The Andrew Dent Scholarship is offered each year to health sector students who need support to undertake volunteer work, electives or study trips that aid people in the Pacific Region. Jacinta Carty, a final year medical student at The University of Melbourne, was a recipient of the Andrew Dent Scholarship in 2010. Her account of his time spent in Vanuatu is included below.
Northern Provincial Hospital Luganville, Santo, Vanuatu by Jacinta Carty
I embarked on my four week elective to Vanuatu with much excitement and some trepidation. From the moment I arrived in Santo I felt welcomed. Though the humidity and insects took some getting used to, I quickly settled into my new island home.
The Northern Provincial Hospital services a large population, as it is the only major health care provider for all of the northern islands in Vanuatu. It has approximately 100 beds, and houses a medical, surgical, tuberculosis, paediatric and maternity ward. There is a small emergency department and general, paediatric and ophthalmology outpatient clinics.
The infrastructure of the hospital was quite impressive, particularly the laboratory which was very modern and air conditioned. Not surprisingly, however, it was very different to an Australian hospital. There were no fans in the wards, with relatives or patients having to fan themselves in order to get relief from the oppressive heat. Babies on the paediatric ward were on adult sized beds and it was not uncommon to see rodents in the corridor.
My time in the hospital was divided between the emergency department, outpatients, paediatrics and maternity. Each morning I would attend the paediatric ward round, where I saw many interesting cases and the most gorgeous children, who despite all they were going through were the happiest kids I have ever seen.
One particular case which stuck with me was that of 11 month old triplets from Pentecost, an island about 150km from Santo. One of the triplets died when she was a few months old after being given some traditional medicine for a febrile illness at the village dispensary (small nurse/nurse aid run practice). The two surviving triplets were admitted due to severe anaemia (Hb of 20mg/L and 50mg/L) and failure to thrive. They received blood transfusions and had several blood tests to try to elucidate a cause for the anaemia, but were eventually discharged without a diagnosis. Worryingly, they were discharged on a multivitamin only and did not have any follow up care planned.
The remainder of my days were generally spent in outpatients. Initially I sat in with some of the local nurse practitioners, who essentially act as doctors (there is no medical school in Vanuatu and hence very few Ni-Van doctors). After a few Bislama lessons, I started seeing my own patients along with Amy, a fellow medical student. It was a fantastic experience and really improved my confidence. We evaluated each patient, ordered investigations as required (limited to basic blood tests and xray) and prescribed medications. We saw many cases of malaria, musculoskeletal problems and respiratory infections. There were also many patients who presented for ongoing management of hypertension and diabetes, a growing epidemic in Vanuatu.
The emergency department was often quiet but an interesting place to spend time. I saw some severe cases of malaria, burns and injuries. Perhaps the most disquieting experience I had was on my first day in the ED. A young boy was brought in by relatives as a stone had been thrown in his eye and he had severe eyelid lacerations and had possibly fractured his tarsal plate. He was given no pain relief or sedation as he suffered through 13 stitches. As he screamed out in agony each time the needle went through, he was told to be quiet and “be a good boy” by relatives and physically restrained by the nurses.
Childbirth is another experience endured without analgesia and vaginal lacerations are often repaired without local anaesthesia. Most labouring women silently endure the pain and are without the support of a partner. There was meconium stained liquor with all of the deliveries I saw suggesting there is fetal distress and the average birth weight is just 2.6kg. Mothers stay in the hospital for less than 24 hours after the delivery and often have difficulty establishing lactation. Sadly, when this occurs it is not uncommon for a neonate to be weaned onto lemon leaf tea and develop severe malnutrition.
There is a Maternal and Child Health clinic at the Rural Health centre in town where the growth of infants is monitored and vaccinations are given. I spent a day at this very busy clinic and was given the responsibility of seeing babies who were unwell or had a condition that needed treatment such as scabies. Usually the clinic does outreach visits to outlying villages however the van they used was not working for the entirety of my placement.
A highlight of my placement was my time spent in antenatal and family planning clinics. As I had not done any women’s health it was great to have the opportunity to learn how to measure fetal height, listen to the fetal heart rate and determine the position of the fetus. I was able to sit on a group education session for mothers at the first visit clinic which was excellent.
My favourite activity on the wards was doing baby checks on the neonates with Dr Wilma. All the babies I saw were healthy and well, although we had a good laugh one day when a baby boy (according to the birth certificate) turned out to be very much a girl!
Whilst in Santo I managed to fit in a lot of sight seeing and cultural experiences which were fantastic. The cook at the hospital, Leone, took us under her wing, lending us her phone, bringing us food and sending us lovely goodnight messages. She took us out to the remote village where she grew up and her home in Luganville where she cooked us a delicious meal and then out dancing at a fundraiser. The caretaker of the house where we stayed, Nora, was also very kind to us and helped me so much with my Bislama. We tried Kava (once was enough!), swam in blue holes, visited some spectacular beaches and saw some amazing fish whilst snorkelling.
I had the most wonderful time in Vanuatu, it was one of the best experiences of my life. I have returned home with many incredible memories, and made many great friends. I have absolutely fallen in love with Santo and plan to return to the Northern District Hospital in the near future. I am very grateful to the Pacific Health Fund for granting me the Andrew Dent Scholarship and making my elective as memorable and fulfilling as it was.