20122013Annual Report

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: Private Bag 3, Deakin, ACT 2600, Australia Telephone: +61 2 6285 1816 Fax: +61 2 6285 1720 Email: main@acfid.asn.au

President’s report 1 Summary of program activities by General Manager Delene Evans 2 Sponsors and supporters 6 Program partners in New Ireland Province and Western Province 7 Field project: In-service clinical training 8 Field project: Namatanai District Hospital 11 Board of Directors 14 Board of Directors’ report and declaration on financial statements 15 Auditor’s report 16 Financial statements and notes to financial statements 17

Contents

Above: A map of PNG showing ADI’s program areas. Top left: HIV/AIDS Technical Officer Audrey Gillis gives a sexual health education session for schoolchildren during an ADI patrol in New Ireland Province. Far left: ADI volunteer Dr Merrilee Frankish gives hands-on neo-natal resuscitation training to health workers at remote Messi Health Centre in New Ireland Province.

Our 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 Papua New Guinea.• Reduce preventable diseases through public health programs and/or health education and/or 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 for 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.• Continue to be a leading non-government professional provider of high quality primary

health care in Papua New Guinea, seeking always to increase public awareness of our work and continual improvement through ongoing rigorous evaluation of programs and activities.

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Australian Doctors International continues to grow and prosper, pursuing a broad range of health projects in both Western and New Ireland Provinces, building lasting partnerships and increasing our profile in Australia and PNG. The commitment, energy and enthusiasm of all involved is palpable.In its early days, the focus of ADI was narrower as it responded to the failures of the health services in PNG. Doctors were deployed to save lives, treat the needy and provide services where there were none. That is still the case, but the emphasis is now particularly on placing ‘development’ at the centre of what we do.It is clear that training clinical staff, strengthening health management and developing the clinical skills of our PNG partners are the road to sustainability. This is reflected in the diversity of projects now being implemented and a more professional program methodology which we have adopted, especially in designing projects and measuring outcomes. These changes will strengthen our application to AusAID for base accreditation. It is an arduous, constant and time consuming process, but, if successful, accreditation will provide regular funding for ‘core activities’.This has meant a busier office in Manly, a greater need for volunteer staff and added responsibility for our part-time staff. Delene Evans, our General Manager, is to be commended for such a successful year and for her constant attention to detail and passion for the organisation. The Program, Finance, Risk and Compliance and Accreditation Committees, which assist the Board, have also been strengthened.As with all NGOs, funding is a constant challenge. ADI does not receive any government assistance and is reliant on the generosity of private donors, corporations and funding bodies. I draw your attention to all those entities listed on page 6. You will be pleased to know that over the last three years we have substantially strengthened our financial position. Monetary revenue has grown from $81,067 for the 2009-10 financial year to $343,172 as at June 2013 – a 323% increase. Non-monetary revenue, a required

financial standard which values all volunteer time spent on programs and donations-in-kind such as medical equipment and a vehicle from Ela Motors PNG, has rocketed from $176,436 to $748,740 – a fourfold increase. Significantly, our retained earnings have increased from $67,758 to $411,120 since June 2010, providing a stronger foundation from which to expand our operations. We continue to be vigilant about expenditure. Because of the efficiency of our management, the wonderful help which we receive from all our volunteers and the generosity of Royal Far West who provide our office space rent free, ADI’s expenses represent less than 10% of our total income, so over 90% of each donation goes directly to support the people of PNG.My appreciation to all our donors, volunteers, staff, Board directors, Committee members, supporters and ADI members for contributing to a most successful year.

Australian Doctors International Inc.President’s report

Dr. Peter Macdonald OAM MBBS MRCGP DA DRCOG

Donations of $2 and over are tax deductibleMake a donation by visiting our website www.adi.org.auor by calling us on (02) 9976 0112

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The Promoting Effective Public Expenditure survey of 166 schools and 63 health clinics by the National Research Institute (NRI) and Australian National University’s Development Policy Centre addressed whether PNG has translated its booming mineral wealth into services for ordinary people. Whilst education services have improved over the last 10 years with an increase of 69% children at school, health services have deteriorated. The number of health clinics fell; the proportion of the population utilising a health clinic decreased by more than 50%; the number of health staff working at clinics fell by around 10% (three-quarters of these dedicated staff contributed to running costs from their own salary!), and the availability of drugs and medical supplies declined. The report states: “The last ten years have not been good ones for the health sector, and it is hard to see evidence of the additional money allocated to the sector on the ground.” These results are unsurprising to ADI as we see firsthand that PNG’s health sector is facing a series of major challenges including a workforce crisis that must be dealt with if it hopes to deliver better health care. Over the past 35 years, there has been little improvement, and evidence from the past decade indicates extremely fragile outcomes. Communicable diseases and maternal, perinatal and nutritional conditions account for over 49% of all deaths. Making matters worse is the emergence of new lifestyle-related diseases such as diabetes.Against this background, ADI is proud of our achievements over the past year with our development partners, the New Ireland Provincial Government (NIPG) in New Ireland Province and the Diocese of Kiunga-Daru’s Catholic Health Services (CHS) in Western Province.

PNG highlights:• Agreement was reached with the NIPG to manage their health Patrol

funds of 400,000 kina ($181,000) to improve efficiency of their funds.• A demanding Patrol schedule was completed by Integrated Patrol

Teams in New Ireland: 11 patrol routes, 135 days on patrol and 92 clinics held at 26 health centres.

• 68 health workers in New Ireland, many of whom had not received in-service training in a decade, received five days of clinical training.• Medical services were restored at Namatanai District Hospital although there is still no water and regular electricity supply and insufficient staff.

• A drug warehouse was built at CHS in Kiunga and a health worker employed to manage it.• Three clinical and health management training meetings for CHS Officers-in-Charge were

completed.• A Nurse Educator was employed at CHS to mentor field staff.• A Health Program Manager was deployed to NIPG for five months to ensure the

achievement of our annual project goals.

Sponsor and supporter highlights:• $100,000 was donated by Horizon Oil for activities in Western Province through CHS. • A 10 seater ‘troupie’ vehicle valued at $63,255 was donated by Ela Motors, PNG’s biggest

automotive dealership. • $15,000 was donated by BD, a global technology company that sells a range of medical

supplies, laboratory equipment and diagnostic products.

ADI has had a very good year in spite of the challenges of working in a deteriorating health system in Papua New Guinea (PNG), and a constant struggle to source donor funds in a very competitive market.Our PNG achievements are considerable against a background of systemic decline. There are no up to date government health statistics so reliance is on other data sources such as the Human Development Index (HDI). HDI provides a composite measure of three basic dimensions of human

development: health, education and income. Between 1980 and 2012 PNG’s HDI rose only by 1.3% annually from 0.324 to 0.466, placing it 156 out of 187 countries comparitively ranked. PNG is below the Asia-Pacific regional average and below such countries as Myanmar.

“I first treated Cressensia two years ago on my first ADI patrol. Her burns have now completely healed, and I’ve recommended that she be allowed to start school.” - Dr Liz Scott (below)

ADI’s medical and non-medical volunteers’ contribution for 2012-13 is valued at $618,668 in accordance with AusAID’s Recognised Development Expenditure guidelines. Donations made in-kind, including medical equipment and a 4WD vehicle, are valued at $130,072.

Summary of overall program activitiesBy Delene Evans, General Manager

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Health volunteers 2012-13

Leona Cayzer, RN Health Manager, Western ProvinceLouise Devereux, RN Health Manager, New IrelandDr Merrilee Frankish In-service health training, New IrelandDr Rosemary Lee Rural health patrols, New IrelandBelinda Olding Aid worker, Namatanai HospitalDr Melanie Olding Namatanai Hospital, New IrelandDr Liz Scott Rural health patrols, New IrelandDr Bruce Slonim Rural health patrols, New Ireland Dr Romany Topsfield Namatanai Hospital, New Ireland

“PNG has a high prevalence of preventable and treatable life threatening diseases.” – Dr Bruce Slonim (below)

ADI’s health volunteers in the field in PNG: Dr Liz Scott in New Ireland (opposite page); Dr Jenny Wilson in New Ireland (above); Dr Bruce Slonim in New Ireland (right); and Louise Devereux, RN at Namatanai Hospital (bottom).

• CEO of BD ANZ Kevin Barrow, Director of Biosciences Chris Bligh and two of their international colleagues joined ADI General Manager Delene Evans in New Ireland for five days to inspect our programs and health facilities and see how BD could help.

• Long-time local sponsor Mark O’Brien of Three Flips Foundation joined ADI President Peter Macdonald on a field visit in New Ireland.

Sydney highlights:Our focus has been on strengthening our organisational structure and internal systems:

• Experienced international development professional, Michelle Abel, who has significant expertise in program management, especially project documentation monitoring and evaluation, joined in February 2013 following seven years as Country Director of the Adventist Development and Relief Agency (ADRA) in PNG. Michelle has overhauled and improved our project documentation to accreditation standards and managed ADI’s Western Province Program.

• Former finance volunteer Marcel Diebold was appointed part-time Finance Manager in September 2012 to manage a diverse and detailed financial portfolio including New Ireland Government funds.

• Volunteer (and Director) David Snedden has focussed on identifying and developing funding opportunities especially in PNG where he has worked as a lawyer.

• Dedicated Volunteer Coordinator Virpi Tuite (a volunteer herself) has helped with HR issues and documentation. She is supported by professional Personnel Manager Therese Impey, who has reviewed and strengthened our employment policies.

• IT development and maintenance has been outsourced.• Our high hitting marketing communications program has

continued at low cost. Last year SBS journalist Stefan Ambruster joined a 10-day health patrol in New Ireland with Dr Merrilee Frankish and Marketing & Communications Manager Leah Boonthanom to produce a prime-time news story and radio feature. PNG media highlights include the Post Courier’s announcement of funding for a mobile clinic for Catholic Health Services New Ireland, a project facilitated by ADI; Air Niugini’s

in-flight magazine’s seven-page feature story about an ADI patrol; and PNG Industry News’ announcement of Horizon Oil’s donation to ADI for projects in Western Province. The Australian medical media has been supportive with stories in Medical Observer and Australian Doctor.

• ADI’s new website www.adi.org.au launched in June 2013 with more interactive features such as online donations and health news feeds. Total website visits were 11,210 (8,049 unique visitors), an increase of 8.0% (6.3%) compared to last year. Google ranks our website first for the search term ‘volunteer doctors’ and fourth for ‘health in PNG’.

• Our quarterly email newsletter is sent to 450 recipients, with a high readership rate that is double the industry standard.

New Ireland ProvinceEight volunteers have poured their energies into integrated rural health Patrols, in-service training and restoring medical services at Namatanai District Hospital. Six doctors were deployed, along with volunteer Health Program Manager, Louise Devereux RN, to Kavieng to assist Provincial Health with building health management capacity. Volunteer Construction Manager Belinda Olding joined her sister Dr Melanie to provide technical advice on a wide range of infrastructure projects to improve the functioning of Namatanai District Hospital in the south. 1. Integrated Rural Health PatrolsIn partnership with NIPG, our Patrols deliver a wide range of clinical services to remote communities. Significant positive changes have increased the effectiveness of Patrols in response to demands from communities, health clinic staff and patrol members. To reduce frustrations being experienced in accessing funds and delays in despatching Patrols, NIPG transferred their annual patrol grant of 400,000 kina to ADI in advance. Under the watchful eye of our Finance Manager, Marcel Diebold, we manage the expenses of this

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project for the NI Government. Patrols now leave on time and savings are being made with the new Ela Motors troupie donated in May 2013 eliminating vehicle hire charges and leaving funds available to finance the Government’s share of in-service training.A physiotherapist to handle the huge volume of musculoskeletal complaints and attend to the disabled and a lab technician to improve responsiveness to TB and leprosy diagnosis have been added to Patrols. This boosts the services provided by other Patrol staff – two dental staff, an eye nurse, a pap smear nurse, HIV educator and a disease control expert. Remote areas would not have received this relief and care without the continued support of Roche Australia and the Hunt Family Foundation, plus Colgate which donated 15,000 toothbrushes and sample toothpaste for villagers.We have introduced feedback forms for use by communities and health staff which will guide future service delivery and form part of our monitoring and evaluation system.2. Clinical In-Service TrainingAs a rule, if the Government undertakes in-service training it is usually focussed on one topic. However, as a result of feedback from a training needs survey by 84 health workers conducted by ADI in 2011, observations from patrol doctors of nursing practice, and analysis of Provincial Health statistics, ADI identified the need for and developed a ‘mixed’ in-service program. The survey results also showed that Community Health Workers were the most neglected in terms of training. Many of them had received no in-service for over a decade and were our primary beneficiaries for the multi-disciplinary training.ADI formed an education committee with representatives of the government and Catholic and United Church Health Services to organise the in-service training. The Committee was chaired by Gedjolly A’aron, a nurse and Provincial Health Education Officer. ADI’s

volunteer Health Project Manager, Louise Devereux provided mentoring and managed the logistics. In April 2013, 68 health staff from across New Ireland Province attended a five day clinical in-service training workshop first held at the Lemakot Nursing School and then repeated in Namatanai in the south.ADI engaged two key training experts: Dr Merrilee Frankish and Associate Professor Lin Lock. Merrilee, a Far North Queensland GP experienced in women’s health, tropical medicine and health education who’d spent five months on

patrols in 2012, taught emergency obstetrics, clinical diagnosis and assessment and drug therapy. She also provided clinical support to local presenters. Lin, who was the facilitator and program reviewer, is a nurse and midwife with post graduate qualifications expertise in strengthening and implementing nursing and midwifery education in Australia and PNG. She was perfect for the project, having grown up in PNG. Both Merrilee and Lin taught in English and Tok Pisin, and generously donated their time for a small stipend. The participants’ daily feedback and end of program evaluations were very positive, with overwhelming requests to continue this type of multi-disciplinary training. ADI firmly believes that providing training for health workers is an excellent application of resources with considerable ‘knock on’ effect back in their remote communities. ADI is very grateful to Gedjolly A’aron for her leadership of this project and her continued advice and cultural insight which she gives our volunteers. Merrilee and Lin agreed to return in 2014 for the next training round. This worthy project was made possible by generous funding from the DAK Foundation Australia, supplemented by a New Ireland Government Grant, ADI funds and volunteer time.

Clinical Summary:Integrated Rural Health PatrolsNew Ireland ProvinceDoctors deployed: 6Days on patrol: 135 Patients treated: 3,047Health centres visited: 52Doctor clinics held: 92Case-based training: 336 hours

Group training: 64.5 hoursDental exams: 5,092Optical exams: 604PAP smears: 286HIV tests: 712New cases of TB: 32

From top to bottom: Dr Rosemary Lee in New Ireland; sisters Belinda Olding (left) and Dr Melanie Olding at Namatanai Hospital; physiotherapy services on patrol for chronic musculoskeletal problems; Dr Romany Topsfield and a young patient from Namatanai Hospital.

ADI has deployed 10 doctors on 11 assignments to New Ireland since 2011. Integrated health patrol teams have made 124 visits to remote health facilities, with our doctors treating 6,632 patients, conducting 265 clinics, and providing 1,004 hours of clinical teaching.

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3. Improving Namatanai District HospitalThis project, sponsored by Newcrest Mining, is our most challenging to date. Eighteen months ago ADI embarked on a project to upgrade and re-establish a functioning district hospital at Namatanai town in the south of New Ireland. The district has a population of approximately 95,000 people and 65,000 outpatients attend the hospital annually. Since July 2012, ADI has deployed two doctors, Romany Topsfield and Melanie Olding, who provided clinical training, medical services and supported staff. Unusually ADI also deployed Dr Olding’s sister, Belinda, an experienced Construction Manager, to provide much needed technical advice on hospital infrastructure.

All these volunteers have shown great commitment and passion but have struggled in the face of adversity. The hospital still lacks reliable power and water supply after eighteen months, there is no functioning operating theatre or X-ray facilities, at least 30 key staff roles need to be filled, and lives are being lost unnecessarily. Our advocacy efforts to bring these concerns to the attention of the District and Provincial Administration have been constant but the Government appears to have other priorities.ADI doctors conducted interactive weekly teaching sessions, developed resources such as wall posters and flash cards to prompt duty staff, taught and mentored on ward rounds, and conducted specific teaching sessions for maternity and outpatients staff (who see over 100 patients a day). Priority topics were child health, in particular neo-natal resuscitation, meningitis management, appropriate antibiotic use, lung disease management and emergency obstetrics. During Dr Melanie’s five month deployment in 2013, deaths from meningitis dropped from four per month to only one in two months. Additionally, deaths from pneumonia dropped from seven to one over the same timeframe. Staff felt very proud that their change in clinical management was saving lives.

A fully functioning drug dispensary was established in a refitted house next to the hospital. The

Top: Mobile pathology services are now provided as part of ADI’s integrated rural

health patrols in New Ireland Province. Bottom: Ela Motors’ Frank Gamoga,

Dealership Manager in Kavieng, handing over the donated troupie to ADI’s Dr Liz Scott and

health manager Louise Devereux (behind)

“By giving rural clinics the capacity to collect specimens [...] it should be possible to improve rates of TB detection.” - Dr Rosemary Lee

dispenser was trained to set up drug storage and ward imprests and 700 boxes from AusAID drug distributions were unpacked and organised so they could be utilised. Regrettably, after this hard work the dispenser was made redundant and has not been replaced.

Western ProvinceADI continues to work in partnership with the Diocese of Kiunga-Daru’s Catholic Health Services unit, which operates eight health centres and 14 aid posts in North Fly and Middle Fly Districts of Western Province.Western Province is the largest and most remote province in PNG. With few roads, and travel by river and air made difficult by the high cost of fuel (about twice the cost of fuel in Australia), Western Province suffers major challenges to the delivery and accessibility of health services. Currently, ADI is implementing two projects in Western Province that are focused on health systems management capacity building with Catholic Health Services. The first project is funded by PNG Sustainable Development Program, and is focused on organisational development for the CHS head office, development of operating policies and procedures, mentoring for the senior staff at the CHS head office, and training of health workers at the eight health centres. The second project is funded by Horizon Oil. This project provides support for bringing the Officers in Charge (OIC) of each health centre together for regular training to improve their clinical and health management skills, and has supported the employment of an additional staff member to establish a centralised drug management system that will ensure the health centres have adequate supplies of drugs and equipment for treating sick people in the communities.The focus of primary health care areas for all training provided by ADI in Western Province are improving infant mortality, reducing maternal mortality, improving the survival of children between 1 to 5 years of age, improved antenatal care, and improve disease control – especially tuberculosis.Key achievements in the past financial year include the building of an inaugural drug storage and distribution system at the Catholic Health Office, plus the employment of a Health Services Support Manager to manage the facility. The warehouse features storage for drugs, vaccines and medical equipment, as well as a staff training and demonstration room. Three separate training events have been held for the OICs: 1) addressing the roll out of new administrative procedures, 2) specific training in child survival skills, and 3) tuberculosis identification, treatment and management. Following advocacy by ADI’s volunteer field worker, Leona Cayzer, the organisational structure of CHS has been revised, and the CHS head office has now doubled the number of staff that are working to manage the health services provided across a large area.In June 2013 ADI received funding approval from PNG Sustainable Development Program to extend this capacity building project until mid-2014. Focus will be on improving health management processes and providing targeted clinical training at health centres through placement of short-term specialist volunteers such as midwives, health management experts, or specialist doctors.

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Other sponsors and supporters

Our volunteers ADI is reliant on volunteers for committees, board directors, administrative staff and in the field assisting our doctors and health managers. ADI wishes to acknowledge the commitment and generosity of our volunteers. Program Committee: Lee Cooper, Jan Howlett, Dr Bernie Hudson, Dr Tariq Khan, Wamiq Khan, Dr Judy Lambert, Anne Lanham (Public Officer & Special Projects), Dr Peter Macdonald, George McLelland, Grace Moyo, Tom White. Accreditation Committee: Kevin Lum-Yip, Turner Massey, Dr Peter Macdonald, George McLelland, David Snedden. Finance Committee: Dr Peter Macdonald, Turner Massey, George McLelland, David Snedden, Luis Medina. Risk & Compliance Committee: David Buxbaum, Dick Magee, Dr Peter Macdonald, Turner Massey, Liza Nadolska. Fundraiser Committee: Holly Blackmore, Irina Blackmore, Lili Koch, Margaret Lindfield, Rachel Macdonald, Dr Peter Macdonald, Wendy Macdonald. Family Planning Project (New Ireland): Dr Sue Craig. Office Volunteers: Mike Bayles, Lucia Hains, Alanna Hardman, Therese Impey, Lan Hue Pham, Lili Koch, Jo Porritt, Stella Roberts, Yvonne Smith, David Snedden (Partnerships Manager), Alison Trevaskis, Virpi Tuite (Volunteer Coordinator), Kate Waterhouse. Field volunteers: Brendan O’Brien, Fred Funmat, Gayle Slonim, Colin Wilson. Part-time staff (who volunteer additional hours): Michelle Abel, Leah Boonthanom, Marcel Diebold, Delene Evans.

Major sponsors $50,000+

Sponsors & supporters

Hunt Family Foundation

ADI is also grateful for the generosity, support and advice of New Ireland businesses

Bisiworks City Pharmacy Lissenung Island Resort Nusa Island Retreat Patu 23 PNG Surfaris Rubio Plantation Retreat

Sponsors and supporters continued

Birthing Kit Foundation Australia Dekanai Constructions Ltd. Investec Lavers Family Foundation Lae Builders & Contractors Ltd. Lions Club, Mareeba Meripath PricewaterhouseCoopers, Port Moresby Radcliffe Waring Graphic Design Raymond J Patmore Chartered Accountant Whiteley Corporation Peter and Nicky Baker Dr Cate Ealing Brent and Vicki Emmett John Forsyth Lili Koch James and Dilanthi McGregor Doug and Chris Olding

Three Flips Foundation

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Message from Rt Hon Sir Julius Chan GCL GCMG KBE MP I Governor of New Ireland Province, PNG

Australian Doctors International (ADI) and the New Ireland Provincial Government have had a very friendly and mutually productive relationship for the past three years. ADI and the Provincial Government signed an MoU in May 2011 that committed ADI to providing doctors and other health personnel for a series of annual patrols throughout New Ireland Province. In return the Provincial Government agreed to provide housing, transport and logistical support.In the three years in which ADI has worked in New Ireland the benefits have been substantial. ADI has spent 254 days on patrol visiting virtually every part of New Ireland. These patrols not only provide critical health care for the people in the areas visited, they also provide training and critical data required to improve the quality of health care for the first time in the rural and remote areas of New Ireland.ADI has provided valuable input into the health planning process in New Ireland by providing assessments and audits of health centres, sub health centres and other health delivery infrastructure. This has dramatically improved the information available from the local level and led to much more efficient use of scarce health care resources.The partnership between ADI and the New Ireland Provincial Government has been of great value to the people of New Ireland, and continuing the partnership for the health and well being of the people of New Ireland is a contribution to humankind.

Sir Julius Chan Governor of New Ireland Province, PNG

Field partners

The Governor of New Ireland Province Sir Julius Chan (left) with PNG Prime Minister Mr Peter O’Neill (right) and ADI volunteer doctor Dr Melanie Olding in Namatanai Town during the announcement of a one million kina ($408,418) grant by the PNG Government to Namatanai District Hospital.

In Western Province, ADI works in partnership with the Catholic Diocese of Kiunga-Daru led by Bishop Giles Cote (top). Its health service is managed by Sister Anna Sanginawa (bottom).

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ADI’s in-service focussed on CHWs – who represent the bulk of PNG’s health workforce – and nurses. Community health workers are often the only staff at aid posts, working to serve small, vulnerable communities with no access to larger health facilities. Equipped with a Year 10 education and 18-24-month training course, usually with an out-dated curriculum, they provide first-line care: delivering babies, plastering broken bones, and prescribing commonly required medications like antibiotics and antimalarials. In an environment where malaria and TB are rampant and significant numbers of deaths from birthing complications go unrecorded, their chief resources are recipe-style books on health care, which outline symptoms and how to treat them.

*Just two days into ADI’s training at the Lemokot School of Nursing, 45 minutes from Kavieng, and James and Annie are glowing with enthusiasm. The content, based on a 2011 survey by ADI of health care workers’ needs, local health statistics and feedback from ADI volunteer doctors, is heavily focussed on maternal health, antenatal care and emergency obstetrics, given PNG’s notoriously high maternal and infant mortality rates. Topics also include child health, TB diagnosis and treatment, HIV and STIs, respiratory illnesses and drug therapy. “Yesterday we learned to use Misoprostol tablets during labour when the woman is heavily bleeding,” says James, who works with Annie at an aid post with 10 wooden beds that have no mattresses, no running water and a broken generator. “We learned how to resuscitate the newborn floppy baby and to manage respiratory patients and TB.” For Annie, who graduated as a community health worker two years ago, it’s a huge relief to access training, as she often faces clinical situations which leave her feeling out of her depth.

In April 2012, 68 health workers travelled from far and wide to the main island of New Ireland to attend one of two five-day health training sessions facilitated by ADI and funded by the DAK Foundation, New Ireland Provincial Government and ADI.

James Kavang and Annie Philip spent six hours on a banana boat travelling over open seas in order to attend Australian Doctors International’s in-service training. James, 56, a nursing officer, and Annie, 40, a community health worker (CHW), didn’t think twice about making the potentially perilous journey from Massau Island to New Ireland. They, and the 66 other health workers who attended the five-day training sessions on the main island near Kavieng in the north and at Namatanai four hours south, were grateful for the rare learning opportunity, delivered by an organisation that understands the significant clinical challenges they face with limited education and few resources.“I met many of the participants last year on patrol,” says ADI volunteer trainer Dr Merrilee Frankish. “They hadn’t had any in-service training for almost a decade.”

Field project: In-service trainingBy Heather Wiseman, Health Journalist of the Year 2012 awarded by the National Press Club of Australia

Above: Gedjolly A’aron, New Ireland Health Education Officer, teaches a session on ante-natal care. Right: Nursing officer James Kavang (top) and community health worker Annie Philips, two of just three medical staff who care for a population of 5,000 people on Massau Island, New Ireland.

“Yesterday we learned to use Misoprostol tablets during labour when the woman is heavily bleeding.” – James Kavang RN

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She, James and another community health worker are the only medical staff on their island of 5,000 people. There is no doctor. “There are complications in deliveries and diseases where I’m not familiar with the diagnosis and treatment,” Annie says. “I radio to get information from health centres, but most of the time no-one is available to help as the network of health radios doesn’t work.”

*ADI’s training, funded by the DAK Foundation and New Ireland Provincial Government, is being delivered by ADI volunteer doctors Dr Merrilee Frankish and Dr Melanie Olding, local health experts, and Associate Professor Lin Lock, an Australian registered nurse and midwife and doctor of philosophy, who spent much of her childhood in PNG. Both Dr Merrilee and Lin speak Tok Pisin fluently, which proves a huge asset throughout the training.

Lin has an in-depth understanding of health care workers’ educational needs, having recently audited PNG’s 11 Community Health Worker Schools for AusAID. She admires community health care workers for their persistence, given their limited training and resources and the demanding situations they’re placed in. She says they often have no choice but to treat complex patients who should be referred to hospital, because of poor access to transport.“Community health workers do the very best they can and know they have limitations, but if they can’t refer, they are really caught,” she says. “I guess it’s pretty frustrating, swimming up hill, day after day. Keeping your motivation must be so hard.”Lin also brings an understanding of culture, which impacts on the local dynamic between patients and health care workers. “In Australia […] health professionals across the spectrum seem to think they’re the expert. They know how you should be feeling better than you do. They’re dogmatic too. They tell the patient what they will do.”Having heard of situations where women have been hit when they change positions while birthing, her training has a focus on the therapeutic benefits of being kind and respectful, as well as building clinical knowledge. “I want them to learn to start to assess the patient the minute they see them,” says Lin. “I want them to think about preventative health, good antenatal care and active management of the third stage of labour, because most women die of postpartum haemorrhage. And to respect the people they are caring for – to be kind.”

*Participants’ feedback on the course suggests that this message has resonated, with one commenting, “I have learnt the skills of being kind to my patients no matter how important [in terms of social standing] they are.” Another writes “Every lesson, topic since day one was all very important as it has encouraged us nurses to do more for our patients.”

“Active learning techniques, such as interactive role playing, are extremely effective, especially when you add a strong emotional hook like humour,” says ADI trainer Dr Merrilee Frankish (pictured above giving a birthing demonstration). “Participants also loved our emphasis on group work, which is consistent with PNG’s ‘wantok’ culture yet difficult to do professionally because so often they are working solo and unsupported.”

Top right: In-service facilitator Associate Professor Lin Lock and trainer Dr Merrilee Frankish Above: Merrilee gives a birthing demonstration, assisted by Lin, for health workers eager to learn.

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Other participants’ comments were:“TB-DOTS, new TB drug, how to use an Obs wheel, dry sputum smear taking, new drugs, management of antenatal deliveries… Now I am capable of doing many procedures because I have learned them through this in-service workshop. I will surely implement without hesitation, without uncertainty, thanks to ADI.”“I have learned ABC of emergency first aid [airways, breathing, circulation], third stage of labour, drug therapy and history taking. I suggest there should be continuous in-service program to update us at our respective health facilities; instead of unnecessary referrals and just leave the patient to die especially in remote areas.” Lin says the PNG Government is trying to improve the country’s health education facilities and the number of people who pass through them. In the meantime, New Ireland’s nurses and community health workers are grateful that ADI is investing in their knowledge and the health of their communities.“The refresher in-service has helped a lot of the participants,” one says. “I suggest that more of such in future will be of great help to the staff and mostly to the people of rural communities.”

ADI will facilitate more in-service training in New Ireland in 2014.

Heather Wiseman visited New Ireland Province in April 2013 as part of a study tour prize she was

awarded by the National Press Club of Australia. She travelled as an independent journalist.

“Every lesson, topic since day one was all very important as it has encouraged us nurses to do more for our patients.” – In-service participant

Rayleen Abert, 32, feels a significant responsibility as the only health care professional working with Tench Island’s population of 60 people. The community health worker, who works at a run-down aid post with no electricity, says she is grateful that disease and serious illness is rare in the community, who “know how to look after themselves”.Rayleen only makes the five hour banana boat ride from Tench Island to Kavieng, the provincial capital of New Ireland, three times a year. She is excited that this latest trip has given her such a rare and valuable learning opportunity. “I really want to gain my knowledge and I want to know how I can work with my patients and to refresh my cases,” she says.“We learned about upper respiratory infections, TB, STIs and HIV so I can properly do my work and investigate my patients.”

ADI’s in-service training represents the first time Isaac Passingan, 37, has had the opportunity to improve his medical education, despite having worked as a community health worker on Tingwon Island for 16 years.

Isaac says as the island’s only health professional, he is “working all the time” to meet the needs of 400 local people. He regularly delivers babies and treats malaria, badly infected sores and bronchitis.“I can do it all myself,” he says. “I trained well. There are not many maternal or child deaths. I teach mothers how to look after their babies and breast feed,” he says. “I teach mothers and fathers to build a good house with good ventilation, because they cook inside, and I tell the father not to smoke close to the baby.”Isaac works at a health centre where there is no electricity and the small generator doesn’t work. He travels four hours by banana boat to access medication and health supplies, which he describes as a “risky trip”. “If my banana boat engine doesn’t work, it is hard. My biggest challenge is if I haven’t got drugs in my health centre. That makes my job harder.”

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Meanwhile, Melanie’s 30-year-old sister Belinda is working elsewhere in the hospital. Belinda has a construction background and is saving lives in other ways. Her main aim at the moment is to install four water tanks to get running water to hospital wards, which should significantly reduce infection and prevent deaths. The 56-bed hospital in Namatanai, which sees about 77,000 patients a year, has four small rainwater tanks – each with a tap. It’s not enough to provide drinking water for patients during the dry season, let alone wash, clean, or flush toilets. Earlier this year, a patient walked down the hill behind the hospital to a creek so she could wash after giving birth. She slipped on the way back up, haemorrhaged and died.Installing extra tanks would be a no-brainer for Belinda in any Australian context, but here it is a slow and tedious process that will take far longer than the Olding sisters’ five month stay. Belinda has already introduced a triage system at the hospital and a system for unpacking AusAID boxes full of medical supplies (when the sisters arrived, the hospital had run out of supplies, but 700 boxes were sitting – unpacked – in a storeroom). Her fundraising efforts have paid for the construction of seven pit toilets (patients previously defecated on hospital lawns and in the backyards of staff homes) and solar lighting (many night-

Identifying human remains fished from a river was just another challenge for sisters Dr Melanie and Belinda Olding during their six-month volunteer assignment at Namatanai District Hospital.

It’s Sunday morning and Dr Melanie Olding, relaxing on the front step at home, is about to hear about something unexpected, gory and very smelly, but she has no sense of that yet, as Pius, the emergency nurse, strolls past the high mesh security fence and down the boggy driveway towards her. Pius tells Melanie that people have been fishing off Number Two Bridge and found human remains, partly consumed, perhaps, by a crocodile. The 32-year-old emergency registrar from Darwin makes the short walk to the hospital where the rice bag and its 30-odd followers await her. She opens the bag, which challenges even her clinically hardened stomach, assesses the decaying contents and scratches out a note for the police.“Intestinal remains brought to me. Indeterminate -- possibly

human, unable to tell if male or female. Possibly large animal. Recommend coroner’s involvement. Please call me for clarification. Dr Melanie.”

Field project: Namatanai HospitalBy Heather Wiseman, Health Journalist of the Year 2012 awarded by the National Press Club of Australia Excerpt reprinted from Australian Doctor magazine Aug 2013

Volunteer sisters Dr Melanie Olding (far left) and Belinda Olding, a construction project manager, during their five month assignment at Namatanai Hospital in New Ireland Province, PNG.

“Earlier this year, a patient walked down the hill behind the hospital to a creek so she could wash after giving birth. She slipped on the way back up, haemorrhaged and died.”

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time emergencies and births occurred in the dark).The situation in Namatanai is far from unusual in PNG. The country has fewer than 400 doctors, only 51 of whom practise outside the capital of Port Moresby. In New Ireland Province, there are just five national doctors serving a population of 160,000 – all of them based in the provincial capital, Kavieng, despite 91% of the population living in rural areas.

*On this not-so-lazy Sunday, while Melanie has been dealing with the fisherman’s catch, Belinda has been touring the maternity ward. Today, she’s found an unattended newborn in trouble. So she makes haste to get her sister. Melanie follows Belinda to the flat, cyanotic baby with excessive secretions and obstructed breathing. Within 20 minutes, Melanie has stimulated, suctioned, bagged and masked the baby, and it has brightened and settled. Melanie has no obstetrics training or experience. This is her least favourite part of the hospital. There’s no fetal monitoring and no chance of a caesarean or blood transfusion. Humidicribs are made with plastic cling wrap.There’s no ventilator, autoclave or phototherapy lamp, or regular electricity to run them. Even taking a woman’s blood pressure can swallow half an hour; it’s a struggle to find a sphygmomanometer that achieves pressure and isn’t spilling balls of mercury.“The wards are filthy so we have enormous amounts of maternal and neonatal infection and mortality,” Melanie says.

Melanie and Belinda’s key achievements

• Clinical training on topics ranging from meningitis to fractures: outcomes included deaths from pneumonia dropping from seven in the first two months to one in the last two months.

• Obstetrics and maternity sessions: staff learnt life-saving resuscitation techniques using a neonate model and ambu-bag.

• Drug storage system and ward imprests: a drug dispensary was established, over 700 boxes of drugs from AusAID unpacked, a dispenser trained and ward imprests set up.

• Staffing: in the absence of a hospital CEO, Melanie appointed new leadership roles and improved staff rosters.

• Solar power and lighting: the pathology lab and three key wards had solar installed thanks to the Olding family, private donors and Shane Clark of Rubio Plantation Retreat.

• Pit toilets: After raising money and goodwill via a community fundraiser, Belinda supported hospital staff to build seven pit toilets, a fundamental public health intervention. Excavation services were donated by Dekanai Constructions Ltd.

• Hand hygiene dispensers: to counter the hospital’s lack of running water, Belinda built and installed hand sanitiser dispensers to improve hygiene.

Left inset: Sr Salome Palis, Sister-In-Charge of Outpatient Ward at Namatanai Hospital. Centre inset: Matron Tulibau Tom, Sister-In-Charge of the Maternity Ward at Namatanai Hospital. Right inset: Sr Wasise Lukas, Sister-In-Charge of the General Ward at Namatanai Hospital.

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Melanie is making her final assessments on the revived newborn when a heavily pregnant woman bursts forcefully through the door, rips off her sarong and makes a beeline for a delivery bed. Melanie and the nurse do their best, but don’t manage to save the woman’s perineum as the baby is born, dark blue, without a heartbeat, in a flood of meconium.

Without the luxury of a laryngoscope, Melanie resorts to deep, blind suctioning and wishes she had the support of someone who could put in an umbilical line. Intramuscular adrenaline doesn’t achieve a heartbeat. For the second time in her life she tries a single shot of intra-cardiac adrenaline. Within 30 seconds the baby’s heart rate is perfect and there’s a short-lived burst of euphoria.It’s ridiculously humid. Sweat runs down the Olding sisters’ arms for the 90 minutes they try to resuscitate the baby. But the baby’s lungs have stiffened. This baby will never draw her own breath.Belinda walks the hospital in search of staff and brings five to stand around the baby to learn an essential new skill.The mother watches on as Melanie teaches each of them how to use the bag and mask, encouraging them to reposition the mask each time its seal breaks. Calmly and gently, she cycles each of them through the process twice, mindful that in Australia no mother would watch on so patiently, waiting to hear their first child’s fate.“I feel horrible for that mother,” Melanie says later. “But I think it’s a price worth paying because there are now potentially five staff members who could save a baby, when yesterday I can assure you they couldn’t.”“You have to find silver linings or it’s just too sad.”Melanie leaves the last staff member to continue with the bag and mask and walks over to the woman still lying on the delivery bed. Gently, Melanie explains that her baby is very unwell, was not breathing when it was born and had no heartbeat.“So we will stop breathing for the baby now and we will bring the baby to you for cuddles. Would you like to cuddle your baby?”The woman smiles, reaches out to hold Melanie’s hand and says thank you. Melanie has been so composed and so sensitive it’s a surprise when her voice gains a terse edge. “She holds the baby for as long as she wants,” she instructs the nurse, before leaving the room.

*When Melanie first arrived at Namatanai, she wanted to tackle and change everything that was wrong, but she soon learned that was futile, a one-way ticket to burnout.“What I have to do is pick the problems that I can make meaningful change to,” she says. In a culture heavily focused on personal relationships, Melanie spent the first three months listening, building the respect of hospital staff and trying to understand why strange things happen. “It’s easy to walk in and say ‘That’s not right’, but you have to sit back and learn.”The sisters say they wouldn’t have coped in this place, where nothing makes sense or goes to plan, without having one another for support.“Just when you hit rock bottom, something wonderful happens and just when you have a win, everything comes crashing down. You need a familiar face to bounce things off and say, ‘Did that really just happen?”

“Melanie and the nurse do their best, but don’t manage to save the woman’s perineum as the baby is born, dark blue, without a heartbeat, in a flood of meconium.”

Dr Melanie Olding will never forget the night she sewed up a seven-year-old child with 13 puncture wounds from a crocodile bite, by the light of a head torch and a kerosene lantern.Called to the hospital at 1.30am, Melanie tracked the chest wounds and found that some were the depth of her index finger. One crocodile tooth had punctured the child’s skull.Melanie supervised a hospital colleague as he flushed the wounds, administered antibiotics and stitched in makeshift drains made from urinary catheters, sterile gloves and tape.Knowing that no surgeon was available at Kavieng, a bumpy five-hour drive away, Melanie evacuated the patient by boat to East New Britain Province for surgical treatment.The child made a full recovery.

Traditional sing-sings and pristine reefs and WWII shipwrecks – just some of the many off-duty adventures enjoyed by Melanie and Belinda.

Heather Wiseman visited New Ireland Province in April 2013 as part of a study tour prize she was awarded by the National Press Club of Australia. She travelled as an independent journalist.

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President Dr Peter Macdonald OAM MBBS MRCGP DA DRCOG Peter is a highly experienced general practitioner and accomplished politician who is currently providing locum medical services to remote Indigenous communities in Australia’s NT and SA. Peter was formerly the NSW State Member for Manly (1991-1999), Director of Plan International Australia (1999 to 2004) and Mayor of Manly (2004-2008). He has also worked in Iran and East Timor with Médecins Sans Frontieres and Timor Aid respectively.

Vice President George McLelland OAM CA George worked for accountancy firms in his native Scotland and in Belgium before migrating to Australia. He was NSW Secretary of Lend Lease’s construction company, Civil & Civic, and Company Secretary for an investment bank. He later spent several years in England as director/shareholder of a private group of companies. George was Treasurer of ADI from its foundation in 2000 through to 2010.

Treasurer A.Turner Massey CA Turner is a Chartered Accountant who has worked with major companies in the UK, as well as the Aluminum Company of Canada in Vancouver and ICI Australia (now Orica) in Sydney. Presently retired, Turner is on the committee of the Scots Australian Council (Australia) and plays an active role in his local community.

Steven Gagau MSc BEng DipBusFLM ADipBA Steven is an engineer and practice manager with 30 years’ experience in the telecommunications and human resources industries. He has expertise in quality assurance, accreditation, training and education, and governance. Currently the Regional Executive Manager of VASP Group Pty Ltd, Steven has previously worked with the Islands Development Bureau, Australian College of Technology, Datec, and Telikom Training College.

Lili Koch Dip. Commerce Lili has had an extensive career in the travel, medical and finance industries. She is an active member of RESULTS International (Australia), an advocacy group for the reduction of world poverty. Lili is also a dedicated ADI office volunteer, managing memberships and helping with fundraising activities, and a long-term financial donor.

Dr Judy Lambert AM BPharm BSc(Hons) PhD GradDipEnvMgt GradDipBusAdmin Judy specialises in the interface between social and environmental aspects of sustainable living in rural and urban areas. She has expertise in environmental, social and medical sciences and business administration with a career spanning research, government policy work as a ministerial consultant, and community sector advocacy. Currently Judy is the Director of Community Solutions.

David Snedden DipLaw (SAB) FAICD David is a former lawyer who specialised in corporate, financial and resources law and advice. He was a partner of Gadens Lawyers for 25 years, and spent five years working in the firm’s Port Moresby’s office. David was also a founding shareholder and director of the Campus Living Villages Group and Superior Coal Limited. He has worked extensively with Australian and Asian companies investing in Australia and the Pacific.

Board of Directors

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The names of the members of the Board of Directors during the year ended 30 June 2013 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 (resigned 8/4/13) • Adrienne Martin – Secretary (appointed 19/8/13)• Steven Young Moloe Gagau (appointed 17/6/13)

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 strategic health planning in Western Province and New Ireland Province, Papua New Guinea.Declaration The Board of Directors declares that:(a) The financial statements and notes, as set out on pages 17-21, 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 2013 and of the performance of the association for the year ended on that date.(b) 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 14th day of October 2013 is made in accordance with a resolution of the Board of Directors.

Dr. Peter Macdonald OAM MBBS MRCGP DA DRCOG President

Board of Directors’ report and declaration on financial statements

This year has been a remarkable year in terms of corporate and other donations and this is reflected in the year end bank balance, $396,032, showing an even healthier position than a year ago.This enabled us to achieve the programs detailed elsewhere in this Annual Report and, the very useful excess of revenue over expenditure of $208,071 for the 2013 year.At the same time we show in the table of cash movements for designated purposes (note 8 in the accounts), that funds received from the New Ireland Provincial Government, $198,702, are to be managed by ADI and to be appropriated in 2013. Another donation from Roche, $50,000, is committed to Kavieng Patrols in 2014.A key highlight of this year is the value of non-monetary donations, $748,740 (referred to in note 3), which have increased by 38% on last year’s figure. Indeed, ADI highly values the contribution of time made by our volunteer doctors, administration staff, and the donations-in-kind made by medical supplies and equipment companies. It is particularly worth mentioning the generous donation of a 10 seater 4WD ‘troopie’ and Yamaha generator, $64,755, made by Ela Motors in PNG.ADI is conscious of ensuring the highest amount of every donation is directed to relief provided by our programs in both PNG provinces, and that your donation is working for a healthier PNG, by keeping overheads and administration costs to a minimum. We appreciate each and every donation.

A. Turner Massey CA Treasurer

Treasurer’s report

George McLelland OAM CA Vice President

• Lili Koch • Judy Lambert • Christopher Lavers (resigned 8/11/12) • David Smith (resigned 7/9/12) • David Christopher Snedden (appointed 20/8/12)

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Auditors’ report

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Notes $ 2013 $ 2012RevenueDonations and gifts

Monetary 82,222 56,594 Non-monetary 3 748,740 542,767

Bequests and legacies – –Grants

AusAID – – Other Australian 270,950 225,130 Other overseas 253,891 26,682

Investment income 4,376 4,433Other Income 47,492 51,924Revenue for international political or religious proselytisation – –Total Revenue 1 1,407,671 907,530

ExpenditureInternational aid and development programs expenditureInternational programs

Funds to international programs 2 263,872 84,841 Program support costs 2 76,528 74,132

Community education – –Fundraising costs

Public 13,625 8,425 Government, multilateral and private – –

Accountability and administration 96,835 68,193Non-monetary expenditure 748,740 542,767Total international aid and developmentprograms expenditure 1,199,600 778,358Domestic programs (including monetary and non-monetary) – –Total expenditure 1,199,600 778,358Excess (shortfall) of revenue over expenditure 208,071 129,172

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

Financial StatementsIncome statement for the year ended 30 June 2013

ADI’s volunteer Dr Jenny Wilson (third from right) on patrol with a

team of New Ireland Provincial Health Workers.

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Financial StatementsBalance sheet as at 30 June 2013

Notes $ 2013 $ 2012AssetsCurrent assets Cash and cash equivalents 396,032 188,260 Trade and other receivables 8,585 5,046 Inventories – – Assets held for sale – – Other financial assets 21,113 19,829Total current assets 425,730 213,135Non current assets Trade and other receivables – – Other financial services – – Property plant and equipment 4 301 1,280 Investment property – – Intangibles – – Other non current assets – –Total non current assets 301 1,280Total assets 426,031 214,415LiabilitiesCurrent liabilities Trade and other payables 5 13,324 9,466 Borrowings – – Current tax liabilities – – Other financial liabilities 6 1,587 1,900 Other – –Total current liabilities 14,911 11,366Non current liabilities Borrowings – – Other financial liabilities – –

Provisions – – Other – –Total non current liabilities – –Total liabilities 14,911 11,366Net assets 411,120 203,049Equity Reserves – – Retained earnings 411,120 203,049Total equity 411,120 203,049

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

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Retained earnings Reserves Total$ 2013 $ 2012 $ 2013 $ 2012 $ 2013 $ 2012

Balance at beginning of year 203,049 73,877 – – 203,049 73,877

Excess (shortfall) of revenue over expenditure 208,071 129,172 – – 208,071 129,172

Amount transferred (to) from reserves – – – –

Balance at end of year

411,120 203,049 _ _ 411,120 203,049

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

Financial StatementsChanges in equity for the year ended 30 June 2013

Financial StatementsCash flow statement for the year ended 30 June 2013

–

$ 2013 $ 2012

Cash flow from operating activitiesReceipts from operations 651,647 360,330

Operating payments 448,611 269,866

203,036 90,464

Investment income 4,736 4,433

Net cash provided by (used in) operating activities 207,772 94,897

Cash flow from investing activities – –Payments for property, plant, equipment –

Net increase (decrease) in cash held 207,772 94,897

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

Cash at end of financial year 396,032 188,260

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 cash flow statement is reconciled to the related items in the balance sheet as follows:

Cash 197,330 188,260

NI Provincial Government funds managed by ADI note 8 198,702 –

Cash at end of financial year 396,032 188,260

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

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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.auThis 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.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 is charged to these programs in the year of acquisition. Depreciation on other propery plant and equipment is calculated on a straightline basis to write off the net cost of each item over its estimated useful life. 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 cash flow statement, 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.

Note 2. International aid and development programs

Note 3. Non-monetary revenue/expenditureInternational and development programsADI has opted to include the following non-monetary revenue and expenditure in its financial statements, in line with the Australian Council for International Development (ACFID) Code of Conduct. The non-monetary value for volunteer doctors and others working on PNG programs was established using AusAID’s Recognised Development Expenditure guidelines.

$ 2013 $ 2012Medical volunteers 428,412 258,045Non-medical volunteers 190,256 163,604Medical equipment and supplies 65,317 121,118Property, plant and equipment 64,755 -Total 748,740 542,767

Financial StatementsFinancial notes for the year ended 30 June 2013

Doctors education and training $ 2013 $ 2012Non-monetary (see note 3 below) 748,740 542,767Funds to international programs 263,872 84,841Program support costs 76,528 74,132Total 1,089,140 701,740

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Cash available at beginning of year

Cash raised during the year

Cash disbursed during year

Cash available at end of year

Programs $ $ $ $New Ireland Province, PNG Namatanai District Health Services 59,500 59,500 – In-service training – 28,500 28,500 – Kavieng Patrols note (a) – 113,000 63,000 50,000 Blood testing kits – 16,000 – 16,000 Solar lighting, Namatanai Hospital – 5,000 – 5,000 General local expenses – 15,000 6,780 8,220 New Ireland Provincial Govt note (b) – 198,702 79,322 119,380Western Province Improving Catholic Health Services 6,740 30,000 9,379 27,361 PNGSDP - Health Management Advisor – 49,474 39,341 10,133 KCC funding – 10,000 – 10,000 L Koch project 33,967 10,000 – 43,967Other AusAID accreditation – 37,000 5,716 31,284 Total non-designated 88,053 143,707 157,073 74,687Total cash movements 188,260 656,383 448,611 396,032 Note (a) Amount donated designated appropriation in 2014 year Note (b) Amount received represents NIPG funds to be ADI managed for 2013/14 years

Note 9. Reconciliation of excess (shortfall) to net cash flow from operating activities $ 2013 $ 2012Excess (shortfall) of revenue over expenditure 208,071 129,172Depreciation 979 1,754Increase in creditors 993 928Capital expenditure – –PAYG 1,587 –Decrease in trade and other payables -2,276 -16,957Decrease in loans payable – -20,000Advances -1,582 –Cash inflow (outflow) from operating activities 207,772 94,897

Note 8. Table of cash movements for designated purposes

Note 4. Property, plant and equipment $ 2013 $ 2012Office equipment at cost 12,967 12,967Less: accumulated depreciation 12,966 12,272Office equipment written down value 1 695Furniture and fittings at cost 1,155 1,155Less: accumulated depreciation 855 570Furniture and fittings written down value 300 585Total written down value 301 1,280Depreciation for year 979 1,754

Note 5. Trade and other creditors $ 2013 $ 2012Creditors and accrued charges 13,324 9,466

Note 6. Other financial liabilities $ 2013 $ 2012Prepaid member subscriptions 1,587 1,900

Note 7. Remuneration of auditorThe auditor Mr. R J Patmore Chartered Accountant does not receive any remuneration for his services.

Postal address P.O. Box 954 Manly, NSW 1655 Australia

T: +61 2 9976 0112 F: +61 2 9976 6992 E: adioffice@adi.org.au

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Photo by Andrew Sweeny, MD

Australian Doctors International Inc. ABN: 15 718 578 292