The maternity ward sees around 1500 births a year, with plenty of grand multis rocking up and many women having had zero antenatal care. The ward consists of a birth suite with three beds, an antenatal room for incoming labouring women with six beds, a couple of rooms for women post-Caesar, and a nine-bed room for post-natal women (no curtains and no ceiling fans here). Women having their first baby generally stay on the ward for 48 hours, and those with other children usually hang around for about 24 hours. The post-Caesar women usually are given morphine, and they try to get the IDC out and mobilisation happening 6 hours later. I’m used to the nice honeycomb dressings our women get – here it’s iodine-soaked gauze covered by Elastoplast which seems to do the job.
The birth suite is one of the few places in the hospital with air conditioning, and has three beds with stirrups, a resuscitaire and a strong metallic smell of blood. It’s quite an intimidating room – very far removed from the comforts of birth suites in Australia – and women are not offered any analgesia during labour. Lucky the women here are stoic!
The Special Care Nursery has a few incubators, a couple of phototherapy lights and a no-shoes policy. There are no ventilators here or anywhere else in the hospital besides theatre. The inpatients of the SCN were mostly premature babies (one born at only 900g – and was only around 1.5kg 50 days later) or those who needed some respiratory support. They seem to mostly use high-flow oxygen although there is CPAP equipment in the cupboard. There is no regular screening e.g. Guthrie testing here, but babies do get Hep B and Vit K jabs.
I spent most of my time during maternity on ward rounds and in clinic, as the hospital was overrun with midwifery students. The hospital also decided in mid-January that medical students were no longer allowed to get hands-on during deliveries. Clinic was held every day in clinic rooms at the end of the building. The team consists of two obstetrician/gynaecologists from the Pacific, one Chinese obstetrician/gynaecologist who can speak a few words of English and none of Bislama, and a few midwives. Family planning isn’t much like Australia – they still use female condoms as well as male condoms, and other options include the pill, copper IUDs, progesterone rods similar to Implanon (except 2 rods are inserted every time), and tubal ligation. Typically, the woman continues to have children until she has the desired number, then gets a tubal ligation when her husband is satisfied. Husbands have to give consent for sterilisation surgery.
Gynae clinic is pretty similar to that in Australia, except without the colposcope. Pap smears/cytology are done but the public health program isn’t as established as Australia’s. Antenatal clinic is reasonably similar – screening questions for pre-eclampsia, palpating the abdomen, measuring fundal height etc… except no one asks about mental health (it isn’t discussed here at all), nor smoking or alcohol use. I am told that chlamydia is present in about 25% of the population, and every woman and their partner get azithromycin as a ‘presumptive’ measure. Booking bloods consist of a full blood count and hepatitis B/syphilis serology, and those women who are concerning for pre-eclampsia get urine MC&S and UECs. There is no OGTT or routine screening for gestational diabetes. The only post-natal depression information I saw the entire placement was a poster in the doctor’s meeting room. There is one ultrasound machine for use, and a few dopplers which are hit and miss – so mostly the foetal heart is heard with a Pinard horn. I didn’t believe it would work until I listened to a few women’s bellies on my own and actually heard the FHR loud and clear! As you can see, antenatal care is not as thorough as it is in Australia and this is probably reflected in maternal and foetal mortality rates.
During this week we also went horse-riding at Santo Horse Riding, run by a lady from NZ who rescues horses from all over Vanuatu. It was a great experience – riding along the beach, through the water, into a mangrove tunnel and through bush. Part of her income from the horses goes back into the local village for building schools and other important projects.
Angus and I also started our PADI open water diving course, diving the SS Coolidge and the various military equipment at Million Dollar Point. It was the highlight of the trip, an amazing experience and would recommend it to anyone! We did it through Allan Power Diving.
Vanuatu Elective 