Medical practice is more complicated in remote locations

Editor—John Rees's commentary on David Berger's account of the management of pneumothorax caused by a vicious fish in the Solomon Islands seemed rather negative.1 Rees considered it wrong that Berger opted for a canoe rather than an aeroplane to transport the patient to hospital. Having worked in the Solomon Islands for more than a year in an even more remote province, I applaud Berger's treatment of the patient and the fact that he requested comments on his actions.

There are so many variables that affect medical practice in the Solomon Islands that a doctor's decision to use one form of treatment (or in this case transport) rather than another should never be condemned. Many factors have to be taken into account when we make similar decisions every week: sudden changes in the weather, aircraft fuel loads, the patience of the aircraft's captain (and the other passengers), time of day (the small aircraft here are often unable to land at night), the state of the provincial health budget, etc. Berger's patient survived so the decision was correct. If the patient had not survived then the decision not to fly him to hospital may still have been correct.