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Annual Review 2002

by Elisabeth and Hermann Oberli

December 2002


Dear friends and relatives,

The frequent precipitations of lately make us realise that the rainy season and therefore the end of the year is approaching. If one refuses to believe that another year is almost gone, the numerous invitations to BBQs, beach or pool parties, Christmas lunches, cocktails, school annual awards presentations etc. are reminders of that fact. Whoever owes others an invitation gives a party before the beginning of December, because that is the deadline for the great exodus. The expats go to their home countries, mostly to hot and dry Australia or New Zealand or to wintry Europe, for their long holidays. The Solomon Islanders go to their island to spend the festive season with their extended family. Honiara is almost deserted from December 15 to the end of January.

What has 2002 brought for this small island state? Have things improved, did they stay the same or have they deteriorated? The present government, elected in December 2001, is still our government a year later, and that is a big, positive surprise. They had to weather a few storms, deal with plots, threats and one or two votes of no confidence from the opposition. However, a lot of time is spent wooing members of parliament and trying to win members of the opposition over to the government's side, which means that there is often not enough energy left for governing! But generally speaking, most people are happy (or at least not too unhappy) with the government's performance. - A few weeks ago the minister of finances said publicly that the economy has hit rock bottom earlier in the year and is now slowly, slowly picking up. The export of logs has increased and brings money into the country. Oh no, some people scream, not more logging of tropical hardwood in the Solomons! But as it is the only source of income at present and as the Ministry of Forests and Conservation tries to promote sustainable logging, I don't think we will see the last of this in the near future. Inflation is still shockingly high with skyrocketing prices for daily goods in the shops. Salaries of Public Servants, on the other hand, are very irregularly paid, which leads to serious financial constraints in many families. Teachers, medical personnel, police, aviation employees and many more have gone on strike during this year. The airport was closed several times for all international and domestic travel. Not exactly a promotion of tourism and very hard on the few dive resorts and dive boats in the country! Hermann was affected too by the closure of Henderson Airport, as he missed a few important meetings in Papua New Guinea and the opening of a conference in Melbourne.

The first week of January 2002 we spend in Lata, Temotu Province, as "prisoners" of Solomon Airlines, after having stayed on Pigeon Island, Reef Group, for a wonderfully quiet and peaceful Christmas. Due to mechanical problems, the Twin Otter plane can't pick us up as planned and promised on Dec. 31. We stay at the totally rundown Luelta Resort. Hermann works at the nearby hospital every day. Patients and nurses are so thankful to see a doctor after more than half a year without one. One's pain - one's gain... once I have accepted this rather philosophical attitude, I tolerate the dark, rainy days without much food or fun better. This is just an example how difficult it is here to plan things and how adaptable to unexpected situations one has to become.

Our many visitors give us much pleasure again this year. The hospital benefits from numerous volunteers: nurses, midwives, young doctors in training and highly qualified specialists, medical students, computer wizards, engineers, all try to improve the situation there and also gain something for themselves. How many big bowls of spaghetti have I cooked, how many Red Snappers in foil pushed into the oven, how many kilos of sweet potatoes peeled and how many crates of beer carried up the stairs and into the house? I have lost count long ago. But providing food and drink and sometimes a place to sleep are not the only requirements. I often have to give advice on problems at home, with the boy/girl friend, at the working place. Thank God for the wealth of experience I have gained over the years to be able to listen, to talk and sometimes even to help. Not "Dear Abby" but "Dear Elisabeth"... The young people usually grow close to my heart, and when they leave after a few weeks or months of hard work under difficult conditions, I feel like letting my own children go. - Not only to visitors and volunteers we say goodbye, but also to very close friends who return to their home countries after many years in the Solomons or move on to another challenge in a different developing country. These are amongst the most difficult moments in the course of a year. I try to keep in touch with them all, and therefore I spend a lot of my time at the computer, writing letters and emails.

The many weapons still at large in the community, despite the efforts of the Government and the Peace Monitoring Council to collect them all, is a serious problem. We hear about a shooting in town or in the rural areas through the radio or our daily newspaper, the "Solomon Star". These outbreaks of violence have nothing to do any more with the ethnic tension between Malaita and Guadalcanal, but are most often fights between individuals, families, tribes or villages. In the olden days there were bow and arrows, spears, rocks, bushknives, fistfights; nowadays people quickly resort to a gun. At least 20 people were killed that way in the course of 2002. But in Burns Creek, where we live, everything is quiet and peaceful.

In May and June this year we spend a few weeks of homeleave in Switzerland. I depart a little bit earlier than Hermann, as I am invited to a wedding in Borneo. There I go through 10 unbelievably interesting days. There is not only the wedding, a mysterious Hindu ceremony, but also many before and after events, culminating in the climb of Mount Kinabalu, 4090 m high. Bride and groom are in front of the wedding party, goading us poor mountaineers ahead and cajoling the last ounces of stamina out of our sore bodies. But we all make it to the top - there are photos to prove it! The recovery time is at least double the climbing time, and back in Switzerland, I have to mount stairs very carefully for a few days. On our way back to Honiara, we spend a week in Cambodia. Hermann is revisiting the Prince Sihanouk Hospital and I fly up to Seam Reap Province with a friend who has come over from Vietnam. We explore the temples of Angkor Wat for three days, but that is not nearly enough time to get an overview of the hidden treasures there. It takes a full day on the Tonlé Sap Lake and River to go back to Phnom Penh by boat, where we do more sightseeing and shopping in the most variegated and lively markets I have ever seen. - Back in the Solomons in early August the whole of Honiara is involved in the festivities and commemoration of the landing of the US Marine Corps on Guadalcanal 60 years ago. We meet some veterans who participated in the Pacific war as young soldiers. It is most interesting to listen to them spinning the yarn.

What has happened at the hospital this year, what were the high and low points there, the achievements and the frustrations? I let Hermann talk about them; he is much more pragmatic than me and more to the point as well. I could go on for 10 pages at least.

The most important event of this year is still to come: Bettina and Stephen are having a baby around Christmas. We are looking forward to join the league of grandparents, though I admit it took some moments getting used to the idea! During the last nine years we have lost 6 dear close relatives, so we think it is about time for an addition to the family, the first one since 1973. If everything goes according to plan, I should arrive in Zürich shortly before the birth and stay in Switzerland until the end of January.

And what is going to happen next year? This is still in the air. We are open for anything. Wishing you all a happy, healthy, peaceful New Year. May it treat you gently!

Elisabeth

Hello everybody, it is my turn now, Hermann's!

Loud music and thundering surf echoes from Graciosa Bay, Lata, Sta. Cruz Islands (Mendana died here in 1595 from Malaria), as I leave the little hospital in the evening of New Years Eve 2001. I feel immensely relieved, but my pulse is still racing and I am dizzy, as I enter the beautiful starlit tropical night, with Orion high above me. The reason: Alex, a medical student from Lata and on his Christmas vacation right now, and I have just resuscitated a young woman with cardiac arrest. Alex was the anaesthetist (Ketamin and Oxygen Concentrator), I was the surgeon and a very capable local male nurse the assistant. Everybody who has gone through a similar experience, even within the well equipped and functioning infrastructure of a "western" hospital, knows about the emotional turmoil after such an event. The patient suffered an incomplete abortion some two weeks ago on the Reef Islands. She was severely anaemic (Hb of 52g/L) and in septic shock. When her condition worsened by the day, she travelled by canoe for three hours to the nearest first aid post. She was given antibiotics and the advice to go to Lata Hospital as soon as possible. She travelled again by canoe, this time 80 km across the open sea, and arrived here just in time. Duplicity of cases: In the hospital there is already a young woman who has given birth in the bush. The birth attendants did a botched job by pulling so fiercely at the umbilical cord, that it broke. She is now bleeding profusely.

Lata hospital, serving a population of 20,000 people scattered over 150,000 km2, has not had a doctor for more than six months. And now, all of a sudden, there is one! That is reason enough for excitement and action. The sister in charge of the only key to the pharmacy has her day off and has to be rounded up first. She hands me the three last ampoules of Syntometrin and the two last bags for blood donations. After a lengthy interval, the laboratory technician is found in the village, where he is already well into celebrating New Year's Eve. He appears at the hospital later in the afternoon to identify blood groups, but he refuses to cross-match the blood because he is too drunk for this more sophisticated test, as he assures me. "Tomorrow", he promises, which means most likely anytime in the future, but certainly not now and probably not tomorrow either.

I go down the dark, rough path to the derelict and sadly run-down Luelta Resort, where Elisabeth and I have involuntarily taken a small room for one week, courtesy of Solomon Airlines. The closer I get to the resort, the more deafening the music sounds. An honourable member of the Provincial Government sways towards me, both hands stretched out, one go greet me, the other one to proffer a lukewarm beer at me. "Hapi Krismas, docta!" "Hey man, that was one week ago". "Ok, hapi niu ia!". The whole male population of Sta. Cruz Island is here, celebrating. Towards the wee hours of January 1st, the Premier of Temotu Province tells me: "You know, doctor, for many months now we have been praying in church on Sundays for the Government in Honiara to send us a doctor. Finally our prayers have been answered. God works in mysterious ways." The next morning I go to the hospital with a slight headache. Both patients are in reasonable condition, with stable blood pressure and functioning kidneys, but of course still febrile and anaemic. However, the laboratory technician appears later in the day, sober enough to cross-match the two units of blood and the patients can finally be given the much needed life juice. On my way back to the Resort, I look in on Alex's parents whom I have known before. They are happy as I praise the work of their son. Alex tells me that the few days work with me have convinced him that he will specialise in surgery. Can he do this at the National Referral Hospital in Honiara? Of course, I assure him, the better part of the training can be done here, and two years have to be done in an overseas' hospital. As I leave the hospitable house, the mother presses one of the famous, huge, dark red and juicy Temotu watermelons into my hands. She promises to come to Honiara soon, as she is suffering of debilitating osteoarthritis of her knee. In the meantime, she had her operation, and only last week did I remove the metal. She is practically painfree and a happy woman.

Why do I tell you this long story of nearly a year ago? It characterises many aspects of the health situation in developing countries, where 80 % of the world's population live: Serious shortage of doctors, inadequate and obsolete medical equipment, need to improvise with the available supplies, a variety of unexpected problems that a doctor will encounter anytime, anywhere. The discrepancy between available resources and mounting demands grows more and more into a gap, which is hard or often impossible to bridge. On the other hand we find the resourceful, devoted nurses, nurse-aids and other auxiliary personnel who do an admirable job with great dedication. After a week of work at Lata Hospital with about 40 in-patients suffering of an variety of diseases, i.e. pneumonia, malaria, premature births, abortions, tuberculosis, and fractures of extremities I hold those co-workers in my highest esteem.

The mood in the country, especially in the outer provinces, is one of infectious carelessness, and the average person does not seem to realise much of the steady decline of the country. I am often nonplussed about the calm with which people accept the fact that a very few criminals have pushed the country into this plunge. As long as everybody has enough to eat, most people are prepared to put up with the situation. This attitude is prevalent in the provinces, but not so much any more in the capital. One wonders for how much longer?

And how are things at the National Referral Hospital?

At the beginning of the year I had to come to terms with a tremendous disappointment: Dr. Silent Tovosia who was made Head of Orthopaedics in mid 2001, leaves our team, after being trained by me and in Australia for many years, to take up work in the Cook Islands. As he never informed me of his decision or explained his reasons to me, I must assume that better pay and living conditions are his main reasons. The Cooks Islands' health system benefits now from an excellent, fully qualified orthopaedic surgeon without contributing anything to his training. This "stealing" of qualified professionals has been going on for some time and is one of the main reasons for our shortage of doctors and other health personnel.

Dr. Patrick Houasia has started his training as an Orthopaedic Surgeon, but he is still only in his first stage and it will take a long time for him to qualify for his diploma. On the other hand, an excellent young surgeon is coming back at the end of the year, after obtaining his Master of Surgery from the University of Papua New Guinea Medical School. I was involved in his training for many years and have great hopes for his future work in the Solomon Islands. However, the shortage of doctors in the country is a massive problem. At this moment in time we have no qualified paediatrician and no gynaecologist/obstetrician in our hospital. Thanks to the many volunteers from Switzerland the situation in the surgical department is not quite so bad. The medical students work without exception very conscientiously and hard, they take responsibilities in the daily running of the hospital and benefit from the experience for themselves and their professional and private future. We have to endure health budget cuts every year. At present Australia is fully funding the country's supply of drugs. Because the salaries could not be paid regularly this year, we have had strike notices from the unions and part of the hospital personnel did actually walk away from work, though we never had to close the hospital down, thanks to a handful of selfless people.

The unfailing support from home - I would like to mention the " South Pacific Medical Projects" and the Stanley Thomas Johnson foundation - puts me in a privileged position, despite the desperate financial situation of the country, to be able to realise numerous small and large projects. The new Fracture Clinic is by far the most comfortable and efficient unit in the hospital. Telepathology is well on its way and getting more important all the time, supported by the University of Basel. The Injury Epidemiology Database is probably the biggest such database in the Pacific. I have been able to send theatre nurses to AO courses in Australia and financially support nurses for continuing education courses at the School of Nursing here in Honiara. At present, three theses of young doctors are near completion, two from local doctors here and one in Switzerland. Last but not least regular and uninterrupted surgical and orthopaedic services have been maintained at the hospital during this difficult year, for the benefit of the people.

I would like to thank friends, relatives, colleagues, hospitals, institutions, drug manufacturers and many more who have contributed in any way to the Health Services of the Solomon Islands. Your support has kept us going and has made a difference in many peoples' lives here. My special thanks to our webmaster. The website www.hermannoberli.ch has been visited well over 4000 times since July 2001. The impact of such a podium is of the greatest importance.

With my very best wishes for you all and a big thank you

Hermann Oberli

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