Extent, causes and impact of road traffic crashes in the Solomon Islands 1993-2012: data from the orthopaedic department at the National Referral Hospital, Honiara.

INTRODUCTION: Road traffic crashes constitute a considerable public health burden and represent the eighth leading cause of death and tenth leading cause of disability adjusted life years (DALYs) globally. However, very little is known about the extent, causes and impact of crashes in low- and middle-income countries including those in the Pacific. This lack of data is particularly true for the Solomon Islands. METHODS: The study is a retrospective record review of a pre-existing, de-identified dataset. A standardised trauma form is completed for all patients presenting to the orthopaedic department at the National Referral Hospital in Honiara with a suspected fracture following a trauma. Data are coded using one of 27 unique codes. Data related to road traffic crashes were extracted from the larger dataset, cleaned and analysed in Microsoft Excel. RESULTS: The database contained 699 records coded with one of seven codes related to road traffic crashes. Patients in the database were most frequently injured whilst a passenger in a car (27.8%), as a pedestrian (24.0%), or as a passenger in an open truck (21.6%). Almost three-quarters of patients were male. Just under half (48.5%) were aged between 10 and 29 years. Alcohol was listed as a contributing factor in 23.8% of presentations. CONCLUSIONS: This is one of the first studies to provide data on road traffic crashes in the Solomon Islands. In this database, young males were most likely to be involved in a crash that resulted in a suspected fracture. Young males are in their prime years of productivity, and injuries that remove them from the workforce could have severe socioeconomic implications. This study found that more than half of injuries were borne by vulnerable road users such as pedestrians and motorcyclists, indicating a need for interventions that take these users into account. Finally, the study provides insight into the large impact that alcohol has on the risk of road traffic crashes.

Barking up the wrong tree: injuries due to falls from trees in Solomon Islands.

OBJECTIVE: To investigate tree-related injuries in Solomon Islands by the types of trees involved, who is affected and the types of injuries caused. DESIGN AND SETTING: Descriptive case series of all cases of injuries related to trees presenting to the National Referral Hospital in Honiara from 1994 to 2011. Data were collected by the attending clinician using a Trauma Epidemiology form, which provides information on age, sex, cause of injury and type of fracture. MAIN OUTCOME MEASURES: Number of injuries by tree type, sex and age. RESULTS: Of the 7651 injuries in the database, 1107 (14%) were caused by falls from trees. Falls from coconut trees led to the highest number of injuries, followed by falls from mango, guava, apple and nut trees. Overall, 85% of injuries occurred in individuals aged < 20 years. For injuries involving guava trees, 77% of patients were aged < 10 years, compared with 46% for the five most commonly involved tree types. Overall, 71% of injuries occurred among males. Of all injuries, 92% were fractures, 3% were dislocations and 5% were non-fracture, non-dislocation injuries. The arm (including wrist, elbow and hand) was the most common location of injury across all tree types. Distal radius fractures in the forearm were particularly common, as were ulna fractures. CONCLUSION: While mangos and guavas are undeniably delicious, the quest for their flesh can be hazardous. Children will always climb trees, but the search for food among children in lower-income settings may lead to higher rates of injury.

Surgical care in the Solomon Islands: a road map for universal surgical care delivery.

BACKGROUND: Access to surgical care and emergency obstetrical care is limited in low-income countries. The Solomon Islands is one of the poorest countries in the Pacific region. Access to surgical care in Solomon Islands is limited and severely affected by a country made up of islands. Surgical care is centralized to the National Referral Hospital (NRH) on Guadalcanal, leaving a void of care in the provinces where more than 80% of the people live. METHODS: To assess the ability to provide surgical care to the people living on outer islands in the Solomon Islands, the provincial hospitals were evaluated using the World Health Organization's Global Initiative for Emergency and Essential Surgical Care Needs Assessment Tool questionnaire. Data on infrastructure, workforce, and equipment available for treating surgical disease was collected at each provincial hospital visited. RESULTS: Surgical services are centralized to the NRH on Guadalcanal in Solomon Islands. Two provincial hospitals provide surgical care when a surgeon is available. Six of the hospitals evaluated provide only very basic surgical procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of Health is currently inadequate for delivering care at the outer island hospitals. CONCLUSIONS: Shortages in the surgical workforce can be resolved in Solomon Islands with focused training of new graduates. Training surgeons locally, in the Pacific region, can minimize the "brain drain." Redistribution of surgeons and obstetricians to the provincial hospitals can be accomplished by creating supportive connections between these hospitals, the NRH, and international medical institutions.

Hospital visits due to domestic violence from 1994 to 2011 in the Solomon Islands: a descriptive case series.

The Solomon Islands has one of the highest rates of domestic violence in the world. This paper is a descriptive case series of all cases of domestic violence presenting to the Solomon Islands National Referral Hospital (NRH) over 18 years. Data were routinely collected from a database of all patients who were treated by NRH general surgery and orthopedic clinicians between 1994 and 2011, inclusive. The total number of cases in the injury database as a result of domestic violence was 387. The average number of cases in the database per year from 1994 to 2011 was 20. There were 6% more female patients (205 of 387; 53%) than male (182 of 387; 47%). Of the cases in which the perpetrator of the violence against a female patient was specified (111 of 205 female cases), 74% (82 of 111) were the patient's husband. Only 5% (5 of 111) of cases in females were inflicted by another female. This analysis provides the best available information on domestic violence cases requiring a visit to a tertiary hospital in a Pacific Island in the specified time period and is undoubtedly an under-estimate of the total cases of domestic violence. Preventing and treating domestic violence in the Solomon Islands and in the Pacific is an important challenge and there is a significant role for secondary and tertiary health services in screening for and preventing domestic violence.

Telemedicine in the Solomon Islands: 2006 to 2009.

Telemedicine has been used in the Solomon Islands since 2000. We used quantitative and qualitative methods to examine telemedicine use in the Solomon Islands from January 2006 to June 2009. During the study period 66 telemedicine cases were submitted to the store and forward telemedicine system being used there. These included orthopaedic, oncology, cardiothoracic, infectious, congenital, gastroenterology and dermatology cases. Most cases (52%) were submitted by doctors at the National Referral Hospital (NRH) in Honiara. The majority of responses came from the NRH (27%). A final, firm recommendation regarding patient diagnosis and/or care was given for 46% of the cases. Interviews were conducted with 23 stakeholders in the Solomon Islands and in Australia to better understand the current and future use of telemedicine. The interviews identified the fragility of the Solomon Islands infrastructure, including the lack of training, as the largest barrier to the future use of telemedicine. The best use of telemedicine appears to be case sharing within the Solomon Islands, with connections to clinicians in other countries as a secondary benefit when particular expertise is required.