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, vulnerability to disease.

Just turned 16, Lucy is shy and hesitant to speak in English. Despite her soft voice, I can tell her command of the language is excellent.

I meet Lucy and her mum Rose at the Nine Mile Health Clinic, nine miles outside Papua New Guinea's capital Port Moresby.

This small, simple clinic services an estimated 15,000 people within a radius of about 4km. The road to it is mud, impassable to vehicles after heavy rain. Not that this really matters, as everyone I see arrives on foot, mostly barefoot.

Lucy sits, hunched, staring at her feet, which have a line of mud around them from the walk. It's not until I ask about school that light flickers in her eyes. She tells me, unsurprisingly, that her favourite subject is "languages". She also enjoys science, social studies and maths. I tell her those were my worst subjects at school and get my first smile.


Except Lucy isn't able to attend school. She has TB and is highly contagious, sick with a disease that's spread through the air when a carrier coughs or speaks.

It's the second time she's had it. She first contracted TB in 2013 but was already well aware of its devastating effects, having watched it kill her father in 2005 when she was just 4.

She's here for treatment, although Rose was initially scared of the clinic, and of western medicine.

Rose believed her husband's illness was caused by sorcery. Despite education campaigns, this is a commonly held fear in communities where belief in black magic, known as puripuri, remains part of everyday life.

Rose's daughter Lucy's gradual recovery thanks to life-saving treatments at the local clinic has turned her into an advocate for conventional medicines to fight a disease many still blame on witchcraft. Photo / Mike Scott
Rose's daughter Lucy's gradual recovery thanks to life-saving treatments at the local clinic has turned her into an advocate for conventional medicines to fight a disease many still blame on witchcraft. Photo / Mike Scott

There is also a stigma attached to having the disease, so patients are often reluctant to
report, turning instead to traditional bush medicines, which mostly involve steaming herbs.

And there is often an expectation the disease will be fatal.

"When people get this sick TB, I used to think that they will pass away only, they will not recover," says Rose. "My daughter Lucy here, in 2013 she got sick. I said this is going to happen to her. The second time again last year. I am scared too. I am worried too. I might lose her."

When Lucy first got sick, she lost a lot of weight.

"Her legs started to swell up. I took her to the general hospital. I carried her, she can't walk," says Rose. "I used the wheelchair to take her in, wash her and then bring her back, lift her up and then put her on the bed.

"When she was on this medicine, she was drinking this medicine, and I was surprised one morning she left me and walked into the shower. I woke up [in the hospital] and I was looking for her, and I asked, 'where is Lucy'. Then I saw her coming out from the shower, and I was surprised, she was walking and I cried.

"I asked her 'Lucy how are you' and she said, 'Mama I am okay'. I could see her legs going back to normal."

Tuberculosis is an epidemic in Papua New Guinea.

New Zealand stopped vaccinating against TB in the 1980s. There are still isolated cases but it's like an old memory you might group with antiquated ailments such as leprosy, hydatids or the plague.

Unfortunately in Papua New Guinea, TB is still very much part of everyday vernacular, taking a life every two hours.

Things are getting worse. In 2016, 33,000 new smear-positive TB cases were detected and treated. Health attendants at the Nine Mile clinic see, on average, 30 new cases each month.

TB is a poor person's disease that lies latent in a third of the world's population.
It emerges to attack compromised immune systems. Populations with poor health and diet, low vaccination rates, overcrowding, high levels of HIV and stress are particularly susceptible.

Papua New Guinea has all these things in spades, and is also in the unenviable position of being on the World Health Organisation watchlist for a particularly nasty, hard-to-treat strand, known as MDR or Multi Drug Resistant.

Numbers of this new strain spiked so alarmingly in 2014 that it was declared a national emergency.

Tackling it is a huge uphill battle. There are fewer than 10 TB specialists in the whole country of scattered islands of almost 8 million people. Remote clinics are poorly staffed, often with no doctors, no medicine and no power.

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George Casper has been to hospital three times to get the last X-ray needed to see if he is finally clear of the disease that has turned his life upside down. All three times he has been turned away, told the hospital has no X-ray film available.

He's been waiting three months. There's not much else he can do. He finished his six-month course of medication, but still feels weak and tired. So he isn't confident that he might finally have beaten the TB which has left his cheeks gaunt and drained his body of mass and strength.

George was a security guard, complete with uniform, a job he looked forward to each day. But constant illness forced him to take time off. His condition worsened until a bad episode when he blacked out, waking days later.

"I was bed-ridden for almost three days, I was completely gone, unconscious, I saw blackness. And then I woke up from total darkness, I could not walk, I was very weak."

Eventually a worried in-law took George to hospital, but he didn't need a doctor to tell him what he had. George had watched TB kill his wife the same way four years earlier.

"When I contracted TB I knew very well that I was close to my wife and I must have got it from my wife, I was thinking I was going to die."

He lives with his 8-year old daughter at his late wife's parents. They all share a shack with two rooms separated only by a bare frame for a wall.

 George lost his livelihood to TB and his inability to work creates tension within his family. Photo / Mike Scott
George lost his livelihood to TB and his inability to work creates tension within his family. Photo / Mike Scott

George is unable to care or provide for his daughter or himself and this has created tension. There is resentment not only at his lack of contribution - he hasn't been able to work in a year - but also around the stigma attached to his disease.

But all he can do is wait. Until the hospital gets more X-ray film, he simply won't know if he has TB or is now clear and can start his life over.

"I am still waiting for the final X-ray, I am being referred back to the private doctor but people like us cannot afford the private doctor."

At each clinic I visit just one person is assigned to all communicable diseases, with patients all treated in the same ward. This means highly contagious TB sufferers lie alongside new mothers and babies, who have been placed next to accident and emergency victims.

Sanitation is non-existent, best demonstrated by the ageing graffiti I see on the back wall of one ward that's been written with fingers soaked in blood.

They say that one person with TB will infect on average 10-15 people per year through coughing, sneezing, shouting and singing.

Despite all this, one physician I speak to remains confident progress is being made.
With 30 years' experience, Dr Pasion Dakulala, the Deputy Secretary of National Health Services in Papua New Guinea, describes earlier national anti-TB programmes as "chicken without a head".

He claims that through the inclusion of partners and funding "we are on the way to truly controlling TB".

While a baby vaccination programme is now in place, it's hard to share Dukulala's confidence, when just several sentences later he tells me the country still needs an extra 50-60,000 health workers to be effective.

Rose and Lucy had to spend two months travelling nearly four hours each day so Lucy could receive life-saving injections as part of a treatment programme that will take 18 months to complete.

Their story may be one milestone on the way to success. She has made huge progress since her legs were so swollen that Rose had to carry her to the clinic each day for injections, an unimaginable task given the steep muddy tracks.

Having seen the results of Lucy's treatment, Rose has even turned local advocate, telling me she now dispels TB myths in her own community.

We finish our chat with Lucy telling me about looking forward to getting back to school. She should be grade seven this year but had to drop out of school because of her illness and misses her friends a lot.

These final words cause her mum's eyes to light up too, reflecting her pride and hope for the future of her daughter.

Treating TB in PNG

•Tuberculosis rates in Papua New Guinea are the highest in the Pacific, with an alarming increase in drug-resistant strains.
World Vision PNG is the principal recipient of a Global Fund grant, which is used to provide technical, human resource and operational assistance to the Government's
National Tuberculosis Programme (NTP).

•The Global Fund is an organisation dedicating to accelerating the end of Aids, TB and malaria as epidemics.

•Founded in 2002 and based in Switzerland, it's a partnership that involves governments, the private sector and people affected by the diseases. The fund raises and invests almost US$4 billion ($5.8b) a year to support programmes run by local experts in countries and communities most in need.

•World Vision's TB programme operates in 20 provinces as part of the NTP. Its projects create awareness about TB, help communities to access the treatment they need, train community based observers to monitor patient treatment, train healthcare workers and clinically manage TB cases.

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