Communications Problems

Currently the fax machine in the National Referral Hospital in Honiara is out of order.

Fax: works again, but intermittently.

Email (nrh@solomon.com.sb): there is a problem with the PC and/or modem. Currently it is not possible to send or receive mails.

The hospital's e-mail is back in operation after the modem was replaced.

General News from Solomon Islands

Today the Solomon Islands dollar has been devalued by 25%.

The new Finance Minister has revoked the Solomon Islands dollar devaluation today, against the advice of the Central Bank. The previous Finance Minister was sacked a few days after he devalued the Solomon Islands dollar by 25%.

Health Services

Viviane von Orelli works two months of her internship year in the surgical department at NRH. Currently she takes successfully care of the children's ward. Her patient fell off a Mango tree which resulted in a fractured right forearm and a fractured left upper arm.

Carlo Camathis, who did an internship in 2000, recently visited NRH to collect the documentation for his thesis "Post-operation treatment of external fixation patients". He has completely documented 53 cases including 650 x-ray pictures.

He brought along USD 2400 collected in Arosa, Switzerland, during a Saturday evening church community gathering, and a Sunday morning ceremony. The generous amount will be invested in the fracture clinic. Our thanks go to all the donors!

Solomon Islands urgently needs 26 doctors. Part of the problem is a loss of 16 doctors in the past: 10 local specialists left the country during the ethnic tensions for their own safety and six have preferred an overseas job to a job at home after graduation. Of course, the employment and working conditions did not help the situation. Therefore the Ministry of Health wants to improve those conditions and try to get back the local doctors as well as attract foreign doctors to work in Solomon Islands. Hope also lies on the nine students who will graduate at Fiji School of Medicine this year (some of them supported by the WHO).

ICLARM - The World Fish Center has donated medical equipment worth almost SBD 71'500 to the hospital in Gizo. The organization has built an experimental farm for cultured black pearls near the hospital. Jewellery made of these pearls was sold at an internet auction in Australia. The profit of this auction was used for the donation.

Due to the shortage of doctors the National Referral Hospital can presently accept emergency cases only. Superintendent Dr. Aaron Oritaimae warns of a decline of the country's health services.

As of today, due to lack of funds, paramedical personnel (x-ray, lab etc.) work on mornings, only.

Out of 36 positions for doctors at the National Referral Hospital only 13 are presently filled. All of surgery and orthopaedics is practically Dr. Oberli's sole responsibility.

Rats have chewed cables in the operating rooms thereby destroying three x-ray image intensifiers. Meanwhile protective wire screens have been installed and traps were set up in the operating rooms three days ago. The traps already served their purpose in the first two nights.

Electrical engineer Ernst Knellwolf from Switzerland (who was here last spring) is back again in Solomon Islands for seven weeks. Among other things he takes care of the x-ray image intensifiers, too.

A sub-regional sports medicine course is being held in Honiara. Main topic is sports medicine in football. Attendees, among them five from Papua New Guinea, range from doctors to referees.

Honiara City Council clinics found an increase of 45% in sexually transmitted infections among young people in the age group from 15 to 20 years.

Lack of knowledge and information, and a limited supply of contraceptives all contributed to this situation. Possible consequences are cervical cancer, infertility, and babies born infected with congenital syphilis by young mothers having syphilis.

If the problem is ignored and nothing is done about it, it could easily result in a HIV/AIDS epidemic in the near future.

Solomon Islands Health Authorities were alerted from Nouméa, New Caledonia, after dengue fever cases were detected there.

Blood tests carried out in Honiara identified three positive cases. One of them, a child, was already hospitalized.

People are asked to clean up their environment to avoid puddles where mosquitoes might breed, and to immediately seek medical advice when they are sick with high fever.

Illustrating the news from 18.02.02:

Two midwives from Switzerland have arrived in Honiara yesterday. They intend to stay for about three months and will support the team at the National Referral Hospital.

Japan has donated another SBD 360'000 for Honiara City clinics. The project includes an extension of the Rove Clinic in west Honiara and a new building, the Panatina Clinic, in the eastern part of the capital.

Yesterday's Walk for Peace ("Wokabaot fo Pis") in Honiara raised more than SBD 70'000 for the Children's Ward at the National Referral Hospital. More than SBD 30'000 were donated by local businesses, diplomatic missions, and individuals, and about SBD 40'000 were collected by school children.

A team of plastic surgeons from the Netherlands will arrive in Honiara beginning of April and work for two weeks at the National Referral Hospital. Another such team is expected in November this year.

66 of 1000 children are likely to die before they reach the age of five years. This figure has been released by the Permanent Secretary of the Ministry of Health and Medical Services, Dr. George Manimo, at the opening of the eleven-day workshop for Integrated Management of Child Illnesses in Honiara yesterday. Many children are exposed to malaria, diarrhoea, malnutrition and respiratory infections, which is often deadly in the early childhood. Health services must therefore aim to increase the chance of survival for children in their first years of life.

Since a dengue case has been reported about a month ago, four patients have died of the disease, nine have been tested positive and many more are likely to be infected. Health and Medical Services Minister Augustine Taneko is determined to fight dengue fever by improving public awareness and education and controlling the Aedes aegypti mosquitoes, which transmit the disease. As part of this program, March 14 and 15 were declared "national clean up days" to reduce the number of breeding places for the mosquitoes as much as possible.

During the last 15 years the TB infection rate in Solomon Islands was about 200 to 300 cases per year. The most common form is pulmonary TB. Most affected are persons between 15 and 64 years old, i.e. the most mobile age group. Unfortunately, many patients try local, traditional medicine first and so, by the time they come to a hospital, the disease is often in an advanced state.

According to Health Minister Augustine Taneko 25 native doctors are working overseas, because they were offered better working conditions. Currently only about half of the necessary positions in Solomon Islands are filled and there is one doctor for about 12'000 people.

There are 36 doctors (expats included) in Solomon Islands, 13 of them work at the NRH. Central and Temotu provinces, as well as Honiara-City clincs, must presently do without a doctor.

A number of health facilities in Solomon Islands were built without official approval by the Ministry of Health. Some were financed by by foreign funding, non government organisations, and politicians. Of course, this eventually interferes with the offical health care planning, when manpower and supplies are required for those facilities.

Webmaster's Note: All our projects are planned and realized in close cooperation with the Ministry of Health and are part of the official Health Service.

Click on picture to enlarge it. From left to right: Ernst Knellwolf (engineer), Dr. Dieter Fenner, Elisabeth Oberli, Rita Müller (midwife), Regina Burkhardt (midwife), Bettina Oberli (filming for Swiss TV SF DRS), Dr. Hermann Oberli.

Today a cheque of SBD 100'000 was handed over to Medical Superintendent Dr. Aaron Oritaimae by the Walk for Peace organizers for the children's ward of the National Referral Hospital.

In the Pacific Islands region Solomon Islands' infant mortality rate ranks second behind Papua New Guinea's.

The Interplast team from the Netherlands at work: operating a child's cleft lip and palate

Left: the team consists of the anesthetist Dr. Fred van Eenennaam (left), OT nurse Ida Burkink-Abbink and the plastic surgeon Dr. Hans de Bruijn. Middle: Ida with the little patient. Right: Dr. Hans de Bruijn operating.

The high quality operating equipment for the operating theater was received from Swiss donors: operating lamps, operating table, microcoagulator, x-ray image intensifier, capnograph, ECG monitor, oxymeter. Our thanks go to all donors!

At the National Referral Hospital in Honiara alone an average number of 150 cases a year of lung cancer were diagnosed from 1995 to 2001.

The Interplast team is going back home to the Netherlands tomorrow. More than 200 patients, most of them children with cleft lips and palate, were operated within a bit more than two weeks' time.

The work of the team was financially supported by charitable organizations in the Netherlands.

Another such team from the Netherlands is expected in Honiara in November this year.

According to PFnet News the Interplast team has given advice to about 200 people and operated 60 patients.

Most Honiara City clinics have run out of syringes, because the national medical store has depleted its stock. Patients who need an injection are therefore asked to buy and bring along their own syringe. When the clinics will get syringes again is not known.

Syringes, together with other medical supplies, are expected to arrive in Honiara tomorrow. If there are no further delays, Honiara City Clinics should get syringes again early next week. The ones still in stock at the national medical store were delivered by airfreight and are to be used for emergency cases only.

The shortage was caused by transshipment delays, not lack of money. Although the government still owes about SBD 5 million to three overseas pharmaceutical companies for the years 1999 and 2000, with the amount growing due to interest, all current shipments are paid for (in advance).

Dr. Oberli writes (translation by webmaster):

It is already the forth time Dr. R. Joller, chief orthopaedic surgeon at the cantonal hospital of Uri in Altdorf, Switzerland, came to Solomon Islands to help us with an orthopaedic problem case.

The patient, a 58 year old man, had a hip joint implant done in Taiwan eight years ago, while visiting the country as Foreign Minister of Solomon Islands. Early after the operation a disabling chronic infection developed, which led to a loose joint resulting in years of pain. Bringing the patient to a foreign hospital was not an option for financial reasons, and locally the means for a successful treatment were not available.

Fortunately, last year the Swiss firm PLUS Endoprothetik donated a so called spacer (an antibiotically coateded interim implant). Already a few months after removing the old implant and replacing it with the spacer, the seven year old infection stopped, and healing set in. Now the interim joint had to be replaced with a new implant.

This time Dr. Joller (as always paying all expenses himself), came with an additional suitcase filled with 30kg of medical equipment (heavy instruments on loan and a large selection of implants). An interesting detail: Dr. Joller also brought along a number of transfusion bags, because shortly before he left we had to tell him that we had no more than 12 bags left. It would have been a real desaster for all involved, if we would have had to cancel the operation due to lack of means for transfusions!

Dr. Joller unpacking...	... his special suitcase	Ready for the operation

The lengthy operation was proceeding as planned (with six transfusions!), the patient can walk again using two canes, and left the hospital a few days ago.

At the opening of the fracture clinic Dr. Hermann Oberli presented the building as a model of how a clinic should look like in the 21st century, and said that such buildings should be sustainable and maintainable.

Later he commented, that although a hospital should be the cleanest place to work, it was sad to see people spitting betel stains on clean walls and tiled floors, making the hospital one of the dirtiest in the world he had seen. He appealed to everyone to respect health premises and make them the cleanest place to live and work.

Transportation and distribution of drugs from suppliers through agents and the nationaly hospital pharmacy to end users is complex and costly. As long as the government does not have money to pay for those costs, the country will continue to experience drug shortages.

Presently there are enough drugs in Solomon Islands. But a change of overseas suppliers caused delays leading to a temporary shortage.

Drugs are bought by Australia as part of its aid program.

Health care at Kilu'ufi hospital and the rural health clinics may have to be temporarily reduced to emergency services, if the necessary funds from the government are not received within a week. Medical staff have not received their last two wage payments either.

Four clinics on Russell Islands (Central Province) will soon run out of basic drugs if no supply comes in within the next few days. Much of the stock was used after a recent malaria outbreak.

Due to lack of power, water, and supplies, the hospital in Lata (Temotu Province) can no longer provide adequate services. The Director of Provincial Health Services, Dr. Günter Kittel from Austria, said that most patients had to be told to leave the hospital and stay with nearby relatives.

Ten days ago a newborn died because of lack of basic medicine. On Sunday a woman died because there was no fuel for the car to bring her to the hospital. And a 20 year old girl died with a treatable form of cancer because she could not be brought to Honiara. Stock of vaccines for children are exhausted.

The last supply ship arrived about two months ago. Since then the arrival of new supplies has been announced and cancelled again about ten times already. The ship is still in Honiara with a mechanical defect. Meanwhile Telekom and the water pump generator supplying water to Lata have run out of fuel. Nothing much, if any, is left for generating electricity. There have been no Solomon Airlines flights to Lata for the last three months for financial reasons.

The only public means of communication currently left is the solar powered PFnet e-mail station which is in operation since end of April 2002.

According to Dr. George Manimu, the newly appointed Permanent Secretary for Ministry of Health, Solomon Islands' health service is in deep trouble. Nurses and other staff currently suffer from two outstanding wage payments, and the drugs in stock will only last for about the next three months. An order for a 12-month supply of drugs worth about SBD 6 million is ready, but the government cannot provide the required funds for the purchase at the moment. So help must come from outside. With todays' ease of transportation, it should be of interest to other countries to prevent epidemics in Solomon Islands and keep Solomon Islanders healthy. Aid organizations have been approached for help, but no relief has been offered yet.

Today the governments of Australia and Solomon Islands have signed a Memorandum of Understanding to reaffirm their cooperation in the health sector.

Australia has already provided 26 million dollars to the Health Sector Trust Account. These funds are used to provide basic health services in all provinces of Solomon Islands, as well as to improve the financial management skills of Ministry of Health staff, especially in the provinces.

A 30-million dollars 5-year project supports the training of staff of the Ministry of Health, the National Referral Hospital, and provincial health services to improve management and planning skills.

Media and Reports

Kurt Brauchli's diary "Our Journey to Honiara" ist is now available on this web site.

The articles about the opening and the history of the Fracture Clinic can be found here.

Projects

Dr. Oberli writes:

This afternoon we managed to get the container picked up by a truck and placed in our garden behind our house. We did not have to pay duties, the container was not even opened. When the last container was unloaded at the National Medical Store, a few things had disappeared. So, this time we decided it would be easier to keep an eye on things in our garden. The container will have to remain here until the Fracture Clinic with additional storage space is finished.

At the very rear of the container we found the most welcome tin containers with xylene and isopropyl alcohol from Schweizerhalle, which allow us to continue our work in the pathology lab.

Our thanks go to all who donated goods and contributed to this successful transport!

Last Friday two 20-liter containers of isopropyl alcohol were handed over to the National Medical Store for storage. Next night the store was broken into. On Saturday the containers were empty. In contrast to methyl alcohol isopropyl alcohol doesn't lead to blindness...

Click here for more.

The fracture clinic is on schedule. Click here to see how it looked on 13.02.02.

The operating personnel is happy with the caps from Werner Bieri AG in Romanshorn, the coats from the old people's home in Altdorf, and the operating shoes from the St. Anna clinic in Lucern. Thank you very much!

There was a small topping-out ceremony yesterday.

A picture of the topping-out ceremony and the clinic in the rainy season can be found here.

Two operating nurses, Marilyn Tohesanau and Nesleen Pentani, have recently attended and successfully completed the AO course for operating personnel in Brisbane. From left: Dr. John Croser, Marilyn Tohesanau, Nesleen Pentani and Helen Lee. Click on picture to enlarge it.

Probably a first in the long (more than 40 year) history of AO: a Prime Minister has visited a course! Sir Allan Kemakeza, Prime Minister of Solomon Islands, visited the hands-on training and watched "his" operating nurses for about half an hour. From left: Dr. Hermann Oberli, Marilyn Tohesanau, Sir Allan Kemakeza, Nesleen Pentani and Dr. John Croser. Click on picture to enlarge it.

Currently the floor in the courtyard is being redone. (Picture)

The Fracture Clinic was officially opened today. A picture of the memorial plaque can be found here.

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