Sunday, 27 November 2011

Part 3

Sat 26th Nov
So no protests yesterday, was all a bit of an anticlimax!
I went in to work when the others did but stopped by Limelounge, a cafe where expats commonly hang out, with Jacinta and we met one of her friends there. Constellia (not sure how to spell her name!) is lovely girl from Greece who’s working as a doctor in the Solomons for a year. The three of us only had a brief coffee at Limelounge, but it was interesting to share common frustrations about healthcare here with Constellia such as locals demanding medications when they’re sick even if they’re not necessary or appropriate, the poor management of chronic conditions and irrational use of antibiotics. Argh!
I should explain one part about living here before I go on. Expats living here commonly employ a local woman as a housekeeper who cleans the house and your clothes every few days. This woman is referred to as a House Mary. I found this odd at first, we’re perfectly capable of cleaning up after ourselves(!), but I’ve been reminded by other Aussies that we’re giving someone a job and at least it’s a job where they’re treated fairly. Our House Mary’s name’s Miriam and her sister-in-law who’s only in her 40s, is very sick in the Gyno ward at the NRH. Miriam was upset yesterday morning when she was at our place because her family and sister-in-law haven’t been told what’s going on and the family’s scared she’s going to pass away soon.
So Jacinta got Constellia on board who was happy to come to the hospital and read over the notes about Miriam’s sister-in-law so she can pass on what’s happening. We all headed to the hospital after coffee and I left them to go to the pharmacy.
It was lunchtime by the time I arrived but I soon got a call from Michael offering to take me to me lunch so he could show me some good spots. I had a great chicken and salad roll, yum! We went for a brief drive around the areas in the hills that are set back from the main street of Honiara, including a stop at the best viewpoint over the city! Then back to the hospital so I could actually do some work!
Doreen and I needed to print the finished newsletters. The technicalities of transferring the file to a computer that could be connected to a printer took a while and a lot of fiddling but we finally printed the A3 newsletter double-sided like we wanted it. Now we knew we could get 600-odd copies printed on Monday for distribution but Doreen wanted to look over the newsletter over the weekend to make sure it was all ok. So the mass printing and folding was put off til Monday.
So I spent the last hour of the day (sounds like a pretty lazy day to me I’m writing this!) making a start on a poster I’ll take out to the Western Province in just over a week’s time. It will eventually be an A3 poster with pictures demonstrating how to make up and administer zinc dispersible tablets and an Oral Rehydration Solution (ORS). A pictorial explanation on this poster will overcome the language barrier that’s likely in the provinces (I haven’t really gone into much about Pijin, it’s the lingua franca of the Solomons though many people in Honiara can speak English. Pijin has a hint of English to it, and I can sometimes get the gist of what people are saying, sometimes not..!) and so I need to channel my creative side...should be interesting..!
Had drinks and dinner..and more drinks..last night with the other expats here who I’ve come to know through my housemates and the Nunans. Was a great night, we’re about to do it all again over a Texan-themed poker game/party tonight! I’m certainly not any use at a poker game but I’m ready to dress up after Eddie and I raided the op-shop in town today!
Til next time, much love to all.
Mon 28th Nov
So I said I wouldn’t be much use at a poker game...but after Jo and Erin taught me the basics when I got there and with some beginner’s luck, I did ok! Was a great night :)
Had a lazy day on Sunday. As I said previously about when I arrived a week ago, nothing much happens in Honiara on a Sunday.
On a sad note, Miriam’s sister-in-law passed away this morning at the NRH. Jacinta and Constellia managed to find out that she was suffering from well-advanced cervical cancer but the family didn’t have the money or the time to take her back to their village so she could pass away more comfortably. This would be a very difficult time for them.
I spent most of today at the hospital today, was probably the best day yet! Worked with Michelle today, an Australian pharmacist who just got back from touring areas in the Western Province with James, another local pharmacist who works at NRH. Michelle and I took off mid-morning to visit the 7 clinics in Honiara and distribute zinc sulphate tablets and new diarrhoea treatment cards because it’s said there’s possibly an outbreak of diarrhoea in the region at the moment but I’ll go into this more later. While most nurses we spoke to had a reasonable idea of how to use zinc, very few clinics actually had stock. This is made difficult by the fact that the tablets aren’t included in the clinic’s medication ordering sheet which goes to the Medicine Store in order to get more stock. It was great to travel around and see even more areas of Honiara that I haven’t already been through in my travels. 
Got back to the hospital at lunchtime and Michelle and I headed to a meeting at 1.30 which Michael and other relevant health professionals from NRH and the clinics in Honiara also attended. It was organised to discuss the recent apparent outbreak of diarrhoea in Honiara. Some are skeptical about the extent and importance of this outbreak; data presented seem to actually represent baseline or usual levels of diarrhoea cases in the area, with spikes in the number of presenting cases seemingly correlating with previously poorly recorded data. Some criticisms of the data and its conclusions were voiced at the meeting, but a plan for the coming days and weeks was formulated in case a cholera epidemic should eventuate. We were all reminded of the signs and symptoms of cholera and everything from the logistics of medication and equipment distribution to the establishment of an isolation ward(s) in the hospital, if necessary, was discussed. This is not to say the threat of an epidemic is high, but this meeting was a good opportunity to run through such measures in the unlikely event that they’d be required.
The meeting concluded mid-afternoon so Michelle and I still had time to work on the zinc poster I started last week for distribution in the Western Province.
We spent the time taking photos of the different steps involved in preparing zinc and an ORS. Was good fun as Michelle (well her hands at least) posed with a half open ORS sachet, a dissolving zinc tablet in just a spoonful of water, amongst other shots for the poster. Yeah, it doesn’t take much.
Stopped at the markets again on the way home, I think I’m getting the hang of how to breeze through the markets like a local..! haha no, unco as always!
Much love to all, hope your Mondays weren’t too tough xoxo

Thursday, 24 November 2011

Part 2

Tues 22nd Nov
Found my way to the hospital on the bus this morning! For someone who’s hopeless with directions and navigating in my hometown at the best of times, I was surprised! I worked with Rollina in ward supply area of the pharmacy today. Rollina’s a jolly Pharmacy Officer who runs ward supply. She oversees the supply of medications to the wards in the hospital through the imprest system. An imprest system is just hospital-speak for the drugs that are kept on the ward for easy access by nurses and others because they’re commonly used for the patients on that ward. 
I headed off with Rodney, a pharmacy officer who works mainly in ward supply. We visited the Labour Ward, Gynecology Ward, Ante-natal and Post-natal Wards. But I didn’t see many little babies in our travels :( The wards are separate buildings connected by covered walkways. There are no real corridors in the hospital, so less air conditioning required! 
Rodney and the other pharmacy officers who look after the imprest system keep a close eye on the levels of both medications and dressings on the ward and record in a book for each ward, the amount of stock required, if any. Different wards are visited on each day so the imprest for a certain ward is topped up once a week, on the same day of each week.
My first impression was that the drug rooms in each ward look tired and rundown. Stock wasn’t stored neatly on the shelves and boxes of medications or dressings were often crushed or torn. Sometimes lights weren’t working in the drug rooms so we strained for natural light as we worked. In saying this, the aesthetics of these drug rooms don’t reflect the efficiency and competence of those who use and manage them - the nurses and pharmacy officers like Rodney. Nurses buzzing around us in the drug rooms were confident in what they were doing and thorough in organising their patient’s medicines, doing all this with good humour and warmth. 
We returned to the pharmacy after assessing what stock was needed on the wards, and Rodney and I went about filling big boxes with the required dressings and meds.
We pushed these boxes on huge trolleys back to the wards which Rodney would carry in (yes, carry. These boxes were not light either) and leave for replenishment of the drug room. 
All this was done by 11.30am, after which time, those working in ward supply seem to be twiddling their thumbs waiting for extraordinary requests from wards for drugs not kept on imprest. I’m so used to a constant and frantic work environment of pharmacy departments back home, this different pace has taken some getting used to! I hung out in ward supply til around 1 when Rollina and I jumped in the truck to head down to Medicines Storage, a big warehouse about 10mins drive away from the hospital. 
I’ve never seen so many meds. This place is about half the size of my local Bunnings with almost ceiling-high shelves filled with boxes and boxes of meds. I noticed UNICEF and UN logos on some boxes and will sus out the story when I’m back working there tomorrow. Rollina travels down to Medicines Storage twice a month with the truck driver to collect meds for the hospital. I’m looking forward to finding out more about how this facility works tomorrow, particularly any problems with its running and the subsequent impact on supply of meds for the nation!
Knocked off at 3 today (cos Rollina’s awesome!) and stopped past the major market in Honiara on my way home. Wow. So much fruit and food, so many people, so hot. I only picked up one or two things because I was already juggling a large-ish bag from work, but I’ll be back to stock up properly as soon as I can!
Wed 23rd Nov 
Laying low today after a bad night thanks to a stomach bug. Can’t think of anything dodgy I’ve eaten so maybe it’s all just cos I’m adjusting to a new climate and diet.
It’s a beautiful sunny day for the first time since I got here, so while part of me is glad I’m not cooped up inside the warehouse that is the Medicine Store today, at least I can enjoy the view from our house! Will try and head down to the market later this afternoon if I’m up to it, I’m really craving fresh fruit. 
That’s all for now, nothing much super exciting going on. Cheers
Fri 25th Nov
Hanging out to see if it’s worth going into the hospital because there’s the potential for riots in light of a vote of no confidence against the Prime Minister this morning. All the volunteers (such as those working with AYAD and similar) have been told to stay home today so I think I’m going to do the same!
Made it to the markets on Wednesday afternoon! Got a bit excited about all the fresh fruit everywhere and found myself trying to juggle a very big watermelon, a pineapple, tomatoes, bread and water! That was fun on the bus home and up the hill to our house in this super humid weather!
The markets are quite similar to the ones I’ve seen in South-East Asia but the vendors are no where near as pushy here, just very grateful if you show interest in what they’re selling and even more so if you buy.
Yesterday was a good, productive day at the hospital. I worked with Doreen, a pharmacist who helps run the Medical Information Centre (MIC). Michael wanted us to get the Pharmacy Division Newsletter finished and ready for printing by the end of the day. The newsletter is about 8 A4 pages worth of articles, information and quizzes that’s distributed to all the health professionals working at clinics across the country. All we had to do yesterday was come up with a cover story and fill in a few gaps amongst the other articles throughout the rest of the newsletter. Michael and Doreen were keen for the feature article on the cover to be about family planning so I went about putting together a summary of contraception options available for both men and women, a brief speel about how each one works and whether or not they offer any protection against STIs. 
I also worked on the Expansion newsletter which goes out to the Pharmacy Officers. It’s a means of providing continuing education for them that contains articles about various drugs and what they’re used for and counselling tips that they’d use in practice. The Officers are required to answer the questions at the end of the newsletter and return their answers to the MIC for assessment and this way, the MIC can track how the Officers are going. Doing this made me realise how important Pharmacy Officers are in the success of pharmacy services in the Solomons but it doesn’t seem like their valuable contribution is adequately recognised (in the form of reasonable wages) yet.
I could have and would have had most of the work for the day done by lunchtime but everyone I work with is quite relaxed as in, why start a job 20 mins before lunch? Just hang out and do it afterwards! Lunch is at least one hour long at the hospital...I’m used to a faster paced way of smashing out what needs to be done, particularly at work, so this more relaxed atmosphere has been an adjustment at the hospital. Maybe I’m too much of a city girl and expect work to always be busy with a never-ending to-do list, but when there’s so much that can and needs to be done at NRH (the hospital’s called the National Referral Hospital), a part of me can’t understand why there’s not more of a general drive to keep ticking boxes.
Anyway, went straight from work last night to the Nunan’s house to celebrate Thanksgiving with Erin and Michael and some of their friends. My first (if somewhat atypical) experience of this American holiday was lots of fun. Erin is ‘half American’ and a couple of their friends are American so it was a good excuse to get together and feast! I met more great people who are doing various work here in Honiara and the view from the Nunan’s house is spectacular.
Still no word on the riots but I’m laying low with the others for now. Much love to all, happy Friday!

Monday, 21 November 2011

Part 1

Sat 19th Nov, 2011
As I left my parents and a couple of my good friends at Melbourne airport this afternoon, I was feeling nothing but nerves. I made my way through the Qantas terminal and forced myself to just keep breathing - deep breaths, and I’d be ok. What lies ahead of me is a wonderful opportunity but I still struggle to get my head around what I’ll encounter. As much as I like to think I can ‘go with the flow’ and roll with whatever comes, this trip will be all that, but on a different, slightly more intimidating level. As a solo girl in a developing country, I like to think I can be strong and independent. I’ll do my best, anyway. I know I’ll have supportive people around me in the Solomon Islands, as long as I’m not in the way and a nuisance, that’s a start.
So... ‘What the hell am I doing?’ It’s a common question from my friends and family lately, something like that anyway.
I am the still-stunned recipient of a scholarship from Monash Uni that enables a final year pharmacy student to travel and work in a country in the Asia-Pacific region. Uni put me in touch with some incredible people who have a wealth of experience in this field and they’ve helped me line up work in the Solomon Islands. Malnutrition as a consequence of chronic diarrhoea is the second highest cause of death in children in the region and treatment with zinc supplementation is one option that can reduce the severity and duration of potentially fatal diarrhoea. 
‘What can you do? You’re not a real pharmacist yet..’ is another question I get, in not so many words...
My impression at this stage is that I’ll be helping to investigate the current usage of this supplement, its availability and health professionals’ knowledge of the therapeutic rationale. In saying this, I’m up for the possibility that this could change, what I’ll do exactly could be very different to my expectations at this time. I’m aware that the logistics of medicine and its effective use often leaves much to be desired in developing countries such as the Solomons. Obviously it’s an issue about which I can only echo other people’s opinions at this stage but hopefully by the end of this trip I’ll have my own experiences that will enable me to form some sort of reasonable viewpoint.
Sun 20th Nov, 2011
At Brisbane airport, my muesli with fruit and yogurt is helping me feel alive again. And I’m enjoying what could be my last decent coffee in a while.
Stayed at a motel near the airport last night but didn’t sleep too well last night due a mixture of worry about not waking up to my 6am alarm and anticipation of what today will hold.
The interest and encouraging words from some of the people I’ve come across in during my travels the last couple of days is helping to ease any residual nerves.
I don’t know who I’ll meet or what things will be like upon arrival which is a little unnerving but hey, it’s an adventure.
Til then, cheers :)
Feeling alone and isolated. 
I waited an hour at Honiara airport after a pleasant flight but noone was there to meet me. Great. After the initial rush of people greeting the newly arrived passengers had died down, I was still waiting. Noone sells sim cards on a Sunday so my temporary phone was useless. As much as I tried to get a contact number out of Mick while I was still in Aus, I arrived in Honiara with only his email address. The one contact number I have is for Tamie, a friend working in another province in the Solomon Islands. She had said she knows Mick so the Customs Officer allowed me to use their office phone to try her. No answer.
I was becoming increasingly panicked but hid it well I thought.
Michael, the Customs Officer was worried about me. This was my first taste of overwhelming kindness and generosity common of the people of the Solomon Islands. Outside, taxi drivers had been hovering, willing to drive me to wherever I needed. Up until then I’d be politely refusing, hanging out for a familiar face but I decided to accept Kelli, a taxi driver‘s offer. I tell him I need to find a room in a guesthouse for the night. He and Michael exchange a few words in Pijin and tell me Chesta is a good place in town.
Kelli’s warm and friendly personality cheers me instantly. If anything, his chatter was a distraction from my worries. I tell him I’m doing work in Honiara with other pharmacists and he picks up two clear plastic bags from in front of his gear stick. One bag contains a blister pack of ibuprofen tablets. It is labelled much like any Australian prescription item with directions and supplementary warnings. The other bag contains loose tablets which, according to the label contain metronidazole, a type of antibiotic. Kelli went on explain how he felt sick a few days ago, and how the medications came to be prescribed. He asked why the ibuprofen needed to be taken with food, sometimes he had pain when he wasn't hungry. I explained that the antiinflammatories can upset the stomach (didn't want to alarm him with graphic information about destroying the lining of his stomach haha) anderhaps Kelli sensed a hint of inexperience in me because he asked how long I’d been a pharmacist. I meekly told him I’d just finished university (minus the fact I’m still not a ‘real’ pharmacist in Australia! I didn’t want to have to explain all that) but Kelli was ever interested in me and my work. 
I’ve already had a sneak peek at the hospital because we popped in on the off chance that they would have a contact number for Michael. No luck. The doctors were very busy and couldn’t stop to help us, we weren’t going to get very far. I’m going to have to get used to the looks I got while we were in the hospital as I was the only white girl in the place, but who can blame people for being curious. I’m sure I’ll come to describe the hospital further in time, but my first impression wasn’t a negative one. It’s set up simply but effectively, without the hustle and bustle of city hospitals. There was a sense of calm about the place. Whether this is a reflection of the attitude of the people in the place or just because it was a lazy Sunday, I’ll soon find out.
So we took off to Chesta Guesthouse which was full and I was worried I would not find a room at the last minute like this, but our next stop was at a guesthouse set back from the main st, in a hilly area. They had a room free thank goodness! I then asked where I could get food that night and Kelli offered to drive me back to the main st because the ‘cheeky’ boys might annoy me on my way back down the hill to the shops. While I wouldn’t have minded a walk, I appreciated Kelli’s offer. We found a convenience store and it’s tuna and crackers for dinner tonight. As Kelli drove me back, he offered to pick me up at 8 tomorrow and take me to the hospital to find Mick. I’m so lucky to have come across Kelli, he’s looking after and treating me like his own daughter.
I’m sitting in my room now. It’s nice and clean, my window looks onto small houses, and kids of all ages play in the street outside. The power is still out everywhere but I’m happy to lay low and jot down my thoughts as thunder rolls in the sky.
Hopefully tomorrow will be better.
Mon 21st Nov
Well it’s been a crazy 24 hours to say the least.
I was hanging out in my room last night when at about 8.30-9pm I got a knock at my door. I thought someone must be at the wrong room but when I asked who it was, Michael answered me. Embarrassed to be seen in my pjs I got him to hang on but I called out to ask how he found me!?! He only explained when I opened the door - he’d gotten carried away doing a weekly radio show that afternoon and only remembered I had arrived in Honiara that afternoon at 4pm when he finished the show!
He’d called all the guesthouses he could think of and tried taxi companies who did a call out to all their drivers! I don’t know how exactly Michael found my guesthouse or how Alex the owner let him knock on ‘the white girl’s’ door(!) but we were soon off to my actual accommodation where I'm staying with 4 other very cool Aussies. They're all about my age, Anna, Jacinta, Gav and Eddie. They all volunteer for AYAD doing various things. Michael had a beer with us when he dropped me off before heading home. 
I felt so much more comfortable now with people who are just like my friends at home. They’re very down-to-earth and work hard with a passion for what they're doing. 
Emma and I were up at 7am this morning and shared fruit and tea looking over a peaceful and still Honiara. It felt as warm as the night before when we’d been sitting outside with beers but fresher.
Michael remembered me this morning! He bounded up the hill to the house from his car just before 8 to pick me up. We stopped at a luxurious cafe for coffee (so no, I won’t have to do without! :D) and he came with me to organise a sim card so I’m finally in touch with the world! Then to the hospital.
Already buzzing with people, we headed straight for the pharmacy department where I spent the day in the dispensary. For day one, it gave me insight as I worked with pharmacy officers, pharmacy students and pharmacists. Students travel to PNG or Fiji to obtain a pharmacy degree and often return to the Solomon Islands to complete their compulsory intern year prior to registration, much like the Australian system. Chatting with all of them was fascinating and they were curious about me and my life in Australia. The pharmacy officers are trained for two years for their role which is roughly equivalent to a pharmacy technician’s job in Australia. I get along particularly well with Benitta and Vera, two of the pharmacy officers, and we chatted all day long about anything and everything. Everyone else in the dispensary were really friendly - noone could believe my story about being left at the airport!
Benitta took me across to the shops across the road from the hospital for lunch. I picked up a lamb curry, lets just say it’s nothing like Australian lamb! 
The afternoon was frustrating for all because msupply, the program used for dispensing prescriptions on the computer, kept freezing and caused a backlog of scripts waiting to be processed. When there are usually 30-odd people sitting on benches outside the cover in an undercover area, this backlog meant standing room only, if you could find a spot undercover out of the now pouring rain. I was told people usually wait about 30mins for prescriptions, but people were now facing an indefinite wait. As we kept trying to get msupply working, the possibility of handwriting labels and the relevant pharmacy records was suggested to a not-so-enthusiastic response...
The IT guy worked some magic and msupply was up and running again...for now. A choatic process line ensued. Generated labels are much like the labels on Australia prescription items but most tablets are loose in a small plastic bag, only very few are in blister packs. This meant A LOT of counting of tablets. In saying, that the pharmacy has a tablet counter which saved a lot of frustration but medication is rationed so quantities vary with each prescription. And I’ve never seen so many antibiotics dispensed!
Caught the bus home with Judith who I work with and Michael drove me from the bus stop home so knew they way to the bus stop each day. When I say bus, picture a decrepit mini-van. But it does the job!
Eddie’s made awesome lasagne, dinner time! Til next time, cheers and love to all