Having borrowed the title from the famous book by James Michener, my story of 2 years as a doctor in the island nation of doesn’t have quite the ring of romance and adventure as his classic tale. However as an anaesthetist from Adelaide in South Australia the time here has certainly turned out to be a great adventure for my family and I.

When the position as an anaesthetist at Vila Central Hospital in Pt Vila came up through AusAid, I was living the quiet life giving anaesthetics in private practice in Adelaide South Australia and working part-time in diving and hyperbaric medicine at the Royal Adelaide Hospital. A few months later I was working well outside my comfort zone in a developing country…a regular Jack-of-all-trades and a master of none.

Vila Central Hospital

Vanuatu relies heavily on the tourist industry for a large proportion of its GDP, and many of the visitors come here to SCUBA dive or otherwise enjoy the tropical waters. Several dive operators work the waters around Pt Vila, catering for recreational SCUBA diving, which is strictly limited to 40m single tank no decompression dives on the numerous local reefs and wrecks (many of which are purpose sunk artificial reefs). In the northern island of Espiritu Santo, the famous shipwreck of the SS Coolidge lies on a sand shelf from 20m at the bow, to 70m at the stern. This site is unique in the world because the local diving code of conduct allows certified divers of any level to perform decompression dives using air to depths of 60m, as long as the dive operators assess them as being competent to do so. This competence is established by working slowly down the wreck to increasing depths and penetration during the divers’ stay. Human nature and financial pressures being what they are, this means that occasionally divers will find them selves “out of their depth” in terms of their qualifications and experience. Despite the potential for accidents that this scenario might project, only 3 deaths have ever occurred on the wreck (non of which occurred whilst diving under the direct supervision of a dive shop), in the many thousands of dives that are performed here every year; and only 1 or 2 episodes of DCI presented for treatment each year arising from Coolidge dives.

A small but steadily growing technical diving contingent visits the wreck each year, but at this stage only one of the dive shops caters for this group. Opportunity for live-aboard diving is very limited in , with only one operator running trips intermittently at the time of writing.

Aside from the recreational dive industry, a small amount of commercial diving takes place in . Inshore commercial dive operators do work on ships’ moorings, sea walls and the like, free diving fishermen collect Sea Cucumber, and a significant aquarium fish collecting industry exists owned by an offshore company, using local and Philippine divers to catch fish by hand using SCUBA and Hookah equipment. I have had no professional dealings with these groups during my time in .

Pt Vila is lucky enough to have a twin lock hyperbaric chamber owned by Hyperbaric Health Services, and run by the Australian trained paramedics at Promedical (a private ambulance company). The chamber was formerly at the Alfred Hospital in Melbourne and will be well known to some. The chamber started its life in based on Espiritu Santo, but for lack of medical and technical staff it was moved to Pt Vila. It is well maintained and staffed, and I felt very comfortable using it for the administration of oxygen tables to 2.8ATA. In the past 2 years I have treated only 5 divers in the chamber (with a total of 15 treatments), however 2 of these had significant spinal sensory-motor DCS, and both made good recoveries with appropriate first aid, extended USN Treatment Table 6, intravenous lignocaine (in one case) and follow-up HBO treatments (18:60:30). As the chamber is not on the hospital grounds, patients either stayed at a hotel between treatments or in the case of the one diver given lignocaine, were admitted to the private medical clinic in Pt Vila for monitoring. The majority of divers held DAN insurance and insurance related delays were minimal, significantly reducing stress on the part of all involved. A further 2 divers were assessed as having mild resolving DCS and not treated, and 3 other divers assessed as not suffering from DCS.

As a physician in diving medicine in Pt Vila, I was consulted by telephone on numerous occasions by local dive shops with fitness to dive queries. I was reluctant to see all the divers in question due to the voluntary nature of my diving medical work, however I was happy to provide a telephone advice service. Naturally without seeing the prospective divers myself, the advice I gave was extremely conservative in nature. I did however see a number of patients with injuries secondary to diving or swimming including ENT problems, marine envenomations and bites, fish poisoning and salt water aspiration/near drowning.

The chamber at Promedical headquarters, Pt Vila.

Some cases of note that come to mind? Several cases of ciguatera and scromboid poisoning. The Red Bass (Lutjanus bohar) is a prime culprit in .  2 shark attacks during my time, one fatal and one nearly so. 2 stingray envenomations, a moray eel bite, a variety of jellyfish stings and on a personal note; a brush with the Magnificent Sea Urchin (Asthenosoma ijimai) and the Devil Stinger (Inimicus caledonicus). Both very painful and best avoided! Multiple coral cuts producing ulcers despite the best of care, leave me with a nice collection of scars on my legs as a permanent reminder of my stay.

Inimicus Caledonicus - no friend of mine!

Local boy with a nice jellyfish sting.

Sadly I leave the beautiful shores of Vanuatu in January 2006, returning to Adelaide to resume work as an anaesthetist. But I know I now have the taste for adventure, and I’m already I scheming about the next trip away!