For
the last two years, Australian volunteer Sarah Brewster has worked as a doctor
at the National Referral Hospital in Honiara. She shared this personal account
of her time at Number 9 on International Volunteers Day earlier this week.
I work on the medical
ward which treats adult patients with infectious diseases such as tuberculosis,
malaria, pneumonia, lung abscesses and rheumatic fever. We also treat some
cancers and a growing number of chronic diseases or lifestyle diseases such as
type 2 diabetes and heart disease.
At times, we are not able to give a name to what our patients are suffering from. Our diagnostic capabilities are limited. We can do x-rays, ultrasounds, ECGs, some blood and specimen tests. There is no CT or MRI machine in the Solomon Islands so detailed imaging is not available.
This poses significant dilemmas at times. For example, a young woman presents with persistent headaches - is she having migraines or is this a brain tumour? If we had a CT machine, we could potentially confirm or rule out a tumour. However, even if we found a tumour, there is no neurosurgery available at Number 9. The only option would be one of the 10 beds at St Vincent’s Hospital in Sydney. These beds are made available to Solomon Islanders at no cost to the patient. Frequently, politics decide what patients are eligible to go.
St Vincent’s will also only take patients with a confirmed diagnosis. So what do I tell my patient? I can only suggest that they raise funds to have a CT scan in Fiji or Australia. With a confirmed diagnosis of a tumour, the patient might then have a chance of getting to St Vincent’s and having treatment in Australia. However, the cost of overseas travel for the CT scan is beyond the realm of possibility for most Solomon Islanders. In such a case, time can be critical – some patients die whilst they try to raise funds. Others resort to custom medicine. This example, which I have encountered many times, demonstrates the multi-dimensional challenges that we face as doctors here on a daily basis.
These sorts of technical limitations are counter-balanced by the skill and dedication of the doctors and nurses. My Solomon Island colleagues have been an inspiration. They are tremendous doctors who achieve so much with limited resources. They have excellent clinical skills as they often do not have technology to rely on. They are highly experienced at procedures, right from their intern year. They are passionate about their work. They treat their patients with care and diligence and immense kindness. These doctors spend time with their patients and ‘stori, stori, olowae’’. They know how important this is to their patient’s recovery. On a personal level, I am indebted to them for their professional support, their friendship and for bringing a sense of humour and much laughter to the ward.
It is difficult to capture two years at Number 9 in a short speech. There are so many stories, so many patients. Many have recovered from illness or disease, many are still sick and many have died. Between 10-15% of the patients admitted to the medical ward, die on the ward. Not included in this figure are the many we send home to die as there is no more we have to offer them. I don’t mean to dwell on the morbid, but I have learnt a lot from seeing the grace and humility with which Solomon Islanders suffer illness and death. We may have all the technology the world has to offer in the West, but we have still have a lot we could learn about coping with adversity and dying.
Notwithstanding all these challenges, the medical ward is an inspiring workplace. Our most senior doctor, a consultant physician, Dr Elizabeth Wore is one of the best doctors I have ever worked with. Under Dr Elizabeth’s unassuming guidance, I have learned more in two years here than my previous four years as a doctor in other places.
Despite being very much out of my depth when I first arrived, having come from general practice, I have always felt unconditionally accepted by the medical team. They are always tolerant of others and never judgmental. On the medical ward, there is a natural tendency to pool our knowledge and work as a team. There is none of that intimidating hierarchy that characterises the medical profession in Australian hospitals. Here, you are not made to feel an idiot by the consultant because you don’t know the answer to a question. This has made learning and practising medicine in the Solomon Islands very refreshing and fulfilling.
In saying thanks and goodbye, I would also like to acknowledge Jen from Australian Volunteers International and AusAID, but also to the Ministry of Health for having me at Number 9.
Lastly, a special thanks to the Australian volunteers and their Solomon Islands counterparts, who have just donated blood today. You have really helped the hospital and the doctors, and ultimately the patients. Thank you.
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