Summary Report – Orthopaedic Outreach Trip to Fiji 15-19th July 2019

Team:

Dr Michael McAuliffe

Dr Peter Myers

Mr John Dash

Mr Martin Mcbain

Dr Bradley Gilpin

I was fortunate to be provided the opportunity to participate in one of the outreach trips to Suva in Fiji earlier this year. I have not previously experienced outreach or had a detailed understanding of the work that they do but suffice to say it was eye opening.

After spending the day en-route we eventually arrived in Suva on the Sunday night before the commencement of work the following day. Unsurprisingly there are many differences to Australia. One of the first things I observed was the differences in road safety. The rules certainly appeared less clear, the roads narrower and less well maintained with limited to no space for pedestrians. Perhaps again unsurprisingly it was these factors that I’m sure contributed to some of the trauma that presented to the CWM Hospital during our stay. The other thing I noticed immediately was how everyone was very welcoming and appreciative of our attendance.

Our first day at the CWMH consisted of a grand round with the local Professor, registrars, resident and a host of medical students. It quickly became apparent that one of the greatest concerns for orthopaedic surgeons in Australia is an even greater issue in Fiji. Many of the current inpatients were admitted for varying degrees of infection whether it be infected metalwork with a draining sinus or kids on the paediatric ward being managed non operatively for pathological femur fractures in the setting of diffuse osteomyelitis. Infection control became one of our key messages during our stay with a series of recommendations being passed over at the conclusion of our stay regarding the simple steps that could be implemented in theatre particularly to minimize the risk of infection. Further we encouraged the department to implement changes and then conduct research or an audit of the outcomes to see what differences these changes make.

After grand rounds we proceeded to clinic. The local orthopaedic registrar had arranged a clinic of patients that were either considered complex or beyond the scope of what would routinely be managed locally. With Dr Peter Myers and Dr McAuliffe both having a particular interest in knee surgery there were a number of patients with sports knee injuries which would otherwise normally go untreated. From this clinic we generated a list of patients that required operative intervention during the week. We planned the lists over the subsequent 3 days with consideration given to local sterilizing capacity. The theatre NUM organized and advised the patients of when their operation had been scheduled.

From Tuesday to Thursday we were provided with a theatre to undertake our scheduled cases. We worked with a local anaesthetic team, local nursing staff and a local registrar. A key focus of our trip was the education of local staff about ways to develop their orthopaedic practice. This ranged from taking the registrar through operative techniques to more general education for the department. Some of the cases operated on throughout the week included the following:

1. Re-excision of a large fungating tumour from medial distal thigh 2. Excision of GCT from proximal fibula/lateral tibial plateau 3. ORIF talus + ORIF medial malleolus + Ex fix ankle 4. Debridement of chronic osteomyelitis from distal femur 5. Left knee arthrodesis with a frame 6. Left distal tibia debridement of GCT + cement + internal fixation

Amongst these cases there were several knee arthroscopies for a variety of pathologies from symptomatic intercruciate cysts through to meniscal pathology and ACL deficient knees. As mentioned above one of the trauma cases we became involved with was a young girl who presented with a compound intra-articular distal humerus fracture after being hit by a car walking alongside the road.

On the Friday prior to our departure we attended the local audit meeting where a summary of the weekly cases including challenges were presented. We presented our cases and discussed our infection control recommendations at this meeting. Certainly our group was of the opinion that far greater benefits can be produced with the encouragement of institutional change/systems rather than the isolated benefit that is provided to the patients who are offered operations during the week of our attendance. It is important to acknowledge that one of the primary limitations of local practice is funding so our suggestions were for simple measures that are cheap and easily applied.

Ultimately, the experience was something that has left a lasting impression on me and I think is something that all trainees and consultants should give consideration to. It has given me new insights into the challenges facing developing nations and has definitely helped me realise how lucky we are in Australia.

Day One: The visiting team reviewing a complex case with the local Professor at handover

Dr Meyers taking the local registrar through a case

Day One: The visiting team attending handover/teaching with the professor and students

Day One: The visiting team on grand rounds