Position           Lamap, SE Malakula

Date                Monday 3 to Thursday 6 August 2015

One of our missions at Lamap was to deliver a supply of medicines from the Central Pharmacy and to donate a quantity of bedding and towels for the use of in patients at the Health Centre.

A load of stuff awaiting dinghying ashore for the Lamap Health Centre

The Lamap Health Centre and adjoining ward block date from the colonial administration

The health centre was refurbished in 2011 courtesy of the French government

The refurbishment amongst other things included rewiring the building and installing mains lighting and power sockets.  Unfortunately there is no generator so all of that is useless and the buildings are lit by small solar installations that the staff appear unable to manage effectively.  The lighting in the delivery suite was described to me as broken and night births were being conducted by torch light.  On inspection this was because the controller was switched off.  So I pressed the button and lo there was light, once again.  Notwithstanding these minor local difficulties the health centre itself was clean, hygienic and tidy.  It is regrettable that the senior of the two nurses has been off sick for nine months and has returned to his home island, taking the Centre laptop computer with him.  The remaining nurse Lydia is doing a sterling job but is on call 24/7 with only a health worker, Helen and also very effective, for backup.  For example women come from a wide area to Lamap to give birth and all more difficult cases end up here despite the absence of a doctor.

Mysteriously we saw a laboratory technician who is on the payroll.  Quite what he does we could not establish as the only equipment available requires electricity and of course there isn’t any.  He was busy filling in forms; whether this was for our benefit or part of a meaningless bureaucratic process we could not establish.

The facilities are clean, tidy and hygienic

Of the eight wards in the block only two are habitable with equipment that presumably predates independence

Competition for Tracey Emmin?

This broken bed adorns the lawn at the front of the ward block.  How long it has been there abandoned we could not say.  Possibly a patient was put out in the sunshine and forgotten.  It is indicative of a state of mind that says that if it is foreign culture we will use it until it breaks and then abandon it.  Local produced traditional things tend to be better maintained.  There is a general lack of technical understanding at even a basic level which makes the introduction and maintenance of solar lighting, computers and even email into the medical function a very difficult undertaking.  We are however very impressed by what the local medical staff achieve with the limited resources available to them and also the responsibility that they accept having imposed on them by a medical administration that appears to have little or no understanding of how to manage, supervise or implement basic systems remote from their central hospital.

The Butterfly Trust, Lynn and Dave Colbert, with whom we have been working, have done an excellent job trying to improve the situation and are very well known and respected in the local communities for their work in health and education.  Without locally grown leadership and good management from the top of the Health Service however it is difficult to see any long term improvement being made.  At the present time there are only 30 doctors in the whole of Vanuatu and the majority of these are in Port Vila with the balance being in Luganville.  Our understanding is that there are no doctors outside of these centres.  There is a critical requirement to place area doctors to cover areas remote from the capital.  It is also necessary to establish local management who are prepared to get out and about, visiting all of the health facilities regularly making sure that they are maintained in a clean and hygienic fashion, that they have an adequate supply of drugs and dressings to treat patients and that the health workers are following a laid down plan of work and responsibilities tailored to each individual location.

It would be great to think that the situation might improve.  Help such as we have been able to provide can only be a short term solution.  Real lasting improvement can only come from within Vanuatu itself.