance that they do get from Australia. That is not to say that we cannot do more. There is always more that can be done and we should always be looking at how we can do more to help some of the most needy people in the world when it comes to health services.

We know that there are risks to Australia, as I said earlier, if this threat is not adequately managed. Disease knows no borders. We come up with borders, as human beings, but diseases, catastrophes and earthquakes et cetera have no borders, and certainly disease knows none, and the impact of one of these diseases, tuberculosis, should not be underestimated.

But as PNG is a sovereign nation, delivering health services for PNG nationals is the responsibility of the PNG government. They made that quite clear to us when we were there. They are happy to receive our assistance and our support, but determining the responsibility for delivering those health services is the responsibility of the PNG government and they could not have made that clearer to us when we were there. They receive the assistance that we give them with open arms and they thank us, but they are a sovereign nation and delivering health services is their sole responsibility. Australian governments can only play a supporting role in delivering those services and assisting the PNG government.

I know this because a few years ago we were there when I had the great fortune of being the Chair of the Standing Committee on Health and Ageing and we conducted an inquiry into regional health issues jointly affecting Australia and the South Pacific. From 6 to 16 October, I led a delegation of the health committee members on the inaugural committee delegation visit to PNG and the Solomon Islands. The member for Swan is here and he was part of that committee and would have heard a lot of the briefings that we received at the time prior to going over there. He was not able to join us but I am sure that he is completely up to date with everything that we heard and saw.

During our visit to both countries, we met with a number of parliamentarians, government officials, health workers, civil servants and other representatives of PNG, as well AusAID and aid agencies that Australia has in PNG and in the South Pacific, to discuss a whole range of regional health issues. We discussed regional health issues that jointly affect Australia and the South Pacific. On our committee's trip, we were warmly received in both countries, both in the Solomons and PNG, and we appreciated the generous hospitality and the support provided by the host parliamentarians and government of PNG as well as our High Commission representatives in each place we went to.

We saw firsthand the hospital systems and the health care that is provided for those people. We saw what the problems were and how Australia was assisting. One of the things that was pointed out quite clearly was that PNG is a very remote, mountainous area. Some of the people who suffer from tuberculosis come into the health clinics, and may even come over to Saibai Island for assistance. They take the antibiotics and feel better, and then go back into their communities. You need to finish the whole prescription of antibiotics and even have a second dose. Because people feel better they decide they do not need the second dose and perhaps the tuberculosis has not fully subsided and it reappears in a more aggressive manner that is harder to treat with ordinary antibiotics. This is why we are seeing this new wave of secondary tuberculosis.

The delegation saw this firsthand. It was a great opportunity for us to learn about how all these things work, about their health services and delivery in countries neighbouring Australia. A benefit of this trip was the strength of the bilateral relationship between the two countries that we have longstanding and important ties with. A big focus of the visit was on tuberculosis and the factors that affect the spread and control of the disease. The inquiry heard in Cairns that TB is much more common in poorer communities where there is overcrowding and a lack of adequate ventilation. When we visited Daru we saw overcrowding. It is a very small landmass with thousands of people living there. We also learnt that patients are less resistant to the disease if they have other diseases, such as HIV, or are malnourished, and many people were.

Professor Maguire of the James Cook University School of Medicine and Dentistry told us that the incidence of tuberculosis is rising in Papua New Guinea. It was very sad to hear that. The rate there is estimated to be 95.3 per 100,000 people. Compare that with the Australian rate of 5.3 per 100,000 per year in 2005. Since 2000, approximately 25 per cent of those cases have been multidrug-resistant forms, known as 163, which add to the complexity and expense of treating the disease. These are usually people who have been diagnosed with tuberculosis, taken a dose of antibiotics, felt better and gone back into their communities where no-one can track them with the disease still in their bodies. The disease comes back in a more aggressive manner that is harder to treat with the ordinary antibiotics that were used in the first instance. We have confirmation that on the PNG side there are some difficulties tracking patients on their release. If we could track them then the health agencies could ensure that they receive the drugs that are required to get rid of the disease from their system. This has been the key contributor to the development of these strains over there.

When we visited Daru diagnostic facilities for identifying people with TB and for identifying people with multidrug-resistant TB were practically nonexistent. These are difficult problems. Sadly, there are no silver bullets or easy answers. I know the Australian government can and does help. Health is a priority for Australia's aid program to PNG. In fact, since we tabled the committee's report in March 2010, the government has announced funding of $1.1 million through AusAID to ramp up PNG's capacity to treat TB cases in the Western Province, which is the region of PNG closest to Australia. (Time expired)

George Christensen (Dawson, National Party) Share this | Link to this | Hansard source

We are here in the 21st century talking about the threat of TB in the Australian parliament. Tuberculosis almost disappeared with 19th century novelists, who wrote of consumption as an everyday occurrence, both giving it to their characters and falling victim to it themselves. Sadly, TB, which was the cause of the death on the death certificates of all the famous Bronte sisters and at least two more of their siblings, is not a thing of the past. Not only has it remained commonplace in some countries, it is now bigger and badder than ever before. Having developed effective treatments for TB last century we now see a growing trend of multidrug-resistant tuberculosis. It is commonly found in many countries, including Papua New Guinea.

The Western Province is one of the most marginalised areas of PNG and also the closest province to Australia. The current Australian border is only a short boat ride away in a little open dinghy. Let us not forget that PNG gained independence from Australia as recently as 1975. Health care in the Western Province of PNG is not like health care in Australia. That fact has seemingly been forgotten by those opposite. A recent report revealed how Daru Hospital was basically just a hospital in name only. The facility was without a doctor, had a radiography and pathology unit that was not operational and had a pharmacy devoid of even the most basic medicines that we would find here in Australia. The hospital building itself was dilapidated and had no access to clean water and no regular supply of electricity. Yet this is the very same hospital that those opposite think is a suitable defence at the moment against the spread of tuberculosis through the Torres Strait Islands and onto mainland Australia.

Let us be clear about one thing. The spread of drug-resistant TB to Australia is not only inevitable under the government's current approach but is already happening. In March, Queensland Health was investigating six cases of TB amongst Torres Strait Islander families with connections to Papua New Guinea. Alarmingly, two Aussies living in the Torres Strait have already developed a deadly strain of multidrug-resistant tuberculosis. The spread of TB into Australia is not unexpected. In fact, Cairns based TB specialist Stephen Vincent assured us that it was inevitable. He predicted in the Australian on 30 October that we would see multidrug-resistant TB in Australia in the next six to 12 months at the most. That inevitability was drawn from two certainties: Australia's border to the north being extremely porous and, on the other side of the border, a disastrously high prevalence of TB—in particular, dangerous growth in the incidence of multidrug-resistant tuberculosis.

Australia—for now—has one of the lowest rates of TB in the world. But in Papua New Guinea, TB consumes 13 per cent of all hospital bed days and is the cause of 11 per cent of all deaths in the Western Province. TB in that incredibly close neighbouring country is more prevalent than the rampant HIV, and a person with untreated infectious TB of the lungs can infect another 10 to 16 people every year. It is a country where the spread of TB is out of control and where the strains of TB are increasingly uncontrollable. It is a country whose shoreline is a short tinny ride from Australia. Of course this disease is going to find its way into Australia without the frontline defence.

The Torres Strait treaty allows thousands of PNG national to cross the border every year for ceremony and for trading. They are not meant to cross the border for the purposes of seeking health care, but they do. PNG nationals who are desperate for tuberculosis treatment know they are not going to find it in the Western Province and choose to take the boat ride south in search of lifesaving treatment. To date, they have found that treatment on Saibai and Boigu Islands in the Torres Strait. Queensland Health has been treating PNG nationals on compassionate grounds at these two clinics. It is an expensive exercise but, it has to be said, it is worth it. These two clinics have been frontline defence for this disease. Without these clinics, those same desperate people will continue their journey, probably even further south to the more populous part of Australia, bringing the disease closer to the mainland and closer to a very expensive health and humanitarian disaster in Australia.

But, without warning, the federal government—who should know only too well how porous those borders are up there—decided that it did not want to fund those TB clinics. The Queensland government earlier this year ordered the closure of TB outreach clinics on Saibai and Boigu, effective as of June, that decision being based on the discontinuance of federal funding for the service. The federal government decided instead to provide funding for treatments in the Western Province. That decision immediately raised concerns in that area. At the coalface we have the mayor of the Torres Strait Island Regional Council, who said he was concerned about the health risk to his Islander residents when PNG nationals continued to turn up regularly for treatment and continued to come to the island. Health professionals, too, raised serious concerns about the effectiveness of trying to treat and prevent TB through a health system in the Western Province that is at best dysfunctional and at worst completely broken.

It now appears that the World Health Organisation has taken an interest in the situation that is now developing in the Torres Strait and PNG. While Australia spends nearly $5 billion a year on foreign aid around the world and we have a Prime Minister wanting to send more money to the IMF to lend to the European Union to bail out Greece, we see a paltry $1.1 million invested in the prevention of this deadly disease right on our doorstep. Once again, we see a government struggling to deal with something of basic importance to this nation and taking something that is currently working and trying their hardest to break it. But it is not just a matter of wasted money. It is a very dangerous threat to the health of Australians. This is a move that takes health care back to the 19th century. Spending foreign aid in a place of dire need in our own region is commendable, but it is not enough to be effective. And to withdraw the safety net of the protection afforded by the TB clinics in the Torres Strait clearly endangers the Australian public.

The Australian public is just as concerned as health professionals and the people of the Torres Strait. Residents in my electorate have contacted my office with their concerns: Renate Kupfer of Slade Point; Sandra and Richard Ruddock of North Mackay; Laura Terry of Mackay; Mark Lauder of Habana; Terri Leota of Mackay; Bridget Foley of Walkerston; Lily Hutchinson of Beaconsfield; Chris Land of North Mackay; Keith and Ann McCollim, who are both pastors at the Holy Trinity Anglican Church in Mackay; Leanne Shepherd of Bucasia; and Deborah Rae of Glenella. These residents who have contacted me are North Queenslanders who, even though they live 1,000 kilometres from the Torres Strait, are acutely aware of the dangers posed by the premature closing of TB clinics on Saibai and Boigu islands.

We have a great Torres Strait Islander population in Mackay. There are also fantastic people of that descent in Townsville and Cairns, many of whom travel back to their island homeland regularly. Without these clinics, the front line of defence against tuberculosis, the risk of infection for those people—residents of Mackay, residents of Townsville, residents of Cairns—grows and grows. And what happens when they come back home—perhaps infected with TB—back to Mackay, back to Townsville, back to Cairns? The closure of these clinics is a great risk to North Queenslanders everywhere.

Funding and developing a tuberculosis program within the Western Province—yes, it is admirable, and it is to be encouraged, but it must be given time to work. Those opposite say that the TB clinics in the Torres Strait are a bandaid solution. But you cannot rip off the bandaid without the healing process beginning. The optimal solution must be properly funded, it must be developed intelligently and it must be given time. Advice must be sought from health professionals and the people on the ground. Advice must be sought and it must be heeded. We are asking the federal government to fund the treatment of foreign nationals. It is also a defence against TB spreading to our own country. The continuation of TB clinics must be funded on humanitarian grounds but also as insurance against a health disaster in this country.

I have sat through a fair bit of this debate and have found it very disappointing hearing the comments coming from those on the other side—disappointing that Labor are walking away from something to which there should be a bipartisan approach. I am disappointed that they are prepared to sacrifice the health of Torres Strait Islanders and North Queenslanders. I am disappointed that they have suddenly adopted a partisan approach to this. I am disappointed with the attacks on the local member, for goodness sake! There have been attacks on the local member, who knows all about this, by people from Adelaide who would not know Saibai from Samoa. But the local member, the member for Leichhardt, does and he knows that these clinics need to stay open. The people up there know it. The government is the only one saying they should not.

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I rise in the House today to speak on the scale of the tuberculosis threat to Papua New Guinea and Australia's aid program. Papua New Guinea is the largest developing country in the South Pacific region. We are internationally recognised for our leading role in the region, particularly in Papua New Guinea and the Pacific. But what I want to say first and foremost is that delivering health services for Papua New Guinea nationals is the responsibility of the PNG government. Australia can only play a supporting role.

About one-third of the world's population is infected with the organism that causes TB, but only about 10 per cent of these people will go on to develop the disease. Once you are infected you can develop the disease at any time, but it is most likely to occur within two years. Australian government agencies are working with the Queensland and Papua New Guinea governments to more effectively treat PNG residents with TB on the PNG side of the border so that they can get their health care at home, which is very important. The Gillard Labor government is providing $1.1 million through AusAID to help ramp up PNG's capacity to treat TB cases in the Western Province, the PNG region closest to Australia. Australian support has already seen PNG make headway, and this additional funding is further ramping up their capacity to treat TB cases in Papua New Guinea.

In my childhood, TB was fairly common, even in Tasmania, and there are still occasional cases in my state. We should be attacking this disease at the source, which is in Papua New Guinea. I understand that our support will help to recruit health staff to improve TB services at Daru Hospital and outreach services in villages along the south coast. This is something we should be very proud of. Other initiatives include the construction of an isolation ward at Daru Hospital, a pilot incentive scheme to improve patient compliance in completing TB medication, training for community members to support TB treatment compliance in communities, training for laboratory staff in Daru in diagnosing TB and continuing support to increase laboratory diagnostic capacity. The government is providing an additional $740,000 to temporarily support Queensland Health TB clinics while PNG's TB care capabilities in the Western Province are improving and to ensure an appropriate transition of TB patients from Queensland Health to PNG. I am advised that Australian and PNG clinicians are working cooperatively to hand over the patients. The first handover of PNG TB patients from Australian TB clinics to PNG took place last month. It was successful, with 21 multidrug resistant TB patients handed over. Two further handover clinics will be held, one in December and one in February.

World Vision reports that, in Papua New Guinea, there are still many misconceptions about TB. Many people believe that TB is caused by sorcery, while others believe that it is transmitted through sharing utensils. Misinformation and lack of education have become barriers to finding a cure. Adolescents and adults who have pulmonary tuberculosis can spread the disease when they cough. One person can unknowingly infect dozens. Those infected may not even realise that it is the disease, which may remain dormant and undetected for years before reactivating and making them ill. This often occurs when the immune system is weakened by HIV infection. If caught early, tuberculosis is curable. However, patients need to receive treatment for six to nine months. Stopping the treatment early leads to a recurrence of the disease, other people becoming infected and, sometimes, antibiotic resistance.

Our approach will provide better long-term health outcomes for PNG residents and is supported by the World Health Organisation. Health is a priority for Australia's aid program in PNG. In 2010, Australia provided $43 million to help to strengthen PNG's health services across the country. This is a significant investment. Through the PNG-Australian Partnership for Development program, we are supporting PNG's own priorities by focusing on four key areas: health, including HIV; education; transport infrastructure; and law and justice. According to AusAID, in 2010 Australia funded 539,000 new textbooks for over 3,400 primary schools and eight teacher-training colleges in PNG. Our support allowed for the abolition of school fees for the first three grades of basic education, supporting the aim of the PNG government to abolish school fees by 2015. Measles vaccination coverage had declined from 67 per cent to 58 per cent in 2009, and was at 59 per cent in 2010. The proportion of children under one year of age fully vaccinated against diphtheria, whooping cough, tetanus, hepatitis B and influenza type B increased from 66 per cent in 2009 to 70 per cent in 2010. This is significant. The Australian government's overseas aid program is improving the lives of millions of people in developing countries. Australia is working with the governments of people in developing countries to develop aid programs where they are most needed and will be most effective. Australian aid has helped our neighbours as well as countries further abroad, and our aid program continues to grow. For example, Australia's aid has wiped out polio from the Pacific. This is a significant achievement. Australian aid has seen more than 1.5 million children immunised against measles and polio in Papua New Guinea. We have a proud record.

Despite a growing global population, the world has made solid progress in the fight against poverty over the past 40 years. A woman's chance of dying during childbirth has dropped by 50 per cent. The chance of an adult not being able to read has halved. The average life expectancy in developing countries has increased by 20 years. Australian aid has contributed to these achievements. It is making a difference to the lives of our neighbours and it is boosting growth and stability in our region. I was pleased to have the Minister for Foreign Affairs, Kevin Rudd, visit my electorate earlier this year to discuss the effectiveness of our aid program. This was a worthwhile visit.

Many constituents in my electorate were keen to find out where our aid money was being spent and to learn about the benefits coming from it. As I have said in this House before, there are many passionate people in my electorate who often talk to me about the Millennium Development Goals and the importance of our aid program. These people include the young people from Results International, who often write to me, my good friend Syd Edwards, Jeff McKinnon and his family and many others. I thank them for their support and commend Australia's aid program.

Papua New Guinea faces critical constraints on its development and it has some of the worst health and education outcomes in the Asia-Pacific region, driven by high levels of poverty and a largely rural population who are often living in remote locations. As one of Australia's closest neighbours and oldest friends, it is in our interest to help Papua New Guinea improve the lives of its people.

Jane Prentice (Ryan, Liberal Party) Share this | Link to this | Hansard source

Papua New Guinea is Australia's nearest international neighbour, and our countries have always had a close association both in times of war and in times of peace. As the Department of Foreign Affairs and Trade's own website states, 'geographic proximity and historical links have given Papua New Guinea a special place in Australia's foreign relations'. With this in mind, I condemn the Commonwealth and Queensland governments for their indication that they will terminate tuberculosis clinics on Saibai and Boigu islands, which currently provide vital tuberculosis surveillance and clinical care for PNG nationals.

Tuberculosis is a potentially fatal disease which debilitates those who suffer from it. It is highly contagious and, worryingly, TB specialists treating PNG nationals with this disease have seen the development of a drug resistant strain. In relation to a disease which already requires up to two years treatment, this development has serious and far-reaching consequences for the health of Papua New Guineans and Australians alike. For six years, PNG nationals have been making the short trip to Australia to access life-saving treatment for tuberculosis. It is a service that these sufferers have come to rely on, not only so that they themselves can recover but to ensure that the disease does not escalate throughout Papua New Guinea.

The international aspect of this issue is complex. The border between Australia and PNG is extremely porous, with tens of thousands of people moving back and forth between Papua New Guinea and the Torres Strait Islands every year. Putting humanitarian concerns aside, I think this movement of people between the two nations means that the stopping of treatment for PNG nationals suffering from tuberculosis is a dangerous prospect as it increases the risk of Australians being exposed to serious communicable diseases with which they would otherwise not come in contact. It is vital that the drug resistant strain of TB we are now seeing does not spread to the Australian mainland.

Just last year, a Senate inquiry was held into the issue of PNG nationals accessing treatment for TB in the Torres Strait Islands. This committee did not find that TB clinics should be shut down. In fact, it recommended the contrary: that the Commonwealth government should increase its funding to Queensland Health, which has been providing a service that essentially falls within national provinces. Why then has the federal government made this decision, a decision which has far-reaching health and diplomatic outcomes for Australia and Papua New Guinea? According to the Department of Health and Ageing the reason is financial. So, yet again, we see the people lose out simply due to the financial mismanagement by state and federal Labor governments.

Thankfully, there are organisations which can look past a budget black hole and address the human face of suffering. Youth with a Mission are one such organisation, and they are breaking new ground through their provision of an Australia-PNG medical ship used to achieve health outcomes in remote areas of the gulf and western provinces of PNG. In only its second year of operation, Medical Ships Australia has already provided 54,732 health services, ranging from issuing mosquito nets to dentistry and optical treatment. Just this month, MSA sailed into history by signing the memorandum of understanding with the PNG National Department of Health, committing the YWAM MSA to assist PNG in implementing its 2011-2020 National Health Plan. The MSA will also be assisting both PNG and AusAID in reaching their millennium development goal for the region.

Whilst the YWAM MSA helps provide an immediate solution to urgent health issues such as the treatment and control of tuberculosis in PNG, importantly it also emphasises a grassroots approach by engaging PNG nationals in their home villages and empowering them to address their own needs through training in and equipping and delivery of life-saving health services. It is clear that it is this approach which will provide a solution in the long term and which will see PNG have the capacity to address these issues independently. Simply cutting off treatment is not only cruel for sufferers and potentially detrimental to disease contagion; it does nothing to assist our nearest neighbour to develop. It will be, realistically, at least a decade before PNG will be in the position to self-manage its tuberculosis crisis. In the meantime, Australia must assist. I support my friend Dame Carol Kidu, the former Minister for Community Services in the PNG government, who said:

Sometimes people forget that providing the support in the Torres Strait also protects Australia from the spread of tuberculosis as much as it provides support to Australia's closest neighbours—those PNG citizens right on the border in Papua New Guinea. In PNG we appreciate that targeted assistance from Australia in partnership with the PNG Department of Health to improve the capacity and service provision in our own clinics near the border. However that addresses the longer term not the immediate issue of a potential threat to Australian citizens that relates to a global health issue, which is targeted in the Millennium Development Goal No. 6.

I condemn the government's action and call on all members to support this motion and put human lives before bureaucracy.

Rob Mitchell (McEwen, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on what I feel is a very partisan motion before the Main Committee today. From the outset, what we need to make clear is that delivering health services for Papua New Guinea nationals is the responsibility of the Papua New Guinea government. This is their primary role. However, in pointing this out, I say that Australia can assist and support PNG nationals, and this is exactly what we are doing.

Papua New Guinea's largely rural and remote population do find it difficult to access basic medical services and we know that there are many key health challenges facing the region, which is why we are working with the PNG government to help address these issues. Our federal government agencies are working with the Queensland and PNG governments to assist and treat PNG nationals with tuberculosis. We are providing $1.1 million through AusAID to contribute to Papua New Guinea's ability and capacity to treat tuberculosis in the Western Province, which, of course, is the closest PNG region to Australia. The government's support helps recruit health staff to improve tuberculosis services at Daru Hospital and outreach services to villages along the South Fly coast. We are also providing $740,000 to temporarily support the Queensland Health tuberculosis clinics while PNG's tuberculosis capabilities in Western Province are improved and to ensure an appropriate transition of tuberculosis patients from Queensland Health to PNG, where both Australian clinics and PNG are working together to hand over the patients.

It is not only this government's support that is providing better long-term health outcomes for PNG residents; that is also supported by the World Health Organisation. In 2010-11 Australia provided $43 million to help strengthen PNG's health services across the country. It was under Labor that Australia signed the PNG-Australia Partnership for Development, which aims to accelerate progress towards the Millennium Development Goals, something I am very passionate about, and other PNG development priorities. The partnership also provides a framework that allows both countries to work together in close cooperation to meet common challenges with a revised partnership schedule agreed at the 2011 Australian PNG Ministerial Forum, some of which are: faster progress towards universal basic education; approved access to quality education at basic secondary, technical and tertiary levels; and improving health outcomes by providing assistance for PNG to vaccinate more children, increase the percentage of births supervised by skilled staff, increase the availability of essential medical supplies and improve access and treatment for HIV-AIDS. AusAID clearly state the following:

Australia and Papua New Guinea are working together to address this challenge through the Partnership for Development. The Partnership sets out mutually-agreed priorities towards reducing poverty and increasing the quality of life for all Papua New Guineans.

They also state:

Australia and PNG have agreed to increase the percentage of babies delivered under the supervision of skilled staff, immunise more children and reduce malaria and tuberculosis.

Under the Health Sector Improvement Program, Australia and other development partners are working through the PNG health system so, in the long-term the PNG National Department of Health can manage and deliver health services. Donor contributions include operational costs for public health activities and staff training.

Australia also funds the World Health Organization in PNG to advise the PNG Government in critical local health areas including: tuberculosis, human resources, pandemic and emergency preparedness such as the current cholera outbreak, and maternal and child health.

Our work in PNG has seen an increase in the PNG Stop Tuberculosis Program from two provinces to five, as well as decreasing malaria incidence and deaths; the immunisation of 900,000 children against measles and other childhood illnesses in 2008; and an increase in HIV testing sites.

Health is a big priority for this government and has always been a Labor priority. It is surprising that the opposition members want to talk about health, because we know it is those opposite who oppose Medicare and the national health reforms, who cut billions from the budget for public hospitals and who continue to receive donations from big tobacco—more than $1.7 million in donations since 2004. The Leader of the Opposition, as health minister in the Howard government, cut $1 billion from public hospitals, which would have been enough to fund over 100 beds. It is Labor who established— (Time expired)

Louise Markus (Macquarie, Liberal Party) Share this | Link to this | Hansard source

I am honoured to have the opportunity to speak on this important private member's motion, and I thank the member for Leichhardt for his work in raising awareness of the challenge tuberculosis poses for Papua New Guinean and Australian citizens in our north. Firstly, can I say that I am disappointed that this is not supported in a bipartisan way. This is a critical issue for our nearest neighbour, for our region and for the residents of our own nation in our north. The risk of the infection spreading across our borders is great, due to Australia's close proximity to Papua New Guinea, particularly the Western Province, which is extremely isolated and which this issue gravely concerns.

The lack of long-term funding to tuberculosis health clinics in Papua New Guinea is a serious, life-threatening challenge that this government has chosen to address with its typical response, a short-term solution: a $631,000 one-off payment to two clinics on Saibai and Boigu islands and $1.1million for work on the Daru Hospital. This financial gesture will look good in the next news cycle; however, it does not deliver any long-term or real solutions or benefits.

TB clinics were, until recently, operational on Saibai and Boigu islands, providing vital TB surveillance and clinical care for Papua New Guinean nationals. The solution this government has provided is short-term funding to keep these clinics operational only until next year. Having lost financial commitment from the Queensland Labor government, this government is not doing enough to address the long-term funding these clinics need to continue to operate. This government has acknowledged that tuberculosis is one of the most significant public health threats to the global population. Words are not enough.

Further, the Department of Health and Ageing claims that Australia has one of the lowest rates of TB in the world. In contrast, PNG has the highest rate of TB in the Pacific region. Australia's border is so close to PNG, particularly to the Western Province, that the risk of infection to our own residents as well as to Papua New Guinean nationals is very serious. To treat Papua New Guinean nationals is to protect our Australian citizens. Instead this government refuses to proactively address this concern. The Gillard Labor government will wait until disaster strikes, fumble its way through a series of policy debacles—which we have seen in other areas—and capitalise on a trendy headline and photo opportunity but without considering either the national interest or the interest of our nearest neighbours. While our Pacific brothers and sisters have very limited capacity to respond to this health disaster, they require our assistance. They require us to come and work alongside them in partnership on a plan and its implementation and also to make sure that its delivery is culturally appropriate.

It is a regional travesty that this short-term-thinking Labor government does not have either the passion or the foresight to take action so that we can work towards addressing more effectively TB in our Pacific region. Efforts should be concentrated on long-term funding for long-term gain. Even for a government that usually thinks only about itself and its own interests, it is baffling that it fails to address the challenge that is sitting on our doorstep. The government will take extensive measures to protect itself but not Australians and Papua New Guinean nationals. Australia's efforts to minimise TB can only be supported by adequate funding allocated to research, drugs, administration and delivery of health services. Australia has been very successful in its treatment of this disease. However, this disease is becoming more and more challenging to treat among PNG nationals, particularly with the increasing prevalence of drug resistant strains of TB. There are challenges with distribution and the correct use of medication, which require doctors and healthcare workers who understand how PNG, its cultures and its village system work. Australia needs to work alongside PNG to provide the correct and adequate resources to alleviate TB in its early stages. We need to work on contact tracing, going all the way back to the village and making sure that every single person in the clan receives medication and treatment. This will require our working very closely with the PNG government to ensure that the plan that we implement together with them will work on the ground. (Time expired)

Chris Hayes (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

I thank the Chief Opposition Whip for bringing this motion forward as it gives us an opportunity to reflect on Australia's relationship with Papua New Guinea, particularly in the area of health. Australia and Papua New Guinea enjoy a mutually significant relationship based on strong geographic and historical ties. In fact, as I understand it, from the Western Province of Papua New Guinea you can paddle some five kilometres and make it to Australia's maritime waters. Due to our strong historical and geographic ties, Australia naturally has a very strong interest in the development of Papua New Guinea and of the Pacific in general. We have heard much about that over the past week. Australia has invested a lot of aid in Papua New Guinea. At the moment a little over $1 billion from the 2009-2010 budget alone has been allocated to PNG aid, of which a large proportion, $133 million, has been directed towards health matters, including $72 million for Papua New Guinea Health for HIV and AIDS programs—which I understand, from previous speakers, have been very much of significance in that region.

Despite this substantial development assistance, we cannot deny that the PNG health system is still incredibly fragile and certainly failing to meet Millennium Development Goals—there is no retreating from that, particularly as they relate to health. It is well established that Papua New Guinea nationals often choose to seek treatment at Australian health facilities on Saibai and Boigu islands rather than attend closer facilities in the Western Province, at Daru. There are a number of possible reasons for that. The low standards of health care in areas have been identified, including issues about governance, administration, difficulties in respect of infrastructure—the size—poor sanitation, water and water quality. Clearly, these matters all have an impact and, as a consequence, people in Papua New Guinea are making a choice to go elsewhere for treatment.

These issues, combined with a lack of qualified staff and clinical supplies and a limited diagnostic capability all contribute to a large number of the communicable diseases, including TB. As most here would be aware, tuberculosis is an infection, primarily of the lungs, caused by a bacteria that often spreads from person to person by the breathing of affected air during close contact. Overcrowding and the lack of adequate ventilation are significant reasons for the high prevalence of TB in poorer communities, particularly in Papua New Guinea. TB incidence in Papua New Guinea is rising to a rate, as I understand, of over 95 people per 100,000, compared with Australia, where it is five persons per 100,000.

One of the issues about TB in Papua New Guinea is that it is becoming largely treatment resistant. Part of the reason for that is inadequate attention being given to follow-up treatment. Once they are getting better from the drugs being administered, people tend to vacate the system, whereas the actual bacteria must be completely eradicated, otherwise it returns to its host and, then, with some degree of mutation it can be not only stronger but more resistant to drug related medication.

This is where the issue about practitioners involved in the field and working with the community becomes very important. Due to geographical proximity and the high mobility of people between Papua New Guinea and Australia, aided no doubt by the Torres Strait Treaty, there is a high risk of this disease being able to cross borders.

The government is already putting $1.1 million into AusAID to help ramp up PNG's capability for treating TB cases in the Western Province. This is an area that geographically is closest to Australia, and it is an area that people are avoiding at the moment. This investment will go towards recruiting staff at Daru Hospital and at their outreach service, which is so critically important to working at village level, particularly in the south Fly coast.

I think this has been a good opportunity for members to focus on this debate and concentrate on building proper services in Papua New Guinea.

Debate adjourned.