Sunday, 5 June 2011

Note for other medical students

I've decided to write a final post for any medical students thinking about going to Helena Goldie as I've noticed I'm getting a bit of traffic from google searches.
I can highly recommend the elective as I really had a wonderful time. It does depend what you're looking for though. 

Helena Goldie Hospital - looking towards the office and operating theatre
The Solomons are very expensive to get to from the UK in terms of flights and whilst buying fresh food at the markets is cheap, it wasn't the cheapest elective I could have had. 
In terms of accommodation I first stayed at Robina House at the hospital which is a really lovely little house, ideal for medical students. All payments go to the hospital as well so staying there is supporting the hospital. However it does mean that if you want to go into town and to go diving/shopping/to the hotel for a drink, it's a 30 min walk (each way) in the heat. With the sun going down at around 6pm every night it also means you have to leave before dark. If you're there with other medical students though you can do the walk in the dark as long as you have a couple of good torches (head-torches are ideal). Just watch out for crabs and frogs on the path.

Qua Roviana Guesthouse
For these reasons, I chose to stay at Qua Roviana, a guesthouse in town for the remainder of my stay. It was a bit cheaper, and in town so meant I could be a bit more sociable in the evenings. I don't think they have a website but if you want to contact them the easiest way would be via the Jen or Graeme at the dive shop. However, if you choose not to stay at Robina House, Helena Goldie hospital will charge you an elective fee so it's worth finding out the costs of everything before you decide.
Here's a link to the hospital website:http://hghospital.jimdo.com/

Medical Stuff:
If you want to go to a 3rd World Country where you get to manage your own patients and run clinics and operate on patients then Helena Goldie probably isn't right for that. There are enough doctors at the hospital to go around really, and so you will not be able to have free reign. However, you will get to assist in operations, and will be asked for your opinion on management of patients during ward rounds. You will also be able to 'essentially' run your own outpatient clinics with one of the other doctors around for help and opinions (to make any final decisions). So you can get a lot out of it if you make the effort. It's a great place to improve your basic examination and diagnostic skills as they don't have even fairly basic blood tests (U&Es, LFTs). 
Drs Graham and Jenny have a blog which they update periodically (as their internet access is very limited) which might help you understand a bit more. I'm sure they'd also be happy to be contacted.

The best part of my trip to Munda was the diving! The water is generally warm (30degrees even when 30m down), and the visibility is (usually) incredible. If you've never scuba-dived before I can highly recommend learning with DiveMunda. If you are already a diver then you'll absolutely love it and there's plenty to see. If you prefer snorkelling then you really wont be disappointed and it is cheaper. Tetepare Island is a MUST for a visit - really a wonderful example of responsible tourism. And if you're interested in the WWII history of the Island, then get Barney to take you on a tour (and watch the Pacific TV series).

Sunset from Agnes Lodge


Tuesday, 7 December 2010

Betel/Beetle/Bitel Nut

There is a very popular drug in the Solomon Islands that grows naturally here. It’s a small nut called Betel nut (pronounced beetle). It seems to act as a bit of a relaxant, and was traditionally used before big community meetings and debates to calm everyone down so that discussions didn’t get too heated. But, like every drug, it has it’s addicts. 
I didn’t get around to having a try of any, but thought I’d relate the process and what it’s like from what Mia told me. 
Powder, Betel nut, and sticks
You buy the nut along with the required lime powder  stick from any local market for around $2 (around 20p) and then you get a bush lime as well. You take the green skin off the betel nut and inside, is the little nut. It apparently looks a bit like a large browny macadamia nut – about the size of a walnut, but round. You then chew it until it gets soft  - I’m told it doesn’t taste all that great (apparently it also makes you salivate quite a lot). Next, you get a mustard stick, and dip it in the lime powder and bite that (with the betel nut still in your mouth). The result is a reaction to the lime powder which gives you the desired buzz and also turns the liquid a BRIGHT red. You then spit out the liquid when you’re done – and if you happen to be walking down the street you spit it right there – this is why I was a bit concerned that there were blood spatters EVERYWHERE when I arrived in Honiara. 
leftovers (normally spat onto street)
Different people have different reactions to the process. Some say they get a bit relaxed and calm. Most people get hot and a bit sweaty. Others get light headed and nauseous. Also, apparently you can increase the hit by chewing with tobacco as well. 

I’d really like to know what the chemical is that causes its effect as I’m not sure how much of addictions to it are social/emotional or whether is much physical dependence. One definite problem is that it does lead to skin cancers of the mouth – Mia has shown me a picture of one on the inside of someone’s lip – about the size of a tennis ball – not pretty!

Wantok:

The word ‘wantok’ in the Solomons refers to ‘family’. However, like in Africa, family doesn’t mean your parents, siblings or children. It usually refers to anyone who is related to, and sometimes to your whole village or tribe. That’s the meaning of the word, but culturally, the concept of wantok is far more complicated. 
You cannot say no to anyone in your wantok. If they turn up on your doorstop asking for help, you have to help them. If they see you on the street with your new pair of sunglasses and ask you if they can have them, you hand them over. If you own a business, they have a right to share in the profits and at times simply walk off with the produce. I’m sure that this wasn’t the original manifestation of the wantok principles of helping everyone in your area when they needed it, making sure people don’t starve, but in a modern world it can be a bit of a hinderance. It basically means that Solomon Islanders struggle to run their own business without being dishonest to their family. Consequently, most businesses such as supermarkets (particularly in the capital, Honiara) are owned by the Chinese.  It also means that government jobs are staffed by family members and government resources are used by relatives. Those who get good jobs often become a bit reclusive to try and avoid running into family members, but they still turn up on the doorstep at all hours of the day. 
Wantok catching a lift home
On the other hand, there are some times when it is advantageous, and the main one I saw was when people become ill. There is no blood donation service in the country, so blood is donated by family members, and when several units are needed, many family members have to donate in order to get the right number of matched units. When the family can’t say no, then it’s not as hard as you might expect in another country. Similarly, if people come to the hospital from far and wide, instead of discharging them home, you ask if they have wantok in the area that they can stay with and come back as an outpatient. It saves a lot of hospital resources and patients usually prefer it.
I do wonder whether this aspect of their culture may end up changing and eventually being lost in the effort to progress in a capitalist way. I think in many ways it would be a shame as it certainly helps to unite people and prevent starvation and extreme poverty. On the other hand, it's hard to know how the country will survive if changes don't happen. It would be interesting to come back in 30 years and see if anything has changed. 

Last days as a Tie Vaka


(Tie Vaka is the colloquial term for foreigners – roughly translated as ‘newly arrived in a boat’)

Honiara chinese: lobster and duck - yum!
I left Munda yesterday with mixed feelings. I was looking forward to spending Christmas with my family for the first time in over 10 years, and Rich’s first hot Christmas (he still thinks it’s weird!). On the other hand, I was very sad to leave all the lovely people that I’ve met and made friends with in Munda. There are some fascinating people living and working in that town, and I was made to feel a part of the community, albeit a fairly transient part. All in all, it felt very strange to get on that plane after a very quick 6 weeks. 
I very quickly cheered up on landing in Seghe when Mia and her boyfriend Zak boarded the plane to join us on the trip to Honiara. We spent the rest of the flight catching up and gossiping about the travellers we’d met in the last couple of weeks. We shared a cab into town, and after settling in to my hotel, I met up with them again that afternoon for some souvenir shopping. Then we all went out for a fantastic Chinese meal. It’s really great to have their company in the city, and I’ve repaid the favour by letting them use the shower in my hotel room because the place they’re staying has got no running water at the moment (it is free though!). First hot water Mia has had in 10 weeks. 
So, today, after a few hours chilling in the best coffee shop (only coffee shop?) in town I shall be heading off to the airport and heading back to Brisbane. It’s been a wonderful few weeks and I’m sad that it’s over – for anyone thinking of doing an elective here, I recommend it very highly. 
Life as a tie vaka has been pretty cool!
The swimming pool at the hotel (a worthwhile extravagance!)

Sunday, 5 December 2010

Final weekend in Munda



Friday evening was a fairly quiet one owing to the fact that I’d had my first coffee in 6 weeks the night before, meaning that I wasn’t able to sleep for hours! So I joined my Munda mates for a few sundowners and a bit of banter over the cricket (sometimes it’s good being surrounded by Australians!), but I faded early so that I could be fresh for my final day’s diving.
Saturday was a spectacularly beautiful day and I tried to really enjoy the scenery knowing it would be the last time I went out on the boat to the reefs and nearby islands. The diving was pretty incredible too. Thanks to the excellent teaching of Jen and Graeme, I really felt like a diver in the water, and my dive buddy Sam, who I did my course with was always calm and I think we both felt at ease. We did 2 dives, and saw quite a bit – several reef sharks and bumphead parrot fish (ugliest fish I’ve ever seen), barracuda and clownfish, not to mention a rather scary attack from a trigger fish. Trigger fish are aggressive little things with nasty sharp teeth that will take a good bite out of you (through wetsuits although we weren’t wearing any) about the size of a £1 (AUS$2) coin. I was a little jumpy, but Graeme managed to kick it away quite effectively with his fins.
Dive Buddy Sam
Sam and I both managed our underwater drills with no problems and even the mask removing one was fine for me. So now we are both properly qualified open water divers which is great as it means I can now dive anywhere. I might be avoiding Sharm el Sheikh for the time being though!
One downside of the day spent diving is that I was left with a bit of a farmer burn (I can’t tan so can’t get a farmer tan). It had pretty much faded by Sunday though so hopefully I don’t look TOO ridiculous. Sunday was spent relaxing and playing cards. Incidentally, if anyone is looking for a good card game, ‘Monopoly Deals’ cards are a much better game than Monopoly the board game and I highly recommend them as a Christmas present for your family. Then I sat watching my final Munda sunset with a group of friends over beers and g&ts, giving Roger and the Aussies stick for the cricket (did I mention it’s great being surrounded by Aussies this week?!).
Ah, I’m going to miss Munda! 

Friday, 3 December 2010

Final Market

Friday was my last ‘market day’ in Munda. There’s a market every day, but the market on Friday is usually quite a bit bigger and people travel from all over to sell their wares, and obviously others to buy.  It usually means that there’s a greater variety of foods available and you can even get pineapples! It’s a great day to stock up on veggies as the quality is usually a bit better.
The atmosphere is always more vibrant and one of the local ‘supermarkets’ hires a guy to make sales pitches on a loudspeaker for all the town to hear. I can hear it from my room so by 4pm I’m usually very keen for the shop to close. After the markets and shops finish, the drinking begins in earnest. The nearby Cava bar is generally buzzing, and although they’re usually relatively well behaved, the work for the policemen tends to increase on Fridays.
Interestingly, the influx of people to the area also leads to an influx of people to the clinic at the hospital, and Dr Jenny and the other doctors are usually run off their feet for the day. It seems that most people can get lifts with their relatives who are coming to sell their wares and so they generally bring their entire family for checkups. 

Wednesday, 1 December 2010

World AIDS day:

Main stage

Today is World AIDS day and the hospital and local community organise an educational festival to mark it. A bit like the Women’s day last week, but on a bigger scale. They started off with a parade on the back of a couple of trucks from just beyond the hospital, into the main town centre. They had set up a big stage yesterday and had a few dignitaries including 2 doctors (the male ones) from Helena Goldie.  They played some popular music to get things going and once a few people had gathered had a few speeches. Then there were some musicians who played not-so-traditional pipe instruments. The traditional ones are made out of large bamboo pipes of different lengths which they bang the ends of to make a sound a bit like a marimba (African instrument) but a bit more hollow – which makes sense. These ones were made from pvc piping, and they also had a couple of drums and a string with some bottle-tops tied to it which served as a kind of tambourine of sorts. The teenagers playing had great rhythm, and they were just clearly enjoying themselves.
PVC pipe players


Then there were some little kids who danced, and then some more music and speeches. I have to say I didn’t stay for the WHOLE thing because it’s unbelievably hot and humid today and it was all in the sun. I just went past a few times to see if there was anything new.  I’m told there will be some plays and a big singing competition – the runner-up last year had a song that basically consisted of the word ‘condom’ over and over again. Still, whatever gets the message across I suppose!
Later this afternoon, I went to watch the children’s Christmas party for the local school. It was very sweet although they did sing one song about acid rain and how technology is making us less human which I found a bit disturbing coming from 7 year old mouths. The best part was when Father Christmas was brought over in full winter Father Christmas outfit to give out the presents. How he didn’t faint I will never know, but it was good fun to watch – especially as he bears an uncanny resemblance to a particular RAMSI officer (albeit with a little paunch). All the little kids were very scared to shake his hand – so sweet.
A very warm Santa Clause
All in all the atmosphere today has been very festive and everyone was very cheerful – an excellent day to be in Munda!