I’m back from two weeks in Malaita, one of the Solomon Islands’ 9 provinces. Malaita is one of the bigger, perhaps more developed provinces, having roads leading from Auki (the main town) both north and east, and a short way south. All the same, Auki is tiny, a few streets with a few shops and a small market and port. Kilu’ufi, Malaita’s main hospital (one of two) is attached to Auki. Quite a nice hospital.
While in Malaita I was able to travel both north and east (south has a lot of river crossings with no bridges and the wet season kicked in big time while I was there, so we couldn’t go that way), to conduct the survey about procurement in the clinics in the small villages. It was great to see how the majority of Solomon islanders actually live, which is very different to the life in the metropolis of Honiara (about 60,000 people). The villages are often quite close together, but then again, that’s just the ones I saw, which were along the road. There are lots of villages which are hours walk or canoe from the main road and I imagine, quite isolated. How the clinics in some of these villages manage to procure any stock at all is a small miracle.
The clinics are run by nurses or nurse aids. There are no trained doctors or pharmacists to spare for such small places. They are generally under supplied in both drugs and equipment. An average of 9 out of 19 of the most commonly used drugs were out of stock at the time of visiting the clinics I went to. These were such basic things as panadol, penicillin, magnesium…Also, it was frustrating to see that no one had, or even had heard of, Coartem, the new malaria medication. Coartem is set to replace chloroquine and fansidar as the primary treatment, is more effective with almost zero tolerance developed and fewer side effects. The problem is that no one has it. There’re loads of it in Honiara, but the process of rolling it out through the provinces is difficult and time consuming, and the Malaria Working Group in charge of this doesn’t seem to be getting through very well. I was surprised because Malaita is one of the more accessible provinces, so I figured it would have been introduced early in the program, but apparently not so. Many of the clinics were out of stock of chloroquine and fansidar, so couldn’t do anything for patients with malaria. Often having no panadol, they couldn’t even offer some analgesia.
Atoifi, the hospital in the east set overlooking the sea dotted with islands and a stunning mountain backdrop, had very limited stock. Two patient with TB had been admitted, but the doctors had to admit that they were just “taking up space”, because there was nothing to be done for them unless some TB kits could be procured. Atoifi is only accessible by boat supply is irregular and unreliable from Honiara.
I’d better go, will try to write again.
i’ll be home in just one week and am getting pretty excited.
9/01/09
Week 5 just completed. Sorry about the lack of updates. The internet’s been down at the hospital for 3 weeks and have been a bit slack with getting to internet cafes.
Settled in well now, and Erin and Michael are back from Australia. Had some time off over Christmas and new year, saw some of the more beautiful parts of Solomons, including an enormous waterfall at the end of a big walk (about 100m high one of my friends estimated…amazing!).
The pharmacy was crazily busy leading up to Christmas and New year, but now it’s really quite. I think perhaps a lot of people are still away in the provinces with family etc. Working on various things that Nunan wants done before he leaves in November, such as the Adult Treatment Guidelines which we’re basing on Vanuatu’s version. The Children’s Treatment Guidelines were recently launched. Interesting going through and looking at the various treatment protocols. For instance, for stroke, there was virtually no recommendation other than life long aspirin. The guidelines quite blatantly said that nothing could be done, and to counsel the family on caring for the stroke victim/acquire a wheelchair etc and hope for the best.
Had an interesting talk with Nunan and Charles, one of the local staff here, about donated medications and how they are such a big problem. The idea is good, but in practice they are more hassle than help in a lot of cases. Solomon Islands (as with most developing countries) has an essential medicines list, containing all the medications that are able to be affordably and reliably held in the country. The problems begin when donations contain drugs not on this list. The drugs may be useful, but in the places they are donated there are often no trained pharmacists or doctors, on nurses or nurse aids. If the durg is not on the list, they usually will not know how to use it. Further, it is a long term treatment then there’s no point prescribing it if you only have 2 months supply. It literally becomes waste. In Gizo after the boxing day tsunami, truck loads of drugs were dumped on the tiny island, so much they had to build warehouses to store it all in. They had no money or means to get rid of it, and couldn’t use large amounts of it because it was out of date, not on the list, packaged in different languages, or so disordered that the effort to sort through it was too much. Some volunteer groups from various places in have come here and visited rural areas to do treatment and diagnosis for a short time. some of them were prescribing things such as diabetes medications which weren’t on the list, supplying two 2 months worth of meds then leaving, thinking that by the time 2 months were up, they would have come across some more. obviously this doesn’t work and just means the patient’s diabetes control is destabilised and has to be restabilised on another med, also reducing the patient’s confidence in medications. I don’t mean to discourage donations, but there is a protocol for doing it correctly which is scarcely met.
Going to Malaita, one of the other provinces, in 2 weeks for 3 weeks. Travelling around there to collect info on how the pharmacy outlets there are functioning, how to improve them etc. looking forward to seeing some other parts of SI than Honiara.
Best go while it’s not raining and try to get home. Wet season is in full swing and it’s difficult to get around.
Until next time
Jane
Hi, I’m not one hundred percent sure that I’m doing this right, but here’s hoping. Ok, well I’ve been here for about 10 days now and here’s post number one, I daresay of not too many. The internet is stuck at 1990’s pace and I only have access at work, so I won’t get too many chances. I’ll try to get a post up every week though if I can.
Everything is going well so far. I arrived in Honiara last Saturday – Michael Nunan and Erin Mitchell (2 ex-VCP pharmacists who I’m working with) picked me up at the airport and took me to the house I’m sharing with 2 other Aussie volunteer girls, 26 and 29yrs old. All the volunteers here have formed a bit of a clan, working in various fields, all late twenties up to early thirties, so a bit older than me.
Work started on Monday, at the National Referral Hospital, working in the pharmacy ward. Michael took me on a tour around NRH. It’s obviously different to any Australian hospitals, a lot more limited, but I was impressed with how they manage. NRH was built by the british in war time, when a lot of fighting was happening on Solomon land, so it has staggered corridors, designed such that someone couldn’t shoot the length of the hospital, and if a shell hit, the explosion would be limited to that section of the corridor. The wards are open (multiple beds in large open rooms) to make it easier to work with limited staff. The families of the patients are required to take charge of the general care of the patient, in terms of cleaning/dressing/feeding, since there are very few nurses. We went in to the TB ward too. Whilst it is separate, it’s far from isolated as it would be in Aust for such a contagious and dangerous disease. We were able to just wander in and out, as were doctors, nurses and visitors. I went on a ward round today, and there were at least two patients just in the general ward who were suspected, but unconfirmed, TB cases. I can only imagine at home, if there was an inkling of TB the patient would be whisked away from all other patients. Met a patient with a really serious case of suspected SLE (systemic lupus erythamatosus – not sure of spelling there) too, who they are having a lot of trouble treating, with allergies or poor response to a series of drugs. They’re trying methylprednisolone IV now, but after that they’re a bit lost for clues, and might even suggest some traditional methods – they were talking about bathing her in water with crushed guava leaves, which can give some relief, but I think only temporarily.
A number of patients on the round needed treatment that they could only get in Australia. One needed dialysis, another had a condition whereby his limbs/fingers/toes continued to grow after the rest of him had stopped, his aortic valve was affected too and he needs corrective surgery, but heart surgery is not available in Solomons. There is little that can be done.
There are quite few HIV cases here, it has not become a big problem in the Solomons yet. There are several projects putting in huge efforts to stop the spread from Vanuatu and PNG (were it is already at epidemic stage) to here, as there is a lot of shipping which runs between these countries, and the proximity is of great concern.
The pharmacy/outpatients department is very busy – there is generally a sizeable que when I arrive at work at 8am, and it’s still there up until we close up around 4:30. Patients hand us prescriptions through a window in the wall, and we prepare and dispense them. Medications are free, but quite limited. Every second prescription seems to be for amoxicillin – compared to home, there are lot more antibiotics dispensed, and far fewer cardiac drugs. We give out quite a large number of STI packs daily too, which are from memory 12 doxy and 2 ceprofloxacillin…I think.
I should get back to work. I’ll try to keep this relatively up to date.
Jane
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