The Healthcare System of Saint Helena, Ascension and Tristan da Cunha: Public Hospitals, Access, Emergencies and Health Risks

On Saint Helena, the Health Directorate, under the Health and Social Care portfolio, has about 250 staff and bears overall responsibility for the island’s health services. For cases the island cannot treat, it arranges referrals to South African and British medical services. Its published priorities cover equitable access to care, prevention, protection against health threats, chronic diseases (diabetes, hypertension, kidney disease), sustainable access to specialist care and patient experience. Its services include the hospital, the clinics, the pharmacy, dental care, community mental health, environmental health and the public health laboratory.

On Ascension, health comes under the island government, with a hospital in Georgetown, a dental service and a clinic at the American base used for certain examinations. On Tristan da Cunha, the government runs the Camogli care centre, opened on 7 June 2017 to British health system standards, so that visiting specialists can carry out more procedures on site and costly evacuations to Cape Town can be reduced. The doctor in charge can be reached by email (camoglihospital@tdc-gov.com).

No contributory health insurance scheme was identified in the official sources read: care is charged to the patient, their insurer or their employer. On Saint Helena, the government distinguishes two scales. The “visitors” scale is for holders of a short-term entry permit (tourists, day visitors, business visits of up to 183 days, emergencies from a passing ship); they must hold valid travel insurance, insurance from an insurer on the island or sufficient means to cover medical costs. The resident rate applies in particular to people who take up direct employment with the government, to those who hold a long-term entry permit or a work permit from a private employer for more than 183 days, to people born, registered or naturalised in Saint Helena, and to certain spouses, partners and dependants.

A care policy specifies that people in full-time employment who live on the island permanently receive care on the same terms as residents, including referrals to South Africa subject to valid travel documents. People on fixed-term contracts who do not live there permanently receive local care at the standard rate, with no treatment abroad unless paid for by the employer or the employee. Elective referrals abroad are reserved for holders of Saint Helenian status. Anyone coming to work undergoes an initial health assessment within four weeks of arrival, with a chest X-ray if they come from countries with a high tuberculosis burden.

On Ascension, the government specifies that all medical and dental care is free for employees under contract and their accompanying family, and that all employees and visitors must hold comprehensive medical insurance, generally taken out by the employer for its employees. Details of reimbursement by situation are in the page healthcare reimbursement.

The entry point for routine care is the outpatient department of Jamestown hospital: nurse triage with no appointment Monday to Friday in the morning, and a nurse clinic by appointment four afternoons a week; the patient first reports to the medical records. District clinics operate in Half Tree Hollow, Longwood, Levelwood and St Johns Villa, with doctor and nurse consultations, diabetes follow-up, child health clinics, family planning, gynaecology and antenatal care. Booking is advised for the nurse clinics in Half Tree Hollow, Longwood and Levelwood. Nurses make home visits for people who are bedridden, disabled or in palliative care.

Jamestown General Hospital has an emergency department open 24 hours a day, men’s and women’s wards, three single rooms, a maternity unit, a two-bed intensive care unit, a chemotherapy unit, an operating theatre (general, gynaecological and obstetric surgery, endoscopies) and radiology (X-ray, CT scan, ultrasound) by appointment after a doctor’s referral. The dental service, housed in the hospital, provides routine care, dentures and limited orthodontic treatment; implants are not offered. France Diplomatie nevertheless insists that specialist care is not available on the island and recommends seeking a doctor’s advice before leaving in the event of a health problem.

On Ascension, Georgetown hospital has two doctors, a midwife and several nurses; it has X-ray and an operating theatre, simple tests are done on site and more complex tests are sent abroad. Complex patients are referred to the United Kingdom or South Africa. The FCDO (the British Foreign, Commonwealth and Development Office) specifies that patients pay for medical and dental care, except employees under contract, that neither Saint Helena nor Ascension has a hyperbaric chamber, and that no qualified rescue diver is available on Ascension.

On Tristan da Cunha, Camogli hospital provides daily care, emergencies, minor surgery and, according to the doctors on duty, procedures such as appendicitis, obstruction or fractures; it comprises consulting rooms, two inpatient wards, X-ray, a small laboratory, an operating theatre, sterilisation, two dental surgeries and an ambulance. Complex cases are transported to Cape Town, and the hospital page indicates that pregnant women travel to Cape Town to give birth. The island has no airport, access to the port can be closed by the weather and only eight to nine ships serve it each year, which explains the requirement for insurance that includes evacuation. The cost of a repatriation or evacuation is covered in the page repatriation assistance.

On Saint Helena and Ascension, the government and the FCDO give 999 for an ambulance; Jamestown hospital asks that its switchboard (+290 22500) not be used for an emergency, as this would delay care. The France Diplomatie page for Saint Helena cites 911 for ambulances and 999 for the police, fire brigade and sea rescue: 999 remains the number to dial first, according to the government. The emergency department triages patients on arrival by clinical priority; it is not intended for routine consultations.

On Ascension, Georgetown hospital takes calls on 66252. On Tristan da Cunha, the FCDO gives 5111 for the police and 5000 for the hospital. For urgent dental care on Saint Helena, the dental service (25387) offers a slot dedicated to toothache; outside opening hours, a swollen face, bleeding after an extraction or a dental injury should go to the hospital emergency department.

On Saint Helena, the hospital pharmacy is open Monday to Saturday morning, with reduced hours on Wednesday and Saturday (repeat prescriptions and hospital prescriptions). A mobile pharmacy accompanies the doctors’ surgeries in Half Tree Hollow, Longwood and Levelwood, and prescribed treatments can be delivered in an emergency. For repeat prescriptions, the request is made when seven days of medicine remain, allowing five working days for processing (email pharmacy.prescriptions@sainthelena.gov.sh or telephone 25867). The FCDO recommends carrying the medicines needed for the whole stay, as medicine regulations can differ from one country to another.

On Saint Helena, importing fruit, vegetables, plants, honey and animals requires a permit from the biosecurity service, and firearms require authorisation. Pharmacy prices are part of the Health Directorate’s schedule of fees, published in two versions (residents and visitors).

France Diplomatie recommends being up to date with the vaccinations of the French schedule, notably diphtheria, tetanus, polio, whooping cough and measles, and considering, depending on the stay, yellow fever (strongly recommended), hepatitis A, typhoid, hepatitis B for frequent or prolonged stays, tuberculosis in children under 15 for repeated or long stays, and rabies and mpox in the event of exposure. A visit to a doctor or an international vaccination centre should be planned well before departure to leave time for boosters. The FCDO refers to TravelHealthPro at least eight weeks before departure.

The France Diplomatie page lists among the diseases to be aware of hantavirus, hepatitis A, leptospirosis, mpox, rabies, measles and tuberculosis. Preventive measures: protect yourself from mosquito bites (covering clothing, repellent, protection of the accommodation, removal of standing water), wash your hands often, cook food thoroughly, drink safe water, avoid animals and seek advice quickly after a bite or scratch. To compare protections for a long stay, the guide expat health insurance presents the options, and Expavy helps you set them against your situation.