Riikka maailmalla: Rarotonga Hospital

Working at the Rarotonga Hospital has been a great and interesting experience. The hospital is small(ish) but surprisingly busy providing healthcare not only for the people of Rarotonga but also for Cook Islanders from outer islands and visitors from all around the world. The outpatient clinics seem to be always full, whereas the wards are usually very quiet. The hospital gets a lot of support from other countries (donations, structural and financial support), and receive visiting specialists often. The surgical team operates almost daily and they are able to manage even challenging and life threathening cases. The staff is very multicultural. In addition to Cook Islander doctors and nurses, there are employees from at least Fiji, Kiribati, Burma, New Zealand, Germany and USA. There are also several medical students mostly from England, some nursing students too. And me!

Facts about the hospital and healthcare in general:

-Four wards: maternity, pediactrics, medical and surgical ward, one emergency department, several outpatient doctors.
- 100 beds.
- One X Ray machine and one ultrasound machine. No CT scans or MRI machines.
- Rarotonga has 217 registered workers at the healthcare (includes also the supporting staff, like the it people). All together in the Cook Islands there are 295 employees at the healthcare. 13 local doctors, 11 expatriate medical officers, 19 expatriate nurses, 2 radiographers from Fiji, one pharmacist from Kiribati, one dentist from Samoa. 53 clinical staff in the outer islands.
- In 2014 the Cook Islands had 14,7 doctors per 10.000 population which is relatively high amongst the Pacific neighbours but still less than the WHO recommendation (17 doctors per 10.000 population).

Fun facts about the hospital:

- A cat called Scrubs lives in the surgical ward. One day my friend was working at the ward and heard a strange noise from one of the storage rooms. Scrubs was lying there meowing, possibly giving birth! My friend told the nurses that the cat might be giving birth in the storage room, and the nurses commented: "Oh, she just loves that room!" But Scrubs isn't the only one living in the hospital. Apparently there are heaps of other cats. One of them is called Panadol.
- The lab has the best morning tea: banana pancakes, buns, croissants etc. I was invited to a farewell morning tea for my friend and we were told to "Eat!", "Eat, eat!" and "Take your time." And we did.
- The hospital does have official visiting hours but when someone is committed to the hospital, there will most likely be a family member present 24/7. They help feed, wash and take care of their loved ones. Sometimes they make sure the patients do their rehabilitation exercises.
- The Social Club for staff members gets together once a month. Once we had a beach volleyball tournament.
- Grand ward round on Wednesday mornings always starts and ends with a prayer in Maori. As do all the other meetings too.

Physiotherapy at the Rarotonga Hospital:

- There are two physiotherapists, one working full time in the hospital wards and employed by the Ministry of Health, the other working in the hospital and in the community employed by a community rehabilitation organization called Te Vaerua. Te Vaerua also has an occupational therapist (toimintaterapeutti) and a rehabilitation assistant, who also work in the hospital and the community.
- Patients can be anything and they have just the same problems as anywhere else in the world, with the added twist of the local lifestyle. Lots of twisted knees, calf injuries, broken bones and strokes. Sports injuries (for some reason most commonly from netball, also from rugby), injuries from MVAs (motor vehicle accidents), arthritic knees and back pain from overweight. In a small place like this you have to be able to handle varying cases and challenging ones too. Therapy itself is just like in Finland but you must be able to apply that to the lifestyle.
- How to apply physiotherapy to the lifestyle? Give advice how to sit when riding a motorbike, how to sweep the floor ergonomically, how to add a heelraise on flip flops, how to use a pareo (saronki) as a way to transfer a patient or how to use it as a sling.
- The challenge is that people don't always seek physiotherapy or they are not referred by the doctor. Also the commitment and motivation to continue therapy is sometimes low, or patients come at different times (late or early) than what their appointment was. From my rugby team I've managed to get only one player to see me in the clinic.

I've enjoyed working at the hospital and doing some home visits in the community. Learning from the staff and the patients has been interesting, challenging and fun. I will miss the sometimes slower pace of working, sometimes the busier one when all patients arrive late and at the same time. I will miss the patients at the wards dressed in pareos. I will miss listening my colleagues' stories and explanations of the local culture, lifestyle and people. I will miss the sometimes grumpy nurses, and greeting patients sitting in the corridors even if they were not coming to the physio. I will miss the committed family members and relatives, the 10-year-old boy who, after meeting me three times finally smiled at me and said a few words and the 3-year-old wee boy who slapped me just below my butt when I was walking to the physio room.

Welcome to the physio!

This is where the magic happens.

TGIF.

Medical ward.

Ward rooms are basic but functional.
There is no aircon so every bed has their own fan.
Windows do have mosquitoe nets but I still got bitten every day
if I wasn't wearing repellant.