A deadly new strain of drug resistant tuberculosis is incubating on the small PNG island of Daru, 10 kilometres off Cape York, Australia’s most northern point. Infectious disease experts say the disease is ‘Ebola with wings’, and want Australia to lead a regional response. ABC reporter Jo Chandler travelled to Daru for this special report.

Just across the Torres Strait from Cape York is the Papua New Guinea island of Daru, population 20,000.

It’s my third visit here, though once was more than enough. The first time was in 2011, on assignment for The Age. I came to poke around reports that were just surfacing about a terrible disease epidemic.

That story changed my life, not least because it nearly killed me. I came looking for a deadly bug, the greatest infectious killer in human history – but the bug found me.

So why have I come back? Because five years after health experts started raising the alarm about what was happening here, warning that it had epic, horrifying potential, their worst fears are being realised – drug-resistant tuberculosis is rampant on Daru Island.

This emergency on Australia’s doorstep is setting off alarms in Geneva, New York and Canberra. How did it get to be this bad? That’s the question that brought me back.

After landing at Daru airport, I meet Walter Abio, who has borrowed the local priest’s old ute to come pick me up. Walter works with the Daru Catholic parish, and he’s giving me a lift into town where I’ll be bunking with the nuns at the convent for a few days.

Right now the town is packed. People from outlying villages have come from along the coast and down the Fly River to join their families to pick up their compensation payments from the infamously polluting Ok Tedi mine.

Daru has become home to many communities whose food gardens and fisheries were poisoned by the environmental impact of the mine, which is still pumping out waste 1000 kilometres upriver.

Right now, the twice-yearly payment is way overdue. And this is a big problem because few people have jobs. They need the money, even though it will likely amount to less than $100.

The weather is so hot it is cruel. A savage drought has killed sago crops. People are desperate. There’s an air of simmering distress and anger stoked by anxiety about when, even if, the money will come. I can see a huge crowd gathering downtown.

Walter won’t take me near that crowd. It’s too dangerous. Firstly, because of raskols and hot heads, and secondly because of what else might be lurking in their midst – the invisible killer that stalks the people of Daru every day, Mycobacterium tuberculosis.

It’s claimed a billion lives in the past 200 years, evolving and outwitting the drugs we throw at it.

According to Walter, when this compensation payment was being shared out a couple of years back, several patients being treated for drug-resistant TB escaped their beds in the hospital and came down to make sure they didn’t miss out on their share. Nurses and guards were sent down to try to round them up.

I’ve been telling stories from Papua New Guinea for seven years, but this one got under my skin in a big way when tuberculosis stowed away with me back in 2011.

Thanks to 18 months of intensive, toxic treatment in a first-class health system, I’m cured. But the episode bound me to this community and to the network of health and development specialists trying to bring this crisis under control.

In the past six months chatter and distress at the highest levels of the international health community about what’s going on in Daru, and in PNG more widely, has reached fever pitch.

Underwriting this flashpoint is the most noble of ambitions – the cornerstone of medical ethics, to first do no harm.

What happens when political sensitivities and economic realities bang up against medical imperatives? Do you quietly try to give your patient the best you can manage under the circumstances? Or do you shout loud for what you know the patient needs, and hang the consequences?

This was the dilemma for doctors scrambling to fix Ebola in Africa last year, and which now confronts TB experts trying to contain the emergency in PNG.

At the centre of unfolding drama is Dr Jennifer Furin, a Harvard University physician and anthropologist, and a world authority on TB. Hearing some worrying dispatches from PNG, she visited Daru last year.

“I arrived in Daru in early October 2015,” she said. “And I went in expecting a very short and focused trip in which I helped get some patients started on the new TB drug bedaqualine.

“But within four to five hours of my arrival on Daru, and spending time at the hospital and reviewing the patients files and seeing some of the sick patients, it quickly became clear to me that I was seeing what I can only say is the worst outbreak of drug-resistant TB that I have ever witnessed in my career.”

Furin is regarded as one of the most experienced hands-on physicians working at the front line of drug-resistant TB. She’s treated patients and run control efforts from the slums of Peru and South Africa and the jails of Siberia.

What she found in Daru put her in a tailspin. The outbreak was unprecedented, although not in terms of raw numbers–there have been bigger outbreaks. What was astonishing was the virulence and penetration of the spread, affecting around one per cent of the population.

What alarmed her even more was the strategy being rolled out to tackle the crisis under the advice of the World Health Organisation (WHO) and other apparatchiks of the global health establishment.

She accused them of compromising their own basic protocols around diagnosis and treatment of drug-resistant TB, of watering down their best advice in order to navigate around delicate political sensitivities in PNG.

“It was in October I reached out to colleagues at WHO who I have known for more than 20 years,” she said.

“In a series of emails entitled MDR TB Disaster in PNG, I tried to share the sense of urgency that I felt over what I was seeing on the ground. And to be honest there was very little that was done about that.”

The WHO was still dealing with criticism over its response to the Ebola outbreak in West Africa last year. Here Furin was warning that in PNG she was seeing ‘Ebola all over again’.

The organisation rejects the criticism, blaming PNG’s fragile health services for the slow rollout of the international response.

While they clashed over strategy, the experts were in furious agreement about the scale of the emergency.

In November an international meeting on the Daru situation convened by WHO and the PNG Health Department in Port Moresby talked about the urgency of the epidemic, describing the cost of inaction as catastrophic.

“You can stand on the shores of Daru Island and see Australian territory,” Furin says.

“We’re talking about an airborne infectious disease here that people can spread without really having any symptoms. It’s a health threat for Australia, and it’s a health threat for the entire Pacific region.

“As we all saw from the Ebola crisis, diseases in one isolated part of the world rarely stay there. And to me this is far more concerning than the spread of Zika, which was called an international emergency, which is spread by mosquitos – this is spread via air.

“You can get multidrug-resistant TB if someone is on your airplane who has it and coughs, you can get it on the subway, you can get it riding in a taxi.’

- ABC