A volunteer from Doc Tours recently visited Sigatoka Hospital to practice Occupational Therapy for the local Fijians. This was Robyn Scheer’s second visit as a volunteer in Sigatoka and she reported back on her experience.
Day 1 Monday: Sigatoka Hospital, Fiji
The week began with an 8 am meeting of all doctors at Sigatoka hospital boardroom to report on weekend events. Patients were discussed and this gave me a brief insight into the business of the hospital emergency department and wards. I was introduced and welcomed by Dr Amos.
I met with physiotherapist Namrata in the physiotherapy treatment room. Namrata was my colleague last year as well and it was lovely to catch up again and I think easier for both of us. We had communicated by email previously when my placement was confirmed. Namrata explained the details of the plan for the week.
The plan for the first day was to participate in health clinic outreach with nursing staff. Sr Layla explained that there was a problem with transport for this day. Plan B. I spent the morning meeting with Namrata discussing patients and issues for her clinic and sharing resources. I provided some donations of kineseo tape that I had identified form my last visit as being useful.
Outpatients were treated for shoulder and back pain and provided treatment and exercises.
An inpatient, a baby awaiting discharge was reviewed to discuss lung management as the baby was recovering from pneumonia.
Plans were put in place for transport for Tuesday and I left at lunchtime to go to town to purchase a mirror to trial mirror box therapy with an outpatient recovering from a stroke.
It is important to spend time in town at the markets, the pharmacy and supermarket to understand some of the issues and challenges for the patients. Using local transport is also important for insight into the lifestyle in Fiji. Many items are available at the pharmacy but can be very expensive for local people. The disability allowance from the government is $50 per month and this would not purchase many weeks supply of items at the pharmacy. Most people rely on friends and family to assist with the cost of equipment or it is donated from overseas.
Day 2 Tuesday: Surgical OPD, Vatukarasa Health Clinic
Early pickup at 7 am with hospital transport. Physiotherapist and her equipment on board.
Clinic staffed by Medical Officer Dr Pryanka and 2 nurses. The Dr lives at the health centre and provides on call service.
First surprise of the day was that one of the nurses was able to have her 4-month-old baby at work, as she is breast feeding. Paid maternity leave is 96 days and many staff need to return to work after this time to support their family.
Outpatients were seen by the Dr and then if required seen by the physiotherapist. Back and shoulder musculo-skeletal problems were presented and education also required around managing diabetes and hypertension.
I attended the adjacent village for a number of home visits with Angela the nurse. The physiotherapist provided me with a Sulu, as it is compulsory to wear in the village.
We saw 5 patients with a range of mobility problems and varying in age from 87 to 17.
Discussion and advice about maintaining mobility and independence with specific exercises was reinforced. I encouraged simple exercise such as walking and swimming and using household items such as cans of tomatoes for strength in upper limb. Education about diabetes was important for a patient who already had an amputation but had not attended the health clinic a short walk away for sugar level monitoring for almost a year.
The young patient Eseta (17) was home from school for the school holidays and had received corrective surgery in Hawaii for her feet and been provided with foot orthotics. She walked with underarm crutches with unsteady gate and was developing finger contractures. She stated that she had been lost from follow up at Lautoka hospital following her surgery some years ago. I provided instruction in passive hand and finger exercises and suggested she try overnight resting hand splints. Seta said she was keen on swimming with a disabled team but wasn’t sure where she could join. I suggested she ask the staff at her school. She is hoping to study accounting next year at University. The physiotherapist will investigate contact with Lautoka outpatients.
Day 3 Wednesday: Outreach to Sovi Village
Arrived at Sigatoka Hospital at 8 am to join nursing staff on outreach visit to remote health clinic in the interior. Transport with Mosi was arranged and the vehicle packed with supplies for the day. It is vital to have reliable transport as a four-wheel drive was required and hospital staff and equipment needs to be carried in a government vehicle. No option of a taxi!
We also collected RN Escialsa from the Rawangga Health centre where she lives with another nurse and a doctor. This health centre provides care for a number of villages and settlements. The trip to the village from Sigatoka took approximately 2 hours.
It was important to have the RN from Rawangga Health Centre as she spoke the dialect of the village. Very little English was spoken. On our arrival the village health worker had gone away for the day and her house was locked. The health worker is someone appointed by the village.
The village arranged for us to use another house for the day to see patients.
Patients began to arrive to have blood pressure and glucose monitoring. The majority were in a healthy range. One person was hypertensive. Medication was provided.
One elderly man was using crutches for mobility due to arthritic knees.
A range of children and babies were checked with their mothers and panadol and worm tablets were provided. No injuries or infections were detected.
The village of 70 grows a variety of fruit and vegetables, chickens and hunt wild pig.
We were very kindly provided with a lunch of bele, tapioca and beef broth.
Our driver returned us safely to Sigatoka at the end of the day.
Day 4, Thursday: Physiotherapy Outreach to Cuvu Village
Transport was provided to Cuvu Health Centre. The centre caters for a wide range of settlements and villages with a resident doctor (Dr Priyanka) and 3 resident nurses.
Outpatients were seen by the Dr and then triaged for nurse administration of medication or dressings or referred to the physiotherapist.
12 outpatients were treated across the morning. Patients were made aware of free cervical screening programme at Sigatoka today if they were able to get to the hospital.
We met with one of the nurses to discuss the housebound patients in the nearby village but it was decided to not visit these patients at this time as they had been visited relatively recently.
The inferential machine was very useful with a variety of musculoskeletal problems and Kineseo tape was useful treatment as well
Day 5 Friday: Outreach from Korolevu Health Centre
Early start 7am pick up with transport for Namrata (physiotherapist) and myself to Korolevu.
Dr Elizabeth and 3 nurses staff the health centre. A busy day of outpatients was scheduled for the physiotherapist and I attended home visits to nearby villages with 2 of the nurses.
We had a list of known patients to review including, CVA, Hip replacement and amputees. All patients had co-morbidities of high blood sugar and/or hypertension. Fiji has a high incidence of Non-Communicable Disease (NCD) in particular diabetes.
Once my Sulu was in place and I was reminded to remove my shoes before entering a home we were on our way with a local driver taking us to the different villages. Seven patients were reviewed with exercise prescription and general advice about managing in the home environment and /or at work. Most of the patients whether amputees or CVA had adapted their home environment to their limitations. Toileting was a challenge for many and this required the use of a bucket, as they were unable to access their toilet. Family members were supportive and provided assistance as able. A review of diet to follow Fiji guidelines was also completed in most cases and information about elevating limbs and general skin care.
The nurse conducted blood pressure checks and general welfare checks with regard to social welfare and equipment as required. A community health worker was available in some villages to assist with language translation and some children on school holidays were also very helpful.
The villages and settlements are located adjacent to a number of resorts and many of the patients work in the resort complex, which can involve shift work, and heavy and repetitive work.
It was an interesting day and we were able to exchange ideas and feedback over lunch.
School children home on holidays were a great help with translating for patients and health workers. They were interested in the work we were doing.
Spending time with housebound patients meant we could discuss their care in the home environment and suggest home exercise programmes; diet, mobility and skin care with their carer.
This concluded my week at Sigatoka and surrounds.
In summary ….
This is the second year I have completed a volunteer week and I feel I was able to build on the experience of last year. It became clear with the outreach clinics that language is one of the big challenges for visiting health workers as many local Fijians do not speak or understand English and we need to be careful that information is understood.
Visitors need to be patient and listen to the experienced health care workers and the patients. We cannot rush people and “Fiji Time” is real.
I am very grateful for the opportunity to see first-hand the working of the Fiji health system. I feel very privileged to have been invited into people’s homes and lives and hope in some small way I have been helpful to them. There are challenges for everyone but a lot of good work going on in all sorts of challenging situations. It is great to have the support of Namrata the physiotherapist and the Dr Amos for arranging such a varied programme for me around their own very busy schedules. I now understand that it is a bit unique to be a therapist and visiting on my own unsponsored provides a very individual experience.
My working life in Brisbane is based at a large metropolitan hospital (Royal Brisbane and Women’s) where I specialize in lymphedema outpatients. I also work privately doing home visits for home modification and equipment prescription for patients. Although day to day this work seems quite different to the work in Fiji there is always the focus on the patient and aiming for best care and independence for the patient.
Thank you all for your patience and welcome, I hope that I was of some small assistance. I will keep in touch with Namrata and forward any resources I come across that may be useful with her patient load. I hope to visit again sometime.
Vinaka (‘thank you’).