I have just finished my first week in Vanuatu, I am staying on the island of Santo in Luganville and working in the northern provincial hospital public hospital. There are 12 other medical students here more than there are doctors!
My first impressions of the hospital is that the facilities are extremely basic, there are four wards; medical, surgical, paediatrics and obs and gynae. The small number of staff is made up from doctors sent as aid from foreign countries such as Cuba and China there are two Ni-van doctors (of Vanuatian nationality trained abroad in places such as Cuba and Figi) the temporary doctors are only placed for a limited time ranging from 1 month to up to a year. This causes huge cultural and language barriers and inconsistencies in the care.
I find out from speaking to other doctors that patients avoid the hospital due to the cost of a stay so the in-patient cohort tend to be the wealthier Ni-vans or the very sick.
I spend the week on medicine with a Cuban doctor who speaks little English or Bislama (pidgen English spoken here). The ward round consists of interesting patients ranging from heart failure, asthma, diabetes to a possible case of guillain-barre and a patient with oculomotor nerve palsy. The most poignant case I saw was is a 24 year old boy with an aplastic anaemia. The doctor suspected leukaemia, however without access to a bone marrow biopsy the diagnosis could not be confirmed, and even if it was there is no access to chemotherapy drugs here. With such low blood counts he is extremely susceptible to infection, however there was no isolation room available and he spent the first night on the wards. This example paints a picture of the recurring theme of the medicine here, diagnosis is often unclear, and investigations and treatments so readily available at home are not accessible and this leaves us feeling discontented.
We quickly learn bits of the language it is quite easy to take a history as it is similar to English and French, these are some of the words I have learnt so far:
Asking if bowel movements are ok is ‘sit sit good?’
Pain: ‘sore’
Uterus: ‘basket belong bebe’
Food/ eating: ‘kakai’
Drink water : ‘drink wota’
Great: ‘numba 1!’
Here are some photos of the hospital and us on the TB ward.