In the Solomon Islands, many rivers to cross

It takes two days’ journey at least from Honiara, capital of the Solomon Islands, to reach the mountain village of Kuvamiti to provide and deliver routine health care and immunization for the people who live and work there. Supply efforts and logistics were even more arduous during the COVID-19 pandemic. A COVID-19 vaccination team driver and his colleague were nearly lost to strong undersurface river currents late last year near Kuvamiti.

There are no bridges on this journey over more than 20 rivers.

Instead those taking the path to Kuvamiti from the capital on the island of Guadalcanal must either range through by auto or wade across the waters. As shown in this photo essay from a field vaccination and health care expedition in May 2023 by a Guadalcanal Province team— supported by UNICEF, WHO and Gavi, the Vaccine Alliance—it’s worth it. The people who live in the hill country around Kuvamiti make it so. Some of them walk for hours to meet the team on its rounds.

17 May 2023. Sam the driver faces the river, again. Photo: © WHO / Neil Nuia

Drivers, nurses, and the islanders themselves in the Solomons travel rugged terrain and open water, overcoming risk and fatigue, to deliver vital health care. 

This essay follows health care workers and bearers heading from the Totongo clinic, on the coast, inland to Kuvamiti village in the mountains. They are bringing COVID-19 and childhood vaccines as well as routine health care to villagers and those who live in the surroundings—some of whom will walk six hours to ensure a child’s checkup. From a vaccination perspective, it is an integrated effort meeting a variety of basic health care needs: treatments, therapeutics and vaccines for children, adolescents and adults. Looking ahead this approach may become increasingly common.

The group huddles to consult and take the measure of the river, led by the medical truck driver, Sam, who works with the province. He’s also the risk manager for river fording. His experience is hard-won: in late 2022 during a COVID-19 vaccine delivery he and a colleague had to swim for it and abandon a vehicle being carried into dangerous deep water by this very same river, the Ruamiti.

^{Photo: © WHO / Neil Nuia}

But the Ruamiti needs to be crossed, and the team does, safely. 

It’s among the many challenges facing the vast Solomon archipelago, which spans 900 islands, 147 of them inhabited. The country is working to catch up and maintain its childhood immunization programs and raise its rate of primary series COVID-19 vaccinations. That vaccination rate in this Pacific island nation stood at 32 percent as of January 2023, up from 9 percent the previous year. 

Heavy rains and erosion in the hills and mountains can block roads with landslides on the large island of Guadalcanal, as shown in this aerial view. The vaccination teams will get out and walk.

^{Photo: © WHO / Neil Nuia}

Not everyone in Kuvamiti lives in the village—many people live in the surrounding hillsides and logging camps. As with this mother and child, they’ll walk down and travel the stunning but rugged walkways for a checkup, routine immunization or health care. Over the last year the vaccination teams have been carrying COVID-19 doses. 

When the word gets out that the team is in the area, people stop what they’re doing, pick up their medical records, and get moving.

^{Photo: © WHO / Neil Nuia}

Nurse Rosemary Raikekeni runs the health clinic in Totongo on the coast of Guadalcanal, six bumpy hours’ drive from the capital. It is the nearest permanent clinic to the many villages in the far interior of the island. It is two hours by Land Cruiser to Kuvamiti village—if there are no landslides, and the rivers are all open for crossing or otherwise many hours’ walk. 

She is the vital link to health care for this part of the country, and is dedicated to it. She’s made that walk several times.

^{Photo: © WHO / Neil Nuia}

Hours later the team arrives in Kuvamiti with cold boxes and vaccines, promotional material and information, and basic medical supplies. Mathew, a health care worker with Guadalcanal Province, will put out an appeal to come for medical support, immunization services and COVID-19 vaccinations.

Rose is a government-approved vaccinator. The Solomons could use more like her—she’s taken a trainee along this trip. The Solomons archipelago as a whole is spread out over 28,000 square kilometers, most of it water, and has a thinly distributed population. This means finding and retaining qualified health care workers is a constant challenge.

^{Photo: © WHO / Neil Nuia}

Pop-up and informal clinics are the standard in the harder-to-reach parts of the country. The Solomons have several small permanent health care clinics like Totongo, Nurse Rose’s home base, ringed around the coast and dotted through the archipelago.

But sparse populations and resources and geography make the interior a more challenging environment.

^{Photo: © WHO / Neil Nuia}

Nurse Rosemary Raikekeni vaccinating a child, Kuvamiti village, 17th May 2023.

^{Photo: © WHO / Neil Nuia}

Rose and the vaccination team keep moving down the paths available to them. Soon enough on Guadalcanal, those paths lead to another river that needs crossing to get where they want to go.

Picking up their gear and making the ford, the health care team crosses the Ruamiti on the way back to Rose’s home clinic at Totomo on the coast, where soon enough the next rounds await.

Read more about the COVID-19 Vaccine Delivery Partnership.