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Surgical Care in the Solomon Islands: a Road Map for Universal Surgical Care Delivery

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Surgical Care in the Solomon Islands: a Road Map for Universal Surgical Care Delivery World J Surg (2011) 35:1183–1193 DOI 10.1007/s00268-011-1097-4 Surgical Care in the Solomon Islands: A Road Map for Universal Surgical Care Delivery Eileen S. Natuzzi • Adam Kushner • Rooney Jagilly • Douglas Pickacha • Kaeni Agiomea • Levi Hou • Patrick Houasia • Phillip L. Hendricks • Dudley Ba’erodo Published online: 13 April 2011 Ó Socie´te´ Internationale de Chirurgie 2011 Abstract the provincial hospitals were evaluated using the World Background Access to surgical care and emergency Health Organization’s Global Initiative for Emergency and obstetrical care is limited in low-income countries. The Essential Surgical Care Needs Assessment Tool question- Solomon Islands is one of the poorest countries in the naire. Data on infrastructure, workforce, and equipment Pacific region. Access to surgical care in Solomon Islands available for treating surgical disease was collected at each is limited and severely affected by a country made up of provincial hospital visited. islands. Surgical care is centralized to the National Referral Results Surgical services are centralized to the NRH on Hospital (NRH) on Guadalcanal, leaving a void of care in Guadalcanal in Solomon Islands. Two provincial hospitals the provinces where more than 80% of the people live. provide surgical care when a surgeon is available. Six of Methods To assess the ability to provide surgical care to the hospitals evaluated provide only very basic surgical the people living on outer islands in the Solomon Islands, procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of E. S. Natuzzi Á P. L. Hendricks Health is currently inadequate for delivering care at the Loloma Foundation, Encinitas, CA, USA outer island hospitals. Conclusions Shortages in the surgical workforce can be E. S. Natuzzi (&) Á A. Kushner Society of International Humanitarian Surgeons, 225 East 6th resolved in Solomon Islands with focused training of new Street, Suite 7F, New York, NY 10003, USA graduates. Training surgeons locally, in the Pacific region, e-mail: [email protected] can minimize the ‘‘brain drain.’’ Redistribution of surgeons and obstetricians to the provincial hospitals can be E. S. Natuzzi William Moore Stack Foundation, Encinitas, CA, USA accomplished by creating supportive connections between these hospitals, the NRH, and international medical R. Jagilly Á D. Pickacha Á D. Ba’erodo institutions. Department of Surgery, National Referral Hospital, Guadalcanal, Solomon Islands K. Agiomea Introduction Department of Anesthesia, National Referral Hospital, Guadalcanal, Solomon Islands Surgical care is the neglected disease of global health in L. Hou many low-income developing countries. While efforts to Department of Obstetrics and Gynecology, National Referral cure diseases such as malaria, tuberculosis (TB), and Hospital, Guadalcanal, Solomon Islands human immunodeficiency virus infection/acquired immu- nodeficiency syndrome (HIV/AIDS) have grown, surgical P. Houasia Department of Orthopedic Surgery, National Referral Hospital, care and treatment of surgical disease remains a low pri- Guadalcanal, Solomon Islands ority in the ‘‘preventative medicine strategy.’’ International 123 1184 World J Surg (2011) 35:1183–1193 surgery groups such as the Bellagio Conference on funded hospitals and hundreds of small health clinics Increasing Access to Surgical Care in Sub-Saharan Africa, throughout the island chain. The Society for International Humanitarian Surgeons The capital of Solomon Islands is Honiara located on the (SIHS), along with the World Health Organization’s northern coast of Guadalcanal. Internal migration has (WHO) Global Initiative on Emergency and Essential resulted in the movement of people from Malaita and other Surgical Care (GIEESC) have laid the groundwork for outer islands to Honiara in hopes of finding work. This has quantification and justification for funding the surgical resulted in crowded and dirty squatter camps that facilitate needs of these developing countries [1–3]. the spread of disease. It has also created periods of civil Surgical conditions account for 11–15% of the world’s unrest. Transportation between the countries’ many islands disability adjusted life years (DALYs), with the most is mainly by ferry, outboard motorboat, or canoe. There are common surgical conditions being injuries, infection, limited and expensive interisland flights. malignancies, obstetric complications, congenital anoma- This article’s goal is to provide information on the lies, and cataracts. To influence global health funding infrastructure, workforce, and supplies as they apply to sources, the state of surgical care in developing countries surgical care in Solomon Islands. We also present a road must be quantified. These data need to be reported by map for the development of universal surgical care for the country, by region, and finally by socioeconomic level of country based on standards that have been previously developing countries. Kingham et al. have reported on the published and issues that are unique to the country. availability of surgical treatment in provincial hospitals throughout Sierra Leone using the GIEESC Needs Assessment Tool [4]. This method allows efficient evalu- Materials and methods ation of infrastructure, workforce, and equipment capabil- ities for the delivery of surgical care by a hospital. The WHO’s Tool for Situational Analysis to Assess Located in the Melanesian portion of the South Pacific, Emergency and Essential Surgical Care Survey was used to the Solomon Islands are just northeast of Australia and collect information on the infrastructure, workforce, inter- New Zealand. The country is an archipelago 1450 km (900 ventions provided, and consumable and reusable surgical miles) long, with a total of 999 islands scattered across a equipment during site visits to 9 of the 12 hospitals in 725,197 km2 (450,000 square miles) area of sea. Only Solomon Islands. These site visits were conducted from 3.8% of this area is land. Solomon Islands is one of the June 2009 through September 2010 as a collaborative poorest countries in the South Pacific. It ranks 135th among effort between Loloma Foundation, the Ministry of Health, 177 countries on the United Nations Development Program and the surgeons at the NRH. Site visits lasted for a min- (UNDP) Human Development Index [5]. The World Bank imum of 6 h (Taro, Sassamunga, Kilu’ufi, Atoifi), and classifies Solomon Islands as a low-income country with a some were conducted while providing surgical care for an gross national income per capita of $910 [6]. The popu- extended period of time at that particular provincial hos- lation exceeds 600,000, with 82% of the people living in pital (NRH, Good Samaritan, Gizo, Tulagi, Helena Goldie rural areas where clean drinking water and proper sanita- Hospital). The hospital site visit data were recorded on tion are lacking. The population is increasing at a rate of individual Needs Assessment Tool data sheets by one 3.5% annually [7]. More than half of the population is evaluator (E.S.N.) based on observations and information under 15 years of age. obtained from the provincial doctors and nursing staff. The Health care in Solomon Islands is publically funded, Needs Assessment Tool, developed by the WHO GIEESC, with 80% of the health care funding from the government consists of a check box questionnaire covering more than and the rest from international development partners 20 items of general information about the hospital capacity (Australia, New Zealand, ROC Taiwan, European Union, as well as infrastructure, human resources available, sur- Japan). In 2006, the total expenditure on health care was gical interventions provided, and availability of emergency 4.7% of the gross domestic product (GDP). The life equipment and supplies for resuscitation. We have col- expectancy in Solomon Islands is 62 years. Infant mortality lected all the data but have selected certain pertinent items is 17 per 1000 births, and maternal mortality is 500 per to publish in the interest of space limitations. The full 100,000 [8]. The incidence of malaria exceeds 30% and Analysis Tool form can be downloaded from the WHO includes infection by Plasmodium falciparum as well as GIEESC website. P. vivax. HIV is underreported because of under-testing for Table 1 lists all of the public and private hospitals the disease [9]. The health care system supports one main located in the Solomon Islands along with each hospital’s hospital, the National Referral Hospital (NRH) located on overall catchment demographics. The hospitals that were Guadalcanal, and seven provincial hospitals located on surveyed are marked with an ‘‘a’’. Operating theaters were outer islands in the provinces. There are four privately inspected and photographs obtained to record supplies and 123 World J Surg (2011) 35:1183–1193 1185 Table 1 Public and private hospitals located throughout the Solomon Islands and the estimated population served Institution Location Population served Status National Referral Hospitala Guadalcanal [600,000 Public Gizo Provincial Hospitala Gizo Island [60,000 Public Taro Provincial Hospitala Choiseul Island 24,000 Public Tulagi Provincial Hospitala Tulagi, Florida Island 30,000 Public Buala Provincial Hospital Santa Isabel Island 26,000 Public Kirakira Provincial Hospital Makira Ulawa 40,000 Public Kilu’ufi Provincial Hospitala Malaita Island [200,000 Public
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