For tourists the Solomon Islands are all about sandy beaches and azure lagoons –but behind this glossy exterior life can be tough, and the nation faces a raft of socio-economic, environmental and healthcare challenges.
With a population of 515 000, the archipelago is the world’s second most aid dependent nation with 61% of its revenue based on overseas support. Its health statistics reflect this, with high birth rates, high infant and maternal mortality, and 22.7% of people living below the poverty line.
When RCS Coffs Harbour student Grace Edwards landed in the Solomon Islands for her four-week medical placement, she knew she was on the adventure of a lifetime – but she also knew she would be seeing realities far removed from water sports and high-end resorts. Here is her story:
Grace split her four week posting between Marovo lagoon, in the north-east of the archipelago, and then at Gizo Hospital in archipelago’s Western Province.
Here we will focus on her time at Marovo Lagoon.
Marovo Lagoon is a tropical paradise. Known as the world’s longest saltwater lagoon, its waters teem with brightly coloured sea life, and the lagoon is a top diving spot for visiting tourists.
Despite this, locals often struggle to make ends meet, working as subsidence farmers and fishing, and healthcare can be a luxury for most of its 6,000 inhabitants.
People need easy access to healthcare services to maintain continuity of care, and Grace quickly realised that this wasn’t an alternative for many of the Marovo locals.
“Many locals live in small villages that are only accessible by boat,” Grace says. “For them it’s tricky to reach healthcare services.”
“So, often nurse aid posts are their only option,” she says. “These clinics have basic medical supplies and are staffed by a nurse – often only one nurse lives in the community so they are the sole provider 24/7.
Patients are funnelled through this system to the clinics staffed by doctors, to the nearest hospital, and then if required on towards the provincial referral hospital, culminating in a referral to Honiara Hospital.
But for the last eight years, a small group of American and Australian doctors, nurses and theatre staff have been visiting the lagoon twice a year to provide further much needed healthcare to locals. They always return to the same villages, often seeing the same patients and providing a form of continuity of care. Grace joined this group of medics, called Marovo Medical Tour (MMT), during the first part of her placement.
Working with MMT, Grace got an insight into key areas like basic primary health education, hospital policy, and chronic disease register recall systems.
There’s no doubt that monetary aid and infrastructure projects can help bolster a developing countries economy and its health systems, says Grace.
“But training local health staff, and putting in place clinical guides, protocols and clearly designated roles within a system can be more beneficial and, in many cases, has positive impacts that last long after the aid money has dried up.”
Health records in the Solomon Islands consist of a “sicky book”, a small paper exercise book with a patient’s name on the front that the patient may or may not remember to carry with them to hospital.
“By reading back through these records it became clear the importance of continuity of care over time, such as that provided by GPs,” she says.
“Continuity of care doesn’t necessarily guarantee a quick cure or answer for a malady, but it can provide a working diagnosis that can be adapted over time with a better chance of providing improvement.
“It also saves the health system time and resources, as repetition can be avoided.”
Preventing non-communicable disease is key in populations that have limited access to health services and medications as the progression rate, morbidity and mortality of these conditions is greater than that experienced by a population that has access to secondary and tertiary prevention services, like in Australia.
Simple strategies like basic nutrition and exercise advice help stop chronic diseases such as diabetes and hypertension from developing – and this was reflected in the chronic disease registry set-up by the Marovo medical tour group.
“Patients that were flagged to have chronic diseases such as chronic obstructive pulmonary disease, heart disease and diabetes were sent out letters a month before the clinic inviting them to attend for a check-up, even if they felt well,” Grace says.
“Locals weren’t used to having medical consultation when healthy, but they attended, bearing their letters with a small glint of pride.
“This allowed for review of blood pressure, blood sugar levels, weight, medication compliance and note of any improvement or decline, which was all recorded in a database.”
These patients also joined small group health education sessions that taught them five simple steps to better health:
1. Drink more water.
2. Eat more food from the ocean and the garden and less from the shop.
3. Rice only once a day and no more than a fistful.
4. Walking until they feel short of breath for at least 30 minutes a day.
5. No more salt or sugar, cut it down, don’t add it to food.
“The patients were very engaged with the group learning and could be seen educating their friends and family and even writing out plans for those who had missed out!” Grace explains.
Empowering people like this gives them more control over their own health and can have a long-lasting, community-wide impact.
Some patients who had been coming each year to the clinic were now having medications for hypertension and diabetes reduced or ceased completely due to their healthy lifestyle changes.
“In a country where medication availability is tenuous and monitoring for efficacy and adverse effects is often not feasible, reducing the need for the medication by improving patient lifestyle carries added benefit,” she says.
Grace’s time in the Solomon Islands wasn’t just about work – she also got into lots of fun activities.
“Based at the Uepi Island Resort, we had a great time every night after work, snorkelling, and playing guitar and singing with the local staff,” Grace says.
“We ate delicious feasts every night, like marlin ceviche from a 300-pound whopper that one of the Americans had caught. During dinner we talked about the day and planned for the day ahead.”
Marovo is humid, with frequent short bursts of rain followed by sunshine and blistering heat.
“So I didn’t even bother trying to stay dry,” Grace says.
Despite the constant rain and sometimes confronting realities of the local healthcare system, Grace wouldn’t have traded her experience for the world.
She has an insight into a unique part of the world, its culture and stunning island scenery – and its beautiful people.
First published in UNSW Medicine newsroom. By Joel Katz, based on report by Grace Edward.