The Bogia medical centre is run-down, swamped with patients and understaffed.
The Herald and World Vision want to raise $100,000 for the urgent water and sanitation needs in the Hanuabada village of Port Moresby, and World Vision wants your long-term support for ongoing work in the Pacific. Each day we'll be reporting on a particular problem for the region and showcasing how World Vision has helped. Today, the challenges facing health clinics.
On one side of a blood-stained wooden table sits an industrial-sized bottle of scabies treatment. On the other, a Bible in a red plastic bag. On the floor are bags of vials filled with out-of-date medicines and old syringes.
With scenes like this it's not hard to see why most local woman still choose to give birth in the bushes rather than come into the Bunapas medical centre.
No maintenance in 30 years until World Vision started supporting the renovation of the clinic. No power since 2005, it's like a scene from a B-grade horror movie. The walls have blood-stained graffiti, toilet pans lie scattered about and old medicine has been dumped in rotting piles in corners and cupboards.
Outside a large wasp's nest is on the wall. Inside the floorboards are so full of termites they have had to move the heavy operating table on to the grass outside, lest it fall through.
The centre is meant to have eight health professionals but is down to just three, barely servicing a community of more than 20,000 people.
Situated on a sweeping river corner to allow water access, the surrounding area is wet marshland. Perfect conditions for the mosquitoes that spread malaria, zika, chikungunya and dengue fever.
Used medical implements are strewn on the floor and across benches at the Bunapas medical centre. Photo / Mike Scott
Inside, clinic head Dr Andrew Ska, is frustrated. "Every day we see a lot of malaria patients, we see a lot of chest infections and pneumonia, so we need drugs and we need antibiotics like amoxicillin, like crystalline penicillin. We need paracetamol. We need the anti-malarials.
"We have none of this in stock. We don't know what to do. I told my health workers here, we are not giving the right treatment. We are already mistreating the patients."
Ska says having no lights makes it difficult to administer injections at night. The centre has no vehicle and patients often have to organise their own medicines from the city of Madang, several hours' drive away.
All the patients here are in the same ward, but really they have no choice. The only other options are an A&E bed on the rotting front porch or a small birthing room out back, which offers little privacy.
It's a dangerous combination where new mothers lie next to tuberculosis and leprosy sufferers, who find themselves with influenza patients and recovering accident victims.
When the ward is full patients are treated outside on the grass where they often lie. Ska says bluntly they need more support.
"I wish some people from the office should come down, from the district administration [but] there is no visit from them to here. They sit up there on their comfortable chairs and do nothing about the people down here, there is not enough supply."
A four-hour drive inland from the town of Bogia, the Bunapas health centre is the only accessible facility for many rural villages. Ska took charge in 2013.
Bunapas centre's Andrew Ska says he and the clinic's two other staff are doing the work of eight. Photo / Mike Scott
"We are supposed to have eight people, eight staff at the health centre, but at the moment we have only three. There is two community health workers and myself.
"I have to come down and sit with them as outpatients and I don't do my job. I have to see patients, I have to treat them, I have to give them injections. There is only three of us and we see about 20 patients in one day and that is a lot for us.
"We work from six o'clock to late in the night. There is no night duty staff so one of us has to come and give treatment in the night, the last treatment and go to bed.
"We work seven days, from Sunday to Sunday. That is a lot of work for just three of us. "I am not leaving this place and going out. Because if I leave there is only two of them. Most of the time I stay at the health centre."
Unfortunately, in the rural areas of Madang these problems are a recurring pattern at every clinic we visit.
Of Papua New Guinea's 19 provinces, Madang has the worst child nutrition indicators. In 2010, a World Vision assessment of 214 under 2-year-olds in Bogia found that almost two-thirds were malnourished. Furthermore, 86 per cent of children were found to be suffering from anaemia, as were 90 per cent of pregnant mothers.
A World Vision representative says the clinics we visit are among the better ones, but honestly it's hard to imagine how they could be much worse.
In the maternity ward of the Bogia clinic, the main health centre for the district of more than 30,000 people on the north coast of Papua New Guinea, it's pitch black and a young mother has gone into labour.
Most women prefer giving birth in the bushes to relying on run-down facilities like those at the Daigul health clinic. Photo / Mike Scott
This is the safest option she has for her unborn baby but she does not feel safe here.
It's Friday, the only day that public transport is reliable, bringing traders to the nearby Golden Market. Most of the items on sale are the stimulant betel nut and a black market homebrew called Yawa or White Soup made with banana, sugar, yeast and instant coffee. Inside the ward, woman in labour's sister-in-law uses a torch to see, as they both listen terrified by the noises from outside.
Groups of drunk men from the market are congregating out front, bored and emboldened by betel nut and homebrew.
One man walks past the entrance deliberately scraping a machete blade behind him on the road, others throw stones on to the roof in a deliberate act of intimidation.
With no security they walk unopposed through the clinic grounds. Drawn to the sounds of labour pains, they beat the walls with their fists while peering through the windows. Stolen curtains have removed what's left of any privacy.
Gone are the new chairs and floor mats, so too the oxygen bottle for pain relief, stolen and cut up to be used as a vessel for White Soup.
Even the walls are being slowly taken, by an infestation of termites. Above one run-down room a sign reads 'dentist', but the last dentist left when the town's power supply was cut permanently in 2005. And yet 21 staff work here diligently, servicing a growing population. Lab technician Patrick Madu has seen huge changes during his 36 years of service. He notes a marked decline when "the Australians left in the 1980s and everything got run-down".
"We find it very heart-breaking to tell the people we have no medicine."
Supplies can take four months or longer to show, if they come at all. Often they are stolen. This clinic has just two pairs of surgical scissors left, and no ability to sterilise, so bloody tools lie in shallow baths of cloudy water until needed again.
One facility we visit doesn't even own a stethoscope, the very symbol of healthcare, and was forced to close during a prolonged El Nino drought in 2015-16 when the water supply ran dry.
The over-stretched Bogia clinic is the main health centre for a district of more than 30,000 people. Photo / Mike Scott
Daybreak brings some relief to the maternity ward. The drunks have retreated and the woman now has a brand new baby to care for.
