Working in a Hospital in Solomon Islands

General Information

04.09.2010

Hospitals

Government administered:

The National Referral Hospital (NRH, also called Central Hospital or Number Nine) in Honiara with 300 to 400 beds is the largest hospital in Solomon Islands.

NRH has the following departments:

• Accidents and Emergencies
  2007: 45,147 patients turning up at A&E
  2008: 55,234 patients turning up at A&E
  

  Triage categories at A&E
  Category	Type	% cases
  1	serious	3
  2	serious	3
  3	less serious	12
  4	less serious	18
  5	least serious	64

• Anesthesiology
• Dentistry
• General Surgery
  2003: 70 beds, adults and children (including Orthopedics)
  2008: 1,971 patients were operated on; 80% was emergency surgery and only 20% elective surgery, however, 5,000 patients were booked for elective surgery in the same time frame.
• Gynecology and Obstetrics
  about 3000 to 4000 deliveries with approx. 100 cesarean sections per year
  two neonatal wards: one for healthy and one for sick newborns
  January - June 2009: 3,508 admissions to the postnatal wards
• Internal Medicine
  2001: 53 beds, 750 patients, average stay 10.2 days
  chest infection, TB, malaria, neurological cases: spinal lesions, old polio (few), leprosy (few), meningitis mostly children
• Ophtalmology
• Orthopedics
  most frequent cases: fractures
  2009: 35 to 39 beds and between 20 and 50 patients per month.
• Outpatients
• Pediatrics
  ratio adults to children about 10:1
• Rehabilitation Division
  • Physiotherapy
  • Occupational therapy
  • Prosthetics and orthotics workshop
  • Workshop for adaptive equipment (wheel chairs, crutches, etc.)

Provincial Hospitals:

Provincial Hospitals do not have specialized departments: everybody does everything.

Size: between 20 and 160 beds.

Flying distance from Honiara: one to three hours.

Location of provincial hospitals:

• Central Province: Tulagi
• Choiseul: Taro
• Guadalcanal: NRH
• Honiara City: NRH
• Isabel: Buala
• Makira Ulawa: Kirakira
• Malaita: Kilu'ufi (which is also the National Psychiatric Unit, and located near Auki)
• Rennell-Bellona: no hospital; Tingoa Clinic on Rennell, the only clinic on Bellona, the Nuku Clinic was closed in 2002 (and is still closed in 2004)
  Note: a clinic in Solomon Islands is not a hospital, and is usually run by experienced nurses, not by doctors.
• Temotu: Lata
• Western Province: Gizo

Administered by other organizations:

• Choiseul: Sasamuqa (also Sasamunga or Sasamungga), 32 beds (United Church)
• Guadalcanal: Tetere: Good Samaritan Hospital (built by Don Bosco International)
• Malaita: Atoifi, 80 beds (Seventh-day Adventist Church)
• Western Province: Munda: Helena Goldie Hospital, 55 beds (United Church)

Before you apply:

Who can apply?

• Doctors (registrars and specialists)
• Medical students in their elective year (="Wahlstudienjahr" in German)
• Nurses (m/f), midwives, if capable of teaching others
• Physiotherapists, capable of teaching others. Occasionally there is a shortage of physiotherapists. The local physiotherapists are quite well trained, you need an advanced knowledge and/or a lot of experience to be able to teach them something.
• Ergotherapists (mostly for adults)
• Medical laboratory technicians

General considerations:

The official language in Solomon Islands is English. Always use English when writing to hospitals or government officials in Solomon Islands.

There is no general shortage of manpower in Solomon Islands, but there is a shortage of well trained and skilled professionals who can help solve problems and train locals.

When passing on your knowledge and expertise, keep in mind that nobody likes to be patronized and there is almost always more than one way to do things right and successfully (and this includes medicine!).

Albert Schweitzer wrote in his book "On the Edge of the Primeval Forest" (Chapter 7, Social problems in the forest):

"We should accept, but try to improve and refine, the rights and customs, and make no alterations which are not absolutely necessary."

What he said about Africa is valid for other countries, including Solomon Islands, too.

Personal requirements:

• an open mind
  You should be able to easily adapt to new, unfamiliar situations in a different culture in order to avoid unnecessary frustration.
   

• realistic expectations
  This is absolutely essential, coming here with unrealistic expectations will just cause a lot of frustration for all parties involved. Read Dr. Oberli's "A week in paradise" and reports from others who worked in Solomon Islands. Read what people write about Honiara. If you understand German, read Christian Himmelberger's report. Have a look at our News section and read what foreign ministries say about Solomon Islands. Take it with a grain of salt, but if it scares you off, you are probably better off looking for a different place to work.

• be ready to accept all kind of shortcomings, and to improvise often
  Solomon Islands is a beautiful country inhabited by basically very friendly and pleasant-natured Melanesians and Polynesians. But it is in a very difficult economic situation caused by a two-year ethnic unrest and for all practical purposes bankrupt. Solomon Islands Health Services are only kept going by massive foreign (mostly Australian) aid.

  The transition from traditional life to the 21st century in this country was a step taking place during World War II, not a smooth transition.

  Technology is available, but does not necessarily function.

  Water, electricity, telephone, gasoline, etc. cannot be taken for granted and assumed to be available continuously.

• to appreciate the social and professional medical context of a poor developing country
   
• good knowledge of English is essential if you want to work in Solomon Islands.

  For medical professionals a good knowledge of English medical terminology and its many abbreviations is very important. If you are not truly familiar with medical English, a book about medical English is a must, just a dictionary is not enough!

  Quick check: is your knowledge of English good enough for a job in a UK or US hospital? If not, it's not good enough for a job in a Solomon Islands hospital either.

• some knowledge of pidgin English would be an asset but is not required. See our books list for a dictionary. By the way, don't fool yourself: pidgin (or pijin in Solomon Islands) English is not simply baby talk English! Read chapter 13 of Jack London's The Cruise of the Snark (available on the internet) for an interesting introduction.
  

(© 2004 V. Gisler)	(© 2004 A. Brand)

Minimum duration of stay:
Two months, preferably three or more

Accommodation:

• Only for students and registrars at NRH: the Kiwi-House (not for free)
• Hotels are expensive
• Guest/Rest Houses
  usually with shared usage of the kitchen and access to a washing container outside to do your laundry
• Private accommodation
• Expats are often looking for house sitters while they are abroad

Check the Answers to our Questionnaire for prices.

Food:

• In the Kiwi-House and in many guest/rest houses you have access to kitchen facilities.
• There are markets where you can buy vegetables, fruit, and fish.
• The hospital cafeteria serves simple meals.
• Inexpensive food is also available in Honiara's Chinatown, which is near the hospital.

Check the Answers to our Questionnaire for prices.

Friends, Partners, Family, and Visitors:

Your friend wants to work in the hospital, too.
This is possible, however, we strongly recommend you work in different departments, especially if your mother tongue is not English. This will force you to use English all the time and your immersion in the different culture will be better.

Your partner/family wants to accompany you.
Your partner/family should consider:

1. A good knowledge of English is essential.
2. Accommodation: the Kiwi-House is strictly for students and registrars, so you have to find another accommodation (see above). But if there is room in the Kiwi-House your partner is expected to live there, so he or she is available in emergency cases. In other words, you will end up living separately.
3. Occupation: your partner will be very busy at the hospital and not able to take care of you during the working hours (which may include weekends). You will hardly find a highly interesting occupation, if any at all, and if you do, you will probably have more spare time than your partner. Whether you can find an occupation depends on your skills and qualifications.
4. Transportation: bus service in Honiara is only available along main roads, but your accommodation and/or your occupation may not be near a main road and you might have to walk considerable distances.
5. Life ain't easy in Honiara: Honiara often suffers from power outages and water shortages, which does not make life particularly pleasant.
6. Spare time: in your spare time there is not much you can do in Honiara. Beach activities are only possible at a few selected places. Public swimming pools or similar options are not available. Flights to other islands are expensive and schedules cannot be relied on.
7. Read what people write about Honiara.
8. Schools: schools in Honiara are good, internationally recognized, but expensive

Conclusion: make sure, you know what you are getting yourself into. Read reports by others.

Someone wants to visit you while you are in Solomon Islands.
Visitors, with whom you want to travel, should not arrive while you are working at the hospital, especially if you are here for just two or three months. You cannot simply adjust your working hours to suit your visitor(s). Keep vacation and work separate: do your traveling before you start working or better at the end of your stay.

Specific additional information

• for students
• for students (and others) going to Gizo
• for nurses and midwives
• for doctors

Contacting the hospital

Contact us, if you have general questions or want to contact a provincial hospital.

Do not expect immediate replies. Communication with the hospital is sometimes difficult. Answers may take several days to weeks. Eventually, you may have to resend your e-mail, but please wait at least two weeks before doing so.

E-Mail (e-mail may be temporarily down for various reasons, but nevertheless is the generally recommended way to contact the hospital):

To: nrh@solomon.com.sb
Subject: Attn [name or title of the person you are addressing]

Fax (to back up e-mail or if e-mail is not available; the fax machine does not always work, so keep on trying):

+677 24 243
Add "Attn [name or title of the person you are addressing]" to the fax header.

Phone:

+677 23600    (time zone: GMT + 11 hours, no daylight saving time)

Mail address (mail is not recommended: it is slow and unreliable, it may take months or never show up):

National Referral Hospital
PO Box 349
Honiara
Solomon Islands

Travel documents required:

• For passport and visa requirements see Immigration Requirements on the Government web site and Travel Information on the Solomon Airlines web site.

• Note: A stopover in Australia may require a visa for Australia: check with your travel agent or use Travel Information on the Solomon Airlines web site.

• If you are going to work at NRH:

  Once the details have been sorted out and you have been accepted to work, prepare a mail with your travel details (flight number, date and time you will arrive in Solomon Islands, flight number, date and time you will leave Solomon Islands, and your passport number) and a copy of your acceptance mail. Send it

  To: nrh@solomon.com.sb
  CC: info@hermannoberli.ch
  Subject: Attn Hospital Secretary - urgent

  This should be done no later than three weeks before your arrival, and don't forget to keep those recipients up-to-date, in case there are any changes in your arrival details!

  With some luck, somebody will pick you up at the airport.

  Bring along any working permit and visa or confirmation thereof you have received, and at least a (printed) copy of your acceptance e-mail, fax or letter.

  If you are having a problem with immigration officials: just ask for an ordinary tourist visa and tell them you would sort it out. Then give your papers and passport to the Hospital Secretary and let him/her do the administrative work. Once you are in Honiara, you will soon find out more about "organization" in the Solomons.

  NRH's information sheet for students says:

  IMMIGRATION

  You are permitted to stay in the Solomon Islands for a period of up to 12 weeks, and the visa will be issued at the Airport. If you wish to remain here longer than this, you must personally apply to:-

  Director of Immigration
  

  Immigration Division
  Ministry of Commerce, Employment & Tourism
  P O Box G26
  HONIARA

  SOLOMON ISLANDS
  Telephone: +677 28841
  Web site

  You must do this 4 months before you wish to come. A Police Clearance Certificate and a character reference from the Dean of your Medical School should accompany the request. The payment of SBD 60.00 for students permit plus the additional conversion fee of SBD 275.00 are also required. All these must be sent to the above address, especially for those who wish to remain in the country beyond the specified period of 12 weeks.

Links to Travel Information

Getting ready

Observe WHO recommendations and travel medicine advice

Vaccinations:

polio, tetanus, measles, hepatitis A and B are a must!
yellow fever: not necessary (unless you arrive from a country where yellow fever is endemic).

Malaria prophylaxis:

Falciparum and vivax are endemic.

Incidence very variable, in Honiara (at the beginning of 2000): 400/1000 inhabitants

Lariam (Mefloquine 250mg/week) or Doxycycline 100 mg daily

No prophylaxis will give you 100% protection except not being bitten by a mosquito! Bring along enough insect repellent (Antibrumm forte works well) and use it. Use a mosquito net. In case of the slightest suspicion, get a MPS (malaria-plasmodium-slide) test, and if positive, start appropriate treatment.

NRH's student information sheet says:

MALARIA PROPHYLAXIS: (As advised by Medical Authorities and WHO here in Solomon Islands.)

The options are:-

Chloroquine 300mgs (2 tablets) weekly

Proguanil (Paludrine) 100mgs (1 tablet) daily

A combination of the 2 drugs may be recommended in certain areas. Please bring a supply of all drugs which you need with you.

Insurances:

A travel insurance covering (at least) medical expenses and loss (theft) of baggage is highly recommended.

A professional malpractice (liability) insurance is not required. The hospital is insured.

Flying to Honiara

You can fly to Honiara International Airport - Henderson Field (previous name: Henderson International Airport; code HIR) from:

• Brisbane, Australia, with Solomon Airlines or Pacific Blue
• Port Moresby, Papua New Guinea, with Air Niugini
• Nadi, Fiji, with Air Pacific
• Port Vila, Vanuatu, with Air Vanuatu or Solomon Airlines
• Nauru, Nauru, with Our Airline (formerly Air Nauru)

Electrical appliances

Mains voltage in Solomon Islands: 240V/50Hz (three-phase 3x415V/50Hz)

Plugs used: Plug with flat prongs (as used in Australia). On the left a view of the receptacle.

Money matters

Currency: Solomon Dollar (SBD) 1$ = 100 cents

Coins: 1$, 50c, 20c, 10c, 5c, 2c, 1c
Notes: $100, $50, $20, $10, $5, $2

For exchange rates see our Travel Information links.

Banks accept Travellers Cheques in US$ and credit cards (Visa and MasterCard/Eurocard). Note: cash withdrawal using your credit card is probably more expensive than cashing Travellers Cheques. Ask your bank.

There are automatic teller machines (ATMs) in Honiara and Auki, where e.g. Swiss bank cards can be used to get cash. Again, ask your bank if your card will work abroad and what fees will be charged.

ANZ intends to install solar powered ATMs in Kirakira, Tulagi, Buala, Taro, Lata and Munda after mid-2007.

Try to get some Solomon Dollars before your arrival, especially if your flight arrives at night time or on a weekend, but don't be surprised if you are not successful. Don't change too much, exchange rates in Honiara are usually better. If you can not get any Solomon Dollars, take along some Australian Dollars in cash. Make sure you know the current exchange rate which changes often.

Banks in Honiara are open from Monday to Friday 09.00 (9am) to 15.00 (3pm).

Possible places to change money, if banks are closed, are the Mendana Hotel or a casino, but the latter will charge stiff fees.

Banks in Solomon Islands:

• Australia and New Zealand Banking Group Limited (ANZ)
  PO Box 10, Honiara
   
• Central Bank of Solomon Islands
  (not a commercial bank)
   
• National Bank of the Solomon Islands Limited
  PO Box 37, Honiara
   
• Westpac Banking Corporation
  PO Box 466, Honiara

Customs Regulations:

Note: this list may not be up-to-date, make sure beforehand.

• free (for over 18-year olds): 200 cigarettes, or 250g tobacco, or 250g cigars, 2 liters of wine/spirits
• no fruits and vegetables (except from New Zealand)
• no honey (for fear of spreading bee diseases; for quite some time even Swiss Toblerone chocolate was (wrongfully) confiscated, because it contains honey)
• no (unlicensed) weapons and ammunition
• no offensive literature, pictures, videotapes, CDs etc.
• no drugs

Before leaving: check for an updated version of this document.

After your arrival

If nobody is picking you up: take a taxi or a bus to the hospital.

Where to report your arrival

Go to the administration or the switchboard (at Accidents and Emergencies). If no one is around, ask a nurse or another staff member.

Hospital resources

Hospital resources are scarce, please use them sparingly! If you use something privately, refund it promptly. This applies to things like telecommunications, transportation, Kiwi-House etc. Please follow your superior's instructions.

Clothing:

Women's clothing should cover thighs and knees, bare thighs and knees are considered indecent in Melanesia. Please wear skirts or pants long enough to cover your knees.

According to official directions, medical uniforms should be worn in the hospital, but this was simply never observed by doctors. Nurses are wearing white uniforms. Doctors are wearing normal clothing, shorts are appropriate for males.

Internet access in Honiara:

There are Internet Cafes in Honiara. One of them is the People First Network Internet Cafe. Cost: SBD 12/hour (minimum SBD 7)

Solomon Telekom offers ADSL and dial-up internet access.

Internet access in Gizo:

A visitor wrote in summer 2004:

Internet access in Gizo is terrible. The Internet office of Solomon Telekom has only one terminal. There is also an Internet Cafe (which I use most of the time), but it is slow and rather expensive. Another Cafe I wanted to test yesterday was not operational.

Internet access in Auki:

Internet Cafe BE-Xpress (opened end of April 2009)

Mobile phones (GSM standard):

You may have to purchase a (prepaid) SIM card from Solomon Telekom or Bemobile.

As of July 2009, Telekom mobile phone service is available in and around: Honiara, Gold Ridge, Tetere (Guadalcanal Province), Tulagi, Yandina (Central Province), Gizo, Noro, Munda, Ringgi, Seghe (Western Province), Auki, Afio, Malu'u (Malaita Province), Kirakira (Makira Ulawa Province), Lata (Temotu Province), Buala, Kia (Isabel Province), Taro (Choiseul Province)

As of September 2010, bemobile mobile telephone service is available in Honiara, parts of Guadalcanal and Auki (Malaita Province).

As of August 1, 2009 7-digit mobile phone numbers are used. Existing 5-digit numbers get a 74 prefix.

Problems:

If you encounter problems, discuss them with your superiors.

Concluding remarks:

Never forget: you are merely a guest in this country and have to accept it with all its shortcomings. Your behavior will determine whether you are accepted or just tolerated by the locals.

Please fill in our questionnaire once you are back home. Others can learn from your experience. Of course, we also gladly accept more detailed reports (perhaps even with pictures?)!

Do you have additional questions? Just contact us.