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We are pleased to report that 4 out of our 5 final year candidates successfully completed the final exit examination. This was run by independent examiners from Australia and New Zealand. We are grateful to Dr Richard Lander (Chief Examiner) and Dr Sud Rao from New Zealand and Dr Peter Cundy and Dr Andreas Loefler from Australia. The exam followed a similar format to the FRACS examination with 2 written papers, 2 clinical vivas and 3 computer based vivas. Candidates were tested on 45 different scenarios. We are proud of the teamwork and cameraderie shown by our final year candidates as they supported their colleague who was unsuccessful.

The next modules commence on Monday 28 July in Kundiawa, PNG highlands. We are grateful to the Sir Joseph Nombri Memorial Hospital which will host us for the next 3 weeks. The topics to be covered include Knee , Foot & Ankle. We will have 16 trainees do the modules. In addition we will do our second ever exit exam. We have 5 candidates presenting for their final exam. They are Shaun Mauili and Areta Samuelu from Samoa, Mark Rokobuli from Fiji , Alex Munamua and James Tewa’ani from Solomon Islands.

Dr Shaun Mauiliu, PIOA final year trainee performed the first ever TENS nail in Samoa. Shaun learned the technique in 2018 at the PIOA Paediatric module. He has recently received a new NET brand TENS set supplied by Narang Medical Ltd. from India which provides cost effective implants for less developed countries.

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The fracture was redcued closed and the surgery took 30 minutes. Well done Shaun and team. Very proud of you.

Today marks the culmination of a 7 plus year journey for Dr. Stephen Kodovaru from Solomon Islands. Stephen received a Master of Surgery in Orthopaedics from the National University of Samoa in Apia. He is the first graduate of the Pacific Islands Orthopaedic Association training program. He is also the current President of PIOA.

You can read more at
https://www.samoaobserver.ws/category/samoa/39922

PIOA is pleased to welcome Dr. Juvencio Dias from Timor Leste. He is our first trainee from Timor and is based in Dili. Juvencio is fluent in 6 languages (English, Spanish, Portuguese, Bahasa, Tetun and his local language. He is a quiet but very hardworking student.

PIOA will faciliate supervision visits by Dr. Matthew Sharland who is based close by in Darwin.

PIOA is pleased to welcome Dr. Haynes Rasin our first trainee from the autonomous region of Bougainville in PNG. Haynes is an experienced general surgeon who has worked in Bougainville for many years. Patients with trauma make up a large part of his surgical workload. He was very pleased to be able to take a supply of implants back with him after the course.

PIOA facilitates the provision of high quality, low cost implants from India and China and encourages hospitals to purchase these implants in order to develop local systems that are self reliant rather than relying on constant donors.

PIOA will facilitate a supervisory visit to Haynes after the August module. Dr. Nik Friederich from Switzerland will visit Haynes and help advise him on how he can further develop the orthopaedic service in Buka.

PIOA welcomes Dr. Viola Kokiva from Kavieng in the Islands region of Papua New Guinea(PNG). Viola is our first female trainee. She has recently completed her Part 1 exam in Port Moresby. Viola said she found the first week of the course very hard. By the end of the third week she was glad she persevered and was proud of the new skills she had gained. This included learning microsurgery skills in nerve and artery repair.

Viola was also the recipient of a generous grant from medical students from the UK who have provided her hospital with funding for orthopaedic implants. PIOA facilitates the provision of high quality, low cost implants from India and China and encourages hospitals to purchase these implants in order to develop local systems that are self reliant rather than relying on constant donors. Viola will pay for half the cost of her implants and the grant from Aruni Mathyalakan and her friends in the UK will cover the other half. PIOA is grateful for their generous gift.

Congratulations to Dr. Raymond Saulep, PIOA trainee at Kundiawa for the best surgical paper at the recent combined General Surgeons Australia (GSA) and Pacific Islands Surgeons Association (PISA) conference held in Fiji. The paper is the culmination of many years work by Raymond’s mentor Fr. Jan Jaworski.

Report PIOA Visitation  in Nonga Hospital, Rabaul

16.06.2018 – 23.06.2018

Dr. med. M. Walliser, Dr. med. Philipp Stillhard

Dr. Kevin Lapu is a general surgeon undergoing orthopaedic / traumatologiy specialization. One additional consultant, 2 registrars and 3 residents are completing the team. The orthopaedic ward has a capacity of around 60 beds. One major and a minor theatre is available. Staff on the ward and in OT, as well as the doctors are motivated and working in a structured and reliable way under the leadership of Dr. Lapu.

As in Lae, our daily work on the wards, in the clinics and in OT was the most important part of our visit. Due to a prior visit of Dr. Philipp Stillhard last April and the previous preparation of several cases for surgery by Dr. Lapu, we could efficiently start with our planned tasks immediately after arriving.

Main surgical activities:

There seems to occur an incredible amount of forearm fractures in the Rabaul area. This was the main topic in OT and we could operate on several forearm fractures, emphasizing surgical approaches, anatomical particularities and special injury types (as Galeazzi and Monteggia fractures).

Due to lack of intraoperative imaging, ORIF  with standard 3.5mm LC-DCP plates was the standard procedure.

 

 

 

Conclusions

Due to good preparation of our visit, we could work efficiently and successfully with a very motivated surgical team, even if our visit was only short. Further visits in this kind would help to further promote decision making, case prioritization and surgical capabilities. Further support in procurement of equipment and implants will help to improve trauma care in the future.

Supervision visits for PIOA trainees in the future

Several hospitals in PNG have been visited during the last two years. We were working out several conditions, which should be satisfied for this kind of direct teaching. It is ideal, if the PIOA candidate is HOD or at least consultant and is also following the PIOA guidelines and principles of fracture treatment. This dedication ensures a high acceptance and full application of our principles by all team members involved during the whole length of the process of treatment. Good leadership and team abilities as well as communicative skills should be present in order to solve organizational problems in OT (especially essential cooperation with anesthesia and scrub nurse teams).

Visits in one hospital should not be too short, ideally around two to three weeks. Though we could show that very efficient visits can be done even during short stays of one week with previous preparation and organization. The overall duration of a mission with European doctors should be at least three to four weeks in order to limit travel expenses and ecological impact.

Certain issues concerning travel conditions, security and accommodation should also be considered.

Two visiting doctors as a team can incredibly increase the efficiency of a visit, whereas principally one doctor can also achieve a lot. As we are planning to split teams from next year on, introducing new trauma surgeons into the project, we will continue with teams of two over the next years. The process of evaluation and selection of capable trauma surgeons is under way as well as the planning of our next mission. PNG will most certainly be the main focus of our clinical work during the next years, but if there are valuable PIOA candidates meeting our conditions in other south pacific countries there are always possibilities to visit other countries as well.

 

Financial Support by the SST (Swiss Surgical Teams)

The 2018 visits were again supported financially by the SST. Travel expenses, especially the flights to, from and within PNG, are a substantial part of the project costs. Living costs in PNG are as well astounding, if the Hospitals don’t provide accommodation for foreign doctors. This is especially true in the Highlands, where accommodation costs even for very basic rooms exceed 100 USD per person per night by far.

The SIGN Set, which was introduced in Lae, was funded by the Swiss association “South Pacific Medical Projects”. This represents also a substantial amount of money, invested for a better trauma-care in the South Pacific.