The National Referral Hospital in Honiara is seeking to establish an oncology unit as part of a project to deliver cancer services in the Solomon Islands.
The cancer treatment room, like the rest of the hospital, suffers from a lack of maintenance. It has louvred windows, no air conditioning, badly rusted fans and the holes in the floor mean that the room is subject to flooding in the monsoon season. The working environment is cluttered with boxes stacked on trolleys and the floor due to there being no storage cupboards.
There are no basic temperature or blood pressure machines to check observations prior to giving treatment and weight scales are borrowed from the Medical Ward on an ad hoc basis. Imaging and pathology services are limited. Treatment can only be given via a peripheral cannula. Cannulas differ depending on which country provided them and there are no bifurcated lines. Intravenous saline and 5% glucose are not available in the volumes normally used for cancer treatment and there are no pumps or giving sets. Not all drugs are available, thereby limiting the protocols that can be used.
The treatment room is staffed by only one registrar and two nurses, none of whom have been given any specialised training in the delivery of cancer treatment. There is no cover if the doctor or one of the nurses is absent for any reason. Providing training and advice and support to the staff remotely is hampered by the patchy availability of internet services.
This presentation describes the approach to developing a model for the safe administration of cytotoxic drugs. The model will use protocols that have been adapted to make best use of the equipment, supplies and drugs available, while minimising wastage. The model will also address staff training and succession planning.