By Dr Tarcisius Kabutaulaka
Health workers are the frontline of Solomon Islands’ battle against Covid-19. They work long hours under difficult circumstances, risk their lives and could potentially take the virus home to their families. Yet, they are dedicated to helping patients, their communities and country.
This article provides a glimpse into the struggles, sacrifices and dedication of Solomon Islands’ frontline health workers. It tells of the chaos in the health system as the country struggles to control the spread of Covid-19. But it also tells of hope as health workers regroup and reorganize and more assistance arrives from Australia, China, Aotearoa New Zealand, the US and others.
The southwestern Pacific Island country with a population of about 700,000 people was free of Covid-19 community infections throughout 2020 and 2021. But since mid-January 2022, the country has reported nearly 6,000 cases, over 80 deaths and a continuing surge. Only about 20% of the eligible population have had their second vaccination jab and nearly 50% with the first doze.
Solomon Islands was not ready for the community spread and health workers took the brunt of the initial impact. This was despite the fact that the country had two years to prepare and the Minister for Health and Medical Services Dr Culwick Togamana had told parliament in December 2021 “the NRH infrastructure has improved with government investment.”
A senior clinical nurse at the emergency department (ED) of the National Referral Hospital (NRH) in Honiara, who agreed to speak anonymously, says “we were overwhelmed by the number of very sick patients seeking medical attention. Many gaps that were identified, such as systems, staffing, space, medical supplies, etc. were never addressed.”
A doctor at the same hospital told of how things were chaotic when the community infections started. Speaking on condition of anonymity, the doctor said, “during the start of the outbreak, the only word that can best describe the situation on the ground was ‘chaos’. There was chaos everywhere.”
Doctors and nurses at NRH struggled to treat patients while many of them succumbed to the virus and the hospital became a hotspot, raising concerns about the wellbeing of both patients and health workers.
“At the beginning, a lot of the staff at the medical and emergency departments tested positive for Covid-19 but there was no place to isolate, so they used whatever room they could find in the hospital. Others sat on the corridor for more than a day unsure of where to go or what to do, and not being offered drink or food. There was also no clear direction on where the Covid patients should go or who will look after them.”
The medical department at the NRH, which is responsible for all the admitted Covid cases, has five physicians and seven registrars. But in the early days of the Covid infections, two physicians were infected, one was on leave and had to be recalled, and another had just returned from maternity leave.
“There was a shortage of staff as a majority of doctors and nurses were infected and had to be isolated. This resulted in those who were not sick working long hours in order to ensure that basic patient care was delivered.”
“In the early days, a majority of the patients admitted to the Central Field Hospital (CFH) were on some form of oxygen support. There were only two or three nurses looking after them because CFH had just been opened there were no nursing staff allocated for it. When nurses did not turn up for their shift, the ones on duty had to stay on for longer hours. Doctors and nurses were exhausted.”
There are similar stories at the Kilufi Hospital in Malaita Province. A registered nurse who works there says the hospital’s TB ward has been designated for Covid patients while TB patients have been moved to the general ward, causing concerns about potential TB infections. Heath workers there are also hard hit. “Almost all the doctors and nurses here [Kilufi Hospital] have had Covid and the remaining ones are often on double shifts. We are all tired.”
One of the challenges for health workers is the fear of bringing the virus home to their families. Dr Paul Popora Bosawai is a private medical practitioner who has a clinic in the Guadalcanal Plains, about 30 kilometers east of Honiara. He has worked with the Guadalcanal Provincial Health Department and the Guadalcanal Plains Palm Oil Limited (GPPOL) to test, treat and protect Covid patients in the surrounding communities. But he fears he might bring the virus home and infect his family, especially his 4-year-old son. “Many times I slept in my car and only see and speak with my son through the window of our house. I am worried about infecting him.” Despite this, Dr Bosawai continues to work with communities because he sees this is a “moral obligation.”
More than a month after the start of community infections many NRH staff still live away from their families at quarantine facilities because they fear taking the virus home.
Health workers who were infected or treated Covid patients were also stigmatized. The senior clinical nurse says as soon as it was known they were infected, “the ED staff was stigmatized. We were unable to access transport, food, accommodation and other things important to our welfare. Nurses had to sleep in the department without food and water. Our patients were not fed because the hospital kitchen staff were too afraid to bring food to the ED. The feeling of being stigmatized by hospital staff and our communities has been really challenging to me mentally.” Similarly, Dr Bosawai tells of road blocks or people avoiding his vehicle when he went to communities to help Covid patients. “They see me as a coronavirus carrier.”
Dr Bosawai says another challenge is the late presentation of Covid infections, making it difficult to manage with limited resources. “Often times people think of kastom (traditional) medicine first. When that fails they come to the hospital, but by then the patient is already severely ill.”
Despite these challenges, the senior clinical nurse in the ED dismisses reports of people dying on the hospital floor. “In my 26-year career here, there was never a moment when a dying person was left on the floor to die. Despite whatever challenges we face, the patients’ dignity is always paramount.”
Things have improved slightly, at least at the NRH and CFH, as protocols were reviewed, responsibilities made clearer, rooms allocated and more medical equipment provided by donors. The opening of the “red ward” (Covid ward) where critically ill Covid patients are now kept has helped. The number of nursing staff in the red ward has now increased with lots of probationers joining the registered nurses and being supervised by them and the doctors on duty. Despite this, the situation is still far from ideal and health workers and patients continue to struggle.
The NRH doctor says, “there are lots of good health workers who stepped up and gave a lot to ensure health services are delivered despite the insurmountable challenges. They hardly complain. All they do is come in and work and go home, or spent days in isolation away from their families. The few who were not infected stepped in and took on shifts, dividing themselves into small bubbles and continuing to work while waiting for their colleagues to recover and return to work. They have my respect.”
But there were also doctors and nurses who were not infected but didn’t turn up for work, either because they didn’t want to do the long hours or were scared.
Assistance from donors has been vital. In the past weeks, Australia and China have been flying in Covid medical equipment and supplies. Australia has used its C-27 aircraft to deliver supplies to Malaita, Western, Makira and Temotu provinces. Aotearoa New Zealand and the US have also provided vaccines.
The Australian Medical Assistance Team (AUSMAT) provided much needed training to health workers. Although the trainings were largely on things they were already familiar with, the NRH doctor says the AUSMAT training gave them confidence to work fearlessly amongst Covid-positive patients. “We already had wings, but the AUSMAT taught us how to spread them and fly.” According to the clinical nurse consultant at the ED, “things at the NRH and CFH have significantly improved because of assistance from AUSMAT.”
As Covid-19 infections, hospitalization and the death toll rise, health workers will continue to be at the frontline of Solomon Islands’ battle against the pandemic. Dr Bosawai says, “if Solomon Islanders want to prevent Covid infections and help health workers, they must follow the protocols put in place by health authorities. They must get vaccinated.”
(Photos: National Referral Hospital Emergency Department. Photo by Kristalee Horoto)
Dr Tarcisius Kabutaulaka is a Solomon Islander who currently works as an associate professor at the University of Hawaiʻi at Mānoa in Honolulu.