A guide to MBBS 5 Rural Attachment

SMHS UPNG
Gabriel Yohang: Public Health Division

Introduction
Rural attachment is part of a clinical exposure for the final year medical student placement in a
rural hospital setting. The provides a platform for medical students to observe and practice
theoretical knowledge gained during the four years of learning public health and clinical
medicine. You will
• experience how provincial and lower level health services operate
• see how health resources are utilized at a district and community level
• see how health care is provided and the health systems available in rural
areas of PNG
You will also:
1. Be exposed to and investigate health problems and needs of communities and
relate them to the environment
2. Describe health services and activities of different government and non-
government health agencies
3. assess adequacy of health services in relation to need

Settings: The rural block attachment will be at a level 4 rural or district hospital facility with
supervision of rural doctors. There are 4 different settings with each student assignment to
different placement.

These are
1 Mountain/ highlands block Mingende, Kompiam, Kudjip, Tinsley, Kainantu,
2 Coastal block Gaubin
3 Swamp medicines Kikori, Kapuna
4 Bush Medicine block Rumginae, Braun, Etep

What to bring to rural attachment

• Each student will be supplied with the following

• Sleeping bag x 1 (except for Gulf)
• Life jacket (Kapuna/Kikori)
• Each student and groups to sign for the items and must return them in good condition,
otherwise they must replace or pay for new ones by the students concerned
• Take your own personal items. Bring enough stationary for exercises and reports, a
calculator, your ID card, diagnostic set and STM books.
• Leave your phone numbers, email addresses with the Secretary, Ms Asi, Prof Guldan,
and Dr Yohang

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Program Timebles and schedule

• Total eight (~8) weeks program

• First week in Port Moresby
• Last week in Port Moresby
• Six weeks in the field: ~10th April?—24th June 2021

• Absent from Health Center or Aid Post without permission from UPNG Supervisor will be
reported to year 5 MBBS Committee.

• Subjects Marks
• Rural Health Report (group)
• Written report 40
• Presentation 20 60
• Aid Post Report (individual) 10
• Individual Project Report (individual)
• Written report 10
• Presentation 10

• Field supervisor marks 10

Total 90 100

Assessment requirement

1 Rural Health Report (Group Oral 20%/Written 40%)

• Report on data at HC which should give critical analysis of the situation
• Must be signed by all in the group
• Minimum length 10 pages double-spaced

2 Aid Post Report (Individual written) 10%

• Report findings at Aid Post
• Submit written report back at SMHS
• Maximum length 5 pages double-spaced

3 Individual Report (Individual) 20%; 10% Oral + 10% Written

• Individual report of findings on a health topic of choice at an Aid Post.
Report could be descriptive and/or interventional. Could implement an
action plan to address health problem.
• Implementation plan could include: HE talks, Organize community groups
to address an issue, etc…
• Maximum length 8 pages double-spaced (including tables, figures)

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 4 Conduct (Individual) 10%
a. Exemplary behavior is expected.
b. Some institutions have written rules and regulations; you are expected to
follow them
c. Punctuality is critical
d. You are expected to participate in all activities daily
e. Mark from Rural Mentor
Note: NO plastic covers for rural reports allowed!

Rural Medical practitioner responsibilities

As part of the exposure in rural block, you will experience and observe the role of the rural
specialist or GP. To experience duties of a multiskilled health professional and be involved in a
multidisciplinary approach to clinical medicine.

1. Has personal clinical responsibility for patients

2. Supervises clinical activities of paramedical staff
3. Monitors health status of population
4. Administers health services
5. Modifies services in response to community diagnosis and perceived
community health needs
6. Reports activities of himself /herself and staff
7. Reports endemic and epidemic diseases

Objectives of rural attachment

1. Demonstrate effective diagnostic and clinical management skills when presented

with a clinical problem

2. Demonstrate leadership, supervisory and teaching skills in the supervision of

paramedical staff within your area of responsibility
• Describe medical and surgical procedures which may be
performed in a rural setting.
• Apply standard
• management procedures and demonstrate their use to health
workers
• Prepare teaching material for in-service training for
paramedical staff

3. Gather morbidity, mortality and birth data from health institutions

• Analyze and interpret this data to obtain an accurate
quantitative representation of each health problem in the area.
Suggest if/how/where changes in data collection will improve
quality of data.

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 • Describe the epidemiology of major health problems in the
area
• Calculate the mean, median, mode, SD, confidence intervals,
• rates(%) for selected population parameters
• Apply t-test, χ2 Z or non parametric test for paired and
unpaired, continuous and dichotomous data

4. 4.1 Describe the duties and responsibilities of provincial health staff and how staff
relate to each other and to provincial and national governments

5. 4.2 Describe staff breakdown and how staff rosters are organized so that all major
areas of responsibility are covered

6. 4.3 Describe procedures for ordering medical supplies for health centers and aid
posts

Community diagnosis and evaluation of health services

5.1 Describe Community Diagnosis and other features of the community which impact on
the public’s health
5.2 Describe how health services may be adjusted to better manage major health
problems, as indicated by community diagnosis, morbidity and mortality data.
5.3 Describe how maternal and child health services may be adjusted to manage birth and
fertility needs, child health monitoring and community health education needs.
5.4 Describe national health policies for the management of major health problems in this
community

6.1 Prepare monthly health center reports

6.2 Prepare quality assurance reports
7.0 Describe essential steps in the investigation and management of epidemics

• What are the health needs of the community? Is the local health service meeting these
needs?
• The Community diagnosis describes the main health problems of a community and
those environmental and social factors that impact on these problems
• Work in groups
Divide the work load between members. Meet regularly to share information to discuss
your findings.
• Group marks will form a major part of your final assessment; it is
important for all to work together.

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Community diagnosis

• History

• Geography/Environment

• Demography

• Social Issues

• Health Resources

• Health Center Services

• Morbidity and Mortality

• Maternal and Child Health Services

Aid post report

1. History of the aid post

2. How the Aid Post operates
3. Catchment population
4. Ten (10) most common reasons of attendances
5. Other activities provided
6. Drug supplies requirements
7. Problems of management
8. CHW attendance
9. Supervisory support?
10. Records
11. Health committees
12. Summary – Strengths and Weaknesses

Family interview

Interview 5 families in the village, while at the Aid Post.

1. Main health worries
2. Opinion of local health services
3. Opinions on access to
4. Opinion to improve health care delivery
5. Health related issues of concern
6. Investigate child feeding practices
7. Living conditions
8. Relate environment, sanitation, etc….
9. Traditional medicine used in household

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 10. Describe similarities and differences between health of people in the village,
those around health center and Port Moresby

Family Health care

• Describe how community is encouraged to take responsibility for its own health
• Any PHC projects in the area?
• What is your idea of a good doctor?

Your resulting community diagnosis is a ranked listing of health problems; it will be determined
by
• Morbidity and mortality data
• Potential impact on Public Health
• Perceived needs of community
• Potential manageability
• Opinion of HW
• District and Provincial health objectives if available
• Justify the criteria used for your community diagnosis
• Provide realistic suggested plans reflective of issues both current and projected
• Report - achievements and progress
• Constructive criticisms with helpful, feasible suggestions of
deficiencies noted

Community project suggestion

1) Malaria
2) Pneumonia
3) Tuberculosis
4) Leprosy
5) Skin infections
6) Diarrhoea
7) STIs
8) HIV
9) Malnutrition/Infant feeding/child growth
10) Adolescent/youth health issues
11) Vaccination services
12) Helminth infections
13) Supervision of health staff
14) Water supplies
15) Waste disposal
16) Costs of health services
17) Family planning
18) Breastfeeding
19) Safe motherhood, home deliveries and VBA’s, the “Three Delays”
20) Dental Health
21) Migration

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 22) Eye health
23) PHC initiatives
24) Health data management
25) Alcohol, betel nut, tobacco and public health
26) Market opportunities for produce
27) Income generation
28) Law and Order
29) Housing
30) Role of missions
31) Mental health problems
32) Traditional medicine
33) Others feasible that interest you?

Statistical Calculations

Incidence: Number of new cases arising in a given period in a specified population

Incidence rate: Number of people who get a disease in a specified period divided by sum of the
length of time during which each person in the population is at risk multiply by 100

Eg

There are 20 people in a group

10 of them get malaria

The susceptible population is 20 however only ten of them get the disease

The incidence is calculated as 10 /20 x 100 = 50 %

Therefore, there is a 50 % incidence of malaria

But for a catchment area of a hospital, you need to know the population of the hospital catchment
area, i.e. a district, or several districts, or a whole province, or maybe several LLGs? And,
usually you need a relevant age group that is susceptible to the disease, maybe adults, or children
under five, or number of live births, or something. Once you find or calculate that denominator,
from a baseline population number plus growth rate additions added to it, you can get it for the
current year of your calculation. It’s really hard, though to get anything accurate, if you don’t
know that relevant population denominator. The above simple example (to give you the
concept) the population is known to be 20. But in the real world calculating the population and
with the age range or condition in question is another story!

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Prevalence: is the number of disease in a defined population at a specified point in time.

Prevalence rate: number of people with the disease at a specified time divided by number of
people in the population at risk at the specified time multiply by 100 or 1000 population.

Eg

There are 200 people in a village

10 of them have diabetes for several years now

The susceptible population is 200 however only ten of them have diabetes

The prevalence rate is calculated as 10 /200 x 100 = 5 %

Therefore, there is a 5 % prevalence of diabetes in the village.

Same situation here—we know the population, and it is 200! But otherwise you need to
find the population or calculate it yourself from other sources, such as the census. Or
maybe the NHIS, if the hospital’s figures for the problem of interest are being submitted to
the NHIS regularly.

Case fatality: is a measure of the severity of a disease and is defined as the proportion of cases
of a specified disease or condition which are fatal within a specified time.

CFR: number of deaths from a disease in a specified period divided by number of diagnosed
cases of the disease in the same period multiply by 100.

Eg

There are 5000 children in a village

100 of them have pneumonia and are admitted to the hospital

20 of these with pneumonia die while in the hospital.

The case fatality rate is calculated as 20 /100 x 100 = 20 %

Therefore, there is a 20 % CFR for pneumonia at the hospital.

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Note that this gives you the CFR at the hospital. But there’s always a problem: do all cases
of a disease make it to the hospital, and maybe just die at home? If not, you’ll never know
how many, so your CFR is for the disease of interest applying to only those cases that
reached the hospital!

Measures of central tendency

1. Used to summarize distributions for interval (location)

2. Measures of variability (indicating spread)

A measure of central tendency is a single value that attempts to describe the data by identifying
its location in the set of data.

The most basic measure is the frequency of a simple count of the affected individuals. However,
count data alone have limited value. To investigate the distributions & determinants of disease, it
is also necessary to know the size of the population from which the individuals were derived
during which the data were collected.

Mean – is the average value and is calculated from the distribution by summing the values of all
the observations and dividing by the number of observations

Median – is the middle value and is the value on the scale that divides the distribution into two
equal parts. It is the value corresponding to the middle observation.

Mode – is the most frequently occurring value in a set of observations.

1. Measures of variability

Although measures of central tendency are useful for summarizing a frequency distribution they
do not indicate the spread of the values even though differently shaped curves may have the
same central tendency.

It is therefore necessary to provide information on the variability, in addition to measures of

central tendency in order to give a clearer idea of the shape of the distribution.

Measure of variability indicates the distance between the highest and lowest values in the shape
of the distribution

This is useful when the distribution is equal or normal

Approximately 2/3 of the values under normal distribution curve fall within one SD of the mean
and approximately 95 % fall within 2 SD from the mean.

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Variance

The choice of a measure of central tendency will depend in large part on the nature of the
distribution of the observation.

For continuous variables with a unimodal and symmetrical distribution the mean, median &
mode will be identical. With a distribution that is skewed, the median is a more informative &
descriptive variable than mean.

If the data are considerably skewed, specialized methods of statistical analysis base on the
median may need to be considered.

One simple descriptive measure of variability is the range. The range is both simple to calculate
and easy to understand, it is far from optimal as a measure of variability.

1. It’s not a stable estimate – as the sample size increases the range also increases
2. Not amenable to statistical procedures & testing
3. A sample may have a large range even whey the majority of the observations are fairly
close in value.

Thus, a preferable measure of variability would include the distribution of all observed values,
not just those at the extremes.

The most informative and frequently employed measures of variability are the variances and its
related function, the standard deviation.

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Each of these parameters provides a summary of the dispersion of individual observations
around the mean.

Variance

To calculate variance – the squares of the differences of the individual observations from the
mean are added together, and the resulting sum of squares is divided by the number of
observations minus one.

 Calculate the differences between each observation (x) and the mean (~x)
 Square the differences (x – x~)2
 The result of differences are added together (the sum of)
 The sums of the squared differences are then divided by the total number of observations
minus one.

Standard Deviation – is the square root of the variance. It is the variability around the mean of
the distribution. It quantifies the spread of individual observations of a value of variability
around the mean value of the sample.

Standard Deviation

This is useful when the underlying distribution is approximately normal or symmetrically bell-
shaped.

Inference

Inference involves making a generalization about a larger group of individuals on the basis of a
sample. Whenever an inference is made about the characteristics of a population there is always
the possibility of it being inaccurate or imprecise, simply because of chance or sampling
variability. This possibility will decrease as the size of the sample on which the inference is
based increases. Thus, as the sample size increases, the true characteristics of the entire
population decrease.

The smaller the sample on which the inference is made, the more variability there will be in the
estimate and the less likely the findings will be to reflect the experience of the total population.
Conversely, the larger the sample on which the estimate is based, the less variability and the

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more reliable the inference. In all instances, the play of chance must be considered as an
alternative explanation when assessing the validity of the study findings.

Hypothesis testing

The null hypothesis represents the assertion that there is no relationship between exposure and
outcome of the disease.

All tests of statistical significance leads to a probability statement or ‘P’ value. The ‘p’ value
indicates the probability or likelihood of obtaining a result at least as extreme as that observed
in a study by chance alone assuming that there is truly no association between the exposure &
outcome under consideration. Any value of P less than or equal to 0.05 (p<0.05) indicates that
there is at most a 5 percent or one in 20 probability of observing an association as large or
larger than that found in the study by chance alone, given that there is really no association
between the exposure and disease. This means that chance is an unlikely explanation of the
findings.

Thus we reject the null hypothesis and conclude that there is a statistically significant
association between the exposure and disease under study.

Despite the conceptual similarity of all hypothesis tests, not all are equally appropriate for any
given situation. The selection of a particular statistical test depends on the specific hypothesis
being evaluated as well as the type and characteristics of the data collected.

‘t’ Test & Chi-squared Tests

The ‘t’Test - continuous data- and the Chi-squared test – discrete data - are the most frequently
encountered tests of statistical significance .

‘t’Test

For continuous data, hypothesis testing involves determining the statistical significance of an
observed difference between the mean values of continuous variables, like weight in Kg, or SBP
in mmHg, of the study groups. This can be accomplished by the normal distribution – if the
variance is known or the sample size is large.

Chi-squared Tests
Remember that Chi-Square is used to test for a relationship between 2 categorical variables,
such as gender, or smoking status (never, current, past).

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 Ho: There is no relationship between the variables.
Ha: There is a relationship between the variables.
If two categorical variables are related, it means the chance that an individual falls into a
particular category for one variable depends upon the particular category they fall into for the
other variable.

Let’s say that we wanted to determine if there is a relationship between religion (Christian, Jew,
Muslim, Other) and smoking. When we test if there is a relationship between these two
variables, we are trying to determine if being part of a particular religion makes an individual
more likely to be a smoker. If that is the case, then we can say that Religion and Smoking are
related or associated.

Chi-square tests give you associations of the PROPORTIONS of cases among the
categorical variables, for example if smoking status is related to gender in a population. A
chi-square test would examine if the proportions of each gender’s different smoking status
you measured (observed) could be just chance, or if indeed indicate that they are likely not
by chance and indicate a relationship.

Confidence Interval – Because estimates vary from sample to sample, it is important to know
how close the estimate derived from any one sample is likely to be to the underlying population
value.

Crude Birth Rate

The CBR is a measure of fertility i.e. the number of registered births per 1,000 of the populations
in a given areas at a specified time.

No. Registered births in a year

CBR = ------------------------------------------------------------------------------------------------------------- x 1,000
Total mid-year population

Crude Death Rate

The CDR is a measure of no. of deaths per 1000 of the total mid-year population in a particular
place at a specified time.

No. Registered deaths in a year

CDR= ----------------------------------------------------------------------------------------------------------------- x 1,000
Total mid-year population

Rate of Natural Increase

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This is a calculation of the crude birth rate minus the crude death rate. It signifies the rise (or fall)
of the population and is also a variable for the population growth rate.

RNI/1000 population = CBR - CDR

Growth Rate

The population growth rate is a measure of the rate of natural increase minus the net migration
into the area.

Infant Mortality Rate

The infant mortality rate is a measure of the number of deaths of children <1year in one year
divided by the number of live births in that same year x 1000.

No. of deaths of child < 1yrs in one year

IMR = ----------------------------------------------------------------------------------------------------------------------------------------------- x 1,000
No. of live births in the same year
Maternal Mortality Rate

The maternal mortality rate is a measure of the number of maternal pregnancy related deaths in
one year divided by the total births in the same year x 1000.

No. of maternal pregnancy related deaths in one year

MMR= -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- x 1,000
Total births in the same year

Effects of Migration
These may affect the population change in various ways. Such as environmental, or personal
factors that may cause this and are known as “push” factors, like natural disasters, political
reprisals, tribal conflict, etc.

On the other hand “pull” factors can influence movement such as favorable climate change,
employment opportunities, peace and order, political and religious freedom, respect for human
rights, better recreational & cultural facilities.

Migration is a spatial movement of a person or groups of persons within a country or specific

territory, more or less for permanent residency.

Immigration is when one enters the country of destination and Emigration is when one leaves
one country in order to move into another.

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Physical Quality of Life Index (Optional)
Introduction:
Economists have developed several ways to assess the process of development in a country.
These assessments are important as it can be an indicator for the living standard for an average
citizen in a particular country. Previously the Gross Domestic Product or GDP was the most
widely used system to assess living standards. However, some critics believe that this method
does not properly reflect the progress of health, education and women’s health in a country.

Therefore an Economist by the name of Morris David Morris created a method in 1979 which
uses three important indices;

1) Life expectancy at 1 year index

2) Infant mortality index
3) Female Literacy Rate

The mean of all these three indices is scored between 0 – 100 and is represented as the Physical
Quality of Life Index or PQLI.

Life Expectancy at 1 year Index = Life Expectancy at one - 38

-------------------------------------------------------------------------------------------

0.39

This is an indicator for good health and education services.

229 – IMR (/1000)

Infant Mortality Index = -----------------------------------------------------------------------------------

2.22
This is an indicator for the quality of health services in a particular area.
Female Literacy index = Actual %

This is an indicator for women’s educational progress and gender equality.

The PQLI therefore is:

PQLI = LEI + IMR+FLI
-----------------------------------------------------------

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Please complete the following evaluation of your students that have been with you.
How would you rate each student in each of the following areas, given their level of training?
Area
Student Name_________________________ Scale: 1 = poor to 5 = excellent
Willingness to learn and ask questions 1 2 3 4 5
Professionalism* 1 2 3 4 5
Organization 1 2 3 4 5
Medical knowledge 1 2 3 4 5
Public health knowledge 1 2 3 4 5
Attitude to and interactions with patients 1 2 3 4 5
Attitude to and interactions with staff 1 2 3 4 5
Punctuality for work 1 2 3 4 5
Completion of allocated tasks 1 2 3 4 5
Health system understanding and management 1 2 3 4 5
Appropriate medical records 1 2 3 4 5
Health Education and Teaching (including tutorials) 1 2 3 4 5
Care of hospital property and accommodation 1 2 3 4 5
Overall effectiveness 1 2 3 4 5
*Professionalism=exhibits role model behavior: dress standard, no/minimal buai, alcohol, etc., no inappropriate fraternization.

Two more to help us with our training/preparation of the students, not their evaluation:
1. What do you feel is/are this student’s greatest strength(s)?

2. In what area(s) do you feel he/she has the most to learn?

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Please complete the following evaluation of your students that have been with you.
How would you rate each student in each of the following areas, given their level of training?
Area
Student Name_________________________ Scale: 1 = poor to 5 = excellent
Willingness to learn and ask questions 1 2 3 4 5
Professionalism* 1 2 3 4 5
Organization 1 2 3 4 5
Medical knowledge 1 2 3 4 5
Public health knowledge 1 2 3 4 5
Attitude to and interactions with patients 1 2 3 4 5
Attitude to and interactions with staff 1 2 3 4 5
Punctuality for work 1 2 3 4 5
Completion of allocated tasks 1 2 3 4 5
Health system understanding and management 1 2 3 4 5
Appropriate medical records 1 2 3 4 5
Health Education and Teaching (including tutorials) 1 2 3 4 5
Care of hospital property and accommodation 1 2 3 4 5
Overall effectiveness 1 2 3 4 5
*Professionalism=exhibits role model behavior: dress standard, no/minimal buai, alcohol, etc., no inappropriate fraternization.

Two more to help us with our training/preparation of the students, not their evaluation:
1. What do you feel is/are this student’s greatest strength(s)?

2. In what area(s) do you feel he/she has the most to learn?

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Please complete the following evaluation of your students that have been with you.
How would you rate each student in each of the following areas, given their level of training?
Area
Student Name_________________________ Scale: 1 = poor to 5 = excellent
Willingness to learn and ask questions 1 2 3 4 5
Professionalism* 1 2 3 4 5
Organization 1 2 3 4 5
Medical knowledge 1 2 3 4 5
Public health knowledge 1 2 3 4 5
Attitude to and interactions with patients 1 2 3 4 5
Attitude to and interactions with staff 1 2 3 4 5
Punctuality for work 1 2 3 4 5
Completion of allocated tasks 1 2 3 4 5
Health system understanding and management 1 2 3 4 5
Appropriate medical records 1 2 3 4 5
Health Education and Teaching (including tutorials) 1 2 3 4 5
Care of hospital property and accommodation 1 2 3 4 5
Overall effectiveness 1 2 3 4 5
*Professionalism=exhibits role model behavior: dress standard, no/minimal buai, alcohol, etc., no inappropriate fraternization.

Two more to help us with our training/preparation of the students, not their evaluation:
1. What do you feel is/are this student’s greatest strength(s)?

2. In what area(s) do you feel he/she has the most to learn?

18
Please complete the following evaluation of your students that have been with you.
How would you rate each student in each of the following areas, given their level of training?
Area
Student Name_________________________ Scale: 1 = poor to 5 = excellent
Willingness to learn and ask questions 1 2 3 4 5
Professionalism* 1 2 3 4 5
Organization 1 2 3 4 5
Medical knowledge 1 2 3 4 5
Public health knowledge 1 2 3 4 5
Attitude to and interactions with patients 1 2 3 4 5
Attitude to and interactions with staff 1 2 3 4 5
Punctuality for work 1 2 3 4 5
Completion of allocated tasks 1 2 3 4 5
Health system understanding and management 1 2 3 4 5
Appropriate medical records 1 2 3 4 5
Health Education and Teaching (including tutorials) 1 2 3 4 5
Care of hospital property and accommodation 1 2 3 4 5
Overall effectiveness 1 2 3 4 5
*Professionalism=exhibits role model behavior: dress standard, no/minimal buai, alcohol, etc., no inappropriate fraternization.

Two more to help us with our training/preparation of the students, not their evaluation:
1. What do you feel is/are this student’s greatest strength(s)?

2. In what area(s) do you feel he/she has the most to learn?

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UPNG-SMHS / Gulf Christian Services Hospitals

Student Agreement

All students spending time training at Kapuna or Kikori Hospital are expected to adhere to a code of
behavior that reflects the overall mission of Gulf Christian Services while spending time rotating through
Kapuna/Kikori Hospital. This code of behavior will apply to the entire time of the student’s rotation,
where they are physically present on station or not (trips, village clinics and health center training).

Personal behavior
Students may not have overnight visitors / wantoks without administration permission.
No one may live with the students without administration permission.
Housing is to be maintained carefully. Students must notify administration if there is a problem with
their housing unit.
No student may chew buai, smoke, use drugs, or drink alcohol on or off Kapuna or Kikori Hospital
property. Violence that will result sexual harassment will not be tolerated in any form.
No person of the opposite sex may be in the students’ accommodation.
Appropriate dress should be worn at all times.

Professional behavior
Students who are taking call as part of their rotation must be on station and accessible during call times.
Students are expected to work at least 8am to 4pm every day they are assigned to hospital duties.
Students must notify the rotation director or Medical Director if they will miss any assigned work.
Students must show respect to patients and other staff members.
Students must work within their level of training and under the supervision of the Kapuna/Kikori
Hospital staff.
Violation of the above standards may result in the immediate termination of the rotation and dismissal
of the student.
Takson YANDA
_____________________________________________________________________________________
Signature Print Date
UPNG – SMHS Student

Signature Print Date

Kapuna/Kikori Representative

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