Annual Report 2011-2012

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ContentsPresident’s report 1 Summary of program activities by General Manager Delene Evans 2Sponsors and supporters 6 Report from the field by Dr Merrilee Frankish 8 New Ireland patrol team members 11Board of Directors 12Board of Directors’ report and declaration on financial statements 14Auditor’s report 15 Financial statements 16 Notes to financial statements 20

ADI goals

ADI is a not-for-profit, non-government health care and development aid organisation. Our goals are to:

• Deliver and strengthen primary health services to rural communities in PNG through Doctor Supervised Integrated Health Patrols.

• Reduce preventable diseases through public health programs, health education and health promotion.

• Increase the capacity of local health workers to manage and deliver primary health services through training and education.

• Improve access to primary health services by rural and remote communities.

• Demonstrate improvement in health indicators as a result of our activities through the use of a structured monitoring and evaluation framework.

Above: Strengthening the clinical and managerial skills of health staff at rural health facilities through training and education is a key component of ADI’s program. Cover photo: Dr Merrile Frankish at Messi Health Centre in New Ireland Province.

ADI is a member of the Australian Council for International Development (ACFID) and a signatory to the ACFID Code of Conduct. ADI is fully committed to the Code, the main parts of which concern high standards of program principles, public engagement and organisation. More

information about the Code may be obtained from ADI or ACFID (www. acfid.asn.au).Any complaint concerning an alleged breach of the Code by ADI should be lodged with the ACFID Code of Conduct Committee. Any other complaint concerning ADI should be addressed to ADI’s President and Vice President via the contact details on the back cover of this annual report.ACFID’s contact details are – Postal address: Private Bag 3, Deakin, ACT, 2600, AustraliaTelephone: +61 2 6285 1816 Fax: +61 2 6285 1720 Email: main@acfid.asn.au

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Dr. Peter Macdonald OAM MBBS MRCGP DA DRCOGPresident

Papua New Guinea (PNG) is in urgent need of assistance as reflected in the priority given to it in our national AusAID budget. After over 10 years of supporting health services in remote rural areas, ADI has refined its development model to emphasise local capacity building and training.

Our volunteer doctors in New Ireland Province (NIP) work alongside local health staff who are always eager to learn from case-based teaching and formal training. During the 2011/12 financial year, our dedicated volunteer doctors Dr Liz Scott, Dr Danni Gitsham and Dr Merrilee Frankish treated thousands of patients and spent many hours teaching as well as dealing with myriad logistical matters necessary to make our projects a success.

There are now two ADI volunteer doctors serving rural populations in NIP, one based in Kavieng doing Integrated Health Patrols to the far reaches of the island province and a second based in Namatanai, 260 kilometres south of Kavieng, to strengthen primary health and resurrect a failing local hospital serving a population of 90,000. This is made possible with funding from Newcrest Mining for three years.

These are ambitious tasks but, in the opinion of ADI, crucial to bringing about real change. It is worth noting that there are no other international aid agencies providing primary health services in the province.

I am happy to report that it has been a vintage

year for ADI. We’ve made real progress with

our program in New Ireland Province and further consolidated our long relationship with Catholic Health

in Western Province. That’s not to say we

haven’t had frustrations and setbacks.

In Western Province, our long serving volunteer health manager, Leona Cayzer, has made great progress strengthening the managerial capacity of the Catholic Health Office and its rural health facilities. ADI is grateful to PNG Sustainable Development Program for the funding to build accommodation for our volunteers in Kiunga and is also in discussion with Horizon Oil regarding significant financial support.

All this activity needs the support of an efficient head office in Sydney. ADI operates on minimal paid staff (four part-timers) and many volunteers who donate hours of their time – to them I say ‘thank you’. Our administration costs represent 7.5% of our budget, as good as any charity we know!

The growth of an organisation such as ADI is dependent on building strong networks and attracting financial support and in-kind sponsorship, as well as a strong ‘team’ represented by our PNG partners and Board of Directors in Manly, Sydney.

I commend this Annual Report to you; it paints a picture of a professional medical aid agency which exists for one purpose: to ‘work for a healthier PNG’.

President’s report

Make a donation by visiting our website www.adi.org.au or by calling us on (02) 9976 0112

Donations of $2 and over are tax deductible

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Summary of overall program activities

by Delene EvansGeneral Manager

Overview ADI’s financial position is the healthiest since operations began in 2002. The number of major supporters has increased, as has their financial commitment. Our major PNG-based contributors are PNG Sustainable Development Program and Newcrest Mining Limited for projects in Western Province and New Ireland Province respectively. In Australia, our major contributors are Roche Australia, the Hunt Family Foundation, The Church of Jesus Christ of Latter-Day Saints (LDS), Lili Koch, Three Flips Foundation and Austpac Chemicals & Commodities. For a full list of our generous sponsors, please see pages 6-7.

Members and friends, who raised a record $35,782 net at our major 2011 fundraising event, continue to provide ADI with a strong, enthusiastic and committed cadre of local supporters. At 30th June 2012, ADI had 134 members due to a concerted effort which has been underpinned by quarterly email newsletters to 350 interested parties and customised promotion to major sponsors. Our marketing efforts have been expanded to appeal to businesses in PNG, which have shown a greater willingness to help their community as they understand the dire health situation there.

The contribution of non-monetary donations has been a very significant component of ADI’s program in New Ireland Province this year. Donations of medical equipment and supplies from

Device Technologies (valued at $110,00), as well as from Roche Diagnostics and DefibTech, have complemented a special project funded by LDS to provide 28 health centres and two hospitals with essential primary health care equipment and associated training by ADI doctors. Our training assists local health workers to improve their diagnostic skills.

Non-monetary donations also include the valuable time donated by our volunteers. Without the contribution of time by our intrepid volunteer doctors in New Ireland, health management advisor in Western Province, and administrative staff and Board of Directors in Sydney, ADI’s programs could not be delivered at such low cost to disadvantaged and remote, rural communities in our nearest neighbour. Based on an AusAID formula, ADI’s volunteers contributed an astounding $420,000 worth of time this year.

We continue to be challenged by the deterioration in the PNG health system, which has slid to 153rd position out of 187 countries ranked in the UN Human Development Index. There has been minimal improvement in health sector indicators since 2002, and no change in the last five years. The National Department of Health states that improved outputs or outcomes are not occurring, despite increased inputs.

PNG also faces a huge health worker crisis. The World Health Organisation has estimated 2.5 health workers per thousand are

Top: Dr Danni Gitsham on patrol in New Ireland, where 40% of the

population live on off-shore islands.Bottom: The Catholic Health

Office distributing water purification buckets to flood affected

communities during a cholera outbreak in Western Province in

mid 2012.

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needed to deliver the minimum standard of health services; PNG has just 0.58 per thousand workers. As well, there are approximately 400 doctors in PNG, a ratio of 1 per 17,502. Australia’s ratio is 1 per 302.

The Save the Children Health Worker Index measures the reach and impact of health workers. PNG ranks 149th out of 161 countries. This report clearly states the case for increasing health worker capacity, which is a major focus of ADI’s work.

Our overarching objective is to build the clinical and administrative capacity of the health staff of our development partners, the New Ireland Provincial Government and Diocese of Daru-Kiunga, so they can deliver higher quality health care to their communities.

Our core activities continue to be clinical treatment, case-based and group training on location and annual in-service training, as well as mentoring and supporting local health staff. Improving the effectiveness of our training has been a central theme this year through the provision of more teaching aids such as models, books and other material for our doctors and health management advisor to use in the field.

Whilst ADI continues its grassroots approach, increasingly our activities now include advocating for change at the PNG National Department of Health and the New Ireland Provincial Government and with politicians and businesses within our sphere of operations, including during seven visits to Western and New Ireland Provinces.

Facilitating and overseeing the deployment of field volunteers and providing back up and support for their activities on the ground requires a substantial commitment of time and resources. Working in PNG is always challenging and the remoteness of ADI’s activities presents many issues for our doctors and our administration.

Increasing the awareness of the ADI brand is a critical component

of our activities. We have enjoyed an amazing year of public relations activities and event opportunities for such a small organisation. Examples include presenting at the Australia-PNG Business Council Conference in Brisbane and having a free exhibition booth at the GP Conference & Exhibition in Sydney.

Major publicity in PNG media has included former volunteer Dr Liz Scott’s patrol to Konoagil published in The National newspaper and broadcast on EMTV, Dr Merrilee Frankish’s Nimimar patrol story published in The Post Courier’s ‘Weekender’, and a feature story about Dr Danni Gitsham’s assignment published in the PNG Report, which targets resource companies.

Australian and New Zealand medical journals play an important role in showcasing ADI’s work and raising interest amongst potential volunteer doctors, and we’ve also been featured in the Sydney Morning Herald, Cairns Post and ABC Radio. Stories have appeared in Australian Rural Doctor, Australian Doctor, Medical Observer and NZ Doctor, as well as in the newsletters and websites of various health organisations. Additionally, there was widespread interest, especially in NZ and Queensland media, in Dr Josette Docherty and Allan Mason’s medical role in an arrow

attack which occurred during their assignment in Western Province.

The ADI website plays a vital role in providing information about our organisation, validation of our credentials and recruitment. An analysis of data shows that from 1 July 2011 to 30 June 2012, we had 10,379 visits to the website (up 2.5% from previous period). Our website ranked No. 1 in Google for the search term ‘volunteer doctor’.

Areas of operationWestern Province

ADI’s development partner, the Diocese of Daru Kiunga (DDK), led by Bishop Gilles Cote, has been providing health, education and pastoral services to communities throughout Western Province for more than 40 years. It operates eight health centres and 14 health posts, disability programs through Callan Services and HIV/AIDS counselling and testing, and is supported by the excellent work of Sr Maureen Sexton and the Sisters of Mercy. ADI celebrated 10 years of partnership this year and recommitted to work collaboratively in the future by signing a new Memorandum of Understanding.

Dr Josette Docherty and partner Allan Mason completed their second volunteer assignment in September 2011. That same year, ADI appointed volunteer Health Management Advisor Leona

Dr MerrileeDr DanniLeona, RNDr Josette & Allan Dr Liz

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Cayzer, RN, to work with the DDK’s Diocesan Health Manager, Sr Anna Sangiwara and other staff. A two stage ‘Capacity Building Project’ was agreed:

1. Build the administrative capacity of the DDK’s head office in Kiunga to manage their health service.

2. Build similar capacity in health centres to improve the management and quality of delivery of primary health care.

Anne Lanham was appointed as Western Province Program Coordinator to manage and develop this project, made possible with funding from PNG Sustainable Development Program (PNGSDP). PNGSDP have been generous sponsors of ADI’s projects in Western Province and recently they agreed to fund the construction of new accommodation for ADI’s volunteers in the Mission complex at Kiunga.

In stage one of the project, weekly operational meetings and fortnightly management meetings were introduced. An organisational structure plus roles and responsibilities for health staff, along with job descriptions, were created and job gaps identified. Other focus areas are financial planning, IT skills, time management, staff recruitment practices, and detailed policies and procedures to deal with complex staff issues, especially in remote locations. In stage two, Leona and senior staff are working hard to strengthen leadership and clinical skills in the health centres. A key objective is to track the health status of more vulnerable groups: pregnant mothers, young children, the elderly and those with chronic diseases.

Our congratulations to Sr Anna, who has been awarded her Diploma in Health Management and is putting this knowledge into practice with confidence and a more skilled team. The Diocese Health Board has been reinvigorated with new leadership under Father Masjon, who has invited high profile community

members to join the Board.

On a visit to Kiunga in April 2012, Anne received requests to enhance the Capacity Building Project: an urgent need for a Health Support Worker to set up a drug warehouse and distribution system; funding to allow all eight Officers-in-Charge of health centres to meet and attend workshops in Kiunga on a quarterly basis; and the deployment of ADI doctors with specialist skills to address the leading causes of mortality and morbidity in North Fly District such as maternal complications, TB, malaria and the rise in deaths of children under 5. ADI has had discussions with oil exploration company Horizon Oil this year which has shown interest in funding these health initiatives.

Over the past 10 years, ADI has sent 23 volunteer doctors on 32 assignments to Western Province and in the same period it is pleasing to note this is the most improved province according to the PNG National Health indicators. We feel that with the help of our generous donors we have built a solid foundation to expand our program in improving primary health care in the province.

New Ireland Province

Our work in New Ireland Province (NIP) could not be realised without the financial and moral support of the New Ireland Provincial Government (NIPG) and its high profile Governor, Sir Julius Chan. NIPG commits 400,000 kina annually (A$200,000) to ADI, to deliver primary health services with their local staff to their remote and rural communities.

Over 160,000 people live in NIP, 40% on offshore islands, which demands a huge logistical effort in terms of planning, communication when many radios do not work, staff organisation, fuel requirements for boats and vehicles, not to mention the challenges of weather and high seas. The province has six doctors all of whom are based at the provincial hospital in Kavieng and

are stretched to service rural areas.

Four projects to build the clinical capacity of the province’s health staff are in various stages of implementation:

1. The continuance of our integrated patrols to the province’s 28 health centres and Namatanai Hospital.

2. The purchase and distribution with training by our doctors of essential primary health medical equipment to all health centres.

3. The planning of in-service training for 70 health workers.

4. The planning of a second doctor to Namatanai District in the south of NIP.

Additionally, we supported an application by New Ireland’s Catholic Church, which delivers a third of the province’s health services, to the Digicel Foundation for a 150,000 kina (A$75,000) mobile health clinic to service 15,000 people around Lemakot. This application was successful.

ADI was blessed with having doctors Liz Scott (May to Aug. 2011), Danni Gitsham (July to Dec. 2011) and Merrilee Frankish (Feb. to July 2012) who generously volunteered their time and expertise to treat and train. With support from the Hunt Family Foundation and Roche Australia, our adventurous doctors saw 3,000 patients and did 490 hours of case-based teaching and 68 hours of group teaching on location. They spent 114 days on patrol and held 147 clinics. All 28 health centres were visited twice and just over half were visited three times, each visit lasting three days.

The top five diseases/conditions treated were musculoskeletal (18%), respiratory (9%), malaria (7%), tuberculosis (5.4%) and gastrointestinal (4.9%). Our doctors report a drop in malaria as a result of the introduction of a new malaria treatment and on-site training reinforced this new protocol.

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Neglected diseases such as yaws (NIP has the second highest incidence in PNG), filiariasis and pockets of leprosy – which are all easy to treat – still plague the province.

ADI’s medical services and clinical training are delivered in partnership with local health staff. The eye nurse, PAP smear nurse, TB officer, dental therapists, HIV/AIDS educator, environmental health and health promotion staff perform hundreds of consultations, do health talks and dental checks in schools, and health promotion in communities. Our doctors are in awe of the hardworking and dedicated patrol staff and health centre staff who work in dilapidated health facilities, managing very challenging medical cases with scarce diagnostic resources, no regular power and limited water and variable drug supplies.

With generous funding from the Church of Jesus Christ of Latter-Day Saints (Sydney) diagnostic primary health medical equipment requested by doctors and local health staff was sourced, purchased, packed and distributed to 24 health centres during patrols. Our doctors taught health staff how to use glucometers, stethoscopes, blood pressure machines and otoscopes to better diagnose, and importantly, also how to look after the equipment.

During the first round of patrols, 84 health staff responded to a ‘learning needs’ survey. Maternal health and safe motherhood, including immunization of children, were overwhelmingly the most important areas of training needs followed by clinical assessment and diagnosis, drug therapy, STIs and HIV/AIDS, TB, malaria, cold chain and family planning. This information formed the basis of our two week-long in-service training programs scheduled for 140 health workers in 2013.

A staff audit was undertaken by our doctors and the report presented to the NIPG. NIP has a shortage of at least 83 health staff when compared to the national standards.

There is no easy solution as staffing numbers are impacted by a staff ceiling, chronic bureaucracy and unavailability of accommodation in remote locations.

An infrastructure audit report was also compiled and presented to the NIPG to assist in planning their infrastructure upgrades. Transport and communication are the highest priorities, followed by safe water supply and sanitation. NI has the lowest rate of health facilities in PNG with water and sanitation. Access to reliable power is a further serious issue for many centres.

In July 2012, with the support of the NIPG and funding from Newcrest Mining of $70,000 per year for three years, an ADI doctor was deployed to the Namatanai District to service its hospital and key feeder health centres and train clinical staff. The hospital sees 65,000 outpatients a year and is staffed purely by nurses and community health workers.

Sydney

ADI has strengthened its organisational capacity with a new part-time program manager and additional volunteers. This need was driven by our submission last year for accreditation by AusAID. ADI passed the desktop organisational review, but the accreditors rejected our submission as we were unable to statistically establish sustainable changes in the health of the populations we served or in the clinical and administrative capacity of local health staff.

This required a major investment in monitoring and evaluation systems, which ADI could not fund at the time, compounded by major difficulties in information collection and sharing in PNG. Encouraged by the visiting accreditors, an appeal was lodged with AusAID, but this was unsuccessful. ADI remains committed to improving the monitoring and evaluation of the impact of our programs, but needs to source funds and services to do so.

Vice President George McLelland and Public Officer Anne Lanham successfully undertook self-assessment of ADI’s compliance with the ACFID Code of Conduct.

Anne Lanham was appointed to a part-time paid position after 10 years as a volunteer (see the section on Western Province for details). Leah Boonthamon is in her fifth year ADI’s marketing and communications consultant, managing the website, sponsor communications, media relations, and our Facebook page.

We have been blessed with the addition of more committed volunteers. David Snedden, a former partner of Gadens Lawyers for 25 years with experience working in PNG, has added significant strength to our fundraising efforts. His advocacy skills are also being harnessed to gain support in PNG. Irina Blackmore has joined the membership team led by dedicated volunteer and director Lili Koch.

Long-term volunteers continue to give outstanding service: Marcel Diebold in finance, Lan Hue Pham our database developer, Ray Lanham our IT go-to person, Wendy Macdonald and her fundraiser event team, and Ali Trevaskis, a registered nurse who sources medical equipment, teaching aids and responds to the many requests of field staff.

Regular committees also share the workload: the Risk and Compliance Committee, chaired by director Chris Lavers, has met three times and undertaken major reviews of insurances and safety of boat travel in PNG. The Revenue Committee has met 11 times and been strengthened with the addition of volunteer and director David Snedden, whilst the Program Committee has met 11 times also and benefited from the overseas aid experience of director Judy Lambert.

– Delene Evans, General Manager

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Major sponsors $50,000+• Device Technologies• Hunt Family Foundation• Newcrest Mining• Roche Australia and Roche Diagnostics

Other sponsors and supporters • ACC Austpac Chemicals & Commodities• Air Niugini• AMAQ Foundation• Aspen Medical• BD (Becton, Dickinson and Company)• Bydand Medical• The Church of Jesus Christ of Latter-Day Saints• City Pharmacy • Count Financial Limited• Defibtech• Kara Limited• Kimberly-Clark Healthcare• Lavers Family Fund• Lili Koch• Medtronic• Ok Tedi Mining Limited• PNG Sustainable Development Program• Rotary Club of Kenthurst• Rotary Club of Manly Sunrise• SMEC Foundation• Three Flips Foundation• Price Waterhouse Coopers PNG• Raymond J Patmore chartered accountant• Royal Far West

ADI is also grateful for the generosity, suppport and advice of Kavieng’s local business community. This includes Lissenung Island Resort, Nusa Island Retreat, PNG Surfaris, Bisiworks, Patu 23, City Pharmacy and Ela Motors.

Sponsors and supporters

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(1) Dr Danni Gitsham training hospital staff on use of cardiac defibrillators donated by Device Technologies (2) Health staff using Accu-Chek diabetes glucometers donated by Roche Diagnostics (3) Tropical medicine textbooks donated by AMAQ Foundation (4) Many Kavieng based businesses provide great support to ADI (5) Some of the medical equipment donated by The Church of Jesus Christ of Latter-Day Saints (6) Sisters at Lemakot Health Centre with an oxygenator donated by Rotary (7) Drugs donated by City Pharmacy in Kavieng (8) Life jackets donated by SMEC Foundation (9) 300 pairs of glasses donated by Geoff Watson

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Teach a village to fish... Training and education are key

Training and education are the foundation of ADI’s patrols, along with working in partnership with a strong team of local health staff. In between treating 1,600 patients, Dr Merrilee Frankish’s six-month volunteer assignment in New Ireland featured lively obstetric drills for health workers and training on the new malaria treatment MALA-1. The other dedicated patrol team members conducted hundreds of pap smears, eye tests and dental examinations, plus water and sanitation inspections and health talks for school children.

Seven patrols over six months“The places I’ve visited have been

unbelievably remote, with local nicknames such as ‘The Last Corner’ and ‘The Last Page’.”

I have been on the high seas, in high winds, through torrential rains, flooding rivers, around fallen trees and evacuated from a sinking banana boat (which thankfully stopped filling with water following my transfer to another boat). We have weathered earthquakes, high tides, tsunami warnings, subsiding concrete floors, watched boats capsize, turned back twice in rough seas and once from a flooded bridge. I have been drenched with sea water constantly and have nearly kissed the ground on safe return. My journeys by road have been just as adventurous!

The places I’ve visited have been

unbelievably remote, with local nicknames such as ‘The Last Corner’ and ‘The Last Page’. Most of the province’s 160,000 people live without running water, electricity, phone coverage, toilets or proper roads. Babies are delivered in health centres by torchlight. Quite simply, many people feel forgotten.

Adverse conditions present many challengesDuring our integrated rural health patrols, I have seen selfless community health workers working without a nurse in adverse conditions with not a squeak of complaint – they are my heroes. I have seen a mother carry her malaria infected baby for a day, often over her head, through flooded water to the health centre and saved her child late at night.

Field report:New Ireland

by Dr Frankishvolunteer doctor

Above: “Mountains dipped straight into the sea, creating

a fjord-like coastline, often with pristine white, black sandy or

smooth stoned beaches. Dolphins dancing, spinning and playing.

Mantra rays leaping and flying fish as our escorts. Schools of tuna

visible 20 metres underwater with birds circling overhead. The sea

clear, turquoise and glorious with mirror-like reflections of nearby island mountains and clouds in

their entire beauty.” - Merrilee

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We have seen many desperately sick people and been able to help most. I have worked and learned from many skilled, exceptional PNG nationals and have heard the heartfelt thanks to our team for coming, teaching, helping and showing that the outside world cares.

Bell tolls daily for victims of curable diseasesI have also heard the bell toll daily for victims of TB where the tyranny of distance leads to interrupted and non-existent drug supply.

This desperation, lack of faith in the health system and pure feeling of abandonment is exemplified in a family we saw where four members tested positive for malaria. This included a young child with a massive spleen and the mother who had pneumonia and malaria. There’d been no treatment available to them in any form.

It didn’t matter how much the mother wanted to care for her loved ones, she was thwarted by a system where health centres close due to understaffing and people needlessly die, as simple and appalling as that.

Tireless teamwork“On arrival [...] we ask the

community what they want from us.”

Each patrol is made up of experienced, intelligent, well-educated and dedicated local

people (see page 11). Some of the places we visit are the original homeplace of our team members.

On arrival at each health centre we ask the community what they want from us. It is no good to go in with a rigid set of ideas – that does not work. I learned to trust that events would unfold as they should and each community’s needs would be sorted out via elders, health workers and church leaders and depending on the range of expertise in each team. It just happened in its own good PNG time.

During our patrol to Murat, the sexual health nurse did over 170 pap smears and the dentist saw over 300 patients. The eye nurse saw 284 patients and the TB DOTS officer educated and saw what is really happening in the rural areas.

It is wonderful to be a part of a team who willingly work together into the night – and at times all night! – educating and treating sick patients in the remote health centres.

Health education is the foundation of ADI’s patrols“Embedding the ADI [...] team in the community for a few days is just the

start of a lifetime of learning.”

Education is the foundation of ADI’s health patrols. We reach out to school groups, health workers and Village Health Volunteers. We teach during every consultation: patient exercises, examination,

how to do pap smears, how to treat sexually transmitted infections (STIs), and how to manage TB, malaria and – my old faithful – obstetric emergencies.

The local communities are a big focus. In Konoagil, we held an education session under the mango trees and stars. Topics discussed included adolescent health, TB, everyone’s favourite the prevention of teenage pregnancy, how to brush teeth, and the dangers of chewing beetle nut.

In Lavongai, a superb community meeting was held at church. The kundu drums were struck and about 80 people gathered to discuss in Tok Place (the local language) issues ranging from the dysentery outbreak to family planning to STIs and subsequent pelvic inflammatory diseases.

Education will lead to lives being enhanced and saved. Embedding the integrated rural health patrol team in the community for a few days is just the start of a lifetime of learning – for us all.

‘NeoNatalie’ the mannequin aids obstetric sessions“We have graduated from the water

bottle of my earlier patrols to this life-like doll which… can breath

and has a cord pulse.”

Halfway through my assignment, ADI became the proud owner of ‘NeoNatalie’, a neonatal

Left: “I saw a beautiful young child with gross hydrocephalus who was destined to live without the simple surgery that would release some pressure from her brain. It all comes down to money. These isolated people have no affordable access to markets to sell cash crops and therefore have no money or affordable transportation to the big hospitals in Port Moresby or Australia.” - Merrilee

Far left: Obstetric training using the life-like NeoNatalie mannequin.

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mannequin which is used to teach obstetric drills in response to PNG’s extraordinarily high maternal and infant mortality rates. We have graduated from the water bottle of my earlier patrols to this life-like doll which when filled with about two litres of water, can breath and has a cord pulse – the hardest part is finding the water in most places! I also have a model pelvis to help show the various ways babies become stuck and how to overcome this problem.

My obstetric talks quickly bore fruit. Two experienced nursing officers told me how they or their staff remembered our sessions “tingting long dokta, i tok putim legs i go antap” –“remember the doctor said to put the legs back right up” for shoulders getting stuck and to try different positions. They proudly stated, “We have to put this teaching into practice”. Hearing these nurses speak with such passion about safer birthing made the hair on my arms rise. I thought, “They do remember and those who want to learn can, given the opportunity and appropriate teaching.”

Joyous distribution of donated medical equipment

“They quickly became very proficient in using the equipment

and proudly showed off their skills to the patients.”

During patrols I distributed medical

equipment and surgical supplies donated by ADI’s sponsors (see page 6). It was an exciting experience and I’ll never forget the health workers’ exclaimations of joy upon opening the boxes or their gratitude.

Introducing this new equipment to health centres necessitated lots of hands on training and education. I taught staff how to test for diabetes and hypertension, conduct ear examinations and take temperatures, measure weight, and perform resuscitation with an ambubag. They quickly became very proficient in using the equipment and proudly showed off their skills to the patients.

Real measurable outcomes One of my most gratifying moments came on returning to Messi after four months and finding that the rates of malaria had decreased from 16 per day – mostly in young children, many life threatening and two in pregnant ladies – to 16 per month. Patients now present early and are treated promptly and appropriately. The staff and community members attributed this success to our team’s initial support and education on the strict use of the new malaria treatment MALA-1. They said they were happy to no longer have to watch people die before their eyes.

This health centre was also no longer running out of medicines, in particular antibiotics which are typically over-used as a cure-all for everything from backache to fever. This too was due to our teaching on rational medications. We were proud of and grateful for the intelligent hardworking selfless staff we repeatedly encounter on our journeys across this province.

Speaking during consultations and at our farewell feast, the staff and community elders said that since the last patrol, the community’s health had improved and staff were more confident about their clinical skills. The community also said that health was the only Provincial Service to reach out and help their village.

Local staff the true heroes“We worked hard in challenging but

magnificent conditions.”

During my six months in New Ireland, I saw 1,600 patients. I also conducted 266 hours of case-based teaching and, most significantly, 78 hours of interactive group training. But my assignment was about so much more than figures.

The hardships for New Ireland’s people may persist, but ADI will continue to tirelessly advocate, educate, support, lead and be there for the people of our closest and neediest of neighbours.

Right: Integrated Health Patrols include an eye

nurse who performs free eye checks and distributes glasses.

Far right: Other patrol team members give preventative health

talks in schools and to communities on a range

of topics including sexual health, maternal health,

TB, HIV/AIDS, basic hygiene and more.

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Some of our dedicated NewIreland patrol team members*

Dominic

Lenean

Edward Audrey

Dominic Sahamie, RN Acting Director of Health, New Ireland Provincial Health (NIPH)“When we go out as an integrated health team, patients in rural areas get services that the provincial government can’t otherwise provide.”

Gedjolly

Gedjolly Aaron, RN Acting Deputy Director of Health, NIPH“My job is to disseminate information in schools and communities. Going out with the ADI team means we can bring our ideas together and it helps me to think outside the box.”

Jennifer

Jennifer Roberts, RN Nursing Officer in Charge at the Maternal Child Health Clinic at Kavieng General Hospital, NIPH“This PAP smear service is a first for many rural communities. The biggest problems I see are sexually transmitted infections and cervical erosion.”

Edward Abel, RN Cold Chain & Logistics Officer, NIPH“During patrols I check the gas fridges, health radios, and medical drugs and equipment. I also enjoy helping train the Community Health Workers to better serve the patients.”

Eremiah

Eremiah Nelson Environmental Health Officer, Kavieng District“I check the water and sanitation of health centres and communities, and educate people about hygiene. If cholera came to our province it’d be a big problem because most people don’t have toilets.” Merelyn

Merelyn Aruke, RN Eye Nurse at Kavieng General Hospital, NIPH“Patrols give me an opportunity to see remote patients and, if necessary, book them in for surgery which is conducted annually by a visiting opthamologist from Australia.”

Robert

Robert Sambale TB Monitoring & Evaluation Officer, NIPH“During patrols I train health workers, update TB register books, check drug supplies, examine patients with suspect TB, and conduct awareness on TB-DOTS to schools and communities.”

Lenean Lamano and Matthew Tulesal (inset) Dental Therapists at Kavieng General Hospital, NIPH

“Dental problems are getting worse in rural areas due to the increasing availability of manufactured food. We didn’t previously see these problems.”

Elizabeth Alwin Patrol Cook“I love going on patrol – it’s my first time to see all the different places in New Ireland!”

Francis Patrol Driver“You need good driving skills to travel over dirt, pot-holed and often flooded roads.”

Audrey Gillis HIV/AIDS Technical Officer, NIPACS“During one patrol a village elder came for HIV testing. He said he wanted to have the experience so he could tell the younger people and encourage them to get tested too.”

Elizabeth Francis

12

Secretary Bronwen ReganBA (Comms), Grad. Dip. (Peace and Conflict) Bronwen has worked for ABC Radio National

and with Governments at both a Local and State level. She has an ongoing interest in international politics and how it relates to national development with a particular focus on the provision of aid in the Asia Pacific region.

Bronwen travelled to East Timor on three separate occasions, including a one month deployment as an International Observer during the country’s national elections in 2007. Bronwen is passionate about forging links between our community here in Sydney and communities abroad

President Dr Peter Macdonald OAMMBBS MRCGP DA DRCOG Peter has over 40 years of

experience in general practice, post-graduate qualifications in anaesthetics and gynaecology, and a successful political career.

Peter was NSW State Member for Manly from 1991 to 1999. In 1999 he joined Medecins Sans Frontieres and went to Iran to work with Afghan refugees in the border region of Masshad. In 2000 under the auspices of Timor Aid he conducted several missions for returning refugees in West Timor. During this time Peter also made several visits to PNG to conduct clinical work and establish ADI with George McLelland and Anne Lanham. Peter was a Director of Plan International Australia from 1999 to 2004. He was Mayor of Manly from 2004 to 2008. In 2011 he was awarded a Medal of the Order of Australia (OAM) for his lifelong work in healthcare and politics.

Peter is currently contracted to the Northern Territory Department of Health and provides locum medical services to remote Indigenous communities.

Vice President George McLelland OAM CA George is a chartered accountant,

originally from Scotland. He worked with Deloitte in Brussels before migrating to Australia where he joined Civil & Civic, the construction arm of Lend Lease, later moving to the investment bank now known as Rothschild Australia. Back in the UK for ten years, he was shareholder/director of a private group of companies. In 1983 he returned to Sydney and set up a recruitment company specialising in the banking and finance industries.

George helped establish ADI in 2000 and was Treasurer until 2010. During the period 2003 to 2008 he also managed ADI’s malaria and filariasis (elephantiasis) programs in Western Province, PNG, which required lengthy trips to the field. George is also the Chairman of Rotarians Against Malaria.

Treasurer A. Turner Massey CA

A. Turner Massey qualified as a Chartered Accountant in

Glasgow with KPMG and after working for a large supermarket chain moved to London with a listed manufacturing company as a Divisional Accountant. He was a member of the Institute

of Chartered Secretaries and Administrators and the Institute of Internal Auditors Inc.

In 1965 Turner migrated to Sydney where he worked for three years before marrying and going to Canada. In Vancouver he worked for the Aluminum Company of Canada before returning to Sydney in 1971. He worked for ICI Australia (now Orica) in their fertiliser subsidiary for 23 years.

Presently retired, Turner is on the committee of the Scots Australian Council (Australia). He was a former chairman of the Manly Fairlight Salvation Army Red Shield Appeal and enjoys being involved in the local community.

Board of Directors

13

Dr Chris Lavers PhD, MBA, B.Com

Chris has held senior roles at Macquarie Bank and Cigna Insurance and

was CEO at Neville Ward Direct (now part of ComSec). Originally from South Africa, Chris also lived in Singapore where he was involved in large scale investment projects. Chris is actively involved in charity work.

Along with his wife and two sons Chris loves the outdoors and travel. He is a founding member of ADI.

Assoc. Prof. Dr David Smith BA, BA (Hons), PhD

David is an international education consultant with expertise in

quality teaching and assessment, issues of and strategies for the middle years of schooling, school self-evaluation, program evaluation, strategic planning and the management of effective school-based change. He has worked with state, Catholic and independent school systems, universities and private tertiary institutions.

David has taught at central and secondary schools, as well as at Macquarie University and the University of Sydney where he

Dr Judy Lambert OAMBPharm, BSc(Hons), PhD, GradDipEnvMgt, GradDipBusAdmin.

Judy has expertise

in the interface between social and environmental aspects of sustainable living in rural and urban areas. She’s particularly interested in improving the links between scientific knowledge, policy and on-ground expertise. Her experience spans research, government policy work as a ministerial consultant, and community sector advocacy,

Judy’s career highlights include: Director of Community Solutions (1993-present), Consultant to Federal Environment Minister (1990-1992); National environmental advocate with The Wilderness Society (1987-1990); Research scientist (1971-1987); Elected Local Government representative, Manly (1999-2008);

Lili Koch Dip. Commerce

Born and educated in Switzerland, Lili has been an Australian resident

for nearly 40 years. She has had careers in travel, medical administration and finance. Lili’s extensive travel has exposed her to the inequities in the third world and the need for assistance, especially in the areas of health and education.

Lili is a founding member of ADI, and has been a sponsor and active volunteer for ADI over the past five years. Lili is also the Northern Beaches group leader of RESULTS International (Australia), an advocacy group for the reduction of world poverty.

President of North Head Sanctuary Foundation (2003-2011); President of Manly Friends of Oecusse (2008-present); Board member of Environmental Defenders’ Office (1993-2003).

In 2006 Judy was appointed a Member of the Order of Australia for services to the community through a range of policy development and coordination roles within the conservation and environment movement, and to local government.

who are in need. She joined the ADI Board in June 2009.

held the full range of academic and administrative positions including Associate Dean of Postgraduate Research. He remains an honorary Associate Professor with their Faculty of Education & Social Work.

David resigned as a Director in September 2012.

David Snedden DipLaw (SAB), FAICD

David is a lawyer, who was a partner of national law firm, Gadens

Lawyers, for 25 years. He spe-cialised in corporate, financial and resources law and advice, and in addition to representing Austral-ian public companies, he worked extensively with Asian companies investing in Australia and the Pacific.

Early in his career with Gadens, David spent five years working in the firm’s Port Moresby office. He was later appointed the first Managing Partner of Gadens, and regularly returned to PNG.

Seeking new challenges, David became involved in the property and coal industries. He was a founding shareholder and director of the Campus Living Villages Group, which pioneered the private development of on campus student accommodation in partnership with Australian and New Zealand universities and now operates an extensive portfolio of student accommodation facilities both on and off campus in those countries, the United States and the United Kingdom. David was also a founding shareholder and director of Superior Coal Limited, which pioneered the reprocessing of tailings at Australian coal mines to recover saleable coal.

After retiring from his involvement in these companies, David became a volunteer for ADI, and was appointed to the Board in 2012.

14

The names of the members of the Board of Directors during the year ended 30 June 2012 or at the date of this report are:

• Peter Alexander Cameron Macdonald – President• George McLelland – Vice President• Alexander Turner Massey – Treasurer• Bronwen Heather Regan – Secretary• Lili Koch• Judy Lambert (appointed 10/11/11)• Christopher Lavers (appointed 20/2/12)• David Smith (resigned 7/9/12)• David Snedden (appointed 20/8/12)

Each of the Board members provided their services on a voluntary basis, with reimbursement for out-of-pocket expenses incurred in the discharge of duties.

The principal activities of the association during the year were to provide medical services, clinical training, community health promotion and conduct strategic health planning in Western Province and New Ireland Province, Papua New Guinea.

Declaration

The Board of Directors declares that:

The financial statements and notes, as set out on pages 16-21, are in accordance with the Associations Incorporation Act 2009 and:

i. comply with relevant Australian Accounting Standards as applicable; and

ii. give a true and fair view of the financial position as at 30 June 2012 and of the performance of the association for the year ended on that date;

In the opinion of the Board of Directors there are reasonable grounds to believe that the association will be able to pay its debts as and when they become due and payable.

This report and declaration dated this 26th day of October 2012 is made in accordance with a resolution of the Board of Directors.

Board of Directors’ report and declaration on financial statements

Dr. Peter Macdonald, OAM President

George McLelland, OAM Vice President

(a)

(b)

15

Australian Doctors International Inc.

Auditor’s report

16

Income statement for the year ended

30 June 2012

Notes $ 2012 $ 2011

Revenue

• Monetary 271,724 182,481• Non-monetary 3 542,767 330,821

– –

Grants • AusAID – –• Other Australian 10,000 –• Other overseas 26,682 –

Investment income 4,433 2,747

Other income 51,924 39,861

Revenue for international political or religious prosellytisation – –

Total revenue 1 907,530 555,910

ExpenditureInternational aid and development

International programs• Funds to international programs 2 84,841 86,978 • Program support costs 2 74,132 24,623

Community education – –

Fundraising costs• Public 8,425 7,395• Government, multilateral and private – –

Accountability and administration 68,193 99,972

Non-monetary expenditure 3 542,767 330,821

Total international aid and development programs expenditure 778,358 549,789

Domestic programs (including monetary and non-monetary) – –

Total expenditure 778,358 549,789

Excess (shortfall) of revenue over expenditure 129,172 6,121

The above financial statement should be read in conjunction with the accompanying financial notes.

Donations and gifts

Bequests and legacies

programs expenditure

Financial statements

Why non-monetary donations are included

If ADI was a commercial operation, rather than an overseas aid charity, the Income

Statement for the year would simply detail the cash income of $364,763, cash

expenditure of $235,591 and show a surplus of $129,172.

Instead ADI has opted, under the Australian Council For International

Development (ACFID) Code of Conduct, to include non-monetary items of income

and expenditure. That is why this year the ‘non-monetary’ total of $542,767

appears as both income and expenditure. (See financial note 3 on page 21 for a

breakdown of this amount.)

The non-monetary value established (using AusAID’s Recognised Development

Expenditure guidelines) for our volunteer doctors and others working on aid and

development programs in PNG was $421,649 (2011 $309,437). We believe

it is both logical and important to place a money value on their valuable frontline

services – albeit that the work is done on a voluntary basis.

Also, ADI receives a range of other significant non-monetary donations –

vehicles, medical equipment and supplies etc. These too are included in non-monetary

donations at $121,118 (2011 $21,384).

All ADI’s cash expenditure, both in Australia and PNG, goes to support the delivery of medical and health services.

17

Notes $ 2012 $ 2011

AssetsCurrent assets

Cash and cash equivalents 4 & 5 188,260 93,363Trade and other receivables 5,046 3,070Inventories – –Assets held for sale – –Other financial assets 19,829 4,848

Total current assets 213,135 101,281

Non current assetsTrade and other receivables – –Other financial assets – –Property plant and equipment 6 1,280 3,034Investment property – –Intangibles – –Other non current assets – –

Total non current assets 1,280 3,034

Total assets 214,415 104,315LiabilitiesCurrent liabilities

Trade and other payables 7 9,466 9,188Borrowings 8 – 20,000Current tax liabilities – –Other financial liabilities 9 1,900 1,250Provisions – –Other – –

Total current liabilities 11,366 30,438

Non current liabilitiesBorrowings – –Other financial liabilities – –Provisions – –Other – –

Total non current liabilities – –

Total liabilities 11,366 30,438

Net assets 203,049 73,877

EquityReserves – –Retained earnings 203,049 73,877

Total equity 203,049 73,877

The above financial statement should be read in conjunction with the accompanying financial notes.

Balance sheetas at

30 June 2012

Financial statements

18

Retained earnings Reserves Total

$ 2012 $ 2011 $ 2012 $ 2011 $ 2012 $ 2011

Balance at beginning of year 73,877 67,756 – – 73,877 67,756

Excess (deficit) of revenue over expenses 129,172 6,121 – – 129,172 6,121

Amount transferred (to) from reserves – – – – – –

Balance at end of year

203,049 73,877 _ _ 203,049 73,877

The above financial statement should be read in conjunction with the accompanying financial notes.

Australian Doctors International Inc.

Financial statements

Changes in equityfor the year ended

30 June 2012

Financial statements

19

$ 2012 $ 2011

Cash flow from operating activitiesReceipts from operations 360,330 239,272

Operating payments 269,866 222.300

90,464 16,972

Investment income 4,433 2,747

Net cash provided by (used in) operating activities 94,897 19,719

Cash flow from investing activitiesPayments for property, plant, equipment (3,236)Net cash provided by (used in) operating activities – (3,236)

Net cash increase (decrease) in cash held 94,897 16,483

Cash at beginning of financial year 93,363 76,880

Cash at end of financial year 188,260 93,363

Reconciliation of cashFor the purpose of the cash flow statement, cash includes cash on hand and in banks and investments in money market instruments, net of outstanding bank overdrafts. Cash at the end of the financial year as shown in the Statement of Cash Flow is reconciled to the related items in the Statement of Financial Position as follows:

Cash 188,260 93,363

The above financial statement should be read in conjunction with the accompanying financial notes.

Cash flow statementfor the year ended

30 June 2012

Financial statements

–

20

Note 1. Summary of significant accounting policies and basis of accounting

The summary financial statements have been prepared in accordance with the requirements set out in the ACFID Code of Conduct. For further information on the Code please refer to ACFID Code of Conduct Guidelines available at www.acfid.asn.au.

This general purpose financial report has also been prepared in accordance with Accounting Standards, other authorative pronouncements of the Australian Accounting Standards Board, Urgent Issues Group Consensus Views and the requirements of the Associations Incorporation Act 2009.

It has been prepared on the basis of historical costs, and except where stated does not take into account current values of non current assets. These non-current assets are not stated at amounts in excess of their recoverable values. Unless otherwise stated, the accounting policies are consistent with those of the previous year.

Australian Doctors International Incorporated is a not-for-profit charitable organisation and this financial report complies with such of the prescribed requirements as are relevant thereto.

A. Foreign currency

Transactions denominated in a foreign currency are converted at exchange rates prevailing during the financial year. Foreign currency receivables, payables and cash are converted at exchange rates at balance sheet date.

B. Depreciation of property, plant and equipment

Property plant and equipment acquired for international aid and development programs are charged to these programs in the year of acquisition. Depreciation on other property plant and equipment is calculated on a straightline basis to write off the net cost of each item over its estimated useful life. Estimates of remaining useful lives are made on a regular basis for all assets. The useful lives are as follows:

Plant and equipment 4-6 years Computer equipment 3-5 years

The carrying amount of property, plant and equipment is reviewed annually by the board of directors to ensure it is not in excess of the recoverable value of these assets.

C. Income tax

Australian Doctors International Incorporated is exempt from income tax under the Income Tax Assessment Act 1997.

D. Cash and cash equivalents

For the purposes of the statement of cash flows, cash includes cash on hand, deposits held at call with banks, and investments in money market instruments which are readily convertible to cash on hand and are subject to insignificant risk of changes in value.

E. Comparative figures

When required by Accounting Standards, comparative figures have been adjusted to conform to changes in presentation for the current financial year.

Financial notesfor the year ended

30 June 2012

Financial statements

Back cover photo: Dental extractions are

commonplace on patrols, as most rural health facilities lack

the electricity and running water required to carry out fillings and

other dental work.

21

Note 2. International aid and development programs

Doctors, education and trainingNon-monetary (see note 3) 542,767 330,821Funds to international programs 84,841 86,978Progam support costs 74,132 24,623

Total 701,740 442,422 Note 3. Non-monetary revenue/expenditureInternational and development

Medical volunteers 258,045 206,084Non-medical volunteers 163,604 103,353

Medical equipment/ supplies 121,118 3,090Property, plant and equipment – 18,294

Total 542,767 330,821Other – –Total non-monetary revenue/expenditure 542,767 330,821

Note 4. Cash and cash equivalentsCash at bank 188,260 93,363

Note 5. Relief FundRelief Fund cash at bank 152,221 86,925

The Relief Fund cash forms part of the cash at bank shown in Note 4 and can only be used for overseas relief purposes.

Note 6. Property, plant and equipment

Office equipment at cost 12,967 12,967Less: accumulated depreciation 12,272 10,803Office equipment written down value 695 2,164Furniture and fittings at cost 1,155 1,155Less: accumulated depreciation 570 285Furniture and fittings written down value 585 870Total written down value at end of year 1,280 3,034Depreciation for the year 1,754 1,757

Note 7. Trade and other payables

Creditors and accrued charges 9,466 9,188

Note 8. Loans by Directors

Borrowings – 20,000

During the financial year the Directors’ loans were repaid and there were no borrowings outstanding at 30th June 2012.

Note 9. Other financial liabilitiesPrepaid member subscriptions 1,900 – Note 10. Remuneration of auditor

The auditor, Mr. R J Patmore, Chartered Accountant, does not receive any remuneration for his services.

Note 11. Table of cash movements for designated

Programs Cash available

beginning of year

Cash raised during

year

Cash disbursed

during year

Cash available at end of

year

New Ireland doctors

23,689 76,120 99,809 –

North Fly doctors

– 19,244 19,244 –

North Flyhealth mgt.

– 19,942 6,740

Namatanai District Health Services

– 10,500 59,500

L. Koch donation

23,967 10,000 – 33,967

Total other 45,707 162,717 120,371 88,053

Total 93,363 364,763 269,866 188,260 Note 12. Reconciliation of excess/(shortfall) to net cash flow from operating activities

Excess/(shortfall) of revenue over expenditure 129,172 6,121 Depreciation 1,754 1,757

Increase in debtors and prepayments 928 1,001

Increase in property plant & equipment – (3,236)

Increase (decrease) in loans payable (20,000) 20,000

Decrease in provisions – (8,713)

Decrease in trade and other payables (16,957) (447)

Net cash inflow (outflow) from operating activities 94,897 16,483

$ 2012 $ 2011

programs

Volunteers' services have been valued in accordance with AusAid’s Enterprise Agreement 2009 to 2011 set out in Recognised Development Expenditure guidelines dated June 2010.

$ 2012 $ 2011

purposes

26,682

70,000

Postal address: P.O. Box 954, Manly, NSW 1655, AustraliaOffice address: Elsie Hill Building, RFWCHS, 18 Wentworth Street, Manly, NSW 2095

P +61 2 9976 0112 F +61 2 9976 6992 E adioffice@adi.org.auABN: 15 718 578 292

www.adi.org.au