Tuesday, 25 March 2008

No Guarantees

Dedicated readers have questioned our failure to dedicate any blog space to “what work is like”. Given that we are here to work, and spend about a third of our day on work, a little piece on work is entirely appropriate. Let’s visit Kilu’ufi Hospital (approximate pronunciation is “Kee-LOO-fee”)..

Our workplace is one of two hospitals in Malaita Province, the other, Ato’ifi, is over on the east coast, and I don’t know very much about it, other than that they had quite a long time without a doctor. Kilu’ufi Hospital is the major healthcare facility for Malaita. People from south Malaita, however, are sent directly to the National Referral Hospital in Honiara for logistical reasons (no roads, and the distance by boat is shorter than to come up the coast to Auki). Kilu’ufi has 127 beds (some of those belong to the national psychiatric unit), and an occupancy of about 90 each evening. There are four doctors who are all registrars, and must work without the support of consultants here. The wards are set up a little differently to what you might be used to: rather than having “co-ed” medical and surgical wards, there are instead the male and the female ward, loosely sub-divided into medical and surgical areas. There are also the maternity, children’s and isolation (tuberculosis) wards.

If you are a hospital worker, or perhaps a frequent visitor to such facilities, you may have noticed an increasing tendency towards “cheerful” d├ęcor, to the point of garishness at times. Also a feature of the modern hospital is the array of floor coverings: tiles, pavers, carpet, linoleum, and a host of non-slip surfaces. Not so at Kilu’ufi, where the scant budget dictates concrete indoors and out; it is exceptionally slippery when a brief downpour or a morning floor mopping is added. This is not to say that it is a concrete jungle – there are plenty of flower beds with pretty exotic blooms, and green, green lawns (with that tropical, broad-bladed, low-growing grass) – just that it did strike me initially as very dim and grey. The grounds are well-looked after, and received quite a makeover in the lead-up to the hospital’s 40th anniversary celebrations last year, with my favourite being the (okay, kind of kitsch) garden bed out the front that spells out in leafy green, “Kilu’ufi”.

Design features aside, this is a hospital in a developing country, and I think an appropriate motto would be “no guarantees”. Just about anything you would take for granted in a Western hospital is, here, either not available, or is on a tenuous supply. Need a blood test? The machine has broken, so there won’t be any results until further notice. Need an ultrasound? Sorry, the radiographer is on annual leave for six weeks. You child’s got meningitis? We don’t have the facilities to diagnose what bug is causing it. We probably wouldn’t have the antibiotics you need anyway, so we’ll give you the best we’ve got. Had a stroke? Maybe it was caused by atrial fibrillation (a heart rhythm disturbance) but we don’t have an ECG to check. Got a wound? It’s gauze, gauze or gauze for dressings, cut in lengths from a big roll in a very non-sterile manner, counted out on the nurse’s desk, and wrapped into paper parcels. Need a bandage to hold it all in place? There’s none on the ward, try the operating theatre, who suggest asking pharmacy. Pharmacy haven’t had any in stock for weeks. Don’t know when they might arrive.

I have seen parents, patients and relatives get angry over such trivial things in Western hospitals: a less-than-pristine bathroom, hospital food, the doctors being late on the ward round, a physiotherapist not performing treatment exactly the way they like, a wait for government funding for their mobility equipment, their favourite nurse being assigned to another patient. I wonder how long it would take for their attitudes to change in a place like this. Our children’s ward doesn’t have functional toilets, so the kids pee in the sink. Some taps in the maternity ward leak with such veracity that the staff have jammed a length of hose on the ends, and shut them off (mostly) with surgical clamps. The baby bathing sinks don’t work. Some of the ward bathroom areas don’t drain, and are constantly wet, scummy and slippery (arrgh, falls risk). The patients have to bring their own crockery and cutlery to hospital, and the food (every day) is rice, greens and a little bit of tinned tuna, maybe a slice of pawpaw if they need a special diet. There are only two or three nurses (not all RNs) looking after twenty-plus patients, and that’s providing everyone shows up for their shifts. People don’t have telephones to call in sick, or to get shifts covered, so it might be just one nurse for the ward that day. A patient is admitted with a neurological condition (undiagnosed) that has left her with lower limb paralysis, but we don’t have any wheelchairs to give out (although the village environment is not appropriate terrain anyway). Her daughter will have to keep lifting her on and off the floor where she sleeps.

There are a hundred frustrations every day, but there are rare and thrilling moments where we can help someone who wants to be helped, and make their life better. One was just last week, where Steve, Willie (Steve’s local trainee prosthetist) and I discovered the husband of our amputee patient had had a stroke recently. He was discharged from hospital with a pretty severe weakness of his right arm and leg. Steve and Willie rigged up a device (made from an old tyre inner tube) to help lift his foot, and almost instantly, he was able to walk by himself for the first time since his stroke. He is working on a therapy programme I’ve given him, and we will see him again at the end of this week.

Recently, I had a staff member come and see me with acute sciatica after injuring her back the previous evening. After about fifteen minutes, all her leg pain had gone, and she had only a little central back pain left. She was quite bewildered (and, to be honest, so was I!! As you know, I’m not a musculoskeletal physiotherapist, so it was very exciting to have someone respond so brilliantly, even better than the textbooks. It doesn’t usually happen here, as people abuse their spines in a very long-term way, and therefore take a long time to improve.) She has been doing her homework, and continues to recover well.

We hope you have enjoyed this short visit to our workplace, and will return soon.

Thursday, 20 March 2008

Sarah's stay


Sarah’s guest blog entry should have alerted most of you of a new presence in our environment. Yes we had the great pleasure, of Sarah sharing our humble abode. We have offered to write references for future flatmates if required. Inside info includes frequent evenings beginning with dinner (she is still an apprentice in this area although the total master of Banooffee pies!), accompanied by pleasant and stimulating conversation. Then one would look at the clock to find it 10:30 pm! Therefore we recommend that if you need to study or work after hours flatting with Sarah might not be the most productive move.

Alas we do confirm Sarah’s suspicions of Steve and gambling but she neglected to mention her own skills at this game. The verdict is still out on Sarah’s poker playing abilities – did her two wins and second runner up indicate a skilled professional or lucky flukes? Is the reason for her always being three stages behind the rest of us a cleaver screen to lull us into a false sense of security, to disrupt the flow of the game, replace the ‘poker face’ with a ‘ditsy face’, just the way she plays (and quite successfully too!), or does the delays in response allow her time to receive her next instructions from her controllers via sophisticated camera and microphone systems? Well, as the phone is unreliable, I’m sure the communication and technology systems here will prevent the latter one from working.

One afternoon Rob, Sarah and I made our way up to the Telekom tower one of the prominent landmarks of Auki. The two Telekom workers appeared bemused when they understood we were wishing to climb the tower, they had yet to do this and it wouldn’t be anytime soon. With their permission (Rob had already got their boss’s permission earlier) we started up. You will be happy to hear no incidence occurred although OSH kept ringing through our thoughts as we descended with shaking (from tiredness) arms and no safety equipment. What a thrill and what a view!!! Great time had by all. Big Thanks to Telekom Auki for an adventure of a life time!

One of our last memories of Sarah is walking down our extremely steep road to the Ute awaiting to convey her to the airport. Laden with two heavy bags (mainly her books – thanks from bring them!) one side and the other with hot buttered jam toast. Next thing she slid over without using her hands to stop the fall! We were wondering if it was an attempt to stay longer (too injured to fly etc etc) but it appears she just couldn’t give up her toast!
Thanks again Sarah for coming and visiting us. We look forward to having you at Rob & Lara’s in NZ!!!

Wednesday, 19 March 2008

Life with a Knife

I remember some ripplings in the media recently about kids being overprotected in Western countries, and the adverse effects on their lives, their motor skills for example. Here in the developing world there are no such concerns – small children climb large coconut trees, walk barefoot through the jungle, and wield fearsome, curved blades known as bush knives. Yes there are a few tendon injuries and infected flesh wounds, but for the most part, Solomon Islanders are very handy with a machete, and they like to start them early.
Our little neighbour, Casper (we may have told some of you about his spectacular, vocal-cord-shredding tantrums, sometimes at three in the morning, other times, just three in a morning) couldn’t be more than two. He shuns clothing, for the most part, but loves to accessorise his minimalist look with a bush knife. The blade is almost as tall as he is, but he swings it quite handily at marauding weeds with no adult supervision. This is not an uncommon sighting here.
In fact, I am seeking advice and supervision from one of the local kids on how to use my small knife to open green coconuts. She has helped me out in the past where I have failed to breach the shell, and I am copying her technique but I just can’t do it like her. Fiona is about eight, I think, so I guess she has about eight years more experience than I do…

On the way to the hospital, I often ride past a few young guys on the side of the road, stopping for a chat, and leaning on their bush knives as they do so. When they all look up and call out “hello”, it is hard for someone from our safety-conscious culture not to be a little alarmed. It is, however, quite a normal thing here, and it is usually people without bush knives that I find more intimidating.

At the hospital, the national psychiatric unit is next door to the physiotherapy department. It is surely the only psychiatric unit in the world where the patients are allowed to wander around with 55cm machetes and open gates. It’s all in the name of gardening, you see, as everything (especially weeds) grow at a scarcely-believable rate. With a bush knife, you can “mow” the lawn, hack back the encroaching jungle, and dig small weeds out of the ground. And that’s aside from the myriad other uses – opening coconuts, husking green coconuts to drink, cutting down trees, and of course, general brandishing by children. We have also embraced life with a knife, in fact we have two – a large and a small one, for all our daily needs.

Monday, 17 March 2008

The promised entry - guest blog

Guest blog: Sarah Wattie (Kiwi/ Wellingtonian)

Well, it is my last night in the Solomon Islands and although relative peace has returned to the country, I remain in fear as Rob, Lara, Kelly and Steve have threatened that should I forget to fufill my blog obligations, there will be trouble. What this means and what they would actually be capable of is a humorous thought, since I am already in Honiara and they are stuck in Auki, devoid of transport and communication with the ‘Other Side’...

Despite their dictatorial stance towards blog duties, I will dearly miss the lot. After six weeks they are well and truly wontoks, Solomon Islands family and great mates.

I stayed with the romancing Rob and Lara, who looked after me like I was a daughter of their very own. Rob took it upon himself to give me a hard time, keeping my confidence at a healthy level. In my opinion, he asks for trouble. One moment springs to mind. We had just enjoyed a cleansing swim in a beautiful river ninety minutes uphill from Auki. Rob sees a pile of sawdust. Normal people would continue on un-phased, if they even noticed it in the first place. Rob however is a bit special and forgetting about his adulthood, took a running leap and jumped straight in, rolling around like a small terrier. Head to toe covered in peachy sawdust. From then on it was Rob a.k.a “crumbed fish.”
Lara on the other hand is a readaholic. She is perhaps the worst case I have come across. I must have known because I packed 15 sizely books into my Solomon’s luggage and she motored through them all! Rumour has it (source: her husband) that when they first arrived, she was down to one book and had to ration the pages. Suffering from withdrawal symptoms she began pacing back and forth in the lounge, lost, directionless. Things are improving but we are not sure that “handing out” books is the solution to the problem. We are worried it may lead to a further entrenched dependency (with Lara asking for more and more books) but there is no easy answer.

Steve on the other hand has tendencies to gambling. It is a good thing we play with chips. If he and Kelly weren’t volunteers there could be room for concern. Always the first to casually suggest a night of poker and next thing you know, game on! It is man against man, in a battle of skill, risk and courage. They say in a developing country it is all about relationships, but there is no room for relationship-building here. On a positive note, he is a really helpful bloke. I have problematic toes (rather knobby and lanky) so using his talents in prosthetics; he gave me some firm but fair advice over one of Kelly’s beautifully cooked meals. You see, it might sound weird to you but the air in the Solomon Islands encourages conversation and lots of it and one easily forgets their inhibitions, resorting to engaging debate on toes and other quirky matters.

I know I know, I am going on and on and I haven’t even mentioned Kelly yet. Please don’t make a big thing of this but a couple of times Rob, Lara and I had to baby sit her while Steve was in Honiara. Babysitting a mid-twenty year old is an interesting job, requiring quite unique skills. It was a first for me but actually rather fun and I am wondering whether there is any employment in this area back in New Zealand? I don’t want to paint the wrong picture though… Kelly shows much maturity in other areas. She is a dedicated, hardworking and intelligent woman (making babysitting an intimidating job at times) so this should not remain too much of an issue.

Now that the truth is uncovered, you might be wondering what my business is, perhaps even thinking that this is all a bit cheeky? All in love, all in love. I may have even exaggerated a little.

My business in Auki for the past six weeks has been as a World Vision volunteer for the peace building project in Malaita. This has been a huge time of growing, learning and broadening my horizons. I have been honoured to share many experiences with team of other Solomon Island peace faciliators. However I will leave the details for another blog.

For now, Rodliea to the Solomon Islands and to the famous four (Rob, Lara, Kelly and Steve). So many fond memories and you will be in my thoughts and my prayers always. :)

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