By Guest Blogger Dr. Leslie Bahn Kawa. MBBS (PNG), M. Med (Int. Med), MRCP II (UK), FSSC

 Dr. L. B. Kawa is a Fellow of Singapore Society of Cardiologists and the Clinical Fellow at the National Heart Centre, Singapore.

Papua New Guineans are well aware of the enormity of the degree of alcohol abuses in their individual societies and the country as a whole. Villages today are witnessing unprecedented levels of illegal dirty brewing by youths and adults alike for either personal consumption or for illegal sales.  Intuitively, lawlessness has been fuelled on a large scale as never seen before. It doesn’t do well either when law agencies are blatantly non existent.

The regulations to control and monitor sales of alcohol if there are any seem to have disappeared into oblivion. Street drinking and drunkards with bottles/cans of beer with rowdy and nuisance behaviors are now becoming frequent sights on the streets of towns and cities throughout PNG. I am not aware of statistics but from my anecdotal observation, the issue is nearly reaching its climax.

The Government of PNG has seen this problem and has unofficially declared it as a threat to the societal values and our Nation’s interests and aspiration. A working team has been seeking public opinions throughout the country for consensus on how to solve the issue and its findings and recommendations I guess are still in process.

I as a citizen as like any other Papua New Guineans feel disgusted, abrogated and even insecure for the future of my children and their children when our nation sits ideal at what is threatening our progress and aspirations.

The complications of alcohol abuse are wide ranging across the medical, social, psychological, neurophysiatric domains.

Thus I write this short article to highlight the implications of the alcohol abuse in PNG. I will try to briefly discuss social and medical issues related to alcohol abuse to broaden our knowledge and raise awareness of alcohol effects and the need for immediate action.

Medical Complications

The medical complications of alcohol abuse are wide ranging. Basically alcohol affects any systems of the body from the head down to the toes as if I would put it that way. Acute ingestion leads to temporary emotional and cognitive disturbances noted by any drinker. The person shifts from a normal person to excitement, stupor and can lead to death. Chronic ingestion has been associated with the following medical problems;

Dementia- Loss of new memory

Eye disease

Swollen parotid glands- glands behind the jaw that produce saliva

• Ruptured food pipe
• Inflammation of pancreases
• Liver disease
• Gut malfunctioning
• Cancers

One of the frightening acute complications of chronic alcohol abuse is called Delirium Tremens. It occurs in someone who has been abusing alcohol for a long time and suddenly for some reasons especially in institutional confinement is deprived of access to alcohol. Many non-specific symptoms develop initially culminating in this condition. It can present as a profound confusional state with often hallucinations and abnormal ideas, sleeplessness, agitation and or tremor. Such patients require immediate medical attention for withdrawal symptoms management and further management to prevent relapses.

One can be able to identify those people who are addicted or have developed craving and or dependency for alcohol by noticing seven features as given in below:

• Sense of compulsion to drink
• Stereotyped Social pattern of drinking
• Prominent drinking seeking behavior
• Increased tolerance to alcohol
• Repeated withdrawal symptoms
• Relieved drinking to avoid withdrawal symptoms
• Reinstatement after abstinence.

Consequences of alcohol abuse

The social implication of alcohol in PNG is prevalent and is slowly breaking apart the fabric of our societies. Just to name a few;

Family and marital problems

 Many males think that alcohol promotes sexual inclinations and mood. In fact alcohol reduces libido and raises partner dissatisfaction that can lead to infidelity.

 Incest

 Incest in PNG is on the rise but no studies have been made to find out the factors associated with this practice. One can only assume many things including alcohol which is a known cause.

Absence from work

 Many working class man and women who abuse alcohol know too well the post effect of alcohol the next day.

Accidents (major factor in > 10% of road traffic accidents)

 Many countries throughout the world have recorded alcohol as a contributing factor to road accidents at >10% but PNG’s figure would be more than that. In fact more accidents that are known and are unreported are caused by drink driving in PNG

Crime associated with acute abuse

We see what we call street boys drink and rowdiness now and again on the streets of PNG towns leading to scuffles and deaths. Many cases have been reported, seen and heard. Papua New Guineans have become desensitized to it.

Vagrancy

Vagrants and squatters living in and around towns and cities also contribute to alcohol abuse and disorder. What has happened in Lae is a class example.

The level of societal decay of morality is fabricated by many other factors including alcohol abuse as one of the major ones and has now transcended national boundaries.

Psychological Consequences.

Decline in libido or interest in sex has been touched. One of the serious psychological consequences of this process that could lead to marriage problem is fairly unknown in medical practice and is known as the Othello syndrome. This is when a person believes strongly and suspects his/her partner fooling around his/her back.

Alcohol abuse can also occur on top of other psychological disorders like depression, anxiety and post-traumatic stress disorders. We know that people tend to alcohol to relieve their problems when depressed, anxious and stressed. Research has shown conclusively that people exposed to supranormal stress or traumas like in ex defense force soldiers returning from wars have high rates of alcohol abuse. Occasionally many have taken their lives in the course.

Neuropsychiatric Consequences

 This complication is not yet seen in Papua New Guinea but one needs to keep an eye out for it sooner or later given the large numbers of people abusing alcohol. Two conditions that would be very interesting to emergency doctors and internal medicine physicians are Korsakoff Syndrome/ Psychosis and Wernicke’s encephalopathy.

Korsakoff is a condition characterized by patient having marked loss of memory and tries to make up stories to compensate for the deficiencies.

In Wernicke’s encephalopathy the person presents with three groups of symptoms; a) eye movement disorders.  b) Confusion.  d) Abnormal drunken walk.

Conclusion.

 Papua New Guineans are well vested with the problems caused by widespread alcohol abuses in our societies. The price our country is paying is immeasurable.

From social effects to medical effects, many are known by all, some are latent and are unseen at large while others are on their way.

Do we need to wait for them to appear before action is taken or is it Prime Time for Action? I leave this unto each and every individual who reads this article to decide. For me its bed time now but I am unable to sleep now to see tomorrow.