Paul S. Dhillon
Saskatchewan, Canada

King Edward VII Memorial Hospital was erected by public subscription and first opened after the Battle of the Falklands on December 8, 1914 on land that was a gift of George Bonner, ESQ. Some reports state the hospital was open in 1912 with the exception of its heating system, which was lost when the SS Oravia sunk. The initial incarnation of the hospital was the Victoria Cottage Home, which was a Poorhouse and Nursing Home, and the pre-fire incarnation “officially” opened in May 1915 when the Victoria Cottage Home was closed. The Churchill wing of the hospital was completed in 1952 and included an operating theatre, x-ray facilities, a maternity ward, and a purpose built dental surgery. The hospital’s history includes fire, war, and royal visits.

The current hospital grounds lie on the north facing slopes of the capital city, Port Stanley, in the British overseas territory The Falkland Islands. The islands are part of an archipelago that consists of two main East and West Islands and about 20 adjacent inhabited islands with small camp settlements and up to 300 smaller islands. The population of the islands is approximately 3,000 people with another 1,800 British Military stationed on the island, mostly in a nearby town, Mount Pleasant. The hospital operates in a unique geo-political environment due to its location and the 1982 conflict between Argentina and Great Britain. With referrals potentially coming from Antarctica, South Georgia, Tristan da Cunha, and numerous foreign fishing vessels, yachts, and cruise ships arriving in port, the range of medicine and pathology seen is vast and surprising. A week might see a seafarer from Southeast Asia with filariasis, a local with hypertension, and then a military off-duty soldier with an ankle fracture after being run over by a seal. Previously hydatid disease was endemic but was controlled in the 1970’s along with the elimination of tuberculosis. Referrals due to the isolation and politics are also difficult and unique in that flights do not operate to the nearest nation of Argentina and must go to Chile for medical evacuations that can be planned. In cases of urgent medical evacuation, the Royal Air Force is tasked to transport the patient by road or helicopter to Mount Pleasant and then onwards by military transport to Montevideo, Uruguay. For more routine consultations that are not of an urgent nature there is an air bridge to the United Kingdom that stops on Ascension Island in the Atlantic before continuing onward to Royal Air Force base Brize Norton, Oxfordshire. This trip is a minimum of 20 hours and the expense to the health care system is not slight. Flights are at the whim of the southern weather patterns and therefore can be canceled on short notice due to strong winds or storms. Prior to 1982 medical services reflected the economy and were not that robust. General Practitioners were the highest level of care on the island and referrals to Argentina, Uruguay, and the UK were possible but fraught with issues around communications and lack of funding. After the 1982 conflict the standards of care improved with the British Military medical services then running the hospital until 2000 with up to 50 beds¹ available with capabilities to expand in case of need.

Saskatchewan, Canada

The first ambulance the hospital obtained was a Ford Thames in early 1960 and there are currently two Land Rover ambulances at the hospital along with the Land Rover Defender for the doctor on call. Currently funding for the hospital and its services comes from government tax revenue, fish license revenue, and through recouping the cost of treatment of foreign nationals and insurance fees. Similar to the National Health Service in the UK there is no payment at the point of delivery of service.

On April 10, 1984 a fire destroyed the previous wooden building that was the hospital. The fire was a tragic event and claimed the lives of seven patients and one nurse. The BBC reporter, Robert Fox, reporting from the scene stated² that “By dawn, all that was left was four stumps of chimneys, the thing wood boarding of the wall, and fittings flapping like charred tissue paper in the wind.” A report into the fire “eliminated arson, the electrical heater in the bathroom, an electrical fault, spontaneous combustion of the mattresses stored in the rooms, and an external source of fire as the cause of the fire . . . we are left with the probability that the fire must have been due to an accidental internal source of fire, inadvertently caused by either a patient, member of staff or an intruder. The evidence before us does not enable us to draw any more precise conclusion.” The hospital was then rebuilt into its current form and it was officially opened by Mr. Timothy Eggar, MP and Parliamentary Under Secretary for Foreign and Commonwealth on 8 December 1987. The new hospital was also named the King Edward VII Memorial Hospital Prince Andrew Wing was officially opened on May 11, 1985 by His Royal Highness Prince Andrew. The building itself now consists of 29 beds in total. This number is comprised of ten acute care beds, a maternity bed, a single bed isolation unit, two bed intensive care unit, seven long stay nursing home beds, and a single theatre with anesthetic room. The small Accident and Emergency Department has space for up to three patients and there is a laboratory available in the building for most routine bloodwork that is required. Transport of seriously ill patients to the hospital is via one of the two Land Rover Ambulances or via a simple van that can be dispatched for more ambulatory patients. Uniquely, a Land Rover Defender is provided for the doctor-on-call in case he needs to travel to a patient off-road. If a patient is brought in by the Search and Rescue helicopter of the UK Ministry of Defence, it lands on the soccer pitch across the road and adjacent to the hospital.

Available services

Currently a surgeon and anesthetist are based at the hospital and are partially funded by the UK Ministry of Defence. An unfortunate memory of the war was the existence of a number of mine fields around the country. The requirement of the military is that a surgeon and anesthetist be present while de-mining is occurring and while any live ordinance is being used in case of injury. Therefore, there is emergency Caesarean section capability on the islands as well as both major and minor surgery. The obstetrical services are provided and led by midwives similar to the UK with General Practitioners with experience in Obstetrics as a consult service available along with the surgeon. Any high-risk pregnancy would be referred to the UK for delivery and roughly 30-50 deliveries do occur on the island each year. Further specialist care is provided electronically via email and also through visiting specialists which come for short periods to the Islands. Visiting specialists include Ophthalmology, Psychiatry, Orthopaedics, Otolaryngology, Oral and Maxillofacial Surgery, and Obstetrics and Gynaecology. Radiological investigations available on the island are limited to X-ray and some ultrasound. Any requirements for CT or MRI are referred off of the island. There exists a living blood bank in terms of the local community in case of need and 2 units of O- blood are kept for absolute emergencies. The one pharmacy on the island is also in the hospital in the Churchill wing and thus provides a unique vantage by which the medical community can monitor drug usage patterns. There are no prescription drug charges for Falkland Islanders or British nationals through a reciprocal agreement between governments. There is a fairly extensive formulary with restocking of drugs potentially taking up to six weeks to arrive from the UK.

Camp visits

Uniquely in the Falklands there is a continuing weekly fly out visit to the colloquially named “camps” that people permanently inhabit on a number of smaller islands, many of them being farmers. These visits are an extension of the GP Clinic based in the hospital. A physician flies on a small government plane and visits these small encampments and houses with consultations occurring sometimes in the back of a vehicle or in a home or bedroom if necessary. Blood and urine samples can be taken in the camp by the physician if required and resuscitation medications are carried in the plane. If a physician is unable to visit due to weather or other issues telephone consultations can occur and the patients can be directed to utilize certain medications pre-positioned in one of the “medicine chests”² left stocked and locked out on the islands which in reality are cardboard boxes stocked with some basic medications including antibiotics.

References

1. Ratcliffe GE, Cetti NE, Bleaney AA. Medicine in the Falklands. A review of the medical services in the Falkland Islands before and after the war of 1982. J Army Med Corps1984;130:16–19.
2. Falklands Hospital Fire. http://londonfirejournal.blogspot.com/2014/09/hospital-fire-1984.html. Accessed on April 6, 2016.
3. Diggle, R (2003). “Medicine in the Falkland Islands” Postgraduate Medical Journal 79 (927): 3. doi:1136/pmj.79.927.3. Retrieved March 30, 2016.