We're outa here

Its a quarter past three on my last shift after a bit over three months in the Solomon Islands so I thought I should give you all out there a bit of a wrap up.

In the last short while I've done a couple more aeromedical evacuations, and on both occasions forgotten to take my camera to work that day! The first one was down to Rennel island, an hours flight due south of Guadalcanal by helicopter. We got to fly over Guadalcanal which was great becuase the mountains go to about 6000ft and the cloud was at 5000ft so we had to fly up valleys to get through. Again the 4km deep sea was an amazing sight. I don't think it could get much darker. On this occasion it was absolutely still on the water which made it hard to see where the surface. We dropped down to 1000ft because the pilot said there was an annoying vibration at higher altitude he wanted to minimise. To be honest I thought any vibration in a helicopter wasn't much annoying as potentially life threatening, but that's just me.

Ourpatient was a small child with a possible case of cerebral malaria and her very concerned mum. On these outer islands even Pidjin is limited so explaining what is happening to parents is very difficult.

The other AME occurred yesterday right in the middle of a big 35 patient mass casualty exercise. With all the staff in and soldiers with mock wounds lying in rows doing a very enthusiastic impression of extreme pain and suffering we got the call for a woman in eclampsia at Kirakira on Makira (also known as San Cristobal) 1 hour to the SE. For those interested her observations on arrival were BP 195/145, GCS 12 (occasional seizure activity), RR 38. We successfully lowered her massively elevated blood pressure but I don't hold strong hopes for her 22 week foetus. At least we saved mum who would have certainly died. Sometimes its a little hard to find a positive in a situation.

I've made good friends with one of the local ambulance drivers in particular. Mathew invited Rachael and me to his home to meet his family which was a real treat. The first time we were shceduled to go it got called off at the last moment. I think it was partly because his wife was a bit embarresed about the size of their house and her poor english. But Mathew talked her around and we drove up for lunch. They live in Naha area which is a suburb up in the hills behind Honiara. Their house is a tiny weatherboard building up on stilts with an immaculate little garden around it. Neighbours are packed in around them in similar accomodation, but the trees and bishes everywhere combined with the fact that noone owns cars means it was very quiet. (at first I wondered what looked different about these areas and then I realised noone has driveways or garages. Because of this houses are perched up on hills behind other houses in a way that would be impossible to reach for the family stationwagon)

We met Mathew's wife, 5 year old son and two year old daughter as well as his Grandmother and their babysitter. It turned out that we were the first white visitors they had ever entertained and I think almost the first in the neighbourhood. Several other people lurked in the house and nearby which we weren't introduced to. We brought christmas presents for the kids, a soccer ball and a bucket and spade, and 10kg of rice for Mathew (which is a standard present - rice is a staple and 10kg costs about 15 hours work at Mathew's quite good rate of pay).

Little Tia quickly adopted Rachael's lap and whispered little pidjin things in her ear. Rachael couldn't quite make out what Tia wanted. She kept pointing and asking the same thing. Finally I cottoned on and asked Tia "would you like a ride in the car", "YES" was the immediate reply. I think that may have been a first too. I havent been able to put up pictures of this visit but if you have a look again soon I hope to have some pics of Mathew's family.

So thats about the end of our stay and the end of my stories. We've had a great time, seen a lot and met a lot of really great people. My friend Dave will be especially pleased I had no need to account matters of a foecal nature, infact other than a lot of insect bites we have been very well. If we know you we will see you soon, if we don't know you, well that's a bit weird and I wonder why you are living vicariously through the experiences of strangers. Maybe I'm still coming to terms with the whole blog thing.

Hope you've enjoyed what we've been able to relay to you and have a great christmas

A night at work

Tonight at work has been like a sampler of all the types of work and events one can expect doing what ought to be a quiet night shift here at the Base. Night shifts go from 16:30 until 08:30 the next morning. The night staff comprise two nurses, a paramedic and a doctor. Half the time there are no patients on the ten bed ward and the only jobs to be done are wait for anyone sick or injured to walk in and listen for the Aeromedical Evacuation (AME) phone. Because of this minimal work load we take it in turns to sleep. Tonight we stared with one patient on the ward with gastro.

The first job was called in at about 7pm. It was reported that a female Australian Federal Police (AFP) officer had been stabbed with a pencil somewhere on the base. As a paramedic I know to be wary of initial reports of injuries and to be honest this sounded odd from the start. I had just packed the ambulance with the required gear to go and get her when an AFP Landcruiser pulled up outside the ward with our patient on board. It turned out she was working behind the bar at the mess on base when a pencil had rolled off the bar and lodged, pointing up, in the rubber matting on the floor. The woman had then walked into the pencil, driving it into the dorsal aspect (top) of her foot. In effect she had actually been stabbed with a pencil. Having realised what had happened she pulled the pencil out. At this point she remembered she isn't good with the sight of her own blood (or, dare I say, the sight of a perfectly good HB pencil embedded in her foot) and proceeded to faint infront of the assembled crowd at the bar.

We cleaned the wound, ensured there was no pencil left in her foot and bandaged it up. As she was still feeling faint she was asked to stay on the ward for an hour or two. I found a spare bed in the ICU to get some sleep before my shift.

Soon after I went to bed the base alarms sounded and a voice over the PA asked the Quick Reaction Force to assemble immediately. These are three teams of soliders ready and quite heavilly armed 24 hours a day to respond to civil unrest. A few moments later the AME phone rang to say we should expect quite a few injured police as a result of a riot just outside town. Fortunately the doctor on duty was also the senior medical officer, so as a result of the minimal information and potential for many, potentially serious cases, the Mass Casualty Plan was activated which involves all staff being called in to work.

The four of us raced around doing all the preparations that were required such as drawing up drugs, clearing areas, laying out stretchers, putting the equipment back in the ambulance that we had just taken out etc etc. We knew that it would take at least half an hour for all the staff to get out to the base from town and we also knew the first patients were only about 20 minutes away so time was limited.

The first arriving patients were fairly obvious. Their police Landcruiser looked like it had been put in a giant washing machine with half a ton or river rocks. It had been hit with so many projectiles its surface was similar to a golf ball. Out got five very sweaty, very shaky (but all walking thank goodness) police officers. We got them sat down and triaged them and got some information out of them regarding what was going on. Luckilly they were the only ones involved so we knew we were'nt going to be totally swamped with patients as had been suggested.

It turned out they had gone to a village behind town with a Royal Solomon Islands Police (RSIP) Patrol to arrest an "offender". The village had objected to this and turned on the police. The RSIP officers had got back to their vehicle and drove off. The AFP officers had been cut off from their vehicle and had to withstand a 40 minute attack from all sides by villagers with rocks, machettes and spears. They had their helmets ,ballistic vests and riot shields with them which was probably what saved them. They had sprayed all their OC (capsicum) spray and had discharged all their warning shots from their pistols but the crowd had refused to stop pelting them until the back-up arrived.

Having taked basic observations and assessed them the rest of the medical staff arrived. It turned out the police had been very lucky (relatively). Appart from a lot of bruises and abrasions the female police officer had been punched repeatedly in the head and another of the men had a spear go between his legs, tearing his pants but only grazing his thigh.

Soon after my colleagues had arrived one of the army medics ran into the ward to tell me one of his soldiers was having a seizure in his tent. I extricated myself from the ward, grabbed some gear and went for a quick jog across the base in the dark to the army tents where a very groggy soldier was just coming to. He had just inexplicably fallen into a seizure while sitting around with his mates. I checked him out and, finding no cause for his seizure, had him stretchered back by his mates to the now quite full hospital ward. It turned out it had happened once before so he will be sent off to Australia tomorrow for an MRI scan of his brain.

Most of the police from the riot were discharged within a couple of hours. The AFP decided not to go back to the village until morning so there won't be any more casualties in tonight with any luck. Its now 04:30 and I'm doing my shift waiting by the phone. The ward is quiet now, except for some snoring. I'd quite like it to stay that way.