Solomon Islands experience--Holiday with a Heart.
|Article Type:||Personal account|
(Beliefs, opinions and attitudes)
Knowledge workers (Practice)
Health care industry (Information management)
Health care industry (Technology application)
Medical informatics (Management)
|Publication:||Name: Health Information Management Journal Publisher: Health Information Management Association of Australia Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Health Information Management Association of Australia Ltd. ISSN: 1833-3583|
|Issue:||Date: Oct, 2010 Source Volume: 39 Source Issue: 3|
|Topic:||Event Code: 200 Management dynamics; 260 General services Computer Subject: Health care industry; Company systems management; Technology application; Company business management|
|Geographic:||Geographic Scope: Solomon Islands Geographic Code: 8SOLO Solomon Islands|
Where does a Clinical Coder from a country town in NSW begin to
tell the story of how she became involved in developing a clinic
recording system for a floating medical clinic in the Solomon Islands?
My story began when my husband Peter (an ambulance paramedic and
Registered Nurse) and I, who are both first aid trainers, attended a
Volunteers' Expo in October 2008. We were intrigued with the
concept of volunteering on board a boat named Medisonship, a floating
medical clinic operating in the far-western provinces of the Solomon
Islands, based on the island of Kolumbungara. This vessel was
commissioned to bring clinical services to remote villages, where such
services were not normally available, as well as to support existing
land based clinics and aid posts. The boat was to travel for three weeks
of our stay with a local island nurse, a volunteer doctor from Australia
and, of course, Peter and myself, to assist with the running of clinics
and then return to its base at Meresu Cove, Kolumbungara Island for
restocking and maintenance procedures. The rest of our stay was to be
spent assisting in the local clinic at Kukudu.
The next challenge arose when I was told that the floating medical clinic had no formal record system in place for its day-to-day operations and, upon discovering my background in health information and medical record work, there was much excitement when I agreed to develop a clinic recording system for the ship.
Some months later, and after much research to find out what systems were already in place within Solomon Islands Health (after all, why reinvent the wheel?), I put together a recording system that could be used either on board the boat or for a village land-based clinic held by medical crew members. My idea was to be able to utilise this document to record essential information which could then be analysed for capturing statistical data and measuring the clinic activities, types of diseases treated, general patient observations and treatment administered. My ultimate goal was, of course, (having been a Clinical Coder for 17 years) to carry out data analysis that could also be helpful in later collating and distributing reported data to health information authorities to both monitor the activities of the clinic boat and to assist with future planning and development of its clinical programs.
We flew from Brisbane, Australia, to Honiara, Solomon Islands, followed by a 12-hour boat trip to Gizzo. From there we boarded a tiny banana boat (supported by a 40hp motor), carrying just Peter, myself and two local Solomon Islander men. One was the driver and the other also a
passenger on the 40-minute trip across the ocean to Meresu Cove. With the sun setting in the west and the waves breaking on the bow of the boat we could just see the whites of our trusty driver's eyes, and we wondered if we would actually make it to our destination, and then in the back of my mind was the question: I wonder how big Medisonship really is? Our modes of transport seemed to be growing smaller on each stage of our trip. Finally, just on dark we arrived, and were relieved to see that Medisonship, which was moored at the dock, was a larger vessel than the one in which we had just traveled. We were greeted by a lovely Australian couple, Glen (Skipper/Manager) and Chris, our hosts for the next five weeks. After a much needed freshen up, a hearty meal followed by a kind of 'staff meeting', we found ourselves in a state of shock after advice from the skipper that Medisonship had mechanical problems and would not be ready for us to travel on, especially to the remote areas where we would need to go to in order to fulfill our medical mission. We had just had our first lesson in Solomon Islands time where nothing happens in a hurry and you cannot just fix things instantly, due to lack of parts and servicing supplies. To be advised of this on our first night was a little disappointing, as our contact in Australia had not given us any idea of the likelihood of this situation. However, we were told that we would be made welcome in the land-based clinic at Kukudu and also that contact had been made with the local Adventist Development and Relief Agency (ADRA) director and that his medical/education team had agreed to take us on board their boat for the same purpose of running clinics in island villages of Vella La Vella.
From then on we found ourselves traveling between islands, sometimes for four hours, across the open ocean in large swells. Unfortunately, we were not on board Medisonship--but you will never guess--yes, once again in a banana boat with a 40hp motor. On board were the driver, the ADRA Director, a large, happy man named Lepese, and the husband and wife team, Phillip (teacher/educator) and Unity Folata (RN), with our medical supplies packed into travel bags. We also took with us a small amount of food supplies and personal belongings; enough to last for a few days. We would be staying in the villages not knowing where we would sleep, but at least we each had a straw mat and a mosquito net for comfort.
Here began an epic adventure we will never forget. We ran medical clinics in the villages, beginning at 8:30 am and finishing at around 5:00 pm, followed by evening health education programs focusing on AIDS prevention and diabetes education. Meetings with village chiefs and elders were also conducted, to make contracts to clean up their village environments and plan for improvement in their water supplies and general health services.
We ran first aid awareness classes, teaching the locals how to administer basic first aid using local raw materials such as bark, leaves and bamboo sticks for bandages, slings, splints and dressings. There was a need for this knowledge within the villages. Some people who attended our clinics for medical care and advice had been victims of injury involving burns and fractured limbs that had never been properly treated, thus resulting in limb deformity and ongoing chronic pain. Other common disorders we encountered were tropical leg ulcers and yaws (a spirochete infection that is very contagious and spread by cross infection from skin-to-skin contact). Type II diabetes is on the increase in the Islands due mainly to the introduction of western food supplies, together with a natural diet based on local foods high in carbohydrates and sugars. Eye and ear infections as well as urinary tract infections are also common.
Did we utilise my clinic recording system?
We had been blessed to meet with Dr Adu Krow from Honiara World Health Organization, and Sue, the chief data statistician for the Solomons, who were very pleased to assist us in any way they could and also give us some information on the types of things we could assist them with while reviewing the records systems in the clinics. On return to Honiara we met and reported our findings and shared areas we identified for quality improvement in their documentation systems, as well as deficiencies in their pharmacy ordering and distribution systems. We were in contact with them throughout our stay and they were very helpful in assisting us to obtain medications for treatment of various illnesses where there was a shortage of drug supplies at the closest clinics or at the local pharmacy within the health service at Gizzo.
When we left Australia for the purpose of volunteering our expertise and time on board Medisonship, we had only limited information and knowledge about living, working and health support in the Solomon Islands. After spending the next five weeks, day and night, working in very extreme, remote and suboptimal conditions in land-based clinics, some of which had been flooded by the 2007 tsunami and were left with no water or power supply as a result, we felt richly rewarded in being able to assist the clinic staff in some small way, even though our original plans had been so acutely changed. Our personal expectations were far exceeded. We learned so much, met so many special, kind-hearted, hard-working professionals within Solomon Islands Health and felt a sense of belonging. We have a completely new appreciation for the wonderful health services that we so often criticise in our own country of Australia. There is something to be said for having a 'Holiday with a Heart' experience, and volunteering your time to help others. We returned to our country with sadness to leave our newly made friends and colleagues behind. We hope to return some day to assist them some more and have gratitude in our hearts that we had been given this opportunity.
I guess in summing up, though my clinic recording system was a useful tool for our field trips in the Solomons, it will probably never be used again after having put the time into developing it. I never really minded; it was a challenging thing to do and most of us who are Clinical Coders always rise to the challenge of a new idea and constant changes occurring and re-occurring! We have an acute eye for detail and a keen sense of investigating and reviewing systems and implementing new ideas and concepts. After all isn't that what makes the heart of a coder tick?
On our return to Australia, we formulated a report to the Australian-based owner and manager of Medisonship, outlining some professional suggestions for improvement, gave some advice for future planning, such as aligning with Solomon Islands Health as a supporting clinic and to get on board with using the Solomon Island Clinical Documentation system, which was already available to medical clinics within the region.
Grafton Base Hospital
PO Box 269
Grafton NSW 2460
Tel: +61 2 6640-2470
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