A balanced response on health services - Solomon Star News

A balanced response on health services

03 December 2013

In yesterday’s editorial piece (‘Is Number 9 Melanesia’s Worst Hospital?’, Solstar 2/12), the author made some very good and challenging points about NRH and provincial health services, highlighting areas of concern of which the Government is no doubt aware and seeking to address.

Arguments of this nature rightly challenge responsible authorities to improve performance and are evidence of a healthy and free media.

The bulk of the article however contained anecdotal reports from a ‘Marine Research Expert’ from Australia, who offered his opinion on health services in the provinces. We feel it is necessary to point out the dangers and flaws in this behaviour.

Everyone has the right to their opinion about the issues facing this country, including visitors; what is unacceptable is for untrained people – foreigners or otherwise – to enter health facilities in any country to diagnose and treat patients or to offer unscientific assessments of individual facility statuses in the media.

We cannot say what condition the people named in the article were suffering (though it is totally unacceptable in the first instance to name individual patients, as the article has done) but we must accept the judgement of the local health professionals managing treatment.

It is also embarrassing for local health authorities for individual facilities to be singled out for criticism, when no structured assessment has been undertaken.

The fact is, healthcare is different in the Solomon Islands compared with other nations. For the  uninitiated it can be confusing, even confronting. When you see local friends, sick and in wildly unfamiliar settings to you, it is upsetting and disconcerting.

The list of medicines is limited, the creature comforts of hospitals are threadbare compared with say, the Royal Brisbane Hospital; the care is genuine however and for the most part, effective.

When a Marine Specialist announces that there were ‘no’ medicines in the facility he visited, what he means is that there were no medicines he’d heard of.

When he pronounces that his recommended diabetes treatment is ‘quite cheap’, costing only AUD$10-$20/month, he ignores the fact that the entire budget for drugs, dressings and medical consumables in the Solomon Islands amounts to AUD$7/person for the entire year.

Most particularly, when tourists and non-medical people visit facilities and make entirely unscientific pronouncements about the state of health facilities, they deeply offend the many health professionals and support staff who work valiantly within them under severe constraints.

When they take it upon themselves to treat patients however, they go a step further, undertaking a dangerous and foolish act and committing a crime; they would not dare to enter a rural hospital in Australia and do the same, for they would be arrested.

So here are some questions arising from the story; without diagnosis or training, an Australian gave a patient 3 antibiotics that had been given to a lung cancer survivor.

We can assume they were highly specialist medications, tailored specifically for the patient that received them… so let’s check: If you gave Clindamycin, were you then able to monitor for the presence of the deadly Clostridium difficile bacteria?

If you gave Meropenem, were you able to do it in strictly controlled conditions, taking into account the rapid resistance that arises even in individual patients with this last-line treatment? If you gave Metronidazole or Doxycycline, were you familiar with the patient’s other medications, many of which these two agents commonly react with? If you gave penicillin (or a penicillin derivative, which includes all the Cephalosporins), did you check whether the patient was allergic and not susceptible to immediate anaphylactic reaction?

If you gave Vancomycin, did you take into account the risk of VRE, the deadly super-bug infecting Australian hospitals? If you gave him Gentamicin, were you able to monitor his blood concentration levels and his kidney function daily?

Of course not – because marine researchers have never heard of these problems.

We undertake a very careful process in the Solomon Islands to select those medicines which are appropriate for the setting, which are affordable and which can be used safely in patients across the spectrum of health facilities.

The medicines are selected by a committee of some of the top physicians and pharmacists in the country, taking into account epidemiology and budget concerns. The system is also tiered; if you are at NRH, you have access to a wider range of drugs than in Munda, certainly – but this is to protect the most solemn oath of all health professionals, in which we ‘first, do no harm’. In light of limited diagnostics and budget restrictions, the list is limited but highly targeted for those conditions which exist in Solomon Islands.

Every 2 years, the list is published as the Essential Medicines List; the latest version (2013) is available from the Medicines Information Centre at NRH.
Of those selected medicines, we currently have in stock 94% of our most critical items at the National level and we are endeavouring to make sure this excellent figure is translated to primary healthcare facilities.

We do not reject criticism of the Ministry of Health and we accept that any stock-out is unacceptable. In responding to such reports, we know that people will always be able to find a facility that is under-stocked, a patient incident that is unacceptable or a death that was avoidable and it is therefore counter-productive for us to engage in ongoing debate.

This is why we do not respond to normal articles criticising the health system or the supply of medicines.
However, the practice of untrained foreigners visiting medical facilities in developing countries to offer their lofty opinions is an epidemic across the region that blights the work of the thousands of local and ex-pat professionals (and millions of aid dollars) that are working to support system improvements. The practice is paternalistic, it is culturally insensitive, it is arrogant and it is absolutely clinically dangerous.

In this case, the gentleman’s friend has recovered and we are pleased to hear that. I suspect though, that as a Marine specialist, he has never stood in a room with a patient in anaphylactic shock, trying desperately to calculate an adrenaline dose to bring him back to life following an allergic reaction.

I would guess he has never realised that a patient has total kidney failure because their Gentamicin was not monitored correctly. I’m tipping he has never seen someone slipping out of consciousness due to an opioid overdose or confronted the family of a grandmother who bled to death because her Warfarin dose was too high.

Their experience of healthcare is narrow and personal, their reaction primal (and understandable); the consequences of their actions though are far-reaching and this behaviour needs to stop.

Whilst we certainly accept that there are deep-rooted problems in healthcare in the Solomon Islands – and the article very correctly points out that malnutrition lies at the heart of many such problems – we simply cannot let the current flood of falsehoods go by without response.

So here are some facts:

- A World Bank/Monash University study recently found that availability of medicines in clinics ranged from 62% in Nurse Aid Posts, to 87% in Area Health Centres. This compares with a global average in the developing world of 45%.

- Current availability of critical items at National Medical Stores is 94%, placing Solomon Islands amongst the strongest in the region; all major antibiotics on the national Essential Medicines List are in stock, as are the major treatments for Malaria and Tuberculosis. Availability varies in provincial areas due to the logistical difficulties in supplying disparate island groups and infrastructure shortfalls which are slowly being addressed. For those who would compare Solomon Islands with PNG and Vanuatu, we would urge you to travel to provincial areas in both countries and make methodologically sound comparisons based on real data and not anecdotal reports.

- The incidence of Malaria has fallen 20%, each year for the last 5 years in the Solomon Islands. There are today less than XXX deaths from malaria each year, due to improved treatment availability, bed net distribution, disease mapping and mosquito spraying.

- Contrary to recent media reports from October, the country has not run out of Amoxicillin or Paracetamol at any stage this year – there is currently 12 months buffer stock of both at National Medical Stores and this was the case last month.

We invite all people with concerns to express them first privately through official channels and educate themselves on the way the health system operates here before going to the media. We also discourage the naming of individual patients in the media, except in exceptional circumstances, for privacy reasons.

We remind foreigners (including Australians) entering Solomon Islands with medications for personal use that it is illegal to give them to patients in Solomon Islands under both local and Australian law. Drug donations should be made (by arrangement only) to the National Medical Stores in Honiara; unsolicited donations are strongly discouraged.

Article by:
National Medical Stores