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Nicole Lamb, a medical student at the University of Sheffield, received an IME bursary for her elective from Jan-Mar 2020. Her project report (below) highlights the different cultural values held by the people of the island she visited.

An insight into the health care in Vanuatu

I carried out my elective on an island called Espiritu Santo in Vanuatu, an archipelago of 82 islands in the South Pacific. The reason I chose Vanuatu was because I knew nothing about the place and neither did anyone else. After some research into the islands my flights were booked and bags were packed. I had no idea what to expect and now I know nothing would have prepared me for the experience I was about to have. 

The first day at the hospital seemed all too familiar, medical student looking lost looking for help for about half an hour. A nurse quickly recognised my lost face and introduced me to the Doctor I would be shadowing to start with. The friendly culture amongst all of the Ni van people was extraordinary, they were always willing to help and had the warmest of welcomes. I started on the medical ward for the first two weeks which was an eye opener for what was to come. Conditions and illnesses I had never seen or heard of before. No imaging machines apart from an ultrasound machine. No blood tests available apart from a full blood count. No cancer treatment.

We started the ward round and throughout I could hear weeping and screaming. I didn't say anything or ask any questions whilst shadowing the doctor as I didn't want to offend anyone asking what was going on as I wasn't aware of their culture as of yet. The doctor later told me that this is how the families mourn after a death. Little did I know that this would become a common occurrence during my elective. In England as medical students we rarely witness death as the health service provided by the NHS is exceptional and the treatment available makes the majority of people better. To witness death occurring every day in young and old was shocking. It quickly dawned on me the lack of resources and facilities was a serious problem here.

I then spent the next few weeks on the women's health ward. Here I assisted in clinics and with births. The time I spent on this ward allowed me to gain an understanding for the research project I set out to do, investigating the ethical position women have with regard to their own healthcare. It quickly became clear the answers to some of my questions as a husband was handed a consent form for his wife's caesarean section in front of me. I spent time in a family planning clinic for a few days which involved women attending to get contraception which their husband had approved. There were several women who opted for a depot contraceptive injection which would cover their contraception from their husband. I found it very difficult to comprehend how it must have felt to not have the choice and say over your own body. Women that didn't comply to their husband's rules were threatened, shunned and often experienced domestic violence. This was proven by the stack of folders standing on the shelf behind the nurse stacked above a post it saying 'domestic violence'. It was the highest stack.

lamb image_1 Left: A bed in the labour ward at the NPH.

Below: A room on the maternity ward

Lamb 2nd_image_3

It was difficult trying to understand their cultural beliefs. Doctors are seen to be like the devil and people will only resort to hospital if there is no other herbal medicine or remedy to try. Patients mostly presented at very late stages of easily treated diseases. One of the biggest problems was asthma. Due to families having indoor fires for cooking and the lack of compliance and technique to use inhalers this resulted in a lot of exacerbations. To make matters worse the hospital was running out of medication for these patients as they relied on drug donations and imports from other islands which could take weeks. Diabetic patients didn't comply with medication which led to serious problems and more deaths. The patients also lacked an education into their health problems, more often than not they didn't understand why they were taking a medication. This was proven with heart failure and high blood pressure patients not getting further prescriptions as they didn't know they would have to take lifelong medication.

I met four brothers on the medical ward which were being treated for reactive arthritis which was thought to have been triggered from a contaminated water source in the south of the island. The brothers remained on the ward for 4 weeks with one of them having to lie on the floor as he was in so much pain. The brothers were slowly discharged one by one. I decided I wanted to see the difference in hospitals between the government one I was currently in compared to the charity run hospital down the road. I introduced myself and was able to sit in on clinics. The first clinic I was in I instantly recognised one of the patients, it was one of the brothers. His reactive arthritis was still there and was getting worse again. He later explained that he was discharged without the medication required as the hospital had totally ran out and his brothers were worse too. Luckily the charity run hospital had some of the medication he required and he was able to return home with medication for them all.

The time I spent in Vanuatu will be truly unforgettable, the most rewarding part of my medical career so far. It has taught me many unforgettable lessons and most importantly it gave me a massive appreciation for what we have here within the United Kingdom. I know the NHS is taken for granted by most people and I only wish that everyone could have the experience I was so lucky to have to be able to appreciate the reality of what we share.

An insight into the health care in Vanuatu