Thanks and goodbye

I'm sitting at the airport about to head off to Brisbane and then home for new year's eve. The weather has been very stormy over the last few days. The thunder normally comes within half a second of the lightning and is so loud you can feel it in your chest. If you are unfortunate (or stupid) enough to be out when the lightning strikes it is so bright (or close) that you are flash blind for several seconds. It's actually hilarous. If you are on the street everyone stops walking for a short time until they can see again. So with the weather comes an absence of phone and internet, so no recent blogs.
Thaks to everyone who read and commented. Its been great to know there are people out there also appreciating my experiences here. I'll see you all soon.

Andrew

Christmas eve

Christmas eve was a night of mixed emotions. I had dinner with some colleagues at the King Solomon hotel followed by a display of traditional dancing. We've been quite busy right up to christmas, and in reality its just another day - the hospital remains active and retrievals are just as likely. It seemed to hit all of us with family and loved ones at home that we were going to miss them on christmas day which was a bit sobering. Fortunately we managed to find ways to reverse the sobering effect of isolation.

The dinner was very nice, particularly for those who enjoy seafood. As well as lobster, crab, sevral kinds of oyster and five different fish there were several sea creatures I don't think I've ever seen. After dinner the dancers came out. In the three weeks I've been here I have only learned so much about the Solomons, but it struck me that neither the dancers nor their costumes were from the Solomons. Having seen (and I have to admit joined in) some traditional Solomons dancing I was quite sure that the dance style was foreign. To me it looked like something from Hawaii.


I asked one of our local employees, Tina, who found this very amusing. The dancers, their costumes and their dance (and Tina for that matter) were Gilbertese. I pride myself on geography, but I drew a complete blank on that one. It means they are from Kiribati (pronounced Kiribas) which is the local word for the Gilbert Islands. These are a series of tiny coral atols that sit on the equator north of the Solomons.





Kiribati holds the dubious distinction of being one of the first nations to begin complete evacuation as a result of rising sea levels associated with climate change (though our recent Prime Minister might contend they are just faking it for sympathy - really, who would want to live on a palm fringed Pacific atol in peace and harmony?) The rising sea level causes the precious ground water to become saline thus making all agriculture impossible. In this way low lying nations become uninhabitable well before they are completly inundataed.

Although these people are being forced against their will from their country by environmental factors Australia does not yet recognise the concept of an Environmental refugee. In an infinitely more generous and community minded gesture the Solomons has donated an entire island to the Gilbertese for their repopulation. The Solomon Islands is a country that itself needs assistance to reestablish its courts, police and general stability and it appears to be showing more understanding and generosity than the country assisting it.

The medical facility

It's been pointed out to me I haven't talked about my place of work. The medical facility provides all medical services to members of RAMSI and also about 900 civilians on the "dependants list" These include members of the various high commissions etc. As we provide for all medical needs there is a Primary Health Center (PHC) which has two GPs, and Dentist and assistant and a paediatric nurse. The Paed. nurse also holds clinics weekly in the large (6000) quasi refugee camp called Burns Creek just outside Honiara where the less-than-welcome Malaitans live. Also within the PHC is a medical laboratory where almost all tests are carried out in-house. Unusual or particularly complex tests are done in Brisbane with samples sent twice a week.

We have a 10 bed hospital ward including two isolation rooms for contagious patients. This is constantly staffed by two nurses and a doctor. These areas are supported by a pharmacy, store and laundry. As well as the ward we have a resuscitation ward with two bays. In this area are the paramedic and management offices.

The facility also has an environmental health division which constantly samples and tests the water, food and environment. They investigate sources of disease and run mosquito control programs each evening.

At the centre of the medical facility is a very impressive, multi million dollar expanding semi-trailer affectionately known as Lorna. Lorna is a mobile surgical theatre allowing major invasive surgery. Also within Lorna is a radiography suite for x-rays and a one bed intensive care unit/recovery area.

The last (and if you ask me most impressive) part of the facility is off base. That is my ambulance, 12 tonne SuperPuma helicopter which is capable of carrying four patients with two medical staff. We also have access to a 2 Bell412 (Iroquois) and a Twin Otter fixed wing aircraft.

A rough list of staff include (in no particular order)...

1 Surgeon

1 Anaesthetist

1 Aeromedical evacuation doctor

2 GPs

1 Dentist

1 Dental assistant

2 Theatre nurses

2 Intensive Care Unit Nurses

4 Ward nurses

1 Paediatric nurse

1 Public health nurse

4 Paramedics

2 Environmental officers

1 Medical scientist

1 In-country Manager

1 Deputy In-country manager

As well as these people the true backbone of the medical facility are the Locally Employed Contractors (LECs) Amongst these are Laundry ladies, receptionists, executive assistants, gardeners, ambulance drivers and security men who guard the houses of those not living in the King Solomon Hotel.

Finally a little about my job. My principal role is to conduct and manage Aero Medical Evacuations (AMEs). I work with a Doctor who is really good at recognising that he has a set of medical skills with which I assist, but he is not a scene manager or communications officer. As well as assisting the doctor with stabilisation, treatment and monitoring of the patient I liaise with the aircrew, air traffic operations center (ATOC), in-country manager, patient and anyone who may be at the landing zone. Additionally during recent times of trouble we paramedics have been stationed remotely at sites identified as trouble spots such as the Prison, Parliament House and the recently burnt down and rebuilt Casino Hotel (Chinese owned). There we established landing zones, coordinated AMEs, triaged parients and provided situation reports. When not busy doing all of the above (or emailing for hours on end) we assist on the ward.

The photos below are...

1. The evening fogging for mosquitos - I'm reliably informed it probably isn't DDT

2. The outside of Lorna

3. Lorna's operating theatre

4. My ambulance in its garage

The earth did move for me!

The Solomon Islands registers about a dozen earth tremors a day. Most of these are too subtle to even be felt, however with such a high frequency significant ones still occur regularly. They are not all the same sensation either. Some are very sharp and others a gentle movement.

A week ago I was in the toilet when I felt a distinct wave move under me like a burrowing mole in a dDisney cartoon (no that was before the Dengue). Some days before that, I was reading a book by the pool at the hotel when I felt what I assumed was a person walking towards me on the timber decking. When I looked up there was no one there - another tremor. Soon after I arrived there was a sudden jarring of my hotel room like a car backing into the tall pylons on which the front of the rooms sit (the hotel is so steep we get to our rooms by cable car).

Today I was about to go to sleep between night shifts when I felt a doozy. The first indication was a teaspoon on the bench opposite me bumped several centimeters and fell on the floor. I was lying on my side and in seconds I was being gently but forcefully rocked back and forth so much I was nearly rolled on my back, I had to brace myself. It was like someone was trying to repeatedly lift one side of my bed up. Clothes swayed in the open wardrobe and the louvre windows rattled closed. This went on for about 20 seconds. Then it started again but this time like there was a jack hammer being pushed up under the floor. Where before it was a slow ryhthmic rocking, now it was a rapid shuddering. Given the precipitous slope the hotel is on I had mad plans for such an event. I was going to run for the back door and step our onto the bank to avoid sliding down the hill in my room. When it actually happened I was so curious and terrified and amazed I just lay there and watched everything happeneing. Footage of earthquakes gives you no indication of exactly how much you can really see everything moving.

When I got to work tonight I asked my Ambualnce driver, Sossimo, if that was a bad one. He told me it wasn't too bad because there wasn't any thunder. When big ones occur (anything under 6 on the richter scale is considered a tremor here) you can hear them coming like thunder. He also pointed out that its only bad when people die. In April this year a quake casued a local Tsumani which killed dozens and left many more homeless.

Dabbling with Dengue

I should mention before I go any further that those of you who do not want to read about gastrointestinal illness should skip this post.

Right, those of you following my trip will notice I have not posted anything for a short while. The reason for this is there are no power points in the toilets and so I was unable to use my computer. (I'll disinfect the computer thoroughly before returning it dad). I was at work the other day, feeling fine, when I was suddenly struck by an unmistakable feeling. It was the sort of feeling that says "you have 10 seconds to find a toilet". I won't go into too much detail but what occurred ten and a half seconds later was one of the most explosive episodes of what we clinicians refer to as runny bum it has ever been my misfortune to experience (and I've been to Africa!) Between mid morning and mid afternoon I had another 25 or so similar episodes.
During this time I managed to drink about 4 liters of water which I hoped would compensate for my fluid loss. Not so. As I got up to go home, very grateful I didn't have to fly anywhere in the helicopter that day, I inspired a look of fascination and fear in my colleagues. I was told afterwards they could literally see the colour drain from my face. I couldn't tell because my vision was narrowing and my ears were ringing. I didn't actually pass out, but I certainly went very wobbly and lay own very quickly. Either way it was a poor time to vomit, but vomit I did.

It was decided I should be admitted to our hospital for the night. For the clinically minded I must have been fairly dehydrated because my blood pressure had dropped by 40mmHg and my resting pulse was 110bpm. Blood was taken for testing, and IV drip was put in and I received 3000mls of fluid overnight as well as Maxalon AND Ondanzatron (anti vomit drugs).

During the night I had a fever, which along with the dehydration and the doxycycline I'm taking to avoid malaria made for some amazing dreams. actually couldn't tell when I was dreaming and when I was awake. At one point I must have dreamt I had an episode of the squirts in bed then woke without realising it. I was so embarrassed I got up to change my sheets and then couldn't find the mess. The nurse thought I was totally nuts when she came in.

The blood tests showed I had an exposure to Dengue Fever. This doesn't mean I really had it, but I'd been infected with enough of the virus (transmitted by Mozzies much like Malaria) that I had produced antibodies and some symptoms. True Dengue also produces a bright red rash, excruciating pain behind the eyes and in all the skeletal muscles, hence its WW2 names Break-bone fever and bonecrusher fever.

By morning it was largely over and I was sent back to the hotel to rest and drink lots of water. I came to the Solomons to sample as much as I could but this was one experience too many.

It never rains, but it pours!

The southern hemisphere summer is the wet season for the Solomons. Actually this should be called the marginally wetter season because there is very little difference. When I arrived in Honiara it hadn't rained for a week and there were dramatic water shortages. The town water was running for about half of each day, so reliant are they on regular rain. As I may have mentioned in an earlier post, Honiara receives between 3000 and 5000 mls. of rain a year. It's pure speculation because there are no weather stations in the highlands of Guadalcanal, but rainfall there is assumed to be nearer 9000 mls. a year! The observant visitor will notice storm drains through town and at GBR that are commonly 2 meters deep and three wide. These can fill within a matter of minutes of rain starting.

We've had two rain storms in the week I've been here, the second one is continuing as I write. All the locals I've spoken to hate and even fear the rain because when it starts at this time of year there is no knowing when it will stop. Apparently the storms will increase in frequency through December until it just doesn't stop, for a month! That's right, it will eventually rain day and night for about 30 days.

At this time the populations of the outlying islands who rely on their food gardens endure a dangerous period. The ground becomes so saturated trees fall over without warning. Landslides on the precipitous hills are common and work in the food gardens becomes impossible. Many of them literally disappear underwater. As a self sufficient islander part of the preparation for this rainy season is to ensure you have enough food stored to last a month without harvesting any more. To me this seems ironically similar to the preparations made in countries bound by snow in winter.

The lawn at GBR within minutes of the rain storm

AME postscript

After we had loaded the lady with obstructed labour into the ambulance and sent her off to the National Referral Hospital (known as number nine after the American base of the same name situated there during the war) I realised she had left her umbrella behind.

So today I went to number nine to give it back and see how the delivery went. Number nine was probably built soon after the war and despite valiant efforts looks like it hasn't progressed much since then. Our anaesthatist works there one day a week as a donation of labour and says that clinically they are top notch. They do not have much modern equipment and lack a lot of the more fancy drugs but they perform major surgery and care for a huge number of patients.

The whole hospital is single story so it sprawls over a large area on the waterfront. I entered with some trepidation and after asking the way half a dozen times found he post natal ward where I was greeted very warmly. The mother's aunt - who was probably 15, quite abit younger than the mother - ran over and proudly led me through the ward of about 20 women to her niece and new baby. Both were doing very well and it took some insistance to stop the mum from getting up to shake my hand (it was under 24 hours since her caesarian section). With her permission I took a photo of the two.

My first flight

Only two hours after starting my first shift I was called out on an AME (aeromedical evacuation). I must confess I had planned to pull all my equipment apart and examine what was where but beggars can't be choosers. My local drivers and I filled the ambulance with a small mountain of equipment and we drove out to the airfield where we met the AME doctor with whom I work.

Normally we would fly in the giant Super Puma helicopter but this had been tasked to another job so we reconfigured a Twin Otter "fixed wing" aircraft with our equipment and took off for Kirakira on the island of San Cristobel, 200km to the southeats of Guadalcanal. The fight was smooth and the views were absolutely stunning. As the Otter is unpressurised we flew at only 9000 feet which allowed a great opportunity for pictures along the way. The temperatutre at 9000 feet is also a lot less so we were able to cool off a bit too. Humidity hovers around 100 percent so even the slightest effort results in torrents of sweat. Reconfiguring the aircraft had our eyes stinging with our perspiration.

As we apprached the grass strip I was a little surprised to see firstly how short it was and secondly that both ends were bordered by coast! The Otter takes off and lands in a very short distance and thankfully we had a little to spare. The fact that the grass was at least knee high also increased our decelleration after landing.

Our patient was a local woman who had been in labour for 18 hours but was unable to deliver. As we pulled up she jumped out of the back of an old 4WD and marched up the stairs. Solomon islanders are very tough people. We secured her on the stretcher and took off again. She required a caesarian section at the National refferal hospital and we didn't want to waste time. As is all too often the case her firrst and only child had died at age 5 from a tropical disease so there was a lot riding on the successful delivery of her second child.

The flight was uneventful. Her blood pressure was very low after so long in labour so we put a drip in her and gave her some anti nausea medication as a precaution. When we landed at Honiara we trabsferred her to the waiting ambulance and she was taken for an emergency C-section. All the while her heart rate was 120, indicating both a low blood pressure (which we raised with the drip) and a significant degree of pain. She declined any pain relief and at no time did she complain. If it were not for the presence of RAMSI and their willingness to use their resources for the local population (technically we are the medical support only for RAMSI personnel) she would have almost certainly died during an unsuccessful childbirth. It is an interesting feeling, a mixture of elation and humility to have almost certainly saved a couple of lives.

Hooked on rice

All pacific nations rely heavily on carbohydrate in their diets. Plants such as cassava, breadfruit and yam grow readily and are farmed extensively in small gardens. The high rainfall and warm climate mean that self sufficiency in these crops is relatively easy. Unlike many of their neighbours, the Solomon Islands have largely turned from these indigenous crops to an exotic source of carbohydrate – rice.

Opinions vary as to why this has occurred. During the Second World War there were large numbers of Japanese troops occupying many of the islands and this was probably the Solomon’s first exposure to the new food. Shortly after the Japanese occupation bloody fighting resulted in even larger numbers of American troops occupying the islands. Interestingly they too were eating rice as it was a compact, long lasting source of energy. Regardless of the initial cause, the Solomons largely turned away from their traditional foods and embraced rice as a staple.
Recently the cost of rice has risen dramatically. Almost weekly increases have seen the cost of a 20kg bag jump from $75 SBD (Solomons Dollars) in 2003 to $120 SBD today. As a reference the average wage is about $32 SBD a day.

Rice has not just been adopted by the urban population either. Outlying islands, of which there are many, also rely heavily on the imported food. Because of high fuel costs and limited, primitive transport a 20 kg bad of rice can cost these people (who earn much less) as much as $170 SBD. Increasingly high food costs have caused even more migration from outlying islands to the capital, a source of much recent ethnic tension.

Such increases have resulted in divided attitudes regarding a solution. Many young people, tired of what they see as the destructive influence of western trade, would like to see the price rise as a motivator to return to self sufficiency. One young cassava seller in the market told me

“I think it is a good thing that prices of rice is increasing as most of us residing in Honiara are too dependant on rice, therefore we never make our own gardens or eat other local produces. Maybe this will make people think and stop relying on rice too much and start considering other food crops.”

Government campaigns promoting national pride have encouraged this attitude which is ironic because the government has quite a different solution in mind. Rather than encourage a return to native crops, the experience of some African nations is being used as an example from which they might learn. Rice was initially farmed in Uganda with poor results until a strain known as Nerica was developed. This suited the local environment and produced much greater yields.
Government corruption (which is rife) means that any profit making industry will be encouraged in favour of self sufficiency. The government wants to engage private firms to start farming rice locally. While this would remove much of the importation costs and potentially lower retail prices it seems inevitable that it will be yet another target for corrupt government practices.

Local deliveries of rice being carried out with typical seriousness.

Honiara - first impressions

Honiara is a small typical Pacific nation capital. There are few buildings more than 2 storeys high and basically two parallel streets, one along the shore and one just inland. Behind these the hills rise very steeply. There is massive unemployment (one of the contributing factors to the recent troubles) and a very low average age (about 15 I think) For this reason the streets are quite crowded with homeless and unemployed young people just wandering around. The life expectancy is only in the 50's so old people are a rarity. I was greeted by an elderly gentleman yesterday and I asked him in my newly learnt pidgin "you how?" he replied "I'm getting quite old"

The weather is very humid with a constant smell of smoke - setting fire to the rubbish bins seems to be the standard method of rubbish removal. I don't like to impose my western values too much, but despite the incendiary rubbish scheme the place is filthy. Compared to towns I've visited in Fiji and Vanuatu it is much worse. Betel nut, a mild narcotic is chewed my much of the population. This involves chewing the nut with hydrated lime and spitting the bright red result EVERYWHERE! - walls, floors, footpaths, occasionally unfortunate passers by. Plastic bags, the cancer of the developing world, are everywhere.

In the centre of town on the seafront is the market. Its a fascinating display of all that is available locally, from flowers to fish. Last year it was the site of some nasty tribal revenge involving machetes and limb removal. Now it seems quite calm, although the ever present RAMSI patrols are a regular sight here.

My month here should be quite interesting. On the 13th the goverment is going to hold a vote of no confidence in the prime minister (who wasn't really elected anyway). We will probably go into "lock down" which involves moving from our hotel to the RAMSI base - GBR. Here we will be living in tents which I am not looking forward to. In my next blog I'll give a bit of a description of GBR and the medical base there.

Nice weather!

Now I've got my mum worried I might as well talk about the weather. The Southwest Pacific has two seasons effectively. Cyclone season and not cyclone season. Cyclone season is October to May when the water is warm. They usually get 2 cyclones above category 3 and a heap of smaller storms. Thunderstorms peak between December and March.

Tropical cyclone paths

Added to that there are earthquakes fairly regularly. One last year (magnitude 8.1) caused a 5-10m high tsunami. 900 homes were destroyed and over 50 people were killed.

Earthquake locations

If we go flying it may be a bit bumpy. It may also be a bit sticky. Each day is 27-30 degrees. In fact the average mean daily temperature only varies by 2 degrees throughout the year. Humidity also remains fairly constant at above 80%. Annual rainfall is measured in meters - anywhere from 3 to 9. December is a transition month for the equatorial trough, (I have no idea what this is), what it means is a time of "exceptionally heavy rain".

Every time I've travelled in the tropics I've consciously thought "thank god I don't have to work in this weather!" I have to say I am not looking forward to the constant perspiration, drinking water, feeling drained cycle. It often takes a couple of weeks to acclimatise to the change. Here in Adelaide its unseasonably cool, in the 20's which is no preparation at all.

The Reason for RAMSI

In late 1998 many people on Guadalcanal became unhappy with the number of people arriving from nearby Malaita. Militant locals began a campaign of intimidation and violence resulting in the sudden migration of thousands of Malaitans back to Malaita or to the capital Honiara. Over the next year the country spiraled into anarchy. A four month state of emergency was called. The president was kidnapped by the opposing militia, the colourfully named Malita Eagles. A new president, Manasseh Sogavare was elected with half the cabinet kept away from the vote because the Malaita Eagle force had taken over the military police. A peace agreement was signed in 2000 but by then the government was completely corrupt and out of control.

One Malaitan leader, Harold Keke, didn't sign the peace agreement and continued an all out guerrilla war. Locals in the Western province also began attacking Malaitan settlers. This resulted in the involvement or rebel members of the nearby Bougainville Revolutionary Army becoming involved. Rather than keep the peace they made a significant contribution to the violence.

By 2003 the Solomon Islands were an official "failed state". Honiara was completely lawless, ruled by gangs and witness to many atrocities. The government called for support. In July 2003 the 2200 troops and police led by Australia and New Zealand arrived as RAMSI - the Regional Assistance Mission to the Solomon Islands. About 20 other Pacific nations contributed troops or police in what was quite a new regional peace keeping initiative.

Law and order was gradually restored and an enormous number of guns and weapons removed from the community. Work has continued restoring the parliamentary system, the judiciary, the police and prisons and general utilities.

In 2006 simmering tensions were set off by allegations the newly elected Prime Minister, Snyder Rini, had taken bribes from Chinese businessmen to influence ministers. Rioting broke out very suddenly and the Chinatown district of Honiara was burnt down. More troops from Australia, New Zealand and Fiji quelled the unrest and the Prime Minister resigned.

Manasseh Sogavare was elected and is still the Prime Minister. He has been openly hostile to Australia and the RAMSI force, expelling the Australian High Commissioner on charges of interference with internal matters. In return the recent Australian Foreign Minister Alexander Downer openly criticised Mr Sogavare and suggested he was corrupt in the Australian media. Relations soured further when Australia requested the the Solomon's Attorney General, Julian Moti, be extradited on child sex charges.

The Australian Government currently recommends a High degree of caution when travelling to the Solomons. While law and order have been restored it is not clever to be out in Honiara after dark.

Where?

The Solomons are part of Melanesia and one of Australia's closest Pacific neighbours. The Nation, which gained independance from the UK in 1976, comprises nearly 1000 islands. More than half of these islands are uninhabited. The capital is Honiara where I will be based and has a population of just over 50,000, or 10% of the national polpulation. English is the official language of the Solomons, however only about 2% of the population speak it. The lingua franca is Solomons pijin. There are about 71 local languages also spoken throughout the islands.

Welcome

Welcome to this, my first attempt at blogging. I am one step off being a card carrying computer illiterate so this will be an adventure for all concerned. I have decided to keep a diary of my month working in the Solomon Islands as a retrieval paramedic, and thought this would be an easy medium for all to see and read about what I am up to. I am now a week away from flying out from Adelaide, South Australia and as yet, other than buying some light weight pants, establishing this blog is the most preparation I have done towards the trip. Stay tuned for more posts.