It’s been almost two months since I left the Solomon Islands, and it’s about time I wrote down some of my thoughts about my medical elective there – both for posterity’s sake, and the hope that something I’ve written will be helpful to students heading out on elective to the same or similar areas and circumstances.

I spent 5 weeks in Gizo in late October/November, 2009 at the Gizo Hospital. The hospital is the referral hospital for the Western Province, and has a catchment population of somewhere between 35,000 and 60,000, depending on the source. Numerous remote nursing stations/clinics make up the remainder of the healthcare facilities available in Western Province. Most of these stations are equipped with only the most basic of supplies, but even so these clinics are very valuable for treating the more common illnesses and injuries that occur, such as malaria, non-life-threatening viral fevers and uncomplicated fractures.

Gizo Hospital manages to do a lot with very little in the way of facilities, personnel and equipment. Services offered at the hospital include Obstetrics, Radiology (X-Ray and Ultrasound), General Surgery (Tuesdays and Thursdays), and Outpatient Clinic (Mondays, Wednesdays, and Fridays). There are 4 inpatient wards (male, female, paeds, and maternity), with a total of about 60 beds.

The Gizo Urban Nursing Service (GUNS) also operates out of the hospital, and provides first-line treatment for malaria, vaccinations, and gynecological services. They might even do more than that, but I never had much contact with them while I was there. Malaria is such a routine illness in the Solomons that the doctors generally only saw the very sickest of patients, or those with complications (i.e. cerebral malaria).

St. Vincent’s Hospital in Sydney, Australia has a program where new registrars at the hospital can spend 3 months in Gizo. St. Vincent’s sends a registrar over 4 times a year, so this means that as a medical student you get the best of both worlds – excellent one-on-one training with a Western trained physician, while working in a 3rd world hospital, learning improvisation and resource management skills, as well as getting experience with tropical disease. The registrar we had supervising us while at the hospital was great, and allowed us to do as much as we felt comfortable doing.

Even though I was only a first year medical student, I got experience in administering anaethetics (Ketamine), drawing blood, inserting cannulas, taking patient histories, giving vaccinations, assisting in minor surgery, and watching a Caesarian section or two.

There are generally 3 to 5 doctors working in Gizo Hospital at any one time, with the majority of them being local doctors trained in Fiji or Papua New Guinea.

The daily schedule is generally ward rounds in the morning (either male, paeds, or female/maternity), and then either outpatients or surgery depending on the day.

Local Culture and Custom as it Pertains to Medical Treatment

Please take what I write in this section with a grain of salt, as this is only my opinion, formed from my own observations and talks with locals and ex-pats, and does not necessarily reflect reality, as I only spent a little over a month in Gizo.

There is a Pharmacy attached to the hospital, although it is rarely well-stocked, and the pharmacist (at least while I was there) wasn’t all that knowledgeable about current treatment regimens. The problem with this state of affairs soon became apparent, so let me explain why many an hour was wasted in clinic trying to figure out if the pharmacy had a particular drug before prescribing it.

The majority of the local population lives much the same way that they have for centuries, because it’s what works best for them. They get plenty of rain, so with the help of a rain tank attached to their home they have no need for a plumbed town water supply. Electricity on the island is provided by diesel generator and is subsequently quite expensive, so many make do without. Fish and seafood are so plentiful in the waters around Gizo that at times there seems to be more fish than water, and you can buy giant tuna in the market for under $7 CAD. Almost everyone it seems has a mobile phone, but otherwise they are self-sufficient. They have very close-knit families, wherein if problems arise, be they medical, legal, or otherwise, they are usually handled within the family rather than being taken to the authorities. And finally, since Gizo is the main referral hospital for the area, many of the patients that present to hospital admissions are from very remote islands with very little in the way of contact with Western civilization.

And so, getting on to my point, there are two major consequences on the healthcare provided to Islanders in Gizo: they present late in illness, when symptoms are severe and illness is often more difficult to treat; and they defer to the healthcare staff completely. Whether in general they are scared, intimidated, or otherwise, I learned that if I were to write them a prescription that they were unable to fill at the pharmacy, either due to lack of availability or ineptness on the part of the pharmacist, they would simply go home to avoid having to see me again in clinic.

The reality of patients presenting very late in illness made for some memorable times in the clinic, but also makes treatment a challenge. I can’t count the number of osteomyelitis cases we saw, especially in young children, where an old (perhaps a year or more ago) fracture had failed to heal correctly, had gotten infected, and only now when the pain is unbearable do they present to hospital for treatment, where they learn that they will need 6 weeks of IV antibiotics. That presents a real problem for some families, especially from other islands: They need to stay in Gizo for 6 weeks, so where do they live? How do they get fed?

Hospital Departments

The outpatients clinic operates on Mondays, Wednesdays and Fridays, and sees a little bit of everything. There is usually plenty of patients to see, and after ward rounds attending clinic will take up the bulk of the day. Some of the presentations I saw while in outpatients include: numerous machete wounds, usually to the left wrist or right leg; uncontrolled diabetes, along with diabetic neuropathy; hypertension, either treated or not, with a plethora of different beta blockers, ACE inhibitors, diuretics, ARBs, and Calcium channel blockers; fractures; osteomyelitis from old fractures that weren’t set properly and/or didn’t heal properly;

The surgical suite stays busy on Tuesdays and Thursdays for elective or non-emergent operations, with the occasional trauma case or emergency C-section occurring. The bulk of the elective surgical cases are made up of tubal ligations, vasectomies, Incision & Drainage of abscesses, and appendectomies, with major surgical cases being referred on to the National Hospital in Honiara. There are two theatres at the hospital, a ‘dirty’ one for minor trauma, I & D, etc., and a ‘clean’ one for internal procedures like Caesarian sections.

I never ended up spending much time in the female or maternity wards, but they were kept busy with births while I was there, with usually at least one each evening.

The male and paediatric wards are located adjacent to each other, and this is where I spent the majority of my time when not in surgery. Each morning started with ward rounds at 8:30am (give or take an hour – remember it’s ‘Solomon time’!), and we proceeded to check on each patient in turn. Although the nursing staff was friendly, a lot of the problems we faced on the wards were with drug administration – either doses were missed, or IV drugs were given orally instead, rather than taking the time to place another IV line. This became a problem when treating osteomyelitis, as in a few cases the antibiotic regimens had to be restarted from scratch. I learned a lot by following around the registrar on ward rounds, listening to her reasoning, and was even able to occasionally form a coherent thought to add to the discussion.

Pidgin English is the local language, and although the vast majority of the vocabulary comes from English, varied pronunciation combined with a strong accent render the locals mostly unintelligible when you first arrive. I would suggest picking up the Lonely Planet guide to Pidgin before arriving, and learn some basic grammar that will come in handy, such as:

• ‘blong iu’ or ‘blong me’, pronounced ‘blong you’ or ‘blong me’, which makes a noun possessive when placed after it. For example, ‘my employer’ = ‘employa blong me’.
• ‘yumi’ = ‘You and me’.
• ‘mifela’, pronounced ‘me fella’ is ‘Me and someone else, excluding you’.
• ‘wifela’, pronounced ‘we fella’ is ‘Me and you’.
• ‘iu fela’, pronounced ‘you fella’ is ‘You and someone else’.
• ‘I’ referring to yourself, is ‘me’ in pidgin.
• ‘lo’ is, as far as I could tell, an article used in many different contexts, to replace ‘the’, ‘a’, ‘an’, ‘to’, as well as ‘in’, ‘on’, etc. For example, ‘I am going to the hospital’ = ‘Me go lo hospital’.
• ‘Wantok’, pronounced ‘wahn-talk’, doesn’t have an exact translation, but roughly means ‘family, including extended family’. In order for patients from other islands to spend time in hospital in Gizo, you need to know if they have ‘wantok’ in Gizo that they can stay with. ‘Do you have family in Gizo?’ = ‘Wantok lo Gizo?’

Most of the locals you’ll see in the hospital or clinic will only speak Pidgin. The medical staff at the hospital all speak fluent English and Pidgin, so they can help translate for you, although it’s helpful if you practice your Pidgin as much as possible. Most medical terms sound the same in English and Pidgin, so as long as you can get a grasp on the basic grammar of the language, I found you can communicate effectively enough with most of the locals.

Things to Know Before You Leave

• Bring a flashlight, as there are only a few streetlights in Gizo, the roads are rough and uneven, so if you’re walking when the moon isn’t out a flashlight is a must.
• The airstrip is located on Nusatupe Island, about a 10 minute boat ride from Gizo. The Gizo Explorer is a big former cattle transport boat that belongs to the Gizo Hotel, and heads over to Nusatupe for pickup and drop-off for each Solomon Air flight. A one-way trip to Gizo or back costs $50 SBD.
• Contact Danny or Kerry Kennedy at Dive Gizo to come over to the jetty on Nusatupe Island to pick you up if you’d rather not pay the $50 SBD. The Kennedys are a very nice, welcoming couple – if you’re up for any diving while in Gizo, I highly recommend them!
• Speaking of diving, it’s worth a second mention – the diving in the Gizo area is apparently considered some of the best in the entire world, and after spending a few weekends out diving myself, and I can see why: plenty of colourful, lively coral reefs full of reef sharks, fish, and the occasional sea turtle. The visibility is outstanding all the time, the water is warm year-round, the currents vary between slow and non-existent, and there are several World War 2 wrecks within easy boating distance of Gizo. Again: I highly recommend filling up your weekends with some diving!
• There are a few cheap places to stay in Gizo, and some not so cheap ones. If you want all-out comfort, the Gizo Hotel charges about $150 AUD/night, and is the only accommodation in town up to Western standards. Cheaper options for students include Phoebe’s Resthouse and Naqua Resthouse, both of which are a short walk from the main market and the hospital. I stayed at Phoebe’s and can recommend it as a nice clean place to spend a month. $100 SBD/night for Phoebe’s, and $120 SBD/night for Naqua. Jacob is Phoebe’s son, and is the current manager of Phoebe’s – his family lives on the first floor, and the second floor has 5 rooms with 2 single beds in each. You can book most of the accommodation in Gizo through Danny Kennedy’s new website – he processes the credit card online, and then hands cash to the resthouse manager, as not very many businesses in Gizo deal in anything other than cash. I didn’t book in advance, but I got lucky – Phoebe’s is generally full and needs to be booked in advance, and I assume it is a similar situation with the other resthouses.
• As of this writing, internet was freely available at the hospital for student use, although I would recommend bringing your own mini-notebook or laptop as there is only one computer available for all the staff to use, but there is an ethernet cord available if you have your own computer.
• There is an elective fee of $100 SBD/week to be paid at the hospital office, which helps to pay for student internet use.
• If you don’t have your own computer and the hospital one is busy (it almost always is), then there are two internet “cafes” in town. Telekom is the national telecom provider, and provides (expensive!) internet access at their office on the main street of Gizo. A cheaper alternative is Solomon Internet Solutions, located on the opposite end of main street from the hospital, close to Dive Gizo, where you can get internet access for about $0.10 SBD/minute, which is cheap even by Aussie standards!

Random Facts That Didn’t Fit in Elsewhere

• “Gizo” is the town, “Ghizo” is the island.
• Fatboys Resort is located on Mbabanga Island, directly east of Ghizo Island.
• Kennedy Island is named after President John F. Kennedy of the United States, who was stranded there for a few days during World War 2.
• The town of Gizo is powered by three massive diesel generators, and so electricity is expensive on the island. Do your part and turn off lights and appliances when you’re not using them.
• The RAMSI Participating Police Force is active in Gizo, and seems to keep the place generally safe. Walking home at night was fine, although just to be on the safe side I would recommend walking in pairs.
• A major tsunami hit Gizo in 2007, and although most everything was repaired by the time I arrived, you could still see damage on other parts of the island.
• Alcohol is expensive here ($3 AUD/can in the liquor store, don’t even think about wine), but the local brew, “Solbrew”, isn’t half bad.
• Fruits and vegetables are cheap ($1 SBD/each for most vegetables) and available in the market 7 days a week. The markets are best on Monday and Friday, as that’s when producers from other islands come to Gizo to sell. Tuna and other fish is also incredibly cheap, but the good stuff is only available after 3pm when most of the fishing boats come back into shore.

And, a reminder to myself in the future, and to those who might not do a lot of flying – seat selection (at least on EVA Airlines) is open up to a 100 days in advance, so if you want to get one of the few “good” seats available on the plane, make sure to login to their online seat selection sooner than the day before.

All considered, only two things I could’ve arranged better, and I couldn’t be more excited about heading out for Brisbane. Halfway around the world, and I only know two people down there, and then only through Facebook. I have a 14 hour layover in Taipei, and other than possibly getting some sleeping done in there, I’d really like to head into Taipei City if I can manage to navigate their mass transit system.

We’ll see how that goes. My flight out of Edmonton is delayed, but it looks like it’s close to boarding now, so off I go.

Update: Okay, now the flight’s been delayed for a total of 1.5 hours. Not too bad, as far as airports go.

Update #2: So, yay for free wireless in YVR, and shame on Edmonton International for not providing the same. Super duper delays as to be expected from Air Canada, so my 6:55pm flight finally got in at 11pm (Edmonton time).

Next up, 18 hours to Taipei! I’ve heard rumors that Taipei has free city-wide wireless, so we’ll see if I manage to post another update.

China has got some serious competition in the over-the-top show category as they plan for the opening ceremonies of the Beijing Olympics in a few weeks.

The grandstand show at the Calgary Stampede was just amazing. I had never been before and I suspect a lot of the awesomeness was due to celebrating Quebec’s 400th Anniversary (Calgary’s sister city) as well as the Young Canadian’s 40th. (The Young Canadians is the group that performs in the grandstand show.) To summarize: 2 hours of continuous action, two amazing strongmen, motocross bike jumping, the most fireworks and pyrotechnics I’ve ever seen in one place.

This past Sunday was time to visit one more Heritage Site in Alberta. Dinosaur Provincial Park is located about 30 minutes north of Brooks, Alberta, and about 1.5 hours from where I’m staying in Drumheller.

It was very hot out, close to 32 degrees in Brooks when I stopped in there, and when I drove down into the Red Deer River valley at the Park it seemed to get even hotter because I was shielded from any breeze.

Not too much to say about this one. I went on one of the various hikes in the park and tried to look for some fossils but didn’t really see much. At the lookout point just before you enter the park there is an amazing view out over the valley, and you can see half a mile in most directions and see the river snaking through the badlands. Very cool.

This weekend Mark and Avis had the brilliant idea to head down to Great Falls, Montana to take in the Independence Day fireworks, and they were gracious enough to invite me along for the ride. Of course I was up for a trip to the States, considering the last time I was down there was a family trip to Disneyland 10 years ago.

I started out the trip in my usual style, by driving into Calgary to meet up with the guys, but forgetting my passport in Drumheller. So three hours and a lot of cursing later, I’m ready to go and we head out of town on Friday afternoon. The trip down there was pleasant, if a bit on the warm side. Mark managed to book us a really nice hotel right along the river where they would later be shooting off the fireworks, so we only had to walk down the stairs and out the door to have a great view of all the action.

One thing that was very different down there compared to any of the Canadian cities I’ve lived in was the number of fireworks being shot off by private citizens in their backyards all day! After about 6pm the explosions never stopped, and continued at least until we went to bed at about 3am. There were people walking along public sidewalks setting off firecrackers and some people even set up launchers for the bigger fireworks right on the sidewalk as well.

The city’s fireworks show didn’t disappoint either, although it wasn’t any bigger than Edmonton’s or Calgary’s.

We spent the rest of the night in the only bar in the city that we could find that was actually open for the holiday, and then woke up bright and early the next morning to head to the mall for the most important part of the trip in Avis’ mind – Victoria’s Secret.

And, now that you’re bored I’ll skip ahead to our drive back through Glacier National Park. The drive is about 70 miles, and took us about 2 hours after all the traffic stops, construction, switchbacks, etc. Unlike most of the Canadian mountain passes (at least the ones I’ve been through), Logan Pass is very high up, and is more of a road over a mountain ridge than anything. The first 50 miles or so wind up the side of various mountains, gaining in elevation (and the fear factor of the precitipous drops, for me anyway) until suddenly the summit of the pass pops into view, and there’s a fairly large parking lot and visitors’ centre at the top.

There was still 5 feet or so of snowpack at the top, so we got a chance to have a snowball fight and slide down the hill on our butts. Apparently there isn’t usually any snow left in most years at this time of the year, so it was a fun surprise for sure. After that, we continued uneventfully down the side of the mountain and back to Canada.

And that’s about it for the trip. It was an amazing weekend for sure. Two down, 849 World Heritage Sites to go!

I had their prime rib, medium rare, and it was very close to the most tender steak I’ve had that I can remember. They serve a very tasty salad with every meal as an appetizer, and they did something amazing with Thousand Island dressing that made the salad taste… amazing. I realize I’m using that word too much, but I really can’t describe it in any other way that could possibly do it justice. I’ll just leave it at that – $110 plus tip, total, for the 3 of us. Do yourself a favour and check it out. Oh, and get the spinach dip for an appetizer.

Not a bad place to start off the tour. Head-Smashed-In Buffalo Jump is located about 20 kilometres outside of Fort MacLeod, Alberta.

I headed out of Drumheller at 9am, and as usual drove through Rosebud on the way to Calgary, and then onwards south to Fort Macleod. I have to say, Rosebud is a wonderfully unique community that I have yet to see replicated to any degree elsewhere. The town is tiny – probably 200 residents or so – and no gas station, franchise of any kind, and only a few small tourist shops. The one thing that it does have that is very obvious as you drive through it is a theatre. Right in the middle of the town is a decent-sized building housing the Rosebud Theatre Company, and big signs announcing the current and upcoming plays. As I drove through I really got the vibe that the whole town exists just for the theatre. It’s the only really visible business in town, and right in the center at that. Very quaint little place, I must say. If you ever have then chance to head out there to catch one of their theatre productions, I’m told they are very well done and worth the drive.

Anyway, I’m getting away from myself. Three hours after I left I was pulling up to Head-Smashed-In Buffalo Jump, about 16km outside of Fort Macleod. It was a very well-done museum, with quite a few interesting displays. The museum consists of 4 or so levels built into the side of the cliff, and as you go (up) through the museum all the displays are laid out until you get to the top level. At the top there is a concrete sidewalk leading out a hundred yards or so to a lookout point where you can get a very good view of the buffalo jump itself, as well as looking out east to the wind farms located a few kilometres out.

Pretty neat trip overall, but short. Worth visiting if you’re within driving distance. One down, 850 World Heritage Sites to go!

My mother instilled in me at a young age a love of travelling. There is so much of our world that we will never get to see, and so much of it that is beautiful, stunning, heart-wretching, or extreme beyond description.

And then I ran across UNESCO’s list of World Heritage Sites, and I realized that someone else had bothered to go to all the work of finding all those hidden cultural and natural gems in this world.

So, I’ve decided to start a life-long journey to visit all of the (currently) 851 natural and cultural World Heritage Sites on the list. This isn’t going to be a mad dash to the finish by any means. I’m currently broke and heading off to school again for another degree, so this will be an “as I have the means” trip. The purpose is really just to point me in the right direction, and to allow me to easily keep track of just how many amazing places I’ve been to, and what I’ve seen.

I hope to keep track of every place I visit on this page, and count down over the years, and hopefully eventually make it all the way to #851!

I’m starting off the trip easy – tomorrow I’ll be heading to #158 – Head-Smashed-In Buffalo Jump. I’ll post a picture to prove I was there and a summary tomorrow!

By the way, the UNESCO World Heritage Centre has as wonderful RSS feed available that lists all 851 World Heritage Sites, as well as includes photos of each site.