August 14, 2014
On August 13th Secretary John Kerry made history and it had nothing to do with Iraq, or the Middle East. He visited a small island in the middle of the Pacific Ocean known as Guadalcanal. Secretary Kerry was the first high level American leader to visit Solomon Islands, the least developed country in the Pacific Region. It is clear from news reports by Reuters, the Associated Press and Australasian news agencies that the history of the Guadalcanal campaign impressed Mr. Kerry as it does nearly every American who travels to this small island nation. Guadalcanal has an unmistakable seductive allure when it comes to WWII history. From the moment one’s plane touches down at Henderson Field where the rusted remains of the airstrip’s 1943 control tower still keeps watch over today’s modern runway, to the crumbling Bloody Ridge monument on a hill adjacent to the air field its historic draw is palpable. A trip into Honiara, the country’s capital city, goes past Quonset huts converted into businesses, an old fighter strip now a golf course and along Iron Bottom Sound the final resting place for many sailors lost during Guadalcanal’s naval battles.
While most adventuresome Americans see Solomon Islands for its historic war wrecks and relics that make for fantastic dive spots the Secretary’s visit has facilitated a new decidedly modern relationship with Solomon Islands based upon the challenges this country currently faces. Solomon Islands gained its independence from Britain in 1978 and since that time the country has struggled to find its unifying voice. After a period of civil unrest and much external support from Australia it is now currently stable, but fragile. Its economy is dependent upon tariffs garnered from naturally resources such as timber, gold, palm oil, and some of the largest tuna stocks in the Pacific Region. These resources leave them vulnerable to outside exploitation that can result in unsustainable forestry and fishery practices. Land use beliefs and rising sea levels in a country made up of over 900 islands have created disputes and displacement that over time will only have the potential to worsen. In a remote environment made up of more ocean than land the deadly impacts of extreme weather events have already been demonstrated. After nearly a meter of rain fell on Guadalcanal torrential floods ripped through coastal villages killing 23, destroying hundreds of homes and displacing thousands. The socioeconomic ripples can still be felt four month after the floods as food gardens were washed away and commerce disrupted. Infectious disease outbreaks due to fouled water and crowded evacuation centers are still on going taxing the rudimentary health system and filling the beds of the country’s inadequate National Referral Hospital.
During his brief visit Secretary Kerry recognized not only the historic ties that bind the United States with Solomon Islands but also the battles that this country currently wages against corruption, natural resource depletion, climate change impacts on sea level and temperature rise as well as its extreme weather events. Today the new battle fields in the Solomon Islands are the hospitals and clinics of the country where there are not enough healthcare providers or resources to diagnose and treat the rising tide of diabetes, cancer and heart disease that have come from western influences and an increasingly more global world. Without the public health capacity to respond to natural disasters including outbreaks of novel viruses similar to ebola and MERS, it will not be terrorism, China, or over fishing that poses the greatest threat to United States or Australasian security in the Pacific Region, it will be unchecked deadly infectious disease outbreaks.
While much of Secretary Kerry’s visit to Solomon Islands involved WWII battlefield tours and remembering of those who fought there he also fostered a much-needed new relationship with the country and its leaders at a time when United States goodwill has waned in the region. It remains to be seen what hard policy and partnerships will come from his historic meetings. An increase in meaningful United States development aid will certainly offset Australia planned reduction in aid dollars to the region. There is little doubt that Secretary Kerry’s visit has taken the United States into a modern relationship with Solomon Islands, one that if crafted properly can serve as a way to remember those historic battles in perpetuity while fighting side by side once again with Solomon Islanders against today’s modern foes.
The recovery from April’s deadly floods has been slow, but steady. The old Mataniko river bridge washed away by the river has been replaced with another Bailey bridge thanks to New Zealand .
The mouth of the Mataniko River and its river banks are slowly being cleaned renovated along the edge of Chinatown
But there is still much work to be done as ship wrecks and still more debris remains along the coast and those who lost their homes rebuild. Thanks to the generosity of our friends to and supporters of the William Moore Stack Foundation we were able to donate $10,000 US to World Vision Solomon Islands in order to provide food and water to flood affected people.
The country is slowly returning to normal.
April 21, 2014
The flooded Mataniko River adjacent to the National Referral Hospital.
Looking for their loved ones washed out to sea
The raging Mataniko River washed away houses and people, mainly women and children.
On April 3rd, 2014 a tropical storm named Ita stubbornly hovered over the island of Guadalcanal in the western pacific. In less than 12 hours Ita dumped over a meter of rainfall on the island. Every river overflowed its’ banks with mud and debris causing flash flooding from the mountains to the sea. In Honiara the Mataniko River cut a new and destructive path through villages carrying away homes, women and children. The old Mataniko River bridge was washed away caring homes and people with it. Out in eastern portion of the country the rivers pushed mud into remote villages destroying their food gardens and fouling their water supply. On the western part of the island the torrent of water tossed cement bridges like building blocks. By the time Ita moved on she was responsible for over 21 deaths, more than 30 missing, hundreds of homes destroyed and over 10,000 people displaced. The city water system was disrupted and what was available was contaminated by river water and sewage making it undrinkable. The infrastructure of Honiara, the capital of Solomon Islands, sustained serious damage to bridges, roads, electrical services and water conduits rendering its fledgling economy a significant blow. Infectious disease outbreaks among residents began within 36 hours of the flood.
WHO HEALTH Situation Report No 2 (SI Floods) 2014-04-16 FINAL
Houses crushed upon the old Mataniko river bridge. When the bridge gave way everything, including people was washed out to sea.
UNICEF SitRep #5 Solomon Islands Floods- 21 Apr2014
Video of the floods
WorldVision video report
March 12, 2012
It’s been 70 years since the tiny island of Guadalcanal leapt from obscurity to the world’s headlines as one of America’s earliest Pacific victories of WWII. And as our plane approached that same airfield that was so strategically important in 1942, it was impossible not to imagine scores of battleships steaming among the islands below and Marine battalions assaulting the beaches.
But a lot has changed in 70 years, and our ASGE Ambassador Program team was here to assault the health care needs of this impoverished nation known as the Solomon Islands. The country’s National Referral Hospital in the capital city of Honiara had received an equipment grant of new GI endoscopes and support equipment, and we had arrived for a workshop to introduce the local physicians to modern endoscopy. Leading our team was Dr. Eileen Natuzzi, a general and vascular surgeon from San Diego who for years has worked with the local surgeons here. She had lined up the equipment grants from Olympus America, Cook Company, and other sources as well as financial support from the William Moore Stack Foundation to make it all happen, and had approached the ASGE about an Ambassador Program visit. The ASGE responded by sending me, Nicholas Nickl, and fellow ASGE member Stuart R. Gordon; also on the team were endoscopy nurse Amanda Moore (Mandy) and equipment technician David Knoblock. Our liaison in-country was Dr. Douglas Pikacha, a general surgeon who has practiced all his life in Honiara. He’d had some previous endoscopy experience between 2005 and 2007, but had never received formal instruction. Our intent was to remedy that lack for him and his colleagues with a combination of didactic lectures and live hands-on demonstrations.
Approximately twenty physicians and nurses attended the 3 day course. Mornings consisted of lectures at the nearby conference center, using many of the ASGE’s slide sets for first year fellow training programs. By late morning the lectures were done and we moved to the endoscopy room in the hospital’s surgical suite for procedures. The first two days concentrated on EGD and the third on sigmoidoscopy. All the program participants took very seriously the unique opportunity to learn from visiting experts, and worked hard to make the most of it. Mandy spent hours with the nursing staff to teach them the standards of patient care and endoscope cleaning, and by the end of the course had them boldly shouting, “time out” at the beginning of each case. Dave introduced everyone to the equipment and loaded them up with troubleshooting tips. And Stuart and I worked alternately to perform the endoscopies, initially completing the exams while describing what we were doing and then working one-on-one with individual physicians to guide their first tentative exploration of the world of GI endoscopy. It was obviously just an introduction, but it was gratifying to see how the budding endoscopists rapidly improved with each exam.
The range of pathology we encountered was breathtaking. Of the thirteen EGD exams seven found cancers, most being quite advanced. Clearly the worldwide epidemic of H. pylori-associated gastric cancer is well entrenched here. In two cases of hepatitis B cirrhosis we encountered incredibly advanced varices, fortunately not bleeding. Stuart and Doug completed what turned out to be the first full colonoscopy in the Solomon Islands. And Stuart performed one of the more unusual exams of the workshop, a teenager with an esophago-pleural-cutaneous fistula caused by a spear injury to the neck (spear wounds being as common here as BB gun injuries in the US).
Travel is broadening, and we also learned much from our brief exposure to this very different culture. For instance, Solomon Islanders hate to wear shoes, no doubt a throwback to simpler times in their own history. They constantly kick their shoes off around the hospital, and we never quite got used to seeing barefoot doctors and nurses in the operating rooms. But the more lasting impression was of the incredible energy of these friendly people. We came to respect their dedication as they struggle to provide quality care to their countrymen against impossible odds. Antiquated equipment and scarce supplies lead to imaginative work-arounds to take care of patients. And their broad smiles were everywhere as their infectious enthusiasm made teaching them a pleasure.
By the end of the workshop we’d covered a range of topics, from scope cleaning to sedation monitoring, from endoscopy techniques to complication management. And several of our talks whet their appetites for advanced endoscopy methods. It may seem futile to think that a 3-day experience can make the Solomon Islands endoscopy-ready. But Dr. Pikacha’s previous experience makes him already a smooth endoscopist, so he will be a good supervisor for his colleagues. And Dr. Natuzzi is committed to bringing new teams to this hospital every six months for several years in order to provide updates, new supplies, and continued training. It’s an ambitious model for accomplishing sustainable intervention to raise health care standards in this poor country, but Eileen clearly has the energy and dedication to make it happen.
Our last day on the Solomon Islands provided an opportunity to remember that many of those battleships, and the sailors and Marines they carried, are still here. Eileen Natuzzi’s interest in the Solomon Islands is personal: her uncle Billy Stack was killed at age 17 aboard the USS Quincy when she was sunk during the Battle of Savo Island, and her work here honors his memory. Our tour of the island’s battle sites included a visit to the American War Memorial, where we laid a wreath to remember of those who fought and died here. As we surveyed the island’s now-tranquil beauty it was again impossible not to hear faint echoes of the battle, or fight down a lump in the throat at the thought of what sacrifices were made.
When we departed, it was with a sense of accomplishment at helping the hospital make a big step forward. But we are also aware of the work yet undone, and how much succeeding teams will have to do. And it’s more than likely that Stuart and I could find ourselves here again on a future trip. International service work, we are discovering, is dangerously addictive.
Nicholas Nickl MD
Dr. Stuart R. Gordon performs endoscopy on the island of Guadalcanal as part of the ASGE Ambassador Program trip to the Solomon Islands while Dr. Douglas Pikacha (right) and other local doctors look on. The 15 year old patient had sustained an esophageal fistula resulting from a spear injury.
Dr. Eileen Natuzzi talks to the workshop participants at the conference center.
Nurse Mandy Moore instructs the nursing staff on endoscope care.
Dr. Stuart R. Gordon assists Dr Rooney Jagilly, one of the staff physicians, in endoscopy technique at the National Referral Hospital. It is also known locally as “Number Nine” because it grew out of the Army Ninth Field Hospital.
September 17, 2011
September 19th and 20th the UN General Assembly will hold a High Level Meeting on Non-Communicable Diseases (NCDs). NCDs are non-infectious diseases such as diabetes, cardiovascular disease, lung disease and cancer. NCDs are on the rise, especially in Low to Middle income countries (LMIC) and Solomon Islands is no exception. In Solomon Islands the prevalence of diabetes is 24% and the leading causes of cancer deaths are breast, liver and lung cancer. Approaches toward early diagnosis and treatment of NCDs must be developed while prevention programs such as dietary changes, smoking cessation and increased activity are encouraged. Many NCDs once diagnosed are treated by surgery: excising a tumor, rerouting blocked bowel, placing a tracheostomy or debriding a diabetic foot infection.
The Solomon Islands health care system is faced with a “triple burden of disease:” high levels of communicable diseases like TB and malaria, a rising incidence of NCDs such as diabetes, cancer and cardiovascular disease and a slow but steady increase in road accidents and injury. Without a strong surgical service strategically placed throughout the islands many people will suffer and die needlessly from potentially curable diseases.
As the UN General Assembly meets for it’s special High Level Meeting on NCDs, representatives from member nations will decide on policy that may promote comprehensive programs to address NCDs. They must recognize the role of surgical care in the treatment of diabetes, cancers, cardiovascular diseases and lung diseases. While prevention is paramount there will be people who need surgical care. A comprehensive program that addresses the prevention, care and treatment of NCDs must include appropriate and cost effective surgical services.