A common-sense science: an interview with Terence Mark

August 31, 2017
Terence Mark

Terence Mark is Medical Officer in charge of the emergency and outpatient department at Kavieng Hospital in Papua New Guinea. 

What is your current position?
I work as a Medical Officer in charge of the emergency and outpatient department at Kavieng Hospital. I take care of all the emergency cases that come in, and I also work as a family practitioner. We have one bed, with very basic monitoring and diagnostic tools, for the whole catchment area of 150,000 people. I run four clinics a week, and for an average clinic, we see about 50 patients a day. I start off in the morning with the emergency rounds then I do the clinics at 3 or 4 o ‘clock in the afternoon, then I go home and take calls. There is no one else who does my job, so I’m on call every day, and I don’t think that’s going to change anytime soon.

Can you tell us about your career path?
I grew up in what you would call the slums and the injustice, poverty, and inequality that I saw made an impression. I knew that if I had the opportunity to serve the less fortunate, then I would take it. I saw the medical profession as the best way I could give and live up to that purpose from the time I was a kid. The opportunity to visibly see efforts translated into life and health wasn’t something I saw in other professions. I wanted to see my investment and time translated in to lifting someone from suffering.

I was really privileged and blessed to have a mother who, by herself, directed and guided and sacrificed for me and my two younger brothers to give us the opportunity to go to school. That all coalesced in giving me the opportunity to study medicine, so I feel like I’m giving back the privilege that I have to the less fortunate through medicine.

What is your career goal?
We are operating with a system that is not functioning, that is not carrying out its duty of service delivery. People suffer so much, and I can’t turn a blind eye to that suffering, to that injustice. I really want in my lifetime to be able to affect a change so that these marginalized communities can experience what health and equality and justice means. I want there to be a system that serves them and is responsive to their needs--that is accountable to their expectations, that delivers value and health to them.

What is the biggest challenge you face in your position?
Working in the emergency and outpatient, if I can summarize my experiences, everyday coming to work, I see injustice, inequality: poverty, illiteracy, and isolation. I see an unequal distribution of wealth. The thing that is most painful to me is that in the 21st century, with all the advances in medical science, there’s no translation of the interventions and cures to the people who need it the most. It’s something that challenges me, and I don’t sleep well thinking about it.

What brought you to GHDI this summer?
It was a desperate bid to look for solutions. Every day that I walked into my department, I saw long lines of people from the community hoping for better treatment and solutions. After suffering in these long lines, once they were ready to be seen, there was very little we could offer to them. That challenged me to see if there was a different approach we could take to delivering health. I looked at the options available to me, and GHDI caught my attention. GHDI was really a common-sense science, a science that was not stuck in the rules that govern a body of knowledge, but something that was pragmatic, responsive, and result-oriented.

What impact do you think GHDI will have on your career?
What I can use is invaluable, in the terms of the knowledge that I’ve attained, the skills, the tools, that are precisely tailored to enabling, to carry out this journey of trying to improve equitable health and service delivery back at home. In terms of carrying out my immediate goals and working towards establishing a primary health system, GHDI is a stepping stone in the right direction. The platform of influence I need to have a conversation with my superiors and the provincial government back at home has been given to me by GHDI. I have a bargaining advantage that I wouldn't have had if I didn’t attend GHDI. GHDI has given me the essential foundation I need to be involved in the long run.

What are you most proud of?
I am proud of a local solution that we developed to reduce waiting times and ensure that the people who came to seek care at the hospital were seen and treated. This was something we did without much outside knowledge or help. It is a system that is functioning quite efficiently in terms of improving the performance of my department and helping the motivate my staff in such a resource-limited setting to work to serve our people.

The program we created involved dividing the eight square meters of space in the clinic in half to more efficiently serve the patients waiting for care. The lines outside the clinic were horrendous. Many of the nearby health centers had shut down, causing our number of patients to increase. We decided to use one half of the building to see the primary healthcare patients and the other half of the building to see the tertiary healthcare patients. We also had a workstation for referrals coming in from the paramedics. The turn-around times amazed us. The culture of the department changed, motivation was high, and there was a lot of satisfaction from the community.

What advice would you give to someone just starting out in health care in your country?
In a country like Papua New Guinea, you cannot go into medicine thinking about yourself. The compensation, financial benefits, the gains and the prestige, do not even compare to the burden that you bare. So forget about status quo and self-interest. Having a heart to serve people, that’s the most important quality to have if you’re thinking about practicing medicine in Papua New Guinea. And when you see injustices, start looking for solutions. Stand up for the vulnerable population, and start looking for answers outside of the country.