Vol. 19 No 1 | Autumn 2017
Supporting O&G practice in the Solomon Islands
Dr Leeanne Panisi
MMed(O&G), Associate Member RANZCOG

This article is 7 years old and may no longer reflect current clinical practice.

RANZCOG has, for many years, provided intermittent support to the Solomon Islands, but in recent years the level of support has been constant. This contribution is invaluable as we work toward building the capacity of our O&G workforce to face the challenges in the Solomon Islands and strive to address the UN’s Sustainable Development Goals (SDGs).

For me, taking up the position as Head of O&G at the National Referral Hospital in Honiara was a daunting experience following my graduation with the Master of Medicine (O&G) from Fiji School of Medicine in 2010. I returned to National Referral Hospital as an O&G Consultant in 2011, coming home to work in an environment with very little mentorship as I strove to step into the role of Head of O&G. My new level of responsibility required me to develop increased leadership, clinical and surgical skills as well as requiring me to take a longer term and broader view of our obstetrics, gynaecology and women’s health services for the whole country, working in collaboration with colleagues across the Ministry of Health and Medical Services.

The National Referral Hospital is the one and only referral hospital for secondary and tertiary care for the Solomon Islands with our population of approximately 600 000 people. We have a maternal mortality rate of 114 per 100 000 live births (2015) and an infant mortality rate of 24 per 1000 live births (2015) nationally. The hospital has 330 beds, of which 94 are in the O&G department, with about 71 to 76 per cent of hospital admissions falling under the O&G department. In 2016, 5925 women gave birth in the unit. Our unit is very busy, with three specialists and two registrars.

Following my return to Solomons, I joined RANZCOG as an Associate Member in 2012, and now our young junior consultants, Dr Chris Dereveke and Dr Jack Siwainao, will also enjoy the educational opportunities and CPD provided, having recently graduated and become Associate Members at the end of 2016. Over the time my junior colleagues were undertaking their O&G training, I benefited from surgical and mentoring visits provided through the Pacific Islands Project (PIP) funded by the Australian Department of Foreign Affairs and Trade (DFAT) and managed through the Royal Australasian College of Surgeons (RACS). This assistance was invaluable at a time in my career when I was still feeling my way and gaining confidence in gynaecological surgery, especially with the range of complex surgeries presenting. These challenging surgeries are a day-to-day event, as most women present late with gynaecological conditions. My close association with mentors, Dr David Simon, Prof Glen Mola, Dr Alec Ekeroma and Dr Adel Mekhail, who have visited Honiara for surgical support visits through the PIP, and others I’ve met at international meetings and workshops, has been invaluable. This mentorship and networking continues.

In the last two years, with the return to the Solomons of a large influx of Cuban-trained interns, DFAT has initiated the Solomon Islands Graduate Internship Supervision and Support Project (SIGISSP) delivered through Australian Volunteers for International Development (AVID) funded by DFAT. The project funds a position of Senior O&G Registrar and Intern supervisor. Dr Victoria Snowball (FRANZCOG trainee) undertook this role in 2015 for six months and Dr Agatha Kujawa (DRANZCOG Advanced Trainee) will complete her term with us in early 2016. We will welcome advanced trainee Dr Rebecca Mitchell to this role in the near future. The AVID-DFAT-funded Senior O&G Registrar position is extremely valuable to us and, based on feedback from the program and Australian doctors, is mutually valuable to those who undertake the role.

Staff benefit enormously from workshops; our own Emergency Obstetrics Skills workshops and the Pacific Emergency Maternal and Neonatal Training (PEMNeT) workshop for facilitators provided by the Pacific Society for Reproductive Health (PSRH).

As well as training and educational support for our medical staff, we regard the development of our senior midwives as an integral part of the strategy to improve services for our women during the intrapartum period. Thus far, we have had 16 senior midwives in leadership roles undertake either a Brian Spurrett Fellowship in Middlemore Hospital, Auckland, or the DFAT-funded RANZCOG Pacific Midwifery Leadership Fellowship Program held in Sydney and this has made a huge difference to the contribution and insights provided by our midwives to the service.

Ms Kathy Gapirongo, Program Manager of the Reproductive and Child Health Unit at the Ministry of Health and Medical Services, has reported on her visit:

As the President for the PSRH, and on behalf of the Solomon Island midwives who have attended the RANZCOG Pacific Midwifery Leadership Fellowship Program, I wish to acknowledge DFAT and RANZCOG for continually supporting Pacific Midwives in this Fellowship program. Acknowledgement is also due to the Brian Spurrett Foundation, which initially set up this program, and has hosted several of our midwives at Middlemore Hospital, Auckland. All of the Solomon Island midwives who have had this opportunity have received great hospitality in the hospitals, clinics, workshops and at various conferences and engagements offered during their Fellowships.

Speaking of my recent experience during October and November 2016, I can say that participation in various workshops increased my confidence and presentation skills. The Midwifery Leadership program opened my eyes and minds to areas of improvement that I can slowly introduce back home in our local settings to help improve our maternal and infant morbidity and mortality status. Though we are aware of the big gaps that we have in our settings and facilities, we strive to provide quality services with the limited resources that we have, with the aim being to work collaboratively with our medical staff and increase the level of our contribution to be able to save the lives of our women and children in the Solomon Islands and the Pacific region as a whole. Obviously, we have limited access to advanced equipment but learning from the processes and systems that are used by the midwives and doctors in Australia and New Zealand is beneficial in motivating us to relook at the way we do things here and where improvements can be made. Our midwives have developed their own practice improvement projects applicable to our workplace settings, and we hope that the projects that we are planning to do – though small – will bring about improvements to our reproductive and maternal health services and the lives of our families in the long term. The RANZCOG Midwifery Leadership Program has been an extraordinary professional development opportunity for the midwives who have attended and we are truly appreciative of RANZCOG, DFAT and our host hospitals – Liverpool and Nepean in Sydney, and Middlemore in Auckland.

For further information on a position as Senior O&G Registrar/Intern Supervisor with the Australian Volunteers for International Development (AVID) Solomon Islands Graduate Internship Supervision and Support Project, please contact Dr David Simon FRANZCOG [email protected] or Jodi Cornish [email protected], Project Manager SIGISSP.

Dr Aggie Kujawa with one of the postnatal nurses and her baby that Aggie delivered by c-section a month earlier.

Dr Leeanne Panisi with labour ward staff, receiving donated goods from Australia.

Srs Marilyn Iro, Kathy Gapirongo and Rebecca Manehanitai at the Pacific Midwifery Leadership Program, Sydney, November 2016.

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