In 2004, I decided to work as a volunteer doctor in Solomon Islands for six months. At the time I arrived the war-like conflict had just been put to an end through an intervention by RAMSI (Regional Assistance Mission to Solomon Islands). Therefore, it was possible to travel safe throughout the whole country. Although I stayed most of my time in Honiara working for the National Referral Hospital, I also decided to go and have a look at a small provincial hospital: Taro Provincial Hospital in Choiseul.
Choiseul is the northernmost province of Solomon Islands. Looking across the ocean, you can already catch a glimpse of Bougainville in Papua New Guinea. Unlike other provinces, Choiseul mainly consists of one big island and not countless scattered small ones. It makes it a bit easier as to know where about all the people live: Most of them in small villages along the coastline of this island. Taro itself, the capital, is on a small island just off the coast from the big island. It's a small village without much infrastructure. There is an airstrip, a small post office, a hand full of shops, a couple of generators for electricity - and a small hospital. The hospital neither had a lab nor an X-ray nor an operating theatre at that time. All these things were under construction as well as an extra ward for patients with tuberculosis. They were also supposed to be finished soon after, but Solomon time also rules in Choiseul and they were still far away from being finished! Anyway, as a doctor it means that you virtually rely on your eyes, hands, nose and stethoscope for your diagnosis. And this is quite a difference to what we are used to in Western Countries where we have everything readily available.
Another important part of the work of a doctor in a provincial hospital is touring around the islands and visiting the patients in their villages. Every bigger village has got a rural health centre that is run by a nurse or a nurse aid. They have very limited means and usually don't see a doctor for years: Solomon Islands are always short of doctors and the provincial hospitals either have no doctor or, if they're lucky, they have one who is responsible for everything. So finding time for a tour is not always easy! And many patients just don't want to leave their villages (or they don't have the means to do so) even if they're very sick. If the patients don't come and see the doctor, we have to go and see the patients in their homes.
One morning, we (Neverlyn, Taro Hospital's nursing superintendent, Winston the boatman, Rob, an Australian surgeon who just happened to visit his friend Chris Millar for two weeks, and myself) packed the "ambulance boat" with first aid boxes, medication, fuel, foul weather gear and sleeping bags and made our way along the coastline to the village farthest away. And, of course, there was foul weather and heavy rain was pouring down the whole day and the boat jumped like a wild horse on the sea! The next day early in the morning, we started the outpatient clinics, one village after the other. We had given all the rural health centres a radio call in advance so the nurses were able to collect the patients for us. It was mainly a sort of triage that had to be made: Which patients could be treated in the village, leaving enough medication behind? Which patients had to be referred to Taro? Which patients had to be referred to Honiara for an operation? The main problem was the patient with a chronic illness like diabetes, severe asthma or hypertension. It's possible to start a treatment right on the spot, but what happens if the pills that you leave behind are finished? And who does a follow-up or even a blood sugar control if there is no testing device available? The nurses in the villages hadn't seen a doctor for more than three years and nobody knows when there will be another visit in the future... Acute infections were actually best to treat: Incision of an abscess and antibiotics. At least there is a considerable chance of healing!
It really was hard work, we visited dozens of patients in several villages everyday until nightfall. Over night, we stayed in the clinics or in some sort of guest house. And I was never short of food: In every village, the women prepared a feast with local food and I just couldn't refuse to taste everything! Even when I was completely stuffed after the fourth meal...
All in all, we were touring for five days along the coastline of Choiseul. It was a very good experience even though the medical means were limited and a long term treatment is virtually impossible. It is also very important to give the local nurses support and advice and to bring them new drugs for their stock. A visit from a doctor at least once or twice a year would actually be necessary for every rural health centre throughout the country - but as long as there is such a shortage of doctors, regular touring is probably an illusion.
And once again, I was impressed by the friendliness and happiness of the Solomon Islanders. This is something I tried to take home with me: Starting the day with a smile!
© June 2005 Franziska Holenstein