Jamestown Hospital

The hospital at Jamestown is the base for my work although I also go out to three peripheral clinics. The hospital is situated near the head of the valley above Jamestown about a mile from the sea with steep rocky slopes on either side but reasonably sheltered by trees.

The buildings are in a Colonial Style about 50 years old but in good repair. There are high ceilings, wooden floors and a veranda. There is no air conditioning but with open windows and fans the temperature is tolerable even on the hottest of days.

 There are three main wards, male and female general wards each with 8 beds which are usually half full. The surgical ward is only used on operating days, once a week and doubles up as the recovery area for the operating theatre.

The operating theatre is small but well equipped with a range of modern equipment for use by visiting doctors of various specialities. There are endoscopes and a laparoscope but no image intensifier.

The anaesthetic machine is up to date and very different from the machines I used when I was last giving anaesthetics, all that is missing is the specialist staff to use the equipment. The current surgeon is a Professor of Surgery from India who specialises in upper GI tract work. We currently have a man on the ward with cancer of the pancreas who might benefit from his surgical skills but do not have the ability to provide the specialist post operative care that he would need. 

There is a small Intensive Care Unit for the more seriously ill patients but unfortunately not enough nurses with the necessary skills to provide 24hr cover. There are plenty of nurses on the general wards are enthusiastic about their work and enjoy a good relationship with their patients. However they are not always as careful as one might wish about following care plans for patients. The atmosphere on the wards is wonderful, on such a small island most people know one another and it is fairly normal to find that patients have at least one relative working in the hospital. Extended families are part of the island culture and the wards are often crowded with groups of people chattering and gossiping, not perhaps are quiet and restful as a hospital should be but a lovely place to be working.

There is a small physiotherapy department with a single partly trained therapist who does what she can. The X-ray machine is an old portable unit not really adequate for the task but due to be replaced in the next year, a specially trained nurse takes X-rays of a reasonable quality but of course it is up to the doctors to interpret them. There is a very good ultrasound machine but again it is up to individual doctors to do the scanning. Ultrasound was in its infancy when I started medicine and learning to use the machine effectively is quite a challenge but I’m slowly getting the hang of it. There is quite a comprehensive laboratory set up and the staff are quick and efficient at getting tests done and reporting back. They will even come and find you to tell you about an interesting or important result. 

The pharmacy carries a rather limited range of drugs but the formulary is generally adequate to meet day to day needs and special drugs can be brought in on the next boat when necessary. Diabetes is a major health problem on the island and an optometrist visits twice a year to provide a retinal photography screening service.

The peripheral clinics are held in the other major population centres of the island and although only a few miles away the drive can often take 30 mins or more because of the steep winding roads through the centre of the island.

The views and clinic settings are spectacular and the clinics themselves well maintained if rather basic. Medical records throughout the hospital are partially computerised and we use laptop computers at the clinics.

A pharmacy van accompanies the doctor and nurses so that patients can usually collect their drugs when they are seen. Clinic days in the more isolated communities are a great social event for many of the older people who do not have their own transport to get to Jamestown and nobody minds being kept waiting if the clinic over runs.

The four doctors working on the island each have special areas of responsibility if not expertise, two of my roles are Mental Health and Care of the Elderly for each of which there are separate institutions. Sundale, the psychiatric Unit, (why do they always have such pleasant sounding names) is a compact old brick building shaded by trees in a small garden but perched high a hill with a magnificent view of the ocean, its in a dreadful state of repair but the staff are committed and the atmosphere is very good. By contrast the Community Care Complex (modern name for a modern building) is an impressive new building in a similar location

but with no shade on a north facing (the sunny side) rocky slope. Despite its poor location the building and its facilities put to shame anything in the public sector in the UK. The unit provides Day Care, Nursing Home Care and a secure area for those with Alzheimer’s Disease. Once again because it is a small community most of the residents are old friends and they are cared for by staff who, if not members of their extended family, are at least known to them which generally guarantees a high level of personal care and commitment.

Despite the apparent good doctor patient ratio, 4 doctors looking after 4000 patients because of our extended roles we are actually very busy.

After a very busy and stressful week, more about that next time, I’m enjoying a relaxing weekend off and spent yesterday in a small fishing boat exploring the dramatic coastline.