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Introduction This section contains elective reports from the South Pacific region. Use the menu above to select a particular hospital/region. Cook IslandsRarotonga, Cook Islands
Destination contact(email): >none available Destination website: >none available First impressions I knew things were going to be very different here, as I stepped off the plane & into the hut that was Rarotonga International Airport, to be greeted by a man playing a ukulele in the immigration hall. Having forgotten to get a document out of my bag, immigration informed me that it was not necessary to retrieve it, and that they would "just trust [me]" when I said I had it! The hospital This very much set the tone for my stay, with everything operating on 'Cook Islands Time': that is to say, things happen when they happen. This extended to the hospital, a 60-bed rather run-down affair sitting on top of one of the few inhabited hills on the island. Ward rounds might happen at 7am, 9am, or not at all. This made life as a student (especially one not living on site, and cycling up the hill every morning!) very frustrating. Equally frustrating was the lack of utilisation of medical students - despite the 6 medical students at the hospital all being final year students in their respective countries, and despite the hospital being chronically understaffed, medical students were relegated to little more than observers, only occasionally being asked even to clerk patients. This was in stark contrast to colleagues on Aitutaki (another Cook Island), who were effectively junior doctors during their attachment. I ventured this to the new clinical director at the hospital, a motivated New Zealand woman, who asked me to help set up a more fruitful & worthwhile elective programme for students. Thus, by the time I left Rarotonga, the wheels had been set in motion to ensure future students will be better informed and more involved. I continue to be in email contact to this day, being consulted on potential changes. How I spent my time in the hospital On the clinical side, 2 weeks were spent on General Medicine, and 1 week on General Surgery. Medicine dealt almost exclusively with the complications of the islanders' poor lifestyles & endemic obesity - diabetes, gout & hypertension. However, more unusual diseases were encountered, such as ciguatera, a transient dysfunctional disease of the central nervous system caused by ingestion of the neurotoxin unpredictably carried by some reef fish. Patients present with abdominal pain, intense pruritus (creating lacerations in an attempt to ease the itch) & limb weakness/paralysis. There is no treatment (other than supportive measures), and recovery (which may not be full) can take up to 6 months. Mornings were spent on the ward, with afternoons in outpatients' clinic with the attending Burmese physician, which acted as a hybrid between a typical outpatients' clinic, and a GP surgery. Surgery was a little more hands-on. Mornings were spent on the ward and in clinic, with afternoons generally free. Two days a week, there was an operating list. Surgery was highly variable, ranging from cholecystectomy (gall bladder removal) to repair of a slipped upper femoral epiphysis (a bone problem seen in children), and was done by an ageing Maori, or a young Fijian, surgeon. I was able to assist in a number of operations, and in some clinics my opinion was actively sought & followed - the latest guidelines from the UK do not reach the Cook Islands quickly, so my post-finals knowledge was considered very useful. In both medicine & surgery, emphasis was on clinical signs & the history - the hospital had only a few basic blood tests available, and imaging was limited to x-ray and ultrasound (which were non-operational for a week, as the hospitals only sonographer was on sick leave!). Any complex diseases, or requiring more advanced investigations (such as CT), were flown to New Zealand, at the government's expense. Given the cashflow problems in the Cook Islands (the islands being heavily dependent on New Zealand for aid), this decision was not taken lightly, either by the doctor or the patient - in chronic disease (such as renal failure requiring dialysis), this was in effect a permanent emigration to Auckland, leaving family behind. Thus many patients refused to be treated, as it would mean leaving the Islands. Time to say goodbye... Having finally got myself onto 'Cook Islands time' (to the point of stopping wearing a watch at one point), it was time to leave again & head home. I was able to move my flight forwards by a few days, allowing me to spend a few days in New Zealand. Despite initially struggling with the heat (30-36 degrees every day) & humidity (due to the island's rainforest), & the constant war against mosquitoes (Dengue Fever having been a real problem on the island in the past), I had developed an appreciation for a people who have (just about) moved into the 21st century (only 2 of the 15 islands have mobile coverage, from a single network started 3 years ago, and the entire island uses a single server for internet access), whilst maintaining a perspective on what's important in life - time to enjoy life, and family & friends. VanuatuNorthern District Hospital (Luganville, Santo)
Destination contact(email): >none available Destination website: >none available What and where is Vanuatu? Vanuatu is a group of islands in the South Pacific, about 3 hours from the east coast of Australia. With a population of only around 200,000, most locals live in traditional villages, There are only 2 real ‘towns’ as such – the capital (Port Vila on the island of Efate) and Luganville (on the island of Santo). These are also the places that are home to the 2 main hospitals of Vanuatu. Although the hospital in Vila is relatively quite well equipped in terms of staff and equipment, the Northern District Hospital is much more basic. It has around 100-or-so beds housing medical, surgical, paediatric, obs & gynae and TB patients. In addition, there are a number of outpatient clinics, the bulk of which cover general problems/infectious diseases (almost all malaria). There are monthly eye clinics/theatres held by visiting doctors. The hospital itself has x-ray facilities, a basic laboratory (malaria films and full blood counts only, really) and limited ultrasound facilities. The hospital is situated up a hill above the town of Luganville. Is it safe? I felt very safe in Vanuatu, but then I was always with a group of people. Due to the fact that it is not a very populated place with limited street lighting, it can get very quiet and dark at nights even in the ‘towns’. What did you do in your spare time? Read lots of books. There are lots of things to see around the island (beaches, caves etc.) and on other islands (eg. Volcanos, etc.). Not huge amounts of restaurants/bars/shops around so it’s not the busiest elective destination. Is there anything that you would particularly recommend others to do? On Santo: Champagne beach and millennium caves (and lots of good dive sites if you like to dive). Be warned though…the nearest dive doctor is on Vila so if something goes wrong, you have to treat yourself. Thought that might scare you. Also, go to the island of Tanna (see the volcano). And on Efate, see the cascades just outside Vila and go big game fishing around Lelapa island. What was the weather like? Rains a lot, but always hot. Santo is less hot/sunny and more overcast than Vila. Tanna is a bit cooler. April/May to October is generally the 'dry' season. What was your accommodation like? Good. 4 rooms, each with a bunk bed and a single bed. All have attached bathrooms. Some beds have own mosquito nets. A students common room/kitchen is attached, which has a TV/DVD player and some books. Check availability of this accomidation when you are arranging your elective. Lester (a nurse) sorts out getting keys for you when you get there. How much did it cost? About £50 for first 2 weeks, then about £25 per week after. Did you enjoy your visit? Yes. Did you find it useful medically? Yes and no. Very little of what you learn is applicable back home. For something different and the chance to ‘do as much as possible with very little available’, definitely. Travel arrangements: Air NZ (Lon-LA-Fiji). Air Vanuatu (Fiji-Vila). Van Air (Vila-Santo). The Van Air internal flights are around £100 return to most islands. These can be booked when you are already in Vanuatu (there are booking offices in Port Vila and Luganville). Don't forget to ask for student discount (25% off!) What was the approximate total cost? Flights £1200, accom £50, living costs £100ish/week. Is there any other information that you think may be useful? The old electives coordinator (Dr Chris Tari) had left prior to my arrival, and at last check there was no-one really coordinating things. Dr Sameesa is the best person to contact at the hospital as he should be there in the near future so will be your best bet for organising electives. The hospital may also move to a newer improved building in the near future - this was under construction when I was there, but given 'island time', it may be several years before it actually opens! |
