Neonatal anesthesia in low birth weight babies at Hospital Nacional Guido Valadares, Dili, Timor-Leste.

Over a 6-month period, eight neonates weighing less than 3 kg were operated on at Hospital Nacional Guido Valadares, Dili, Timor-Leste. Each was operated on for an abdominal condition. There is no postoperative neonatal ventilation, neonatal inotropes, fluid warmers, or parenteral nutrition available at Hospital Nacional Guido Valadares. Medical air and nitrous oxide are unavailable. Oxygen from cylinders is the only gas available in theaters and on the wards. Generally equipment is problematic and not designed for neonates. Five of these infants perished in hospital perioperatively, representing an in-hospital mortality of 62%, another is presumed to have died following discharge, and two recovered well. This represents an estimated overall mortality rate of 75%. This is not surprising given the difficult circumstances in theater and the limited postoperative support services available. The resources and time deployed in operating on these small neonates is significant. As difficult as it may be surgical enthusiasm and the uncertainties surrounding prognostication should not displace practical and realistic assessment of the likely outcome of operating on very small babies in low resource facilities where perioperative support is limited. Future development in the Timor-Leste healthcare sector will hopefully provide an environment where improvements in outcome can be achieved.

Mortality and outcomes of elderly patients admitted to the intensive care unit at Cairns Base Hospital, Australia.

OBJECTIVE: To determine the survival and outcome of elderly patients admitted to the intensive care unit at Cairns Base Hospital. METHODS: A retrospective review of patients aged 60 years or over admitted to the ICU (a Level 2 general unit) at Cairns Base Hospital, a regional hospital in Queensland, during 2003-2005. Mortality was determined by review of hospital records, the Queensland register of deaths, and direct patient or family contact in November 2006. Demographic and clinical details were collected, and the EuroQol-5D questionnaire was used to assess current and pre-ICU quality of life. RESULTS: 432 patients aged >or= 60 years had 469 admissions to the ICU during 2003-2005. Long-term outcome was determined for 68%: 201 (46%) were confirmed dead, and 94 (22%) were confirmed alive, while the outcome for 137 (32%) remained unknown. Allowing for an estimated mortality of 39% in the unknown group, the overall estimated mortality was 60%. Mean follow-up time was 2.4 (SD, 0.9) years (range, 11-35 months). As age increased, mortality increased: 37% for the 60-70 years age group; 50% for 70-80 years; 61% for 80-90 years, and 83% for > 90 years. The quality of life of survivors was lower on follow-up than on ICU admission. CONCLUSIONS: Elderly patients admitted to the ICU have high mortality. As age increases, mortality increases. Elderly survivors can expect a lower quality of life after an ICU admission, although on average the difference is not great.

Travel insurance and medical evacuation: view from the far side.

Travel insurers and medical evacuation companies have a responsibility to provide an efficient high-quality service to their clients. These companies often deliver a standard far short of best practice and far short of their promotional brochures. Their services are overdue for governmental review and a lifting of standards. Travellers must be given realistic advice about the risks of foreign travel and that healthcare resources at their destination may be very limited. Travellers must check with their insurer that the policy they buy truly meets their needs. Some people should not travel overseas.

Twenty-three years of labour floor records, Vila Central Hospital, Vanuatu.

Vanuatu is an island nation in the south-west Pacific. Vila Central Hospital (VCH) is the country's major referral hospital. The handwritten labour floor records from VCH between 1979 and 2001 were examined and collated. During this period 28,638 women received care. The mean Caesarean section and instrumental delivery rate were 5.2% (2.1-8.2% per annum) and 1.8% (0.9-3.2% per annum), respectively. The post-partum haemorrhage rate fell from >5% in 1979 to <1% in 2001. The overall hospital maternal mortality rate was 7/10,000. These records represent the largest published series of labour floor data collected from any Pacific island nation.

Kava drinking in Vanuatu--a hospital based survey.

Kava is an intoxicating non-fermented beverage native to the Pacific Islands. In Vanuatu men traditionally drank kava on ceremonial occasions. Now however men and women drink kava on a casual basis. To assess the kava-drinking habits of current-day ni-Vanuatu, 150 people were surveyed at Vila Central Hospital, (50 medical and 50 surgical patients plus 50 staff). 35% of those surveyed drank kava, (9% daily). 59% of men and 15% of women drank kava (approximately 4:1). 51% of all men drank kava at least weekly, compared to 11% of women. For any given kava-drinking episode men drank more than women, (4.3 +/- 2 vs 3.3 +/- 1.3 shells). There was no significant difference in age between drinkers and non-drinkers or in usage rates between patient groups or staff. Women attaining higher levels of education and women resident on Vanuatu's main island were more likely to drink kava. Of the women surveyed who were resident on outer islands none drank kava. This study reveals that the consumption of fresh kava on a regular basis is very common in Vanuatu. If this is the case it also suggests that whilst much is written about the dermopathy, weight loss and, more recently, possible liver disease associated with kava use that these and other health problems are of doubtful significance. This is also supported by field experience.

Population, public health and tubal ligation in Vanuatu.

The association between population growth and public health is often neglected. Between 1989 and 1999 Vanuatu's population grew by 30%. Unless this growth slows existing public health problems will worsen. To gain insight into family planning habits 111 ni-Vanuatu women undergoing tubal ligation were surveyed. 85% had 4, or more, children. Women resident on the outer islands had more children than those on the island containing the nation's capital. The implication is that ni-Vanuatu women perceive 4 children as desirable. With approximately half the population entering their reproductive years in the next decade this is too many to avoid a population explosion in Vanuatu. Public health campaigns must promote the benefits of a small family. Urgent education and widespread provision of effective family planning is required to avoid a future public health crisis. Aid donors need to be made aware of this as an absolute priority.