Kosrae State Hospital

On Wednesday last week I had my orientation around the Arthur P Sigrah Kosrae State Hospital (named after it's first director and the very first doctor on the island).

My first glance at where I would be spending most of my time over the next month. 

And I have to say, it was rather nice to be back in the world of medicine. Amidst a week where everything had been new and unfamiliar, it was good to feel back on home turf.

It sounds silly, but it really was settling to hear someone say 'MI' or 'O.R' or 'hypertension' etc., for two reasons: it was incredible to see that the language of medicine apparently stretches the bounds of all the world's time zones, and it was fun to return to all these terminologies that I had left behind after a whole 9 months of being completely surrounded by them during the intense 3rd year I had at medical school. 

I found the rest or my orientation equally full of similarities with my previous experience of UK-based medicine....

The hospital is basic, yes. But it's got everything one might need to serve a population of 7000. It's got all the equipment, all the paperwork, the departments, the staff, the medications... Just more basic, fewer or 'old' versions of them. Which is what one might expect for a hospital of limited resource. And, as someone from home pointed out, old equipment served the people of the UK just fine 20/30 years ago. It still works.  it's just not as high tech as what we see in the NHS hospitals of today. 

So overall, I was most impressed with the hospital. 

Here is a sketch I made of the layout....

And here's a breakdown of what they've got in each department;

'A&E' - one triage room, with a nurse. And one ER room, equipt with some key meds and necessary equipment (IV lines and fluid, airway management, defibrillator - although i was told this isn't   working at the moment (!) and it's the only one around so fingers crossed no one needs it until it's mended!

(Triage)

(Emergency room)

OPD (out patient department) - 4 consulting rooms with the obligatory uncomfortable chairs in the waiting area that are always (in all hospitals I come across) placed far too close together in my view considering they're all occupied with sick people. Haha.

See - pretty similar to the UK ones, just not as 'up to date'/clean/clinical.

Pharmacy - stocked with a good range of medications. Funnily enough, the set up is very similar to UK dispensaries - all alphabetised on a bunch of neatly organised shelves. Supply is from nearby Philippines or Guam or Honolulu.

This pharmacy is the only place to get medications on the island (over the counter stuff like paracetamol is sold at some stores). It's open during normal working hours but closes overnight and weekends - again, quite like the set up in UK.

Radiology - this was probably my favourite 'department' and is headed up by Roger the Radiographer who was quite a character. Facilities: X-ray, Ultrasound and ECG/heart trace. Whilst they have just received (last year) a very nice new GE X-ray machine, the X-rays are developed by hand (!). Amazing.

(X-ray machine)

(Developing room)

(The finished product - nice and old school. These days in the NHS all the images are on computer screens. How boring. This here is much more exciting and like how it is on the telly!)

(Ultrasound)

Admin offices - director, assistants, continuing professional development spaces with computers etc, conference/meeting room. All the usual stuff. With air con! Which makes it a nice space to hang out when it gets very warm during the day!

The ward. Yep, just one. 6 bays, with anything from 3-6 beds in each bay. Separated into male and female bays. The middle bay is Intensive Care with just two beds and more equipment placed within the bay. And the novelty of a curtain to cover the doorway (!). When I think of the brand new Intensive Care Unit at Chester I've had the privilege of going to a couple of times throughout this year, which looks like something out of 2001: A Space Odyssey, it makes me think how lucky the NHS and the patients that ever need to be treated in I.C.U are. 

There's also a paeds room with 4/5 beds in it and one or two single-bed rooms for people who need to be in isolation or need more care with basic needs like washing and toileting.

(The ward, plus a little girl with a fever, and a nice nurse called Yoleece)

(The ward bays)

(Nurse's/doctor's station)

(The ward medication 'cupboard' and prep space)

The hospital has a laboratory, albeit in an outbuilding. It can do some things but alas not many. The most surprising thing I've heard in regards to what the hospital can't do is culture of bacteria/microorganisms from blood or urine. This is a really common and importantly rest we do in the UK to a) determine if there is an infection in the first place, b) find out what bug it is that's causing it so that you can decide c) what drug to combat it with. Here there is the more coarse judgement of 'well, it's probably x/y/z bug so we'll give it a/b/c antibiotic'. 

It is also not possible to do cardiac enzyme markers - also a common thing done in the UK for patients with chest pain that's suspicious of a heart attack. 

Histology and cytology samples also cannot be analysed on site and get flown (!) to Guam for testing. 

(Laboratory)

The lab can do more standard things such as full blood counts, kidney function tests, liver function tests and (importantly for here) TB sputum tests.

OBGYN is well catered for via a labour room with two beds. Yep, you might be in labour with someone else here. And a delivery room with a resuscitaire (the little table/cot that the baby goes on straight away to get cleaned up/airway cleared and checked before being given back to mum). This room also double as an operating room for cesarean sections and gynaecological procedures.

(Sorry, no pictures of this one!)

The operating theatre. They do a small range of surgeries by the sounds of it - wound debridements, amputations (a common complication of poorly controlled diabetes), diagnostic abdominal surgery, cholecystectomy (taking out the gall bladder), appendicectomy (taking out the appendix) but nothing 'major' in the abdomen. There's also an anaesthetics room attached to the O.R and a doctor specialising in anaesthesia. 

The Well Baby room is a place for the post-natal and baby clinics to take place. Checking baby weight, length, immunisations, development etc.

NCD clinic - non-communicable diseases. This is mainly diabetes and hypertension/high blood pressure. A happy place, and evidence of the benefit of talking therapy. See, patients don't get given a time for appointments at the hospital. Rather they get given a to come in next (it is given at the end of their previous appointment) and then they just turn up whenever they feel like it on the day of the appointment. There is of course a common time that NCD clinic happens (Monday and Friday mornings) but it's a bit of a free country in terms of when you rock up. There is of course a system whereby the first person to show up gets seen first and a queue forms from here. But people do end up just hanging around for most of the morning. Although, the nice thing about this is that everyone ends up sitting together whilst they wait. And they laugh and joke and catch up and often help each other out with taking the screening measurements (weight, blood pressure, blood sugar finger prick test). It's lovely to see. And what's more - the doctors do the appointments with the door open (!) so people frequently come out of the consulting room and would say to the group 'ah well, looks like I've still got to take the medication' or something along the lines of 'no more sugar for me' etc. marvellous! 

There are also services for antenatal care, maternal and child health, family planning, mental health, substance abuse and infectious disease but I don't know much about these yet. Watch this space!

So hopefully I've managed to depict the fact that this hospital caters well for the population and is, for the most part, truly structured in a way similar to a hospital from back home, albeit a simplified version. 

I'm sure it will be a fascinating month here and my two supervisors, Dr Tholman Alik and Dr Carolee Masso, have kindly put together a programme that aims to get me exposure in all areas of the hospital's work.

I look forward to writing about some of what I see soon!