Neo Horizon Surgery Solomon Islands

15/11/2025

Health Tip:

Recently, a relative of one of my patients with diabetic foot ulcers remarked that he observed that I always personally attend to the patient and apply the dressings myself. I explained that diabetes and diabetic wounds have now become major causes of surgical admissions at NRH, leading to major limb amputations and even deaths. Because of this, I have developed a deep personal and professional interest in understanding the science and behaviour of wounds and wound healing.

I have spent years observing how diabetic wounds behave, recognising how different they are from wounds in non-diabetic individuals. I wanted to understand why healing is slow in diabetics, why infections progress rapidly, and how underlying comorbidities alter the biology of healing. Alongside extensive literature review, these experiences have shaped a slightly different method and approach that I now use when managing wounds, especially diabetic wounds.

Managing diabetic wound infections is a long, difficult, and often daunting journey. Just when you think you have gained control, a sudden and unexpected turn can set everything back. Many people assume that a wound is a simple matter, often thinking wound dressing is solely a nurse’s task. While this is true for many uncomplicated wounds, it is dangerous to underestimate diabetic wounds. If not taken seriously, and if infection sets in, the consequences can very quickly become limb-threatening and even life-threatening.

This is a reminder to everyone: be conscious of your health status. Get checked and know whether you are living with diabetes. If you are diabetic, adjust your lifestyle and keep your blood sugar within the acceptable range. And if you develop even a small blister or minor wound, seek medical attention immediately. Do not wait. Even a week of delay can be too late. In diabetic wounds, time can determine whether you keep your limb or your life.

02/11/2025

A Surgeon's Life is never dull.

This sunny Sunday afternoon, I was sitting under a frangipani tree outside the house, just relaxing and listening to music on the radio. Then a familiar song by Bryan Adams, “Please Forgive Me”, came on. It brought my mind instantly back to 1996.

At that time, I was a Trainer Surgical Registrar, working at Kilu‘ufi Hospital in Malaita Province, Solomon Islands. My Surgical Consultant then was Dr. Narayan Rao, from UK.

Kilu‘ufi Hospital, by definition, was a small rural hospital with very limited resources. Despite that, we performed many surgical procedures, including some life-saving ones where we often had to improvise because of the lack of equipment and support facilities.

Among the hundreds of cases we handled, a few extraordinary ones stood out in my memory, but one case, in particular, remains vivid to this day. It was that of a seven-year-old boy who was admitted with a head injury. We operated on him, opening one side of his skull to remove blood clots that was compressing his brain, a procedure known as a burr hole and craniotomy, under General Anaesthesia.

Kilu‘ufi Hospital did not have an Intensive Care Unit, as most hospitals in the Solomon Islands. Nevertheless, the boy recovered well in the general ward, regaining full consciousness and movement of all his limbs. However, about two days later, he began to show signs of reaccumulation of the blood clot compressing his brain.

So we took him back into the operating theatre. Under normal sterile technique and sterile draping, we removed the stitches from the scalp wound and reopened the skull into the outer covering of his brain. We performed the procedure with the boy fully awake under local analgesia only, rather than general anaesthesia.

It was our usual practice to play soft music in the theatre to create a calm atmosphere during surgery. On that particular day, we had Bryan Adams’ cassette playing softly in the background.

As we were evacuating blood clot from the boy’s brain (extra dural space), we heard sounds coming from beneath the sterile drapes. At first, we thought he might be in pain, so we asked him. The boy said he felt no pain, he was fine. He added, in a cheerful tone, that it was his favourite song by Bryan Adams playing, and he was simply singing along.

The boy made a complete recovery and was discharged from the hospital well and sound.

Now, as I sit under the frangipani tree listening to that same song again after all these years, I can’t help but wonder where that boy might be today. He would now be in his mid thirties.

Bryan Adams - Please Forgive Mehttps://www.instagram.com/bryanadams/The dog in the video belonged to the studio owner, but liked BA and followed him during h...

31/10/2025

Unexploded Ordnance: A Public Health Alert.

During the Second World War, from 1942 to 1945, one of the fiercest and bloodiest battles between Japanese and American forces in the Pacific was fought on the Island of Guadalcanal, in what was then the British Solomon Islands Protectorate.

Hill 84, as the Americans called it, is the area now known as Lengakiki Ridge.

In recent years, several unexploded bombs have detonated, killing or injuring innocent people. For me, these incidents bring back vivid memories. In the 1970s, as a kid growing up in Lengakiki and the Town Ground area, my siblings, friends, and I would spend our days playing and exploring those hills, completely unaware of the dangers buried beneath our feet.

I remember that whenever there was a grass fire, we would walk through the ashes, searching for whatever we might find, thinking we were discovering treasures. We never realized the deadly risks.

These unxploded bombs also provided opportunity for a few foolish individuals, risk-takers who tried to cut open unexploded bombs to extract the gunpowder for making dynamite used in illegal fishing. Some were badly or fatally injured.

Now, more than 80 years after the war, these unexploded ordnances (UXOs) have become unstable. They can easily detonate at the slightest disturbance.

Honiara, the capital of Solomon Islands, is literally sitting on a time bomb.

I cannot help asking a few questions:

Why did Japan and America have to fight their war so far away from their homes? Why bring their conflict to our peaceful islands, when we had no quarrel with them? They often claim that they fought to defend our freedom. But whose freedom did they defend? Certainly not ours. Today both of them are our friends.

All they did was leave behind tonnes of deadly explosives, rusting silently beneath our soil and sea, posing a public health risk for our people today.

If they could bring all their bombs here during the war, why could they not take them back when the war ended? Afterall, these bombs were not made in the Solomon Islands. They were brought here.

Today, as Honiara and parts of Guadalcanal, as well as many islands in the Western Province, remain contaminated with UXOs, it is time for decisive action.

There should be a law requiring all war-affected areas to undergo systematic UXO clearance. It should be a National priority to urgently push for the clearance of UXO. International partners, especially Japan and the United States, should be held accountable to assist in the cleanup of the remnants of their war.

Eighty years on, the people of Solomon Islands should not have to live under the shadow of a war that was never ours.

19/10/2025

A Growing and Silent Epidemic

SCLEROSING LIPOGRANULOMA of the P***S.

Over the years in my practice, I have treated many males presenting with a condition known as Sclerosing Lipogranuloma of the P***s, also referred to as Paraffinoma or Vaselinoma. This condition arises as a serious complication of pe**le augmentation following the injection of paraffin, baby oil, or similar substances into the pe**le tissue.

In sclerosing lipogranuloma, the body’s Immune system recognizes the injected substance as foreign and mounts a foreign body inflammatory reaction against it. This process leads to chronic inflammation, fibrosis, and hardening of the pe**le tissue.

Many patients SUFFER Silently and in Deep EMBARRASSMENT. What begins with high hopes for a more “glamorous” or “enhanced” life often ends in Pain, Deformity, and Disappointment. The stories are tragically similar: The Decision is often made under the influence of alcohol and peer pressure, and the injection is performed by untrained individuals.

It must be remembered that with just One WRONG Decision and One Pe**le INJECTION with foreign body, TWO of the most Fundamental Functions of Human LIFE, Urination and Reproduction, can be permanently damaged.

From my clinical experience, I can confidently declare that failed pe**le augmentation has reached endemic levels. If this trend continues, I predict that in the years ahead we will face an increasing number of long-term complications of sclerosing lipogranuloma, including scrotal lymphoedema and possibly Pe**le Cancer.

This is not just a medical issue, it is a Public Health Warning. Education, early intervention, and awareness are essential to prevent further suffering among men who fall victim to this dangerous and misguided practice.

10/09/2025

Interpreting the Dengue Test

The Dengue Rapid Diagnostic Test (RDT) is commonly misinterpreted, yet understanding it is crucial for accurate diagnosis and management.

The test detects three different markers:
NS1 antigen,
IgM antibody, and
IgG antibody,
each of which reflects a particular stage of the illness.

NS1 stands for Non-structural Protein 1, which is a viral protein produced by the dengue virus. When the RDT detects NS1, it means that the virus is circulating in the blood and that the patient has an active infection.

NS1 is usually present from the first day of illness until about the fifth day, a period known as the FEBRILE Phase. During this phase, the patient typically experiences high fever and headache, and the virus is at its peak activity.

As the illness progresses, the patient’s immune system begins to respond by producing antibodies.

The first antibody to appear is IgM, which begins to show up around day five, just as the levels of NS1 start to decline.

IgM is part of the body’s immediate defense system, and its appearance coincides with the CRITICAL Phase of dengue fever. This is the stage where the immune system fights the virus most aggressively.

While the antibodies are attacking the virus, the body may also suffer from collateral damage in the form of cytokine storm and capillary leakage, leading to a dangerous shift of fluids within the body. Platelet destruction can occur at this time, and the patient may develop bleeding tendencies.

Clinicians are trained to closely monitor for the cardinal signs of the critical phase, as this is the most dangerous part of the illness.

IgM can remain detectable in the bloodstream for up to three months after infection.

If the patient survives this immune battle, the disease moves into the RECOVERY Phase, which usually begins about 48 Hours after the critical phase and lasts from day seven to day ten of the illness, though recovery may extend for up to several weeks. During this period, the patient’s condition gradually improves.

Around day nine, another antibody known as IgG begins to appear in the blood. IgG provides long-term immunity against the specific dengue serotype that caused the infection, and unlike IgM, it remains in circulation for many years.

Understanding the meaning of RDT results therefore depends on recognizing which marker is positive.

If NS1 alone is positive, the result indicates an early active infection during the febrile phase.

If both NS1 and IgM are positive, the patient is in an acute phase of infection, likely transitioning into the critical period.

If IgM and IgG are both positive, the infection is somewhere between day nine and three months after onset, when the body is moving from acute illness into recovery but still shows evidence of recent exposure.

If only IgG is positive, this does not mean an active infection but rather reflects past infection and immunity, which can last for many years.

It is also important to understand that dengue fever does not have a specific antiviral treatment. Management is supportive, focusing on maintaining adequate hydration and controlling fever. Paracetamol (Panadol) may be used to reduce fever during the febrile phase, but it should be stopped once the patient enters the critical phase. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen must be avoided altogether because of the increased risk of bleeding.

30/08/2025

What I think our Nation is lacking and needs is "Brain Empowerment", where the minds, skills, and talents of all our people are fully developed and used to build a better future.

I think the Barriers to Brain Empowerment are:

1. Many young people struggle with substance abuse and untreated mental illness. This destroys potential and creates what we can call "Brain Rot".

2. Our schools, research, and training systems are weak, causing many dropouts.

3. Graduates often leave school with skills that don’t fit the jobs available.

4. There are still big gaps between men and women, and between regions, in education and job opportunities.

5. We don’t involve our diaspora well, even though they have skills to share.

6. Poor pay and working conditions cause "Brain Drain", where skilled workers leave for other countries.

7. The private sector is too small, limiting jobs and industries.

8. Many people cannot train in fields they are passionate about.

9. National plans often don’t match the talents and interests of individuals.

To overcome these barriers and unlock our human potential, we need to set clear goals:

1. Stop "Brain Rot" by preventing drug abuse, providing rehabilitation, and promoting mental health.

2. Reduce "Brain Drain" by improving pay, working conditions, and career opportunities.

3. Activate our "Brain Reserve", the hidden potential of women, youth, the elderly, and returning citizens, so no one is left behind.

4. Promote "Brain Circulation" by working with our diaspora and building international partnerships so knowledge and skills flow both ways.

5. Build strong foundations for "Brain Empowerment" through fair education, research, and innovation systems.

6. Match training with people’s real passions and talents so every profession is covered.

7. Support jobs and businesses locally and globally, making the best use of our people’s skills.

My Slogan

"Fight Brain Rot" – protect young minds.

"Stop Brain Drain" – keep our best talents at home.

"Activate Brain Reserve – empower women, youth, elderly, and returnees.

"Promote Brain Circulation" – share skills with the world and our diaspora.

"Achieve Brain Empowerment" – unlock the full potential of our nation.

My thoughts for today

29/08/2025

Like Father, Like Son.
Father, performing surgery at PMGH in 1998, upper picture.
Son, assisting in surgery at PMGH in 2025, lower picture.

23/08/2025

Microscopy and Rapid Diagnostic Tests are both established diagnostic tools used to detect malaria, and they are sound scientific methods that have been proven effective over time.

Microscopy, the older of the two, allows direct visualization of parasites, identification of species, and estimation of parasite density. However, its accuracy is heavily influenced by the skill and experience of the microscopist, meaning that results may vary from one technician to another.

Rapid Diagnostic Tests, on the other hand, are based on antigen–antibody reactions and are therefore less affected by observer bias or human error, producing more standardized results regardless of who performs the test.

This difference can be likened to sending a message through the post office compared with sending it by email. Both deliver the message, but one is slower and more reliant on manual effort, while the other uses newer technology to provide fast and reliable outcomes.

When comparing performance, microscopy under expert conditions achieves a sensitivity of about 95 to 98 percent, specificity of 98 to 100 percent, a positive predictive value above 95 percent, and a negative predictive value also above 95 percent, though both may fall if parasite density is low or the microscopist is less experienced.

Rapid Diagnostic Tests show slightly lower sensitivity overall, about 85 to 95 percent for Plasmodium falciparum and around 70 to 90 percent for other species, with specificity in the range of 90 to 95 percent. Their positive predictive value is usually between 85 and 90 percent and their negative predictive value between 90 and 95 percent.

RDTs offer an accuracy that is consistent and not dependent on human interpretation.

I would place more confidence in RDTs in routine clinical use, since their antigen–antibody mechanism avoids the subjectivity that can undermine microscopy.

23/08/2025

Can you imagine.

If we step back and look carefully at what it means to be born into this world, the statistics alone are enough to leave us in awe.

At the biological level, a man releases between 40 million to 1.2 billion s***m in a single ej*******on. Yet only one of those s***m will succeed in fertilizing the egg. The probability of a particular s***m reaching the egg is therefore somewhere around 1 in 100 million or more. That means the chance of you, specifically, being conceived rather than any one of millions of alternative possibilities is already almost zero in mathematical terms.

But that is only the beginning.

Each of your parents also had to be born, against the same astronomical odds. To get to you, you must multiply your chance of existence not just by your parents’ probabilities, but by your grandparents, great-grandparents, and every generation before them.

If you consider just 30 generations back, around 1000 years, there are over one billion direct ancestors in your family tree.

Each of those individuals had to survive childhood diseases, injuries, wars, famines, and natural disasters, and then had to meet and have children with one particular partner at one particular moment in time.

If even one of those unions had not occurred, you would not be here today.

Adding the weight of history makes the improbability even more striking.

Colonialism, as disruptive and painful as it was, created circumstances that allowed new kinds of human connection. Education brought together people from distant villages, churches redefined marriage customs, employment moved men and women across islands, and migration reshaped entire communities. These movements created the exact pathways for our parents and grandparents to meet.

Statistically speaking, if they had remained confined to their traditional villages, the probability of them ever encountering one another would have been minuscule.

Colonialism, therefore, not only reshaped economies and societies but also the very networks of relationships that led to our conception.

Taken together, the probability of you being born, at this exact time, to your exact parents, is so small that mathematicians often call it practically impossible.

Some estimates suggest that the odds of any one of us existing, when traced back through the required line of survival and encounters across generations, is about 1 in 400 trillion.

And yet, here you are.

This leads to a profound truth: none of us are here by mistake.

The Bible affirms this in the words of Jesus, who said that even before we were born, He knew us. If our birth is both mathematically improbable and divinely intentional, then life must be treated as sacred and purposeful.

To waste it on things that benefit no one is to ignore the miracle of your own existence.

When you find and live your purpose, serving others, using your gifts wisely, and honoring God, you transform the improbable gift of life into something meaningful.

In doing so, you not only respect the struggles of your ancestors and the forces of history that made your birth possible but also glorify the God who gave you life and knew you before the foundation of the world.

My Thought for today.

10/08/2025

People are often attracted to places that are more developed, where services are efficient, infrastructure is advanced, and opportunities seem abundant.

But we must pause and ask ourselves, did those places simply appear that way by themshelves? Of course not.

They became what they are because their forefathers had a clear vision for their future. They worked tirelessly, endured sacrifices, and faced hardships head on. Their determination built the systems, roads, schools, hospitals, and economies we now admire.

Every thriving city and prosperous community stands on the shoulders of past generations who chose to act. They did not wait for someone else to come and fix their problems, they did it themselves.

This is a universal truth: Development is not given, it is earned.

So when we abandon our own homeland, expecting to enjoy a better life in someone else’s place without having contributed to its growth, we must question the fairness and logic of that choice.

If we do not like what we see in our own community, the only way to change it is to take responsibility and work for that change. Waiting for outsiders to solve our problems is both unrealistic and self defeating.

We must have a vision, a clear picture of what we want our country, our towns, and our communities to become. Then we must work with determination, patience, and unity to make it happen.

What we build today will outlast us; it will bless or burden the generations that come after us.

The comfortable life we desire for our children will not appear by wishful thinking; it will be carved out by the sweat, sacrifice, and persistence we invest now.

If we do nothing to improve where we are, we forfeit our moral right to enjoy what others have worked hard to create.

God has placed us where we are, a Country blessed with abundant natural resources for a reason, not to run away when things get difficult, but to be the builders and restorers of our own land. We cannot claim pride in our heritage while refusing to take part in shaping its future.

"When the going gets tough, the tough get to work". And if we want our children to inherit a land they will be proud of, then the time to start building that legacy is now.

Facebook asked, so I thought I'd share this piece.

05/08/2025

Understanding Diabetes and Blood Sugar in Everyday Life

Diabetes mellitus is a disease that happens when the level of sugar in your blood becomes too high. The sugar, called glucose, gives your body energy to function. Your brain depends on glucose to stay alert and in control of your body.

When you eat food that contains carbohydrates like rice, bread, or sweet potatoes, your blood sugar naturally rises. Your body then releases a hormone called insulin, from the pancreas. Insulin helps moves glucose from your blood into your body’s cells, where it is used as energy or stored for later use. This helps lower your blood sugar back to a safe level.

In a healthy body, the amount of glucose in your blood is tightly controlled and usually stays between 4.2 and 6.2 mmol/L. If your blood sugar gets too low, such as when you fast for a long time, your body can bring it back up. It does this by taking sugar stored in the liver, called glycogen, and convert it back into glucose. If the stored sugar runs out, your body has a backup plan. It can create new glucose from lactic acid, fatty acids and amino acids in your body. This is called gluconeogenesis. So, even when you’re not eating, your body works hard to keep your blood sugar level just right.

One of the main sources of sugar in the blood is the carbohydrates we eat every day. These carbohydrates are found in food such as cassava, yam, bananas, rice, noodles, bread, flour, and sugar. Carbohydrates come in different forms. Some are simple and can be absorbed directly into your blood, like glucose and fructose. Others are more complex, like starch, and must be broken down into glucose before they can be used.

Digestion starts in the mouth. As you chew, enzymes in your saliva begin breaking down starch into smaller fragments. When the food reaches the small intestine, other enzymes break the starch down further into single sugar molecules like glucose, which is then absorbed into your blood. Some starch is not digested in the small intestine. Instead, it moves into the large intestine, where it is broken down by healthy gut bacteria. This produces helpful substances like short-chain fatty acids that are good for your health.

Now, the speed at which the sugar enters your blood is important, especially for people with diabetes. Some foods cause a fast rise in blood sugar, while others raise it slowly. This speed is measured using something called the Glycaemic Index (GI). Foods with a high GI are quickly digested and absorbed, leading to a fast rise in blood sugar. Foods with a low GI break down slowly, giving your body time to absorb sugar bit by bit.

The GI of food depends on the type of starch, how the food is cooked, what you eat it with, and even whether it’s hot or cold. For example, boiling food like sweet potatoes or cassava usually results in a lower GI compared to frying, which can make the starch break down faster and raise the GI. Bread or Rice, are softer, making it easier to digest quickly and leading to a higher blood sugar spike.

On the other hand, if you boil starchy foods and then cool them before eating, like cold boiled potatoes the starch changes form and becomes more resistant to digestion. This can actually lower the GI, which is better for blood sugar control.

Adding vegetables to your meals also helps slow down the digestion of starch. Vegetables contain fibre, which slows how quickly food moves through your stomach and intestines. This delay reduces how fast sugar gets into your blood. For example, if you eat cassava with leafy greens or taro with slippery cabbage, the fibre in the vegetables helps reduce the glycaemic impact of the starchy food.

Using coconut milk in cooking, such as in local dishes like cassava pudding or taro in coconut cream, can also lower the GI of the food. Coconut milk contains healthy fats, and fat naturally slows digestion. When digestion slows down, sugar is released into the blood more gradually. This makes meals with coconut milk friendlier to people with diabetes, compared to eating dry or plain starchy foods by themselves.

Fruits also contain natural sugars, and they have their own glycaemic index. Some fruits, especially ripe and soft ones like ripe bananas, pawpaw, or watermelon, have a higher GI and cause a faster rise in blood sugar. Less ripe or more fibrous fruits like green bananas, guava, or apples have a lower GI and are more slowly absorbed. Fruits also contain fibre and water, which help reduce how quickly sugar is absorbed.

It is important to understand that different types of sugars have different effects on your blood sugar. Glucose, which is the body’s main sugar, has a glycaemic index of 100. It is absorbed very quickly and causes a rapid increase in blood sugar. Fructose, which is found in fruits and honey, has a much lower glycaemic index, around 15 to 25, because it is absorbed more slowly and needs to be converted by the liver before it can be used as energy. This means fructose does not spike blood sugar as quickly as glucose. However, eating too much fructose over time (especially in processed food or sweetened drinks) can lead to fat buildup in the liver and other health problems.

Glycaemic load is another helpful idea. While the glycaemic index tells us how fast sugar enters the blood, glycaemic load tells us how much sugar will enter the blood from the actual amount of food you eat. For example, watermelon has a high GI, but the amount of sugar in a small slice is low, so its glycaemic load is not very high. That means you can still enjoy it in moderation without a major effect on your blood sugar.

For people living with diabetes, or anyone trying to stay healthy, it is important to choose foods that raise blood sugar slowly and steadily. Traditional foods like boiled green bananas, taro, yam, and cassava eaten with vegetables or coconut milk are better choices than processed snacks, white bread, or sugary drinks. Knowing how your food is prepared, whether it’s baked, boiled, fried, or eaten with vegetables, can help you manage your blood sugar and avoid complications from diabetes.

Understanding the glycaemic index and how it changes with cooking and food combinations gives you the power to make better decisions every day. It is not just about what you eat, but how you prepare and combine your food. This knowledge is a useful tool we have to prevent and control diabetes in our communities and protect the health of our families for generations to come.

01/08/2025

"From Curing Disease to Caring for People"

Another Way of Thinking About Health.

Most hospitals today are designed to fight sickness. They are set up to treat diseases, give medicine, and carry out surgeries. This kind of care is very important and can save lives.

But there is still something missing. Hospitals often forget that people are more than just their sickness. They have feelings, families, culture, beliefs, and fears.

So we must ask ourselves: what if we change our way of thinking from only about curing diseases to also include truly caring for people?

Health is not just about the body. It is also about the mind, the spirit, the land, and the people around us. When someone is sick, the whole family is affected. In our culture, healing means being supported, prayed for, and surrounded by people who care.

But when many people go to the hospital, they feel lonely, afraid, and ashamed. Quite often Health Workers are too busy to talk kindly. Some patients feel they are being treated like numbers, not people. Others don’t go to the clinic at all because they fear being judged or ignored. Some people choose to stay home or use traditional herbal medicine instead. This shows us that something is not quite right with the way we deliver health care.

“Caring for people,” really mean something deeper than just giving medicine. It also means listening to them, comforting them, showing kindness, involving their families, and respecting their culture and beliefs. Even when someone cannot be cured, we can still care for them because they still deserve peace, dignity, and love.

This doesn’t need a lot of money. It needs leaders, health workers, and communities to remember that people come first. Medicine is important. Surgery is important. But even more important is how we treat the person who is sick.

In the end, people may forget what medicine we gave them. But they will always remember how we made them feel when they are at their lowest point in their life. When we move from curing disease to caring for people, we bring back trust, healing, and dignity into our health system. And that is something we all need.