By Jamie Tahana of RNZ
Doctors in Papua New Guinea say the coronavirus crisis is only getting worse as some hospitals shut their doors to patients and others struggle without supplies as basic as gloves.
Health officials and doctors interviewed by RNZ Pacific have described a health system teetering on the brink of collapse and a country that has no real grasp of just how widespread the virus really is.
Officially, the country has recorded 10,915 cases of Covid-19 and 107 deaths, according to government figures released on Wednesday night.
David Mills, a doctor at a hospital in Enga province which covers a remote chunk of the country's rugged Highland interior, said "those numbers just need to be ignored".
"They're not even a remote figure of what's going on ... It's really moving about as fast as it could possibly move.
"It's very hard for us to just guess the number of actual cases that are out there because the more mildly ill, they're not even coming within cooee of us."
Fewer than 90,000 tests have been carried out in a country of nine million people since the start of the pandemic according to government figures, and in many remote parts, testing capacity just isn't there.
One senior health official in the Western Highlands city of Mt Hagen, who spoke to RNZ Pacific on condition of anonymity, said only a tiny proportion of the population had been tested, and only when the hospital had enough test cartridges.
"We really don't have any real grasp on it," the official said.
Figures supplied showed that in Western Highlands, with an estimated population of half-a-million, only 4760 had been tested as of Monday - 951 of those tests had come back positive.
"And as well we know that there is anecdotally an increase in community deaths," they said.
"We don't have a death register here. But we certainly know that there are more bodies coming up from Port Moresby of people who've died after a short flu-like illness."
"People are saying, 'in my village in the last two weeks six people have died', I mean that's just not the numbers that normally die."
In the northern district of Madang, a senior health official who also asked to remain anonymous, described the situation there as horrible.
Officially, the region had 150 cases, and recorded its first death last week. The official said the numbers were almost certainly wrong.
"It is fast spreading. Numbers are surging daily. The number of positive cases coming in has gone far beyond our surveillance," they said.
The province only had a few staff in main towns. But with the virus now in rural districts, they were struggling to even check.
"We need more test cartridges," the official said.
"I'm worried about that population in the far remote settings of the province."
Papua New Guinea is a country of nine million people and only 500 doctors. Its health system is on the brink at the best times, dealing with a lack of staff, funding and resources as it battles epidemics like polio, drug-resistant tuberculosis, malaria and HIV.
Now, Covid-19 has pushed it further towards the precipice.
Mt Hagen hospital, one of the country's main referral hospitals, has been walloped by the virus. One hundred and four of its 675 staff have tested positive, and last month, financial constraints meant the hospital had to scale down services, closing the outpatient's clinic and cancelling elective surgeries.
As the number of coronavirus patients keeps rising, the pressure on an already beleaguered health system will only get worse. Mt Hagen hospital used to fill oxygen cylinders twice a week, now they are doing it every day. The official feared they might run out with the increased pressure.
It was the same story in nearby Enga, where Mills said some of the province's other health clinics had had to close.
"Just keeping a modicum of services going has been really difficult," he said.
And in the capital, Port Moresby, where last week the national Parliament was adjourned for four months after a quarter of the staff were infected with the virus, the main hospital has been over capacity for weeks.
Port Moresby General Hospital head of obstetrics and gynaecology Glen Mola said dozens of staff had succumbed to the virus and those left working were starting to burn out.
Last month, 40 per cent of the mothers in his labour ward had tested positive for the virus. That was down to about 10 per cent but Mola did not take it as a sign things were improving.
"All the Covid inpatient facility has been full every day for the last month or so," Mola said.
"We've now established three field hospitals in Port Moresby; one at the netball courts, one at the aquatic centre and, most recently, a tent arrangement in the carpark."
The hospital had received extra machines to test for the coronavirus and extra supplies from international agencies to help manage, Mola said. But they were still dealing with major hurdles to procure basic supplies.
"It's a different thing every day," he said. "Some days we run out of this antibiotic or the other antibiotic. Some days we're short of this kind of IV fluid or the other kind of IV fluid. Sometimes we're short of gloves."
Gloves were an issue in Mt Hagen, too.
"Right now, for instance, our order for gloves hasn't come up so we've got no stock. I have to go and try to negotiate to get some urgently up. This should never happen," the senior Western Highlands official said. "We're still taking too long to get the stock out of Port Moresby and up to the Western Highlands."
Mill said even the most basic items were proving a problem.
"We had to use some of our very scarce resources to buy some tape from Australia the other day because there's just none to be had."
There were reasons for hope, the doctors said, and some supplies were getting in including planeloads of personal protective equipment and ventilators donated by the likes of the World Health Organisation, Australia and New Zealand.
But the supplies were still too slow in getting out to where they were needed, and procurement systems were too cumbersome, often requiring requests to be made weeks in advance.
When a pandemic hit that could become impossible, they said.
The government - while not responding to requests for comment - has acknowledged strains. Prime Minister James Marape has spoken of "rampant community transmission".
In a statement this morning, national pandemic response controller David Manning again pleaded with people to obey health measures, what the government called Niuepela Pasin - the new normal. Authorities are struggling to get people to adhere to social distancing measures, and where lockdowns have been instigated, they've been largely flouted.
The country's vaccination programme is finally getting underway. About 500,000 doses of the AstraZeneca vaccine are due in the country under the international Covax programme, which will mostly go to frontline workers.
But doctors said they were coming up against a lot of vaccine denial, even among medical staff. Western countries' decision to suspend the AstraZeneca vaccine because of a fear of blood clots had done little to help, they said.
"We're really struggling with trying to dispel misinformation, conspiracy theories and the view that 'I don't need it because I've got innate immunity'," Mola said.
"This is one of our biggest challenges for the moment."