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Norsup Hospital, Norsup, Malekula, Vanuatu

Hospital:

Norsup Hospital is an approximately 60 bed Government Hospital situated on the water's edge in the village of Norsup on the Island of Malekula in Vanuatu. It is the regional hospital for Malekula (2nd largest island of Vanuatu), Ambrym and other smaller surrounding islands. In this area it is the only medical centre that has had a doctor in recent years with the rest of the clinics being staffed by local nurses. It has adult, paediatric, maternity and TB wards.

There is an outpatient clinic staffed by hospital nurses and the doctor once a week. It has an X-Ray machine, pharmacy and very limited pathology (haemoglobin, white cell count, malaria slide, CSF gram stain, Sputum smear for AFBs). There is an operating theatre present if you wish to use it.

Country:

Vanuatu is a pacific country made up of 83 islands and a population of approximately 200,000 people. Its capital is Port Vila on the island of Efate. Malekula is a large, rugged, tropical island that is one of the most linguistically diverse per head of population in the world. The official languages are Bislama (similar to Pidgin), English and French. It was actually a colony administered by the French and English at the same time and this lead to unnecessary duplication of many systems (e.g. schools, hospitals, police etc.) in two languages.

Many parts of the island are inaccessible by road due to large ridges and gullies along the coast, this led to little mixing of different groups of people on different parts of the island and hence many distinctive indigenous languages and cultures developed over time. From the north of the island (where Malekula is) the main way to travel to the south and west of the island is by air (there are 3 airstrips on Malekula) or by boat. Travel to other small islands along the coast is by boat and the only way to Ambrym is by plane.

Vanuatu is one of the 50 poorest countries in the world and the majority of the population live a subsistence lifestyle with their own farming plots. As the country is tropical and the population is predominantly coastal food and water are not major issues, hence malnutrition is not a major problem. Despite the financial problems of the country people are continually welcoming and friendly and the island is a place where you feel extremely safe at all times of day and night.

Medical Experience:

I worked with another doctor from Australia as the only doctors in the hospital and the region for 4 months. While we were there another doctor (from NZ) took leave. The full gamut of medical problems was encountered. Doctors managed the inpatients and did one outpatient clinic a week which was for patients referred by the nurses (patients were told to come back on the day the doctor did his clinic!).

There is a lot of obstetrics, if patients were thought to warrant caesarean they were transferred to Luganville or PortVila on one of the 6 flights per week off the island, the vast majority of obstetric patients are managed at the hospital though with the assistance of the midwives. Other major problems were malaria, TB, skin and soft tissue infections, STIs (although no HIV in 2002), pneumonia, meningitis etc. Patients who were thought to require major surgery were also transferred. A regional clinic was done once a week to other medical centres with transport via 4WD, boat or plane depending on location.

It was only possible to get to Ambrym once in 4 months due to problems with funding and leaving the Norsup hospital for 2 days. I was one of only 2 doctors (both of a similar level and background) and we were responsible for all areas of the hospital. We were 'on-call' the whole time although the nursing staff would try and not call you overnight if it could possibly wait until the morning. The reality was that we would have been preferred to have been called out on more occasions than we actually were. One elective medical student also came during our stay that we supervised with all areas of work in the hospital.

Working hours:

We would typically start at 8:30 a.m and finish in the late afternoon. Normally had 1 hour for lunch. Often I would use this time to snorkel on the coral reef right outside the hospital and 'doctor's house', much to the amusement of the locals. There were some very busy times initially when I was on my own but having another doctor helped with sharing the workload.

Working requirements:

Medical training in Australia was sufficient for me to work in Vanuatu and I had an extended working visa, which I got after going there.

Hospital staff:

One other doctor as I have mentioned. 6-8 nurses working in the hospital at any one time. Also pharmacy staff (always had some drug option in every situation), the radiographer, 2-3 lab staff, maternal and child health nurses, 3-4 hospital administrators, maintenance / kitchen staff etc.

Language:

Everyone spoke Bislama which was relatively easy and very enjoyable to learn from a medical point of view as it has some basis on English and is very descriptive. The nurses spoke either French or English as their 'western' language depending on how they were trained, or both. They would normally speak up to 3 other local languages. Your standard Ni Vanuatu on Malekula who had done some schooling normally spoke 4-5 languages

Town facilities:

Norsup and the village Lakotoro 5 kms away are the regional centres with the hospital, government offices and quite a few schools. There's probably up to a couple of thousand people in the direct area but it's hard to say exactly. They have had mains power since about 2001.

There is a market once a week in Norsup with the freshest fruit and vegies and lots of live crabs if that's your thing. There is one shop in Norsup, actually part of the hospital with some tinned food, sweet biscuits , etc. and occasionally ice cream. The general store in Lakatoro has a range of supplies; food, drinks, stationery, clothing, etc. even lawn mower's are available. There is a reliable yet small post office in Norsup. There are no restaurants, pubs, internet cafes, hotels or sealed roads to name but a few. There are countless nakamals to consume copious quantities of kava (not recommended)

Travel:

  • A short walk from Norsup there is a couple of large beaches, one with entirely black sand. Plenty of snorkelling out the front of the hospital and local walking abounds
  • Volcanoes - some of the only places to see live volcanoes in the world are in Vanuatu. Namely the islands of Tanna (a bit easier to get too) or central Ambrym where you walk across the moonlike landscapes of volcanic debris to get there. They are very impressive
  • Diving - fantastic reef everywhere. The wreck dive of the SS Coolidge (trans atlantic passenger ship from the 30s converted into WWII naval vessel) at Luganville on Santo island is one of the best in the world (attracts people from all over the world). Also can dive million dollar point where the US military dumped millions of dollars of tanks, guns etc into the ocean rather than selling it to the locals at cut prices or taking it home.
  • Pentecost island - to see the locals traditional Pentecost land dives, think bungy jumping with vines strapped to your legs into dirt, not for the faint hearted.
  • Most tourists only see the inside of a bar in Port Vila when they stop off from their cruise that docks in Vila harbour. There are also many resorts near Port Vila. You can fly to Luganville on Santo or Port Vila in about 20 - 30 minutes for internet, government agencies, mod cons etc.

Hospital contact:

Dr Derek Allen or 'The Doctor'
Norsup Hospital
Norsup
Malekula
VANUATU

My contact details:

Dr James McMahon
Infectious Diseases Registrar
Royal Melbourne Hospital
Grattan St Parkville VIC