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by Barry Barford

By | Avoiding the pitfalls of shipping | No Comments

When shipping medical equipment overseas it’s easy to overlook and get caught out by obstructive regulations. In previous articles we’ve discussed some of the problems that can arise when a shipment arrives at its destination. In this article we’ll look at some issues that can prevent the shipment even leaving Australia or failing to arrive, if not dealt with properly.

Packing without pests

Donated medical equipment shipped in a container is usually packed into the container as is, without any additional protection. However, more fragile items may need to be securely packed, particularly if they are to be shipped as less-than-container-load (LCL) cargo. If the equipment is to be packed into a wooden box or crate, it’s important to use the right timber. All wooden packing material, including pallets, used for export must meet the requirements of the International Standards for Phytosanitary Measures (ISPM). In the case of timber used for international shipping purposes the standard is ISPM15. It applies to all wood more than 6mm thick and requires it to be treated against pests, meet bark tolerance requirements and be appropriately marked as shown at image 1.

All professional packers for export will know about this requirement, but anyone less may not. If unsuitable timber is used and it is not detected before leaving Australia, the cases may be destroyed on arrival overseas or be refused entry. At very least they will be sent for treatment, risking damage to the contents. In summary, always specify ISPM15 timber when packing for export. For more information go to https://www.agriculture.gov.au/export/from-australia/wood-packaging/faq-ispm15#what-is-ispm-15               

Insurance – who needs it?

Most donated, used equipment is shipped uninsured because shippers don’t want to pay premiums for goods of little or no commercial value. Insurance for second-hand goods is difficult to get anyway, and if it is obtained it tends to negate the low-value declaration made on shipping documents to help the receiver avoid customs duty and taxes. However, if new or high-value used goods are being shipped it could be an expensive mistake not to insure them. Enquire about premiums with your freight forwarder to make an informed decision and then specify “insurance required” on your shipping instructions if appropriate.

 Container safety versus culpability

There is a horrifying Youtube that can be found on the internet where a container is being lifted by a crane and about to be swung onto the ship, when the floor of the container suddenly bursts open and a load of concrete slabs crashes onto the wharf below. Had anyone been standing underneath they would have been killed instantly. That container somehow slipped through the safety checks and you wouldn’t want to be the person responsible for it. If you’re going to buy your own used container you must make sure that it meets the standard for export. This is governed by the International Convention for Safe Containers. Not any old container will do as those sold for storage, for example, may not be structurally sound for shipping purposes. So when buying a used container specify that it will be used for export shipping purposes and ensure that it has a valid CSC plate and certificate. The plate looks something like image 2 and is usually attached to the left door.

Agonising over air freight

DAISI doesn’t normally use air freight but those who do will know that since 1 March 2019 all air freight exported from Australia must be x-ray screened before it can be loaded onto the aircraft. This procedure, known as piece level screening, was introduced in response to heightened security concerns. Freight is classified as either homogenous – where all the items in a carton are exactly the same and uniform in every respect when viewed on an x-ray monitor – or non-homogenous where cartons contain mixed goods of varying shapes and sizes. If you do use air freight on occasion and are shipping non-homogenous goods, make sure the cartons are supplied loose and not on pallets. The reason for this is that if the security staff are not certain of what they are seeing on the x-ray monitor, they will open the carton for a manual inspection. If the cartons are plastic-wrapped onto a pallet they can’t do this and the whole consignment will be returned to you for resubmission at your expense.

Batteries not included?

Medical devices are replete with lithium batteries – lithium ion and lithium metal – which are among the most contentious items in the shipping world. On the face of it they are categorised as Class 9 dangerous goods and have been implicated in a number of aircraft and cargo ship fires. However, there are many, many exceptions to the rule which are beyond the scope of this article to describe in detail, but suffice it to say that the final classification of lithium batteries will depend on a number of considerations including the following:

  • Are the batteries installed in the equipment?
  • If not, are they packed separately with the equipment?
  • Are they lithium ion (generally rechargeable) or lithium metal (generally not rechargeable)?
  • How many batteries are there in total?
  • What is the rating of the batteries in watt hours?

As a very rough rule of thumb, if the batteries are either installed in the device or packed separately with it, are limited in number and have a rating of less than 100 watt hours, they will be an exception to the dangerous goods regulations. However, there is a lot more to it than that so get advice from your freight forwarder as declarations and hazard labels may be required. Note that different rules apply to different transport modes – IATA for air freight and IMDG for sea freight. A good way to make a self-determination is to get hold of a material safety data sheet (MSDS) from the battery supplier and check the Transport section. In the example at image 3 it indicates that the batteries in question will be an exception to the dangerous goods rule so long as certain packing instructions are complied with.

Shipping can be a headache, but it will be a lot easier armed with an awareness of the obstacles and how to overcome them.     

Barry Barford is an Associate Member of DAISI and a former Shipping & Logistics Officer.   

By Mavis Nishimura Podokolo

By | Gizo Hospital is Feeling Blesssed. | No Comments

GIZO hospital in Western Province this week received medical gifts worth AUD10,000, it is reported.

According to Dr Mike Buin, surgeon at the Gizo Hospital, the medical gifts received ranges from crutches, operating theatre equipment, gowns, kids’ toys, books and medical trolleys.

“The Gizo hospital team have received medical gifts worth AUD10,000. 

“Gifts range from crutches, operating theatre equipment, gowns, kids’ toys, books and medical trolleys. A big thank you to our friends and volunteers from Australia, Dr Tutuo and your team for the gifts to Gizo Hospital. 

“We hope to get over this pandemic soon so that you can come and visit us again,” said Buin.

He said Dr Narko usually volunteers to Gizo hospital as part of Doctors Assisting in Solomon Islands or DAISI, now known as Doctors Assisting in the South Pacific Islands. 

“You can check out their website.”

Buin adds that usually DAISI has about two to four tours to Gizo Hospital per year where specialist surgeons come and operate.

“However, due to the covid-19 situation, all surgical tours in 2020 were cancelled. And, 2021 tours are also uncertain and likely to be no DAISI tours for this year as well,” said Buin.

By Ian Hosking Richards

By | COVID ward opens in Honiara | No Comments

The recently opened 56-bed field hospital in Honiara, which has been totally funded by Solomon Islands Government through The Ministry of Health & Medical Services (MH&MS), is now ready to take patients.  The Order of St John has been working closely with MH&MS on the project.  They have provided 8 stations which will monitor the more serious patients and will provide additional St John Ambulance Service nurses to cover staff shortages when necessary.  St John Ambulance Service will also provide all covid-19 patient transport, as mandated by the current state of emergency provisions.

The country is lucky to be able to call on locals who have experience in handling infectious disease outbreaks.  The Chief Advisor to the Ministry of Health & Government was formerly the World Health Organisation (WHO) representative in Africa for Ebola, and the Head of St John, Mr Doug Kelson, set up two field hospitals in PNG to handle the cholera outbreak about 12 years ago.

In his weekly address, Prime Minister Manasseh Sogavare spoke at length about the new facility.  He outlined the role of the hospital in caring for asymptomatic patients as well as those with mild to moderate signs of the virus.  He added that any patients showing severe signs of covid-19 would be treated at the National Referral Hospital’s isolation units.  Mr Sogavare explained that the project was entirely funded by the government due to the urgency of the situation, and that the process of applying for donor funding would have taken too long.

Prime Minister Manasseh Sogavare spoke at length about the new facility.  He outlined the role of the hospital in caring for asymptomatic patients with COVID-19

So far Solomon Islands has been largely successful in keeping the virus out of the country.  For months it had no cases at all.  The first case was reported at the beginning of October shortly after international students were repatriated from The Philippines. 400 students had been stranded there after the country went into lockdown.  Despite having tested negative 3 times before being repatriated, the student tested positive after arrival in Solomon Islands.  The current tally is 17 cases, with 5 having made a full recovery.  Whilst there has yet to be any cases of community transmission, it is a widely held belief that this is only a matter of time, and that within the next 8-10 weeks we will see cases of community transmission. 

The Prime Minister acknowledged this in his speech, remarking ‘This is the first of its kind in Solomon Islands, an important achievement in our ongoing fight against the deadly virus.  The completion of the field hospital will further enhance our preparations for various possible scenarios, including community transmission if it may arise’

Ian Hosking-Richards is the current Sponsorship Officer for DAISI, and also, in his own right, the Founder of The Solomon Foundation, and the current Solomon Island’s Honorary Consul (Elect) for NSW. Ian has been actively involved on many fronts improving the delivery of medical services to the Solomon Islands. Ian has been actively involved with DAISI in the establishment of a cardiac assessment and rehab service at Gizo Hospital and National Referral Hospital and in providing surgical services to Solomon Islands requiring treatment in Australia. Both DAISI and The Solomon Foundation enjoy all the benefits of this working partnership.

By Robert Iroga

By | Solomon Islands records its first COVID-19 Case | No Comments

Solomon Islands has recorded its first confirmed COVID-19 case today, in its capital Honiara. The single confirmed case is being quarantined at National Referral Hospital (NRH) in its isolation ward.


Minister for Health Dr Culwick Togamana has disclosed that precautionary measures have also been undertaken with the patient (COVID-19 patient) at NRH Isolation ward that included doctor – patient communication via mobile phone and staff of isolation ward 1 and 2 restricted from crossing over.

Speaking to the nation today to detail what his ministry is doing after the country has recorded its first COVID-19 case, with the patient now in the NRH Isolation Ward, Togamana said it has also been agreed that family and relatives are to bring clothing for the patient with all dirty clothes to be kept in bag for wash after discharge. “Additionally any food from relatives for the patient must be pre-packed or canned food and dropped off at NHEOC for health workers to deliver,” he said in his address on radio.

Togamana further stress that all the staff who are involved in operations undergo daily risk assessment and adequate Infection Prevention and Control procedures have been put in place and they pose no risk to the community or family members.

“On the safety of front line staffs, all staffs at the NRH care areas are not allowed for cross overs to other care areas, and each workflow is now implementing a unidirectional work-flow. Accommodation for front line staffs on 2 weeks deployment is been progressed, where duty staffs will follow a strict pre-deployment deployment and post deployment instruction,” he said.

Robert Iroga is a reporter for the Solomon Business Magazine

By Barry Barford

By | Use own containers or LCL to beat the bond | No Comments

Swire Shipping, which practically has the monopoly on cargo shipping services to Papua New Guinea and the Solomon Islands, has announced it will, with immediate effect, impose a security deposit (bond) on all of its carrier-owned containers released to aid shippers. This is in response to a growing number of containers detained or abandoned by consignees who, to make things worse, often fail to pay detention charges as well.

It doesn’t matter if shippers such as DAISI are innocent bystanders, all aid shippers are caught in this blanket impost on the use of carrier-owned containers. Bonds are typically US$3,000 for a 20-foot container and US$5,500 for a 40-footer, and while they are fully refundable if the container is returned in good condition within the free period (14 days in the Solomon Islands), they represent a substantial additional outlay.

But there is a way around them. Consider purchasing your own shipper-owned container. A used container in good condition can be purchased for around $3,000 and once you’ve packed it with your equipment and shipped it to its destination, it simply remains with the consignee. You pay no bond, you don’t have to return the container to anyone and the freight rate is considerably less than you would pay for a carrier-owned container. Note, though, that containers for export shipping must have a valid CSC plate and certificate in accordance with the International Convention for Safe Containers.

In fact the consignee may choose to sell or use the empty containers, which have a significant inherent value.  These containers are often used for storage or, in remote parts of the South Pacific where construction resources are scarce, incorporated as components into construction projects as shown below.

331DEDC7-3368-4736-BF52-A204A41568AFTwo left-behind medical aid shipping containers in remote outpost being used as a foundation for building a family home.

An even better policy is to ship only what is really needed and use a less-than-container-load (LCL) service rather than pack, say, a laparoscopy stack into a container and then hunt around for other stuff to fill the container with. Goods such as this should be professionally packed, as in the photo below, designed for loading and unloading by forklift and suitable for shipment by sea or air.

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COVID-19 response: Four Maquet Servo 1 ventilators professionally packed for LCL shipment to East Timor. (Photo courtesy Pentagon Freight Services, Darwin.)

Barry Barford is DAISI’s Shipping & Logistics Officer and a shipper’s representative for a number of medical training organisations.

By Elvis Japhlet

By | Third DAISI container arrives Sopas | No Comments

Dr Elvis Japhlet takes selfie of the third DAISI shipping container this year to arrive at Sopas Hospital. 

 

On behalf of Sopas Hospital Staff, the Sakarawan community and EPHA, I would like to thank DAISI once again for the arrival of another container full of medical equipments and supplies today. Particularly the organisation and logistics required for such a feat by DAISI PNG Program Officer Mark Taffa, with money contributed by Owen Miller Foundation and Horten Medical.

 

We truly thank you from the bottom of our hearts, and look forward to putting this equipment to good use with future DAISI surgical trips once COVID-19 travel restrictions are lifted.

Dr Elvis Japhlet is the head surgeon at Sopas District Hospital in the remote highlands of PNG, and has been working together with DAISI to improve the delivery of surgical services to Enga Province. 

 

By Barry Barford

By | Aid shipments affected by COVID-19 | No Comments

Photo courtesy Freightwaves.

It’s sometimes hard to comprehend the speed at which COVID-19 has spread within Australia and around the world – it’s just four weeks since the virus spread was declared a pandemic. During that time two container loads of medical equipment and supplies shipped for DAISI to Sopas District Hospital have arrived in Papua New Guinea, but what options for shipping remain over the coming weeks?

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The extent to which freight movements have been affected depends on the mode of transport. Air freight, most of which is carried on passenger aircraft, is severely restricted owing to the suspension of most international flights by Qantas, Virgin and the airlines of neighbouring countries. Pacific Air Express continues to operate a dedicated freighter service from Brisbane to the Solomon Islands, Papua New Guinea and Vanuatu. Express delivery companies such as TNT, DHL and Toll are offering restricted services subject to availability of flights.

Sea freight remains largely unaffected, although schedules have had to be adjusted to allow for the 14-day transit time between ports required by many countries. However, this situation may change as Pacific Island nations take action to protect their vulnerable communities. Already the Solomon Islands have imposed a 14-day quarantine period (before ships can enter port) on arrivals from any international port, unlike most other island nations which specify particular ports. Less-than-container-load (LCL) services are still operated by Kalgin Global Logistics and Vanguard Logistics from Sydney,Melbourne and Brisbane, but these too rely on the regular schedules of carriers like Swire Shipping.

Among the countries assisted by DAISI, only Papua New Guinea and Fiji have so far reported cases of COVID-19. As at midday on Thursday PNG had two cases and Fiji 15, with neither country reporting any deaths. However, it should be noted that elsewhere in the Pacific numbers are rising. French Polynesia, which in the last week of March had reported 18 cases, now has 51. And New Caledonia which at the same time had seven cases now has 18.

Resumption of normal freight services is unlikely to come soon and it could get worse before it gets better, but a gradual easing of restrictions could occur depending on the success or otherwise of each country’s efforts to contain the spread of the virus. By any measure the situation locally is nowhere near as dire as in Europe and the US, and for that we can be thankful.

Author: Barry Barford is DAISI’s Shipping & Logistics Officer and a member of the UK-based Humanitarian Logistics Association.

By Dr Elvis Japhlet

By | Second and third container arrive at Sopas | No Comments

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Sopas Hospital staff in front of the second shipping container delivered this year.

On behalf of Sopas District Hospital staff, community and Enga Provincial Health Authority (EPHA), I would like to thank Doctors Assisting In South-Pacific Islands (DAISI) and its executive for the first and second containers of medical equipments/supplies received this year with value more than one million kina.

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Our extreme gratitude is extended to Horten Medical/various hospitals in Australia/individuals/organisations/companies that have assisted and/or donated these medical equipments/supplies, and the Owen Miller Foundation largely responsible for paying for freight charges.

These donations will truly go a long way in saving the lives of many people in the highlands of PNG particularly Enga Province.

This is indeed a huge blessing.

Special thanks to so many individuals in particular Dr Gary McKay, Roshini McKay, Mark Taffa, Matt Rickard, Christophe Berney, Carina Chow, Adelene Ong, Jessica Lim, and all DAISI team members (cannot mention all their names as too many) who have visited Sopas District Hospital and all who have contributed in one way or the other towards these supplies.
God Bless you all!

 

Dr Elvis Japhlet is the head surgeon at Sopas District Hospital in the remote highlands of PNG, and has been working together with DAISI to improve the delivery of surgical services to Enga Province. 

By Michael Kabuni

By | COVID-19: the situation so far and challenges for PNG | No Comments

Papua New Guinea (PNG) became the first country in the South-Pacific to declare a state of emergency (SOE) in response to COVID-19.

 

Section 226 of PNG’s Constitution lists an “outbreak of pestilence or infectious disease” as grounds for declaring a national emergency. With more than 470,000 confirmed cases and over 20,000 deaths worldwide at the time of publication, the first recorded case in PNG on 13 March 2020 was sufficient reason for the National Executive Council (NEC) to declare an SOE. Among other things, the SOE gives the government the power to control the movement of people, vehicles, and goods; maintain and regulate transport; and regulate or prohibit use of public roads.

The emergency lockdown, which prevents the movement of people between provinces and puts restrictions on international flights, will only last for 14 days, subject to an extension of another 14 days. All schools and universities have shut for two weeks starting on 23 March. Non-essential services are shut, including most government departments, the courts and small businesses. The only exceptions are essential services such as banks, hospitals and shopping malls.

This blog gives a summary of the statistics, the situation in PNG leading up to the SOE and some of the challenges PNG faces.

What do the statistics look like?

According to the National Health Department’s Situation Report issued on 13 March – the latest publicly available data – 25,262 people entering PNG have been screened since January. Almost 3,000 have been identified as ‘persons of interest’, of which 2,230 are being actively monitored and 697 have completed the 14-day follow-up period.

A rapid response team comprised of medical professionals has investigated 16 people. Of those investigated, 14 samples were collected, with 10 testing negative for coronavirus while four samples are pending results. The other two did not meet the case definition for coronavirus and were not tested. Sixteen other individuals who were in direct contact with the first positive case are currently being quarantined.

First confirmed case

The SOE comes after the first confirmed case of COVID-19 was reported in Bulolo District in Lae, Morobe Province. On 13 March, a 45-year-old Australian man employed by Harmony Gold Mine in Bulolo returned from a trip to Spain, one of the hardest hit European countries for coronavirus. He did not show COVID-19 symptoms of coughing, flu or fever at the Jacksons International Airport, where a basic test for temperature and a self-administered travel history and health form was all that was required to enter PNG. But 24 hours after transiting to his workplace in Bulolo, he began to show signs of flu and a slight fever and was immediately isolated.

Swabs were taken and sent to the Medical Research Institute in Goroka for testing. Three announcements followed. First the Health Minister Jelta Wong declared a probable case, and Prime Minister James Marape followed up by declaring the result as negative. Further tests were conducted and the prime minister confirmed the positiveresult for COVID-19. Police Minister Bryan Kramer then stated on Facebook that the inconsistent results were due to faulty test equipment, and that requests had been made for further testing to be conducted in Melbourne.

Challenges for PNG

While the government responded to the confirmed case by immediately declaring an SOE and 14-day lockdown, the varying test results and inability to detect the virus at Jacksons International Airport has led to widespread criticism on social media. It has also shone a light on the key challenges PNG faces in relation to the pandemic.

First, there is no way of knowing whether there are other positive cases of COVID-19 in PNG. When the World Health Organization (WHO) declared COVID-19 as a global public health emergency on 30 January, PNG relied on screening done at airports in Singapore, Hong Kong and Australia to determine whether passengers could enter PNG. The government is now calling for anyone who has entered PNG since 7 March to come forward for testing. This includes those who travelled with the man who tested positive in Bulolo, who had himself travelled from Singapore to Port Moresby before transiting to Lae. Even the Chief Medical Officer for the emergency committee set up under the SOE, Sam Yockopau, has suggested that COVID-19 may have entered PNG since December 2019 but only presented as the common cold or flu.

Second, is poor health infrastructure. The initial swabs were flown to the Medical Research Institute in Goroka, which has the test equipment. However, there are no isolation facilities for anyone testing positive. Initially an isolation ward was delegated at the Port Moresby General Hospital, but the Nurses Association protested, arguing the lives of more than 1,000 patients would be at risk if coronavirus was brought into the ward. Things may improve when 10,000 AusAID donated COVID-19 test kits, which are awaiting clearance, are released for distribution around the country. The UN is also setting up 30 temporary isolation wards.

Third, managing the PNG–Indonesian border. Indonesia has the highest death ratefrom coronavirus in the world at 9.3%. The 820 kilometre border with Indonesia has long been a challenge for understaffed and ill-equipped immigration officials and the PNG Defence Force. It will be a massive task to immediately lockdown the movement of traditional border crossers – people living within the vicinity of either side of the border.

Fourth, there is the challenge of funding. PNG has been struggling with high debt and low revenue over the past few years. The government has requested an aggregate K860 million (US$252 million) from the IMF, ADB and World Bank to fight COVID-19. The World Bank component (US$20 million or K68.2 million) will be spent on priorities identified by WHO and PNG’s National Department of Health in its National Emergency Response Plan. These priority areas include: modular isolation facilities for priority provinces; laboratory equipment and supplies to expand testing facilities, including financing for specimen transport; training and technical assistance for infection prevention and control, and rapid response in priority provinces; and risk communications. The funding from the ADB (US$50 million or K170.5 million) and IMF (US$182 million or K620.7 million) will be used to fund priorities identified in the National Emergency Response Plan.

Conclusion

The PNG government has not handled the initial case of coronavirus well, but subsequent quick action has been impressive. The declared SOE was the best decision for PNG given the dire state of the health system and lack of access to health facilities outside of urban centres. Most PNG provinces are isolated due to lack of road networks, so if the air and sea travel restrictions are effectively implemented, it will reduce the spread of the virus if other positive cases are detected. However, if it does spread, it will be very difficult to bring under control. The success of the SOE will also depend on how the funds are managed. After the last SOE declared in 2018 in Southern Highlands following the devastating earthquake there, K450 million(US$132 million) was allocated for disaster relief. Even then, there were complaints of lack of funding affecting disaster response. Diligent management and timely allocation of the funds is important for fighting COVID-19.

 

Author Michael Kabuni is a Teaching Fellow in Political Science at the University of Papua New Guinea.

by Dr Sepehr Lajevardi

By | All 2020 DAISI trips cancelled | No Comments

Unfortunately due to COVID-19 pandemic, and lock-down measures, it has been announced today to all DAISI members, and our partnering colleagues in the South Pacific, that all trips for 2020 have been cancelled.

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Prof Peter Hewett, the Solomon Islands Program Officer stated today ” It is most unfortunate, but I  think this was inevitable and the best decision”, an opinion echoed by Dr Carina Chow & Prof Christophe Berney both surgeons heavily involved in DAISI trips planned for Papua New Guinea later this year, with Dr Chow stating “I think this was a smart move in this crazy time”.

DAISI partner surgeons Dr Elvis Japhlet & Dr Kennedy James from Sopas Hospital and Alotau Hospital in Papua New Guinea, and Dr Rooney Jagilly from National Referral Hospital in the Solomon Islands today shared their agreement that such a move was “in the best interest of the public good”.

“Our heart goes out to these vulnerable nations, with no telling how they will cope with the pandemic, but at the moment our presence there would be more a hindrance than a help” advised Dr Danny Kozman, Co-Vice Chair for DAISI.  “Special thanks also goes to those unsung heroes in the South Pacific who are integral to the planning and organisation of DAISI trips.  Not to forget also those from the PNG and Solomon Island’s Medical Board including Ms Francina Ega and Ms Pou Haro responsible for processing the over 70 applications for temporary medical registration, which unfortunately will now not be used for 2020”.

All volunteers who require help with organising refunds for their flight and accommodation should contact staff@daisi.com.au  An update to all those involved will be issued towards the end of the year, to allow volunteers and patients who missed out this year to be included next year.

Author: Dr Sepehr Lajevardi  is a member of DAISI.