PORT MORESBY, Papua New Guinea — Polio was vanquished by the Pacific nation of Papua New Guinea 18 years ago. Now, as world leaders gather there for the Asia-Pacific Economic Cooperation summit meeting this week, polio has returned — on top of raging drug-resistant epidemics of tuberculosis, malaria and H.I.V., and deadly flash points of preventable diseases like whooping cough and measles.
All over the country, there are symptoms of a profound public health emergency; young and old are getting sick and dying unnecessarily, while facilities lack basic medicines and equipment.
Doctors and experts say the unfolding crisis is the realization of their worst fears after years of deterioration and neglect.
“We were expecting something like this,” Dr. Anup Gurung, a public health specialist with the World Health Organization, said of the polio outbreak at a news conference in the capital, Port Moresby, in September.
He pointed to the erosion of vaccination rates, which are down to 30 percent in some parts of the country. “It’s like someone lit a paper castle where everything is on fire,” he said.
Officials in Papua New Guinea hope that hosting the Asia-Pacific Economic Cooperation, or APEC, meeting in Port Moresby will elevate the country’s international profile, but the health crisis has become an embarrassment for a nation with an abundance of gold, copper, silver, oil and gas.
Public frustration with the summit spending has already led to two national strikes. The collapse of health services has been a focus of the protests.
The return of polio is a clear indicator of the failures, with Papua New Guinea accounting for 21 of 109 cases found globally this year.
The Papua New Guinea outbreak is vaccine-derived, which means that weakened live virus excreted by vaccinated children has mutated and escaped into the rapidly increasing unprotected population. Dr. Gurung blamed “the steady breakdown of the health system” for the country’s polio emergency.
Local and international experts point to three interlinked causes of the country’s health crisis: the collapse of the medical supply chain; changing relations with the country’s biggest aid donor, Australia; and rampant corruption.
Getting medicines, equipment and other supplies around Papua New Guinea has always been challenging. The country has few roads, formidable geography and a widely dispersed population, with about 80 percent living in rural and remote locations.
That improved with assistance from Australia, but the Australian government withdrew from the arrangement in protest in 2013 after Papua New Guinea awarded the national medicine supply contract to a local company that Julie Bishop, then the Australian foreign minister, said had no accreditation and “a history of supplying substandard drugs.”
The company, Borneo Pacific, won the contract — worth 32 million Australian dollars, or $ 23 million — despite its bid being millions of dollars higher than those of reputable international organizations. At the time, the Medical Society of Papua New Guinea said the deal would “lead to the deaths of many Papua New Guineans.”
Reports from health facilities across the country indicate those fears have been borne out. (Borneo Pacific did not respond to requests for comment.)
Health workers in aid posts, clinics and even major hospitals regularly report running out of basic medicines like antibiotics, analgesics and antimalarials, said Dr. Sam Yockopua, chief of emergency medicine at the National Department of Health and secretary of the National Doctors Association. Many rural facilities have closed for lack of supplies or workers.
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Dr. Yockopua identified “endemic and epidemic” corruption as the root cause of the health care system’s failures, echoing the findings of international investigations.
A national audit last year also documented widespread “unavailability of lifesaving and essential drugs” and urged the removal of the entire medicine procurement division. The government did not respond to questions about the report’s recommendations.
Signs of crisis are everywhere.
About five hours’ drive northwest from Port Moresby, navigating a fractured coastal highway, the Catholic sub-health center in the village of Terapo operates in a condemned building without water or power and with few medicines. It serves more than 500 patients each month, many traveling long distances because government aid posts have closed.
At Kerema Hospital, the major facility in Gulf Province, another hour’s drive, Abel Benedict, a pharmacist, said he had not received his monthly order for four months. Dr. Christopher Munguas, a surgeon, said lifesaving catheters and surgical tubes were often unavailable.
“Drugs are another headache altogether,” he said.
Dr. Peter Sol, an obstetrician, said that before 2014, when the former Australian government agency AusAID was delivering supplies, “you could see all the medicine in remote rural aid posts, health centers. They actually delivered.”
Now, Dr. Sol said, “we hardly see those supplies that we used to see before.”
Despite its immense resource wealth, Papua New Guinea has the lowest life expectancy in the Pacific at 62.9 years, according to the World Health Organization. And it may be getting worse.
The number of people infected with malaria parasites, for example, grew almost ninefold to 432,000 in 2017 from 50,309 in 2014, according to the Papua New Guinea Institute of Medical Research. The survey blames the lack of treatment drugs in many parts of the country, together with a decline in international support.
Similarly, a decade ago, Papua New Guinea was being congratulated for its efforts against the spread of H.I.V.; now, infection rates are rising. A survey has also exposed “alarming rates of H.I.V. drug resistance,” said Dr. Angela Kelly-Hanku of the Institute of Medical Research. This is largely because H.I.V. patients are unable to secure reliable supplies of antiretroviral medications, she said.
There is also a national shortage of condoms.
“The most basic H.I.V. prevention tool, and we don’t have enough,” Dr. Kelly-Hanku said.
The country also has some of the most alarming rates of tuberculosis in the world — including drug-resistant strains described as “Ebola with wings” — and the head of the national tuberculosis program recently conceded that the health system was too weak to tackle the problem.
Even larger cities have problems. Prof. Glen Mola, one of the nation’s most senior medical specialists, blamed supply chain failures for a resurgence of stillbirths in Port Moresby.
Until a decade ago, latent syphilis infection in pregnancy was one of the most common causes of stillbirths in Papua New Guinea. This risk was virtually eradicated through universal screening in pregnancy, but then the supply of the $ 1 finger-prick blood tests dried up last November.
“At Port Moresby General Hospital we didn’t have a case of a death of a baby from syphilis for five or six years, and then we started seeing them again this year,” Professor Mola said.
The hospital has also been running out of H.I.V. antiretrovirals and malaria tests. Surgeons are even rationing procedures because of a shortage of sutures.
Professor Mola said a colleague with extensive experience in Africa had observed that while corruption was common there, in Africa “they skim off the cream and still leave some milk for the people. In Papua New Guinea, they take the lot.”
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Corruption has played a big role in the nation’s health crisis but is not the whole story, said Prof. Stephen Howes, an economist at the Australian National University in Canberra who studies Papua New Guinea. The national government slashed its health budget 37 percent from 2014 to 2016 as commodity prices fell.
Conditions in Papua New Guinea have also been directly affected by the country’s changing relationship with Australia, its nearest neighbor and former colonizer. Like other international donors, Australia has shifted focus in recent years to infrastructure and capacity building rather than saving individual lives through direct services.
“That move out of service delivery was a mistake,” Professor Howes said.
Australia also owed Papua New Guinea a political debt after it agreed to process and resettle asylum seekers in detention camps on Manus Island, Professor Howes said, making Australian officials wary of criticizing the country over issues like corruption.
Though the Manus Island facility closed last year, there are hundreds of refugees still being held in Papua New Guinea. Australia also fears that pressuring Papua New Guinea too much could push it into the arms of China, which is courting Pacific nations.
“We are increasingly looking at P.N.G. through a strategic or in fact through a China lens, and that makes us reluctant to say anything that might annoy them,” Professor Howes said.
China and Australia have both invested millions in supporting the APEC meeting, which the Papua New Guinea public has come to view as a drain on government spending.
Charles Kerere, a parish priest in the Gulf Province village of Lese, said children in his community were dying from illnesses like diarrhea because the aid post had no medicines. He said he feared an outbreak of polio in the province, which recorded its first case in August.
“I’ve been to Port Moresby, I’ve seen lots of money has been pumped into the city,” Father Kerere said. “They are so concerned with trying to please the world leaders that Papua New Guinea is O.K. But under the carpet we have huge problems in our country, and people are suffering. They are crying for services, basic services.”
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