As fear of the global coronavirus pandemic gripped the world in April, a 19-year-old woman arrived at the Port Moresby General Hospital looking for help.
The teenager, who the ABC is calling Joyce, was not infected with COVID-19.
She was heavily pregnant and experiencing high blood pressure, and was referred to the hospital so she and her unborn baby could be checked.
But amid fears of the virus, and with no temperature testing facilities at the hospital to confirm Joyce was not carrying COVID-19, she was turned away.
Joyce returned to the settlement where she lives. From there, things became disastrous.
“The blood pressure problems became worse over the next couple of weeks and then she became blind,” Glen Mola, one of the country’s foremost obstetric experts, said.
“Several days later, after she’d been blind for three or four days, she came to the labour ward.”
Joyce’s baby had died.
This week, Joyce regained some vision in one of her eyes. It is still not clear if she will fully recover.
It is because of cases like Joyce’s that Professor Mola is advising women in PNG not to fall pregnant for the next two years.
The head of Obstetrics and Gynaecology at the University of PNG, who helps run part of the maternity ward at Port Moresby General, said the pandemic had made pregnancy even more perilous for women and their babies.
‘It’s not best to plan a pregnancy this year’
Papua New Guinea is already one of the most dangerous places in the world to give birth.
But Professor Mola is concerned the fear surrounding COVID-19 — in addition to the outbreak itself — is making conditions worse.
The country has so far only recorded 10 cases of the virus, but it is thought some cases may have gone undetected.
“Every day I see problems that have occurred because women have tried to access care when they’ve had problems and they haven’t been able to do so,” he said.
Professor Mola said the Port Moresby General Hospital was now set up to screen people with fevers or respiratory symptoms at the front gate and “most” pregnant women were now being accepted.
But he is concerned health services in other parts of the country are not “over the fear”.
“Of course, when we actually start to get cases of COVID-19 morbidity and perhaps mortality, will all this fear come back again? One has to be very concerned about that,” he said.
During the Ebola outbreak in Sierra Leone from 2014 to 2016, more women died from obstetric complications than from the disease itself, according to the non-government organisation Care.
“The epidemic made things even worse as health services were stretched and pregnant women avoided hospitals,” Care said.
The organisation is concerned there could be a similar situation in PNG if there is a COVID-19 outbreak.
Professor Mola said the safest option for women in PNG was to delay having babies for a while.
“It’s best not to plan a pregnancy this year or perhaps even next year, because we don’t know how the epidemic is going to run,” he said.
Delaying pregnancy in PNG is not always easy
It could be a big ask. The average woman in PNG will have at least four children in her life.
And they also sometimes face logistical and cultural barriers when trying to access contraception.
The not-for-profit family planning service Marie Stopes, which runs outreach clinics in PNG, had to temporarily suspend its operations when the country’s lockdown first came into place in March.
“We instituted basically a shutdown of all of our services, which is something we do very, very reluctantly,” the country director David Ayres said.
“It’s been incredibly challenging. At the core of it is we knew we had to keep working and we had to find ways to keep working. The demand for services doesn’t change.”
Mr Ayres said apart from challenges arising from the fear of COVID-19, many women struggled to access services because of initial domestic travel shutdowns and the economic impact of lockdowns.
“And this was simply because the public transport she would normally have relied upon wasn’t there.”
The number of cases in PNG is low, but Mr Ayres says fears there may be a bigger outbreak in the future persist.
“The big fear is, in the midst of a pandemic, the health system simply doesn’t have the … capacity to deal with the mother who comes in with complications during pregnancy,” he said.
Marie Stopes has now resumed its operations, having gotten protective equipment for staff and changed some procedures.
And Mr Ayres said the country’s Department of Health had provided “strong leadership” in “saying regular health services need to continue”.
But some services were still interrupted, sparking fears the inescapable focus on coronavirus could have detrimental effects on other health issues in the country.