The main findings of our survey of 20 health care providers in the Solomon Islands were that critical illness was common, with the four most common conditions leading to critical illness being malaria, diseases of the respiratory system including pneumonia and influenza, diabetes mellitus and tuberculosis. Respondents stated that many basic (e.g. pulse oximeters, oxygen concentrators) and most advanced monitoring, diagnostic, and therapeutic equipment was lacking. Respondents identified the lack of health care personnel as a pressing issue and endorsed the notion that high-quality secondary hospital-based care and primary care should co-exist.
As with all survey research, a limitation of this study is that we collected data on attitudes and beliefs rather than actual clinical practice. There was also some missing data, particularly for questions asking respondents to rank the top five causes of death in patients they treat and rank the top five resources that would most help them treat critically ill patients. Despite steps taken in survey development to maximize clarity, respondents may not have understood the question, or may have found the survey too long. There was also missing data where respondents left questions blank. It was difficult to ascertain if this was because they felt they did not have the appropriate knowledge to answer the question or if it was left blank for another reason.
There is inequity in access to critical care in LMICs throughout the world, yet intensive care medicine is a developing discipline in almost all LMICs [1
]. Two major challenges have been identified in providing critical care in LMICs: the first is that there is little infrastructure to deliver healthcare and the second relates to the pre-morbid condition of patients and their disease presentation [13
]. More specifically, challenges to the provision of critical care in LMICs include: access to appropriately trained ICU staff, infrastructure including buildings and basic supplies such as water, electricity, oxygen and compressed air, technical services such as medical and nursing equipment, transportation, and supporting disciplines including laboratory, radiology, surgery and transfusion service [1
]. Challenges also include the limiting factors of intensive care medicine such as poor health status and delay in presentation to medical care [1
]. We have identified that many of these challenges are also barriers to providing critical care in the Solomon Islands.
The WHO states that every hospital where surgery and anaesthesia are performed should have an ICU, defined as a specialized unit with more skilled nursing care than on general wards, 24 hour monitoring and the provision of oxygen [16
]. The Solomon Islands do not have an ICU or any similar facility, and critically ill patients are looked after on general medical wards.
It is thought that hospital mortality can be reduced by simple measures such as increasing nurse:patient ratios, adequate monitoring and greater medical supervision to a percentage of hospital beds [17
]. There is a great need for simple, inexpensive therapeutic interventions and methods for monitoring critically ill patients that can be shown to be effective [18
]. For example, introducing pulse oximetry together with a good oxygen supply reduced case fatality rates for pneumonia by 35% in Papua New Guinea and the overall mortality risk was significantly reduced by the improved system [19
]. An ICU can be created to prioritise basic and inexpensive therapies and fit into a coordinated service that benefits all critically ill patients [17
], with the exact personnel and equipment composition of such an ICU depending on local diseases, the hospital's financial and human resources and the community's needs [3