Levuka Hospital

Levuka is home to the only hospital on the island of Ovalau with a population of 8000 fijians but it also caters for  Fijians from the surrounding small islands whom travel by boat to the hospital if their illness cannot be managed by their local nursing stations.

It is only a small hospital working more as a GPs practice with only a few admissions at a time on its wards ( around 10 patients or so). The building itself  is relatively new and has a fantastic coastal view. It has provided me and Tom with a very scenic walk in in the morning, which we are really going to miss.

View from outside the hospital 

The downstairs has a front waiting room where the patients get triaged by the nurse and pick up their 'notes', an A5 folded piece of card  with lots of past history sheets stapled in in no logical order.

 

There is then a daily general outpatients department where I spent most of my time manning one of the two consultation rooms. Here I spent my time impersonating a a GP :P taking histories and examining patients with an array of complaints, performing simple investigations when necessary (Xray , U/S, ECG & blood work facilities is pretty much all that the hospital offers & even then anything other than FBC has to be send to the mainland) medicate them ( again only a small  number of medications are stocked) and admit when necessary. Patients could also be referred on or choppered ( costing FJ$5000) to the well equipt hospital in Suva if out of the remit of the Levuka facilities & physicians knowledge.

  

The majority of my time seemed to be spent treating the  mannyyyy wound infections that come through the door ( it seems any cut gained in Fiji is doomed to need antibiotics). In addition to wounds and scabies there are even more patients just wanting sick notes complaining of "body pain", numerous rugby injuries, whilst i remain on the lookout for anyone that may have dengue, but generally just a mix of similar issues to that of the UK. Although dissimilarly from the chatty patients of the UK, taking a history from fijans is a million times more hard work! They always give one word replies, tend to just agree if you ask them a symptom and they seem to know nothing of their past medical hx and its not like their “notes” will help! Oh well adds abit more of a challenge i suppose.

A specialist clinic also runs daily fluctuating between Postnatal clinic, antenatal, diabetic and hypertension. The 2 doctors here have been great at getting me involved, however I would definitely call it being thrown in at the deep end. They let me run the antenatal clinic for  2 of the weeks, watching me with the first few patients and then telling me just to come and get them if I need any advice. With the hospital being so small it is usually pretty easy to find one of them when in need...luckily.

It took me awhile to get used to having so much responsibility, I definitely asked my fair share of questions during the first 2 weeks but gladly i did get more used to managing patients and having to advise patients on their conditions as the health education of patients here is very poor. I did feel a bit like i was playing doctor though, sat in my own room armed with a prescription pad. Gladly though i didnt feel too out of my depth as the doctors were never too far away to double check things with and the nurses were also a great and friendly resource.

Upstairs in the hospital they have the wards, ( womens, mens, maternal, paediatric and labour). Each morning the ward round is ran by one of the two doctors. However there only tends to be about 10 patients maximum so you get to know them pretty quickly.

They have a small operating theatre where they deal with minor wounds needing surgical attention and other simple procedures such as circumcision. My only visit was to assist when one of the prison inmates had slit his wrists. It was quite a bizarre scene. He was lying in his orange jump suit with a Bula shirt wrapped around each wrist whilst 2 prison officers stood watch in big boots and hats. I wouldn’t say it was the most sterile of procedures.... and the prisoner found it highly amusing when his wrist turned into a “sprinkler”.  Sadly the same man returned only a few days later having ripped out the stitches and lacerated his wrists further... With no one on the island fully trained to deal with mental health issues, once treated,  he had to be transferred over the mainland.

The hospital staff are all very friendly and I really enjoyed being part of their little hospital community. After a busy days work they end the day with a game of Volleyball or netball together on the court inside the hospital grounds which is always good fun. There is constant banter , although i can only ever understand half of it as its often in fijian! 

During an afternoon in the hospital one of the nurses was rushing round asking everyone what their blood group was as an inpatient had a Hb of 4 and was in desperate need of blood before they attempted to get her medically evacuated to Suva to stop the gastric bleed. I announced that I was O+ and was whisked away to donate the blood for the patient ! It was nice to think i was helping someone and i was overdue to donate anyway so why not in fiji !!

During my time I got to help with a birth which I enjoyed and was allowed to practice my suturing skills when repairing the ladies perineum following a tear during birth. The women here get no pain relief at all. Not even gas and air.

Other than that i have got to do plenty of cannulations and venepucture, speculum exams, suturing, casts on various fractures, catherisations, PR exams ( not the most enjoyable exam for anyone) and also an evacuation of retained products of conception after a miscarriage.

It was great being allowed to be so hands on J

Best wheelchair i have ever seen. Great improvisation.