Monday, 24 September 2012

Aitutaki Hospital

Sorry for lack of updates! I will be slowly putting more information about Aitutaki.

My elective buddy, Ben, has left this afternoon, and now that I'm lacking a companion to hang out with, I have a whole lot more time to blog!

I figured it is about time to show you around Aitutaki Hospital. There is very little information about Aitutaki particularly for prospective elective students, so here are some snapshots of the hospital life...

Aitutaki Hospital site, looking from the driveway. Outpatient clinics and the ward are on the right hand side, and the far end on the left has the dentist, public health nurse and the hospital manager's offices.
The student bedroom - free accommodation at the cost of being first on-call during your elective (if you are on hospital grounds). You can get called at all hours of the day and night. Ignore the mess of the room, but there are two single beds (old hospital beds), two bedside cabinets and a really... iffy sink. Definitely not a five star hotel suite, but it serves its purpose. The nurses call it the "President Suite." Lol.

 Aitutaki Hospital is currently manned by one permanent doctor, Dr Koko, who provides 24/7 emergency services. It really should be run by two doctors, but other doctors have come and gone in the past, only staying for short periods. Hospital services are largely like a rural GP service, with clinics running Mon-Fri from 9am-12pm and 1pm-4pm. If there are any inpatients (usual number of inpatients are 0-5), ward round occurs at 8am during weekdays and 9am on weekends.

The outpatient department waiting area. Patients are often found waiting an hour before clinic is meant to start and expect you to start early (argh). Today I had a patient who turned up at 7.45am when clinics are meant to start at 9am. Patients wait here, and somehow figure out the order in which to see the doctor(s). You don't really get a chance to call the next patient in, because as soon as your current patient leaves, the next person comes in whether you are ready or not!
   Patients turn up with 'emergency' cases all through the day and night if need be. By majority, they are minor conditions not requiring emergency care (e.g. common cold, allergic rash), but emergencies do present themselves from time to time ranging from full-blown heart attacks to motor vehicle accidents. In my 6 weeks here so far, I've been blessed to not have had a cardiac arrest in the hospital but there had been one the previous week before my arrival.

The hospital has two outpatient clinics - one is often manned by elective student(s) whilst Dr Koko runs the other. Students can always ask questions if there are any doubts, but by in large, can run the clinic solo with full responsibilities of prescribing on the island (Dr Koko only takes final year medical students). Most common presentations are, (1) common cold, (2) skin infections/boils and (3) diabetes/hypertension/gout.

Our outpatient clinic room. It's pretty much a GP office.

Tuesdays and Wednesdays are the "NCD" or "chronic disease" days where patients with diabetes, high blood pressure, gout and etc come for their check ups (usually 2 monthly).

Hospital back yard with pawpaw (papaya) plantation. Students are welcome to help themselves to the pawpaws as they ripen. Be warned, too many can give you the runs!
 Patients often turn up well before the clinic is meant to open (e.g. 8:10am) and expect to be seen early. I've been given the funny looks when I told them I'm not starting until 9am just so I could check my mails and get the programmes started etc.

Computers are slow here, but it does work, and just fast enough for video Skyping. The hospital uses one of the older MedTech programme for patient records (a common GP software which is not very much liked), and because everything goes through Rarotonga and back, it is slow. It is not uncommon for computers to freeze or system to crash for half a day or more.

What is available at the hospital? Well, there is an x-ray machine and a new ultrasound scanner (only been here for 2 months!). Eteta is our super-pharmacist/radiographer/phlebotomist who runs the pharmacy, takes x-rays and does blood tests. She's only had 6 weeks training for all this! Aumate is the other pharmacist at the hospital.

In terms of medications, it is largely dependent on orders from Rarotonga, but selection is very limited. Everything else is based on donations from students who have gone by. Enalapril is our only ACE inhibitor and it annoys me greatly that many go to New Zealand and get put on quinapril and come back! We do have Metoprolol, Bendrofluazide, Felodipine, Candesartan, Digoxin and Nifedipine but it's about it! We have no antihistamines except Phenergan (Promethazine) so anyone turning up with allergic rash gets zonked to sleep with 25mg of Phenergan lol Only diabetes drugs are Metformin, Gliclazide and Insulin. When you are on Aitutaki, you have to learn to do without.

Commemorating my emergency call out at midnight on the ambulance... in my pajamas! The ambulance rarely gets used on the island.
I am currently self-treating myself for probable gastritis with triple therapy. Unfortunately, no Clarithromycin means that I have to use the old regime of Omeprazole-Amoxicillin-Metronidazole combo. But students can get medications free of charge if need be. But this is not the best place to get sick... I've been battling with this tummy ache for 2 weeks now <_<

There is also a dentist at the hospital who can manage basic dental conditions. Our public health nurse deals with sexual health clinics, antenatal things and immunisations etc - she's also one of two midwives on the island.

Sparky's (the dentist) clinic. This is all we have in terms of dental services.
I am running out of things to write about currently. Will update with more photos later!


  1. oh so you had possible gastritis as well! Hey dont you have to have proven peptic ulcer and h.pylori to get triple therapy? or dont they have scopes there? sucks if you had penicillin allergy

    1. Well Mr Howey, we have endoscopists come once a year to Rarotonga. And I've cured myself so I'm all good, except for the bike crash yesterday. Well, I haven't come out in rashes after amoxicillin and flucloxacillin so I think I'm okay... don't have clindamycin here lol