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Here's another report I find worthwhile posting in its entirety although 6 years 'old'.  No bone crunching or fallopian tube rolling alert.  The most eyebrow-raising part may be the survival medical Pijin at the end of the article.  Note the recurring bigfala mango theme :

http://student.bmj.com/issues/03/09/life/334.php

Pidjin paradise

Sammy Radstone shares her experience of the Solomon Islands. Look out for the bigfala mangoes

The Solomon Islands, a tiny country made up of 992 islands in the Pacific Ocean, is where I chose to do my elective. The population is mostly Melanesian, whose forbears migrated from Papua New Guinea. The ancient traditions of worshipping ancestors, headhunting, and cannibalism were gradually eroded during the late 19th and early 20th centuries with the arrival of missionaries from the West. The second world war saw fierce battles between Japanese and American troops raging around the islands, especially Guadalcanal, and much now rusted military equipment still remains. The islands achieved independence from Britain on 7 July 1978, and the country remained relatively peaceful until 2000, when ethnic tensions erupted. Although the violence was predominantly restricted to a few islands, the entire country has experienced an economic downturn and a huge decline in the limited amount of tourism it once had. The Solomon Islands is now one of the poorest countries in the south Pacific.

Equipment and privacy in short supply

I arranged to do a five week placement at Helena Goldie Hospital on the island of New Georgia. The hospital has 55 beds serving a population of around 35 000 people. It is primarily funded by the United Church of the Solomon Islands, which means it is better funded than many of the hospitals in the country with donations from churches overseas (you do not have to be Christian to do an elective here). But the hospital still has problems with supplies. Although we had the only working electrocardiogram machine in the entire country, we ran out of the recording tape. Electricity supply was erratic and disappeared for two weeks, leaving us without any x ray machines and limited laboratory facilities. The electricity company then had the cheek to telephone all its customers to ask for bill payments so they could afford to ship in the part needed to fix the problem.

Solomon Islanders are extremely welcoming and friendly, and I was made to feel a real part of the local community in a short time. The hospital day started at 7 30 am with morning devotions–a half hour service that was punctuated with amazing singing, usually in Pidjin English or Roviana, the local language. A ward round followed by visits to all the patients, checking on progress and making further treatment decisions. Malaria, tuberculosis, and trauma were the main reasons for admission, and patients tended to stay a lot longer than they would in Britain. The beds were crammed into the ward and there were no screens for privacy. Doing a simple rectal examination required taking the patient to theatre, as it was the only private place. Once the ward round was completed, the two doctors would do any surgical cases that had presented.

Operations were done with either local anaesthetic or under ketamine. This obviously limited the type of operations that could be done, and more complicated cases were sent to Gizo, the provincial capital, about two hours away by boat. Once I had grasped the basics, I acted as the anaesthetist as well as helping the doctors. Tubal ligations were common, as were abscess drainage and appendectomies.

Diving in a hot bathtub

I had no scheduled activities in the afternoons, and I usually had the time to enjoy the amazing snorkelling and diving that the Solomons has to offer. The seas are tropical and at times it was like walking into a hot bathtub. Coral and marine life (including small sharks) was abundant, and there were also wrecks of ships and planes from the second world war within easy depth. The Solomon Islands is reputed to be one of the best places in the world for diving.

Lingo

Although English is the official language of the country, Pidjin is more widely spoken; a form of corrupted English that has evolved over the decades into a language recognised in its own right. Learning the lingo was great fun, and the patients really appreciated the effort (box).

Key facts

• Population–400 000
• Language–English
• Capital–Honiara
• Currency–Solomon Islands dollar
• International code–+677

Reaching into the community

The hospital has a regular touring programme that visited outlying islands on a two month basis, and I had the opportunity to accompany the team on one of their three day trips. The motorised boat was loaded up with equipment, and we set off to remote villages along the New Georgian coast. The routine of the visits roughly follow the same pattern. On arrival at a village, we would be directed to an area where we would set up the clinic. The area would range from being a rural aid post, a church hall, to being under a house in the open air. Word would spread around the village, and gradually people would arrive to be seen. Babies were weighed and progress recorded in individual baby books. We gave immunisations, disseminated health education, and saw ill patients.

Again, patients had no privacy as everyone would stand around the clinic; in villages without television we were welcome entertainment. Medicine was practised empirically. We had no laboratory tests, so if the history pointed to malaria, the patient was given antimalarial drugs. Antibiotics were doled out left, right, and centre with no thought for sensitivity or resistance, and paracetamol was given with abandon. Despite this seeming lack of evidence based medicine, most patients apparently improved.

Hands-on experience

There was no on-call rota, as the doctors and the senior nursing staff lived in the hospital grounds. If there was a problem, someone went to find the doctor, failing that, a senior nurse. However, if they bumped into me first (or I was foolish enough to go and find out if there were any new patients), I was asked to see the latest admission. This was an excellent opportunity to get hands-on experience. I was expected to diagnose and prescribe drugs for the patients. Although this was daunting at first, the nurses were extremely knowledgeable, and the Solomon Islands has its own version of the British National Formulary, with drugs that are supposed to be easily available in the country. In the last week of my placement, the doctors went away to a conference, leaving me the most medically qualified person in the hospital. Again, the nurses were excellent. In the past there have been periods of many months where there were no doctors at all, and the senior nursing staff ran the hospital. Medical backup is always at the other end of the telephone, and we used this when faced with a baby with meningitis, who did not seem to be improving.

Five weeks was over before I knew it. On my last night a feast was arranged in my honour, and I ate my last Solomon Islands meal surrounded by many good friends. If you want an elective in a tropical paradise unspoilt by tourism, with plenty of hands-on experience, then the Solomon Islands is the place for you.

Sammy Radstone, final year medical student, University of Birmingham
Email: sammyradstone@hotmail.com

studentBMJ 2003;11:307-348 September ISSN 0966-6494