Medical Angels in Papua New Guinea
Medical Angels Provide a Much Needed Service in the Jungles of PNG
Using primarily his own resources, an extraordinary individual and his team are providing an incredibly important yet unsung medical service to a nation of people where many do not have access to the very basic health services. HeliOps spent time looking at the life-saving work being done by Manolos Aviation along the northern coast of Papua New Guinea.
Jurgen Ruh came to PNG from Germany in 1983 and established a life in this equatorial island. He married locally and has raised his three kids there. He started out in marine salvage (where he made his money) never imagining that he would eventually be saving the lives of hundreds of people using helicopters (where he is spending his money). To understand what he is achieving it is important to have an appreciation of the nation he now calls home.
Papua New Guinea (PNG)
PNG occupies the eastern half of the island of New Guinea. Also included are the islands of Bougainville, The Admiralty Islands (Manus) and New Britain. Located just to the north of Australia on the Pacific Rim of Fire, this is a land of geological and cultural extremes. It is a must see and experience for those intrepid souls who want to flavour a world that has withstood the tests of time. With 852 known different languages, this is a land of just 6.7 million people who primarily live in remote customary villages with few if any basic services such as clean running water, sewerage or even doctors. Forty per cent of its people live a self-sustainable lifestyle. Its neighbour Australia has 327 doctors for every 100,000 people – PNG has five.
In 2010, PNG’s estimated infant mortality rate was 374 per 100,000 live births (but this may be an underestimation given the remoteness of so many people) - Australia was 43. The statistics of kidsreachingtheageoffive are evenworsewhencomparing PNG with Australia. Life expectancy in PNG improved from 38 (in 1960) to 63 (in 2014) – Australia’s life expectancy is presently more than 82.
It is obvious from the aforementioned figures that health should be a serious priority in PNG but its Government spends about 4.3% of GDP compared to Australia’s 9.4%. With so many people living in remote areas, it would be thought that there would be many well-stocked and support health centers but alas, that is not the case. Most people in PNG live outside the main cities and therefore miss out on even basic health care. Making things even harder for the villagers is PNG’s geography. Still volcanically active, the island has a tall sheer mountain range as a spine and many of these mountains extend to the coast. That geography explains how so many languages came to be – it was, until the advent of aviation just too difficult for people to move around the country.
Lastly, while the country is ostensibly a parliamentary democracy, this is overlaid on a tribal/clan system. The strength of the clan system can be witnessed through the many clan wars and fights (particularly in the Highlands) that have been waged for generations and often result in deaths or maiming. Equally though the village system is why people have survived. Everything is shared and everyone is responsible for each other. Wantok as a system, is an anathema to the individual focus of western societies yet has been essential to the survival of Papua New Guineans. Largely Melanesian, PNG people have little regard for time – as one pilot put it, an appointment regardless of the actual time is half past morning or half past afternoon.
With little infrastructure and the terrain making the building and maintenance of roads difficult as well as expensive, air transport is PNG’s single most important form of transport. It was as late as the early 1930’s when Australian explorers explored what was thought to be an empty PNG Highlands using the airplane. What they found was home to roughly one million people, made up of several hundred different ethnic groups who had never encountered Europeans before. Amazingly, in the course of merely one generation, the highlanders experienced contact with Europeans, colonization, and decolonization while dealing with the massive cultural change that this contact entailed.
Along comes Jurgen
Jurgen started out in East New Britain in the marine salvage business and to this day still has a coastal freighter business supplying the islands and coastal areas. In 2009, he decided he needed a helicopter to support the salvage business and so went to Australia and trained to be a helicopter pilot. On successful completion, he returned and began supporting his business. Despite operating privately, a local helicopter operator complained to the PNG aviation authorities at the time and despite the regulations not requiring, the regulators insisted that he gain an Air Operator’s Certificate. To justify the expense associated with setting up a certificated operation, he decided he needed three income-producing helicopters and so began Manolos Aviation. “In the end,” he points out, “I became a true competitor to the complainant and their tactic of objection backfired.”
About eight years ago, he began conducting medical patient transport out of Lae. His first medical transport mission was to transport a pregnant mother to a health facility. “The person who made the phone call for help had walked for one day from his village to find a phone. In the meantime, it took the villagers a day to carry her from one side of the valley to the other where that village had an open sports area I could land at,” Jurgen explained. Despite her complications, the 12-minute flight from the village to the local Lae hospital saved her life. It was then that Jurgen thought that more needed to be done. He has since set up a base at Alotau in the Milne Bay area because the many islands in the area has meant most have no access to medical care or have to endure long and sometimes treacherous small boat rides to seek help.
PNG’s remote areas include not just the mountains and highland areas but also the islands that lie off the coast. What the figures don’t reveal is the personal suffering that many mothers in remote areas endure. Often, there are breached births, or babies dying in the womb or birth canal, or placenta that remains in situ, among a myriad of other complications that arise. Often, transport to the nearest health clinic, as basic as many are, requires days of travel. In the case of the highlands, mothers will need to walk or be carried. Travel from the islands involves hazardous journeys in dugouts. Other illnesses and injuries occur in the villages but Jurgen says that the vast majority of his work, about 60%, is transporting mothers and their children. Since 2015, Jurgen estimates that the helicopters at Lae and Alotau have directly saved at least 700 people. These are people who would have most definitely died had they not had access to the helicopter service. Some still don’t survive but according to Jurgen, the rate has improved from losing two mums every year to about one every two years. Jurgen commented that the health centers are calling in earlier now, “and having something simple such as us having a toll free number, helps the survival rate.”
There are politicians in the PNG Government who acknowledge the work being done by Jurgen’s team. The local Member of Parliament for Esa’ala Open Electorate, the Honourable Davis Steven (who is also the country’s Minister for Aviation) said that they supported the establishment of the base at Alotau because he believed that his people needed access to the basic care that the local hospital provided. “In the short time the helicopter has been operating in the islands,” he said, “the service has saved many lives.” Because the cost of flying comes out of the district budgets, Davis Steven travels by banana boat from home to his office in Alotau, not by helicopter. He has set up a mattress and rice cooker in the room next door to save money on hotel bills. “The money we have is needed to look after the people,” he said, “not for me to have comforts.”
PNG’s new Governor General, Bob Dadae who also served as for the past 15 years as theelectedmemberoftheKabwum district, has flown with Manolos and seen the work they do. He said that the company has saved many lives and he hopes to set up a fund to help keep the service going. So there are people within the Government who see the value of this service but unfortunately, many other MPs and bureaucrats in PNG do not share these representatives’ integrity or vision.
Adding to the funding restriction, hospitals in PNG had their budgets cut by 25% in 2016 as the fall in resources income bit. Many health centers do not have basic essential drugs so to ensure his patients have a reasonable chance of survival, Jurgen has decided to gain his own pharmaceutical licence in order to be able to hold the proper quality assured medical drugs for cost effective distribution to remote areas where the service operates.
Some private organisations also support the service. For example, Milne Bay Estates has provided land near the local airfield in Alotau so the service can develop a base away from the present town location and enable future emergency night flying. Trukai (a rice product packaging, distribution, sales and marketing company) also provides sponsorship. “We have to be careful how we seek support as we are still a commercial company doing commercial work – it’s how we separate the medical retrieval work from our commercial operations as far as sponsored funding goes that is important,” Jurgen said. In reality the commercial operations and his marine business are financially supporting the retrievals. “If this company was run by an accountant,” he mused, “we would not be doing medical retrievals.”
There is nothing fancy about what Manolos does or how it does it. It is a VFR transport service. His facilities at Alotau and Lae are basic but no less effective. Lae services an area of some 50,000 square miles, much of it in Morobe Province with a population of about 675,000. His cars, trucks and ambulances are sourced from around the world (wherever he can find the cheapest) – there’s little of anything new because he puts the limited financial resources where they are needed most, into patient care. To last or be reliable, equipment in PNG has to be robust and simple.
An example of how finances are prioritized in Manolos is that while the ground vehicles may be basic, the company employs four flight nurses. The nurses are not provided by the health service and are funded from within company resources. The nurses prepare the patients for movement, provide attention in flight and follow up once they are in the hospital. “Many village people have never been to a hospital before,” Jurgen explains. “So they will sit at the hospital not knowing how to gain attention for care so we have had patients die at the hospital waiting for attention. So the concept is that our nurses will provide care from the time the patients are picked up and then follow up to make sure the patients aren’t being forgotten.” He also provides the ground ambulance from the Lae base to the local hospital. He has also purchased a used ambulance from Canada. His idea? - to develop a mobile Intensive Care Unit (ICU) for mothers only. “The plan is that we will take them off the helicopter and stabilise them in the ICU before delivering them to the hospital.”
A fleet suited to the job
The company’s fleet presently includes three BO105s, a BK117 and an S76. Three more IFR-capable BO105s are on the way. Lae Base has a BO105 and a BK117. Alotau has a single 105 at the moment although there are long term plans to also eventually base an S76 there.
The BO105 is Jurgen’s helicopter of choice because it has twin-engines (Jurgen believes essential given the mountainous terrain and extensive areas of water being overflown); it’s fast and small enough to get into most unprepared village areas, and as Jurgen notes, “it is as tough as nails.” He also points out that the difference in capital investment is significant. “$500,000 compared to say $1.4 million for a BK is a big difference and the lower capital cost means we can keep the charge-out rates down.” Fifty years ago, the BO105 made its first flight, and it was the first helicopter to feature a rigid, hingeless rotor head made of titanium and glass-fibre-reinforced rotor blades. Of the 1,400 aircraft built, 400 remain in service around the world.
The BK has also proven to be an effective helicopter especially as it has more room in the cabin, is a little faster than the 105 and has better range – but it’s higher downwash can cause problems, and it costs more to run. Again there’s nothing new in the fleet. Like his ground vehicles, Jurgen scouts the world for his helicopters. The helicopters are analogue to keep them simple to maintain and suited to withstanding the high temperatures, humidity and heavy rainfall experienced in PNG, especially around the coast.
If the finances allow, Jurgen wants to eventually run an S76 out of his Alotau base. This base is providing a service to an area of about 80,000 square miles and around 300,000 residents. Much of the area covers the islands to the east of Milne Bay. He said that recent task took about 6 ½ hours because the BO105 had to refuel on the way out and back. Refuelling is done using hand pumps from drums stored at various locations throughout the island chain. The job was called in about three in the afternoon and because of the time needed to get there and back, and as the aircraft cannot operate at night, Alotau’s 105 could not depart until first light the next morning. Whilstthemothersurvivedherordealofan obstructed labour, theunborn child died the next day whilst en route to the Hospital. “We could have done the same job in 3.5 hours total and immediately after callout in the S76,” he said. “We would have departed and been back before dark and the unborn child probably would have lived then.”
The combination of weather and terrain serves to challenge the pilots daily. As one pilot ‘Jay’ (called ‘Jay’ because his name is also Jurgen) noted, “ no day is ever the same and you never know what is coming up.” The weather can change almost instantaneously. Cloud in the mountains can form instantaneously with jut a shift of the wind. As a result, a pass may be open when transited in the morning but an hour later it could completely be closed. So a half hour flight to the village may turn into a two-hour flight home.
Thunderstorms are a regular feature in the islands and the mountains. They can develop and move quickly. Even the islands themselves can prove a challenge being anything from a flat atoll to a towering dormant/extinct volcano. So the pilots need to be aware of what is happening around them, read the weather and then anticipate the results. They always need to be thinking of alternatives.
One of the big challenges for the company is getting paid or getting paid on time. Manolos is often carrying 3 million kina (about US$1 million) of owed money and around 800,000 kina (about US$250,000) over 180 days. Jurgen pointed out that if pressure is put onto the health centers in respect of payment for services provided, then the health centers tend to just stop calling for help and as a result people die. It’s a dilemma that he continues to deal with.
They Are An Eclectic Bunch
Manolos has an interesting staff profile. The pilots (5 permanent and 3 casual) are from all corners of the world – Germany, Holland, Finland, New Zealand, Canada and Australia. Jurgen highlights that it’s not a job for many because it is residential (he runs his permanent pilots on a four to five months ‘on’, one month ‘off’ roster. In his ongoing effort to provide Papau New Guineans with opportunity, and in order to attract national pilots, Jurgen is planning to establish a flying school at Alotau using an aircraft such as the Bell 206.
Shamus Howard, a New Zealander and the company’s Check and Training Captain said that the job was ideal for an intermediate pilot; someone with about 2,000 to 2,500 hours experience and who ideally has had time working in mountains. Extensive sling time is not a prerequisite though as little of the work involves lifting loads. “Pilots who are suited to this job are those who want a bit of adventure and who want to develop their skills – there’s a lot of opportunity here and it’s damn interesting flying,” he said. “Pilots who come here for the money are screened out pretty quickly. We have found that attitude just doesn’t work here as money becomes the focus rather than the job.” Apparently, a lot of applications come from tuna boat pilots although as Shamus points out, they tend not to have a lot of mountain flying time.
Shamus said that they do try to advance pilots quickly to keep them interested and to counter the lower pay compared with the resources industry. “Pilots are usually employed at the Alotau base on the 105 to gain PNG experience in lower and less hazardous terrain, before moving to Lae onto the 105 and BK for exposure to the more challenging the mountain and highland areas. There is even a chance to qualify on the S76.”
“We provide the pilots with a sole-use house and a vehicle. The married pilots tend to be more stable and families become more involved with the community. We also try to provide employment for the spouse working in the business,” Jurgen explained. “It is an opportunity to learn a new culture and quite frankly, many who come here find that PNG gets into their blood.”
The primary maintenance base is in Rabaul. Major maintenance is conducted there while minor maintenance is carried out at the Lae and Alotau bases.
He has six maintenance apprentices, all female and all from remote areas. “These girls are as sharp as tacks but it is the males who get the chances at the airlines and other places. So I purposely employ the girls from the remote villages to give them an opportunity that they would not otherwise have.” He has found other advantages with employing the girls, “one of our girls, Belinda, is only about 38kgs and she fits down the tail booms to get to the hard to access points. So where in the past, the engineer had to use dental mirrors and spend ages getting to things, Belinda heads down the tail boom, gets the job done in no time and comes out still smiling!”
Where the usual apprenticeship takes five years, he is allowing 7 years if needed. This accounts for the girls’ lack of exposure to many things in modern life and to properly develop their engineering skills. He has four girls occupying a house to provide each other with support as they get used to not being in a village.
Disabled people in PNG have few opportunities but at Manolos, two wheelchair-bound people form the company’s flight follower team. The flight followers track the aircraft on computer screens and are responsible for initiating any emergency responses. Nancy, one of the flight followers said that she got sick at about a year old and then spent another year in hospital. That sickness robbed her of the use of her legs. “Jurgen saw me being pushed in my wheelchair on the street one day and offered me a job – I was surprised, but of course I took it and I’m so glad I did.” So rather than being considered a burden, Nancy now contributes to her family and lives a fully functional life.
Only True Answer
There is no doubt that the BO105s and BK117 of Manolos are saving an extraordinary number of lives, lives that previously would have been needlessly lost due to the lack of basic healthcare. In the PNG’s challenging political and fiscal environment, Jurgen Ruh’s vision of a PNG helicopter emergency medical service continues developing because there are some in PNG who can see its value and supports him in his endeavours.