Our final weekend in Vanuatu

So it was our final day of placement on Wednesday but certainly not the end of our Vanuatu adventures. We had planned to go to Erakor on Thursday, having been there for the fire show in our first week we had found it so stunning in the evening sun we felt it would be a fantastic place for a beach day. 

We got up early, had breakfast and set off on our walk to the water taxi. The walk takes about 45 minutes and we definitely wanted to miss the heat of the sun.

On or first visit to Erakor the water taxi had been free, we'd been in the evening but had read in the book it was always free! Much to our dismay we turned up at the taxi pier to be told it was 1000 vatu each, expecting to not have to pay we'd only brought our emergency bus money which amounted to 980vatu between us. When we explained we worked at the hospital they said they'd allow us to pay 1000 for the both of us. This however still was beyond our budget. To make matters worse I dropped a 100 vatu coin through the slats of the pier. At this point tensions were running high so I jumped into the water alongside the pier and started rummaging for the pound coin sized coin in the pool beneath the wood. It was, I think, at this point they realised, we weren't trying to get away with not paying, we genuinely had no more money. To my relief I found the coin, someone lent us 20 vatu and we boarded the taxi! 

Stress over we went for a stroll around the island. It was as beautiful as we remembered 

The corridors of plants in between the villas 

Beaches all to ourselves 

Secluded and so quiet 

Just us all morning! 

We did some reading and had our picnic lunch of crackers, cheese and some cooked beef. We both said due to the sogginess of our crackers it was one of the worst lunches but definitely the best view! 

We made our way round to the su loungers at the front to spend the afternoon looking out over the lagoon 

The 1000 vatu taxi fare gave us a 1000 vatu voucher to spend on food or drink so we treated ourselves to some chips and enjoyed our diet cokes with some iced glasses 

A perfect afternoon

We listened to music, read our books and watched the sun come down. This place is literally as close to paradise as we've been and we had a truly brilliant day 

That evening was a quiet one. We had tuna omelettes (for the final time!) and sat with the med students, played some cards and shared some funny stories from our last few weeks. 

The next day we were in two minds as to whether to venture to Pango beach or whether to enjoy some time by the pool. We both had some home 'life admin' to do so decided to stay back and get that done. We spent the morning intermittently jumping in the pool to cool off

And headed down to our new favourite lunch spot 'Chill' for a fantastic view and some yummy food and some celebratory champagne. 

The evening we had been invited to Dr Dyxons, the consultant surgeon, for dinner and drinks. We headed down to this super nice complex complete with security guard, swimming pool and self contained little villas. He came a bit late having had a hectic day at work. He'd lost one of our favourite patients the day before and seemed to be struggling a bit so we sat down to some fruit cocktails and munched some pizza. It was really nice to chill and he had some really good life lessons for us with regards to our future careers.

We excused ourselves at 10 as we desperately wanted to say goodbye to the gang at Cafe Du Village. We rung down to check it was still open and then ran down to catch them before they closed. Sheila and Wendy were waiting for us at the bottom of the stairs so excited to see us! 

Sheila had made us some bags with our names on, we couldn't have been more touched, they're hand woven, with the cours of the Vanuatu flag on one side and 'Alex' and 'Emie' on the other (such an adorable spelling!) these two ladies have made or trip so much better, cyber memories we made with both of them will stay with us for ever and they've made sure we can write to them from England which hopefully we'll continue to do until one day maybe we'll visit agai.  

Sheila, Amy, Wendy and me 

Amy's bag 

Made from woven banana leaves, we're desperate to get these through customs but if not we got good use of them on our last Saturday 

We had a lot of cloud during the day in our last full day by this meant that we got down to packing and clearing up our mess! We had bought some champagne to drink whilst watching the sunset at the waterfront so we just prayed all day for a nice sunset. 

430 came and the sky was lovely, we headed down, grabbed some island time ice cream and sat near our favourite spot to watch the sun come down 

Cheers

Not the most beautiful we've seen but definitely a fitting way to end our stay. 

In the evening we met with Hannah, hannah, Megan and Andy for dinner at Au Fare. We got there in perfect time to watch the fire show, on a stage in the ocean! This was followed by music from Philip and Jimmy, the same singers from

Cafe du village (we got a cheeky mention!) We both had steak and chips washed down with a free cocktail (my first piña colada!) 

Piña colada

Enjoying our last night in Vanuatu

We have had the most incredible, enriching and enjoyable time in Vanuatu. We don't think we could've chosen a better place for our elective and will be so sad to leave. We've made brilliant friends (Silas our bus driver has beeped and waved a good few times since the weekend round the island), and had some fantastic experiences both medically and culturally. We're not ready for the adventure to end so watch or New Zealand 

 

Thankyou Coconut PalmS

Bye Vanuatu

We'll never forget you! 

And we end almost exactly how we began

From a hand each at city hospital, Nottingham to a foot each in Vanuatu, South Pacific weve truly gone full circle even on the other side of the world. Mine and Amys first ever 'involved' surgery experience was skin grafting of a man in Nottingham who had 3rd degree burns to both hands. We got to sit with a plastic surgeon each and assist with the operation and three years later on our final week on placement in Vanuatu we both got to assist in a skin graft to the diabetic feet of two ni-Vans. We have had a brilliant final few days but I'll have to start with Monday

Monday we went back to the medical ward, it was great to see how some patients had really improved since we were last on this ward, we also felt useful, knowing how the ward rounds worked and how best to assist and be part of the team. I saw a lady with gangrenous fingers of unknown cause that the consultant and I got to analyse and clinically evaluate together and Amy saw a 15 year old girl with the most shocking cardiac signs she had ever seen! The girl had a visible heave and thrills all over her chest, her heart murmur could be heard in her back it was that loud, another thing that drives home the severity and prevalence of rheumatic heart disease in Vanuatu. 

We went back for clinic the afternoon which ended up being our only 'on call' of our placement. We followed Dr Sale to emergency helping to clerk a patient with heart failure in, Amy smashed his cannula in like a complete pro whilst I labelled blood bottles and wrote in the notes. A lady came in with really bad diabetes, almost in a coma, this at home would have been a really scary high pressured situation but here it was dealt with meticulously but in a very calm manner. Nothing was rushed, with a lack of medical tests and facilities the doctors rely entirely on their own judgement and their own skills and knowledge base.  Within half an hour the lady was talking and responding to pain whereas before I had stabbed her (unsuccessfully) with a needle and she hadn't even winced. This was a late shift but a really cool day! Definitely a good way to end our time

In medicine in Vanuatu. We went back to munch on our new favourite dinner. TACOS!

The following day we had arranged with Dr Dyxon to go back on the surgical ward with him. The ward round was amusing as usual with a lady being treated with two lines of Cadbury fruit and nut for low blood sugar before actually checking her blood sugar which turned out to be 28 (normal being 3-7!!) needless to say I'm sure the poor lady enjoyed that treatment anyway! 

We watched some debridements and a breast biopsy and I got to assist with the skin graft.  It brought back memories of City hospital but there was a definite shortage of working equipment on this occasion, that being said the result was still impressive, the ladyy being given a new covering of skin to her foot. 

Amy in theatre 

Sharps bin!!

That evening we went into town for one of our last meals out of the trip. We had read brilliant reviews of a place we walk past all the time so decided to give it a go as the view was said to be spectacular. It certainly didn't disappoint, the sun may have gone behind the clouds but watching out over Port Vila harbour never seems to get old 

We had delicious food for a really reasonable price and an amazing dessert of the tallest chocolate soufflé we had ever seen! 

View from 'Chill'

Amy had a really juicy beef steak with mushroom sauce 

I had spicy chicken wings with blue cheese sauce and chips!! YUM!

Shock at the height of the pudding! 

So tasty!

We may have to come back to Chill before the trip is over, it was probably a good thing for our waist lines and our bank balance that we haven't found this place sooner! 

The next day we went back to theatre having had a bit of a disaster with our visas. For the last 5 days we have been here illegally having outstayed our tourist visa! We were under the impression, as we had queried this a number of times, that or elective supervisor was going to extend it for us. We checked this a final time on Tuesday to find that it hasn't been done as she needed our actual paper passports to do this! Wednesday morning was a passport collection mission before making it in to pop into Dr Dyxons theatre. 

Our experience in theatre has been a brilliant one, everyone is in such high spirits, there's always reggae playing that everyone struggles not to bob along to, so many laughs and so many jokes and yet very few errors appear to be made. We were encouraged to get fully involved, both of us having acted as first assistant in our last two days. Amy did her foot skin graft, getting to stitch and assist, again throwing us back to times as a CP1 student. I (finally) put a cannula in successfully and assisted the anaesthetic assistant Michelle with his intubation. The whole day was great, we truly felt like part of the team, the operations we had wanted to see didn't take place In the end though. 

We had hoped to watch a laparotomy and a mastectomy but a surprising barrier was in the surgeons way. The lady with the laparotomy needed blood on standby just in case something went wrong, similar to the process in England. The surprising thing to us was that this meant they had to wait for someone to come in and donate blood, normally family members, this blood then has to be screened and tested for compatibility. -all this was supposed to happen by lunchtime apparently, sadly it didn't happen so the operation got postponed again. The lady who was having the mastectomy got a bout of pneumonia so her operation too had to be postponed. This didn't dishearten us though as our other experiences had been so involved and memorable. 

Amy assisting in a debridement (or two)

Surgery in Vanuatu has dramatically changed both of or impressions of it as a specialty. There is a completely different vibe in the operating theatres in Vanuatu, one that is generally a much more pleasant place environment to work in. We both feel these have been some of our favourite days of our elective, something we never would have anticipated. What a great few days to finish on

Dr Dyxon, consultant surgeon

Michelle the hugable anaesthetic assistant (and chief of Pango, Efate!)

We went to thank Dr Kevin for always checking up on us during our time here. 

We headed into town to celebrate finishing placement with a proper ice cream sundae from Jills Cafe. It was delicious and a lovely place to see the sunset and reflect on our last few weeks 

THANKYOU Vila Central Hospital 

For a completely fantastic placement 

We are not Pooh stick masters!

It's our last full weekend! Our last time to explore the island. We've had some elaborate plans. Some of which have fallen through but let's start with the last few days of our week on surgery!

We finally got to watch an amputation in surgery something that Amy in particular had been really keen to see. I was worried Itd turn my stomach too much after my experiences in derby. We watched this lady who's diabetes had gotten the better of her foot have her foot have her forefoot removed. I'm sure that in England they take time with the surrounding tissues; closing off blood vessels, creating muscle flaps to cover the end of cut bones. In vanuatu they just saw the foot off and drop it in the bin. Amy ( who was scrubbed in at the time)'s face was an absolute picture of horror. It was over pretty quickly, left open for a future skin graft, so many banages put on by Amy and Dr Ricky, and job done! A very eye opening difference to surgery practised in the UK

We've again seen a number of cases that have again made us feel incredibly lucky to be a part of the NHS, a health service that can provide so much, people can expect the most exciting medical developments to be offered to them and where there's few illnesses without successful curative or palliative treatments. Many cases of cancer here that just can't be treated without the families having large sums of money. Cases of diabetes that are terribly managed because of lack of education and cases of other life limiting diseases where there's little or no support for patients and family.

We cracked on Thursday night, five weeks at coconut palms and we haven't succumbed to ordering pudding. This changed on Thursday. We got ourselves a piece of chocolate cake and banana cheesecake and man they were good! 

Our Friday ended up a long day but pleasantly broken up by a Samoan lunch. Our consultant; Dr Dyxon in between sawing feet into bins had been cooking us a feast. He's from Samoa not vanuatu so whilst it wasn't the traditional vanuatu surgery lunch we've been treated to before it was extremely delicious. We had sashimi and noodles with a special sauce, some rice, island cabbage, manioc and kumala. Mm it was yummy. We struggled to remember a time our consultants in UK would ever make all the staff lunch! Maybe it's something we should remember in our future careers as it definitely boosts morale amongst the troops

Our last weekend was set to be a packed one. We were going to watch sunrise and see the market early in the morning on the Saturday along with a trip to the Mele cascades. The weather stopped our big adventure tho. We made our way down to the market at 730, this was very fruit filled and buzzing, we had breakfast at Jills cafe, an American diner but full of locals. Our eyes were probably bigger than our bellies after our small corn flake portions each morning! We tucked into a full American breakfast and a breakfast burger. Mmmmmm. 

We then decided the cascades would be better on a sunnier day so made our way to the museum. We were allowed in for free as we're working at the hospital, there were so many traditional artifacts from the outer islands these were really interesting and our guide 'edgar' explained some of the more local history. As we had just about seen all of the museum Edgar asked us to sit down as he was going to draw some sand pictures. This was another tradition from the outer islands, a story telling method where pictures are drawn in the sand that take no longer and no shorter than the story they describe. It was like falling into a completely calm state watching Edgar move his finger in the sand, not breaking contact once. He also ended his demonstration by playing a few tunes on the traditional flute and the Vanuatu national anthem on an instrument donated to the Ni-Vans by the Indonesian people. 

We had a long walk, did some souvenir shopping and our last weekly shop at Au Bon Marche and headed back to coconut palms for dinner and some reading! 

Sunday the sun was out! We skyped home and headed into town to grab a bus to the cascades at mele. These are the most epic waterfalls, you climb

Up them barefoot, against the force of the water holding onto a flimsy bit of rope. Something safety regulations in the UK definitely wouldn't allow! It was so amazing, there were little levels of short waterfall and then a huge waterfall feeding them all. We jumped in. Swam over the rocks and went behind the cascade of water! Such a cool experience. After ten minutes or so in the pretty chilly water we swam out and made our way down again. We sunbathed to dry off at a lookout point that had a gorgeous view over hideaway island and had some water and a brilliant ice cream!

We played a few games of pooh sticks, relatively unsuccessfully! And then headed back to coconut palms to read our books, have some lunch and indulge in a buy one get one free cocktail (we had a voucher) such a lovely day to end our last weekend.