Insights from a medical outpost

8:17 PM Wednesday 22 July, 2009  (At anchor – Sola, Vanua Lava)

It was a slow day aboard Chimere today.  Most of us slept-in till 7:00am, with no real responsibilities, other than filling up with petrol, getting some water and buying more lemonade – for passengers who might need an at sea pick-me-up in the next few days.

There was also a bit of washing going on, which was most welcomed. Wearing wet clothes day after day can really get to you

The medical team eye-tested the children at the school today and no doubt we’ll hear more about their activities when they come aboard tomorrow morning for the trip out to Motalava.

Mike, Jo, Graeme, Chris and Terrance went ashore for a few hours today and who should they run into, but two guys we’d got to know during our time on the other side of the island – at Vureas Bay.  They’d walked about 4 hours to Sola to make a short phone call and were about to start the 4 hour walk home.  They were very excited to see the crew and one, John, was still wearing the shirt and cap we’d traded with him for fruit.  For the journey, Mike pulled out two cans of soft drink for the guys which they were very happy to receive; a luxury they would rarely experience, being largely outside the cash economy.

In order to fill you in a bit more on the medical activities of this mission I once more hand over to our cub-reporter, Dr Graeme Duke …

Medical Post

The Vanuatu Prevention of Blindness medical clinics take a fair deal of coordination, communication, and organisation. As Rob said “We do more than just eyes.” Here’s a brief overview.

1.    Preparation
The project and the clinics take a fair bit of advance organisation on the ground. This preparation is largely due to the fantastic work of Richard Tatwin project manager, optometrist, international cricketer, husband-to-be, and all-round good guy) and his assistants based in Port Vila, and Don & Meg Macraild Sale, Australia).  Richard has wonderful people skills, calmness and confidence, as well as local knowledge and respect, and goes about his job without any fanfare and often without us realising what he has had to achieve. See for more info and team bio.
As in any successful venture communication is all important. The surrounding villages need to be given advanced warning of our arrival, as there is rarely any other form of transport than by foot, and this may require several hours to reach the village in which the clinic is held. Notification of and support from the local aid worker (if present) and the village chief are all important.
As an example, we found one village had not been notified and they were all up tending their gardens (some distance from the village) and very few could attend the clinic! The Team stayed another day (Sunday) only to find some conflict in the villagers’ minds who were both committed to attend the local church worship service (which often goes for 3 hrs!) and wanting to make use of the medical care.

2.    Supplies
Before setting out we must choose what equipment is needed. None of the villages or their ‘aid posts’ carry the equipment or supplies we need. It’s BYO everything literally.
Our equipment and supplies are selected, sorted, and stored in “Baxter IV fluid” boxes because these are small and sturdy boxes and were more than satisfactory when the clinics only travelled by air or road. They are but not so good in the rain or the sea (!) and so Mike and I are working on an alternative for future trips.
We started off with 30 boxes for one Team.  Now that we have 2 teams for the latter section this number grew to over 40! So Mike and I spent nearly 6-hours last Sunday afternoon sorting and rationalising the contents of all the boxes, so that each team need only take 8 boxes instead of 15+. These boxes contain medical and optometry diagnostic tools, pharmaceuticals, administrative essential (patient record cards, replacement batteries, eye charts, stationery, etc) and most importantly a sufficiently wide range of spectacles and sunglasses to cover most scripts.

3.    Getting to the Clinic.
All modes of transport are used. This year we are based on the yacht Chimere (under Captain Rob Latimer) from Australia. The yacht provides a transport, accommodation, storage, etc. This is a great boon given many of the clinics are in remote and hard-to-get-to islands and villages. There are no wharves or jetties. All deliveries and retrievals are by dinghy to and from the shore, often in swells and rocky slippery ledges and crashing waves. (I hope my insurance covers this?) There are no parking spots for the doctor’s Beemer or Merc!
Most villages are then accessed by walking, anywhere from 10-60min, from the landing site. There are few roads, the walking tracks are often muddy and slippery and steep and there are no taxis or buses in these remote tropical places. Thus we arrive at the clinic hot sweaty and exhausted and in need of resuscitation. Any motion sickness or sleep deprivation from the sea voyage adds to the ‘wonderful’ emotions experienced!
The friendly greetings make up for these hardships. Most of the villagers want to show hospitality and greet the new comers! Imagine walking into the Outpatient Dept and all the patients had been waiting hours and still make the effort to come over and greet you? Maybe we should recommend this as part of “Patients Rights and Responsibilities” in Australian hospitals.

4.    Team Members.
A minimum of four are required to run each clinic – one for clerking, a doctor or nurse for the medical screening, an optometrist for ophthalmological  assessment, and another to dispense the spectacles. The local nurse or aid-post worker is always a helpful addition. There are no tea-breaks, sick leave cover or shift-hours. Everyone continues until the work is done.
Patients queue, in a fashion, there being no booking system! Nor have I heard of any FTA (Fail to attend) patients. Villagers accumulate around and outside the clinic and await their turn. There are no complaints.

The first team member documents the name, age, address (i.e. Village) together with any medical or eye complaints, on a pre-printed record card.
Our patient then takes his/her card to the doctor and/or nurse where. My command of Bislama is limited so this makes for a short consultation.
“Hello. You sidoan, ples…..Nam bilong you?…OK…Me check blud (=blood pressure)…. Now me check sugar. Showem han bilong you? ..(and as I am about to lance the finger  to draw blood) Stik! One, two , three, ouch (and advance the needle quickly!)” The drawing of blood it amusing, with most screwing up their eyes and looking the  other way, not knowing how much pain will ensue. When they realise it’s all over often there is a huge grin and laughter, followed by a round of laughter and giggles from all the onlookers . There’s no such thing as a private visit to the doctor.
It is routine to check the blood pressure and blood sugar level on most patients as hypertension and (type 2) diabetes are common. Other complaints – such as toothaches, abdominal or chest pains, antenatal checks, etc) are assessed and dealt with. As I said there is no privacy, no bed or couch, so if anyone needs a more detailed assessment I ask them to remain behind, to examine them in another room. Examples of makeshift “examination rooms” include 2 pews side-by-side at the back of the church altar, or a mat on a concrete floor, or a bed in the local aid clinic.

We also try to give simple advice about diet. Such as not too much rice or coconut milk which are high GI foods; correct way to lift heavy items to reduce backache, etc.
The team optometrist now inspects the eye, tests refraction, retinoscopy, tests and determines the appropriate spectacle prescription.
Finally the appropriate spectacles are selected and handed out with a brief warning about not scratching the lenses, when to use them (long distance or reading). We have donated sunglasses, readymade spectacles, cases, and hats. Priority is given to the correct script rather than the colour or style although the later is still important and a source of much amusement.

5. Entertainment.
These clinics provide not only ophthalmological and medical care but also are a source of entertainment for the village. Everyone gathers around to watch through the doorway or the windows, or simply wander up to watch the event. Inquisitive children watch with fascination as the blood pressure dial move up and down, or the glucometer, or the tempanic thermometer tick away before providing the readout. Shouts of glee accompany the finger prick glucose tests! The sight of a well known family member or friend newly bespectacled also causes much amusement and delight. The sight of the young men in a new pair of trendy sunglasses leads to whoops of approval.
If time and planning permit, the laptop and data projector and portable generator are brought on land to show “Ice Age” or “Finding Nemo” to the delight of these first-time movie goers. They will even sit quietly for an hour whilst the usual technical hitches are solved! Popcorn is not required.

Stay tuned for more exciting medical insights.

Smooth sea, fair breeze, and back to sea tomorrow.


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