Michael Nunan's email diary from Vanuatu

1st entry: Arrival!
I have arrived safely in Port Vila, Vanuatu and started work at the hospital.

I went to work on the first day I was here, helping to put together training modules for the Youth Ambassador Pharmacist here who is heading off to the provinces on Monday for 8 months to run training of new Pharmacy Technicians. The result was a 1pm arrival, 2pm commence work for 5 straight hours! Trust me to arrive on a busy day...

Since then, however, I have had yesterday off. I walked around town for a while and went for a swim at a nearby beach. It's a fascinating place, Vanuatu - there's evidence of enormous wealth (eg. big yachts in the harbour) but 95% of the town seems very poor. A lot of the town is made up of shanties in huge areas - literally just lean-tos separated by a couple of metres of dirt road from each other. I'm keen to have an explore through one of these areas soon.

The hospital is fairly run-down looking and serviced by about half a dozen Australian and New Zealand specialists in different fields. I think it's got about 130 beds but is mainly outpatients. It's pretty intense - there are an average of 8 births a day at this hospital alone (and most births occur at home) and when I arrived for work this morning, there would have been 50 people in the waiting room (at 7.30am), many holding babies and tiny children. Childbirth occurs with no pain-killers - women with a lot of pain will get a couple of panadol afterwards. I know this because I was talking to a med student last night who's been here for 4 weeks. So medically – this could be an interesting couple of months...

The med students (about 4 or 5 of them) invited me to dinner with them last night and we are all going on a tour of the island (Port Vila is on the island of Efate) on Sunday.

I have spent this morning in the central medical stores at the hospital, installing the AMH and APP guides onto these whizz-bang new computers which are going to be sent to the major islands. Then I wrote simplified instructions on how to use them for the Techs and Nurses in those areas. Amanda (Head Pharmacist) and Sophie (Youth Am Pharmacist) were VERY impressed by the donations of AMHs and APPs that I brought with me (Special thanks to Dad and John Coppock respectively) and they are all going to be put to good use.

Happy new year to everyone!!!
Mick.

2nd entry: Tuesday 11 January
Everything is going very well – I'm splitting my time between the projects Amanda's got for me and working in the dispensary of the hospital. This morning, I started a stock-take of the hospital's Imprest (that's the drugs that are kept on the ward) and after one ward had found roughly two dozen examples of batches that have gone out of date. (Eg Lanoxin, Prednisolone, Aspirin - all out of date, some by years). And this is in the Paediatrics ward!

It's not the pharmacy's fault, mind you. The nurses often don't understand how to properly rotate stock and the Imprest list is not updated regularly enough to accomodate the policies of different doctors.

But it's great experience for me – and working in the dispensary is working out really well also – I can now (pretty much) dispense in Bislama!

I have also spent a lot of the first week looking at the overall supply of drugs to the country, which is all run through the Central Medical Stores at the hospital – the other day, we unloaded a shipping container of drugs – a 6 month supply!! In the worst heat imaginable, it was unbelievably hard work. I'll never complain about twice daily deliveries in Melbourne again! I'm getting a good picture of the chain of supply ...

But from a non-pharmacy viewpoint, I'm having a ball – a cyclone clipped us the other day which gave us some fairly wild weather – but much to our disappointment, it didn't come right over the top. It was the same cyclone that – last we heard – was heading towards Queensland. The weather's now brightened up and it's back to lunchtime swimming.

3rd entry: Thursday 13 January
Very quick news: I am heading to Norsup on a flight in 4 hours to run the hospital pharmacy there – the lady who usually does it has to come to Vila and the guy who was going to replace her has been held up. I will be on my own for at least a few days and may be there for around two weeks ... It's very exciting! Director of a hospital pharmacy at 21? Tee hee hee...

4th entry: Friday 14 January
Amanda called today and the latest news is that I am here until someone can be found to replace me – the original guy has now fallen through (so I must have done enough in my first two weeks to get her to put her faith in me!). It really is amazing – on my own, I'm running outpatients' dispensing (between 60 and 100 scripts a day there), supplying orders to all the aid posts on the island, running the Imprest for every ward (that's the supply of drugs wards have actually IN the ward and needs to be updated every two days or so) and trying to manage the stock and pre-packaging levels.

I could be here until the 2nd of February now, or maybe just late January. My room is like a prison cell (v small, white walls, hospital bed), I have to brush cockroaches, geckos (they're the best) and spiders out of my way to get into bed, the shared shower has only one tap (cold, of course), the toilet is flushed with a bucket, last week that cyclone hit right here and the damage from the cyclones over the last few years is evident everywhere – lots of roofs missing) and this area has one if the highest rates of malaria I've ever heard of! The entire island is only dirt roads and very few people speak English (maybe one or two at the hospital). I can now dispense in Bislama and my reading of that language is getting better! I get three meals a day which is good, because the only shop nearby is a little Co-op that doesn't have a fridge or anything like that – most stuff is just laid out on the ground or on tables.

Since this is a referral hospital though, it is fairly big (about 50 beds and an active outpatients) and I am just amazed at the experience I'm getting. In my wildest dreams, I didn't imagine any of this! Just in the right place at the right time to help – I'm finally proving useful...

5th entry: Monday 24 January
Well, it has been a whirlwind couple of weeks!
 
I am still on an island called Malekula in Malampa province. The hospital here is the major hospital for the province. It is where people are referred to from the health centres, dispensaries and aid posts around the province (which has about 30,000 people and is made up mainly of tiny islands). It is also the third largest hospital in Vanuatu. In Norsup, the pharmacy department is responsible for supplying drugs and equipment to all of the 3 types of centres I've mentioned, running the Imprest system at the hospital (which, as I've said before, is the ward's supply of drugs) for Maternity, General, Children's, Surgery and Outpatients as well as dispensing to outpatients who get prescriptions. So yeah, that's what I've spent my last two weeks doing.

This place is unbelievable. There are no made roads anywhere on the whole island and in Norsup, there is only one shop (a little Co-Op that doesn't have a fridge). The homes are in most cases either corrugated iron sheds, or thatched huts 3m by 3m. Inside, they have just a few sleeping mats on the floor –everything is done outside. The toilets are communal ones for the town and there are wells and village taps to get water. Malaria is rife (I would dispense at least 50 courses of drugs for new patients for malaria alone – and every one of the clinics we supply would do at least that, judging by how much medicine they order) and our supply of drugs is limited to some stock standard ones. There is one doctor for the whole province, who is based at the hospital here and he has no specialty.

It was a bit lonely at first (no one speaks English and I'm living here at the hospital) but a few days ago, Chris, a med student from Melbourne came and is now staying with me. At the hospital, things can be really good or really bad. Chris and I went canoeing yesterday to the most beautiful island I've ever seen – this tiny thing, with about 70 people living on it, about a kilometre offshore.

At other times, things can be pretty hard – the other day they were trying to get an IV line into this little baby boy who kept vomiting up the oral stuff. They exhausted every option and we were all in earnest discussion as to what else to try. Every vein, every technique, cut-backs on the ankle to get a vessel, IM metoclopramide to stop the vomiting ... nothing worked. It was all probably too late anyway and he died about half an hour later of dehydration. It was the second baby the Mum had lost in the same way – just because it takes a few days to get proper advice for referral and then get the kid to hospital from where she lives.

Well, I could write for hours. Every day I'm learning something new and I'm actually going to miss the place when I go. Tomorrow, I'm due to fly to an island called Santo, where I've got to start the first module with a new girl who's going through the pharmacy training program. I'll stay on there and work until the end of the week and then it's back to Port Vila!