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NRH Front line doctors under stressful and hazardous work conditions, SIMA calls for urgent action

Doctors' consultation at the NRH
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As a Civil Society Organization, the office of Solomon Islands Medical Association (SIMA) is appealing to the National Referral Hospital (NRH) CEO and MHMS Minister and his PS not to turn an unsighted eye and neglect to the work conditions of doctors and nurses at the emergency department of NRH.


“It is with great distress SIMA wishes to inform your offices and responsible authorities that our Emergency doctors and nurses are working around the clock under immense and repulsive work conditions,”Dr Pedical Togamae, Solomon Islands Medical  Association President said in a statement today.

He said the NRH Emergency department was closed for more than a month now, for a 1.9 million worth of maintenance and refurbishment work. “Work has ceased to progress at the moment due to funding delays and due to the Pacific Games commitment. The Pacific Game 2023 has also negatively impacted on Emergency doctors and nurses at NRH and is indeed a crucial concern. They are performing their duties in make-shift tents on tar marc (car park) and on west wing porch of hospital,”Togamae said.

He said the availability of beds for unfavorably ill patients is questionable.

“Working space for doctors and nurses is unease. Let alone the immense heat that doctors and nurses with their patients have to withstand 24/7,” the statement, said.

SIMA understands that the renovation has been stopped since the games started as the NRH executive decided to use the renovated Emergency Ward Entry to transfer Athletics from Polyclinic to the Athletic ward or to the X-ray for imaging.

“This action is uncalled for as the delay has a lot of negative implications to the care we offer to the Citizens of this Nation,” Togamae


He added currently the Emergency Ward has only 18 beds (this includes 9 beds outside the NRH, BSP atm machine) and each day, an average of 70 patients presented at ED and an average of 49 patients were kept at the Emergency department overnight. This means that only 18 are sleeping on the bed, some on the benches and the rest are at the floor along the corridors outside the Pharmacy or told to go home and return the next day to get their treatments.

“Despite its closer the NRH Emergency Ward sees it fit to re-open the renovated resuscitation room to cater for PG athletics to use as a waiting room. Currently two (2) doctors from emergency department will be relocated to the PG poly-clinic facility. On average the emergency department will be covered by eight (8) doctors per day. They will cover three (3) eight (8) hourly shift works, which means only two (2) to three (3) doctors covering each 8hours shift.

“This is a grossly unacceptable under-staffing for a national tertiary institution like NRH. There is extreme for emergency department doctor-patient disparity of approximately 1:10000 (Doctor: Patients) ratio in Honiara city alone (pop of Honiara SI national statistics office July 2023). This will mean that they have shorter recovery days and off-days for the next three (3) to four (4) weeks. This situation will ultimately result in our doctors and nurses suffering from burn out, stressful work condition, poor work performance and poor decision making. This will further place many lives under enormous risk with unwanted health outcomes. The critical working space will also increase risk of acquiring airborne diseases (flu-like /TB infections) and occupational injuries (needle stick). Patients’ well-being cannot be guaranteed in such environment and resource constrained situation. Patients being cared for on walk ways and hospital floor is unacceptable and should be viewed inhumane,” Togamae said.

“This calls for an investigation into office of NRH CEO and Permanent Secretary of Health to explain why such only tertiary national Emergency Department renovations are denied of funds,”he said.

“SIMA is seeking answers from the government, NRH CEO, Minister of Health and permanent secretary of Health, why do we have emergency funds to build million-dollar worth facilities during the COVID-19 outbreak within months yet today we are witnessing the only national tertiary institution and workforce wellbeing slips into crisis and decay Solomon Islands is a hyper-epidemic region, as such we are expecting increasing work load with arrival of PG delegates and current fourth quarter weather. SIMA therefore strongly condemns the level of attention that the office of NRH CEO, Honorable Minister of Health and the Permanent secretary of Health have towards these eye-sore work conditions,” said the SIMA President.

“SIMA can only sympathize with its members’ and patients’ wellbeing at the current make-shift Emergency department. Patients are kept on hospital porch for more than 24 hours on daily, being exposed to heat and cold has become a norm. What does all these imply? Solomon Islands as a member state of International Labour Organization (ILO) has failed to recognize and uphold the ILO Charter 187: Promotional Framework for Occupational Safety and Health Convention, 2006. Healthier and safer workplaces can prevent at least 1.2 million deaths every year, according to a 2018 WHO study. Many deaths and disabilities can be prevented through addressing major health threats at the workplace, such as stress, long working hours and shift work, prolonged sitting at work, work-related climate sensitive diseases, such as heat and cold stress, as well as workplace air pollution. The workplace is a key setting for action in many WHO global health initiatives on environment and climate change, non-communicable diseases, mental health, tuberculosis, HIV and other communicable diseases,” the doctor said.

Togamae said the 24/7 digital economy and , long working hours, high demand and rapid change with low personal control can be devastating for physical and mental health and wellbeing of our doctors and nurses.

He said in the Ministry of health and Medical services there is nothing nor limited opportunities and new ways of working provide solutions for extreme work conditions, for example, by requesting medical disaster response teams (Australia/NZ) to assist in times as this.

The Solomon Islands Medical Association is calling on the NRH CEO, honorable minister for Health and Permanent Secretary of health to put their priorities right, investing finance to resume maintenance work.

The people of Solomon Islands and citizens of Honiara city, the silent majority, are calling on Minister of Health and his Permanent secretary to come down from your offices (just across the road) to address the National Referral Hospital Crisis, said Togamae.

Meanwhile he said the Solomon Islands medical association thanks the government for its unprecedented support to health of Solomon islanders; many patients can still access their clinicians in difficult situations as this.

“Nothing can absolutely replace the gold standard: in-person care in our hospitals. Solomon Islanders need their healthcare heroes who are working overtime to deliver this due care safely. This equally indicates that the Ministry of Health and Medical services and Government of the day must ensure that the welfare and health (physical/mental) of Solomon Islands doctors be upheld. The international labor organization charters: Promotional Framework for Occupational Safety and Health Convention, 2006 must be upheld. For this will ensure safer work safety and healthier workforce,” Togamae concluded.

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