All wantok,
Very interesting news article. My two toea is that we have to improve mental health, its an integral part of attitude change.

http://www.thenational.com.pg/060507/w7.htm


The need for counselling in PNG

By A Special Correspondent
With the fast advance of Westernisation in Papua New Guinea, never has the need been greater for counselling.
AIDS, alcoholism, smoking, gambling, drug abuse, lack of a healthy lifestyle, marriage breakdowns, and a whole vicious circle of related social problems have taken root in modern PNG.
Employees need counselling to become more productive in the workforce, likewise, those who have been retrenched as they try to adapt to a new life post-work.
Those who have been involved in major critical accidents such as conflicts, crime, or aircraft crashes need counselling as they go through what is known as Post Traumatic Stress Disorder.
Many Papua New Guineans in the prime of life - from age 35 to 50 - are dropping dead because of stress.
And yet, many Papua New Guineans are unaware of the importance of counselling, saying that it is an unnecessary luxury "bilong waitman".
This is something that concerns Luke Haun, a senior counsellor with PNG Counselling and Care, the country's leading private counselling service.
"One thing we realise in Papua New Guineans is that people cannot distinguish between a psychological disorder - that is caused by issues like financial situation within families, alcohol or drug-related problems, or unstable marriage relationships - and a medical disorder," he says.
"It's all to do with the feelings and emotions of the person.
"Take, for example, my experience within the mine sites.
"When I go to the mine sites, I do marriage counselling or family counselling.
"If a child is sick, and the father is working within a mine site, he is psychologically affected by worries; therefore, he is stressful within the workplace.
"While he is stressful, his performance is impended within the workplace, and he can have something like migraine headaches or pain around his head and back.
"In this situation, it's best to see a counsellor first before you get any medication.
"Within Papua New Guinea, they cannot distinguish between these situations (psychological and medical) and they go and see a medical doctor first.
"A lot of Papua New Guineans die young because they have psychological problems that are unattended.
"A medical doctor cannot diagnose what is wrong because it's a psychological situation.
"This is my concern.
"There has to be a lot of awareness to Papua New Guineans about how to differentiate between psychological disorders and medical disorders, and how a psychological disorder can advance into a medical situation."
HIV/AIDS counselling, or the lack of it, is something that Haun also points out.
"Are we attending to the psychological problems of the person affected by the virus?
"That's why many HIV/AIDS victims die young: because of their low self-esteem, 'I am an outcast'.
"How much are we doing to encourage responsible sexual behaviour?
"Sex is very much an act that spreads HIV/AIDS.
"It comes back to responsible sexual behaviour.
"I believe that the more we provide counselling, the more it will help the fight against HIV/AIDS."
Haun says a lot of work-related stress is caused by problems within the family such as a sick child, or no money for school fees.
This causes a vicious circle of drinking, gambling, drug abuse, womanising, debt, poverty HIV/AIDS, and eventual death.
"Counselling is helping people and giving them information that is relevant to their situation," Haun adds.
"Counselling can actually provide information and awareness to the person concerned, because in counselling, you are dealing with a person who comes for counselling.
"The counsellor will provide counselling if he (patient) comes.
"Your life is your life and how you live it is your decision.
"A counsellor can only offer suggestions and options for the person to consider, but the person himself has to make the decision.
"A counsellor is not a problem-solver."
Haun is disappointed that the human resource departments of many large government departments, companies, and statutory organisations fail to realise the importance of counselling for their employees.
"The HR managers are indirectly saying that they are not interested in helping their employees.
"This (counselling) is a very important thing for them to consider.
"In fact, the companies that are referring their employees to us are mainly mining companies.
"After receiving counselling, they give 101 per cent because they appreciate their employer referring them for counselling."
Haun is a busy man as PNG Counselling and Care attends to clinical counselling services, telephone counselling, local employee assistance programs, workplace awareness programs, counsellor training programs, school programs, public awareness programs, and consultancy services.
He constantly travels around the country as the company services corporate clients such as Porgera Joint Venture, Westpac, Air Niugini, SP Brewery, Post PNG, Bank South Pacific, Mirupasi Lawyers, Coral Sea Hotels (Ela Beach Hotel), Kumul Hotels (Crowne Plaza), Starwest Constructions Tabubil, and Good Fielder International.
He has an impressive track record of providing counselling support for major critical incidents such as armed hold-ups, shootings and killings, hijackings, rape, natural disasters, airline crashes, and helicopter crashes.
"A lot of confidentiality is involved," Haun stresses.
"This is very important because you are dealing with someone's private life."
He is a specialist in workplace counselling, critical incident debriefing and health counselling.
Before joining PNG Counselling and Care in 2003, Haun worked as a counsellor with the Catholic Health Service in the Highlands.
He holds a Diploma in Religious Studies from the Bomana Seminary, and an Advanced Certificate in Counselling and Counselling Education from the Christian Institute of Counselling.
The Bouganvillean has had wide experience in personal, relationship and health counselling in PNG plus training attachments in the Philippines.
Haun has two University of PNG psychology graduates under his wings, and company director Aaron Hayes is also a qualified psychologist.
The company also draws on the services of casual counsellors where and when needed.
PNG Counselling and Care is a secular, professional counselling service provider, which seeks to provide effective counselling interventions in a supportive, non-judgemental environment.
While non-religious in approach, it encourages its clients to draw strength from their individual faiths and belief systems.
PNG Counselling and Care conducts its practice in accordance with the Code of Ethics of the Australian Psychological Society.

The rapidly changing times and the pressures of current life in PNG is causing a lot of psychological problems. There is however no accurate data on this widespread problem and how they are dealt with.

WHilst I agree in the main with this article I find it difficult to agree with the writer about the fact that many young people are dropping dead. And that this is due to non-medical problems with stress.

1. the writer has no accurate data to support that assertion.

2. Nobody drops dead from a non- medical condition alone. Stress that
causes death is due to its effect on underlying medical conditions
such as heart diseases or high blood pressure or secondarily to drink
driving etc. These conditions still need to be dealt with medically
in joint care with counsellors or psychiatrists.

If in the event that other body systems are normal the person simply
goes on and develops mental illness if he/she cannot cope with stress.

3. the writer claims that people may go for medical attention for stress
related symptoms.

WHilst this is true, the converse is also possible. Somebody with a
physical disorder may go to a counsellor and the fact that the person
has a treatable disorder may be missed.

What is needed is accurate data and the need for all workers in that field to cooperated and provide interlinked care.

Ta

Thank anon, for the response.

Stress, will definitely trigger other medical conditions. That is beyond doubt. I agree with you totally that "joint" care is prerequiste to improve the overall health of the patient.

Althought concrete data are not yet available, Mr. Huan, may have a valid hypothesis. However, the article seem to be self promoting rather then discussion the validity of the hypothesis. It should have outlined a few cases that may have proved his concern.

kas

This is a genuine question, I have only ever heard of Marijuana being available in PNG are there other drugs available, I have never met anyone who talks about drugs or uses drugs that comes from png so was interested what is there and do you consider Beetle nut to be a drug, I have chewed it and it had an affect on me similar to drinking beer, are there health affects from chewing baui....

thanks Mes

I absolutely share your sentiments Ta and kas, thank you for and superb synopsis with reference to holistic approach to health care.

I really believe that approach to tangible and sustained solutions to issues of development in health sector, agriculture and any other sector must encompass an integrated approach. Economist, Environmental Scientist, Engineers, Mathematicians and Health workers must sit down together and address issues, whether be it mental health, aids, alcohol abuse, drink driving, violence, etc.

Huan touched on the important point that stress and the consequent medical condition related is also economically, financially, demographically and socially related. How we improve health of the continuum sustainably, depends on these coordinate approach, some discribe it as Knowledge management(KM).

Peter Barter Job as the Minster of Inter-Government relations in this regard is a very influential position. Used in the right manner could cultivate the integrated approach to solving development problems. Setting up the ministry to foster interaction may be something we require.

kolwan

Beetlenut is a mild drug.

There were few studies on beetlenut whether it could trigger heart complications. But as far as I know, beetlenut in moderate amount is ok.

Bad habit that comes with non-traditional beetlenut chewers is the spitting. Usually mouthful of red stuff is sprayed all over the place making it disgusting.

Betel nut contains many chemical known as alkaloids. The main one which produces the effects of betel nut chewing - the euphoria - is due to one of these alkaloids, called arecoline. Arecoline is similar in structure to a neurotransmitter produced by our own body called acetylcholine.

I do not want to go into all the details but suffice to say that we conducted 2 main studies plus other related studies at the Sir Buri Kidu Heart Institute on betel nut chewers in which we showed that:

1. betel nut chewing increases the heart rate. The increase is significant in the first 5 minutes.

2. betel nut chewing produces variable blood pressure response.

3. betel nut chewing produced significant changes on the electrocardiograph (electrical activity of the heart muscles) indicating significant reduction in oxygen supply to the heart muscles.

Based on experiments by other investigators (not in PNG) using rat models in which acetycholine was used (in betel nut it's arecoline) we proposed that arecoline might be acting in a similar mode of action to that of acetycholine. Although acetycholine reduces the heart rate, small amounts of acetycholine fascilitates the release of adrenaline, which increases the heart rate. Thus arecoline from betel nut may be acting indirectly on the heart through adrenaline. Other studies have also shown that acetylcholine applied directly to artherosclerosed (fat deposits) blood vessels caused then them to constrict. When applied on normal blood vessels (with no fat deposits) it caused them to dilate (open up). The mechanism is not known.

Therefore we concluded from these studies that:

1. betel nut chewing is a cardiovascular risk factor in PNG. This risk factor is not an independent risk factor.

This means, if you have other risk factors, especially in the high risk age group 40+, high blood pressure, high BMI, smoker etc., the chewing of betel nut may precipitate a heart attack.

Link to the Sir Buri Kidu Heart Institute study:

http://www.csanz.edu.au/abstracts/abstracts/288.htm

These series of studies were prompted by our priniciple investigator (Sir Prof. Isi Kevau) who attended to late Sir Buri Kidu at PMGH and observed that earlier that evening, Sir Buri Kidu had chewed a lot of betel nut before he started having chest pain and was rushed to A&E.

Unanswered questions.

1. Does betel nut chewing produce a change in the pH (indicated by the red color of betel quid)?

2. Is this change the critial step required to increase the absorbtion of arecoline from the mouth into the blood stream?

3. Why is there an increase in the heart rate when we expect a decrease? Is it via the release of adrenaline?

4. Are the electrocardiographic changes indicating low oxygen supply due to the increase in the heart rate or is it by a direct constriction of the blood vessels?

5. How can we explain the observation that acetycholine applied to artherosclerosed (fatty deposit) blood vessels, it caused them to constrict? The answer may also answer how betel nut may be acting.

6. What is the chemical reaction: betel nut (alkaline) + lime (acid) + peper (????)= salt + water + other product????

7. If we know the answer to number 4, we may be able to produce a chemical that will be able to remove the betel nut stains on the teeth and on the streets.

So mi larim displa ol questions blo any young scientists to try and solve.

Good summary there! Dr. Who. To add abit or to partly answer those questions.

1. As, you have said, it is an acid-base reaction which liberate heat. It could be easy to measure the pH in a chem lab, before & after mixing the ingredients.

2. Not sure about pH changes but the heat liberated, can vasodilate (opens up small vessels) locally in the oral mucosa (the surface linning of the mouth), thus increasing blood flow to the mouth leading to increased absorption.

3. The increase in heart rate is an interesting phenomena as we expect to see the opposite. Were there any subjects with reduced heart rate or all subjects had increased heart rates? Did all your subjects have predisposing factors for artherosclerosis?

4. & 5. Substances which normally dilate blood vessels (eg. arecoline), do not do so in the event of an early atherosclerosis as well as late. Infact, they do the opposite (vasoconstrict) predisposing to 'heart attacks'. This phenomena is known as 'endothelial dysfunction'. The mechanism is complex. Usually the normal endothelial keeps a balance between dilatation & constriction making use of incoming signals (eg. arecoline) that tells it what to do. In disease state (atherosclerosis), you could simply say, the endothelium becomes confused & constricts instead of dilating.

6. As I have said earlier, it could be an acid-base reaction, liberating heat. Some people believe, this heat, over a long time, damages the mucosa, giving rise to leukoplakia (white thickening of the surface lining of the mouth) which eventually leads to mouth cancer (squamous cell carcinoma or scc).

Endothelial dysfunction is an early stage of atherosclerosis and 'buai' can be used as a screening method. Once detected drugs are available to reverse it. Subjects with late atherosclerosis may be hard to treat or reverse & they may also be at risk when undergoing this 'buai' screening test so they have to be monitored closely by a physician during the test, because they can collapse with 'heart attack' during the test.

The only active substance in this mixture ('buai') is arecoline. There could be others too, who knows!

It's an interesting area that needs expanding Dr Who.

Thanks!

WNM

Thats right.

What we have are all hypothesis.

Wantoks, thank you for the info, a wonderful site to read very infomative information.

Apart from the buai, how about daka and kamban?

saudena

'daka' contains some known chemicals (shttp://en.wikipedia.org/wiki/Betel), however their physiological effect (generalized or systemic effects on the body) derserves further research.

'kamban' could be cacium oxide (CaO) or calcium hydroxide Ca(OH)2 depending on how it is produced. I suppose CaO is when the shell is burnt & Ca(OH)2 is when CaO is mixed with water & then dried. I'm not really into chemistry, a chemist can elaborate further on this. However, the main component is calcium. Cacium is a physiological substance (normal requirement) which the body uses to make bone, muscle contraction, cell signalling, nerve signalling, blood clotting etc. Cacium oxide neutralizes acids to liberate heat. I think the final pH of the 'buai' in the mouth is not too high or too low. Otherwise, one would have an acid or alkali peeling or sloughing (burn) of the oral mucosa (skin of the mouth) & one would stop chewing the 'buai' immediately & start looking for a Dr. I hypothesize that the problem is the heat produced during acid-base reaction & not the pH changes. The pH changes may be important in keeping certain substances in their active form eg. arecoline. If the final pH is not favourable for them then they may change to become inactive form. By active I mean it can have an effect on the body in some ways and inactive, I mean the same substance, but it is chemically modified, such that it can not have an effect on the body

It is also reported that calcium hydroxide is used to apply to wounds to cause contraction & to arrest or stop bleeding. I have seen people applying kamban to wounds. It is not a popular practice & deserves further investigations.

However, one should be aware that 'kamban' is not purely Cacium oxide or Cacium hydroxide. It is not factory made & tested by chemists. I've also had rumours that locals are using other subtitutes(?) when they run out of shells.

Also no-one knows the final products of the mixture 'buai'. I don't know if any chemist in PNG has tried investigating yet or not but one could simply start by checking the pH before & after mixing.

That's all from my side.

WNM

Thanks for your answers about buai na daka and stuff, I knew when I chewed it that first time by my laughing and feeling slightly heady that it must have had something in it, was worried about the affects on my heart etc but seeing it was my first and last time thought it was worth it, just for my own understanding, NOW the big question, is it addictive, I saw guys argue over the last buai nut..... and the woman of the house I stayed in would be furious if she woke up and had no buai.

No idea on that or no scientific evidence yet. Probably more of a habit then addiction.

WNM..

Addiction is usually a repetitive action, bad habit for example. It must be addiction. I heard some mothers store partially chewed buai in the freezer to continue next day.

I think addiction is usually followed by withdrawal syndrome while habits aren't.

WNM

My guess,
is that it is an addiction if you have uncontrollable cravings for something, or mood swings when you can't have it.

For instamce I chew Chewing Gum all the time, but you couldn't say I am addicted to it. For instance; If I don't have any gum, I don't have any cravings for it. I just go and gnaw the bark off trees.

Hooked....Who me?......Ralph.

The withdrawl syndrom is to go gnawing on the diwai bark, so it must be addiction. On the otherhand, you might require psycological evaluation to determine whether it be a phobiaic nature of your behavior.